The Opioid Crisis: Spotlight on Kenton County, Kentucky

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The opioid crisis has caused significant harm to individuals, families, and communities in the state of Kentucky. For the past five years, Kentucky has ranked in the top ten in the U.S. in rates of fatal drug overdose, with a majority of overdose deaths – around 70 percent – caused by opioids. Since 1999, drug overdose fatality rates have increased by an astounding 800 percent.

Between 1999 and 2005, they increased by 212 percent. From 2005 to 2014, they increased 61 percent. And between 2014 and the 2021, they increased by just over 99 percent. Let’s put that in real numbers: in 1999, around 197 people in Kentucky died of drug overdose. In 2021, 2,250 people in Kentucky died of drug overdose.

These overdose fatality numbers are driven by opioid addiction and opioid overdose, which is why we call the situation we’re in now – and have for ten years – the opioid crisis. No one is immune from the opioid crisis. Opioid addiction and overdose can impact anyone, at any time, from any demographic group.

From blue-collar workers in rural and industrial areas to white collar executives in urban high-rises to middle class families in the suburbs, everyone is vulnerable. If you haven’t read about how and why the opioid crisis developed, and how we got to where we are today, we’ll give you a brief overview now. Then we’ll discuss how officials in Kentucky reacted to the crisis, and focus on one county in Kentucky – Kenton – where we own and operate NKY Med Clinic in the town of Covington.

A Timeline of the Opioid Crisis in the U.S.

The Centers for Disease Control (CDC) identifies three phases of the opioid crisis, also known as waves. Here’s how the experts at the CDC describe the three waves:

1990-2010: Wave One

The first wave began in the early 1990s and lasted until around 2010. This wave was driven by a dramatic spike in the number of prescriptions written for opioid painkillers, along with assurances by doctors and pharmaceutical companies that the new class of opioid painkillers did not have significant risk of addiction. However, the numbers told a different story. This increase in prescriptions corresponded with a steady increase in opioid addiction and overdose nationwide.

2010-2013: Wave Two

This second wave started around 2010 and lasted until around 2013. In response to the significant harm caused by the first wave of the crisis, national policy makers changed prescribing rule and guidelines, making long-term prescriptions for opioids difficult to obtain. Though this change was well-meaning, one unfortunate consequence was a phenomenon called the prescription to addiction pathway. In the absence of a prescription, many individuals who developed an opioid addiction – called opioid use disorder (OUD) – switched to illicit drugs like heroin. The prescription to addiction pathway resulted in an unprecedented nationwide increase in heroin addiction and fatal heroin overdose.

2013-2019/2020: Wave Three

The third wave began around 2012-2013, and while the CDC has not declared this wave over, many experts think it ended in 2019-2020, with the arrival of the COVID-19 pandemic – we’ll get to that in a moment. Wave three has been different than the first two waves in one important way. Rather than prescription opioids or heroin, fentanyl and other synthetic opioids are the main drivers of this wave. In fact, CDC data indicates almost a third of overdose fatalities in 2016 involved synthetic opioids. This upward trend in the presence of fentanyl in fatal overdose victims has continued through 2021 and 2022, according to data published by the Drug Enforcement Agency (DEA).

Many analysts identify a new wave, called Wave Four, which has not been explicitly defined by the CDC – yet. However, the increase in fentanyl – an opioid fifty times stronger than heroin and a hundred times stronger than morphine – along with a complex array of factors related to the COVID-19 pandemic – has resulted in another surge in overdose deaths. The social, psychological, and emotional turmoil of the past two years has increased vulnerability to addiction overall, and the influx of fentanyl, which drug dealers use to produce illicit fake-prescriptions opioids and to enhance the effects of stimulants such as methamphetamine and cocaine, combined to make 2021 the worst year on record for fatal drug overdose.

To put the Kentucky data we opened this article with in context – and to help us understand the scope of the statewide response to the crisis – we’ll share the latest nationwide statistics on the opioid crisis, then move on to more data from Kentucky, and specific data from Kenton County.

