Drug to reverse opioid overdoses is more available than it used to be; health official says stigma still exist around carrying it

By Shepherd Snyder, WEKU

The annual Kentucky Drug Overdose Fatality Report says overdose deaths in 2023 dropped by 9.8 percent from the year prior; 2022’s report showed a 5 percent decrease compared to 2021.

Photo from Wikimedia Commons

That comes as access to naloxone has improved, in part because of state and federal programs that support local health departments and emergency services.
Holly Buchenroth, an assistant professor in Eastern Kentucky University’s Emergency Medical Care Program, says requesting access to naloxone has become an easy process.

“Any first-responder agency can get access to this naloxone if they qualify and are in a rural county that's eligible, and all they have to do is complete a training, make a request and document the usage or distribution,” Buchenroth said.

Naloxone is a nasal spray medicine that reverses opioid overdoses with no negative side effects. It’s also sold under the brand names Narcan and Evzio.

Kentucky got $800,000 last year from the federal government to dispense Narcan to first responders in rural counties. Last year, more than 160,000 units of the medicine were distributed across the state.

Scott Lockard, public health director of the Kentucky River District Health Department, says the added resources have been a big help. The health department serves Knott, Lee, Leslie, Letcher, Owsley, Perry and Wolfe Counties. 

“A couple years ago, Narcan was much harder to access, and we've seen much more awareness around harm reduction and the importance of getting Narcan, naloxone out there,” Lockard said. “So pretty much there's no excuse now.”

Other agencies, like the Pike County Health Department have fared similarly. Director Tammy Riley says in 2021, the agency wasn’t able to distribute any naloxone kits to individual community members, with just 82 Narcan kits distributed to the county in total.

They’ve since been able to turn that around.

“Compare that to our 2023 data, 3,500 Naloxone kits were distributed through the harm reduction program, 25 Naloxone kits through first responder and community organizations and 240 Naloxone kits to individual community members,” Riley said.

Riley says they’ve also focused on education. For every box of Narcan they give out, they inform its receiver on how to use it.

“When you see those numbers of distribution, every box that's distributed to an individual is provided with about a five to 10 minute education session,” Riley said. “We don't just hand naloxone to an individual and say, ‘Good luck.’”

The life-saving drug is also getting cheaper. Buchenroth says that’s in part because of its availability over-the-counter at chain pharmacies.

“You can pick up a generic two pack now for about $35, so the price has come down,” Buchenroth said.

But access in rural areas could still improve. Riley says in places like Pike County, where the health department covers a large area, it’s harder to follow up with those in recovery compared to urban areas like Lexington or Louisville.

“We need a Quick Response Team in Pike County, so when those individuals do refuse those 911, first responder services, we could deploy a Quick Response Team to find that individual in the throes of reversal when they're most likely to seek treatment,” Riley said.

Other officials, like Lockard, say getting rid of the stigma that carrying Narcan involves is also an issue.

“Although the resource of the service may be here, they're still reluctant to make themselves available to the resources that they can access,” Lockard said. “So how do we reduce the stigma? How do we do more training in the communities?”

Maria Slone is a social worker with Lexington’s community paramedicine program and works with a quick-response team. She says there’s a simple way to bridge that gap: community involvement.

“They're not going to have as many resources as we have, but how much buy-in is in their community members and their law enforcement and their courts and EMS providers?” Slone asked. “What does that look like for them to have that buy-in?”

Most recently, the state has launched a website that shows a map of all the locations naloxone is available, both for free and for purchase. It’s available at findnaloxone.ky.gov.

Community event at church addresses health needs in Frankfort

A variety of health-focused vendors set up tables in the parking lot of First Baptist Church Frankfort on June 14 to share information and host activities with attendees. (UK photos by Lindsay Travis)

By Lindsay Travis
University of Kentucky

Coretta Scott King said, “The greatness of a community is most accurately measured by the compassionate actions of its members.”

On a warm Saturday in June, First Baptist Church Frankfort opened its doors to more than 500 individuals in the community to put an emphasis on their well-being. It was part of the fourth annual Dr. Rosby L. Glover Unity in the Community event — a day of fun, food, music and raising awareness.

The fruits of this effort are an extension of collaborations with key community partners, including Capital City Activity Center, Meals on Wheels Greater Frankfort, Kentucky State University Cooperative Extension and the University of Kentucky.

“The day is an effort to bring the whole community together, to not only just have fellowship, but to bring awareness to physical health, diabetes and other health issues,” said Bishop Tiangello Hill, senior pastor of the church. “It means that we're doing our job. It means that we are reaching beyond the four walls and being a help to all mankind.”

The event is held in honor of the church’s late pastor, the Rev. Dr. Rosby L. Glover, who made it his mission to be an advocate for the Frankfort community for children and families. His widow, Lady Kimberly Glover, said “This was a vision of ours, and I’m elated to see Frankfort continue my husband’s mission to serve the community and its families.”

The compassion for Frankfort is evident in talking to those behind the June 14 event, like Glover.

“People care about this event because when people get together, we're all just people,” she said. “No matter what race, what nationality, it’s bringing love for one another, showing how much we care. And just to know that the church is here to help anyone in need.”

In an effort to share important health information with the community, inside the church, guests could complete free health screenings. The Lions Club partnered for diabetes screenings and the Franklin County Health Department donated screening materials and time for blood pressure screenings.

UK's Refocus Project, aimed at African Americans, answered
questions about opioid overdoses. (UK Photo by Lindsay Travis)

Tents and tables lined the church parking lot and nearby Clinton Street showcasing the services provided by a variety of health-focused agencies. Among those tables were UK’s Sanders-Brown Center on Aging and its Engaged Aging Lab, the College of Health Sciences’ Physical Therapy program, the Research Examining Factors Associated with the Opioid Crisis among Underserved African Americans (REFOCUS) research team, and the Cooperative Extension Service.

It’s an intentional approach from researchers and clinicians at UK to address the specific needs of the Frankfort community. The city, at one time, had the nation’s second-highest prevalence of Alzheimer’s disease in African American adults among other health challenges.

The partnership is an important one to Elizabeth Rhodus, assistant professor at Sanders-Brown and the Department of Behavioral Science in the UK College of Medicine.

“We connected with Dr. Glover a few years ago to think about how we can help provide health care, access and resources to individuals in the community,” said Rhodus. “We are excited to see that partnership grow.”

Saturday’s event is an extension of Sanders-Brown’s partnership with First Baptist Church Frankfort. Researchers meet monthly with church members to help address the commumity's needs. It’s part of Rhodus’ Engaged Aging Lab, which takes lessons learned from research and clinical spaces out into the communities to address health gaps.

Rhodus and her team provide support and resources for Alzheimer’s disease and dementia through research which focuses on everyday activities that support healthy brain aging, caring for individuals with dementia and community-engaged research for health equity. They use practical methods and everyday items in ways to help people live healthy and reduce their risks for diseases.

