Drug Use and Overdoses Continue to Plague Kentucky and the Nation

By: Erinn Broadus

According to data from the National Center for Health Statistics, drug overdose deaths in the US have surpassed 100,000 during a 12-month period for the first time in history. Nationally, overdose deaths increased 20% from June 2019 to June 2020. In Kentucky, overdose deaths increased by a staggering 35% during that same period, from 1,706 deaths in June 2020 to 2,303 in June of 2021. Historically, Kentucky generally has maintained higher overdose rates than the rest of the nation, but there was an alarming uptick in 2020.

Opioids are still the main drugs present in overdose deaths in Kentucky and nationally, but methamphetamines are making a resurgence. For the year ending in June 2021, there were 1,832 predicted overdose deaths from opioids—including heroin, opium, natural and semi-synthetic opioids such as hydrocodone, and synthetic opioids such as fentanyl and methadone. 91% of opioid overdose deaths in this category were from synthetic opioids, such as fentanyl or tramadol. There were 920 overdose deaths due to psychostimulants, such as meth. Interestingly, fatal overdoses that involve heroin have decreased 63% from 299 in 2016 to 111 in 2020. This is likely due to the influx of highly-potent synthetic opioids such as fentanyl.

While meth is only the second most prevalent drug in overdose deaths, it is the number one drug found in Kentucky State Police laboratories—accounting for 48% of total lab submissions in 2020. There were over 13,000 methamphetamine trafficking and possession citations in 2020, compared to just under 4,000 for heroin and opioids. This indicates that meth is by far the most significant drug issue facing Kentucky residents and police.

The quality and ubiquity of drugs in Kentucky and throughout the nation is something we have never seen before. Fentanyl and similar analogs are 80-100 times stronger than morphine and are often mixed in ways that are incapable of securing any degree of consistency—leading to overdoses on an unprecedented scale. Potency and availability have not just expanded for opiates; meth’s resurgence is primarily due to a new production technique that is cheaper and produces more potent meth. After ephedrine became more challenging to acquire in the US and Mexico, meth producers found a way of replacing ephedrine with different concoctions of readily available ingredients, thus vastly expanding how much meth was being produced and how many people could produce it. Both meth and fentanyl can now be made cheaply and are stronger than ever and everywhere.

Because of this, some officials are beginning to reevaluate the mantra that addicts need to hit “rock bottom” and ask for help themselves before they can be treated. The potency and availability of drugs on today’s market often mean that “rock bottom” is death.

Reversing this trend has proved challenging for most of the nation, but the CDC recommends several key evidence-backed strategies to reduce overdose deaths. One of those recommendations is expanding access to treatment, specifically medication-assisted treatment (MAT).

Casey’s law is one way that Kentucky provides treatment for those who can’t or won’t enter in-patient treatment independently. The law was passed after Matthew Casey Wethington died from a heroin overdose at the age of 23. His parents tried and failed to get their son into treatment before his death, but he refused and ultimately succumbed to his addiction. Casey’s law took effect in July of 2004 and created a way for loved ones to force an individual into treatment if they pose a risk to themselves or others.

Further, drug courts provide alternatives to incarceration that force individuals into personalized treatment plans. Addiction and recovery are paved with mishaps and relapses, and drug courts are the best way to help individuals navigate those circumstances while aiming for constant improvement. Pushing drug addicts to prison forces them to detox but often provides no counseling or strategies for remaining clean upon release. Without continued treatment, many released users return to drug use with a heightened risk of overdose because of their reduced tolerance.

In lieu of prison time, drug courts should be utilized in every situation where drug addiction is fueling criminality. Research indicates that when compared with adults who did not graduate or enter drug court, those that graduated had much lower percentages of felonies or misdemeanors within 1 or 2 years after graduating. A cost-benefit analysis of drug courts by the Washington State Institute for Public Policy found a 100% chance that drug court programs will produce benefits greater than implementation costs. Specifically, for each participant, they found $9,438 in benefits.

But there should still be options for drug users who end up in jail. Kenton County has created a substance abuse section that connects inmates with treatment, including medication-assisted therapy, the 12 steps, and three months of aftercare and reentry resources. Of those that completed treatment and aftercare, only 24% were rearrested and jailed three years later compared to 68% of those who did not complete the program. Unfortunately, overcrowding, underfunding, and staff shortages in jails around the state make the Kenton County Jail an anomaly.

Upon release, those with substance abuse problems must have access to a continuum of care. That includes constant therapy, meetings, peer accountability, and access to medication. Currently, 92 out of Kentucky’s 120 counties have no recovery housing, and many of them do not allow medication-assisted therapy.

A continuum of care takes many forms and needs to be available every step of the way. That includes access to treatment for everyone, regardless of location, criminal history, and ability to pay. Another marginalized cohort is drug-addicted mothers who are pregnant or postpartum. SAMHSA’s treatment locator indicates that there are currently 32 residential treatment facilities that allow pregnant women in all of Kentucky. Even fewer—just 15 locations—provide buprenorphine or naltrexone. This is particularly concerning given that Kentucky’s rate of babies born with neonatal abstinence syndrome (NAS)—or being born addicted to drugs from the womb—is nearly four times the national rate. The rate of babies born with NAS per 1,000 newborns was 23.1 in Kentucky, compared to just 6.8 nationally (2018).

The only way Kentuckians can get through the drug epidemic is with a focus on treatment and access to treatment. Some of the hardest-hit areas of Kentucky are rural and have the least available services for those in need. Further, hiring individuals with past felony convictions or in active recovery should be prioritized and encouraged. Kentucky remains one of the handfuls of states with the highest opioid dispensing rates—68.2 per 100 people. Ten counties in Kentucky have more opioid prescriptions than people. In Perry County, there are 316 opioid prescriptions for every 100 people. It is clear that addiction is widespread in Kentucky and expanding access to a wide variety of treatment options is of paramount importance.