Opioid epidemic is in a 'fourth wave,' seeing multiple substances being used at the same time, and fentanyl is the most common

A person uses fentanyl in Portland, Oregon, Jan. 23. (Photo: Patrick T. Fallon, AFP, via Getty Images and KFF)

By Colleen DeGuzman
KFF Health News

The United States is knee-deep in what some experts call the opioid epidemic’s “fourth wave,” which is not only placing drug users at greater risk but is also complicating efforts to address the nation’s drug problem.

These waves, according to a report from Millennium Health, were the crisis in prescription opioid use, followed by a significant jump in heroin use, then an increase in the use of synthetic opioids like fentanyl.

The latest wave involves using multiple substances at the same time, combining fentanyl mainly with either methamphetamine or cocaine, the report found. “And I’ve yet to see a peak,” said one of the co-authors, Eric Dawson, vice president of clinical affairs at Millennium, a specialty laboratory that provides drug-testing services to monitor use of prescription medications and illicit drugs.

The report, which takes a deep dive into the nation’s drug trends and breaks usage patterns down by region, is based on 4.1 million urine samples collected from January 2013 to December 2023 from people receiving some kind of drug-addiction care.

Its findings offer staggering statistics and insights. Its major finding is how common polysubstance use has become. According to the report, an overwhelming majority of fentanyl-positive urine samples — nearly 93% — contained additional substances. “That is huge,” said Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health.

The most concerning, Volkow and other addiction experts said, is the dramatic increase in the combination of methamphetamine and fentanyl use. Meth, a highly addictive drug often in powder form that poses several serious cardiovascular and psychiatric risks, was found in 60% of fentanyl-positive tests last year. That is an 875% increase since 2015.

“I never, ever would have thought this,” Volkow said.

Among the report’s other key findings:

• The nationwide spike in methse alongside fentanyl marks a change in drug use patterns.
• Polydrug use trends complicate overdose treatments. For instance, naloxone, an opioid-overdose reversal medication, is widely available, but there isn’t an FDA-approved medication for stimulant overdose.
• Both heroin and prescribed-opioid use alongside fentanyl have dipped. Heroin detected in fentanyl-positive tests dropped by 75% since peaking in 2016. Prescription opioids were found at historic low rates in fentanyl-positive tests in 2023, down 89% since 2013.

But Jarratt Pytell, an addiction medicine specialist and assistant professor at the University of Colorado’s School of Medicine, warned these declines shouldn’t be interpreted as a silver lining.

A lower level of heroin use “just says that fentanyl is everywhere,” Pytell said, “and that we have officially been pushed by our drug supply to the most dangerous opioids that we have available right now.”

“Whenever a drug network is destabilizing and the product changes, it puts the people who use the drugs at the greatest risk,” he said. “That same bag or pill that they have been buying for the last several months now is coming from a different place, a different supplier, and is possibly a different potency.”

In the illicit drug industry, suppliers are the controllers. It may not be that people are seeking out methamphetamine and fentanyl but rather that they’re what drug suppliers have found to be the easiest and most lucrative product to sell.

“I think drug cartels are kind of realizing that it’s a lot easier to have a 500-square-foot lab than it is to have 500 acres of whatever it takes to grow cocaine,” Pytell said.

Dawson said the report’s drug use data, unlike that of some other studies, is based on sample analysis with a quick turnaround — a day or two.

Sometimes researchers face a months-long wait to receive death reports from coroners. Under those circumstances, you are often “staring at today but relying on data sources that are a year or more in the past,” said Dawson.

Self-reported surveys of drug users, another method often used to track drug use, also have long lag times and “often miss people who are active for substance use disorders,” said Jonathan Caulkins, a professor at Carnegie Mellon University. Urine tests “are based on a biology standard” and are good at detecting when someone has been using two or more drugs, he said.

But using data from urine samples also comes with limitations. For starters, the tests don’t reveal users’ intent.

“You don’t know whether or not there was one bag of powder that had both fentanyl and meth in it, or whether there were two bags of powder, one with fentanyl in it and one with meth and they took both,” Caulkins said. It can also be unclear, he said, if people intentionally combined drugs for an extra high or if they thought they were using only one, not knowing it contained the other.

Volkow said she wants to learn more about the demographics of polysubstance drug users: “Is this pattern the same for men and women, and is this pattern the same for middle-age or younger people? Because again, having a better understanding of the characteristics allows you to tailor and personalize interventions.”

All the while, the nation’s crisis continues. According to the Centers for Disease Control and Prevention, more than 107,000 people died in the U.S. in 2021 from drug overdoses, most because of fentanyl. In 2022 in Kentucky, 2,135 residents died from overdoses, and fentanyl was identified in more than 1,500 of the deaths, 72% of them.

Caulkins said he’s hesitant to view drug-use patterns as waves because that would imply people are transitioning from one to the next.

“Are we looking at people whose first substance use disorder was an opioid use disorder, who have now gotten to the point where they’re polydrug users?” he said. Or, are people now starting substance use disorders with methamphetamine and fentanyl, he asked.

One point was clear, Dawson said: “We’re just losing too many lives.”

KFF Health News is a national nonprofit newsroom producing in-depth journalism about health issues. 

Kentucky had 5% fewer drug overdose deaths in 2022 than in '21 but many counties reported an increase in OD deaths

State Department for Public Health map, adapted by Kentucky Health News

By Al Cross

Kentucky Health News

Kentucky is still losing more than 2,000 citizens a year to drug overdoses, but last year's total was less than the year before, the first decline since 2018, according to the state's annual Overdose Fatality Report.

The report, issued Thursday, says 2,135 Kentuckians died from overdoses in 2022. A preliminary report had put the number at 2,127. The final figure is 5.4 percent under the final 2021 figure of 2,257.

However, many counties had more overdose deaths than in 2021, and "Addiction remains one of the most critical public health and safety issues facing the Commonwealth of Kentucky," says the report, issued by the state Office of Drug Control Policy.

The office's director, Van Ingram, said in a news release, “Over the past year, we have heavily focused on increasing access to clinical care for those suffering from addiction while offering more harm reduction measures,” including distribution of naloxone (Narcan), which blocks the effect of overdoses.