The Opioid Crisis: National Statistics

The CDC reports the following numbers for the years 2019-2021. As you read these numbers, keep in mind that they begin just before COVID-19, and end a year and a half after the introduction of the vaccines. These are the total fatal overdoses for any/all drugs:

  • 2019: 67,697
  • 2020: 78,056
  • 2021: 107,306

And these are total fatal drug opioid overdoses:

  • 2019: 50,178
  • 2020: 69,061
  • 2021: 73,453

We’ll frame these numbers the same way we framed the initial numbers we shared from Kentucky. Between 1999 and 2021, the overdose death rate increased 364 percent, from a rate of 6.1 death per 100,000 people to a rate of 28.3 per 100,000 people.

That’s about 17 percent a year, which is cause for alarm.

The yearly increase for the state Kentucky was more than double that for the same time period: it increased from a rate of 4.9 overdose deaths per 100,000 people to 49.2 overdose deaths per 100,000 people.

That’s why public health officials and addiction treatment and awareness advocates call it a crisis. It’s ongoing, and, if we take all the latest data at face value, the COVID-19 pandemic has made it worse. However, all the news is not bad. We know what works to prevent opioid overdose and addiction. Awareness is the primary, evidence-based tool we can use for prevention, and integrated treatment is the primary, evidence-based tool we can use to support people with OUD, a.k.a. opioid addiction.

We’ll discuss how public officials and communities across Kentucky use both those tools in a moment.

First, let’s take a look at the overall overdose data from the state of Kentucky.

Addiction and Overdose Facts and Figures: Kentucky

According to the CDC, the Kentucky Cabinet for Health and Family Services, and the University of Kentucky College of Public Health, these are the latest statistics for Kentucky.

2016-2012: Fatal Overdose in Kentucky

Those numbers show a 50 percent increase in overdose death over the past five years, with an 11 percent increase in the percentage of opioid-involved fatalities, and a 78 percent increase in opioid overdose fatalities. The percentage of heroin involved fatalities decreased by 16 percent. Let’s drill down on the 2021 data, in an effort to understand how overall opioid fatalities significantly increased, while overall heroin overdoses decreased.

Here’s the 2021 specific data:

  • Fentanyl was detected in 1,639 overdose fatalities, or 73%
    • That’s 16% increase from 2020
  • Methamphetamine detected in 1,075 overdose fatalities, or 47.8%
    • A 32% increase from 2020

The Kentucky Office of Drug Control Policy (ODCP) explains the effect of fentanyl, methamphetamine, and COVID-19 on the 2019-2021 surge:

There has been an increase in illicit fentanyl and its analogs within the drug supply. An opioid was involved in 90% of all overdose deaths in Kentucky, and fentanyl was detected in more than 70% of those cases not only in Kentucky, but nationwide. This problem is exacerbated by the widespread availability of potent inexpensive methamphetamine. COVID-19 caused interruptions to people’s daily lives bringing about greater isolation, economic concerns and increased anxiety about the future, public health, sickness, and the ability to meet one’s basic needs. All of these are detrimental to those struggling with addiction or in recovery.”

When we read information like that from an official source, we know the officials who wrote it are on task: that shows a nuanced understanding of the overall problem. Now let’s look at how the state of Kentucky has responded to the opioid crisis – which may surprise you.

The Response in Kentucky

We have high praise for the public officials in the State of Kentucky. Their response is comprehensive. It’s data driven. It’s responsive to the needs of diverse communities. Officials prioritize efforts that aren’t popular with everyone – especially people new to the contemporary approach to addiction treatment and support. Harm reduction programs, needle exchange programs, access to addiction treatment, and enhanced access to medication-assisted treatment for opioid use disorder – MAT for OUD – are all important components of the statewide response.

We have high praise for the public officials because evidence shows all those things are effective in reducing the harm caused to individuals, families, and communities by the opioid crisis.

Here’s an overview of the response, which is organized by the Kentucky Overdose Response Effort (KORE).

