Across the United States, the epidemic of fentanyl continues to plague communities and neighborhoods. In Kentucky alone, drug overdose deaths from prescription opioids, heroin, and fentanyl have reached record highs, devastating lives. From 2016 to 2017, the number of fatalities from drug overdoses in the state of Kentucky leapt 11.5% to reach 1,565, according to the Kentucky Office of Drug Control Policy. Of these deaths, the potent opioid Fentanyl was a factor in 52% of deaths.
Fentanyl, a synthetic opioid and Schedule II, controlled narcotic that is used mostly in end of life scenarios and intensive trauma medical care, has been a leading factor in overdose deaths across the United States. The primary reason? It’s nearly 50 times more potent than heroin. Meaning drug dealers and cartel members use it to lace typical heroin batches and more to make their product more attractive and addicting for users. However, users often have no idea how much fentanyl could be cut into their batch, making overdose a more likely possibility.
“The gravity of today’s report underscores just how much is at stake in the ongoing battle against the nation’s opioid epidemic. This is a fight we must win for the sake of our families, our communities, and the commonwealth as a whole. We will continue to leverage every available resource to close off the funnel of addiction and to help our fellow Kentuckians who are struggling against this scourge.” – Governor Matt Bevin
The report that governor Bevin mentions is the Overdose Fatality Report, which was compiled using data from various state run agencies within the state of Kentucky handling poison control, injury prevention, and the medical examiner’s office. Here are some of the more startling statistics to emerge:
- Heroin was present in roughly 22% of deaths
- Xanax was present in 36% of deaths
- Gabapentin was present in 31% of deaths
- Fentanyl was present in 52% of deaths
- Methamphetamine was present in 29% of deaths, over double from last year
- The counties of Jefferson and Fayette reported the most overdose fatalities, 352 and 123 respectively
Fentanyl levels within Kentucky continue to rise due in part to the efforts of drug cartels in China and Mexico. State officials are struggling to find ways to stop the drug from crossing borders, especially as the drug becomes cheaper to make, easier to distribute, and more profitable. Fentanyl may be the most deadly addictive drug that the world has ever seen up to this point, and there doesn’t seem to be an end in sight.
Kentucky Fights Back
State efforts to combat the scourge of fentanyl include public awareness and naloxone distribution drives. The Kentucky sponsored “Don’t Let Them Die” campaign offers information and resources on substance use disorders, drug treatment options, and naloxone, the overdose reversing agent that has saved hundreds of thousands of lives.
Additionally, the state has called upon the Kentucky Justice and Public Safety Cabinet to partner with Operation UNITE in order to create a call center for people seeking treatment and assistance with substance abuse problems. The KY Help Call Center is available for people to speak with live specialists about treatment options near them to help with substance use disorders.
State officials also launched the findhelpnowky.org, which is a directory and search engine for drug treatment options based on location and specific parameters. Kentucky State Police also helped fund and start the Angel Initiative that pairs individuals with local Kentucky State Police officers to help put them in contact with treatment programs near them.
In the General Assembly 2015 session, lawmakers introduced a comprehensive bill to help fight the state’s heroin epidemic. Senate Bill 192, or the “Heroin Bill” was one of the first major legislative moves in the state to help fight back against the deadly drug epidemic of opiates and synthetic opioids. The bill included stronger penalties for dealers and traffickers and advanced treatment options for addicts who need help. Importing heroin into Kentucky with intent to distribute or sell is a crime punishable by up to 10 years in prison. Dealers who are caught selling between 2 and 100 grams of heroin are not eligible for parole until they have served at least half of their 5-10 year sentence. The bill also provides new funding to make treatment more readily available throughout the state, with an immediate boost of $10 million and an additional $24 million annually.
In addition to the tougher penalties for trafficking and provisions for increased substance use treatment services, the bill also included Good Samaritan laws, more funding for needle exchange programs in health departments (pending approval of local jurisdictions), and an increased of funding for naloxone distribution. The result of this influx in available funding has so far helped to stave off the growing number of overdoses and reduce supply levels of illegally diverted narcotics. However, these efforts may have also been the impetus for an increase in the amount heroin related overdoses from 2016 to 2017.
The Kentucky Senate Bill 192 also made revisions to the Kentucky Revised Statue 217.186, now granting the pharmacists, first responders, and other proper authorities the ability to dispense naloxone via physician-approved protocols. By June of 2016, more than 600 pharmacists received Naloxone certification status, and by 2018 that number nearly doubled, covering over 103 of the 120 counties in Kentucky. Emergency Medical Services in the state measured naloxone administration in more than 3000 EMS calls during the final quarter of 2016. Officials believe that the increased availability of naloxone made possible through state and local harm reduction programs has the potential to seriously reduce drug overdose fatalities in the long term.
Epidemiology of the Opioid Crisis in Kentucky
In 2017, the International Journal of Drug Policy, in tandem with the Kentucky Department for Public Health, forensic laboratories, and the Kentucky Chief Medical Examiner, put together a comprehensive look at the epidemiology and current trends of the crisis in Kentucky. The study was intended to help describe the changes in Kentucky’s drug overdose trends and discuss what the future could hold for improved drug control and surveillance. By compiling death certificates, postmortem toxicology results, ED records, law enforcement records, and prescription drug monitoring programs, the researchers were able to chart the demographic changes in drug overdoses in the state over the last decade.
