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Combating Kentucky’s Opioid Crisis

When Ruby Ann Gayheart was a little girl, she loved going to church. She loved the sense of connection and community, and the singing of hymns like “Glory, Glory, Glory” and “One Day at a Time.” Even then, Ruby had a sad secret, the first of many, and maybe what she loved most was going up to the altar, kneeling in her flowered dress and whispering that secret to God. “And I would cry,” she says, “It was one of the highest highs I ever felt.”

She would recall that feeling during dark times in the years ahead as she struggled through the shallow highs and deep lows of opioid addiction. Gayheart’s story echoes that of too many in Kentucky, where a national crisis is hitting especially hard and people across the commonwealth are trying to hit back with a combination of cooperation, regulation, and innovation.

Last year, Kentucky lost a record 1,404 people to overdose, according to the Kentucky Office of Drug Control Policy, one of the highest overdose death rates in the nation. Overdose now kills more Kentuckians than homicides or car accidents.

Among the drugs most frequently found in the systems of overdose victims were fentanyl (47 percent of victims), heroin (34 percent), and oxycodone (19 percent), all of which are classified as opioids, as are drugs like hydrocodone (sold as Vicodin), codeine, and morphine.

Opioids are a category of narcotics that impact how the body and brain process both pain and pleasure. Morphine, a natural opioid that first was derived from opium in 1805, takes its name from Morpheus, the Greek god of dreams. Some of the first opioid addicts in Kentucky were Civil War soldiers who received the drug to numb the pain of battlefield injuries. Today’s crisis also encompasses synthetic and semisynthetic opioids.

Greed, not need

According to U.S. Rep. Hal Rogers, who represents Kentucky’s 5th District, much of the current crisis stems from greed, not need. “Drug companies started this by pushing doctors to prescribe strong pain medications,” he says. Speaking from his office in Somerset, the 18-term Republican singled out the actions of Connecticut-based Purdue Pharma, maker of OxyContin. “Purdue Pharma sent out armies of salespeople to doctors’ offices to tell them of this wonderful drug they said was not addictive, and that proved not to be true. And they paid the price.”

In 2015, Purdue Pharma agreed to pay $24 million to settle a lawsuit filed by the Kentucky attorney general’s office related to the company’s OxyContin marketing practices in the state. Purdue Pharma admitted no wrongdoing and did not respond to Kentucky Living’s request for comment, but has faced similar lawsuits from many other state and local governments, as have other drug producers and distributors.

In June, Attorney General Andy Beshear announced plans to file additional lawsuits against drug companies, as evidence warrants, and provided $8 million from the settlement to drug treatment centers around the state.

David Cobb is public relations and marketing manager for Isaiah House, a private residential substance abuse treatment center in Willisburg. “We have 88 clients here at any given time,” he says. “Five years ago, we didn’t even have half that.” Isaiah House offers treatment programs of varying lengths that combine structure, exercise, classes, therapy, job training, and Bible study. While some facilities wean clients off their addiction using a protocol of other drugs known as medication-assisted treatment, at Isaiah House, clients have to stop using cold. “That’s really hard,” says Cobb, himself a recovering addict.

The treatment center also offers a relatively new alternative to cold-turkey opiate detox that uses a neuro-stimulation device to block pain signals to the brain. However, most insurance companies do not yet cover its cost.

Isaiah House once had a treatment program for men and women, but now focuses on men and refers women to other facilities, like Chrysalis House.  For clients to pay for the 30-day treatment program, Cobb says staff members use an income-based sliding scale or work to find other ways to deliver services. Plus, Isaiah House takes insurance, including Medicaid. The federal program’s expansion under the Affordable Care Act, according to Cobb, has proven to be a lifesaver for many addicts. “The Medicaid expansion through Obamacare has really transformed this ministry and helped us treat people who otherwise wouldn’t be able to afford treatment,” he says.

Connecting those with substance abuse disorders to both treatment options and the means to pay for them is part of the mission of Operation UNITE, a nonprofit based in London that Rogers helped create in 2003 to serve his district, where the opioid crisis has been especially devastating. UNITE—which stands for Unlawful Narcotics Investigations, Treatment and Education—uses a combination of state and federal funds, along with private donations, to offer a variety of programs, including vouchers for long-term drug treatment. UNITE receives approximately 1,200 calls per month from people seeking help or information on dealing with a substance abuse-related issue.

The organization also sponsors education and prevention initiatives, including Camp UNITE for middle school youth who are at high risk of drug use, whose immediate family has been directly impacted by substance abuse, or who can’t afford a summer camp experience. In addition, there are anti-drug UNITE Clubs for children in grades 4-12 that provide mentoring and community service components. Last year, more than 7,000 students were members of these clubs in nearly 100 southern and eastern Kentucky schools.

“It’s succeeded beyond anything I’ve dreamt of,” says Rogers, adding that the program is a national model.

Educate earlier

Operation UNITE President and CEO Nancy Hale says the organization supports a comprehensive statewide K-12 anti-drug education curriculum for Kentucky schools. “We’re not starting young enough,” she says. “Many schools are waiting until middle school. Because the average age of first-time drug use in southern and eastern Kentucky is 11 years old, we need to begin to educate youth early.”

Hale says part of that curriculum has to include understanding why people become addicted to opioids, how to make good choices, how their bodies are affected by substance use, and the consequences if they choose to use drugs. Children and youth need to understand they may be at greater risk if they, a parent, or a sibling has a history of addiction—whether it is alcohol or other drugs, she says.