Among counties with 10 or more overdose deaths, Bath County, in east-central Kentucky, had the highest rate of overdose deaths in 2022, 18.5 per 10,000 residents. After it came Lee County, 15.1; Floyd County, 13.3; Estill County, 13; and Knott, 12.6. The state rate was 5 deaths per 10,000, down from 5.3 in 2021.

Rates for 65 of the state's 120 counties were not released because they had fewer than 10 drug overdose deaths. The actual numbers of overdose deaths in a county were not released if it had fewer than five.

Opioids were involved in 90 percent of overdose deathss, led by fentanyl with 72.5%, which was 6% less than in 2022. The number of overdose deaths "was also worsened by the widespread availability of potent inexpensive methamphetamine," the report says. Many victims had more than one drug in their system; 50.1% had fentanyl.

The Centers for Disease Control and Prevention recently released a national overdose death report, which listed Kentucky as one of only eight states to record a significant decline (at least 100) in overdose deaths, the release from Beshear's office noted. It said "Beshear has increased the number of treatment beds in the community by 50% and secured the largest number ever of corrections-based addiction treatment beds."

The release also said "A recent article from The Associated Press noted that . . . the decrease in overdose deaths is due to Kentucky’s intentional work to address addiction and offer more treatment services," but that is an overstatement. The article paraphrased Columbia University epidemiologist Katherine Keyes as saying that since Kentucky and other states with declines had high overdose-death rates during the epidemic, their declines (emphasis added) "might be a sign that years of concentrated work to address the problem is paying off. State officials cited various factors for the decline, like social media and health education campaigns to warn the public about the dangers of drug use; expanded addiction treatment — including telehealth — and wider distribution of the overdose-reversing medication naloxone."

Researchers think they have finally found a treatment that works on methamphetamine addiction, but say more research is needed

Kentucky Health News

As methamphetamine causes more addiction and death, treatment specialists have despaired for medicine to fight it. Now researchers may have found one.

A study published The New England Journal of Medicine found that a combination of two relatively familiar medications "was safe and effective in treating adults with moderate or severe methamphetamine-use disorder," the National Institutes of Health said in a news release.

The medicines are the antidepressant bupropion, usually sold as Wellbutrin, and naltrexone, which is use treat alcohol and opioid-use disorder. "The findings suggest this combination therapy may be a promising addition to current approaches to treatment, such as cognitive behavioral therapy and contingency management interventions, for a very serious condition that remains difficult to treat and overcome," NIH said.

Dr. Nora Volkow

The research was conducted in the clinical-trials network of the National Institute on Drug Abuse. NIDA Director Nora Volkow said, “There is a growing crisis of overdose deaths involving methamphetamine and other stimulants. However, unlike for opioids, there are currently no approved medications for treating methamphetamine use disorder. This advance demonstrates that medical treatment for methamphetamine use disorder can help improve patient outcomes.”

The study was conducted from 2017 to 2019 in drug-treatment clinics across the country, among 403 adult volunteers aged 18 to 65, who had moderate to severe meth-use disorder and said they wanted to stop or reduce use of the drug.

They were given an injection of extended-release naltrexone every three weeks and daily extended-release tablets of bupropion (or placebos, if in the control group). "Investigators performed four urine drug screens at the end of each stage of the trial," the release said. "Participants were considered to have responded to treatment if at least three of four urine screens were negative."

Overall, participants who for the treatment "responded at a significantly higher rate" than the control group, the release said; "When screened during weeks five and six, 16.5% of those given the naltrexone/bupropion combination responded, compared to only 3.4% of those in the control group. Similarly, when screened in weeks 11 and 12, 11.4% of the treatment group responded, compared to 1.8% of the control group."

Researchers calculated that the treatment was about as effective as most medical treatments for mental-health disorders, measured by their estimate that nine people would need to receive it in order for it to benefit one person.

That doesn't sound like a good success rate, but the release said, "Participants in the treatment group were assessed to have fewer cravings than those in the control group and reported greater improvements in their lives as measured by a questionnaire. . . . Importantly, there were no significant adverse effects."

Dr. Madhukar Trivedi, right, of the University of
Texas Southwestern Medical Center, led the research.

Long-term meth use causes changes in the brain that “can contribute to severe health consequences beyond addiction itself,” said Dr. Madhukar H. Trivedi of the University of Texas Southwestern Medical Center in Dallas, the lead researcher. “The good news is that some of the structural and neurochemical brain changes are reversed in people who recover, underscoring the importance of identifying new and more effective treatment strategies.” 

Bupropion and naltrexone had been tried alone on meth users, with limited, inconsistent effect. "Now, in combination, these compounds seem to have an additive or synergistic effect," the release said. "While there are U.S. Food and Drug Administration-approved medications for other substance use disorders, no medications have yet received FDA approval for methamphetamine use disorder. The effectiveness of this medication combination is progress toward improving treatment of this addiction."

The treatment is not ready for FDA approval. The researchers said they need to see if responses are better with longer treatment or concurrent behavioral therapy, such as contingency management, "which uses motivational incentives and tangible rewards to help a person attain their treatment goals," the release said. That has proven to be "the most effective therapy for stimulant-use disorders but is not widely used, stemming in part from a policy limiting the monetary value of incentives allowable as part of treatment."

"Experts have become increasingly concerned about the recent spikes in deaths from stimulant drugs including meth and cocaine," The Hill reports. "More than 16,000 people died from meth-related overdoses in 2019, a tenfold increase from 2009. The increase in deaths is likely in part due to a more potent meth coming from Mexico and laced with fentanyl, a synthetic opioid 50 to 100 times more powerful than morphine. Experts have worried the pandemic has worsened the problem, with more people turning to meth, relapsing in treatment and overdosing."

Methamphetamine returns to Appalachian Kentucky, in a more deadly form, and it's causing fear and division in communities

Dakota Scott, with her two-week-old daughter, fights meth addiction at Karen’s Place Maternity Center in Ashland, a facility for women in addiction recovery (Photo by Hilary Swift for The New York Times)

Timothy Williams of The New York Times reports from Louisa: "Home deliveries from the local food bank now require a police escort. A shop owner has started to carry her gun to work. And the local constable, who rarely had to pull his weapon in the past, has drawn it a dozen times over the past year. All because people hooked on methamphetamine have threatened them. . . . A very public push to end opioid abuse has unwittingly ushered in the return of crystal meth."

