Lawmakers join Ky's largest addiction treatment provider to oppose Medicaid payment cuts; centers trying to negotiate cuts

By Deborah Yetter and Tom Loftus
Kentucky Lantern

The state’s largest provider of drug and alcohol treatment is warning that looming cuts in Medicaid reimbursement to some providers could damage efforts to curb addiction that has engulfed Kentucky — just as the state is showing improvements.

Matt Brown

“Kentucky has made significant strides in access to treatment,” Matt Brown, chief administrative officer for Addiction Recovery Care, or ARC, told a legislative committee Tuesday. “With these cuts, it could completely set back addiction treatment in our state 20 years.”

A handful of companies that provide substance use disorder treatment, including ARC, have been notified they face cuts of 15% to 20% from some private insurers that handle most Medicaid claims, Brown told the committee.

Brown noted that overdose deaths in Kentucky have declined for the past two years after years of rising. Kentucky also has the most treatment beds per resident, most of them through ARC, he said.

The state’s latest annual overdose report, released in June, shows a decrease in deaths to 1,984 from 2,200 the year before, a decline of 9.8%.

Brown was joined by Deron Bibb, chief financial officer for Stepworks, a recovery program based in Elizabethtown, and ARC executive John Wilson, also executive director of the Kentucky Association of Independent Recovery Organizations, speaking to the interim joint Health Services Committee about the cuts.

“This will likely result in higher overdose rates, higher recidivism, more crime and incarceration,” Bibb said. “We need to understand the full scope and impact of these cuts.”

The cuts have been announced by three of the six managed care organizations, or MCOs, private insurance companies that handle claims for most of the state’s $16 billion-a-year Medicaid program, Brown said.

Under their contracts with the state, the MCOs generally have authority to set rates they pay providers. The state pays MCOs a fixed amount per member to cover Medicaid costs.

One company also has begun notifying patients it will no longer cover addiction services at ARC effective Sept. 30, Brown said.

He did not identify the MCOs that have announced cuts and declined to do so after the hearing, saying ARC and other companies are still attempting to negotiate with them.

The Kentucky Association of Health Plans, which represents the MCOs, said in a statement released Thursday by spokesman Tyler Glick, that its members “are proud to work collaboratively with quality, trustworthy providers of behavioral health and substance use disorder treatment” and access to those services is “top of mind” to ensure those in need receive care.

“Health plans strive for the best networks possible and are encouraged by the state to prioritize plan member outcomes and value-based care,” it said.

Sen. Stephen Meredith, R-Leitchfield and co-chairman of the health committee, said Tuesday the lawmakers likely would seek more testimony on the subject, including from the MCOs.

“I know there’s two sides to every story,” he said.

Wellcare, with 420,000 members, is the largest of the six MCOs followed by Passport by Molina, Aetna, Anthem, Humana and United HealthCare. Together they oversee payment of Medicaid claims for about 1.4 million Kentuckians.

Wilson said the recovery organization he represents wants to make sure lawmakers are aware of the situation and already has asked them to voice concerns.

“There’s going to be real world consequences and I think it’s important to let legislators know what’s taking place,” he said.

Some defenders benefitted from owner’s largesse

Several lawmakers have signed letters urging that the MCOs suspend any cuts to substance use treatment until the General Assembly can further review the matter. They include some in key leadership positions and some who have benefited from campaign donations from ARC founder and owner Tim Robinson and his employees.

ARC, a for-profit company based in Louisa, has emerged as the state’s largest and fastest growing provider of addiction services, financed largely by Medicaid, the government health plan with the majority of funds from the federal government. Growth took off after 2014 when substance use treatment was included in the Medicaid expansion authorized by the Affordable Care Act.

The Lantern reported the company took in about $130 million last year in Medicaid funds and was by far the largest recipient of the about $1.2 billion the state spent on substance use treatment.

The company and Robinson also have become among Kentucky’s major political donors with more than $500,000 in contributions over the last decade — with funds divided among Republican causes and those of Gov. Andy Beshear, a Democrat, the Lantern reported earlier this month, citing campaign finance and other public records.

Sen. Phillip Wheeler, R-Pikeville, who has received $19,900 in contributions from Robinson, his wife Lelia and ARC employees since 2016, on July 9 sent a letter to Kentucky Medicaid Commissioner Lisa Lee urging the cuts for addiction services be suspended “until the legislature fully understands the reasons behind them.”

“Kentucky has made great progress in tackling the addiction crisis that has touched so many of our constituents, neighbors, colleagues, friends and family members,” Wheeler said.

Cutting reimbursement now “could negatively affect some of our most vulnerable citizens and prevent us from seeing these positive trends continue,” his letter said.

A similar letter addressed to “to whom it may concern” was signed by Rep. Patrick Flannery, R-Olive Hill, who has received about $17,000 in campaign contributions from Robinson and ARC employees.

Another letter was signed jointly by Senate President Robert Stivers, R-Manchester, House Speaker David Osborne, R- Prospect, Rep. Kimberly Moser, R-Taylor Mill and Meredith. Moser and Meredith are co-chairs of the joint Health Services Committee which heard from ARC and other treatment officials Tuesday.

Republican supermajorities control the Kentucky House and Senate.

Robinson has given $10,000 to the Kentucky House Republican Caucus, and $15,000 to the Kentucky Senate Republican Caucus in the last four years.

Robinson also has given other contributions to campaigns of Republican state legislators in the past decade including $4,100 to Moser and $2,000 to Osborne.

From 2021 through 2023, ARC companies and employees gave about $252,000 to a political committee supporting Beshear, whom Robinson, a Republican, has said he admires and would like to see run for president.

Bibb, Stepworks’ chief financial officer, gave $500 to Flannery in December 2023 and $2,500 to the Kentucky House Republican Caucus in October 2022, according to Kentucky Registry of Election Finance records.

Not asking for more money, just no cuts, says company official

Brown said that one concern of the MCOs is the cost of treatment, in particular long-term treatment for addiction.

ARC understands concerns about costs, but experience shows people with addiction benefit the most from long-term services, Brown told the committee.

“It is not just about surviving from their addiction but thriving in their communities,” he said. “Long-term treatment is vital.”

Without quality treatment, costs to the state will rise elsewhere, Bibb said.

“These costs will not go away,” Bibb said. “They simply will shift back to the emergency room, the judicial system, foster care, homelessness.”

ARC is willing to work with the MCOs and the state to ensure it is using money efficiently and effectively, Brown said after the hearing.

“Everybody’s got to be good stewards,” he said. “We’re committed to helping provide a solution.”

Brown and Wilson said representatives of treatment providers plan to meet with MCOs and state officials in coming weeks to try to resolve their differences.

“We’re not asking for more money,” Brown said. “We’re asking for no cuts.”

Wheeler, in an interview, said he appreciates the support of Robinson, a longtime friend since college together at the University of Kentucky, but that’s not why he sent the letter.