KORE: An All of the Above Approach to the Opioid Crisis

The KORE Mission:

“Expand and sustain an equitable recovery-oriented system of care and reduce opioid-related overdose deaths in the Commonwealth of Kentucky by increasing access to evidence-based prevention, harm reduction, treatment, and recovery support services.”

Guiding Principles:

  • Reduce harm by the following methods:
    • Prevent initiation of opioid use
    • Prevent opioid misuse
    • Detect need for treatment as early as possible
    • Improve treatment access and engagement
    • Support retention in treatment
    • Sustain recovery and prevent relapse

Naloxone:

  • Improve Access: Naloxone, a.k.a. Narcan, is a fast-acting, lifesaving, overdose reversing drug
    • 71,387 Narcan kits distributed
    • 5,032 overdose reversals reported
  • Syringe Service Programs (SSPs): SSPs reduce the transmission of disease like HIV and hepatitis C, and connect people in need to treatment, healthcare, and housing resources.
    • 22 SSPs across Kentucky

Family Support:

  • Early childhood consultants have helped 816 women and children affected by opioid addiction

School Programs:

  • The Too Good For Drugs Program:
    • 252 schools
    • 112,230 students supported
  • Source of Strength Peer Leader Program:
    • 97 schools
    • 5,595 peer leaders trained
  • Positive Action Youth Program:
    • 11 Clubs statewide
    • 2,895 participants

Treatment:

  • 28,625 citizens received KORE-sponsored treatment support
  • Medication-Assisted Treatment (MAT), or Medications for Opioid Use Disorder (MOUD)
    • 10,356 citizens received MOUD in various settings, including:
      • Residential treatment centers
      • Pregnant and Parenting programs
      • Community mental health centers
      • Drug courts
      • Community pharmacies
      • Jails and/prisons
    • The Treatment Access Program (TAP):
      • KORE will act as “payor of last resort” for uninsured individuals who need:
        • Residential treatment
        • Intensive outpatient treatment
        • Methadone programs
      • 5,172 citizens have received treatment support
      • 1,074 have received methadone support
    • Primary Care Integration:
      • KORE sponsors programs for early detection of OUD in a “meet them where they are” model in:
        • Federally Qualified Health Centers
        • Primary Care Clinics
        • Rural Health Clinics

Recovery:

  • Recovery Community Centers (RCC)
    • RCCs host community support meetings like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA)
    • They become community-based support hubs
      • 11 RCCs
      • 4 Youth Drop-In centers
    • Recovery Capital: Personal, Social, and Community Improvement
      • 16,031 citizens supported in accessing “…the total resources that a person needs to move toward recovery.”
    • Re-entry
      • Housing and employment support offered to 4,149 justice-system involved individuals upon return to society
    • Employment
      • The Strategic Initiative for Transformational Employment (SITE) connected 829 citizens to job training connected with over 2,500 businesses with regards to re-entry employment

It’s clear why we repeated the phrase high praise twice when we introduced the array of programs Kentucky has adopted in response to the opioid crisis. All of the programs above are active today and funded by KORE. That’s how they use awareness and treatment to address the opioid crisis in Kentucky.

Now we’ll narrow our focus, and look at the details on the ground in Kenton, Kentucky, where we own and operate NKY Med Clinic in the town of Covington.

The Opioid Crisis in Kentucky: Kenton County

Kenton County is located in Northern KY on the border with Ohio, just across the Ohio River from the city of Cincinnati. Kenton has a population of 170,000 people, and is a mix of rural, exurban, suburban, and urban communities. It’s known for having two county seats: one in Covington, near Cincinnati, and one further south in Independence.

What you’ll see in the following data from Kenton is the picture of a county that’s been hard hit by the opioid epidemic in a state that’s been hard hit by the opioid epidemic. In the following data, we use the fatal overdose rate per 100,000 people, because that allows us to compare rates across counties and states without using too many large figures. Think of the following rates this way: in the U.S., a low rate of overdose fatality is under 20, a medium rate is between 20 and 40, and anything over 40 is high.