“We focus on telling people about five main areas to try to reduce your risk for dementia: sleep, nutrition, exercise, novelty — or doing something new — and socializing, are the great things for your brain,” said Celeste Roberts, research program manager at the Engaged Aging Lab.

Oil timers can relax the mind and body through visual cues.

Roberts kept a bottle of lavender-scented lotion and an oil timer on the table. The items may be simple, but as Roberts explains, they can relax the mind and body through aromatherapy and visual cues.

She and Sanders-Brown’s April Stauffer answered questions from people stopping at their tables for hours. They handed out helpful flyers on a range of topics related to brain health.

“Having a conversation with people about what they can do every day on their own and giving them the tools they need to ask the right questions about their health is key,” said Roberts. “Unity in the Community gives us an opportunity to start that conversation.”

On Clinton Street in downtown Frankfort, physical therapy students looked like they were playing games with attendees who stopped by their table. In actuality, they were conducting fall risk and balance assessments they’d use in clinic — a four-square step test and a timed up-and-go test out of a chair.

“Depending on how they score we can tell them if they’re at an increased risk for falls or not and provide them with helpful information,” said Sheila Clemens, an assistant professor in the Department of Physical Therapy. “This community is potentially at risk for being underserved and they may not get this information elsewhere. We’re happy to offer this easy access.”

In the next booth, the focus was on engaging members of the Black community in research. It’s part of the REFOCUS project, led by Danelle Stevens-Watkins, acting dean and professor in the Department of Educational, School and Counseling Psychology in the College of Education.

“We came to this event to help educate the community about opioid overdoses,” said Mona Goggins, a research assistant with REFOCUS. While the number of overdose deaths in Kentucky declined 9.8% frpom 2022 to 2023, there was an 8% rise in overdose deaths among Black Kentuckians. “Our hope is people want to participate in our study so we can increase awareness and gather information that will improve treatment in the Black community.”

The project is primarily focused on Lexington and Louisville, but the REFOCUS representatives shared that guests were “getting what they needed from the table” from education to sharing stories to seeing themselves represented in research efforts.

“I think that when you try to look at treatment from just one lens, you miss out on so many different groups in the population. I think it's important to recognize what different cultural backgrounds and factors that influence people's lives in the way that they experience opioid use,” said De’Asia Beard, a REFOCUS mresearch assistant.

UK’s Cooperative Extension Service has been a long-time partner in this community initiative. Sanders-Brown works closely with Carla Carter, an extension agent for family and consumer sciences at the Franklin County Extension Office.

Carter, a long-time member of First Baptist Church Frankfort, helps coordinate monthly workshops at the church and was the emcee for the Dr. Rosby L. Glover Unity in the Community. She thanked Debora Bobbitt and Reverend Anna Jones for organizing the day.

The event took a holistic approach to community health, with pieces focused on the spectrum of age ranges represented. In addition to health screenings for older age groups, the church donated 65 bicycles to kids in the community — doubling their previous giveaway goal — to foster health and exercise.

It took a team of people to put on the event and a strong spirit of collaboration from the team at the church to make such an impact in the capital city.

Rhodus and her team know there’s a health need in this area that can benefit from targeted resources and outreach paired with different research approaches. The team shares a similar goal with First Baptist Church Frankfort:

“Let’s literally build unity within all of these communities to support every individual, wherever they’re at in their aging journey — childhood all the way throughout their older age,” said Rhodus. “Let’s tailor the health pieces that they need to support a healthy, active lifestyle.”

Where to find more information:

• Sanders-Brown offers a variety of resources for people with questions about brain health. You can get started online here.
• The Engaged Aging Lab is ready to help caregivers and community members. You can find those resources online here.
• Anyone with questions about the study REFOCUS and opioid use in the Black community can email REFOCUS@uky.edu.
• UK’s physical therapy program also offers clinics for the public. More information is available online here.
• The Cooperative Extension Service provides practical education to help people, businesses and communities solve problems, develop skills and build a better future. Find more about their services online here.
• The Kentucky State University Cooperative Extension Program strengthens underserved communities, families, farmers, individuals and youth to improve their quality of life with state-of-the-art, research-based educational programs. You can learn more about their services online here.

Huge grant fails to reduce ODs by 40%; does show a 9% drop over four states, saving an estimated 483 lives, but few in Ky.

The National Institues of Health’sNational Institute on Drug Abuse and the Substance Abuse and Mental Health Services Administration funded the study through the NIH HEAL Initiative.

By Melissa Patrick

Kentucky Health News

A four-state, $350 million research grant that included Kentucky fell far short of its goal of reducing opioid overdose deaths by 40% over four years, instead showing an estimated 9% drop in such deaths. 

"That translates into an estimated 483 opioid-overdose deaths that were averted in the communities that received the intervention," said Patricia Freeman, part of the HEALing Communities Study research team and an associate professor of pharmacy at the University of Kentucky.  

Another model, comparing those to communities to a control group of counties with similar charcteristics, showed a 15% average reduction in opioid-overdose deaths in the intervention communities, which Freeman said was "very close to reaching statistical significance."

"It's still consequential even though it didn't reach statistical significance," said Freeman. "An estimated 483 lives were saved. And just because it didn't reach statistical significance doesn't mean that it was not a meaningful public-health impact." 

In Kentucky, there was no real difference in the adjusted rate of opioid-related overdose deaths between the intervention counties and the control-group counties, with 59.8 deaths per 100,000 residents in the intervention communities and 59.3 per 100,000 in the control communities. 

The study compared the control and intervention communities for one year, July 2021 through June 2022. 

"In retrospect, I think people will say that the 40% was a very ambitious goal," said Freeman. The researchers in the paper said likewise, adding, "The trial may have been underpowered to detect substantially smaller yet clinically meaningful differences."

An underpowered study does not have a sufficiently large sample size to answer the research question of interest,"  says the National Library of Medicine. according to L.D. Case and W.T. Ambrosius in an article titled "Power and Sample Size," published in Topics in Biostatistics.

The study, published June 16 in The New England Journal of Medicine, found no differences in estimated opioid-overdose deaths among the four states, nor any statistical differences between urban and rural communities, by age, by sex or among racial and ethnic groups. 

The research paper identifies several unforeseen challenges that likely diminished the impact of the interventions. Those include the Covid-19 pandemic, which began just two months after the start of the study’s intervention, an increase in the prevalence of fentanyl in illicit drug markets, and a 10-month implementation period, which may have been too short for communities to fully implement and see the effects of their efforts, says a UK news release.  

The four-year study, launched in 2019, included 67 communities affected by opioid abuse, including 16 Kentucky counties. UK  received $87 million from the National institutes of Health for the study, the largest competitive award UK has ever received. 

The other participants were Boston Medical Center in Massachusetts, Columbia University in New York City and Ohio State University. 

The Kentucky counties where interventions were made were Boyd, Boyle, Clark, Fayette, Floyd, Franklin, Kenton and Madison. The control-group counties were Bourbon, Campbell, Carter, Greenup, Jefferson, Jessamine, Knox and Mason.