Rather he’s concerned about the impact of cuts of up to 20% on ARC’s services, which he said have helped many people in the region including a brother who benefited from its treatment program.

Also, he said, ARC is a major employer in the area where jobs have been scarce and also trains its clients for jobs.

Local governments mulling ways to use opioid settlement funds

KFF Health News graphic

By Zacharie Lamb
WKMS

More than a year after local governments across Kentucky began receiving shares of the legal  settlement with opioid manufacturers and distributors, several local leaders in far western Kentucky are still figuring out how best they can use those funds to tackle the opioid epidemic.

State governments across the country have been tasked with stewarding a portion of funds acquired through regional and national opioid settlements with companies including Johnson & Johnson, McKesson and CVS. The settlements stem from multiple nationwide lawsuits against the firms for their role in fueling the opioid epidemic.

According to the Centers for Disease Control and Prevention, around 75% of drug overdose deaths were connected with opioids in 2022. That accounts for the deaths of more than 81,000 Americans that year. Kentucky’s Justice and Public Safety Cabinet said in its 2022 Overdose Fatality Report that a little over 1,500 people who died from overdoses in the state were found to have fentanyl in their system.

State governments and localities are using the settlement funds to try to heal communities affected by the opioid crisis and prevent others from being affected.

Kentucky has secured around $900 million from the settlements. Those funds have been split into two pools, with half earmarked for a state commission and half divvied up among the state’s county and city governments. The state sent the first installments to local governments in December 2022. Payments are expected to continue until 2038, with no deadline for when funds must be spent.

Lauren Carr. opioid-settlement adviser for the Kentucky Association of Counties, helps county officials follow the best practices and reporting guidelines for the settlement funds.

“You can't take these funds and use it for a program that was already being funded. You can't take these funds and supplant. These funds are supposed to be to supplement,” Carr said. “Either integrate a new program or supplement the existing programs that you have – seeing where barriers are – and providing those services.”

(However, Morgain Patterson, director of municipal law with the Kentucky League of Cities, told Kentucky Health News that while some states prohibit opioid settlement dollars from being used to fund existing programs, called supplanting, Kentucky's statute does not, "so they could be used for current programs . . . as long as they relate back to opioid-use disorder or co-occurring substance-use disorder and mental health issues." For example, she said settlement money could be used to purchase Narcan, even if the city or county is already paying for it. That said, Johns Hopkins University has put together a document of principles it supports that says, 'Jurisdictions should use the funds to supplement rather than replace existing spending.' This document is posted on KACo's website.)

The law creating the state opioid commission has a list of 29 possible uses for the funds. Carr said the list provides pathways for localities but doesn’t expressly limit their use.

The Paducah Police Department is using some of the city’s settlement dollars to staff a new position focused on lowering recidivism for the people with substance-use disorder. Police Chief Brian Laird said hiring a deflection specialist has been a long-term goal for his department.

“We encounter folks regularly that are homeless, folks that have mental health issues, folks that have drug abuse issues,” Laird said. “Instead of the officers continuing to respond over and over to these folks, we have somebody that can follow up with these individuals and try to get them some help.”

Deflection is a relatively new philosophy in law enforcement that focuses on keeping individuals with substance-use disorder from entering or re-entering the court system by avoiding interactions with police. Laird said that he’s aware of other social-work positions in police departments in Kentucky but believes Paducah may be the first in the state to hire a deflection specialist.

The position will be paid partly by the department's budget, but most of the funding comes directly from settlement money. Applications for the position closed in April, and Laird hopes the specialist to be on board by August.

Other county and city governments in far western Kentucky are still trying to figure out how to spend their portion of settlement funds.

Murray officials formed a work group before the first payments were received to investigate possible uses of the funding. City Administrator Jim Osborne said the city is still working with the state Attorney General’s office, which oversees the opioid commission, but that no official plans have been made.

“The goal would be using the money to not necessarily just in one area of but could combine areas that are approved uses,” Osborne said. “I think the key is finding a happy medium of where best it would be used … something that's legal, transparent and would help the community.”

Similarly, Marshall County Judge-Executive Kevin Spraggs said he wants to make sure settlement funds are used in the most efficient way possible.

“We want to make sure wherever this money goes, ultimately, it's put to the best possible use,” Spraggs said. “We don't want to jump into something without doing a lot of research, and we'd like to do something with a proven track record, percentage wise, where the most people are being helped.”

For Carr, addressing the opioid epidemic has two major components – prevention and harm reduction. She said that many localities focus on prevention, with programs like “Just Say No” to kepe people from becoming substance users in the first place. Harm reduction focuses on helping individuals who are already using drugs.

The list of 29 potential uses include programs for intervention, treatment and recovery services for substance users. The funds could also be used to educate the general public and provide training to health care providers, recovery specialists or law enforcement.

The list also includes things like drug take-back and disposal programs and expenss for naloxone, branded as Narcan, that can block opioid overdoses. Carr said that increasing accessibility to the medication and teaching the public about its use could help to prevent deaths.

“At the end of the day, a dead person doesn't recover,” Carr said. “We all can be first responders. Whether it's at a basketball game, at the library or at a Walmart, you never know when you may be a first responder, and so being prepared is something that will help save lives for individuals that are in active addiction right now.”

Program for mothers and pregnant women with substance-use disorder gets grant to help more Black women get its services

Freedom House (Photo provided to Kentucky Lantern)

By Sarah Ladd

Kentucky Lantern

The Volunteers of America chapter that includes Kentucky will spend $123,000 over the next nine months to figure out how to get more Black women into treatment for substance-use disorder.

Volunteers of America Mid-States received the money from the Kentucky Association of Health Plans, the trade group for health insurers in the state, to fund a new initiative called Access Justice.

With the grant money, scholar, writer and activist Brandy Kelly Pryor will evaluate VOA’s Freedom House, which is a program for “pregnant and parenting women” who have substance-use disorders. Her report is due in April.

The 31-year-old program, with locations in Louisville and Manchester, also lets minor children (under the age of 18) stay with their mothers during treatment. Kelly Pryor will primarily study Louisville and may branch out elsewhere at later.

Jennifer Hancock, president and CEO of Volunteers of America Mid-States, said this move is in direct response to the high rates of maternal mortality among Black women and the disproportionately high overdose rates among Black Kentuckians.

Kentucky overdose deaths decreased in 2023 for the second year in a row, according to the state's Drug Overdose Fatality Report.

In 2022, 2,135 Kentuckians died from an overdose, marking the first decline since 2018. Ninety percent of those deaths were from opioids and/or fentanyl.

In 2023, the number of fatal overdoses was down to 1,984. Fentanyl, a powerful synthetic opioid, was involbved in 1,570 of those — about 79% of the 2023 deaths. The 35-44 age group was most at risk, the report shows. Methamphetamine was involved in 55% of 2023’s overdose deaths.

Despite the overall decrease in the state, the number of Black Kentuckians who died from a drug overdose increased from 259 in 2022 to 264 in 2023.

