Kentucky, an Unlikely Model for Overdose Reduction
A few things became apparent immediately after I began my specialization in addiction counseling. The first one is that I am exactly where I need to be; I instantly fell in love with the work. But there was also the frustration of lousy policy getting in the way of effective treatments. Counseling programs are only a tiny piece of the puzzle in the age of synthetic opioids. Fatal overdoses are surging, and we can’t treat dead people. So, the question becomes, what programs work to reduce fatal overdoses, and how do we get more people engaged with these programs?
When I looked at drug policy in different states to see what programs had been successful, an unlikely state surfaced as having made titanic improvements: Kentucky. Being a Kentuckian, I was pleasantly surprised to see Kentucky be one of only eight states that substantially reduced overdose deaths. Not only did they reduce overdose deaths, but they did so by 10%.
Addiction policy is a political nightmare. The programs with the best outcomes can appear weak on crime, which, in a red state like Kentucky, can be the kiss of death to your political career. While it was surprising to see Kentucky embrace policies other than the ineffective and damaging war on drug policies, it was not surprising that their outcomes improved when I reviewed the policy changes. These changes have worked for years, but optics have gotten in the way. Let’s review Kentucky's changes that have helped them be so successful.
Naloxone availability
The most critical intervention with the most significant return on investment is increasing the availability of an opioid antagonist, naloxone. Opioid antagonists bind to opioid receptor sites in the brain without activating them. This process reverses the depressive effects that opioids have on the respiratory system and gets the person breathing again, saving their lives in most cases. Naloxone is highly effective, reversing overdoses in 90% of cases. Kentucky distributed 165,000 doses of naloxone last year. Ensuring more community access in high-risk locations and improving education on how and when to administer will continue to improve outcomes.
Access to treatment
Kentucky has become the #1 state regarding access to addiction and mental health treatment. This is a recent improvement when, just four years ago, Kentucky was ranked 32nd. Not only does Kentucky have more access to treatment, but it also has access to long-term treatment, which we know improves outcomes. When it comes to substance use treatment, longer is better (3-12 months), and ARC has brought over
1,000 new beds to Kentucky with long-term treatment as an option. Increased/more accessible access to medication-assisted treatment
Unfortunately, seeing red tape get in the way of treatment is very common. Any part of the process that creates delay from when a person decides to get treatment to accessing that treatment worsens outcomes. The readiness to recover is a fleeting state of mind, and providers must strike while the iron is hot. Arbitrary prior authorizations and logistical headaches frustrate people who are already struggling with the decision to get into treatment. Representative Kim Moser’s bills SB 51 and HJR 28 help to reduce these burdens and quicken the process for these individuals receiving care. Moser has also supported and facilitated expansions to “Casey’s Law,” which has helped providers get their patients’ treatment.
Needle Exchange Programs
Kentucky has opened 84 needle exchange programs, serving 35,000 people. These programs reduce the risk of blood-borne pathogens and prevent biomedical waste. Needle exchange programs cut the rates of HIV/HCV by 50% in communities where they are implemented. But that is not all they do. Needle exchange programs also present an opportunity to connect people suffering from addiction with treatment services in a non-coercive way.
We need more
While Kentucky has made tremendous progress and is a good model for other states to follow, we have a long way to go. Several evidence-based interventions remain that are not being utilized. Safe injection sites are the most clearly effective interventions that there is no political will to implement. Criminal penalties for simple possession create insurmountable barriers for many people struggling with addiction to reenter society and rebuild their lives. This is where stigma gets in the way of pragmatism and costs people’s lives.