Freeman noted that the published study results don't reflect county-level data, but the impact of the interventions in all 67 communities.  

The interventions involved increasing education about overdoses; increasing overdose-prevention education and distribution of the anti-overdose drug naloxone; increasing access to and retention of medications to treat opioid-use disorder, including methadone and buprenorphine; safer opioid prescribing, dispensing and disposal practices; and reducing the stigma of addiction.

 

"Specific efforts in Kentucky included partnering with 145 organizations to distribute more than 40,000 naloxone units," the news release says. "Strategies to help people find and stay in treatment deployed 26 peer-recovery coaches and 16 care navigators and provided $411,848 in transportation support.

"Other activities included partnering with 35 pharmacies to install permanent medication-disposal drop boxes, which has resulted in the incineration of more than 6,500 pounds of leftover medication. Efforts to reduce stigma and increase awareness of treatment resources produced 64 communication campaigns, resulting in 73 million engagements."

The study's principal investigator, Sharon Walsh, a professor in the College of Medicine and College of Pharmacy and director of the UK Center on Drug and Alcohol Research, said in the release, “Our findings demonstrate that implementing these evidence-based practices through community-engaged strategies and partnerships can make a meaningful impact on combating overdoses, even amid the rapidly evolving opioid epidemic and unprecedented disruptions like the Covid-19 pandemic,”  

Freeman said researchers are continuing to analyze the data to look at the impact of each strategy used in the study, and have written a paper that is under peer review, looking at how naloxone distribution changed in the intervention and control communities.

She said they will also continue to analyze the impact of the interventions on non-fatal overdoses, the impact on overdoses that involved opioids and other substances, since this study was specific to opioids, among other things.

Also coming are results from the control communities, which received the interventions after the comparisons between the control communities and intervention communities were complete.

"We'll be trying to really understand what were the strategies that were the most impactful in our communities," Freeman said. 

Looking forward, Freeman said she thought Kentucky could see some long-term benefits from this study because of the infrastructure, technical assistance and training that was set up with the agencies and organizations to implement the study. "I'm interested to see what's going to be a longer term impact," she said. 

The good news is that Kentucky has experienced two years of declines in overdose deaths. In  2022, it was one of only eight states that saw a decrease in drug overdose deaths, and in 2023, it saw a 10% drop in such deaths, according to the state's Office of Drug Control Policy.

Updated 06/25/24: This article has been updated to reflect the correct attribution for the definition of an "underpowered study" to be  L.D. Case and W.T. Ambrosius in an article titled "Power and Sample Size," published in Topics in Biostatistics.

Fewer dying from overdoses, but advocates say Kentucky needs more people mentoring others through addiction and recovery

The availability of Narcan has helped reduce overdoses.
(Photo by Morgan Watkins, Louisville Public Media)

By Sylvia Goodman
Louisville Public Media

Shawn Nutter walks through The Healing Place’s men's facility in Louisville’s Russell neighborhood. He just completed the months-long recovery program, and now, Nutter’s working as a peer mentor for other people going through the same thing.

“You get six guys to get to intimately know, so you get to really understand what's going on with them,” Nutter said as he wound through the facility. “The things that could possibly help them or maybe hindered them in this process.”

He says he feels like he’s found his calling. Before coming to the Healing Place, Nutter said he worked as a chef, but now he wants to get certified as a peer support specialist.

“I want to know everybody that comes through here just because I like to know people,” Nutter said.

It’s a specialization sorely needed in the state. Earlier this month, Kentucky’s Office of Drug Control Policy released its annual report on fatal overdoses. For the second year in a row, overdose deaths went down (9.8 percent, more than triple the national decrease of 3%) but remain well above the levels the state saw before a 2020 spike rocked Kentucky.

And the numbers aren’t down across the board. Deaths continue to rise among Black Kentuckians, who have yet to see a decline since 2020. In 2018, 77 Black Kentuckians died of fatal overdoses, according to the report. Last year, 264 Black people in Kentucky did.

Gov. Andy Beshear declared the secind reduction in a row a win for the state while acknowledging there is more left to do. “We still have a long way to go, but celebrating success, celebrating doing better, celebrating having a better year is what gives us the strength to do even more,” he said.

Tara Hyde, CEO of Louisville's People Advocating Recovery, attributed the spike to the isolation of the pandemic and a drug supply heavily saturated with the powerful synthetic opioid fentanyl. “The fact remains that thousands of people have still lost their lives,” she said. “Thousands of families have been impacted.”

Hyde says advocates and service providers in the state know the work is far from over, especially in Black and Brown communities across the state. “We still are hesitant to really create more recovery supported spaces I think that's the re-energizing of saying, ‘I know that these systems are working, we just need to keep moving in that direction’.”

Improving outcomes for those in treatment

Recovery-supported housing, community centers and employment centers are popping up around the state to aid people as they leave treatment. Hyde said there are many examples across the state that her group has helped to foster, but services aren’t always centered in the communities that need them most.

Sharon Walsh, the director of the University of Kentucky’s Center on Drug and Alcohol Research, largely credits the decline in deaths to the much more widespread availability of the overdose-reversing drug naloxone, branded Narcan, which Walsh called a “miracle drug.”

Walsh said the 2020 spike in Kentucky was horrific and she can’t imagine how bad it would have been without the availability of naloxone, but she says there’s still work to be done the day after someone survives an overdose.

“You pick [naloxone] up at a fair, and then you have it in your pocket, and maybe you get to use it,” Walsh said. “That's incredible that you get to save someone's life. Does it make a longer term difference for that person whose life you saved? That's where the critical importance of linkage and education comes in.”

It’s an emphasis on those post-treatment spaces that could lead to declines in overall overdose numbers, Walsh said. She also emphasized the importance of working directly in the most impacted communities.

“People want to go to providers that look like them,” Walsh said. “If there aren't any providers that look like them, then that is also another barrier.”

A lot stands in people’s way of accessing that care, Walsh said. In rural communities, the closest treatment center can be hours away, or in majority Black areas with historic under-investment, medical care in general is often difficult to access.

“There's some very innovative programs going on with our colleagues out in Jefferson County that really can serve as models for other people to do, but they definitely need to be scaled up,” Walsh said.

There are several organizations in Kentucky that have boots on the ground going in to provide harm reduction and education to people directly — things like naloxone, fentanyl testing strips and hygiene supplies.

Abbie Kent is on the street team of the New Day Recovery Center in Winchester. She travels across the state, from urban areas to tent camps in rural Kentucky forests. Kent said the fact that she lived through to recovery and is able to provide resources to people breaks down barriers.

“They see me with a two-year-old track mark,” she said. “I was an IV drug user for the better part of 20 years, and my arm shows that when I come to people. They realize I'm not just some clinician.”

Kent said she is out there every day for people, going into overdose hotspots without judgment. “It's not about evangelizing, it's about planting the seed with people, and then making sure they have the resources to turn around and help somebody else,” she said, adding that she is able to build that trust only by being in those spaces and making herself a part of the community. Then when people need help, they know whom to ask.

