Some Ky. counties using settlement money to make new opioid-withdrawal treatment available to a small number of residents

The device uses low-intensity electrical pulses to reduce withdrawal symptoms. (WDRB photo, from NET Recovery Corp.)

The device uses low-intensity electrical pulses to reduce

withdrawal symptoms. (WDRB photo, from NET Recovery Corp.)

This story has been updated.

By Melissa Patrick

Kentucky Health News

four Kentucky counties are making a new treatment to reduce opioid-withdrawal symptoms available free to a few of their residents, using money from the state's settlements with drug manufacturers and distributors.

Three more counties are in the queue, and others are in discussion. Counties and most Kentucky cities get half the settlement money, more than $900 million over the next 15 years.

Meade, Scott, Bullitt and Franklin counties have committed settlement money for the treatment of limited numbers of residents with opioid-use disorder. Letcher and Shelby counties are in the process of final approval, and Bell County is in discussions with NET Recovery Corp.

The company is named for the "neuro-electric therapy" that its non-invasive "NET Device" delivers. Asked about the device's success rate, company spokesman Jeff Lott said, "A person treated with the NET Device for more than one day is significantly more likely to remain opioid-free without medication."

The amount of money committed to NET Recovery for treatment from each county varies. 

Company spokesman Jeff Lott said since the NET Device gained U.S. Food and Drug Administration approval, the cost for a treatment is $5,500. He said in an email that some counties received a discount if they started negotiations before FDA approval. 

"If we had already started negotiations with an amount for less than $5,500, we are still honoring that price for the first contract," Lott said. 

In Bullitt County, CFO and Community Development Director Keith Griffee said the county has signed a service contract for $50,000 to provide treatment services for 15 residents, or $3,333 per person.

The same per-person figure applies in Meade County, where Treasurer Tammy Graham said the county had allocated $60,000 of its opioid-abatement money for services to 18 residents.

Scott County Court Clerk Stacy Hamilton said Scott County had approved $110,000 for 34 residents. That amounts to $3,235 per person.

Franklin County's $75,000 contract is for 15 patients at $5,000 each, The State Journal reports.  

Lott said Shelby County plans to vote on its contract Tuesday, July 2. He said the county is looking to commit $100,000 to the program. He did not say how many residents this contract would serve. 

He said Franklin County had voted to approve a service agreement for $75,000 to cover 15 patients, but the contract has not been signed. That amounts to $5,000 per person.

Lott said NET Recovery is still in talks with Letcher County, which had backed out of its initial $125,000 contract with NET Recovery.  Lott said the two-year contracts allow either party to terminate the contract. 

"It is my understanding that they still want to participate for a lesser amount," Lott said.

He said the company is working to get other counties "to help their people get a brand new FDA-cleared treatment that can change the lives of their residents."

"We are counting on the counties to help fund this," Lott said. "If anyone has a question about how they can get their county to sponsor it, they can email me. I'd love to talk them through it." (His email address is jeff.lott@netrecovery.net.)

Isaiah House lauds NET Device

The neuro-electric therapy to reduce withdrawal symptoms will be offered exclusively through Isaiah House, a Christian-based rehabilitation center based in Harrodsburg.

The NET Device (Photo from company website)

Mike Cox, chief operating officer of Isaiah House, said the treatment involves taping tiny electrodes behind the participant's mastoid process, behind the ear, to deliver a carefully programmed series of tiny electrical pulses that stimulate the production of the body's natural neurotransmitters, such as endorphins.

"We know that those neurotransmitters become depleted and replaced by the drug" chosen by those with opioid-use disorder, Cox said. "When a person tries to stop taking the drug, then he or she begins to experience intense cravings and the body goes into withdrawal. It is that terrible experience of intense cravings, that horrible sickness that keeps people from stopping using the substance that keeps them using. Not for the euphoria of it, but just to survive." 

He said they will have 30 reusable units on hand for the treatment, which lasts five to seven days.

While the device will be helpful, Cox said, it is not the single solution. 

"We see it as a tool to help them on the front end of treatment," he said. "This device is a new tool in the toolbox to really help people overcome the fear and experience of being sick from withdrawal and the intense cravings, which are . . . really the reasons why many people are afraid to get treatment." 

According to state data, in 2023, nearly 80% of Kentucky's overdose deaths involved opioids.

Medications are available to treat opioid-use disorder, but Cox noted that many people use more than one substance. And while the clinical trial of the NET Device focused on opiates, he said it also helps with the withdrawal symptoms of other drugs, from nicotine to methamphetamine.

"We know the device to be effective for all drugs," Cox said. "They have specific programming for each type of drug, which makes this device unique. . . . The additional upside to this device over medications is that it addresses the concerns of abuse and diversion."

Later, he said, "We have witnessed, really the positive impact of this device on a lot of people without any negative side effects. And, FDA approval is further evidence of the efficacy of this device in reducing cravings and withdrawal symptoms."

Cox said Isaiah House will only be paid a "small amount" for the additional work required by his staff to offer the therapy.

Who qualifies for it? 

Cox said participants will be considered for the NET Device on a case-by-case basis. "We just want to help people," he said.

Because insurance does not pay for the treatment, Lott said, "At this time, we're only focusing on treating people from counties who have paid for it or anyone can choose to pay and be treated." 

Bullitt County's contract says the participant must be diagnosed with opioid-use disorder, be admitted on a separately paid basis into a participating service program with a residential drug-addiction treatment facility, be a resident of the contracted county, and meet the clinical eligibility for the treatment, including a desire to participate in the program. 

Lott added that a participant must also be 18, and cannot be pregnant or have a pacemaker.

Cox said Isaiah House is starting the program in one of its men's facilities in Washington County and one of its women's facilities in Mercer County. Eventually, he said the treatment would be offered at all of their residential facilities.

Letcher County backs off its plan to spend $125,000 in opioid-settlement money on an experimental therapy by Isaiah House

The Bridge device, which requires a prescription,  "sends

gentle electrical impulses . . . to the brain to reduce

withdrawal symptoms," its website says. (Photo from site)

By Sam Adams

The Mountain Eagle

The Letcher County Fiscal Court has reversed itself — at least for now — on whether it will give $125,000 of its opioid settlement money to a Christian-based drug-rehab center for an experimental electrical-stimulation therapy.

The court voted 4 to 1 with one abstention to table the contract with Isaiah House, a Willisburg-based nonprofit, until County Attorney Jamie Hatton can negotiate it. Hatton said the contract, brought to the court by jail minister Ted Adams of Letcher, does not allow the county to back out in case the treatment doesn’t work. “There’s nothing in there about termination for cause,” Hatton said.

Three of the five magistrates who had voted to give the money for the treatment expressed reservations this week, echoing Hatton that the contract needs to be negotiated, and saying the treatment is unproven, and at $5,000 per patient would allow only 25 patients to participate.

Adams was livid that the court did not approve the contract, saying the court voted to give the money before the NSS-2 Bridge device was approved by the federal Food and Drug Administration, and now wants to back out after it has been approved. “ It doesn’t make any sense,” he said.