Officials have warned for a year or more that meth was making a comeback even as the opioid epidemic continued in Appalachia. It returned in "a powerful new form," Williams notes, and that "has brought a sharply different set of problems . . . If pain pills left residents struggling to help many family members deal with the risk of overdose, methamphetamine has bred fear and division."

Referring to homeless meth users, Louisa Mayor Harold Slone told the Times, “Half the people want to take them to the river and tie something around their neck. We hadn’t seen that level of anger before.” State police told Williams that in some places, about three-fourths of arrests are related to meth crimes — "mostly shoplifting, burglary or assault, but occasionally attempted murder."

Much as a crackdown early in the last decade on prescription opioids led to a surge in heroin, the latest crackdown and increased awareness of the epidemic has "unwittingly accelerated the switch to methamphetamine," Williams writes.

"Opioid users, increasingly fearful about overdosing on heroin and fentanyl, have been desperate for a substitute. A powerful Mexican organized crime syndicate, the Sinaloa drug cartel, has sought to fill the vacuum by targeting Appalachia, federal drug officials say. . . . The new Mexican variant is often mixed with cocaine, and increasingly, with fentanyl. Law-enforcement officials said cartels mix in those ingredients because fentanyl is inexpensive to produce, enhances the effects of meth and appears to cause faster addiction. Meth users around Louisa sometimes add their own dangerous ingredients, including wasp repellent, which users say produces a more intense high."

Nov. 15 workshop in Ashland will help rural journalists cover the difficult topic of substance abuse and recovery; space is limited

The epidemic of opioid use and other substance abuse has hit many rural communities hard, but rural news media have a hard time covering this difficult subject, for various reasons. On Nov. 15 in Ashland, a workshop for journalists will try to change that.

Macy

Covering Substance Abuse and Recovery: A Workshop for Journalists will be held at the Marriott Delta Downtown by the Institute for Rural Journalism and Community Issues and Oak Ridge Associated Universities. Registration is now open; space is limited, and the earlybird registration rate of $50 is good until Nov. 1. Registration will close Nov. 8.

Burton

The workshop is designed to help rural journalists cover a subject that needs covering, in order to help their communities deal not only with substance abuse, but to know how recovery is possible.

The agenda is packed with a variety of experts in the field including award-winning journalists, authors, researchers, officials, and people in recovery. Several award-winning journalists who have been leaders in covering these topics in Appalachia and adjoining areas are among the speakers:

• Beth Macy, award-winning author of Dopesick: Dealers, Doctors, and the Drug Company That Addicted America, recently released in paperback. She will appear via Skype.
• Terry DeMio and Cara Owsley, Pulitzer Prize-winning journalists from the Cincinnati Enquirer; DeMio has been the newspaper’s opioid beat reporter for five years, and Owsley is photography director; they worked on the Pulitzer-winning series, "Seven Days of Heroin."
• Eric Eyre of the Charleston Gazette-Mail, who won a Pulitzer in 2017 for revealing county-by-county patterns of opioid distribution in West Virginia.
• Sharon Burton, editor and publisher of the Adair County Community Voice in Columbia, Ky., a national leader in substance-abuse coverage by small newspapers and winner of the 2016 Al Smith Award for public service through community journalism by a Kentuckian.
• Kentucky Justice Secretary John Tilley, who is a former legislator, attorney and television journalist.

Attendees will learn about the issues from a variety of experts in the field including award-winning journalists, authors, researchers, officials and people in recovery. The goals are to help journalists:

• Understand the depth and breadth of the problem and how it affects local communities
• Know how to get reliable data and other local information for reporting
• Develop local, state, regional and national sources for stories and story ideas
• Hear reporters explain how they cover the problem and the people affected by it
• Appreciate the role of local news media in reducing the stigma that inhibit local action

Research by Oak Ridge Associated Universities has shown that the stigma attached to drug use and addiction are major obstacles to news coverage of the problem, which makes it harder for communities to find solutions.

The workshop will begin with an informal gathering at the Delta hotel on Thursday evening, Nov. 14, and run from 8:30 a,m. to 5:15 p.m. Nov. 15. Online registration is required, and a room block with a favorable rate of $109 a night is available at the Delta. The registration site has a link to the hotel reservation site. Please contact Institute Director Al Cross with any questions: al.cross@uky.edu.

More than 100 people gather in Owensboro to talk about meth; police officer says they're losing battle with highly addictive drug

Crystal methamphetamine (Drug Enforcement Administration)

The methamphetamine problem is so bad in Owensboro that the city commissioner hosted a community forum to discuss it, Katie Pickens reports for the Owensboro Times.

“This issue affects almost everyone in this community,” Commissioner Larry Conder told a crowd of more than 100 at the Sept. 10 forum.

Methamphetamine is also called meth, crystal, chalk and ice, among other things. It is an extremely addictive stimulant.

The forum included a panel offering perspectives from local law enforcement, a district judge and the director of a local group fighting substance abuse, all of whom said the issue with meth in Owensboro and Daviess County is worse than it's ever been, Pickens reports.

“We’re seeing a shift from smokers” to those who inject the drug, said RonSonlyn Clark, senior director of substance-abuse services at RiverValley Behavioral Health. “Just ask those who work at the needle exchange clinic. We’re seeing an increase in crisis services from meth-induced psychosis, and we’re seeing an increase in dangers to law enforcement.”

Owensboro Police Department Street Crimes Unit Supervisor Sgt. Michael Nichols said police are losing the fight against meth, Pickens reports.

“There’s not a section of Owensboro devoid of this problem,” Nichols said. “Meth is the one demon that shows no mercy — it doesn’t care what [your race or nationality is]. Once it gets its claws into you, it’s a wrap. It truly is the devil, in my opinion.”

Nichols said that in 2016, the department found 3.8 pounds of meth. In 2017, the number was 8.9 pounds and in 2018 it was 14.1 pounds. Already this year, he said, 18.38 pounds have been logged into evidence, but most of the meth is never uncovered by law enforcement, Pickens reports.

Clark told the crowd that meth takes a financial toll on a community, saying that every dollar spent on meth equals $7.46 taken from the community, Pickens reports.

Mental Health Court Judge Lisa Jones said that while the problem was worse in that area than other parts of the state, all of Kentucky is struggling with the problem, which doesn't get enough attention because of the epidemic of heroin and other opioids, Pickens reports.

