Coleman wants opioid commission to shift focus to prevention, especially among youth; leaves small door open to ibogaine

By Melissa Patrick
Kentucky Health News 

Kentucky Attorney General Russell Coleman laid out his mission for the next phase of the Kentucky Opioid Abatement Advisory Commission Tuesday, calling on them to focus on building a "gold-standard statewide prevention program" with settlements paid by opioid makers and distributors.

Attorney General Russell Coleman (Photo provided) 

"It's a plan of zealous collaboration, zealous collaboration," he said. "To be successful, the Office of the Attorney General and this commission must have a strong partnership. We must also further connect this body with organizations throughout our commonwealth . . . to focus on that necessary three-legged stool of treatment, prevention and enforcement." 

Coleman called on the commission to focus on prevention as it considers the coming round of grant applications. "I encourage you to place a strong emphasis on boosting Kentucky’s critically needed prevention efforts," he said.

Coleman added that his office is in the midst of developing new youth prevention initiatives that focus on education.  

"When we're in an environment where children are experimenting with these dangerous substances as early as 11 – we're seeing it in late elementary school – we have to have conversations with our kids earlier and earlier," he said. Later adding, "It's our responsibility, yours and mine, to prepare them for this threat they are facing in a new threat environment." 

When asked what his vision for a statewide prevention program would look like, Coleman told reporters that it will be important to look at what states such as Georgia, Tennessee, Virginia and Mississippi are doing. 

He said Virginia has a robust "one pill can kill" prevention effort and Mississippi had rolled out a "very creative approach that uses name, image and likeness of Ole Miss players to be able to engage and get that message out there, to permeate in the social media space. I would love to institute a program here that looks a lot like what is ongoing in the state of Mississippi." 

As for treatment and enforcement, Coleman said Kentucky is doing a great job in most of the state when it comes to treatment beds, and he told reporters that the drug cartels in Mexico are doing a great job of getting these substances into the U.S., which means collaboration is key, saying there is a need to "tear down the silos between federal, state and local" enforcement efforts.

"Again, we have to do very strong enforcement piece, but it has to be alongside a stronger prevention effort and continuing to treat our addicted neighbors," he said. 

In Kentucky, half of the nearly $900 million in settlement money is being distributed among cities and counties, and the other half is controlled by the commission, which is housed in Coleman's office.

So far, the commission has awarded 59 grants totaling about $21.5 million, with 23 aimed at prevention, totaling about $8 million; and 36 toward treatment and recovery, totaling about $13 million – but in addition to $10.5 million the legislature allocated in 2022 for behavioral-health treatment as an option to incarceration in Clark, Christian, Daviess, Greenup, Hopkins, Kenton, Knox, Mason, McCracken and Warren counties.

So, only about a fourth of the total state funding from the settlements has gone to prevention, which Coleman wants to emphasize.

Ibogaine

Coleman asked the commission to drop a proposal by its previous director to fund research aimed at legalizing the psychedelic drug ibogaine for drug treatment, saying he had given the idea "careful study, thorough consideration and honest conversation." 

"In that spirit, I respectfully ask this commission to step back from previous proposals to allocate $42 million to ibogaine research and the unproven, expensive clinical trial for a psychedelic that is, as you know, currently a Schedule 1 drug in the United States."

Noting that some call the settlements "blood money," he said "This is too precious to gamble away with that degree of risk at that amount."

He said he will ask Commission Director Chris Evans to propose a $5 million pool of resources for research and innovation grants that could be open to applications for funding research on ibogaine. 

"If someone brings forward an ibogaine research proposal that fits the criteria of this new innovative grant proposal, I hope this commission will give it full and fair consideration," he said. "It's not zero sum."

Ibogaine is a psychedelic derived from the African iboga plant. It is illegal everywhere except Mexico and New Zealand and has been reported to reduce or eliminate drug-withdrawal symptoms, but comes with some risk to the heart in some people. 

The proposal to commit about 5 percent of the settlement money on clinical trials that could lead to federal approval of the ibogaine for treatment of opioid-use disorder was led by former director Bryan Hubbard, who had been appointed by then-Attorney General Daniel Cameron.

Hubbard is continuing this effort in Ohio. The Lexington Herald-Leader reported in late February that he has signed a contract with the State of Ohio. Hubbard told the newspaper he is working for the state to “deliver novel treatment access and research opportunities for veterans and opioid-dependent individuals” and is partnering with an Ohio-based foundation to “create the framework for ibogaine clinical trials in Ohio.”

Bipartisan praise from commission

Commission member Karen Butcher, whose son died of an opioid overdose, told Coleman that she was pleased that ibogaine could still be considered for clinical research. "It's no secret that I've been the loudest proponent for that," she said. 

State Health Secretary Eric Friedlander, after describing himself as on the other end of the spectrum in support of ibogaine, praised the vision of Coleman, who is a Republican.

"I want to thank you. You're laying out a vision for us. You're here with us today. You are really taking the bold step and the responsible step and the brave step of putting yourself out there. Giving us a vision around prevention, addressing head-on some of the things that we haven't agreed on in this committee," said Friedlander, who works for Democratic Gov. Andy Beshear.

Commission member Jason Roop, a pastor who has said he is in recovery, called on Coleman to not lose sight of the fact that addiction is generational, saying it is important to tackle this problem holistically and not in silos: "I would encourage all of us to consider addiction from a holistic standpoint, prevention, treatment, law enforcement, all of it kind of going together to represent our efforts."