While drug overdose deaths in Kentucky decreased 15% last year, officials this week said there is still more work to be done.
Van Ingram, executive director of the Office of Drug Control Policy, said while there were 233 fewer deaths, there were still 1,333 lethal overdoses last year.
"That isn't acceptable. It's not a number we can live with," he told the Interim Joint Committee on Health, Welfare and Family Services this week.
Ingram said the 10 counties where people are statistically at the greatest risk of overdosing are Madison, Clark, Kenton, Boyd, Gallatin, Pendleton, Owen, Jefferson, Grant and Campbell.
Madison County Coroner Jimmy Cornelison told The Register earlier this month the county had 42 confirmed overdose deaths and two more pending.
"We've already surpassed last year," he said then.
The confirmed number of overdoses is potentially the highest ever in Madison County. In 2016, there were 33 overdose deaths in the county. That increased to 40 in 2017 and 42 last year.
While Madison County continues to see increases, the state of Kentucky saw its numbers fall from a record 1,566 deaths to 1,333 in 2018.
The statewide decline was by far the largest in at least a decade, state officials said. In 2013, the overdose death rate fell by close to 3%, they said.
Ingram said the 15% decrease was a bright spot because the nation as a whole saw a decrease of a little less than 5%.
He said some of the policy initiatives include curbing the number of controlled substances prescribed by doctors. From 2015 to 2018, the number of opioid analgesics dispensed in Kentucky fell by a little more than 800,000. That's equivalent to 64 million fewer dosage units.
"As a state, we have come to learn treatment isn't enough," Ingram said as he described some recent initiatives undertaken by his office. "Transitional housing for people in early recovery and employment support for people in early recovery are just as important as anything else we can do.
"People do get better, but it doesn't always happen on our timetable. It happens on theirs. We want to do the things we can to increase the odds that people stay in recovery and continue to get better."
Ingram was among a group that spoke about the results of numerous policy initiatives in Kentucky to reduce the number of drug overdose deaths. Last year's decrease followed years of steady increases in the death toll, driven mostly by a rise in opioid abuse, heroin and fentanyl.
Dr. Doug Oyler of University of Kentucky HealthCare testified that the initiative had reduced opioid prescriptions by 1,300 annually just within that health care system.
One initiative is expanding the use of medication-assisted treatment, known as MAT, to treat opioid use disorders. Ingram said 1,240 doctors practicing in Kentucky have received a federal waiver to prescribe the drug buprenorphine, used in MAT. Ingram added, however, that most of those doctors are treating five or fewer patients.
Buprenorphine has also become the No. 1 drug being diverted or given to another person for illicit use. Ingram said that was tragic, but that the abuse of buprenorphine generally doesn't cause overdose deaths.
State Rep. Robert Goforth, R-East Bernstadt, a pharmacist by trade, asked if Kentucky needed to pass legislation to increase training for doctors in hopes of reducing the diversion of the drug. Ingram said Kentucky could require more rigorous training than the eight-hour online course federal authorities require before prescribing buprenorphine.
"We should look into that," Goforth said in response.
Ingram said arrests for possession of heroin were down 15% and arrests for trafficking heroin were down 12% from 2017 through March of this year. He added that heroin deaths were down almost 54% during the same period.
Ingram attributed the downturn to fentanyl from China flooding the United States. He said the drug cartels recognized that it was a more profitable business model to buy chemicals from China than it is to grow opium poppies. He highlighted the fact that fentanyl trafficking arrests are up 73% in the state.
LRC Public Information contributed to this story.
Jonathan Greene is the editor of The Register; follow him on Twitter @jgreeneRR.