"In Kentucky last year, there were 8,000 heroin arrests,” Jones said. “There were 35,000 meth arrests."

Panelists said meth takes an average of four to seven attempts to quit, taking an average of 20 years off a user's life; contributes greatly to abusive relationships and neglectful households and, as estimated by Nichols, contributes to 75 to 80 percent of violent incidents.

Anyone seeking treatment for a substance use disorder, including a meth addiction, can find help on the state's treatment locator findhelpnowky.org or on the treatment hotline 1-833-8KY-HELP.

Opioid panel in Mayfield says most new addictions start with prescription drugs, may transition to methamphetamine

Attorney General Andy Beshear moderated a panel in Mayfield
about opioids. (Photo by Liam Niemeyer, WKMS-FM)

A panel of addiction specialists and health-care leaders in West Kentucky “repeatedly said that addiction prevention in many cases starts at home,” in a panel discussion panel Aug. 1 about how to tackle the opioid epidemic, Liam Niemeyer reports for WKMS-FM in Murray.

Prevention at home includes getting rid of unused prescriptions and paying attention to the signs of addiction in others, such as changes in personality and stealing money, the panelists said.

All attendees of the event at Sullivan University in Mayfield got opioid disposal kits that neutralize prescription drugs -- like the ones provided to four counties, including Henderson and McCracken, through the Kentucky Opioid Disposal Pilot Program, launched in 2017 by Attorney General Andy Beshear, who led the discussion .
Beshear said most new addictions continue to be caused by prescription drugs. “Making sure that we don’t have the same prescribers flooding our communities, cleaning out every single medicine cabinet, and raising awareness that a stocked medicine cabinet is a threat to their kids is one of the most important steps we can take,” he said.

The Kentucky General Assembly passed a law in 2018 that requires pharmacists to inform customers about how to safely dispose of unused opioids and other controlled substances, and either provide or offer to sell them a product designed to neutralize the drugs, or provide an on-site disposal.

Jeremy Colwell, 32, of Hopkinsville, talked about the stigma that comes with addiction, noting that he had been in recovery from opioid addiction for three years and had been revived from overdoses multiple times with Narcan, the leading brand of naloxone.

“The best way to fight the stigma is just the fact that we’re another human being. We all have vices. Some of us just have problems manifested in different ways than others,” Colwell said. “So, the best way to stay out of the stigma is to stay in the solution. Don’t just point out the problem we have, but help us find the solution for it.”

Dr. Jeff Carrico, an addiction treatment specialist at West Kentucky Family Healthcare, said the region hasn’t been as severely impacted by the opioid epidemic as other parts of the state, and added that people with addictions in that region usually transition to methamphetamine if they can't get access to their prescription drug of choice.

Niemeyer reports that the panel also encouraged people with addictions to seek treatment and to use the Graves County syringe-exchange program, which opened in April.

OD deaths in Ky. dropped nearly 15% in 2018; officials credit many policy initiatives, but say 'incredible challenges' remain

By Melissa Patrick
Kentucky Health News

Kentucky saw a nearly 15 percent drop in drug-overdose deaths in 2018, the first decline since 2013, and almost three times the national decline of 5.1%.

Most of the deaths were again caused by fentanyl, a synthetic opioid that can be up to 50 times more potent than heroin, according to the annual Kentucky Office of Drug Control Policy report.

The state recorded 1,333 overdose deaths in 2018. That was 233 fewer than in 2017, when 1,566 were recorded, a decline of 14.9%.

Toxicology reports are available for 1,298 of last year's deaths; fentanyl was found in 786 autopsies, or nearly 61% -- up from 52% in 2017 and 47% in 2016.

Van Ingram, executive director of the Office of Drug Control Policy, said in a news release that the overall decline was likely the result of the state's many policy initiatives, along with a growing awareness about the dangers of opioids and the threat of overdose.

“We’ve pushed hard to develop the most comprehensive approach possible, combining education and treatment with a multitude of other harm-reduction strategies,” Ingram said. “We still have a great deal of work to do, but it’s clear that Kentucky’s efforts are making an impact.”

Reflecting anecdotal law-enforcement reports, there was increase in deaths from methamphetamine, a stimulant that has long plagued Kentucky. It was found in 428 cases, up from 357 in 2017.

The report says overdose deaths from heroin declined in 2018 and did those from alprazolam, an anti-anxiety medicine that is often known by its brand name Xanax; and from gabapentin, which sells under the brand names Neurontin, Gralise and Horizant and is often taken along with other illicit drugs to enhance their effects.

Heroin-related deaths dropped 30% to 188 in 2018, from 270 in 2017. Deaths involving alprazolam dropped 20% to 214 cases, down from 269 in 2017. Deaths from gabapentin dropped 30%, to 255 cases, down from 363 in 2017.

Deaths related to the widely used pain medication oxycodone dropped to 110 from 157 respectively, or 30%.

“The numbers are trending down, but our state still faces incredible challenges,” Justice and Public Safety Cabinet Secretary John Tilley said. “This crisis claimed more than 1,300 lives last year and inflicted untold heartbreak on our families and communities. I only hope the latest numbers serve as evidence that strong interventions and better access to treatment can and do save lives."

Rate is per 100,000 residents; data from
2018 Kentucky Overdose Fatality Report

Of the 1,333 deaths, 1,247 of them, or 93.6 percent, were Kentucky residents. County-by-county figures in the report are based on deaths of residents, and are adjusted for age.

Boyd County (Ashland and Catlettsburg) had the highest rate of fatal overdoses in 2018, followed by Madison (Richmond and Berea), Kenton (Covington, Independence, etc.), Clark (Winchester) and Campbell (Newport etc.).

Counties with fewer than 10 deaths were not included in the rate calculation, so the report have rates for only the 23 counties with 10 or more overdose deaths.

The highest rate of overdose deaths continues to be among people between 35 and 44, followed by 25-34, then 45-54.

State and federal efforts

The state and its partners have launched a number of efforts to battle the state's opioid and substance-abuse epidemic, including the KY Help Call Center (1-833-859-4357), which provides information on treatment options and open slots among treatment providers and an online website that provides a similar service called FindHelpNowKY.org.