The state of Kentucky had a rate of around 30 fatal overdose deaths per 100,000 people per year from 2015-2019, but that rate increased to 43 in 2020. That’s now in the high range, and far greater than the rate of 4.9 deaths per 100,000 people per year at they very beginning of the opioid crisis in 1999.

Keep those numbers in mind as you look at these figures for Kenton County.

Kenton County: Opioid Epidemic Data

  • Fatal Overdose Rates (per 100,000):
    • 2016:
      • Total: 50 per 100,000
      • Opioid: 38 per 100,000
      • Heroin: 12 per 100,000
      • Stimulant-involved: n/a
    • 2017:
      • Total: 69 per 100,000
      • Opioid: 58 per 100,000
      • Heroin: 11 per 100,000
      • Stimulant-involved: 21 per 100,000
    • 2018:
      • Total: 55 per 100,000
      • Opioid: 45 per 100,000
      • Heroin: n/a
      • Stimulant-involved: 10 per 100,000
    • 2019:
      • Total: 47 per 100,000
      • Opioid: 38 per 100,000
      • Heroin: n/a
      • Stimulant-involved: 15 per 100,000
    • 2020:
      • Total: 50 per 100,000
      • Opioid: 45 per 100,000
      • Heroin: n/a
      • Stimulant-involved: 14 per 100,000

Those numbers tell us that between 2016 and 2020, the years for which we have access to county-level data, Kenton had consistently high overdose rates compared to the rest of Kentucky. They peaked in 2017, decreased significantly in 2018 and 2019, but began increasing again in 2020. As indicated in the statement from the Kentucky Office of Drug Control Policy (ODCP), the presence of fentanyl and complications related to COVID-19 are likely driving the recent upward trend both across Kentucky and in Kenton County.

The Response in Kenton: KORE Programs Step In, Locals Step Up

Evidence shows Kenton needs support. According to Team Kentucky: Cabinet for Health and Family Services, the following four KORE programs are active in Kenton County:

  1. Naloxone Harm Reduction Services:
    • Pharmacies
    • Mobile Units
    • Local treatment providers
  2. Support for Parenting and Pregnant Women:
  • Integrated Care for Pregnant and Parenting Women connects hospitalized women with treatment services
  • Treatment Assistance Program (TAP) provides intensive outreach and support to women and children involved in public assistance or child welfare programs
  1. School Prevention Programs:
  • Positive Action Program active in local boys and girl’s clubs
  • Too Good for Drugs Program active at Miles Elementary
  • Source of Strength Program active at Woodland Middle School
  1. Treatment Assistance Programs:
  • Nine KORE programs support – and sometimes pay – for treatment needs in Kenton, including:
    • MAT programs
    • Residential/IOP programs
    • OUD programs
    • Methadone programs (including ours)
    • Peer support programs at domestic violence shelters
    • OUD/MOUD in the Kenton Detention Center
  1. Recovery Support
  • Additional active local programs include safe and affordable recovery friendly housing resources, and employment assistance in collaboration with the Northern KY Workforce Development Area.

It’s clear that communities in Kenton are committed to mitigating the harm caused by the opioid epidemic. It takes time, energy, and dedication to organize, initiate, and administer every program listed above. Funding from the state and KORE doesn’t magically make programs appear. That takes real people getting up every day and doing everything they can to make the world a better place, starting with the community where they live.

That’s why we’re proud to be on the community resource list available online through KORE, and grateful for the peers and community members that support our ongoing efforts in Covington at NKY Med Clinic.

The materials provided on the Pinnacle Blog are for information and educational purposes only. No behavioral health or any other professional services are provided through the Blog and the information obtained through the Blog is not a substitute for consultation with a qualified health professional. If you are in need of medical or behavioral health treatment, please contact a qualified health professional directly, and if you are in need of emergency help, please go to your nearest emergency room or dial 911.