The risk factors that are associated with increased opioid abuse, addiction, and overdoses are especially prevalent in the state of Kentucky. Kentucky had the third highest drug overdose rate in the U.S. in 2015 and has remained in the top 10 highest rates in the nation since that time. Kentucky also had the sixth highest number of fentanyl seizures in the nation. The fentanyl epidemic reached a crisis point in 2014, when the number of fentanyl related deaths tripled.
Between 2010 and 2014, heroin related deaths within the United States more than tripled and heroin became the largest contributor to drug overdose mortality (23%) in 2014. This trend marks an overall increase in poly-substance usage and non-medical use of prescription medications such as opioids. In fact, the rise of non-medical usage of painkilling medications and the rise in heroin-related overdose deaths is not a coincidence. Policies at the state and national level have focused on reducing the availability of prescribed narcotics and promoting abuse-deterrent measures and policies. The switch that many addicts make from prescription painkiller misuse to the usage of heroin, illicitly diverted fentanyl, and fentanyl analogs is a dangerous and an immense challenge for drug overdose surveillance to cover.
While Kentucky deals with the opioid and fentanyl crisis that claimed the lives of more than 20,000 people in 2016, a new threat in the form of highly synthesized and purified crystal meth is now rearing its head. Methamphetamine never fully disappeared, but it has made a resurgence in Kentucky where meth-related deaths more than tripled from 2013 to 2016, totaling 252 casualties. In 2017 alone, there were more than 100 overdose deaths in Jefferson County involving meth or a mixture of it and other drugs. Kentucky isn’t alone in this: across the nation, deaths related to stimulant overdoses rose by more than one third between 2015 and 2016, totaling 7500 deaths.
Part of the reason for this resurgence is that many addicts who began abusing prescription drugs turned to methamphetamine and other street level narcotics as a cheaper and easier means of getting high. Before 2005, methamphetamine was produced mainly in dangerous homemade labs across the United States, but thanks to the Combat Methamphetamine Epidemic Act of 2005, passed by George Bush, the DEA and law enforcement was able to curtail the sales of cold and allergy medicines that contained pseudoephedrine, ephedrine, and phenylpropanolamine, all ingredients in meth. This act severely cut down on the number of home labs.
However, Mexican cartels took up the responsibility of fulfilling the supply to meet demand and began mass producing the drug on a scale unseen before. Statistics show that the number of domestic meth labs in the U.S. declined continuously since 2010 and hit a decade low in 2016. However, the amount of methamphetamine seizures at the border has increased continually since 2008. Cartels have saturated the market with higher quality, pure methamphetamine.
Whereas 20 years ago the drug was produced in homemade meth labs using cold medicine purchased from drug stores, today’s meth from south of the border is sometimes cut up with fentanyl as well, the deadly opioid. Cartels cut batches of methamphetamine and heroin with the synthetic opioid fentanyl to make their product seem even better. They’re not attempting to kill their customers - that would be stridently anti-capitalistic - but they are increasing the risk of killing first-time customers if those customers ingest the substance without knowing that it is laced with fentanyl.
Pharma Lawsuits Continue
Attorney General for Kentucky, Andy Beshear, recently filed another lawsuit against the pharmaceutical industry, specifically the manufacturer Teva, for allegedly promoting a fentanyl-based cancer drug for off-label use within the state of Kentucky. The lawsuit claims to that the manufacturer persuaded physicians to prescribe its drugs, Fentora and Actiq, to help treat chronic pain despite the drugs only being approved for acute pain in cancer patients. Allegedly, Teva’s marketing and salesforce team was instructed to target doctors and general practioners who were not trained in pain management practices. According to Attorney General Beshear, the company grew its presence in the state market while contributing greatly to the drug epidemic. Teva had the largest share of opioids per gram sold in Kentucky over a nearly ten-year period.
Beyond Birth Kentucky
In 2016 in Kentucky there were more than 1200 infants born to drug-addicted mothers. These children were some of the unintended victims of the drug crisis that have had no voice thus far. The University of Kentucky’s PAThways and Beyond Birth programs have been useful tools to help hundreds of mothers in Kentucky struggling with substance abuse to get the treatment and child support services they need. In November of 2018, the University of Kentucky opened the doors to a brand new 11,000 sq. foot facility to help women get comprehensive care for substance abuse treatment.
People Advocating Recovery
People Advocating Recovery is a statewide nonprofit that has used funding from the federal opioid bill to help train people in overdose prevention and naloxone distribution. So far, the state has used more than $100,000 to train Kentuckians in opioid-overdose prevention, giving away more than 1000 naloxone kits in 2018 alone.
As Kentucky’s communities continue to address the epidemic of drug addiction and to turn the crisis around, it’s important to continue recognizing the successes these efforts have produced. For information about addiction treatment services and programs within Kentucky and the latest news surrounding national trends in pain management and prescription medication legislation, visit the Landmark Recovery blog. Landmark Recovery is emerging as a leading provider of drug and alcohol rehabilitation that is effective and affordable. Our programs include residential treatment, iop treatment, and medical detox centers.