By Melissa Patrick
Kentucky Health News
A panel of survivors, drug-recovery experts and providers lauded Kentucky's 5 percent reduction in drug-overdose deaths between 2021 and 2022 on a Kentucky Educational Television program, "Disrupting Addiction: A KET Forum," but said there is still more work to do.
Host Renee Shaw opened the program by sharing data from the state's latest annual Overdose Fatality Report, It shows 2,135 Kentucky residents died from overdoses in 2022, 5% less than in 2021. Fentanyl was identified in more than 1,500 of the deaths, 72% of them. By age group, people 35 to 44 had the most overdoses.
Van Ingram, executive director of the state Office of Drug Control Policy, said Kentucky was one of only eight states that reported decreases of 100 or more overdose deaths in 2022, compared to 2021. "That's over 100 families that are impacted," he said. "But still, we're losing six Kentuckians every day to preventable disease, preventable death."
Ingram said another challenge is that in addition to fentanyl,
Xylazine, a non-opioid animal tranquilizer that has been approved for veterinary use, is being added to the drug supply.
"It's really going to cause us to redouble our efforts and look for new ways," he said. "There are Xylazine test strips, we'll be looking at those. It's just unbelievable that if fentanyl wasn't deadly enough, now we have to add something else to it."
Asked why the top five counties with the highest rates of drug overdose deaths in 2022 (Bath, Lee, Floyd, Estill and Knott) were all in Eastern Kentucky, Ingram reminded Shaw that Appalachia was ground-zero for the opioid epidemic.
"It still remains one of the hardest hit areas in the country," he said. "There's just not the resources a lot of times in those communities that others have, and that makes things more difficult."
Rep. Kim Moser, R-Taylor Mill, chair of the House Health Services Committee, said she attributed the 5% drop in overdose deaths to strong policies that have been passed in the last nine years, a changing conversation around addiction that makes it easier to pass strong policies, and improving resources. However, noting the more than 2,000 overdose deaths in 2022, she added, "We still have a long way to go."
Despite last year's drop in overdose deaths, Madison County Coroner Jimmy Cornelison said his county is on track to see more than last year. He added that while fentanyl and methamphetamine ae his main two culprits, he is seeing an upswing in cocaine use, which he said, "was gone for some time."
Asked what can be done to reverse these numbers, Cornelison said he doesn't know if there is an answer. He said Madison County is fortunate to have a strong support system, including its EMS that distributes Narcan, a drug that can reverse the effects of an opioid overdose. He said the drug is expensive and puts a strain on the EMS budget, but without it, overdose numbers would be much higher.
Cornelison encouraged policymakers to listen to their local people because they see this situation in a different light: "We see what it does to families and friends."
State Health Secretary Eric Friedlander also talked about the value of Narcan: "Hopefully that Narcan distribution has helped people survive. . . . You can't get to treatment if you're dead, right? You can't turn your life around if you are seeing the coroner."
There are evidence-based, medication-assisted treatments for substance-use disorders, such as methadone, buprenorphine and Suboxone, but nine out of 10 Kentucky drug users go untreated.
That is largely due to access issues and the stigma that still exists around these treatments, said Dr. Devin Oller, primary care and addiction medicine physician at the University of Kentucky.
"I don't have any medication for heart failure, for diabetes, that is as effective in terms of reducing death as buprenorphine and methadone -- 50% drop in mortality if I'm able to get folks started on that. But again, the barrier is that access point," Oller said.
To the criticism that using these drugs is just trading one drug for another, he said, "We would never say to a patient with diabetes that using insulin is trading one drug for another, right? So why do we do that for addiction?"
Oller said this criticism often stems from mistaken beliefs that addiction is a choice or that there are no genetics or trauma involved. He said addiction is a chronic disease of the brain that has a great prognosis with effective treatment.
Asked about ibogaine, a psychedelic drug that is illegal in the U.S. but has been anecdotally reported to stop the withdrawal symptoms of opioid dependence, Oller said, "It may be part of of the long-term solution, but Kentuckians are dying right now. And so we need to do whatever we can to get them access to these evidence-based treatments, that again, reduce the risk of death by 50%."
The
Kentucky Opioid Abatement Advisory Commission recently held a
public forum to learn about ibogaine as it considers using some of the money the state is getting from settlements with drug makers and distributors to help get the drug get approval from the
U.S. Food and Drug Administration.
Bryan Hubbard, executive director and chair of the commission, the main advocate of the idea, said the commission is in the "exploratory phase" when it comes to ibogaine.
"What we can say is that observational data suggest that ibogaine could be added to the existing treatment options that we have, and that it may represent a breakthrough opportunity to pioneer an additional therapeutic that can deliver some fairly dramatic results, at least when it comes to the front end of the long term recovery process that has been mentioned thus far," Hubbard said.
Asked about the heart risks associated with ibogaine, Hubbard said it's important to remember that the drug is not administered in a medically or clinically controlled setting outide the U.S., and a panel of experts at the public hearing said the risks can be mitigated with proper screening of patients and appropriate monitoring during treatment.
As host, Shaw also highlighted several recovery programs, talked with Nancy Hale of Operation Unite about the importance of early prevention and education, and talked with staffers at the Estill County Health Department about its mobile harm-reduction program, including a syringe exchange.
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