A 2023 state report on maternal mortality also showed substance-use disorder contributed to nearly 60% of all maternal deaths. Most maternal deaths in Kentucky, 88%, are preventable, says the report from the state Cabinet for Health and Family Services.

Black partcipants at Freedom House's Kentucky locations are less likely to complete its program than those of other races, Hancock said.

“I think some of it is about the stigma that they face coming into treatment,” Hancock said. “I think that there could be some cultural and familial pressures that they experience disproportionately.”

Kelly Pryor’s study is expected to provide answers as to why Black Kentuckians leave the Freedom House program without completing it, she said.

“Women, generally speaking, have to be convinced that they deserve treatments and that they are worthy of getting this help and support versus trying to do it on their own,” Hancock said.

In her analysis, Kelly Pryor will “identify gaps in care and opportunities for improvement, ensuring that substance-use-disorder recovery services are equitable and accessible for everyone who needs them,” VOA said. The nonprofit will then come up with plans to fill any gaps in care and access.

Hancock doesn’t know if the solution will be “an internal-to-VOA process that needs to be improved, or if it’s more of a public campaign that we need to wage to reassure Black women that they’re worthy of treatment, that treatment is a place where they can feel supported and feel seen and heard.”

The measure of success, Hancock said, will be when VOA and Freedom House start seeing “better engagement rates of Black women” and higher program completion rates.

Kelly Pryor said in a prepared statement, “Building on principles of healing justice, we will ensure a process that facilitates those most affected, leading us toward the best solutions for recovery and prevention. This effort will take time and involve critical self-reflection, yet the return will have an indelible impact on Kentucky and beyond.”

Breathitt, Lee, Jessamine and Nelson counties are certified as Recovery Ready Communities, totaling 14 in effort's 14 months

Kentucky Health News map

Gov. Andy Beshear presents Recovery Ready Community
certificate for Lee County to Scott Lockard and Jo Ann Fraley
of the Kentucky River District Health Department. (Photo by Al Cross) 

By Al Cross
Kentucky Health News

Four more Kentucky counties have been certified as Recovery Ready Communities, signaling that they have the services needed to help their residents recover from addiction. That brings the total to 14 out of 120; the program began 14 monhs ago. "We've got 106 to go," Gov. Andy Beshear said.

Breathitt, Jessamine, Lee and Nelson counties earned cetification by showing they are able to provide addiction treatment to their 123,000 residents, according to Beshear, who presented Lee County's certificate at a wide-ranging press conference Thursday.

Scott Lockard, public-health director for the seven-county Kentucky River Disrrict Health Department, accepted Lee County's certificate with Jo Ann Fraley, who runs the department's harm-reduction program, which includes a syringe exchange to prevent disease among intravenous drug users and steer them into treatment.

"The substance-use-disorder problem is the largest public-health issue that we are facing today in Eastern Kentucky and many parts of our commonwealth," Lockard said.

Noting another major topic of Beshear's press briefing, Lockard said, "These great economic-development announcements are fabulous, but each one of those factories need people to work in them. Second-chance employment is huge, and we have so many people who are being impacted by substance-use disorder, especially in our part of the state, in Eastern Kentucky."

Lee County's recovery program is based in The Hub, in the health department's annex. "Our motto at the Hub is 'We meet people where they are, but we do not leave them there,' because it's key that everyone who comes through our door is treated with respect and dignity."

Lockard said the program has gotten more 230 people into treatment, including three that morning. They were immediately transported to a treatment facility, Lockard said: "When they're ready, we need to get them in there right then."

When people leave residential treatment, The Hub offers them 11 support groups, links to second-chance employment and "a ministry that fills the soul," Lockard said. "You know, this emptiness left by drugs, we need to fill it with somethng else, and if we can get individuals back and show them that they have worth, that they have dignity, then we have the possibility to really help them to be gainful members of our society and fill some of these many jobs and just have a higher quality of life."

 

Lockard said substance use must be approached as a disease. "We cannot incarcerate our way out of this problem." He said The Hub includes a court diversion program for low-level drug offenders.

Immediately before the recovery discussion, Beshear and State Police Commissioner P.J. Burnett announced a statewide drug roundup of 206 suspects, mostly on trafficking charges. Burnett said another 50 suspects are still being sought.

To be certified as recovery-ready, a county must have peer-support services, mental-health treatment, addiction treatment, employment services and a stigma-free environment to encourage recovery. The program "encourages communities to provide transportation to and from employment services and job interviews, allowing Kentuckians to make positive changes in their lives while filling much-needed jobs and contributing to the commonwealth’s record-breaking economic growth," a news release from Beshear's office said. 

The release included statements from representatives of the other counties.

“This is a huge step in continuing to move Breathitt County forward in applying for grants that will improve the lives of every person in our county,” said Breathitt County Circuit Court Clerk James Elliot Turner II. “We need to provide every opportunity for each person in Breathitt County to fulfill their potential. This is a win for our people.”

Shauna O’Nan, Jessamine County Health Department harm reduction director, said “There is no set path of recovery, but after going through this certification process, we are confident, as a community, that we will be able to meet people where they are on that path.”

In Nelson County, "Collaboration and community involvement underlie Nelson County’s efforts to provide recovery resources to its citizens," the release said. Jessica Bickett, safe-communities specialist with the Lincoln Trail District Health Department, said “Nelson County has a strong network of community partners who are committed to supporting the recovery community.”

"These communities are stepping up to help fellow Kentuckians who are struggling with addiction," Beshear said. "We are grateful for, and we applaud, their good work."

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

Paths to treatment

If you or a loved one are struggling with addiction, connect to treatment by calling 833-8KY-HELP (833-859-4357). Information about treatment programs all across the commonwealth is available at FindHelpNowKy.org.

Information on how to obtain the life-saving drug naloxone, which is used to reverse an opioid overdose, can be found at that website as well as at FindNaloxoneNowKy.org and FindMentalHealthNowKy.org.

Visit the State Police website to find a 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.

To find recovery housing, go to FindRecoveryHousingNowKY.org.

Coleman reappoints two members to state opioid commission

By Melissa Patrick

Kentucky Health News

Attorney General Russell Coleman has reappointed two members to the state opioid commission, thus not changing the balance of votes on the issue of syringe-exchange programs, which he says he opposes.

Those members are Jason Roop, an assistant professor of business and theology at Campbellsville University, who represents victims of the opioid crisis, and Van Ingram, who works for Gov. Andy Beshear as executive director of the Kentucky Office of Drug Control Policy and fills a slot representing the drug treatment and prevention community. Each of their terms expires in 2026. 

The Kentucky Opioid Abatement Advisory Commission has nine voting and two non-voting members. The legislature created the commission in 2021 to distribute the state's portion of the $900 million in settlements with opioid manufacturers and distributors, with half of the money going to the state and the other half going to local governments. 

The money is provided in installments and so far, the state has awarded 110 grants worth more than $55 million for treatment, prevention and recovery.