The Department of Corrections is overhauling the way it addresses substance abuse. Kentucky State Police have launched the Angel Initiative, which allows anyone with a substance use disorder seeking treatment to visit a KSP post, where they would be directed to treatment.

The General Assembly has passed several laws in recent years, including a crackdown on pain clinics, limiting opioid prescriptions for acute pain to a three-day supply (with exemptions), tougher penalties for heroin dealers and more funding for drug treatment and other response efforts.

A news release from Senate Majority Leader Mitch McConnell's office points out that Kentucky is also benefiting from nearly $200 million in federal money that he has helped to secure.

That includes an $87 million federal grant recently awarded to the University of Kentucky to address the opioid epidemic in 16 high-risk counties, which is the largest grant in the school's history and an indicator of the magnitude of the problem.

"I’ve made the fight to save lives from the horrors of addiction and abuse a top national priority," McConnell said in the release. "The results of our work at the federal and state level with our many local partners on the front lines are evident in today’s announcement."

Data for the report were compiled from the Kentucky Medical Examiner's Office, the Kentucky Injury Prevention & Research Center and the state Office of Vital Statistics.

Ambulances report fewer overdose calls, say trend is partly due to availability of drug antidote Narcan and increased use of meth

Your local ambulances may be getting fewer calls for drug overdoses, but that doesn't necessarily mean that your local drug problems are decreasing.

The Anderson News found that OD ambulance calls in the Central Kentucky county fell 20 percent from 2017 to 2018, from 95 to 77 -- but the county's emergency director, Bart Powell, "said he and others in emergency management attribute the decline in ambulance calls to the widespread availability of Narcan, the drug used to revive overdose victims," Publisher-Editor Ben Carlson reports. Also, "Addicts are turning to other sources to get high."

“Meth is more common and generally doesn’t lead to overdose. It’s cheaper, too,” Paul Barrick, leader of the local HEROES (Helping Educate, Reaching Out, Ending Stigma) organization, told Carlson, who writes: "Powell agreed that it appears meth is being used in place of heroin, in part because of changes in the law that make obtaining it more expensive and difficult."

Powell said other ambulance services in Kentucky have seen similar declines in OD calls and attribute them to the availability of Narcan, the commonly used brand of the drug naloxone, which counteracts opiates and opioids.

"Narcan, which previously was administered only by medical care providers, has in recent years been made available to police officers and the general public," Carlson notes. "As a result, those who overdose on opioids can be revived by family members, friends or responding police officers if they arrive ahead of an ambulance."

Powell said, “The introduction and availability of Narcan to the general public has resulted in a slight reduction on our runs because they are self-treated at the scene,” Powell said. “That’s backed up by other EMS providers in the state.”

Barrick, "who for years has helped raise awareness of opioid addiction and education, said there are some encouraging signs. “Families are much more educated regarding treatment options,” he said. “The stigma regarding addiction has changed, and schools and churches are also more willing to help with support and education.”

Another report on the upsurge of methamphetamine in Kentucky, this time from an eastern county: Johnson

Methamphetamine image from Drug Enforcement Administration

While most of Kentucky's focus has been on finding ways to combat the state's heroin and prescription drug epidemic, another drug that had captured headlines just a few years ago is on the rise -- methamphetamine.

Meth use has long been mostly prevalent in Western Kentucky, but is moving east.

“We’re completely eat up with it around here,” Paintsville Police Chief Mike Roe told Aaron K. Nelson of The Paintsville Herald. “It’s an epidemic.”

Nelson reports that according to the Johnson County Judicial Center, meth production is on the decline in Johnson County, but possession and trafficking of the drug is on the rise.

"The numbers for first-offense meth possession started with a handful of charges in 2008. They slowed down in 2012, but have skyrocketed since, peaking with 80 charges in 2017," he writes. And as of early May, Nelson reports that there have already been 26 charges in the county.

Nelson adds that first-offense manufacturing of methamphetamine peaked in 2013 and 2014, with 20 cases each year, compared to just one case in 2016, one in 2017, and zero so far in 2018. But at the same time, trafficking of the drug has increased, reporting that "first-offense trafficking meth cases in 2017 were the highest on record," with those numbers having been tied or exceeded already in 2018.

“A few years ago, you had manufacturing here. A lot of shake-and-bake,” Roe told Nelson, referring to the relatively easy — and dangerous — method for making low-quality methamphetamine in small, portable labs. “Now, it’s coming in from Detroit, Louisville, Huntington … everywhere.”

Beth Warren of the Louisville Courier Journal has reported a similar meth surge in Louisville, and Dave Thompson of The Paducah Sun has reported that methamphetamine is now the "drug of choice" in Western Kentucky and Southern Illinois.

"Meth-related deaths in Kentucky more than tripled from 2013 to 2016, when 252 people died, according to the Kentucky Injury Prevention and Research Center. More than a third of those deaths were in Jefferson County," Warren wrote. "Police across Kentucky intercepted more than triple the amount of meth last year than they did in 2013, according to a recent state police report. Nearly 11,000 drug seizures submitted to the state crime lab last year were meth — more than heroin, cocaine and fentanyl combined."

“I would say trafficking is our top priority,” Roe said. “Busting these dealers.”

Meth resurges in Ky. and is cheaper and more lethal than ever

"While Louisville frantically tries to rescue residents from heroin, fentanyl and pain pills, another drug is creeping back to prominence: crystal meth," Beth Warren reports for the Louisville Courier Journal.

And while the drug can be made through a "simple but dangerous process of mixing easy-to-get ingredients," there are fewer local labs these days and most of it now is being made in Mexico by cartels and is "cheaper, easier to get -- and more lethal," Warren writes. "And sometimes it's secretly mixed with fentanyl, which is even deadlier than heroin."

"It's deadlier than the public perceives," Russell Coleman, U.S. attorney for Western Kentucky and a former FBI agent who has worked drug cases, told Warren. "Methamphetamines are the next phase of the drug epidemic in this commonwealth."

Steven Bell, a spokesman for the U.S. Drug Enforcement Administration, told Warren that today's meth, often dubbed "ice," has a purity often close to 100 percent, which is "much more lethal than the 50 percent purity of local one-pot labs."

Warren notes that meth never really went away, but instead has "resurged."

Dave Thompson of The Paducah Sun recently reported that in Western Kentucky and Southern Illinois, methamphetamine is the "drug of choice," according to law enforcement and rehabilitators in the region.

