Kentucky Opioid Epidemic
Josh Justice was an all-American type of boy growing up. He was athletic, a star on his high school football and basketball team, ran cross-country and participated in almost any outdoor activity he could during his adolescence. He went on to play basketball at the University of Pikeville.
“I was the golden boy,” said Justice when describing his younger self.
This all changed when Justice started using prescription painkillers. At 9 years old, Justice remembers sipping his first sip of alcohol stolen from a friend’s father’s stash. He started consuming alcohol on a more regular basis at age 12. At 15, he started using marijuana. Soon after, he dabbled in stronger substances such as cocaine and prescription painkillers.
Justice found himself with easy access to these types of opioids. His best friend worked as a technician at his family’s pharmacy in Pikeville, Kentucky, with access to thousands of pills each shift. They were using together and he began stealing painkillers such as OxyContin, hydrocodone, and Xanax. According to Justice, this amounted to around 20,000 pills total over a six-year period of working at the pharmacy, all of which Justice and his friend were taking. At 19, Justice knew this problem of using and stealing drugs had turned into addiction.
“I did not set out to become addicted to OxyContin,” Justice said.
On March 16, 2001, Justice was involved in a car accident and was ejected from the passenger seat of his friend’s vehicle and thrown 50 feet into the air. Eighty-nine OxyContin and 300 to 400 Xanax pills were founded with the boys in the car, all stolen from the pharmacy, Justice said. All of this is subject to Justice’s recollection, attempts to obtain police reports were not obtained due to lack of information.
This accident resulted with a major spinal cord injury for Justice and he was sent to Cardinal Hill Rehabilitation Hospital in Lexington, Kentucky. Justice had to use a wheelchair to get from place to place and began to do therapy to see if he would ever be able to walk again.
“All I remember was glass breaking and seeing trees upside down,” said Justice recalling his accident.
In the eyes of an addict, this injury was Justice’s gateway to get more pills to feed his addiction. He took around 12 doses of 600 mg to 1,000 mg OxyContin a day for nearly four years for his chronic spinal pain. The prescriptions that he was given for his injury by his doctor would only last him for three days of a 30-day supply, he said.He turned to buying more off of people illegally wherever he could around the Pikeville area, he said.
According to Justice, he had nearly half a million dollars in medical bills after his accident. Once he was walking again and stable enough, Justice was able to return and maintain a full-time job, he went back to his construction job at a company co-owned by his father and uncle.
He got a settlement from the car accident and spent thousands of dollars on painkillers.
At19, he began dating a woman who was a non-user who he had known from Pikeville High School. He said she was a fun time to be around and she would drink with him and smoke marijuana, but no hardcore drugs. Justice kept his girlfriend in the dark about his addiction for nearly three years. One day she caught him in the act doing lines of crushed prescription pain killers in the bathroom.
“There was no denying what was in plain sight, she saw white lines on the back of the toilet seat,” said Justice.
Later, she began using opioids, too. One day she and Justice were pulled over while driving and searched. Justice was arrested for possession of half of a Percocet pill that he claims he forgot he had on him. (This incident could not be verified from police reports.) He was first sentenced to one month in jail which was followed by one month of house arrest. Justice said he went back to jail on Oct. 6, 2004 for three months.
On the day Justice was released from jail, Dec. 16, 2004, he began his journey of sobriety. He started a 12-step recovery program for drug addiction for three months. He said he learned about addiction and replaced his obsession with drugs with working out. He found hope during his recovery program and knew that one day he could feel normal again. Justice said that nobody ever “graduates” or fully completes a recovery program. It is something you carry for the rest of your life.
Addiction has hold in the state of Kentucky with alarming rates of overdoses, fatalities and usage. The opioid epidemic has caused the use of heroin and prescription painkillers to sky rocket in areas all across the Commonwealth. From the year 2000 to 2016, the number of opioid-related overdose deaths has increased 13 times in the United States. The epidemic has caused nationwide panic with an urgency in our region to assess the problem and implement solutions to address the issue.
A report on death rates from opioid use from the National Vital Statistics System from 2000-2016 showed that of the 42,249 opioid-related overdose deaths in 2016, 19,413 (45.9%) involved fentanyl; 17,087 (40.4%) involved prescription opioids; and 15,469 (36.6%) involved heroin.
Prescription opioids are used to treat moderate to chronic pain and are prescribed by doctors. The use of these powerful opioids has changed from mainly being a form of pain relief for cancers patients to being for moderate-to-severe pain treatments for non-cancerous illnesses.
The three most common opioids used pertaining to overdose deaths include methadone, oxycodone (the main active ingredient in OxyContin) and hydrocodone (the main active ingredient in Vicodin). Other categories include synthetic opioids, such as fentanyl and heroin.