Attorney General Russell Coleman

Coleman's opposition to syringe exchanges was revealed when Chris Evans, the commission's executive director and a Coleman employee, passed on a vote approving a grant for the Boyle County Agency for Substance Abuse Prevention because it included help for a syringe exchange. 

In passing, Evans said Coleman doesn't support the exchanges. Coleman, a Republican who was elected in November, later said that was especially the case for programs that are not limited to one-for-one exchanges. His spokesman said Coleman would not base commission appointments on the issue.

As of February, 41 Kentucky counties had syringe-exchange programs that operate under a one-to-one rule and 24 counties have needs-based exchanges, according to the state Department for Public Health. It estimates that the overall return rate of syringes is 85% to 90%. 

Syringe exchanges are supported by research. The Centers for Disease Control and Prevention says injection drug users who have access to exchanges are five times more likely to get treatment than those who don’t. Another study says the exchanges do not encourage drug use or increase the frequency of drug use among current users.

Exchanges were authorized by the state's 2015 anti-heroin law, in an effort to thwart the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles among intravenous drug users. 

They also work to reduce overdose deaths by distributing naloxone; reduce medical harms such as skin, blood stream, and heart valve infections that severely injure substance users and incur large health care costs for society; and connect substance users to treatment and recovery supports in order to achieve sustained abstinence.

Patricia Freeman, a University of Kentucky pharmacy professor, has also been reappointed to the commission – by UK as a representative of the HEALing Communities study team, which is working on reducing drug-overdose deaths. Her term will expire in 2026. 

Two new non-voting members have also been appointed. State Rep. Chris Fugate, R-Chavies (Perry County), was appointed by House Speaker David Osborne to replace retiring Rep. Danny Bentley, R-Russell. Karen Kelly, chief of staff to U.S. Rep. Hal Rogers, R-5th District, was appointed by Senate President Robert Stivers to replace Carlos Cameron. 

Other members of the commission are Republican state Treasurer Mark Metcalf, who also passed on the Boyle County vote; Cabinet for Health and Family Services Secretary Eric Friedlander, who works for Beshear; Von Purdy, a vice president of Simmons College in Louisville, representing citizens at large; Darren "Foot" Allen, a retired state trooper, representing law enforcement; and Karen Butcher, representing citizens at large.

Recovering alcoholic built Kentucky's largest substance-use treatment provider, which has 1,800 beds and 1,350 employees

Map from Addiction Recovery Care website, via Kentucky Lantern, adapted by Ky. Health News

By Deborah Yetter
Kentucky Lantern

LOUISA, Ky. — Around the office at Addiction Recovery Care, Vanessa Keeton is still known as “Client One” — marking her status as the first client of the first recovery center ARC opened as a group home in Lawrence County.

But her official title is vice president of marketing, where she has worked since 2012, a little more than a year after she entered the program known as Karen’s House — choosing it over jail for a string of drug and alcohol-related offenses.

Vanessa Keeton
(Lantern photo by Matthew Mueller)

“Dec. 2, 2010, that was my first day,” she said. “That’s a day I’ll never forget as long as I live. That’s the day that everything changed.”

ARC, too, has changed dramatically since it started as a treatment home for women run by volunteers, based largely on Bible study and prayer.

It now operates as a for-profit company paid $130 million last year by Medicaid, the federal-state health plan which in 2014 expanded access to addiction treatment, or substance-use disorder, as it’s now known.

Gov. Andy Beshear has praised ARC for helping Kentucky — ravaged in recent years by addiction and overdose deaths — become the state with the most treatment beds per resident in the nation, according to an East Tennessee State University study.

“With the help of organizations like ARC, we are working to build a safer, healthier commonwealth for our people,” Beshear said, speaking at an ARC ribbon-cutting for a new facility in March.

Owned by founder and CEO Tim Robinson and his wife, Lelia, the company provides the couple an annual income of about $533,400, according to a 2022 tax-filing by Odyssey Inc., a non-profit affiliated with ARC.

Tim Robinson (Lantern photo by Matthew Mueller)

Robinson said he and his wife struggled financially for years while establishing the treatment business — facing potential foreclosure on their home and repossession of their car. He doesn’t think that income is unreasonable.

“We took a lot of risks,” said Robinson, 48, a lawyer and recovered alcoholic who says he has been sober since 2006 — two years before he started building the faith-based treatment business that would become ARC. “I’m living the American dream. I’m doing better than I ever thought I could be doing financially.”

Kentucky’s largest provider

The fast-growing company is by far the state’s largest substance-use treatment provider, with 1,800 residential beds in 24 Kentucky counties, and reaches hundreds more clients through outpatient services. ARC, which estimates it provides 75% of treatment beds in Kentucky, also is planning programs in Ohio and Virginia.

Earlier this year, ARC opened a 40-bed behavioral health unit with plans to expand to 300 at the former Our Lady of Bellefonte Hospital in Ashland, which closed in 2020. In 2020, ARC opened its largest center — with a capacity for 700 — on the campus of St. Catharine College in Springfield, which closed in 2016.

ARC is no longer simply a treatment organization, said Matt Brown, a former ARC client who overcame addiction and now serves as ARC’s chief administrative officer and president of ARC Healthcare. “We view ourselves as a behavioral health system,” Brown said.

While Christian faith remains at the heart of its mission, ARC relies on professional therapists, medical specialists including nurses and doctors, a structured treatment program and medication such as Suboxone to reduce the cravings of some patients for drugs and help them maintain sobriety, Robinson said.

Its religious component — which includes tracking how many clients decide “to follow Christ” (1,320 in 2023) — is strictly voluntary, according to Robinson, who said he was able to get sober in 2006 with the help of a local pastor and friend who “led me to the Lord.”

More importantly, he said, is that the number of clients who agree to stay in long-term treatment up to six months has increased steadily, which he thinks is the best indicator of effectiveness of the program.

Medicaid, which funds the majority of substance treatment, doesn’t require programs to measure outcomes.

But ARC measures its own outcomes, which it reports to Medicaid quarterly, Robinson said. That includes a retention rate of around 70% of its clients in treatment for up to six months and even longer through periodic contact with a case manager.

“I’ve been in this a long time,” Robinson said. “Long-term residential treatment is the reason people recover.”

As an indicator of success in addressing addiction, the Beshear administration points to the decline, for the second year in a row, of overdose deaths in Kentucky.

The state’s latest overdose report, released in June, shows a decrease in deaths to 1,984 from 2,200 the year before, a decline of 9.8%.

Last year, ARC received about $130 million in payments from Kentucky’s Medicaid program — more than double the amount of its closest competitor, Spero Health, a Nashville- based company that received $60 million in Kentucky Medicaid funds in 2023, according to the Cabinet for Health and Family Services, which licenses and oversees treatment facilities and Medicaid.

ARC accepts private insurance, but Robinson and Brown said almost all of the company’s revenue is from Medicaid, since their clients generally have lost jobs and any health insurance because of addiction.