The device, marketed by Innovative Health Solutions Inc. of Versailles, Ind., was approved under an FDA program called “the de novo premarket review,” which the FDA describes as “a regulatory pathway for some low- to moderate-risk devices that are novel and for which there is no legally marketed predicate device to which the device can claim substantial equivalence.”

Devices approved under that program are assessed to be low- to moderate-risk to patients, but it does not include an assessment of whether the devices have a therapeutic effect. A test included only 73 patients, 64 of whom self-reported decreased distress during opioid withdrawal after getting the device. Critics say the device has not undergone a randomized test to account for a placebo effect. While the company charges $600 per device, Isaiah House is asking the county for $5,000 per patient.

Adams said he could “bring in all the churches” where people have seen results of the device, but some magistrates said they would prefer that he brought in someone from Isaiah House and people who have used the device.

“The only thing is, I would like to talk to some people it helped,” District 5 Magistrate Benny McCall said. “I have talked to some people who said it didn’t do much for them, but I’d like to talk to some who say it has.”

District 1 Magistrate Jack Banks also questioned whether the device is worth the money the court would have to pay, saying it would only possibly help 25 people and that’s not guaranteed. Adams, however, criticized other programs the county has agreed to help fund, including the Harm Reduction Program run by the Kentucky River District Health Department. He said the court gave $50,000 to “buy needles for people to kill themselves.”

District 3 Magistrate Deb Collier responded, saying the needle exchange can’t be criticized because it prevents people who are addicted to drugs from passing deadly diseases such as AIDS and hepatitis to others by sharing needles.

Judge/Executive Terry Adams suggested the county wait to see how other patients in other counties that have agreed pay Isaiah House have progressed, but Ted Adams stopped him. “How many people are going to have die?” he said.

That also drew a response from Collier and from Banks, who said the court is watched about how it spends the opioid money and has a responsibility to spend it well. Banks said people are watching, and “if we spend $125,000 on this and it doesn’t work, how does that look on us?”

“How does it look to give $125,000 to CANE Kitchen?” Ted Adams asked.

Banks said CANE Kitchen is part of a rehab program that helps people get back to work, but Adams said that’s part of his ministry, too.

Collier, McCall, Banks, and Judge Adams voted to table the issue until Hatton can negotiate. Ted Adams left immediately when the vote was taken.

Lottery system will determine who gets 48 licenses for retailers and 10 for processors of medical cannabis in 11 Kentucky regions

By Melissa Patrick
Kentucky Health News

Gov. Andy Beshear gave an update on the medical cannabis licensing program Thursday, after signing this year's medical cannabis bill into law the day before.

"We have worked hard to create a safe system that limits or eliminates abuse while still providing relief to that veteran suffering from PTSD or individual suffering from unbearable epileptic seizure after epileptic seizure," Beshear said during his weekly news conference.

Rep. Jason Nemes presents Senate changes to HB 829
on the House floor Monday, April 15. (Legislative photo)

House Bill 829, sponsored by Rep. Jason Nemes, R-Middletown, has been described as a "clean-up" bill for Senate Bill 47, the measure that legalized medical cannabis during the 2023 session under the sponsorship of Sen. Stephen West, R-Paris. 

"In essence, all 829 does is set up the Office of Medical Cannabis and carries out the provisions of SB 47 as was passed last year," West said while presenting the bill on the Senate floor.

The final version of HB 829 will allow Kentucky to start issuing medical cannabis licenses to businesses in July in hopes that the product will be available to dispensaries in January 2025, when the program is set to go into effect. 

“It does allow these businesses — the growers especially — to get up and running, start growing product so there's actually something there to sell January 1,” West explained at the April 12 meeting of the Senate State and Local Government Committee.

It also allows cities to opt out of the medical cannabis program before Jan. 1, 2025, even if a licensee has been approved before that date. 

"Cities and counties have the opportunity to take a local vote. They can also pass ordinances that prohibit implementation," West said while presenting the bill on the Senate floor. "If someone is licensed before that time, it's buyer beware; they will have to take that into account as they apply for the license."

On Thursday, April 18, Beshear and Sam Flynn, executive director of the Kentucky Medical Cannabis Program in the state health cabinet described how the licensing would work under a regulation filed that day.

The new regulation will allow businesses to apply for a cannabis business license from July 1 through Aug. 31. Beshear said 10 licenses will be available across the state for processors, and 48 for dispensaries, the retail outlets. All their cannabis must be cultivated, processed and produced in Kentucky.

Flynn said the program has created 11 licensing regions to ensure Kentuckians with qualifying conditions have access to the product.

Beshear also announced that the state, in partnership with the Kentucky Lottery Corp., will issue the medical cannabis licenses using a lottery system. The first lottery will be held in October.

"This is what states are moving towards," said Beshear. "It reduces or eliminates litigation and it creates a more fair process, not one where people bid against each other and only then the big companies can be a part of it, but one that provides at least a chance for everyone who can meet the criteria." 

Flynn said the licensing process is designed to ensure that the industry is "stable and sustainable" with a focus on "small business" and meeting demand from people who have cards enabling them to buy medical cannabis.  

And, he said, each region will have at least four dispensary licenses available per region, with no more than one dispensary located in each county, with the exception of the state's two largest counties - Jefferson and Fayette - which are allowed two each. 

HB 829 also allows public and private schools to opt out of the program and requires public school boards to establish medical-cannabis policies by Dec. 1. The policies must prohibit the use of medicinal cannabis on school property, or allow use with several options for administration.

The legislature did not expand the list of conditions that would make Kentucky residents eligible for medical cannabis beyond what was allowed in HB 47. In January, Beshear asked lawmakers to add 15 more medical conditions to the list, and West filed a bill to increase the list from seven to 21 conditions. West's SB 337 died in its assigned Senate committee, having never been called up for a hearing. 

The eligible conditions in the current law, passed by the legislature in 2023, are cancer, multiple sclerosis, muscle spasms or spasticity, chronic pain, epilepsy, chronic nausea and post-traumatic stress disorder.

Several Ky. water systems exceed new federal limits for 'forever chemicals'; all systems must test for 3 years, correct if needed

WKYT map, adapted by Kentucky Health News

By Al Cross
Kentucky Health News

Several Kentucky water systems, mostly on and near the Ohio River, will have to fund ways to reduce certain cancer-causing substaces for which the first federal limits were issued Wednesday, April 10.

The substances are PFAS, a joint acronym for per-fluoroalkyl and poly-fluoroalkyl substances, which are widespread and last a long time in the environment without breaking down, so they accumulate in the human body. They have been linked to low birth weights, liver disease and kidney cancer.

The substances have been used in waterproof clothing, nonstick frying pans and firefighting foam. For example, PFOS was the key ingredient in the fabric protector Scotchgard and related stain repellents, and PFOA was used in carpeting, cloth and sealants.

Public water systems will test for the chemicals for three years. If the limits are exceeded, the new Environmental Protection Agency rules will give them two more years to install treatment systems.