Drug-overdose deaths of Kentuckians fell 9.8% last year, but rate among state's Blacks increased 5%; overall U.S. decline was 3%

Graph by Kentucky Health News from state data

By Al Cross
Kentucky Health News

In 2023, 9.8 percent fewer Kentuckians died from drug overdoses than the year before, according to an annual state report released Thursday.

A preliminary report from the Centers for Disease Comtrol and Prevention last month showed a 7.9% decrease, but the CDC now includes deaths of non-residents. The state Office of Drug Control Policy says in the state report that it uses only resident deaths "to better target harm reduction and prevention activities for Kentuckians." 

The state report was funded by the CDC and prepared for the office by the Kentucky Injury Prevention and Research Center at the University of Kentucky, as an agent for the state Department of Public Health.

It said 79% of the overdose deaths involved fentanyl, a powerful synthetic opioid, and 55% involved methamphetamine, a stimulant with psychedelic properties. The numbers are based on blood tests of victims, who usually have more than one illegal drug in their bloodstream.

“Fentanyl is what’s driving this crisis. If we could ever get a handle on that I think out potential for success is unbelievable,” Van Ingram, director of the drug-control office since 2004, said at an event in the state Capitol rotunda attended by people from the treatment, recovery and law-enforcement communities.

Gov. Andy Beshear told the crowd, “Some of the best news in this report is how much better than we were than the rest of the country,” in which overdose deaths declined 3%, according to the CDC. “Today’s news follows a long list of positive actions we have taken with so many people in this room,” he said.

Earlier, Beshear said, "The sad fact is we still lost 1,984 Kentuckians." That is about the same as in 2020, and much more than 2019. And he noted that overdose deaths among African American residents of the state rose 5% in 2023, from 259 to 264, after rising 22% from 2021 to 2022. While the recent increase was much less, "That is unacceptable," he said.

The rate of drug overdose deaths among Black Kentuckians in 2023 was 68.3 per 100,000, which was 52% greater than the white rate of 45 per 100,000.

The age group with the most overdose deaths was 35-to-44-year-olds, with 571, but the number was 13.4% less than in 2022.

In that year, 2,135 Kentuckians died of drug overdoses. The decline of 9.8% “represents 151 families whose loved ones still have a chance to recover,” said Dr. Jody Jaggers, the Kentucky Pharmacy Education and Research Foundation's director of public health education.

Jaggers demonstrated how easy it is to use naloxone, which stops the effect of an overdose. "It's something that you can even teach a child to do," he said.

Known by the brand Narcan, the nasal spray is now easily available in generic form without a prescription. Jaggers said the key is getting it into the hands of people who are most likely to witness an overdose. 

The report says the state distributed 160,000 doses of Narcan in 2023, and Ingram indicated that the increased availability of naloxone was a factor in the 9.8% drop in overdose deaths. The state recently put up a website, FindNaloxoneNowKY.org, to help Kentuckians find it easily.

Among counties with 10 or more overdose deaths, for which overdose-death rates were calculated, the highest rates were in four counties that adjoin each other. Estill County had 27 overdose deaths for a top rate of 187 per 100,000 residents; second was Lee County, with 11 deaths for a rate of 155.9. Third was Breathitt County, which had 18 for a rate of 150.6. Fourth was Powell, which had 16 for a rate of 121.1. Fifth was Floyd, which nearly adjoins Breathitt; it had 35 deaths for a rate of 109.9 per 100,000.

Other counties with rates higher than 60 per 100,000 (in purple on the map below) were Bourbon, 85.9; Boyd, 94.2; Carter, 90.4; Clark, 72.9; Clay, 68.9; Franklin, 61.9; Garrard, 61.9; Jefferson, 66.3; Knott, 100; Lincoiln, 76.4; Madison, 72.1; Montgomery, 62.8; Perry, 93.3; Pike, 74.5; Rockcastle, 91.8; Rowan, 94.9; Wayne, 59.8; and Whitley, 59.3.

Counties with rates lower than those, but higher than the state average of 45.9 per 100,000, were Bell, 50.7; Boyle, 56.8; Bullitt, 51.6; Harlan, 57.3; Jessamine, 56.2; Johnson, 59.3; Laurel, 54; and Taylor, 50.1.

Map from state report, adapted by Kentucky Health News

First naxolone shipment under settlement with drug maker arrives

Teva Pharmaceuticals' generic naloxone

Kentucky Health News

Nearly 8,000 doses of naloxone, which reverses the effects of drug overdose, were delivered to Kentucky this week as part of a settlement with Teva Pharmaceuticals, Attorney General Russell Coleman announced.

In October, Teva agreed to pay the state more than $71 million over 13 years, resolving allegations that the company’s marketing and promotional practices fueled the opioid-overdose crisis. In addition to the cash payments, Teva agreed to provide more than 23,000 units of naloxone.

The shipment, the first of four expected this year, went to facilities in Louisville, Florence, Ashland, Paducah and Frankfort. The Opioid Commission is partnering with the Cabinet for Health and Family Services as well as the Kentucky Pharmacists Association for distribution.

“Naloxone is a critical lifeline for Kentucky families struggling with addiction,” Coleman said in a news release. “Equipping first responders, health professionals and treatment providers with this all-important medication can help save lives for Kentuckians on the road to recovery.”

Half of all opoid-settlement funds go to local governments. The state's half is distribited by the Kentucky Opioid Abatement Advisory Commission is responsible for the distribution, part of the attorney general's office. On Tuesday, June 4,, the commission will award its next round of grants.

Kentuckians can find out how to get free naloxone near them at FindNaloxoneNowKY.org. Naloxone is also sold under the brand name Narcan by Emergent Solutions Inc.

Drug-overdose death rates were more common among service-industry employees before pandemic, but not afterward

By Allison Rogers

University of Kentucky

Drug-overdose deaths spiked following Kentucky’s Covid-19 stay-at-home and business-closure orders in 2020, but the industries that suffered the most overdose deaths were surprising, according to research conducted by the Kentucky Injury Prevention and Research Center at the University of Kentucky College of Public Health.

In the years leading up to the study, Kentucky’s service-industry employees experienced the most drug-overdose deaths. However, workers outside service industries were more likely to die by drug overdose in the months following the Covid-related shutdowns of 2020, the researchers found.

The study was published in the peer-reviewed journal Injury Prevention in 2023 and funded by the National Institute of Occupational Safety and Health, part of the Centers for Disease Control and Prevention.

Graph by Kentucky Injury Prevention Research Center

Analyzing drug-overdose death certificates and toxicology tests from 2018 through 2021, researchers found a significant increase in deaths rates for both sectors. In 2019, the rate per 100,000 employees was 46.7 and 45.7 for service and non-service industries, respectively. In 2021, those rates were 76.2 and 81.9.