The state spent $1.2 billion on substance-use-disorder services in the fiscal year that ended June 30, 2023, with most funds coming from the federal government, according to the cabinet.

Robinson, a former county prosecutor who started his business from a home office in Louisa, has emerged as a major political donor and well-connected business leader who recently joined the Kentucky Chamber of Commerce board.

Beshear singled out Robinson for recognition in his State of the Commonwealth speech in January, calling him “an essential partner in our fight against addiction.”

Robinson, a lifelong Republican, is effusive in praise for Beshear, a Democrat, in part because of the governor’s emphasis on addiction treatment and the governor’s frequent references to his own religious faith.

“I’ve never been for anybody like I’ve been for Andy Beshear,” Robinson said. “I hope he runs for president.”

‘Treatment on demand’

ARC employs 1,350 people, 500 at its headquarters in Louisa, population 2,600, perched above the forks of the Big Sandy River, across from West Virginia. The company is Lawrence County’s largest employer, even more than the school system.

About 40% of its workers are “graduates” of its treatment program, Robinson said, and most of its upper management — himself included — are in recovery from addiction.

ARC promises “treatment on demand,” and operates a 24-hour hotline people can call to identify help within 15 minutes, including transportation, if needed, to one of its centers. Last year it served more than 12,000 individuals from 119 of Kentucky’s 120 counties.

Tim Robinson in front of one of his buildings in 
downtown Louisa (Lantern photo by Deborah Yetter)

It has developed a network of job-training programs including welding, automotive repair, lawn service, culinary arts, chaplaincy and food service. As part of that, ARC has rebuilt more than a block of rundown buildings in downtown Louisa into a coffee shop, commercial kitchen, community theater and an event space.

It offers clients a chance to get certification toward a trade and get college credit for some training.

ARC owns a pharmacy used to provide medication to clients, a laboratory for medical testing and operates a health clinic in Louisa. Also, Tim and Lelia Robinson founded the private Millard School, a Christian academy in Louisa attended by some children of their employees.

Vanessa Keeton and her husband James live in Louisa and their son attends the Millard School. James, a 2011 ARC graduate, manages the Second Chance garage which repairs and restores vehicles for the public as well as maintaining an ARC fleet of about 200. “We restore cars and we restore lives,” he said.

ARC runs a sophisticated marketing program complete with a website, billboards, television and radio commercials, a social media presence, sponsorships and news releases, contracting with the Louisville-based public relations firm, RunSwitch. Scott Jennings, a CNN commentator and Republican political consultant, is one of RunSwitch’s founding partners. ARC spends about 4.5% of its revenue, or about $5.8 million a year on marketing.

Vanessa Keeton said the marketing is important to promote awareness of its services to those in need, “to meet people where you are.”

‘Dangerously brilliant’?

Some outsiders criticize ARC for its rapid growth, its size and Robinson’s political giving, including Mark La Palme, the founder and former CEO of Isaiah House, a treatment program based in Harrodsburg.

La Palme, now retired, said he worked with Robinson on a project in the mid-2000s but parted ways over disagreement with practices including designating clients as “interns” in ARC programs for low pay while in treatment, saving the company the cost of paying a regular employee.

He calls ARC “huge,” has called it a “bully” in a social media post and questions its rapid expansion. La Palme also questions the prolific giving of Robinson and ARC entities, which rank among the state’s major political contributors.

“It seems like you’re buying political influence,” he said.

But he acknowledges that Robinson has been highly effective in building ARC into the state’s largest treatment system: “He’s dangerously brilliant.”

Robinson said he considered La Palme a friend and colleague but they parted ways after a proposed collaboration fell through. Robinson said ARC’s programs meet all state standards, are accredited and the company works to provide high quality care.

He said internships are a way of introducing people to job skills they will need to succeed once they leave treatment and interns in various job training programs receive a paycheck either through ARC or an outside employer.

Robinson said he doesn’t apologize for political giving, seeing it as a way to support causes and politicians he believes in.

And he doesn’t think ARC is too big, saying that the company had to expand to remain viable within the constraints of Medicaid reimbursement, which pays for most of its clients. “We had to grow to survive,” he said.

The Robinson employees who spoke with Kentucky Lantern, including Brown, are highly enthusiastic about the boss.

Brown, trained as a physical therapist, battled addiction for 18 years before coming to ARC as a patient and remaining as an employee.

Robinson is “a visionary,” Brown said during a tour of ARC properties in Louisa, “He sees things in people before they see it in themselves.”

‘Papaw taught me’

Robinson said he grew up in adjoining Martin County, in “the poorest part” of a poor county. His introduction to business came from his grandfather who owned a country store. “He put me on a pop carton to run the cash register,” he said. “Papaw taught me about business.”

Another boyhood business venture of Robinson’s — selling baseball cards — would provide a life-changing entrée into college and law school, when he was befriended by Inez banker and businessman Mike Duncan, a former Republican national chairman and mentor to many young people in Martin County.

Robinson said he and Duncan crossed paths when he began selling baseball cards to Duncan's son, Robert M. “Rob” Duncan, who was appointed U.S. attorney for Eastern Kentucky under Donald Trump. Duncan is now the top deputy to state Attorney General Russell Coleman.

Robinson said he considers both Duncans friends but remains closest to Mike Duncan, a trusted friend and adviser. He said Mike Duncan, showed interest in his boyhood baseball-card venture and became a mentor, encouraging Robinson to go to college — a prospect he hadn’t considered.

“Nobody in my family ever went to college,” Robinson said.

But with Duncan’s encouragement, Robinson graduated from the University of the Cumberlands in Williamsburg, earned a law degree from the University of Kentucky and was elected student body president at both institutions.

Good times and bad times

“He helped me through the good times and the bad times,” Robinson said.

Among the worst times: Robinson’s 2003 indictment for felony vote fraud while he was student body president at UK, after some 750 voter registration cards collected during a student government drive were never turned in. Apparently forgotten, they were later found in a student-government office, according to a 2003 Lexington Herald-Leader story.

“It was devastating,” Robinson said. “I thought my whole life was over.”

Instead, with the help of his lawyers, Robinson pleaded guilty to a lesser misdemeanor charge of failing to turn in the registration cards and paid $90 restitution. Robinson said he dropped out of law school during the legal case, but was readmitted and graduated.

But that ordeal, plus the death of his mother while he was at UK, “finished my mental health off,” Robinson said. He returned home to Eastern Kentucky to work but alcohol by then had a powerful hold on his life.

Back in Lawrence County, Robinson joined in law practice with a friend and became an assistant county attorney but by then said he had become a “raging alcoholic” though still somehow able to perform his job.

He would drink on weekends, come to work on Mondays hung over and avoid alcohol on days he had to be in court. Toward the end of the week, Robinson said, he’d resume drinking and stay drunk till the following Monday. “I was leading kind of a double life,” he said.

That continued until a deputy sheriff at the courthouse where Robinson worked intervened. The deputy, also a pastor and a recovering alcoholic, helped Robinson stop drinking through prayer and support — taking him with him to nightly events where he would preach and play Bluegrass music.

