Kentucky's New Heroin Law Makes A 'Culture Shift'

WASHINGTON — On Tuesday night, Kentucky lawmakers passed wide-ranging legislation to combat the state’s heroin epidemic. The bipartisan measure represents a significant policy shift away from more punitive measures toward a focus on treating addicts, not jailing them.

The state will now allow local health departments to set up needle exchanges and increase the number of people who can carry naloxone, the drug that paramedics use to save a person suffering an opioid overdose. Addicts who survive an overdose will no longer be charged with a crime after being revived. Instead, they will be connected to treatment services and community mental health workers.

At a Wednesday morning press conference before he signed the bill into law, Gov. Steve Beshear (D) said the legislation sent a simple message to addicts across Kentucky: “We’re coming to help you. Work with us. Help us to help you to get on the road to recovery.”

In the past, help along the road to recovery in Kentucky typically meant an abstinence-only program that barred the use of medically assisted treatments — the very treatments the broader medical establishment deems essential to an opiate addict’s survival. In January, a Huffington Post investigation chronicled how this approach was failing opiate addicts. It found that the vast majority of heroin addicts in Northern Kentucky who suffered fatal overdoses in 2013 had some experience with 12-step or other abstinence-only treatment.

Medically assisted treatments such as the drug Suboxone, which can blunt opioid withdrawal symptoms and an addict’s cravings without causing intoxication, are barred from the state’s publicly funded network of residential facilities known as Recovery Kentucky. Those facilities, The Huffington Post found, had high dropout rates and questionable oversight. Mike Townsend, who runs Recovery Kentucky, told HuffPost at the time that he would not permit the use of Suboxone in his treatment centers.

Although the new law doesn’t address Recovery Kentucky, it makes clear that the state now views the use of medically assisted treatments as a matter of good public policy. The legislation includes funding for “county jails that employ evidence-based behavioral health treatment or medically assisted treatment for inmates with opiate addiction.” It also provides funding to community mental health centers and other providers to offer similar treatments, especially for pregnant addicts.

Kentucky state Rep. John Tilley (D-Hopkinsville), who helped write and shepherd through the legislation, called it a “culture shift.”

“I want to encourage the use of medically assisted treatment,” said Tilley, who chairs the state’s House Judiciary Committee. “I think the model that we’ve used for years in this state can be effective, but to not use what evidence and data and research and science tells us will work — I think that’s going to cost us lives.”

Tilley addressed the Huffington Post story when discussing the new law. “I know that your article focused on particular resistance to the use of Suboxone, but nothing in this bill would bar the use of Suboxone or other medically assisted treatments. … I, for one, think that it should be part, should be one of those options, one of those tools in the tool box,” he said, noting that he has a copy of the HuffPost story in his briefcase.

Dr. Allen Brenzel, medical director of Kentucky’s Department for Behavioral Health, Developmental and Intellectual Disabilities, said that the legislation moves the state toward a more open-minded approach to treating addiction. “It opens the door to what most of us think is best — individual, patient-based [treatment]. What are their needs rather than having a dogmatic one-size-fits-all [approach],” he said.

Townsend, who runs Recovery Kentucky, declined to comment on the legislation. “I haven’t read it yet,” he said.

No cultural shift can take place in the treatment world without funding. Tilley said there is real money set aside for the new approach. But others like Terry Carl, who runs the Kenton County Jail, remain cautious.

Carl told HuffPost that he sees the bill as a positive but he isn’t sure where the money will come from to pay for treatment. “That’s a big question,” he said. “I’m really not sure how this is all going to be generated and where it’s going to come from.”

Anne Roberts, who lost son Patrick Cagey to a heroin overdose in 2013, said she was not very optimistic. She doesn’t think the legislation goes far enough in changing the abstinence-only culture in Kentucky — a deeply rooted sensibility she sees firsthand as a member of a Lexington-based task force looking at the heroin epidemic. As with Carl, the funding question is a big one for Roberts.

Success may ultimately hinge on the state’s medical community and court system. The new law says nothing about the state’s drug courts, which refuse to allow defendants to take Suboxone or methadone — a stance that is now at odds with federal policy. Attorneys in Kentucky recently filed a federal lawsuit against the state and its drug courts over the anti-medication rule.

The legislation does try to better integrate the medical community into the addiction treatment system. It calls for medical schools and graduate training programs to offer a minimum of 10 hours of coursework dedicated to the study of addiction.

The law also pushes for emergency room personnel to provide referrals and other interventions to addicts. Tilley said that although such help has not been made mandatory, hospital administrations have bought into the idea. As the Huffington Post investigation pointed out, emergency rooms in Kentucky had often seemed indifferent to addicts’ ultimate fate and had few resources available to them.

“When they leave the hospital, where does it go from there? There’s no hook for treatment. There’s no intervention. We wanted to partner with community mental health centers and other providers to offer that,” Tilley explained. “It’s sort of based on the model of rape crisis services and victim advocates and the role they play.”

Jason Merrick, a staffer at the Grateful Life Center, a Recovery Kentucky facility, sees the legislation as a victory. As chairman of the Northern Kentucky chapter of People Advocating Recovery, he has pushed for greater access to medical approaches to treating addiction.

“I think it’s amazing that Kentucky has finally joined the 21st century and allowed for some real solid evidence-based interventions that will help to combat this epidemic,” Merrick said.

In the last three weeks, he said, two former residents of Grateful Life had succumbed to fatal overdoses. And last night, Merrick learned that a cousin in Ohio had died from an overdose.
Source: Huff Post

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