Service occupations with the highest drug-overdose death rates were restaurant wait staff (10%), cooks (7%), landscaping and groundskeeping workers (6%) and auto-service technicians and mechanics (6%). Among non-service-industry jobs, overdose deaths occurred most often among construction laborers (15%), carpenters (7%) and freight, stock and material movers and hand occupations (7%).

From 2018 through 2021, there were 1,789 drug overdose deaths among service-industry workers in Kentucky, compared to 2,838 for non-service workers.

Terry Bunn, lead author of the study and director of the injury-prevention center, said “Service-related industry employees may have been more resilient and adaptable to changes in employment status compared to non-service-related industries and could find employment in other essential industry sectors during the pandemic such as the home improvement and building materials industry and the grocery store industry sector.”

Fentanyl was the most commonly identified drug in overdose deaths in both industry groupings, with 44% of identified substances among service-related industry deaths and 48% of identified substances among non-service-related deaths. The second most common drug with elevated frequencies detected in drug-overdose deaths was methamphetamine, with 24% of identified substances among service-related industry deaths and 28% of identified substances among non-service-related industry deaths.

Bunn hopes the results will alert employers in all industries to the need for a plan to handle on-site drug overdoses and substance use. “It is important for businesses to know about local community resources for timely linkage to substance use disorder treatment and to recovery support services as well as availability of on-site naloxone,” she said.

Early data show 7.9% fall in overdose deaths in Ky. in 2023 was much more than national drop, but number of ODs remained high

Centers for Disease Control and Prevention graph; to enlarge, click on it; to download, right-click.

By Melissa Patrick

Kentucky Health News

The Centers for Disease Control and Prevention's latest provisional overdose-death data say drug-overdose deaths in Kentucky fell by 7.9 percent in 2023, more than the national decline of 3%. 

Morgan Hall, communications director for the state Justice and Public Safety Cabinet, cautioned that the CDC's numbers are predictions and are subject to change and said the state Office of Drug Control Policy will release official numbers in a couple of weeks. 

Gov. Andy Beshear said in an email provided by the cabinet, "By working together, Kentucky is making great progress in leading those with addiction to recovery. We will release the 2023 report in the next coming weeks and will not stop fighting until every life is saved." 

Predicted provisional counts represent estimates of the number of deaths, with adjustments for incomplete reporting that always occurs. 

Despite the decline in overdose deaths, the numbers remain high. 

In Kentucky, the provisional report shows that 2,125 people died from a drug overdose in 2023, down from 2,309 in 2022. Nationally, 107,543 people died from a drug overdose in 2023, down from 111,029 in 2022. 

During this same period, all but one of the seven states adjoining Kentucky saw varying declines in overdose deaths. West Virginia saw a 1.3% increase, to 1,441 overdose deaths in 2023.  

CDC graphic shows ODs by drug class; click on it for a larger version or right-click to download

Several states saw drug-overdose fatality declines of 15% or more, including Kansas (16%), Indiana (17.9%), Maine (15.9%) and Nebraska (24.7%), according to the CDC report.  

And 16 states saw increases in drug overdose deaths, with the highest increases in Alaska (44.1%), Oregon (30%), Nevada (28.9%) and Washington (27.6%).

Like the rest of the nation, most of Kentucky's 2023 overdose fatalities were linked to fentanyl and other opioids. This was followed by psychostimulants (including methamphetamine), cocaine, and natural and semi-synthetic opioids (including, methadone, oxycodone or hydrocodone). 

Kentuckians who are struggling with drug abuse or who are concerned about a family member's substance use can search for treatment providers at www.findhelpnowky.org or contact the KY HELP Statewide Call Center at 1-8338-KY-HELP (1-833-859-4357).

Website that helps Kentuckians find addiction treatment now helps them find naloxone, the drug that reverses opioid overdoses

Photo from Kelley-Ross Pharmacy Group

Kentucky Health News

The FindHelpNowKy.org website, which helps Kentuckians find addiction treatment, now also can help them find places to get naloxone, which reverses opioid overdose.

The website, which has been used over 240,000 times to facilities since its inception in 2018, now also includes social-services resources and locators for recovery housing and mental-health treatment.

In 2022, a Kentucky survey found that 73 percent of respondents said they didn't know where to get naloxone, often known by the leading brand, Narcan.

“We are making it easier for Kentuckians to find the life-saving help they need,” Gov. Andy Beshear said in a press release. “While there is always more work to be done, we are taking another step forward on our mission to help our families fight and overcome addiction.”

Naloxone has become more available thanks to retailers, grants, reduction of stigma associated with addiction, and proactive distribution by community organizations,local health departments, recovery centers and regional prevention centers, the release said.

In addition to the central hub of FindHelpNowKy.org, some of the services can also be reached at FindMentalHealthNowKy.org; FindRecoveryHousingNowKy.org and FindNaloxoneNowKy.org. The latter website provides overdose prevention and response training relevant to people most likely to witness overdose.

“People can and do recover from addiction and mental health issues,” said state Health Secretary Eric Friedlander said. “And our goal of bundling these services in one central location will only make that journey to recovery easier across the continuum of risk.”

The collaborators on this website are the Kentucky Injury Prevention and Research Center and the state departments for Public Health and Behavioral Health, Developmental and Intellectual Disabilities.

“Addiction and mental health issues affect Kentuckians in every county and every ZIP code,” said Dr. Katie Marks, commisisoner of the latter department. “There should be no shame in seeking help and no barriers to finding evidence-based, compassionate care and treatment. These website updates address that at its core – getting our fellow Kentuckians on their road to recovery with resources that are close in proximity and right for them.”

The National Alliance on Mental Illness says 1 in 20 U.S. adults experience serious mental illness each year. In Kentucky, 189,000 adults are reported as having a serious mental illness, the release said.

If you or a loved one are struggling with addiction, the KY HELP Call Center can connect you to treatment by calling 833-8KY-HELP (833-859-4357). Visit the Kentucky State Police website to find a police post where those suffering from addiction can be paired with a local officer who will assist with locating an appropriate treatment program through KSP’s Angel Initiative. Call, text, or online chat 988 to connect with suicide-prevention, mental-health and substance-use-disorder counselors. They are available to all Kentuckians 24/7/365, the release said.

Myths surround the deadly drug fentanyl; here are the facts

Photo illustration by CorbalanStudio, iStock/Getty Images Plus

By faculty and staff of the HEALing Communities Study

University of Kentucky

Fentanyl is a synthetic opioid that is about 50 times stronger than heroin, making it an incredibly powerful drug. It is often made illegally and added to other drugs like heroin, methamphetamine, cocaine, ecstasy and benzodiazepines such as Xanax. In Kentucky, illicit fentanyl has become a significant concern, and was detected in over 70% of overdose deaths in the state 2022.

Unfortunately, the spread of misinformation surrounding fentanyl has fueled unnecessary fear, leading to stigmatization of people who use drugs that can prevent them from seeking treatment and essential harm reduction services. Additionally, it may prevent someone experiencing an overdose from getting life-saving help. Let's address some of the most common myths:

Myth: Fentanyl is naloxone-resistant.
Fact: Naloxone is a medication that quickly reverses the effects of opioids and helps restore breathing in someone who is experiencing an overdose. Naloxone does work to help reverse a fentanyl overdose. Make sure you always call 911 in the event of any overdose.