Though Robinson said he knew nothing about treatment or programs such as Alcoholics Anonymous, he decided he needed to expand services in the region that in the mid-2000s offered little.

“I was convinced God was calling me to stop practicing law and start a recovery center,” Robinson said.

So he did, leaving his law job and starting out of a home office on Nov. 3, 2008.

Robinson got help from Rev. Ralph Beiting, a Catholic priest who founded the Christian Appalachian Project. Together they opened a recovery house for women in Lawrence County called Karen’s House.

It was a makeshift operation run by volunteers with donated goods, including some old Army cots. Meanwhile, Robinson was taking men to the closest treatment center, Chad’s Hope in Clay County, getting occasional funding from Operation UNITE, launched in 2003 by U.S. Rep. Hal Rogers to help Kentucky battle rising addiction — in particular the tide of opioid pain pills engulfing the state.

But broke and discouraged, Robinson was close to quitting when he contacted a consultant who suggested he expand by opening a second recovery center for men. He located a site in Fleming County and in 2013, Belle Grove Springs was opened by the company that would become ARC.

Brown, now ARC’s chief administrative officer, was among the first clients admitted to the men’s center.

The following year, under the expansion authorized by the Patient Protection and Affordable Care Act, Medicaid began funding substance use disorder services and a reliable funding stream opened. Kentucky was among the first states to include addiction as a service covered by Medicaid.

While the income was welcome, it wasn’t enough to finance ARC’s operation and Robinson said the company’s only choice was to expand and recoup more money through a higher volume of clients. “People thought we were growing because we were booming but we had to grow to survive,” he said. “You cannot make it on a couple of small facilities.”

ARC didn’t show a positive cash flow until 2019, he said.

‘Take our time’

While ARC expansion has slowed, Robinson said the company is still looking at other opportunities, including expansion into Virginia, which has far fewer treatment beds than Kentucky. “We’re going to take our time,” he said.

ARC also was flagged in a budget item this year by the state General Assembly with a $12 million allocation over two years directed to the Life Learning Center in Covington, an organization aimed at helping people develop skills to improve their lives “through gainful employment.”

The budget line says the funds are to be distributed to the center to support “treatment, rehabilitation, and community reintegration in partnership with Odyssey Inc.,” the non-profit arm affiliated with ARC.

Robinson said he expects Odyssey to submit a proposal as treatment provider for a program the center plans to establish in Somerset.

And while his work has expanded statewide and beyond, Robinson said he’s committed to staying in Louisa and keeping his company headquartered there.

“I’m where I’m going to be,” he said. “This is my adopted hometown.”

Coleman details $12 million in opioid grants, says his opposition to syringe exchanges is greater if they don't have one-to-one rule

Attorney General Russell Coleman talks to DV8 Kitchens
owners Rob and Diane Perez. DV8 Kitchens is getting
one of the prevention grants. (Photo by Melissa Patrick)

This story has been updated. 

By Melissa Patrick
Kentucky Health News

Attorney General Russell Coleman issued details Thursday of more than $12 million in grants from the state's opioid settlements for prevention, enforcement, treatment and recovery.

One of the grants will expand a syringe exchange, and was not supported by Coleman's appointees to the commission. He confirmed at an event Thursday that he opposes the exchanges.

"I'm extremely concerned that needle exchange further perpetuates drug use, and it will not be supported by me or this administration," he said in response to questions at an event he held to highlight the grants.

Coleman said the 51 grant recipients, chosen from 160 applicants, represent "bold ideas" aimed at trying to "save lives and tackle this crisis," with a focus on the three-legged stool of prevention, treatment and enforcement.

“We’re building programs and services that help Kentuckians for the next generation,” he said.

The announcement was made at DV8 Kitchens in Lexington, which employs people in recovery and is getting a $151,730 prevention grant to establish an employee-success mentorship program. 

“By connecting those in recovery with meaningful employment, we can give them a second chance at success,” DV8 owner Rob Perez said in a news release from Coleman's office. 

At the event, Perez stressed that while DV8 is "for people," its success is also good for the community. "Every time one person doesn't return back to addiction, we saved $37,000 as a community," he said.

Coleman's office oversees the Kentucky Opioid Abatement Advisory Commission, which the legislature created in 2021 to distribute the state's portion of the $900 million in settlements with opioid manufacturers and distributors, which are being paid in installments. The commission has awarded $55 million in 110 grants, including $10.5 million the legislature allocated in 2022 for behavioral-health treatment as an option to incarceration in 11 pilot counties. 

Coleman said its important to remember where this settlement money comes from. “This is blood money, purchased by pain and devastation of families across this commonwealth, which is why we must be such stewards of this money,” Coleman said. "We're honoring those we've lost by our stewardship and how we use this money effectively." 

Half of the settlement monies go to the state and the other half goes to cities and counties. The commission is housed in the attorney general's office and is headed by Chris Evans, a former chief operating officer for the U.S. Drug Enforcement Administration.

Syringe exchanges

Evans was one of the Coleman appointees who did not support a grant to the Boyle County Agency for Substance Abuse Prevention at at the June 4 commission meeting. In passing on the vote, he revealed Coleman's position on syringe exchanges.

The grant was approved by a majority vote. Coleman took office in January and has not yet made all of his five appointments; those members serve two-year terms. The other voting members are appointed by the University of Kentucky or serve by virtue of their office, including Coleman, who has designated Evans to hold his seat.

Two of the five positions that are appointed by Coleman were reappointed in June 2023, before he took office, with their terms expiring June 30, 2025. They included Karen Butcher and Von Purdy, both representing citizens at-large. Coleman appointed Darren "Foot" Allen, representing law enforcement, in February and that term will expire June 30, 2025. The other two positions to be appointed by Coleman expire at the end of this month. At this time Van Ingram, representing the drug treatment and prevention community, and Jason Roop, representing victims of the opioid crisis, fill those positions.

Asked if Coleman will make decisions about future appointments to the commission dependent on the person's view of syringe exchange programs, spokesperson Kevin Grout answered "No" in bold letters in an email.

Kentucky Health News asked Coleman if his lack of support for syringe exchanges for intravenous drug users, which are supported by research, could put a chilling effect on future applications for these programs.

He replied, "There's been no grant that has been blocked because of my personal opposition." He went on to say, "I don't support needle exchange. I support very robustly prevention, treatment and enforcement."

Asked if he had research to support his opinion, he said, "I'm a strong proponent of Narcan [an anti-overdose drug] and I'm a strong proponent of prevention. I'm very concerned that particularly when there's not a one-to-one ratio, a one-to-one return on needles that it is an enabler versus the harm reduction that we're actually seeking."

Some syringe exchanges have a one-for-one requirement, but regional health official Scott Lockard said in 2016 that most exchanges at that time used a "patient negotiation model," giving the user as many needles as they need for one week to assure they use a clean needle each time, often up to a capped amount.