The state Department for Environmental Protection listed these water systems as exceeding the new limits of 4 parts per trillion: Ashland (4.74 PFOA), Augusta (4.43 PFOA), Cynthiana (8.35 PFOS), Georgetown (5.46 PFOS), Lewisport (Hancock County, 12.7 PFOS), Maysville (5.09 PFOA), North Marshall County Water District (11.8 PFOA), Paducah (4.54 PFOS, 4.07 PFOA), Russell (5.62 PFOA), South Shore (23.2 PFOA, 18.9 PFOS). The last two towns are in Greenup County.

The Louisville Water Co.'s Payne Plant at Prospect had a PFOS level of 4.31, but the level at its Crescent Hill plant was only 2.75.

Some water systems exceeded the EPA requirements in at least one test in 2019 and 2023 but were not listed as exceeding the new limits during the period. Those were Brandenburg, the Graves County Water District, Hardin County Water District No. 2, Henderson (north), Kuttawa, Morganfield, Northern Kentucky Water District (Fort Thomas), Owensboro, Providence, Sturgis and Worthington (Greenup County).

Erin Haynes, chair of epidemiology and environmental health at the University of Kentucky, has studied the chemicals for many years. “It’s all around us,” she told WKYT. “So we need to just be conscientious of different sources and how we can do our best to reduce our exposure. But analyzing it and reducing the levels in our drinking water is a wonderful step in the right direction.”

"Some funds are available to help utilities," The Associated Press reports. "Manufacturer 3M recently agreed to pay more than $10 billion to drinking water providers to settle PFAS litigation. And the bipartisan infrastructure law includes billions to combat the substance. But utilities say more will be needed."

Database lists opioid-settlement payments to local governments

Screenshot of first page of KFF Health News database of settlement
payments in Kentucky through March 4 shows the top 15 recipients.

How much money are your local governments getting from the settlements of lawsuits filed against opioid manufacturers and distributors? You can track it with a new online database from KFF Health News.

Kentucky is getting $478 million from the settlements through 2038, and a like amount is being paid each year to local governments in the state. State government got $100.7 million in 2022 and $17.4 million in 2023. It will get $21.8 million this year and the same amount in 2025, and an average of $24 million a year after that.

The state's money is being allocated by the Kentucky Opioid Abatement Advisory Commission, operated out of the attorney general's office. Local governments' spending is up to their governing bodies.

"This database undercounts the amount of opioid settlement money most places have received and will receive," note Aneri Pattani and Lydia Zuraw and Holly K. Hacker of KFF Health News.

The database reflects only the largest settlement so far, $26 billion to be paid by pharmaceutical distributors AmerisourceBergen (now called Cencora), Cardinal Health, and McKesson, as well as opioid manufacturer Janssen (now known as Johnson & Johnson Innovative Medicine).

It does not include settlements with other drug manufacturers and retailers Walmart, Walgreens, and CVS. Data from these five companies will be added in July, according to BrownGreer, the settlement firm that gets the money and makes the payments. It is not handling some additional settlements such as the agreement between Kentucky and four Midwestern states with regional supermarket chain Meijer.

Other settlements, including with OxyContin manufacturer Purdue Pharma, are pending.

Medical-cannabis 'cleanup' bill passes House; critics disappointed more qualifying conditions not added and say it increases hurdles

By Melissa Patrick

Kentucky Health News

In what the sponsor calls a bill to "clean some things up," more restrictions are being added to the state's medical-marijuana law and provisions were added to allow local school districts to opt out.

State Rep. Jason Nemes

One of the key provisions in House Bill 829, sponsored by Rep. Jason Nemes, R-Middletown, would allow public and private schools to opt out of the program.

Public school boards are required to establish policies related to the use of medical cannabis no later than Dec. 1, 2024. The policies must either prohibit the use of medicinal cannabis on school property, or permit the use with several options for administration, as outlined in the bill. 

The measure would also allow local governments to apply a small local fee to compensate for any additional costs caused by the operation of cannabis businesses; prioritize Kentucky hemp businesses for state contracting; and clarify the powers that the state Cabinet for Health and Family Services has when it comes to inspection. 

It would also abolish the provisional license, which allows someone who makes an application for a license to sell medical marijuana to get the product while the application is pending. Nemes said this "put the cart before the horse."

When the House passed the bill 66-30 on March 12, it allowed the state to move the dates up for licensing, which would allow product to be obtained when the program starts Jan. 1, 2025. 

A floor amendment, filed at the request of the Kentucky League of Cities, was approved to allow cities to be able to opt out of the medical cannabis program before Jan. 1, 2025, even if a licensee had been approved before that date.

The committee substitute for the bill would require a patient to consult with a pharmacist annually to make sure the medical cannabis does not have a negative interaction with the patient's other prescriptions.

That  prompted several Democrats to object in the floor debate, saying the new requirement , with a potential cost of up to $40, imposes another hurdle in accessing medical cannabis.

"It seems like we're adding even more hurdles to make this medicine harder to receive, more expensive for folks to access. . . . I really wish we were back here today to make this medicine more accessible to the people of Kentucky who have been asking us to do this for years," said Rep. Rachel Roberts, D-Newport. 

Rep. Rachel Roarx, D-Louisville, said allowing public school districts to opt out "puts barriers in place" for students who benefit from medical cannabis for conditions such as epilepsy. 

Rep. Josh Bray, R-Mount Vernon, disagreed and supported the opt-out provision for schools, saying that he recognizes the need for this because some schools are concerned about the liability of administering a drug that is not authorized by the U.S. Food and Drug Administration.  

Rep. Cherlynn Stevenson, D-Lexington, said she was disappointed that the bill wouldn't expand the list of qualifying conditions that could be treated with medical cannabis, as was recommended by at "statutory advisory board of doctors and nurses appointed by the state licensing boards."

Stevenson said she hoped these conditions would be added in the Senate, where the bill has not been assigned to a committee.

Anti-fluoride legislators cry 'local control' and 'forced medication;' dentists say it's been proven to reduce tooth decay for 70+ years

Centers for Disease Control and Prevention graphic; click to enlarge

By Deborah Yetter

Kentucky Lantern

As a dental hygienist working with low-income schoolchildren in Louisville, Jennifer Hasch said the untreated tooth disease she saw was shocking.

Some teens had decay so severe they had to have all their teeth pulled and be fitted with dentures. Middle-school kids reported being unable to sleep because of pain from infected and abscessed teeth. First- and second-graders required inpatient oral surgery under anesthesia because of the severity of tooth and gum disease.

“It was heart-wrenching,” said Hasch, who’s on the steering committee of the Kentucky Oral Health Coalition.

Adults don’t fare much better.

Kentucky ranks 49th in overall oral health and is among the top states in the number of toothless, older adults. And last year, a University of Kentucky oral health physician described to legislators patients being air-lifted to the UK hospital because of life-threatening infections from dental disease.

Yet a group of lawmakers led by Rep. Mark Hart, R-Falmouth, is pushing a bill to make fluoridation optional for local water districts, despite what Hasch and others, including the American Dental Association and the Kentucky Dental Association, say is overwhelming evidence fluoride safely helps reduce tooth decay.

