DATA STORY
Be Informed… Be Empowered!
Lessons Learned from the Opioid Epidemic in Kentucky
compiled by Dr. Teresa McGeeney
Kentucky has been hit hard by the opioid epidemic. What began with prescribing medicine to control pain quickly transformed to a large population becoming addicted. When measures were put in place to make opioids more difficult to access and consume, many people turned to illicit forms of opioids like heroin and fentanyl. Throughout the crisis, policies have been put in place at the national and state level to try and improve the situation, some of which have had a positive impact and others which had unintended negative impacts. This crisis has helped us learn about what works in preventing drug overdose and substance use.
The opioid epidemic has taught us four main lessons:
Limiting access to a substance reduces use.
When one substance becomes harder to access, people often turn to a different substance.
To prevent substance use, the underlying reasons why people use must be addressed.
Harm reduction strategies help people who use drugs and communities at large.
Overall, the opioid epidemic has made it clear that making prevention, harm reduction, treatment, and recovery resources widely available saves lives.
Context: The Beginning of the Crisis
The opioid epidemic began after prescription opioids were widely prescribed by physicians after prematurely being marketed as safe by pharmaceutical companies. Prescription opioids were later found to be highly addictive and rising numbers of people across the country were misusing the substances.
Numerous efforts were put in place to make it harder to get and misuse prescription opioids for nonmedical use. This helped to decrease prescription opioid misuse and overdoses.
Curbing the Trend of Prescription Opioid Misuse
The number of prescriptions for the most commonly prescribed opioids, hydrocodone and oxycodone, decreased after 2012. Hydrocodone has continued to steadily decline, but oxycodone prescriptions have fluctuated, going up between 2013 and 2016, and then declining from 2016 on.
Though there are more hydrocodone prescriptions than oxycodone, oxycodone remains the most common prescription opioid contributing to overdose deaths in Kentucky. Opioid overdose deaths have generally mirrored the trend line of oxycodone prescriptions in Kentucky, increasing until 2012, dropping, increasing again until 2016 and then dropping again. This gives good evidence that the when prescriptions decline, so do prescription opioid overdose deaths.
Heroin and Fentanyl
After prescription opioids became harder to find and use for nonmedical purposes, many people who were using prescription opioids switched to heroin, an illegal opioid. A few years later, fentanyl, an extremely potent opioid became increasingly available. Fentanyl is still the leading cause of overdose deaths in Kentucky, and now other substances are being laced with fentanyl, including stimulants like methamphetamine. Stimulants like methamphetamine have seen a climbing death rate in recent years. This underscores the reality that limiting access to one particular substance does not address the underlying issues that lead someone to use substances and may not solve the overall problem of substance use and overdoses.
People use substances for many reasons. People who use substances are more likely to be facing major stressors in their life, such as poverty, challenges in relationships, mental health issues, and other adverse experiences over their lifetime. There are also genetic predispositions that make someone more likely to become addicted to substances. Once someone begins using substances regularly, like opioids, they may develop a chemical depedency on that substance, making it very difficult to quit. This is part of the reason many people switched from using prescription drugs to heroin when prescription drugs became more difficult to find.
For these reasons, it is critical to address underlying issues in the community that contribute to substance misuse to truly reduce rates. It's also very important to begin prevention outreach at a young age because early use of substances is a strong predictor of Substance Use Disorder later in life.
Importance of Comprehensive Prevention Efforts
An analysis from 2018 KIP Survey showed that after controlling for demographic factors, youth who began using substances earlier in life were much more likely to currently misuse opioids, and the effect was stronger the earlier they began using substances. A follow-up analysis showed the same pattern among adults who began using substances in adolescence, with those who began using younger at an even higher risk of currently misusing opioids.
This underscores the importance of reaching young people early and changing their attitudes towards substance use in order to impact the trend of opioid misuse and substance use more broadly.