Myth: People can overdose by touching or inhaling fentanyl by accident.
Fact: Despite sensationalized news stories, simply touching or coming into contact with someone who has overdosed does not cause an overdose. Secondhand exposure poses no danger, so don't hesitate to administer naloxone and save a life.

Myth: You can tell if fentanyl is in your drug by looking at it.
Fact: It is very difficult to know if what you are using contains fentanyl just by looking at it, tasting it, or smelling it. Fentanyl test strips can help you find out if what you are using may have fentanyl or fentanyl analogs in it, but they are not always 100% accurate. It is always safest to assume fentanyl may be present. Try not to use alone and have someone who can administer naloxone present in the case of an overdose.

After at least 3 deaths in 7 months, weekly in small Western Ky. county alerts its readers to the dangers and details of fentanyl

Most of this week's front page; click it to enlarge.
Photo illustration is based on a DEA image. 

Kentucky Health News

After three fentanyl overdoses since June in Crittenden County, the first recorded in the county of 9,000 people, and another death in which fentanyl could have been a contributing factor, the local editor-publisher thought it was time to alert his readers to the danger.

"Considered by some as the grim reaper of recreational drugs, fentanyl has hit Crittenden County like a reaper’s scythe over last the few months," Chris Evans of The Crittenden Press began his story, which reported the deaths without the victims' names, noted that the county normally has about three overdoses of any drug in a year, then gave a rationale for the story and made it an implicit example to follow: "Observers say small communities like Marion should raise awareness or prepare to see more deaths in their neighborhoods."

Evans quotes local and state officials and writes, "Fentanyl is approximately 100 times stronger than morphine and 50 times more potent than heroin. Illegal manufacturers often lack understanding, ability and precision to make fentanyl. It’s not a forgiving drug. One minuscule mistake is irreversibly deadly."

Dr. Christopher Kiefer of the state medical examiner’s office told him, “High-school-age kids might be swapping pills. That’s not uncommon. They might think they’re getting a mild painkiller pressed in a lab. They might think it’s Oxycodone or Lortab, but it ends up being fentanyl. You don’t have to be using a needle to die of an overdose. . . . It is a dangerous time right now because people don’t know what they’re getting,”

Crittenden County (Wikipedia map)

Evans adds, "The doctor further explains that fentanyl made and distributed on the black market can be dressed or disguised as just about anything. Someone may think they’re getting a pill from a friend’s mom’s medicine cabinet when it’s something far more sinister and deadly." He quotes Marion Police Chief Bobby West as saying that families and friends of drug users can be the best preventers of overdoses, and “Conversations need to be had about this drug and how it can kill you.”

Evans concludes, "The stark reality of this drug is that it can creep undected into any corner of society and become an instant killer. Now, it’s in Marion." His package also includes sidebars about synthetic opioids (fentanyl is one) and a quick-look box giving strete names for the drug, how it is used, what it does and what an overdose can look like: "Stupor, changes in pupil size, clammy skin, cyanosis, coma, and respiratory failure."

Evans has made this week's issue available online, here.

Drugs getting stronger and killing more Kentucky children; report calls for protective action, also to keep kids from getting guns

Graph from state report, adapted by Kentucky Health News

By Deborah Yetter
Kentucky Lantern

Kentucky’s youngest children continue to be at risk of drug overdoses from accidental ingestion — with the number of fatalities and the strength of the drug, or combination of drugs, increasing.

Eight children died from ingesting drugs and another 47 suffered an overdose in the fiscal year that ended June 30, 2022, among cases reviewed by the Child Fatality and Near Fatality External Review Panel, which released its annual report Thursday.

The majority of overdose victims in the report were age 4 or younger. Five years ago, by contrast, one child died among the 32 overdose cases it reviewed, the panel reported.

And just a fraction of child overdoses in Kentucky are identified in the report; the panel reviews only cases where abuse or neglect is suspected in the death or near-death of a child.

In 2022, 721 children were treated in Kentucky hospital emergency rooms for drug ingestion, with 72 requiring hospitalization, according to emergency department data, the report said.

Dr. Melissa Currie, a forensic pediatrician and founding member of the panel, said such cases are among her greatest concerns.

“I do believe ingestions are a major problem and it’s getting worse rapidly,” said Currie, a professor of medicine with Norton Children’s Hospital and the University of Louisville medical school. “We need to do a better job of educating parents about how dangerous that is.”

Drug use in the home presents the greatest risk, the report said.

“Children living in a home with a caregiver using illicit or other dangerous substances are at a higher risk of accidental ingestion,” the report said. It said children also are at risk of ingesting drugs used to treat opioid use disorder, such as buprenorphine.

Among the drugs children are ingesting: opiods, fentanyl, drugs used to treat opioid use disorder, and increasingly, cannabis or other products containing THC, the main chemical in marijuana.

Often such cases involve a combination of drugs.

One example it cited: A 19-month-old who died tested positive for fentanyl and morphine in a home where an adult overdose death had occurred just two months before and where both parents reported using heroin. Two other children in the home tested positive for fentanyl, a powerful, synthetic opioid.

Cannabis products were linked to the deaths of two children who ingested them, the report said.

Currie said the public doesn’t realize the risks even of legal products derived from hemp, such as gummies.

“It can still put kids in the ICU,” she said.

Most deaths or injuries preventable

Created in 2012 to conduct comprehensive reviews of child deaths and serious injuries from abuse or neglect, the independent panel of physicians, judges, lawyers, police, legislators and social service and health professionals meets regularly throughout the year to analyze such cases.

It is charged with producing an annual report to detail its findings to the governor, lawmakers and other officials along with recommendations for improving conditions for children in a state that has long ranked high for its rate of child abuse and neglect.

A member of the panel, state Sen. Danny Carroll, R-Paducah, said he has not had an opportunity to review the final report, but a spokesman said Carroll and the General Assembly generally consider its findings in crafting public policy.

The 2024 report examined 202 cases in which 68 children died and 134 suffered life-threatening injuries from July 1, 2021 to June 30, 2022. Most of the deaths were from neglect; 10 were from physical abuse.

The report says nearly all 90 percent of the deaths and injuries could have been prevented with appropriate precautions, such as safely storing medications or securing firearms.

Areas the panel examined this year included drug overdoses, physical abuse, neglect, firearm deaths including suicide and the role of the Cabinet for Health and Family Services in responding to reports of child abuse and neglect.

Common factors in child deaths and injuries included household financial stress, mental illness, family violence and addiction.

The report charts only a fraction of Kentucky’s child overdose/drug-ingestion cases because the panel is responsible for looking only at cases involving neglect or abuse in the death or near death of a child. In 2022, 721 children were treated in Kentucky hospital emergency rooms for drug ingestion, with 72 requiring hospitalization, according to emergency-department data.