“It’s a bill that will undo an unfunded mandate and return the issue to local control,” Hart said, speaking before the Feb. 7 meeting of the House State Government Committee in support of his House Bill 141.

Hasch and other oral health professionals are fighting HB 141, which would eliminate the fluoridation mandate established in 1954.

“There are kids that already are suffering,” Hasch said. “Water fluoridation protects that from getting worse.”

Dr. Stephen Robertson, executive director of the state dental association, urged lawmakers to reject HB 141, saying “Kentucky is not in a position to take a step backward in oral health.”

“Please listen to our professional advice and continue to provide consistent fluoride access to our patients in community water supplies,” urged Mary Ann Burch, representing the Kentucky Association of Dental Hygienists.

They didn’t.

Instead, the committee approved HB 141 by a vote of 16-1, framing it not as a public health issue but rather one of local autonomy. The bill now is pending in the House.

“This is a local control issue,” said co-sponsor Rep. William Lawrence, R-Maysville. His city was the first in Kentucky to add fluoride to its drinking water supply in 1951.

“Local control — that’s what this bill is about,” said Rep. Steve Rawlings, R-Burlington, also a co-sponsor.

“Let’s just leave it to local control,” said Rep. Kevin Bratcher, R-Louisville.

In all, six members of the committee cited “local control” as grounds for passing HB 141. Rep. Keturah Herron, D-Louisville, cast the only no vote.

Bill hasn't moved since Feb. 9

After getting out of committee, the bill went to the House Rules Committee, which is controlled by House leaders. It has been there since Feb. 9, which could indicate that its sponsors haven't yet rounded up the votes to pass it through the full House.

Meanwhile, though, the prospect of allowing local water utilities to eliminate fluoride from drinking water has Kentucky dental and public health officials frantic.

“Other than setting my hair on fire, there’s not enough words I can say that this is a critically important step, if Kentucky takes it, to harm developing teeth, children’s teeth and adult teeth,” Dr. Connie White, Kentucky’s deputy public health commissioner, said on a recent call with health advocates.

Fluoride reduces cavities by 25%, White said.

Not only will it lead to even more tooth decay than Kentucky already has, she said, it will drive up costs of Medicaid, a government health plan for low-income individuals that covers nearly half of Kentucky’s children.

Filling one cavity in a child costs Medicaid about $250, which could add million of dollars to the cost of the program, White said.

Already facing a shortage of dentists in the state, especially pediatric dentists, removing fluoride from community water supplies will mean longer delays in care, Hasch said.

“We don’t have the resources to handle that increase,” Hasch said. “All these dental providers are desperately trying to catch up with the current need.”

Dr. Bill Collins, a longtime dentist in Eastern Kentucky, said too many children in rural areas on well or cistern water already lack access to fluoridated water and suffer much more from dental decay as a result. Compounding the problem is high use of sugary sodas and lack of access to oral health care throughout the state.

He said he’s baffled about why lawmakers want to remove the fluoride mandate.

“They don’t see the need for fluoride because they haven’t experienced the decay that we have out in the rural areas,” said Collins, director of the Red Bird Mission dental clinic in Beverly, in northern Bell County. “If this happens, they’re going to experience it and they should be held responsible.”

‘Grounded in science’

Kentucky's statewide adoption of fluoridation, hailed as one of the major public-health advances of the past century by the U.S. Centers for Disease Control and Prevention, has made Kentucky a national leader, advocates said.

A naturally-occurring mineral, flouride helps strengthen tooth enamel and prevent decay when added to water in small amounts, Hasch said. It helps when children’s teeth are developing, but the main benefit is topical exposure to fluoride from drinking treated water.

The recommended level is 0.7 parts per million, which Hasch said is comparable to adding one drop of fluoride to about 11 gallons.

The Louisville Water Co., the state’s largest public water provider, has been adding fluoride to water it gets from the Ohio River since 1951, said spokeswoman Kelley Dearing Smith.

The river water already contains some natural fluoride and the water company adds enough to bring it to the recommended level, she said.

“We are grounded in public health,” she said. “Everything we do is grounded in science.”

The Louisville Water Co. joined insurer Delta Dental of Kentucky, the dental and dental hygienists associations, the Oral Health Coalition and the Kentucky Primary Care Association in a letter to legislators urging them to reject HB 141.

“Community water fluoridation is a safe, reliable cost-effective prevention measure to keep teeth strong and reduce cavities by at least 25%,” the letter said. “We are deeply concerned about any efforts to make water fluoridation programs optional in our communities.”

‘Forced medication’

Questions about fluoride’s safety and efficacy have persisted over the years, despite evidence to the contrary. 

Four rural water districts submitted letters in support of HB 141: the Grayson County Water District, Irvine Municipal Utilities, the Martin County Utility Board and the McCreary County Water District.

Craig Miller, division manager for the Martin County water utility.], wrote, “The facts are out there proving fluoridation of water is dangerous to human health.” He said eliminating fluoridation would save Martin County about $14,000 a year, which he said could be better spent upgrading the problem-plagued water system.

Nina McCoy, a longtime activist for better water in Martin County and a member of the utility board said she wasn’t consulted on HB 141 and the board didn’t vote on the matter. She suggested legislators defer to public health officials. “I don’t pretend to be an expert in this at all,” she said.

A letter from Stephen Whitaker, superintendent of the McCreary water district, cited potential “adverse effects of fluoridation” including thyroid, tooth and bone problems.

Lawrence, a co-sponsor of HB 141, called adding fluoride to water “forced medication.”

Hasch, with the Oral Health Coalition, dismissed claims of studies linking water fluoridation to health problems as “junk science” and said the overwhelming body of research supports it as safe and effective.

Collins, who has practiced dentistry in Eastern Kentucky for more than three decades, said he doesn’t understand persistent distrust of fluoride.

“I really don’t understand why they are so adamant about removing this,” he said. “It’s something that’s time-tested and shown to be a good thing and it’s safe. It’s just mind boggling.”

Eastern Ky. towns fight to recover from opioid epidemic, with help from newcomers and recovering addicts, national author reports

An event in downtown Hazard: “When somebody gets clean, they want to change the world,” Stephanie Callahan, a former addict and current business owner in Hazard, said of the town’s new can-do spirit. “You do something just to prove you can do it.” (Photos by Stacy Kranitz for The Free Press)

By Sam Quinones
Republished from The Free Press

In early 2020, Mandi Fugate Sheffel, 42, opened a tiny bookstore in her hometown of Hazard. Everyone thought she was crazy.

Downtown Hazard was a forbidding place to start any business, much less a bookstore. Most coal mines that once supported the area had closed. Many brick buildings from Hazard’s heyday were gone, bequeathing a gap-toothed look to Main Street.

What’s more, Fugate Sheffel couldn’t afford a website or employees. She had never run a business before. And she had a complicated personal history to wrestle with.

But she loved to read—particularly contemporary Appalachian authors like Silas House, James Still and Gurney Norman, who told stories that felt real to her. She figured others in town were tired, like her, of driving two hours to Lexington to buy books.