"Meth-related deaths in Kentucky more than tripled from 2013 to 2016, when 252 people died, according to the Kentucky Injury Prevention and Research Center. More than a third of those deaths were in Jefferson County," she writes. "Police across Kentucky intercepted more than triple the amount of meth last year than they did in 2013, according to a recent state police report. Nearly 11,000 drug seizures submitted to the state crime lab last year were meth — more than heroin, cocaine and fentanyl combined."

Coleman pointed out that because meth damages the body over time, causing things like convulsions, strokes and heart attacks that aren't always associated with the drug, it isn't always recognized for the "havoc it wreaks," Warren writes.

She notes that today's meth looks like chunks of clear glass with a slightly blue tint and can also come in white pills that can be crushed into a powder.

Charles Wilson, 32, a self-described "meth head" who is in recovery, told Warren, "It's safer and cheaper" to purchase meth from a cartel instead of a local lab, adding that he used to pay about $700 for an ounce of meth in Albany, Ky. Louisville Metro Police Sgt. Paul Neal, a veteran narcotics detective, told Warren that the drug is cheaper in Louisville, as low as $300 per ounce, because there is more available.

Coleman told her that police now are finding as much meth as marijuana on interstate and local roadway traffic stops. And because meth causes its users to become paranoid and agitated, it's often referred to as "the drug of violence," especially compared to heroin which causes user to become lethargic.

Unlike heroin, there's no antidote or medication-assisted-treatment for meth, though addiction specialists told Warren that they are optimistic that these intervention and treatment options will eventually be developed and approved.

Meth is top drug problem in West Ky.; Paducah Sun story also gives essential information about drug abuse and treatment

"In Western Kentucky and Southern Illinois, law enforcement and rehabilitators see methamphetamine as the drug of choice, responsible for a large majority of substance-related arrests," Dave Thompson reports for The Paducah Sun. "The drug is cheaper than many others on the street. It's made with ephedrine or pseudoephedrine, common in some decongestants, along with other chemicals depending on the method the cook uses."

The National Institute on Drug Abuse says meth gives the brain significantly higher levels of dopamine, a chemical associated with pleasure, desire and motivation, than cocaine, and remains in the body longer, Thomspon notes.

The story tracks a young man identified only as Cody, who used the drug for six years before getting treatment at Four Rivers Behavioral Health through the McCracken County Drug Court. "Alienated from his family, with no one to rely on and facing felony charges, Cody finally decided he'd had enough," Thompson reports.

"I'd been through enough to where I was ready to sober up," he told Thompson. "I was definitely going to die . . . I took anything from anybody. I've dropped out of college twice over meth. I've totaled people's cars and left them in the roads. . . . I'm 27 and I've been to jail probably 20 times."

Thompson's story includes information that helps educate readers about drug abuse and its treatment: "Drug addiction is a disease. That's the prevailing opinion among many drug treatment programs like Four Rivers. Those who work in the field call it substance use disorder. That term is both an attempt to de-stigmatize those who use drugs and to understand that the issue is more complex and requiring of deeper treatment than simply telling someone to choose not to be addicted."

"Meth doesn't have the same extended withdrawal symptoms as drugs like opiates," Thompson writes, but "a person needs to learn how to deal with the cravings that might still linger. . . . A post-meth life can include lasting mental and physical effects, including psychosis, years after a person's last dose, Fleming said."

Heroin gets the headlines, but meth is Ky.'s biggest illegal drug

Heroin has been getting the headlines, because of overdoses, but the resurgence of a near-pure form of methamphetamine has made meth the most common illegal drug in Kentucky, reports Miranda Combs of Lexington's WKYT-TV: "One out of three cases studied at the state lab is crystal meth."

Jeremy Triplett, a supervisor at the state forensic laboratory, told Combs, "It's all crystalline now. You never see just the really junky meth we used to see. You can clearly see there's a bigger industry at play. Meth is clearly the number one drug in Kentucky right now."

Richmond Police Commander Bob Mott told Combs that crystal meth from Mexico has "driven the price down and put the lab people out of business." He said his department seizes twice as much meth as heroin.

Williamsburg Police Chief Wayne Bird told Combs that the drug is "more addictive than the stuff we saw years ago," and is called "ice" because it looks like ice crystals.  "He said it makes users paranoid," Combs reports. "In the last year, the number of foot pursuits and car chases skyrocketed for Williamsburg police."

Poll provides more evidence that heroin use is increasing in Ky.; Chandler calls state's opioid epidemic 'truly shocking'

People in health care and law enforcement know that heroin use in Kentucky has increased, and that the state still has a big problem with prescription opioids. Now a statewide poll shows that Kentuckians at large are more collectively aware of the problems, too.

The latest Kentucky Health Issues Poll found that 17 percent of Kentucky adults know someone who is using heroin, up from 9 percent in 2013 and 13 percent in 2015. It also found that 27 percent of Kentucky adults say they know someone who has abused prescription pain medication. That was within the poll's error margin of plus or minus 2.5 percentage points. The poll was taken Sept. 11 through Oct. 19 for the Foundation for a Healthy Kentucky and Interact for Health, a Cincinnati-area foundation.

A news release from the Foundation for a Healthy Kentucky noted that statistics from the federal Centers for Disease Control and Prevention indicate that heroin use has increased sharply across the U.S. among men and women, most age groups, and all income levels.

Ben Chandler

"The country, and Kentucky in particular, are facing an opioid epidemic that is truly shocking," said Foundation President and CEO Ben Chandler. "Kentuckians are seeing friends and family members struggle with addiction, and the increase in heroin use is particularly alarming. Heroin overdose rates are climbing across the country, and Kentucky is no exception."

The poll showed that Northern Kentucky was the place most likely for adults to report that they had family members or friends who had experienced problems because of substance use. In the eight counties comprising the region, 36 percent reported knowing a friend or family member who had problems due to heroin, and almost 30 percent knew someone who abused prescription pain medications.

While heroin was less of a problem in Western Kentucky, that region appears to be experiencing problems with prescription-drug abuse and methamphetamines; 24 percent of adults there said they knew someone with a prescription-drug problem, and 21 percent knew someone who had a meth problem.