Here are some of the key findings and recommendations:

Overdose and ingestion cases

In light of a rise in such cases over the past five years, the panel recommends better education for all professionals involved in medication-assisted treatment for adults with addiction.

Among cases of drug ingestion by children that were studied by the panel, 37% of their caregivers were receiving medication-assisted treatment, including medication for opioid misuse.

That training should stress reminding patients to safely store medication and for health professionals to report when a parent relapses.

It also recommends the Kentucky Board of Medical Licensure, which governs doctors, provide more continuing education to doctors on opioid ingestion in children.

The report also recommends training for medical marijuana providers. The Kentucky General Assembly in 2023 approved the use of medical marijuana for certain serious conditions though the law does not take effect until 2025.

It also urges more public education on safe-sleep practices and the dangers of a child sleeping with an adult, especially one who is impaired.

“Drinking and drug use (even prescribed) impair our ability to care for a child, making bed-sharing and other unsafe sleep practices even more dangerous,” the report said.

Tor the seventh year in a row, the panel asked the legislature to fund family-recovery courts statewide, not just in Jefferson and Clay counties.

And it urged a statewide system to create a “Plan of Safe Care,” a federally required system to track and assist families with children at risk, particularly infants born exposed to drugs.

Despite the federal requirement, Kentucky — and most states — have not fully implemented such a system with responsibility not clearly defined.

“We need to put this on everyone’s radar,” Currie said. “Somebody needs to step in and take responsibility or the legislature needs to assign responsibility.”

Firearms a ‘deadly means’

The report also says access to firearms continues to put children at risk.

In one case, a 4-year-old playing with a loaded handgun he found in the glove compartment of a car fatally shot himself. In another, a 14-year-old was fatally shot in the head by a friend while handling a loaded firearm in the parents’ bedroom.

Contrary to many parents' belief, research demonstrates that most children know where guns are stored and they will touch a firearm if provided the opportunity despite education not to touch it.

The report also factors in child suicides, citing the death by suicide of a 14-year-old boy who had access to unsecured firearms in the home.

The panel reviewed seven suicide cases from 2022, five fatal — four involving a firearm — and two attempts resulting in serious injury. The average age of the child was 13.

Sadly, the panel reports, the cases it reviewed were just a portion of all suicide deaths of youths in Kentucky for 2022, when 29 children under 18 died by suicide..

The report cited “a significant increase” in firearm injuries in cases it reviewed for the past five years involving 48 deaths and 24 near fatalities.

The panel classified such cases as “access to deadly means” that were largely preventable. In many cases, parents had told children not to handle firearms or thought they had hidden the weapon, the report said.

“Contrary to the beliefs of many parents, research demonstrates most children know where guns are stored and will touch a firearm if provided the opportunity despite education not to touch the firearm,” it said.

The panel recommends the legislature research national models and develop legislation to promote safe storage of firearms.

Currie said she understands firearms legislation is controversial but said it shouldn’t be when it comes to child safety.

“It should be a non-issue,” she said. “That should be something we can all agree on.”

UK will study the effects of newly prevalent drug xylazine ('tranq')

Terry Hinds Jr. and Cassandra Gipson-Reichardt (UK photo by Mark Cornelison)

By Elizabeth Chapin

University of Kentucky

Two University of Kentucky researchers have received a $2.65 million federal grant to study how the brain is changed by the mixture of fentanyl and xylazine, a veterinary anesthetic commonly referred to as “tranq.” It is increasingly being used to enhance the effects of fentanyl, a potent opioid that can be deadly even in small amounts. 

Cassandra Gipson-Reichardt and Terry Hinds Jr. associate professors in the College of Medicine’s Department of Pharmacology and Nutritional Sciences, received the five-year grant from the National Institute on Drug Abuse to see how the drugs change the brain’s signaling pathways.

These are the only preclinical studies now funded by NIDA to address an epidemic of xylazine-fentanyl use, and will be the first to determine neurobiological and behavioral impacts of the drug combination and identify treatment targets to reverse xylazine’s effects on fentanyl.

The combination of xylazine and fentanyl caused a 1,127% increase in xylazine-positive overdose deaths in the South in 2020-21, and other problematic health effects, including tissue death from poor circulation.

Xylazine is posing other new challenges to the fight against opioids, since it decreases the usefulness of naloxone (branded as Narcan), the drug that reverses the effects of an opioid overdose.

Gipson-Reichardt and Hinds will study the brain circuits that are changed when xylazine and fentanyl are used together and see if these changes are responsible for making naloxone less effective. They have already identified unexpected pathways controlled by the combination that may reduce the actions of naloxone. In their work, they will determine if targeting these pathways could be therapeutic.

“By studying these processes in detail, we hope to better understand the ways xylazine and fentanyl interact in the brain and how they affect behavior,” said Gipson-Reichardt. “This knowledge could lead us to new strategies for treating people who are struggling with the combined use of these substances and help make naloxone more effective in saving lives.”

 
Gipson-Reichardt and Hinds will collaborate with Kelly Dunn of Johns Hopkins University in Baltimore to translate findings to inform the public on individual factors that may lead to worse clinical outcomes during withdrawal from the xylazine-fentanyl combination.

Overdose Awareness Day was opportunity to raise awareness and reduce stigma of drug use; now it's National Recovery Month

By Melissa Patrick
Kentucky Health News

Each year, the last day of August is observed as International Overdose Awareness Day, to raise awareness of overdoses, acknowledge the grief felt by families and friends who have lost someone to a drug overdose, and to reduce the stigma of drug-related deaths. 

Heather Spurlock-Venters, who is a peer-support specialist at Addiction Recovery Care, shared her story of loss in an ARC news release. 

Spurlock-Venters, who is in addiction recovery, said she was sharing the story of her brother-in-law Sean Riley's overdose death to help others battling addiction. The release notes that Riley died a year ago and that Spurlock-Venters was early in her own recovery when she learned of  his overdose death. 

“When you’re in active addiction, you think you’re bulletproof and that nothing like that can happen to you. It never crossed my mind that one day one of us wasn’t going to be here,” she said in the release. “He passed away that day not only because he used, but used alone. He didn’t have anyone there to help him or try to bring him back. That’s what we do as people in recovery. We reach back for the ones still suffering because we know what it is like to suffer. I don’t want anyone else to ever go through that – not if I can help it. . . . We don't have to be a statistic." 

The release adds that with the influx of fentanyl and other synthetic opioids, there has never been a more dangerous time to be using illicit substances. It also provides a one-page list of resources to educate people on overdose risk factors, prevention, signs and symptoms of an overdose and how to respond to an overdose. 

According to the Kentucky Office of Drug Control Policy’s 2022 Overdose Fatality Report, there were 2,135 overdose deaths in Kentucky last year. This was 5% fewer than in 2021. Fentanyl was identified in 1,548 of the deaths, or 72.5%. Nationwide, 109,680 people died as a result of drug overdoses in 2022.

