City Officials Get Eye-Opening Report on Kentucky's Opioid Problem

Posted on October 6, 2017

     It would come as no surprise to most people to learn Kentucky is in the middle of an opioid epidemic. It has been a tough puzzle to solve. Many of the people involved in Kentucky’s response spoke to city leaders Thursday about current trends in the state and what some communities are doing to reverse the growing number of overdose deaths. One key point the experts made was that the first step in the effort is getting the medical community to recognize prescription pain medications are not always the best choice for pain management.

     Van Ingram, the director of the Kentucky Office of Drug Control Policy, told city officials the state is reducing the overexposure to prescription pills. In 2011, Ingram said doctors prescribed 371 million doses of pain medication. That dropped to 301 million doses last year. Ingram says controlling the amount of prescription pain medication in the state is the first step in a long-range fight. “Heroin and fentanyl are really what are driving overdose deaths in the commonwealth right now, but make no mistake, this not just a heroin and fentanyl problem,” said Ingram. “This starts with prescription drugs.”

     The door to addiction is often opened with a prescription for pain. “Eighty percent of the people who die of a heroin or fentanyl overdose will have started with a legitimate prescription drug prescribed for a legitimate need,” said Ingram. Doctor Douglas Oyler, an assistant professor at the UK Department of Pharmacy, said one in five times the prescription written by a doctor is the right one, but most are too powerful for the patient’s needs. He said it’s important that groups battling the problem refocus on new ways to treat pain and change the expectation of patients. “We’re not taking your pain meds away, but providing a more comprehensive approach,” Said Dr. Oyler. He says UK uses leadership teams to address the problem, involving doctors, pharmacists, nurses and pain management.

     Kentucky has passed legislation aimed at controlling the overexposure to pain medicines. Adam Meier, Deputy Chief of Staff for Governor Matt Bevin, told the group the challenge is bringing about behavioral changes in the state. One behavior the state is trying to change is a doctor’s automatic reaction to a patient in pain. Meier says the message to the medical community is prescribing pain medication should be a last resort, not the first step. The state is also focused on peer support, for those going through the struggle of drug addiction, and is looking to develop better types of care for doctors to use. Meier says they’re starting the effort at medical and dental schools in Kentucky, hoping to develop better approaches to pain management.

     The administration also wants to see enhancements to the KASPER system, which helps track who gets prescription pain medicine and how much, to ensure the data collected is used efficiently. There’s also a push to make naloxone, many times referred to as Narcan, easier for people to get for use in overdose recovery. “What we’re trying to do, from the top down, is really coordinate and streamline our efforts so we can be more efficient with the resources we have,” said Meier. “There’s not enough resources, there will never be enough resources,” he warned. Ingram says the state is working to roll out new projects to help cities battling the problem, including a new phone number people can call to work through the bureaucracy of the substance abuse system.

     There is also an effort underway to eliminate the amount of fentanyl in the illegal drug market, but Ingram says that’s a much more difficult challenge.  The state passed House Bill 333, a KLC initiative, in the 2017 Regular Session of the General Assembly. Ingram warns, however, that lawmakers can’t legislate the overdose problem away. “I wish I could tell you we could come up with something in Frankfort that could fix this tomorrow, but that’s not going to happen,” said Ingram. “You can’t fix complicated, long-term problems with short-term solutions.”

     As the struggle to control the problem continues, those caught in the web of addiction continue to die at alarming numbers. Kentucky is third in the nation in overdose deaths. In 2016, 1,404 Kentuckians died of an overdose — a 7.1 percent increase from 2015. Doctor Allen Brenzel, medical director at the Kentucky Department of Behavioral Health, says Kentucky is struggling to get the problem under control. “As hard as you’re working, as hard as our community activists are working, we’re not tackling this overdose problem,” said Brenzel. The statistics of overdoses in the state also continue to change. Brenzel said the largest number of overdose deaths in Kentucky in 2015 was in the 45-55 age group, but in 2016 that changed to the 35-44 age group.

     Health risks from Kentucky’s drug crisis are also taking a toll on the state. Kentucky is the worst state in the nation for hepatitis C cases. Brenzel says the key is everyone in the process working together, from law enforcement to the medical community and state lawmakers. He outlined an opioid relief effort the state has undertaken, called KORE. It’s utilizing a $10.5 million federal grant to tackle high risk areas in the state. $2 million will be spent on prevention and millions more on treatment, including scholarships to ensure people can afford the care they need and expanding the availability of naloxone.

     The Kentucky League of Cities is committed to working with state lawmakers in the fight against the opioid epidemic. KLC Governmental Affairs Manager Bryanna Carroll moderated Thursday’s panel. She said it’s encouraging to see Governor Bevin’s administration and UK Hospital lead the way in the effort to control the epidemic. “They have a great four prong approach to dealing with the problem,” said Carroll. “They are looking at prevention and treatment as well as recovery support and harm reduction. We know approaching the issue from all corners will help cities as they battle Kentucky’s substance abuse crisis.” The KLC Board of Directors voted the issue one of its top legislative agenda items for 2018.