"The goal is that they use a clean needle for each time they inject," Lockard said then. He said it is impossible to adhere to a strict one-for-one requirement. For example, he said users don't always keep up with their syringes or sometimes will tell you they are sharing them.

Coleman said he is a very strong advocate for wide distribution of Narcan, "given the nature of the threat we're seeing. . . . Narcan needs to be as ubiquitous as a fire extinguisher given this threat. But it always has to be Narcan plus a pathway to treatment, Narcan plus education. Because Narcan itself can be an enabler in some contexts. We want to make sure it's always coupled with treatment, coupled with prevention." 

Coleman also talked about his plans to build a statewide drug prevention program, with a goal of rolling it out this next school year. 

“We exist in a commonwealth where as little as one pill can and is taking our sons and our daughters,” he said. “But yet we lack a statewide prevention effort in our commonwealth. That will change.”

Coleman's office declined to release details of the grants until Thursday's event. Here's a summary of how the 23 new prevention grants will be used: 

Anderson County Agency for Substance Abuse Prevention, $171,100 for expansion of school-based prevention efforts and law-enforcement training.
Appalachian Research & Defense Fund (Legal Aid), $125,000 for legal support and wraparound services that help stabilize people in recovery by addressing employment barriers and other destabilizing civil legal issues.
Big Brothers Big Sisters of the Bluegrass, $185,301 for a high-school mentoring program, to empower high school students to become positive role models for younger students.
Boys and girls Clubs of Kentuckiana, $200,000 for an innovative program aimed at opioid prevention for youth aged 6-18.
Carter County Public Library, $101,500 to hire resource specialists to prtovide greater access to recovery-oriented programming.
Covington Partners, $225,450 for prevention programming that includes out-of-school-time programs, school-based health services, mentoring, drug and violence prevention and family engagement.
Cumberland Trace Legal Services (Legal Aid), $125,000 for legal support and wraparound services that help stabilize people in recovery by addressing employment barriers and other destabilizing civil legal issues.
DV8 Kitchen Vocational Training Foundation and DV8 Kitchens, $151,730 for the mentorship program, which will focus on removing barriers, supporting career-path development and job readiness while supporting recovery and wellness.
Girl Scouts of Kentucky Wilderness Road Council, $59,052 to launch the Building the Bridge to K-12 Girls Leadership Project, a community-based prevention program that focuses on increasing girls’ positive childhood experiences.
Jewish Family and Career Services, Louisville, $77,207 for enhancement of wraparound services for youth, to include opioid addiction screening and active prevention.
Legal Aid Society, $125,000 for legal support and wraparound services that help stabilize people in recovery by addressing employment barriers and other destabilizing civil legal issues.
Legal Aid of the Bluegrass, $125,000, same as above.
Mercy Health – Lourdes Hospital, $76,552 for a hospital-based, pharmacy-led tapering program, which slowly resudes doses of a drug over time to reduce withdrawal symptoms.
Operation Parent, $87,011 for prevention education of parents of 4th, 6th and 9th grade students in several Kentucky counties.
The Safety Blitz Foundation, $126,335 for a pilot version of The Coaches vs. Overdoses™ program, which addresses youth opioid misuse, the proliferation of synthetic opioids including illicit fentanyl, through prevention, education, awareness and community drug-disposal programming.
Scott County Sheriff’s Office, $91,847 for Drug Abuse Resistance Education in 5th and 9th grades.
Taylor County Schools, $208,824 for a school-based prevention program.
Three Rivers District Health Department, Owenton, $320,803 for a partnership with the Planet Youth program to implement a population-wide primary prevention process designed to take informed actions to increase protective factors, decrease risk factors and ultimately change the environment of children and youth.
University of Kentucky Research Foundation, $380,572 for development of prevention coalitions in Fayette County, educating 4th through 12th grade students and building community capacity and engagement around prevention efforts.
Operation UNITE, $751,850, for continuation and expansion of its Educate. Empower. Prevent. Program, which provides prevention training to students from 4th through 12th grades.
Wanda Joyce Robinson Foundation, Frankfort, $90,472 to start a youth substance intervention and prevention program that prevents substance use and abuse and promotes positive youth development and stronger families. The foundation helps children with incarcerated parents.
WestCare Kentucky, $100,404 for Camp Morilla, a free addiction prevention and mentoring day camp program for youth ages 9-12 and their families who have been impacted by family opioid use.
Young Men’s Christian Association of Greater Louisville, $248,487 for the YNOW Mentoring Program, which focuses on helping youth develop healthy drug-and violence-free lives.

Here is a summary of how the 28 new treatment and recovery grants will be used: 

Appalachia Regional Healthcare, $94,572 for expanding its peer recovery team so peer recovery coaches can be placed in four more hospitals.
Backroads of Appalachia, $167,025 for women in recovery with workforce training and employment opportunities.
Boyle County ASAP, $282,610 for expansion of its harm reduction program (including a syringe exchange), resilient-kids programming and case management efforts.
Celebrate Recovery Fairdale, $30,004 for weekly recovery meetings.
Center for Employment Opportunities, $255,109 for expansion of employment services for justice-impacted individuals in treatment or recovery.
Chrysalis House, Lexington, $227,273 for treatment for pregnant and parenting women.
Comprehend, Inc., $426,087 for opening a buprenorphine clinic in a community mental health center.
Eastern Kentucky Concentrated Employment Program, $450,000 for career and support services for people who are in recovery and comorbid polysubstance use who are interested in entering or re-entering the workforce.
Family Nurturing Center of Kentucky, $221,937 for services to children impacted by their caregiver’s opioid use and provides needed support to parents in recovery.
Family Scholar House, $245,110 for a five-step approach revolving around wrap-around services during and post-treatment to progress individuals from ‘crisis to stability’ targeting single parents, foster alumni, individuals facing reentry and post-secondary students.
Grin Grant, Lexington, $361,251 for expansion of dental restoration scholarships and peer support services and launch of a new recovery program.
Hope Center, $680,280 for in-patient, residential treatment for men.
Hope Springs Church, $50,462,Supports regular recovery support meetings and events.
Horsesensings, Inc., Bagdad, $115,219 for therapeutic job training in the horse industry and housing for those in recovery.
Isaiah House, $250,000 for recovery housing and job training aftercare opportunities for those in long-term recovery.
Kentucky Hospital Research and Education Foundation (Ky. Hospital Assn.), $250,000,Supports expansion of a program that ensures patients have 24/7 access to care.
Lake Cumberland Area Development District, $277,552 for case management and supportive services to individuals in recovery seeking to re-enter the workforce.
Life Learning Center, Covington, $498,500 for "a cutting-edge, technology-enhanced system designed to fill existing gaps in recovery services by providing continuous, real-time data, support and accountability."
Mercy Health-Marcum and Wallace Hospital, Irvine, $179,834 for recovery services for individuals with criminal justice involvement.
Natalie’s Sisters, $88,356 for expansion of services for women who have been sexually exploited or trafficked.
Northeast Kentucky Regional Health Information Organization, $331,997 for the Career Ready Workforce Project, which will focus prevention efforts on high-school students preparing to enter the workforce, individuals struggling with addiction ,and local agency staff members seeking to increase employable skills.
Ramey-Estep Homes, Rush, $222,801 for teen prevention-education programming, expansion of first-responder trauma-treatment programming and expansion of treatment and recovery access.
Recovery Café Lexington, $276,278 for expansion of recovery support model to a third location in Frankfort.
Transitions, Inc., Covington, $156,000 for expansion and enhancement of treatment services, as well as expansion of community education and prevention activities in the African American community.
Voices of Hope-Lexington, $538,021 to increase the quantity and quality of recovery support services for people in or seeking recovery.
Volunteers of America Mid-States, $664,587, for two recovery community centers in Lincoln and Pulaski counties.