"Kentucky's experience with both prescription and illicit opioid abuse has been more severe and longer-lived than that of most other states," the news release said. "This year, the foundation's Howard L. Bost Memorial Health Policy Forum will focus exclusively on the substance use crisis in Kentucky. The free public forum will take place Monday, Sept. 25, in Lexington."

Meth labs were more prevalent in 'dry' counties in 2004-2010; adds to evidence that making alcohol legal decreases drug use

Meth use is more prevalent in counties where the sale of alcohol is illegal, say researchers at the University of Louisville. They looked at meth-lab seizures in Drug Enforcement Administration records and local-option ordinances in Kentucky counties from 2004 to 2010, and found that "the number of meth-lab seizures in Kentucky would decrease by 34.5 percent if all counties became wet." (UofL maps: Meth lab seizures by county, with green indicating more busts; alcohol status: red for wet, orange for moist or limited, and yellow for dry)

In 2010 Kentucky had 39 "dry" counties (where all alcohol sales are banned), 32 "wet" counties (sales are allowed), 20 "moist" counties (contain some wet jurisdictions) and 29 "limited" counties (sale by the drink in restaurants meeting certain criteria). All the dry counties were rural; several have since gone wet or moist.

For the study period the mean lab-seizure rate was 2.17 per 100,000 residents in wet counties, 2.26 in moist counties and 3.92 in dry counties. The highest rates of lab seizures were along the border of Tennessee, a state in which beer is generally available but stronger drink is less so.

Christopher Ingraham of The Washington Post reports, "After running some statistical tests, the researchers found that this is more than just a simple correlation." They said, "Our results add support to the idea that prohibiting the sale of alcohol flattens the punishment gradient, lowering the relative cost of participating in the market for illegal drugs."

"In other words: people who buy alcohol in places where it's illegal become accustomed to dealing with the black market," Ingraham writes. "If you're going to get punished whether you trade in booze or trade in meth, why not give meth a spin?" (Post graphic using data from UofL study)

The UofL research "fits in with other findings showing harmful effects of localized alcohol prohibitions," Ingraham writes. "A 2005 paper in the Journal of Law and Economics found that when Texas counties changed from dry to wet, their incidences of drug-related mortality decreased by 14 percent as people substituted alcohol for other drugs. Records from the Kentucky State Police show that dry counties tend to have higher rates of DUI-related car crashes than wet ones, presumably because when you live in a dry county, you have to drive farther to get your booze. A 2010 report from the Robert Wood Johnson Foundation found that binge drinking rates were often higher in Alabama's dry counties than its wet ones."

National magazine looks at drug companies' efforts to stop anti-methamphetamine bills, especially in Kentucky

In a strong piece of investigative reporting for Mother Jones magazine, largely about Kentucky, freelancer Jonah Engle delves into the history of how making methamphetamine became a simple task via over-the-counter cold medications, and how drug makers have warded off most state laws intended to make the decongestant pseudoephedrine more difficult to purchase. (Photo by Stacy Kranitz: Cleaning up a meth lab found on school property in London.)

Engle's well-rounded story examines the issue from the viewpoints of politics, law enforcement, drug users and the effects of their habits on their children, while looking at how small-town life -- especially in Kentucky, where meth-related cleanup and law enforcement cost the state $30 million in 2009 -- has been hit hard by the drug. When a bill in 2011 to require a prescription for pseudoephedrine, a Washington-based group representing the makers and distributors of over-the-counter medicines and dietary supplements, reportedly spent more than $303,000 in three weeks, with most of the money spent on "robocalls," or automated telephone messages. The bill failed, but in 2012 the legislature passed a law with a tighter limit on the amount of pseudoephedrine anyone can buy in a month, after a strong radio advertising campaign by the Consumer Healthcare Products Association. The drug is kept behind counters so purchases can be tracked but does not require a prescription.

Engle tells a tragic story of meth in many states, ever since 2007, when the process called "shake-and-bake" or "one-pot" method, became commonplace. "The number of clandestine meth sites discovered by police has increased 63 percent nationwide," Engel writes. "As law enforcement agencies scramble to clean up and dispose of toxic labs, prosecute cooks, and find foster homes for their children, they are waging two battles: one against destitute, strung-out addicts, the other against some of the world's wealthiest and most politically connected drug manufacturers. In the past several years, lawmakers in 25 states have sought to make pseudoephedrine—the one irreplaceable ingredient in a shake-and-bake lab—a prescription drug. In all but two—Oregon and Mississippi—they have failed as the industry has deployed all-star lobbying teams and campaign-trail tactics such as robocalls and advertising blitzes."

In Oregon, the number of meth labs found by police dropped 96 percent since the bill was passed, while in Mississippi the number dropped 74 percent, Engle writes. "Children are no longer being pulled from homes with meth labs, and police officers have been freed up to pursue leads instead of cleaning up labs and chasing smurfers. In 2008, Oregon experienced the largest drop in violent-crime rates in the country. By 2009, property crime rates fell to their lowest in 43 years. That year, overall crime in Oregon reached a 40-year low. The state's Criminal Justice Commission credited the pseudoephedrine prescription bill, along with declining meth use, as key factors."

"Everywhere else, industry has prevailed," Engle reports. "Many states have very limited laws on what lobbyists must report, and they don't monitor spending on robocalls or ads. But news reports and my interviews with legislators in Southeastern and Midwestern states where meth labs are most concentrated—and where CHPA had the biggest fight on its hands—show that the pharmaceutical industry deployed a mix of robocalls, print and radio ads, as well as a Facebook page and a website, stopmethnotmeds.com. These states include Alabama, Kansas, Missouri, North Carolina, Oklahoma, and Tennessee." (Read more)

Over-the-counter drug makers start campaign to educate potential meth 'smurfers' about consequences of their actions

By Al Cross
Kentucky Health News

The lobby for makers of over-the-counter drugs, which has fought laws to tighten controls on sale of cold medicine that is used to make methamphetamine, is starting a public-education campaign to discourage evasion of the system that tracks purchases of pseudoephedrine. The targeted states are Kentucky and Alabama, which could be key to preventing passage of laws like the one in Mississippi, which requires a prescription for pseudoephedrine. UPDATE, 4/19/13: Missouri has been added.