So, on January 30, she opened Read Spotted Newt in a 250-square-foot space—the size of a small bedroom.

 
I met Fugate Sheffel last spring when I visited Hazard for the first time. I came to speak about my book, The Least of Us, about America’s drug-addiction epidemic. I had heard about the town, and had formed an image of it as the buckle on Eastern Kentucky’s opioid belt.

Mandi Fugate Sheffel poses outside her bookstore in Hazard.

From Fugate Sheffel, though, I heard another story—one that I heard elsewhere in the Appalachian coalfield.

“When you don’t have industry, you’re having ecological disaster and a drug epidemic—you would think all those things would get us to a place where the town would be uninhabitable,” Fugate Sheffel told me. “But that’s not what I’m seeing at all. I’m seeing a lot of people rally.”

The loping hills of Eastern Kentucky are studded with scores of towns like Hazard—and nearby Prestonsburg and Pineville and Corbin—that, over the centuries, emerged in the valleys and along its rivers. By the early 20th century, coal dominated the region, with roughly 700,000 men and boys toiling in the mines of Kentucky and neighboring West Virginia.

In the 1990s, “as one declined and things got worse, the other increased and things got worse,” Les Stapleton, the mayor of Prestonsburg, pop. 4,000, 35 miles northeast of Hazard, told me about the correlation between jobs and drugs.

Larger forces over which locals had little or no control exacerbated things: the rise of natural gas for power plants, new environmental standards, our shifting political and cultural landscape.

By the early 2000s, the region had become the epicenter of the new opioid epidemic, which had its epicenter in Eastern Kentucky, West Virginia, and southwest Virginia.

Downtowns emptied out. Buildings were abandoned. Business startups seemed dominated by “pill mills”—clinics that prescribed huge quantities of prescription painkillers. In the little evangelical churches, they prayed for an end to “hillbilly heroin.”

The state cracked down on the pill mills, but by 2017, Perry County was the worst-hit county in the United States when it came to hospitalization for opiate addiction.

But then, weirdly and unexpectedly, at the same time that everything was falling apart, things started to get better—and that old world started, very tentatively, to build itself back up.

In the past few years, some 43 businesses have opened in Hazard, creating 171 new jobs, said Bailey Richards, the town’s coordinator of downtown development. That includes a toy store, a café, a women’s boutique, a quilt and apparel place, and a smoothie shop. A longtime restaurant just moved downtown.

The population, which declined for most of the latter half of the 20th century, now appears to be inching up. The growth was driven mostly by outsiders—new families, mostly from cities in Kentucky, in search of a better future, and immigrants, including health-care workers a nascent Latino community.

Shane Barton, the downtown-development coordinator at the University of Kentucky’s Community and Economic Development Initiative, went so far as to call Hazard “a hip destination for young people.”

It was hard to say why this was happening. Gradually, people were becoming more aware of the crisis of Appalachia and were doing things trying to help. Covid-19 pushed people to move out of the cities. And there were the recovering addicts; they weren’t expensive to hire if you needed a barista or someone to stock your shelves or paint your walls, and they were eager to work, to live.

In Hazard, about a quarter of the new jobs are held by recovering addicts. In Pineville, an hour and a half southwest of Hazard, one-third of new jobs are filled by people in recovery, said Jacob Roan, who oversees economic development in the Bell County seat.

“When somebody gets clean, they want to change the world, and have ideas of how to change the world,” Stephanie Callahan, a former addict and current business owner in Hazard, told me. “You do something just to prove you can do it.”

Joey Jones poses in his Ready Set Play toy store in Hazard.

That’s what inspired Joey Jones—the can-do spirit.

Jones and his wife, Nikki, grew up in Hazard, went to the University of Louisville, and in 2019, returned home after ten years away, now with two kids.

Though a trained social worker, Joey Jones opened a toy store. This was last year. He called it Ready Set Play, and it’s on Main Street. Jones advertises on social media and, despite selling toys that are available online, he is expanding.

“The small business community here feels like family,” Jones said. Mandi Fugate Sheffel, who knew something about hard times and people coming together, agreed.

She had been in high school in the 1990s, as the mines were closing and pain pills were invading. “One day, we were drinking beer in the back of a truck,” she said. “Then, all of a sudden, these pills were everywhere.” By 1997, she was an OxyContin addict.

The addicts dubbed a local park “Pillville,” and Fugate Sheffel got out. She moved to western Kentucky, came home in 2002, got sober, married, had a son. She survived.

So did her bookstore, against all odds.

A few days after she opened it, in 2020, it was flooded. Then Covid hit and Kentucky’s governor banned in-store shopping, and Fugate Sheffel thought this might really be it for Read Spotted Newt.

But after news media reported on Read Spotted Newt’s woes, Fugate Sheffel started getting orders from all over. Soon, she said, “I was shipping books everywhere—Boston, Florida, Texas, L.A.  Anybody who had any tie to Eastern Kentucky who knew this was going on were like, ‘We gotta make sure she makes this work.’”

By late 2020, she had moved to a larger space—a triangular building on a corner that once housed Hazard’s tourist welcome center. The city renovated it for her.

There are other pockets of hope scattered across the region.

In Prestonsburg, an hour north of Hazard, there are five locally owned restaurants, all but one of which opened in the last five years. An Indian restaurant is coming soon. The two-block historic downtown once had eleven abandoned buildings. Now, all are occupied.

In Pineville, pop. 1,600, the downtown was similarly decimated. Now there are boutiques, a hair salon, a furniture store, and several restaurants. Importantly, noted Roan, the economic-development director, “Those businesses are still in business six, seven years after opening.”

In Corbin, pop. 8,000), just up the Cumberland Gap Parkway from Pineville, several old buildings have been redone. They now house restaurants, a clothing boutique, a print shop, a café, an ice cream parlor, a record store, and a pinball museum.

“Everybody is like, ‘What can I start? What’s missing around here?’ ” Corbin Mayor Suzie Razmus told me.

Something else locals are starting to see in these places: people. On the street, outside their favorite coffee shop, chatting with a friend through an open car window.

In the past, a town grew from a big factory that employed hundreds or more people. But no one’s waiting any longer for factories or big-box stores—to say nothing of the mines or unions—to save them.

Prestonsburg Mayor Les Stapleton: “If a deer gets killed on the

highway, I pull over and put it in the truck and get rid of it . . .

I don’t want people seeing that the first time they drive into town.”

“Too many have come in to try to save us, and they don’t,” said Stapleton, the Prestonsburg mayor. “We got to do it ourselves.”

Now, he’s facing a problem he could never have anticipated: a shortage of affordable housing. This has been driven, he added, by outsiders who, since Covid, have been moving to Prestonsburg and other towns across the region.

Jeff Siegler, whose firm Revitalize, or Die advises small towns on rebuilding, said the area’s success “has to be about small, incremental victories—one business at a time.”

The new generation of mayors, town councilors, and city planners across much of Appalachia, who had come through the disaster of the last three decades and seemed inspired by recovering addicts in their own communities, understood what Siegler was saying: small is good; local is good; people are good.

