Improving Access to Opioid Use Disorder Treatment in Kentucky
In March 2021, the Pew Charitable Trusts (Pew) was invited to provide the Commonwealth of Kentucky with technical assistance on its substance use disorder (SUD) programs and policies and provide a set of policy recommendations. To better understand the strengths and gaps in Kentucky’s treatment system, Pew met with more than 100 key stakeholders, analyzed available federal and state data, and reviewed the current legal and regulatory landscape.
The scope of this memo is treatment for opioid use disorder (OUD), including expanding access to medications for opioid use disorders (MOUD) and behavioral therapy, particularly for justice-involved individuals who would benefit from diversion from jail to substance use treatment.
By way of this memo, Pew provides 12 policy options categorized by four domains that will build on Kentucky’s efforts to address the opioid crisis and may result in measurable improvements in access to MOUD. To read the memo in its entirety, click here: Pew Kentucky Memo FINAL.pdf
Gov. Andy Beshear Announces $4.6 Million in Grants to Expand Treatment and Recovery Services Including those for Pregnant and Parenting Women with Opioid Use Disorders
Beshear along with the Office of Drug Control Policy (ODCP) and the Kentucky
Department for Behavioral Health, Developmental and Intellectual Disabilities
(KDBHDID) announced that a total of $4,645,070 has been awarded to twelve
non-profit organizations throughout the commonwealth. The total grant funding
has been distributed among Community Mental Health Centers and Neonatal
Abstinence Treatment Programs from the Senate Bill 192 Treatment Grant which is
administered by ODCP.
The grant awards are
primarily focused on addressing Neonatal Abstinence Syndrome (NAS) by offering
comprehensive residential treatment services to pregnant and parenting women.
ODCP and the KDBHDID
collaborated together on reviewing and administrating funding to licensed
not-for-profit organizations that are aggressively addressing NAS by developing
or expanding comprehensive evidence-based residential treatment services and/or
outpatient treatment and recovery supports to pregnant and parenting women with
opioid use disorders who are transitioning from residential services.
The full list of the
Community Mental Health Centers and Neonatal Abstinence Treatment Programs
subaward recipients to receive funding from SB 192 Treatment Grant:
- Cumberland River BH - $250,000
- Lake Cumberland (Adanta) - $212,600
- Lifeskills, Inc. - $241,900
- Mountain Comprehensive Care Center - $250,000
- NorthKey - $250,000
- Pathways - $250,000
- Pennyroyal - $250,000
- River Valley - $250,000
- Seven Counties - $250,000
Neonatal Abstinence Syndrome
- Communicare - $242,000
- Chrysalis House - $250,000
- Cumberland River BH - $248,600
- Lifeskills - $213,400
- Mountain Comp Care - $250,000
- Pathways - $250,000
- River Valley - $248,700
- Seven Counties - $250,000
- UKRF-PATHways - $238,800
- Volunteers of America - $249,900
Drugs of choice in Kentucky
Substance misuse, particularly the diversion and abuse of prescription drugs along with heroin, methamphetamine and illicit fentanyl, remains one of the most critical public health and safety issue facing Kentucky. For years, the annual number of Kentuckians who died from drug overdoses steadily climbed exacting a disastrous toll on families, communities, social services and economic growth.
The Office of Drug Control Policy believes the increase is due to a rise in illicit fentanyl and its analogs within the drug supply. The problem is also exacerbated by the widespread availability of potent inexpensive methamphetamine.
Kentuckians struggling with a substance use disorder, either themselves or within their families, can call 1-833-8KY-HELP (1-833-859-4357) toll-free to speak with a live specialist about treatment options and available resources. The specialist will conduct a brief screening assessment in order to connect callers with the most relevant treatment services as quickly as possible. Options include everything from medication-assisted treatment to faith-based care, and the specialist will help callers work through all the variables, such as location and cost.
Kentucky is in the midst of a gripping heroin epidemic. The state has responded with community- driven approaches to educate the public and prevent future addictions.
Heroin is an opioid drug made from morphine, a natural substance drawn from the seed pod of various opium poppy plants
Heroin enters the brain rapidly and binds to opioid receptors on cells located in many areas, especially those involved in feelings of pain and pleasure and in controlling heart rate, sleeping, and breathing. It is especially deadly because it is both highly addictive and unpredictable. It is also dangerous because there is no way to know what exactly you are buying.
Increasingly, heroin is being laced with fentanyl, a powerful synthetic drug.
Fentanyl and fentanyl analogues are the deadliest drugs and most addictive drugs our nation has ever seen. They are powerful synthetic opioids that are similar to morphine but is 50 to 100 times more potent.
According to the 2019 KY Overdose Fatality Report, fentanyl was involved in 759 cases, approximately 58% of all overdose deaths for the year. Acetylfentanyl was involved in 419 cases, approximately 32% of all overdose deaths for the year.