Four Rivers Behavioral Health, Paducah, $232,251 for a mobile recovery support vehicle program that provides services to adults.
Young People in Recovery, Louisville, $301,440 for peer-led chapter and life-skills curriculum programs for people seeking recovery and a youth prevention program for middle- and high-school-aged children and their parents in five communities.

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.

In third round of grants from opioid settlements, director passes on one, saying Coleman opposes syringe-exchange programs

Russell Coleman announced Chris Evans's
appointment on Dec. 19. (WKYT image)

By Melissa Patrick
Kentucky Health News
 

The leader of the agency that makes grants from the state's opioid settlements declined to vote for a grant with more money for a syringe-exchange program, saying Attorney General Russell Coleman does not support such programs -- which are considered a key tool for reducing harm to people who inject drugs.

Kentucky Opioid Abatement Advisory Commission Director Chris Evans, who works for Coleman, passed on a June 4 vote that approved a grant to the Boyle County Agency for Substance Abuse Prevention, one of 119 such county agencies.

"This application does increase outreach, which includes educational training, Narcan distribution and referrals to treatment," Evans said. "However, the request does increase the funding of the syringe-service position, which the Office of the Attorney General does not support syringe exchange programs. So I will be passing on the vote of this application."

Asked later why Coleman opposes syringe-exchange programs, Coleman spokesman Kevin Grout said in an email, "Attorney General Coleman is committed to supporting effective prevention, treatment and enforcement efforts. He strongly supports the distribution of Naloxone and other overdose reversal drugs. However, he cannot support syringe-exchange programs, which he believes enable drug use without effectively promoting recovery."

Syringe exchanges are supported by research. The Centers for Disease Control and Prevention says injection drug users who have access to syringe exchanges are five times more likely to get treatment than those who don’t. Another study says the exchanges do not encourage drug use or increase the frequency of drug use among current users.

The exchanges were authorized by the state's 2015 anti-heroin law, in an effort to thwart the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles among intravenous drug users. As of March 14, the state had 80 operational syringe exchange programs in 65 counties.

Later voting against the grant request because of their opposition to syringe exchange programs were commission members State Treasurer Mark Metcalf and retired Master State Trooper Darren "Foot" Allen, whom Coleman appointed to fill a slot representing law enforcement.

Allen said, "There's some people that I trust that tell me this is okay. However, I'm just not in favor of needle exchange. I suspect that this time next year, I won't change my position but I am open to looking at that option," he said. 

Despite the opposition, Boyle County's ASAP grant request for $282,610 passed with a 6-2 majority vote. The commission is comprised of nine voting and two non-voting members from the legislature.

Third round of grants approved

The Boyle County grant was the only one put up for a vote that had any opposition at the commission's June 4 meeting. In all, the commission members approved 51 organizations to receive just over $12 million in grant money. 

The legislature created the commission to distribute the state's portion of the approximately $900 million in settlements with opioid manufacturers and distributors, half of which goes to the state and the other half goes to cities and counties. The commission is housed in the attorney general's office and is headed by Evans, a former chief operating officer for the U.S. Drug Enforcement Administration.

Of the $12 million in this round of grant money, 28 of the awards were given for treatment and recovery, and 23 were given for prevention. This is the third round of state grants, with $32 million awarded to 59 groups in the first round and $13.9 million awarded to 34 groups in the second round.

Asked for brief details of each grant, Grout said they would be announced next Thursday at a press conference at DV8 Kitchen-East End in Lexington, one of the grant recipients.

The 28 new treatment and recovery grants are:

Appalachian Regional Healthcare, $94,572.
Backroads of Appalachia, $167,025.
Boyle County ASAP Board, $282,610.
Celebrate Recovery Fairdale, $30,004.
Center for Employment Opportunities, $255,109.
Chrysalis House, $227,273.
Comprehend Inc., $426,087.
Eastern Kentucky Concentrated Employment Program, $450,000.
Family Nurturing Center of Kentucky, $221,937.
Family Scholar House, $245,110.
Grin Grant, Lexington, $361,251.
Hope Center, Lexington, $680,280.
Hope Springs Church, $50,462.
Horsesensing Inc., $115,219.
Isaiah House, $250,000.
Ky. Hospital Research and Ed. Foundation (Ky. Hospital Assn.), $250,000.
Lake Cumberland Area Development District, $277,552.
Life Learning Center, $498,500.
Mercy Health - Marcum and Wallace Hospital, Irvine, $179,834.
Natalie's Sisters, $88,356.
Northeast Kentucky Regional Health Information Organization, $331,997.
Ramey-Estep Homes, $222,801.
Recovery Café Lexington, $276,278.
Transitions Inc., $156,000.
Voices of Hope - Lexington, Inc., $538,021.
Volunteers of America Mid-States, $664,587.
Four Rivers Behavioral Health, $232,251.
Young People in Recovery, $301,440.

The 23 new prevention grants are:

Anderson County ASAP, $171,100.
Appalachian Research & Defense Fund (Legal Aid), $125,000.
Big Brothers Big Sisters of the Bluegrass, Inc., $185,301.
Boys and Girls Clubs of Kentuckiana, $200,000.
Carter County Public Library, $101,500.
Covington Partners, $225,450.
Cumberland Trace Legal Services (Legal Aid), $125,000.
DV8 Kitchen Vocational Training Foundation and DV8 Kitchens, $151,730.
Girl Scouts of Kentucky Wilderness Road Council, $59,052.
Jewish Family and Career Services, $77,207.
Legal Aid Society, $125,000.
Legal Aid of the Bluegrass, $125,000.
Mercy Health - Lourdes Hospital, $76,552.
Operation Parent, $87,011.
The Safety Blitz Foundation, $126,335.
Scott County Sheriff's Office, $91,847.
Taylor County Schools, $208,824.
Three Rivers District Health Department, Owenton, $320,803.
University of Kentucky Research Foundation, $380,572.
Operation UNITE, $751,850.
Wanda Joyce Robinson Foundation, $90,472.
WestCare Kentucky, $100,404.
Young Men’s Christian Association of Greater Louisville, $248,487.

The grant application portal is closed until the commission opens it for the next round of awards.