Instead of trying to lure massive out-of-state companies with tax incentives, they were thinking about beautification projects and homeowners and places where people could congregate.

“That’s the shift,” said UK's Shane Barton. “How can we make our communities people-ready as opposed to industry- or investment-ready?”

Still, progress is uneven, and many small-town economies are frail. Self-reliance may take them only so far.

The drug problem rages on. Fentanyl seems to be mixed into everything on the street, creating staggering numbers of overdoses. On top of all this, a form of perverse gentrification has taken hold that’s peculiar to this birthplace of the opioid epidemic. Legions of national drug treatment centers catering to the addicts have moved to the region—sopping up cheap real estate and pricing lower-income buyers and start-ups out of the market.

But at this point, that seems like a minor, mostly surmountable hurdle, at least to the people here who have stopped waiting for outsiders—coal companies, big-box retailers, Frankfort, Washington—to save them.

That is definitely the way Stephanie Callahan, in Hazard, sees things.

Now in her early forties, Callahan, like Mandi Fugate Sheffel, was part of the generation consumed by Oxycontin. She got clean when she had a baby—this was 15 years ago—and built a career as a showroom saleswoman at a local furniture company. But she yearned to do something on her own.

She loved fashion. For two years, she had been running a side hustle out of her bedroom, selling plus-size clothes. She hated that she had to go to Lexington every time she needed a new top or skirt.

So, in the summer of 2021, Callahan quit her full-time job and rented a space in downtown Hazard that had once been a gym. Her father said she’d lost her mind, opening a women’s clothing store during Covid. She did it anyway, calling it Hot Mess Express, which is what her mother and friends often called her.

She showed them: in her first two years, Callahan had 2,000 repeat customers. She now has nine part-time employees and will soon open a men’s store.

It wasn’t just about the clothes. It was about people in Hazard, like so many towns, trying to find their way back to each other.

“When I was growing up, we had arcades, movie theaters, mom-and-pop restaurants,” Callahan said. Now, “there’s no place for people to go talk to each other.”

So, she put a brown leather couch, almost as an afterthought, in the middle of the store, intending it for men accompanying their wives and girlfriends to sit and scroll through their phones or read a magazine—kill time. Instead, it became the focal point of the store, and it made Hot Mess Express a community hangout as well as a women’s boutique. A little place, or nook, where people would say hi, catch up, laugh, hug, gossip.

“It’s comfortable,” Callahan told me, referring to the couch. “I have a photo of the mayor asleep on it.”

Sam Quinones is the author of four books, including his latest, The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth. You can follow him on X at @samquinones7.

Hardin, McCracken and Scott counties are certified as Recovery Ready Communities, bringing Kentucky's total to 10

Kentucky Health News map from Wikipedia base map

Kentucky Health News

Three more counties have been designated as Recovery Ready Communities for their commitment to providing residents with access to addiction treatment and recovery support and removing barriers to the workforce, raising the total to 10 out of 120, Gov. Andy Beshear announced Wednesday.

"Thank you, Hardin, McCracken and Scott counties, for leading with judgment instead of division," Beshear said at a press briefing Thursday.

The three join seven other counties: Boone, Boyle, Campbell, Grant, Kenton, Perry and Woodford. Counties certified as Recovery Ready provide transportation to and from employment services and job interviews, allowing residents to make positive changes in their lives while filling much-needed jobs, and can earn certifiction in other ways.

"Hardin County’s emphasis on educating youth on the impacts of addiction through collaboration with the county’s school system combined with the outreach of the Lincoln Trail District Health Department and the training offered to local school officials makes the county Recovery Ready," a state news release said. "Not only is it educating all its citizens about the dangers of addiction, but it is providing recovery resources through its participation in an active Agency for Substance Abuse Planning board."

Sara Jo Best, the health department's director, said “While this certification highlights the successful work that has been done so far, it also creates an opportunity for additional activities that we can undertake as a community.”

McCracken County won its certification with distinctive ways of fighting addiction. "An entire city block in downtown Paducah has been transformed into a unified campus allowing seamless delivery of services to at-risk youth, addiction treatment and metal health disorders," the release said. "McCracken County is also home to a mobile access van that serves people throughout the region while working with public and private stakeholders to create a countywide treatment system that is accessible and affordable."

Scott County’s certification turned on collaboration among local law enforcement and grassroots recovery advocates. "The Georgetown Police Department has demonstrated a profound commitment to addressing addiction-related crime and disorder through Operation Hope, which is the agency’s local version of the Kentucky State Police’s Angel Initiative," the release said. "Additionally, the police and local advocates have worked with local food banks and shelters to ensure local citizens have a place to stay safe and do not need to go hungry."

To learn more about the program and to apply for certification as a Recovery Ready Community, click here.

Seven mobile crisis-response grants aim for 'better treatment, a lot quicker' for people undergoing mental-health crises

Kentucky Health News

Seven local-government organizations are getting grants to start community crisis co-response programs, which form partnerships between behavioral-health professionals, law enforcement or other first responders and local governments in order to lower the distress of individuals in crisis and avoid unnecessary hospitalizations and incarcerations while extending crisis services to communities.

The money comes through a state Cabinet for Health and Family Services grant. The recipients are Boyle County, Christian County, the Cynthiana Police Department, the Lexington Fayette Urban County Government, the Maysville Police Department, the Perry County Ambulance Authority and the Warren County sheriff, in Bowling Green.

Perry County EMT Scott Helle (Image from WYMT) 

Perry County EMT Scott Helle told Hazard's WYMT that in a mental-health crisis, taking a patient to a hospital can be a burden on hospital staff and adding “wait time for their patients to be able to see a mental-health provider.” The grant will allow the ambulance service to add a community paramedic, peer support specialist or case manager to its staff.

Helle said “It will give us the opportunity to give them better treatment, a lot quicker,” and the pilot grants will help other communities create similar teams.

Mike Rogers, director of Boyle County Emergency Medical Services, said in a state news release that the grant “will ease the burden on our law enforcement, hospital, judicial system and emergency services.”

Robert Peak, assistant police chief in Cynthiana, said This will be an invaluable resource to the most vulnerable members of our citizenry. Realizing that mental health and chemical dependency cannot be fully addressed by traditional police strategies is key to implementing programs such as this.”

Warren County Sheriff Brett Hightower said, “Having qualified professionals working alongside our team of law enforcement will help expedite and assess the needed care for those in crisis, which better serves our community.”

Several recipients sent the state videos about what they hope the funding will do in their communities. To see the video provided by Maysville police, click here. To see a video from Boyle County, click here. To see Helle's video, go here.

Businesses are pitching local governments to give them money from the national opioid settlement; Ky. advisers say to go slow

Information for this story was also gathered by Kentucky Health News.

By Aneri Pattani
KFF Health News

The pitches are bold and arriving fast: Invest opioid settlement dollars in a lasso-like device to help police detain people without Tasers or pepper spray. Pour money into psychedelics, electrical stimulation devices, and other experimental treatments for addiction.