In recognition of Intrenational Overdose Awareness Day, the Kentucky Injury Prevention and Research Center highlighted resources for preventing workplace drug overdoses and supporting recovery from substance-use disorder.  

KIPRC reports that Kentucky had its highest number of workplace overdose fatalities in 2021, with 18, which was triple that of 2019. The number dropped to seven in 2022. 

“We are glad to see that fatal overdoses decreased both in Kentucky residents in the general community and at work,” Rebecca Honaker, program director for KIPRC's Kentucky Occupational Safety and Health Surveillance, said in a news release. "Despite the decrease, workplace overdose deaths remain a significant concern."

To help small businesses address this issue, KIPRC issued a "Hazard Alert" in August about the issue of workplace overdose deaths that included recommendations and resources for employers to help them create a recovery-ready workplace.

And to recognize Drug Overdose Awareness Day, the center released the Kentucky Small Business Toolkit for Hiring Employees in Recovery, which provides additional ways to become a recovery-friendly workplace, including addressing stigma, recruitment, how to use tax credits, bonding programs, community resources, and how to promote a business a recovery-friendly.

Looking forward, September is National Recovery Month.

“Substance use is a dangerous and deadly disease, but treatment is available and recovery is possible,” Matt Brown, president of ARC Healthcare, said in the ARC release. “We remain committed to doing everything we can to reduce overdoses in Kentucky and educate people on the many pathways to recovery.”

People who are struggling with drug abuse or who are concerned about a family member's substance use can search for treatment providers at www.findhelpnowky.org. And for those seeking recovery housing, visit findrecoveryhousingnowky.org. KIPRC also offers a Drug Overdose Prevention Tackle Box, A Guide for Communities.

Study expands access to naloxone, which blocks drug overdose

The study includes distribution of naloxoone (brand name
Narcan) at public events. (University of Kentucky photo)

By Elizabeth Chapin
University of Kentucky

Thursday, Aug. 31, marks International Overdose Awareness Day, a time when attention is directed toward raising awareness about opioid overdose and ways to reverse the deadly effects.

One such way is naloxone, a medication that has become more available throughout Kentucky in recent years with the University of Kentucky’s HEALing Communities Study playing a significant role.

Naloxone, also known by its brand name Narcan, is a medication that when given in time can quickly reverse the effects of opioids and help restore breathing in someone who is experiencing an overdose.

Increasing access to naloxone is one of the evidence-based strategies implemented by the HEALing Communities Study to reduce opioid deaths in Kentucky. Launched in 2019, the $87 million study is focused on 16 counties hardest hit by the opioid epidemic. The goal is to develop sustainable solutions that can be scaled across the commonwealth.

So far, the study has helped thousands of Kentuckians get access to the lifesaving medication. Since the first unit of naloxone was distributed in April 2020, more than 86,000 units of naloxone have been distributed across the 16 counties participating in HEAL.

To put it into perspective: In 2019, the year before the HEAL intervention was launched, that number was just about 7,000, says Trish Freeman, a professor in the UK College of Pharmacy who leads the HEAL Prevention Team and coordinates HEAL’s naloxone education and distribution efforts.

In 2022, 2,127 Kentuckians died from a drug overdose, with 90% involving opioids. While Kentucky’s overdose death rate decreased by 5% last year, it’s still among the highest in the nation.

“No one should die from an overdose and naloxone is one of the most effective ways to intervene and save a life,” said Freeman. “By getting naloxone into the hands of more Kentuckians, we are saving lives today while informing the blueprint for the most effective way for communities to do so going forward.”

Most of the naloxone distributed by HEAL is delivered through partnerships with various community organizations and agencies including treatment, criminal legal system, social service and public health programs.

The study, which is broken down into two waves of eight counties each, has partnered with 245 agencies across all 16 counties. The HEAL Implementation Team, led by Hannah Knudsen, a professor in the UK College of Medicine, works hand in hand with partner agencies to provide the support needed to implement overdose education and naloxone distribution with their clients.

Knudsen’s team of implementation facilitators meet with a wide range of agencies to share information about HEAL’s overdose education and naloxone distribution program and then work with agencies to establish a workflow and provide technical assistance to ensure effective implementation.

The HEAL Prevention team operates a naloxone distribution hub in the Center on Drug and Alcohol Research for partner agencies that also includes training materials, because education about overdose and how to use the medication is required. Under a standing order agreement, HEAL co-investigator Michelle Lofwall, physician and professor in the College of Medicine, signs the order as the physician of record for all naloxone distributed.

The agency partnerships reach those at highest risk for overdose, especially within the criminal legal system, where HEAL has partnered with jails and prisons, drug court, pretrial services, police departments, and probation/parole programs.

The risk of overdose is increased when people are released from a correctional facility because tolerance for the drug can decrease significantly during a period of abstinence. After release, an attempt to use the same amount of opioid may lead to overdose or death, says Carrie Oser, professor in the UK College of Arts and Sciences and co-lead of the HEAL Criminal Legal System Team.

Most jails partnering with HEAL offer naloxone as part of the discharge process. Some, including the Madison County and Jefferson County detention centers, have opted to install “vending machines” in lobbies or discharge areas. The digital kiosks streamline tracking and mandatory training.

“The agencies we work with choose what works best for them given their unique staffing and organization needs. The most important thing is that people who are discharged are getting access to naloxone during this critical time,” said Oser.

Beyond agency distribution, naloxone is dispensed through the HEALing Communities Study comes from its own outreach team. HEAL prevention specialists reach people directly at venues like community events, social service agencies, businesses, schools and addiction treatment and recovery facilities.

In addition to educating people on how to recognize an overdose and properly administer naloxone, the team addresses a lot of myths and misperceptions people have.

“People need to know it’s safe to use on anyone and won’t hurt someone who isn’t overdosing,” said Gabi Deaton, a HEAL prevention-specialist coordinator. “We also talk about the Good Samaritan law, which protects people from prosecution when they report a drug overdose. Our goal is to make sure they’re confident, equipped and ready to intervene in the case of an opioid emergency if they ever need to.”

Deaton serves as the prevention specialist for Campbell County and organizes the outreach efforts of her colleagues assigned to the seven other counties in the HEAL’s second wave.

While the team generally visits locations with people at higher risk of overdose, they reach a larger cross section of the public compared to the agencies. Their visibility helps reduce the stigma surrounding opioid use disorder and ensure that more family members, friends and bystanders are carrying naloxone.

Deaton says people sometimes reach out to thank her after the naloxone she gave them is used to save a life. There are too many to remember them all, but she still keeps in touch with some who are now in recovery.

Soon, it will be easier to access naloxone nasal spray products, including brand name Narcan and its generic counterparts. These products were recently approved by the U.S. Food and Drug Administration for sale over the counter and should be available in pharmacies and other retail stores that sell OTC products by mid-October.

Overdose education and naloxone distribution by a wide range of agencies will likely still be needed to ensure that cost is not a barrier and that people learn now to effectively use naloxone to respond to an overdose.