Ruby Gayheart had all of those risk factors when she swallowed her first opioid pill in 2002, a prescription she received for pain following an ATV wreck. The secret she’d whispered to God in her childhood church was that she had been the victim of sexual abuse by multiple abusers. Her parents, both alcoholics, split up when she was 10, and she moved around, often feeling lost and unprotected, “like a rag doll, like something was wrong with me.” The sexual abuse continued until she was 18.

When she first took opioids, “I liked the energy it gave me, the feeling of getting out of myself. It numbed me. But if I didn’t have it, I was like a zombie. I was the walking dead.”

Opioids create an initial feeling of bliss because of the chemical reactions they stimulate in the brain. The intensity of the high—which Gayheart says might last only 15 or 20 minutes—eventually diminishes, and people start seeking the drugs to stave off the feelings of sickness, lethargy, and anxiety that accompany withdrawal.

Van Ingram, director of Kentucky’s Office of Drug Control Policy, says once opioid addiction takes hold, “The brain has been rewired and starts to perceive these drugs the same way it perceives food and water.” The opioid-hungry brain will essentially hold you hostage, torturing you until you meet its needs. “We act like it’s just an issue of will,” Ingram says. “It’s really a chronic disease you’re going to have for the rest of your life.”

And it sets in fast. William Barnes is a surgeon at the Livingston County Hospital in Salem. “We used to give patients 20-30 pills, which is way too many,” he says. “If you take them more than three or four days, you’re at risk of addiction.” New laws require doctors to administer drug screens to chronic pain patients. “We were surprised by how many of our patients weren’t taking their drugs,” Barnes says. “They were selling them.” Doctors also use the Kentucky All Schedule Prescription Electronic Reporting System (KASPER), which tracks controlled substance prescriptions. Also, he says, “Now, we’re only legally able to give them two or three days of pain medication.”

Those new restrictions on prescription opioids have fueled the popularity of heroin and fentanyl, which are both cheaper and deadlier. Like heroin, the street-drug versions of fentanyl (known as analogues) are often produced in illegal drug labs overseas and smuggled into the U.S. If the ingredients aren’t mixed properly, the user can end up in the morgue.

For more than a decade, Ruby knew that she was headed in that direction, but couldn’t get off the path. She has two daughters and says, “I knew I let my kids down, and that’s the worst feeling ever.” One day in 2013, she spent part of an afternoon walking outside among the trees lining Pigeon Roost Road near Hazard. She was wanted by the police for drug possession, and was consumed both by guilt and the craving for another high. “I wanted to die,” she says, “but part of me wanted to live.” That realization, glimpse of light, led her to make a dramatic move.

“I walked into the state police post and said, ‘Here I am.’ That was the best decision I made in my entire life.” That’s because Kentucky’s criminal justice system adapted its approach to the drug crisis by developing a protocol for medically assisted treatment. Kevin Pangburn, the Kentucky Department of Corrections’ director of substance abuse treatment, says, “The Department of Corrections is the largest provider of substance abuse services in Kentucky.”

Necessary innovation

In 2015, Kentucky’s General Assembly provided $3 million to develop a medical protocol for treating prison and jail inmates suffering from addiction. Pangburn said the resulting program has helped Kentucky earn a national reputation for innovative approaches to treating addiction.

The New York Times recently highlighted Kentucky’s efforts, focusing on the 24-hour substance abuse program at the Kenton County Detention Center. The program works

Read about naloxone, a tool that is helping save lives.

to create a “therapeutic community” among inmates: “… rethinking jail, as Kentucky has, as a place of sanctuary and recovery for a population that has lost hope, might not just be advisable; it may be indispensable.”

Another approach: diverting addicts who’ve been charged with possession or other low-level crimes into treatment instead of jail. That’s the mission of Drug Courts, which operate in all 50 states and in 113 of Kentucky’s 120 counties. Drug Courts administer a structured, individualized program for people with the disease of addiction, giving them the chance to kick their habit, typically while living at home.

Judge Kevin Holbrook has presided over Drug Courts in Johnson, Lawrence, and Martin counties since 2003. “When Drug Courts came in, they were seen by many in the public as soft on crime, but the problem has gotten so big, the public has come to recognize and accept the vastness of the opioid crisis in Kentucky and in the U.S.,” he says. “Drug Courts have been one of the few bright spots we’ve seen while battling this epidemic. The change in the person—both physically and mentally—is most remarkable and rewarding.”

Drug Court is where Ruby Gayheart found her way out. “It was hard. I never felt like I was smart enough or good enough, but now I know that I am. And Drug Court gave me that. Drug Court works. It’s a gift.”

Today, she is more than four years clean and sober. Her daughters, now 21 and 15, are back in her life. She’ll graduate December 3 with a bachelor’s degree in substance abuse counseling and plans to go to grad school. She wants to help other people get clean. There are still challenges. She lost her home recently in Hazard, but losing her possessions didn’t shake her resolve.

“The one thing I haven’t lost is my recovery,” she says. Hazard’s First Presbyterian Church later offered them the use of a house, and a welcome into their community.

There are no guarantees with addiction, but Ruby Gayheart feels good about her prospects, especially on Sunday mornings when she pulls out her hymnbook to sing something familiar.

Yesterday’s gone sweet Jesus
And tomorrow may never be mine 
Lord help me today
Show me the way
One day at a time. 

—Marijohn Wilkin and Kris Kristofferson 

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