Opioid manufacturers and distributors are paying more than $54 billion in restitution to settle lawsuits about their role in the overdose epidemic, with little oversight on how the money is spent. KFF Health News and Kentucky Health News are tracking how state and local governments use or misuse the cash.

The marketing pitches land daily in the inboxes of state and local officials in charge of distributing money from the settlements in opioid lawsuits over the next two decades or more. Kentucky is getting $900 million, split evenly between the state and local governments.

The money is coming from an array of companies that made, sold, or distributed prescription painkillers, including Johnson & Johnson, AmerisourceBergen and Walgreens. Thousands of state and local governments sued the companies for aggressively promoting and distributing opioid medications, fueling an epidemic that progressed to heroin and fentanyl and has killed more than half a million Americans. The settlement money, arriving over nearly two decades, is meant to remediate the effects of that corporate behavior.

But as the dollars land in government coffers — more than $4.3 billion as of early November — a swarm of private, public, nonprofit, and for-profit entities are eyeing the gold rush. Some people fear that corporations, in particular — with their flashy products, robust marketing budgets, and hunger for profits — will now gobble up the windfall meant to rectify it.

“They see a cash cow,” said JK Costello, director of behavioral health consulting for the Steadman Group, a firm that is being paid to help local governments administer the settlements in Colorado, Kansas, Oregon, and Virginia. “Everyone is interested.”

Officials of the Kentucky Association of Counties and the Kentucky League of Cities told Kentucky Health News that they are advising cities and counties to not rush to spend the funds, because they don't expire and might be used more effectively if they are allowed to accumulate.

Morgain Patterson, the cities league's law director, said it is encouraging the state's 149 elibigle cities to form partnerships "to build more of an infrastructure" for things like job training for people in recovery. She noted that Ashland, which is getting about $100,000 a year from settlements, issued a request for propopals from people and groups interested in the funds.

Tim Sturgill, general counsel for the counties association, said it has hired a new employee, starting Jan. 4, who will help county officials understand both what they can and should do with the money.

The key to deciding how to spend the settlement money, public-health and policy experts told KFF Health News, is to critically evaluate products or services to see if they are necessary, evidence-based, and sustainable, instead of flocking to companies with the best marketing. Otherwise, “you end up with lots of shiny objects,” Costello said. And, ultimately, failure to do due diligence could leave some jurisdictions holding an empty bag.

Van Ingram

Van Ingram, executive director of Kentucky's Office of Drug Control Policy and former police chief in Maysville, told League of Cities writer Jeff Moreland that local governments need to be cautious.

“I think they need to put the brakes on, and I think you can’t get too much stakeholder input,” Ingram said. “We need to be hearing from our public health departments; we need to be hearing from any treatment providers we have in the area. We need to hear from people who are in recovery now and find out what barriers they are facing. It’s time to do a community inventory of recovery capital and look at the things you have in place, but more importantly, the things you don’t have in place.”

Ingram added, “I’m encouraging community leaders to develop a five- to 10-year plan. This money is spread out over 18 years, and you’ve got to have a direction you want to go in and a plan you want to meet. We’ve got one shot at this, and then it’s gone. I think it’s incumbent upon the state and communities to spend these dollars wisely.”

KFF Health News obtained emails in eight states that show health departments, sheriffs’ offices, and councils overseeing settlement funds are receiving a similar deluge of messages. In the emails, marketing specialists offer phone calls, informational presentations, and meetings with their companies.

In 2022, North Carolina lawmakers allotted $1.85 million of settlement funds for a pilot project using the first FDA-approved app for opioid use disorder, developed by Pear Therapeutics. There were high hopes the app would help people stay in treatment longer. But less than a year later, Pear filed for bankruptcy.

The state hadn’t paid the company yet, so the money isn’t lost, according to the North Carolina Department of Health and Human Services. But the department and lawmakers have not decided what to do with those dollars next.

$1 million for drug-disposal pouches

Jason Sundby, CEO of Verde Environmental Technologies, said the Deterra pouches his company sells are a low-cost way to prevent expensive addictions.

Customers place their unused medications in a Deterra pouch and add water, deactivating the drugs before tossing them, ensuring they cannot be used even if fished out of the trash. A medium Deterra pouch costs $3.89 and holds 45 pills.

The goal is to “get these drugs out of people’s homes before they can be misused, diverted, and people start down the path of needing treatment or naloxone or emergency room visits,” Sundby said.

Sundby’s company ran an ad about spending settlement dollars on its product in a National Association of Counties newsletter and featured similar information online.The Deterra website prominently features opioid settlement funds as a potential funding stream to purchase drug disposal pouches. Several other companies have taken similar approaches, urging consumers to consider applying opioid settlement funds to their products.

It may be paying off. Deterra is set to receive $1 million in settlement funds from the health department in Delaware County, Pennsylvania, and $12,000 from the sheriff in Henry County, Iowa. The company also has partnerships with St. Croix and Milwaukee counties in Wisconsin, and is working on a deal in Connecticut.

Several other companies with similar products have also used their product sites to urge jurisdictions to consider the settlements as a funding stream — and they’re seeing early success.

DisposeRx makes a drug-deactivation product — its version costs about a dollar each — and received $144,000 in South Carolina for mailing 134,000 disposal packets to a program that educated high school football players, coaches, and parents about addiction.

SafeRx makes $3 pill bottles with a locking code to store medications and was awarded $189,000 by South Carolina’s opioid settlement council to work with the Greenville County Sheriff’s Office and local prevention groups. It also won smaller awards from Weld and Custer counties in Colorado.

None of the companies said they are dependent on opioid settlements to sustain their business long-term. But the funds provide a temporary boost. In a 2022 presentation to prospective investors, SafeRx called the opioid settlements a “growth catalyst.”

Critics of such investments say the products are not worthwhile. Today’s crisis of fatal overdoses is largely driven by illicit fentanyl. Even if studies suggest the companies’ products make people more likely to safely store and dispose of medications, that’s unlikely to stem the record levels of deaths seen in recent years.

“The plausible mechanism by which they would even be able to reduce overdose is a mystery because prescription medications are not driving overdose,” said Tricia Christensen, policy director with the nonprofit Community Education Group, which is tracking settlement spending across Appalachia.

Safe storage and disposal can be accomplished with a locking cabinet and toilet, she said. The FDA lists opioids on its flush list for disposal and says there is no evidence that low levels of the medicines that end up in rivers harm human health.

Milton Cohen, CEO of SafeRx’s parent company, Caring Closures International, said keeping prescription medicines secure addresses the root of the epidemic. Fentanyl kills, but often where people start, “where water is coming into the boat still, is the medicine cabinet,” he said. “We can bail all we want, but the right thing to do is to plug the hole first.”

SafeRx has been awarded $189,000 in opioid settlement funds in South Carolina to work with the Greenville County sheriff and local prevention groups.

Products to secure and dispose of drugs also provide an opportunity for education and destigmatization, said Melissa Lyon, director of Pennsylvania's Delaware County Health Department. The county plans to mail Deterra pouches and postcards about preventing addiction to three-quarters of its residents.