Kentucky's Regional Prevention Centers (RPCs) have been working to identify and facilitate collaboration between coalitions and community groups working to reduce and prevent substance use. RPCs also provide training and connect community members to prevention resources like specific evidence-based prevention programs as well as initiatives that support building resilience and overcoming trauma. To learn more about how you can plug in with the RPC in your region, click here.
In addition to working to prevent substance use, it is important to acknowledge that many people already use substances. Harm reduction is a public health approach that tries to reduce the harm of using substances. Two important harm reduction strategies for opioids are distributing medicine that reverses overdoses and creating syringe exchange programs so that people don't reuse needles that can spread diseases.
HIV and Hepatitis C Outbreaks
In 2015, Scott County, Indiana saw an outbreak of HIV cases. In the span of a year, there were 185 new cases of HIV in a county that had seen 5 cases in the prior decade. The outbreak was traced back to people who were sharing syringes to inject opioids. In 2014, Kentucky had the highest rate of new Hepatitis C cases in the country and since then Kentucky has remained in the top 10 states. The increase in cases of Hepatitis C, a blood-borne virus, was also traced back to people sharing syringes to inject opioids.
In response to these disease outbreaks among people who using opioids, in 2015, the Centers for Disease Control and Prevention (CDC) produced a report that assessed the vulnerability of counties across the country for rapid HIV/Hepatitis C outbreaks. Nearly half of Kentucky's counties (54 of 120 counties) were identified as at-risk for a rapid HIV/Hepatitis C outbreak.
Syringe Exchanges
To address the risk of disease outbreaks, Kentucky's Senate Bill 192 allowed counties to start harm reduction syringe exchanges, which provide new, clean syringes to people who use drugs. Syringe exchanges are an evidence-based strategy to prevent the transmission of diseases like HIV and Hepatitis C that can spread if drug users share and reuse syringes. Syringe exchange programs also help to connect people who use drugs to treatment services, overdose prevention resources (e.g. naloxone) and other important behavioral health resources. There are now 74 operating syringe exchange programs in 64 counties in Kentucky. You can find a syringe exchange program by clicking the map.
Life-Saving Impact of Naloxone
Naloxone is a medicine that has been used for decades to reverse opioid overdoses. In 2015, an easy-to-use nasal spray of naloxone (NARCAN) was approved by the FDA. This made naloxone much more easily used by people without medical training. In March 2015, Kentucky passed Senate Bill 192, which allowed pharmacies to dispense naloxone to individuals without a prescription. This greatly expanded access to naloxone and has helped to curb the trends of opioid deaths. You can find a place to buy naloxone by clicking the map below.
Find a pharmacy selling naloxone or a syringe exchange by clicking the map or the following link: https://odcp.ky.gov/Stop-Overdoses/Pages/Locations.aspx
Find a pharmacy selling naloxone or a syringe exchange by clicking on the map.
In Summary…
Effective and accessible prevention, harm reduction, treatment, and recovery resources are all critical pieces to fight the overdose epidemic. These resources should be made as widely available as possible to save lives and make our communities safer.
Resources
If you or a loved one need help…
FindHelpNowKY.org helps individuals find a treatment center that is accepting new patients for substance use now. Available online or by phone. Call 1-877-318-1871.
The Kentucky Opioid Assistance and Resource Hotline is staffed by nurses and pharmacists nationally certified in toxicology. A service of the Kentucky Poison Control Center, the hotline is available 24 hours a day – 7 days a week. Call 1-800-854-6813.
The National Suicide Prevention Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals. Call 1-800-273-8255 or chat at SuicidePreventionLifeline.org.
The Crisis Text Line provides 24/7, free and confidential support for people in crisis. Text 741741 from anywhere in the US to be connected to a trained Crisis Counselor. Find more info at crisistextline.org.
ABOUT THE AUTHOR: Teresa McGeeney, PhD, is an epidemiologist at REACH Evaluation. She leads Kentucky's State Epidemiological Outcomes Workgroup (SEOW) with funding support from the Kentucky Department of Behavioral Health, Developmental and Intellectual Disabilities (BHDID). Both BHDID and the SEOW were integral in creating this data story, by providing data, expertise, and feedback.