Often time's dealers are mixing fentanyl with other drugs, such as heroin, pills, cocaine, methamphetamine, and MDMA. This is because it takes very little to produce a high with fentanyl, making it a cheaper option. This is especially risky when people taking drugs do not realize they might contain fentanyl as a cheap but dangerous additive. They might be taking stronger opioids than their bodies are used to and can be more likely to overdose.
To impact the problem, the Kentucky Office of Drug Control Policy will continue to work towards increased public education, increased access to treatment, enhanced penalties for major traffickers, and greater access to Narcan (also referred to as Naloxone).
With the lethality, availability and use of stimulants all greatly increasing in the U.S. in recent years and the COVID-19 pandemic complicating the treatment landscape for patients and practitioners alike.
The rise of stimulants this decade have created a fourth wave in the nation's substance use disorder epidemic. An increase on the supply side has gone hand-in-hand with rising demand:
As with all substances, the KY-ODCP recommends increasing, encouraging and teaching harm-reduction best practices.
This class of drugs includes:
Prescription drugs such as amphetamines [Adder - all and dexedrine], methylphenidate [Concerta and Ritalin], diet aids [such as didrex, Bontril, Preludin, Fastin, Adipex P, ionomin, and Meridia] and illicitly produced drugs such as methamphetamine, cocaine, and methcathinone .
Methamphetamine causes high levels of the pleasure-inducing chemical dopamine released in the brain. That makes the user feel great, energetic, and fast. At the same time, it triggers epinephrine and norepinephrine, which causes a higher heart rate and blood pressure.
The drug, which can be snorted, smoked, injected and even, comes in tablet form.
Users' moods can become extreme and elevated. As their intense feelings dissipate, they feel a strong urge to get that feeling back.
The moods and physical symptoms triggered by meth use can be so strong that they incite psychosis or panic. The drug can stay in the body for about 12 hours. Users may be unable to sleep for days.
The switch to methamphetamine is due to the lack of access to pain medication; opioid users, increasingly fearful about overdosing on heroin and fentanyl, have been desperate for a substitute.
Powerful Mexican organized crime syndicates have sought to fill the vacuum by targeting Kentucky. The traffickers follow the same business model that allowed them to inundate the nation with heroin: make meth potent and sell it cheap to ensure a steady customer base, and ultimately, mass addiction.
The new Mexican variant is often mixed with cocaine, and increasingly with fentanyl because it is inexpensive to produce and enhances the effects of meth and appears to cause faster addiction.
Cocaine is a powerfully addictive stimulant made from the coca plant, which is native to South America.
The drug sends high levels of dopamine, a natural chemical messenger in your body, into the parts of your brain that control pleasure. Cocaine is an intense, euphoria-producing stimulant drug with strong addictive potential.
Dealers often mix it with things like cornstarch, talcum powder, or flour to increase profits. They may also mix it with other drugs such as the stimulant amphetamine, or synthetic opioids, including fentanyl. Adding synthetic opioids to cocaine is especially risky when people using cocaine do not realize it contains this dangerous additive. Increasing numbers of overdose deaths among cocaine users could be attributed to this tampered cocaine.
Cocaine comes in a few different forms. The most common is a fine, white powder. It can also be made into a solid rock crystal.
Senate Bill 192 ~ " The Heroin Bill"
The most talked-about issue of the General Assembly’s 2015 session was also a main focus of the late-night closing hours of the session as lawmakers struck an agreement on a comprehensive bill to battle the state’s heroin epidemic.
Heroin is devastating Kentucky families in a number of ways, and the legislation approved strikes back against the deadly drug on a number of fronts. The multi-prong approach includes stronger penalties for dealers and traffickers and better treatment options for addicts seeking help.
Lawmakers approved the legislation, Senate Bill 192, just hours before adjourning the 2015 session in the early morning of March 25. The bill was signed into law later that morning by Gov. Steve Beshear. Since the bill contained an emergency clause, it took effect as state law as soon as the governor signed it.
Under the new law, importing heroin into Kentucky with intent to distribute or sell is a crime punishable by up to 10 years in prison.
Those convicted of selling between 2 grams and 100 grams of heroin will not be eligible for parole before serving at least half of their five to ten years sentences. Those caught selling even more would face sentences of up to 20 years.
The new law also recognizes the health crisis that heroin poses and provides new funds to make treatment more widely available to those seeking help. The state’s addiction treatment system will receive an immediate $10 million boost followed by $24 million annually.
Another newly established tool in the fight against the health problems associated with heroin will permit clean needle exchanges at health departments, if a local jurisdiction approves. Supporters say the needle exchange programs show success in curbing the spread of Hepatitis C and HIV infection from shared needles. The programs also bring addicts into health departments where they’ll be closer to the state’s network of care and more likely to seek help for their addictions.
SB 192 will increase the availability of naloxone, a drug that can reverse the effects of a heroin overdose if promptly administered. The bill also encourages people to call for help when overdose victims need it by including a “Good Samaritan” provision. That will shield people from prosecution when they seek help for someone who overdoses.