The Consumer Products Healthcare Association rolled out the campaign in Alabama last month. It joined with the Kentucky Pharmacists Association and the Kentucky Retail Federation yesterday to announce the program in Kentucky, and won the blessing of its primary adversary in the state's legislative battle, Senate Republican Leader Robert Stivers of Manchester. Also on hand at Wheeler's Pharmacy in Lexington was Democratic Gov. Steve Beshear, who had stayed out of the fight until he signed the bill.

Stivers, who is in line to become Senate president, was asked if the drug makers' move signaled a truce in the battle. He indicated that he would wait to see the impact of this year's law, which reduced the amount of pseudoephedrine that can be bought during one a month, before trying to tighten it. "Let's look at the history and see what happens," he said. Earlier, he said: "I appreciate the fact that they're coming here in a very conciliatory way, a very open way, to say we all know there is a problem."

Beshear noted that fewer meth labs have been found in Kentucky this year, but said the success of the law depends on educating the public: "As laws are passed, criminals adapt and find new ways of getting around them."

Preventing that is the goal of CHPA's "Anti-Smurfing Campaign," named for the practice of meth makers using others, "smurfs," to buy pseudoephedrine for them. Beshear noted that the new law makes smurfing a felony, and said the posters are "designed to make smurfers think twice" and "think of the moral and criminal consequences of their actions." He told cn|2 Politics, "I think will be a good deterrent in this situation."

CHPA's director of state government affairs, Carlos Gutiérrez, said the posters were tested in 2011 with focus groups of Kentuckians and strike a balance of educating potential smurfers without alarming law-abiding buyers of pseudoephedrine.

In its efforts to kill Stivers' prescription bill during the 2012 legislative session, CHPA spent more than any other lobbying group has ever reported spending on a legislative session, and that did not include hundreds of thousands of dollars it spent on radio commercials urging listeners to lobby legislators about the bill. Lobbies in Kentucky do not have to report what they spend on such indirect lobbying. Guiterrez was asked if CHPA would do that, and he said he would look into it.

UK study definitively shows that meth labs proliferate in state's counties where pseudoephedrine sales are high

A University of Kentucky research study published in the Journal of the American Medical Association this week shows a direct correlation between pseudoephedrine sales and methamphetamine production in Kentucky counties. Pdeudoephedrine, the main ingredient in Sudafed and similar decongestants, is the key feedstock for meth labs. The General Assembly further limited its sale this year.

“We find that counties where more pseudoephedrine is sold, more methamphetamine lab seizures are reported. Even though Kentucky requires pseudoephedrine sales to be tracked electronically, in real-time, the per-capita sales in some counties appear to be aberrant. Our results indicate a 565-fold variation in pseudoephedrine sales between counties. It is highly improbable that demand for pseudoephedrine in these counties is solely due to cough/cold/allergy,” explained Jeffrey Talbert, director of the College of  Pharmacy's Institute for Pharmaceutical Outcomes and Policy.

The other authors of the study are College of Pharmacy faculty members Karen Blumenschein and Trish Freeman, staff member Amy Burke, and Arnold Stromberg of UK’s Department of Statistics. For a copy of their report, click here.

Meds-for-meth bill drew record lobbying expenses, not even including radio and newspaper ad campaigns

Makers of over-the-counter drugs spent more than any lobbying interest ever had during a single Kentucky legislative session in their effort to defeat a bill requiring prescriptions for the key ingredient in methamphetamine, Bill Estep reports for the Lexington Herald-Leader.

"The Consumer Healthcare Products Association spent $457,053 on lobbying activities in the first three months of this year's legislative session, according to reports filed with the state Legislative Ethics Commission," Estep writes. "The group's lobbying effort was so dominant that it spent more than the next five groups combined in that period, January through March, according to spending reports."

And the figure doesn't even included hundreds of thousands of dollars that the trade group spent on radio and newspaper campaigns, because the lobby-reporting requirements do not apply to messages aimed only at the general public. The group did report spending on "a phone-bank operation to put people in contact with legislators to voice concerns about legislation to require a prescription for medicine containing pseudoephedrine, which is now available over the counter," Estep writes.

Read more here: http://www.kentucky.com/2012/04/30/2170495/makers-of-cold-medicines-set-new.html#storylink=cpy

The efforts, dating back to 2010, were partly successful. The legislature passed a bill "that will require a doctor's prescription for pseudoephedrine, but only after someone has bought 24 grams of the medicine a year," Estep notes. "A 48-count box of the generic medicine with 30-milligram pills contains 1.44 grams of pseudoephedrine. The bill excludes limits on gel caps and liquid pseudoephedrine." (Read more)

The lobbying effort wasn't only about Kentucky. The makers of Sudafed and other pseudoephedrine preparations are trying to stave off similar efforts in other states, and viewed Kentucky as a sort of firewall after seeing prescription-only laws pass in Oregon and Mississippi.

Read more here: http://www.kentucky.com/2012/04/30/2170495/makers-of-cold-medicines-set-new.html#storylink=cpy

Read more here: http://www.kentucky.com/2012/04/30/2170495/makers-of-cold-medicines-set-new.html#storylink=cpy

'Meds for meth' bill is about to become law despite heavy lobbying campaign by pharmaceutical companies

The bill to limit purchases of a popular cold medicine used to make methamphetamine passed the General Assembly today and Gov. Steve Beshear said he would sign it.

The Senate voted 29-8 to approve changes the House made in Senate Bill 3, sponsored by Senate Majority Floor Leader Robert Stivers, R-Manchester, left. The bill would require a prescription to buy more than 7.2 grams of pseudoephedrine in a month and 24 grams in a year. "A generic box of pseudoephedrine with 48 pills, each with a 30-milligram dosage, contains 1.44 grams of the medicine," Jack Brammer of the Lexington Herald-Leader reports. ""Gel caps and liquid pseudoephedrine would be excluded from the limits in SB 3 because making meth from those forms is considered more difficult."

The bill’s sponsors had wanted lower limits, and initially a prescription for any amount, "but they compromised with opponents who worried about inconveniencing cold and allergy sufferers," Brammer notes. "The pharmaceutical industry has lobbied aggressively against the state requiring prescriptions for pseudoephedrine at any level," ranking first in reported lobbying expenses without even counting its extensive advertising campaign. The industry apparently viewed Kentucky as a sort of firewall, the absence of which could make passage of similar "meds for meth" bills in other states. Only Oregon and Mississippi now have such legislation.