“The Deterra pouch is to me a direct correlation” to the overprescribing that came from pharmaceutical companies’ aggressive marketing, Lyon said. Since the settlement money is to compensate for that, “this is a good use of the funds.”

Law-enforcement that the Justice League would envy

Other businesses making pitches for settlement funds have a less clear relationship to opioids.

Wrap Technologies creates tools for law enforcement to reduce lethal uses of force. Its chief product, the BolaWrap, shoots a 7½-foot Kevlar tether more than a dozen feet through the air until it wraps around a person’s limbs or torso — almost like Wonder Woman’s Lasso of Truth.

Terry Nichols, director of business development for the company, said the BolaWrap can be used as an alternative to Tasers or pepper spray when officers need to detain someone experiencing a mental-health crisis or committing crimes related to their addiction, like burglary.

“If you want to be more humane in the way you treat people in substance use disorder and crisis, this is an option,” he said.

The company posts body camera footage of officers using BolaWrap on YouTube and says that out of 192 field reports of its use, about 75% of situations were resolved without additional use of force.

When officers de-escalate situations, people are less likely to end up in jail, Nichols said. And diverting people from the criminal justice system is among the suggested investments in opioid settlement agreements.

That argument convinced the city of Brownwood, Texas, where Nichols was police chief until 2019. It has spent about $15,000 of opioid settlement funds to buy nine BolaWrap devices.

After Brownwood’s purchase, Wrap Technologies issued a press release that did not mention Nichols but quoted Kevin Mullins encouraging more law-enforcement agencies to “take the opportunity afforded by the opioid-settlement funds to empower their officers.” The company has also sent a two-page document to police departments explaining how settlement funds can be used to buy BolaWraps.

Language from that document appeared nearly word-for-word in a briefing sheet given to Brownwood City Council before the BolaWrap purchase, listing "Chief Terry Nichols (Ret.)" as the companyu contact. The council voted unanimously for the buy.

BolaWrap's process hasn’t been as smooth elsewhere. In Hawthorne, California, the police department planned to buy 80 BolaWraps using opioid-settlement funds. After it paid its first installment of about $25,000 in June, the state Department of Health Care Services informed it that the BolaWrap is not an allowable use of these dollars.

Sturgill said he hasn't heard of any Kentucky counties buying BolaWraps.

Patterson said some local governments have spent money to increase local addiction treatment and recovery programs, and the league is advising its cities that they sign a memorandum of understanding with such providers to fully document how the funds are being used.

She said that if a local government spends settlement money on things not mentioned in the settlement agreements or state law, it is required to report that to the state attorney general, who oversees settlement spending in Kentucky.

How are your local governments spending their settlement money, or planning to spend it?

State finds several water systems, most on the Ohio, have levels of 'forever chemicals' above a limit being considered by EPA

Kentucky Lantern graph from state data, adapted by Kentucky Health News

By Liam Niemeyer
Kentucky Lantern

Per- and poly-fluoroalkyl substances, commonly known as PFAS or “forever chemicals,” are in Kentucky’s rivers and lakes. The chemicals are accumulating inside Kentucky’s fish. They are in municipal water treatment systems, and some have levels higher than a proposed federal limit..

That is what the Kentucky Department for Environmental Protection has found the past few years as it has investigated how widespread PFAS is in Kentucky’s drinking water and environment, the department’s commissioner told a state legislative committee Thursday.

“We have gathered a lot of information. None of the information that we’ve gathered has been or ever was intended to be used for regulatory purposes,” said DEP Commissioner Tony Hatton. “We’re looking at it primarily from a public-health standpoint, and primarily from a drinking-water aspect.”

Chemicals classified as PFAS have been used for decades in a wide variety of industrial purposes, from firefighting foam to nonstick cooking ware because they are highly heat-resistant and stick-resistant. The resistance comes from their strong chemical bonds; they are dubbed “forever chemicals” because they don’t break down easily in the environment.

These chemicals also have a wide range of potential detrimental health impacts at high levels: increased risk of some cancers, hormonal changes, increased cholesterol levels, decreased vaccine responses in children and more.

Hatton said the Energy and Environment Cabinet has done its “investigative work” and conducted the testing not only to be aware of how widespread PFAS was in state waters but to prepare for proposed federal regulations setting maximum limits on how much of some kinds of PFAS are allowed in drinking water.

The U.S. Environmental Protection Agency sets legal limits for over 90 contaminants in drinking water, but not for PFAS. EPA has health advisory limits, which are unenforceable, that advise how much PFAS exposure is needed over a lifetime before adverse health effects occur. That limit is set at .004 parts per trillion (ppt) for one version of the chemical.

The legally enforceable maximum limit the EPA is proposing would cap two types of PFAS at 4 ppt. State officials have found much higher levels of PFAS in some municipal water systems in Kentucky.

Sen. Robin Webb

The water in the Greenup County town of South Shore had 23.2 ppt of one type of the chemical, the highest in the state, Louisville Public Media reported. And the 1,100 residents of the Ohio River town were not notified, state Sen. Robin Webb of Grayson said at meeting of the Interim Joint Committee on Natural Resources and Energy.

“No notice requirements, people. And that’s a problem. I think we all have the right to be notified when we’re dealing with the commodity that’s necessary for life,” Webb said. “This is a big deal.”

In the sampling so far, most of the water systems with PFAS levels above the proposed federal limit are on the Ohio River. Earlier this year, the state sued the DuPont chemical company, alleging PFAS pollution in Kentucky from a West Virginia facility upstream on the Ohio. The state is demanding the company pay all past and future costs for monitoring and treating PFAS in drinking water.

Treating water for PFAS won't be cheap

Webb, a Democrat, said the Republican-dominated legislature should consider providing more funding to water systems in the next two-year budget, especially with the pending federal limit on PFAS.

Sen. Brandon Smith, R-Hazard, asked Hatton if forever chemicals had been seen in fish caught in Kentucky waters; the commissioner replied that a state report found PFAS in all of the 98 fish samples taken throughout the state.

Past Democrat-led efforts to regulate PFAS through state legislation have gained little traction. Rep. Nima Kulkarni, D-Louisville, has been the primary sponsor of bills the past three years to set maximum limits in drinking water and discharge limits into state waters. A version of the legislation in 2023 was not even assigned to a House committee.

Hatton said PFAS can be filtered out at water utilities, but treatment is expensive. He said the city of Leitchfield, which draws water from Rough River Lake, is asking the state for financial help to the tune of $1 million to implement a granular activated-carbon filter.

Activted carbon is “great stuff, but once the receptors get filled, it doesn’t want to hold on to anything anymore, you have to regenerate it or replace it. So there’s gonna be ongoing costs,” Hatton said.

He said the state is focusing on how to treat drinking water systems for PFAS before addressing the other “complex” aspects of the issue, including the sources of forever chemicals.

Sen. Cassie Chambers-Armstrong, D-Louisville, urged officials to also address potential sources of PFAS exposure, for example, in children’s products, in addition to focusing on drinking water.