Fentanyl can be made both legally, as a prescription used to treat chronic pain, or made illegally to enhance the effects of other drugs like heroin. According to the National Institute on Drug Abuse (NIDA), “Heroin is an illegal, highly addictive drug processed from morphine, a naturally occurring substance extracted from the seed pod of certain varieties of poppy plants.” Usually in the form of a white or brown powder, it can be ingested through snorting or smoking. Another form of heroin that is commonly referred to as “black tar” heroin is diluted and injected into the veins using needles.
It was Thanksgiving Day and Sarah noticed her older brother was missing from the dinner table. She sat with her parents, grandparents, uncles and aunts and numerous cousins, but Matthew was nowhere to be found. Eventually the rest of her family noticed his absence, too, and they found him sitting alone outside on the back porch. He seemed distant and overly skinny from his normal figure. Sarah said his torso and arms were unusually small and he had been wearing XXL t-shirts that swallowed his body.
This was not the first time that Sarah was suspicious that her brother was using drugs. As a 10-year-old, she recalls a trip with her family to the Rite Aid down the street from her neighborhood in Lexington, Kentucky. She said Matthew went to the bathroom in the store and stayed in there for half an hour. When he finally came out, he seemed high and had a bloody nose. He fainted and the pharmacist behind the counter called 911 for medical assistance. They eventually figured out that he was high off of fumes from a computer cleaning spray inhalant. She said this was the starting point of a long road of drug abuse, heartache and fear that her brother and family endured over the next 10 years.
It wasn’t until high school that Sarah understood the severity of her brother’s drug problem and began to see it as an addiction. Her parents tried to shield her from it as much as possible during her adolescence but eventually she caught on.
Matthew’s addiction stemmed from frequent use of marijuana and alcohol but grew to prescription painkillers like morphine, Xanax, OxyContin and hydrocodone. These painkillers led to his use of heroin. After Sarah had her wisdom teeth surgery in high school, she remembers having to hide her medications of high-dose painkillers from fear of Matthew finding them. He had previously stolen doses of morphine from their grandparents.
His drug use continued from high school into college. He got caught and arrested on Western Kentucky University’s campus during the one semester he attended during 2011, with possession of marijuana and alcohol.According to Sarah,Matthew was later kicked out of the university after a three-strike policy after these instances. One of the other instances was when an RA found a beer can in his dorm room trash can.
“He was like a magnet to the authorities,” said Sarah.
According to Sarah, he was arrested at a later date in Nashville while at a music concert with a blunt filled with marijuana in his pocket
After his use of marijuana and prescription painkillers led to the use of heroin, their parents knew he needed professional aid with his addiction, Sarah said.
Sarah, whose asked her last name not be used to protect her family’s privacy, said she was suspicious that her brother was using drugs. As a 10-year-old, she recalls a trip with her family to the Rite Aid down the street from her neighborhood in Lexington, Kentucky.
According to Sarah, he was arrested at a later date in Nashville while at a music concert with a blunt filled with marijuana in his pocket.
After he began using heroin, their parents knew he needed professional aid with his addiction, Sarah said.
He was in and out of rehab, got sober and relapsed. He now lives in North Carolina, where he has been clean for two years, Sarah said.
Still, she worries about him.
“I try not to live in fear,” said Sarah.
Kentucky has implemented numerous policies and acts to influence the opioid crisis in order to see an impact on use, overdoses and fatalities. According to the 2017 Combined Annual Report from the Kentucky Office of Drug Control Policy and the Kentucky Agency for Substance Abuse Policy, the Kentucky Justice and Public Safety Cabinet announced in July 2017 that “eight programs in Kentucky will receive a total of $16.3 million from the state budget this year to combat heroin and substance abuse in the Commonwealth.”
According to the same report, the top five counties with the highest death rates related to both heroin and fentanyl combined in 2016 were Jefferson County (59), Campbell County (21), Fayette County (20), Boone County (12) and Kenton County (11).
The U.S. Department of Health and Human Services (HHS), Food and Drug Administration (FDA) and National Institutes of Health (NIH) have implemented programs for mental health addressing the opioid crisis through funding for medical innovation for mental health. The Cures Act, or 21st Century Cures Act, was passed on Dec. 13, 2016 that allocates $4.8 billion to the NIH over the next 10 years in efforts to improve medical practices in order to address opioid abuse in the United States.
In an effort to regulate the distribution of opioid prescriptions through pharmacies in Kentucky, the state uses a program called KASPER. According to the Kentucky Cabinet for Health and Family Services, “The Kentucky All Schedule Prescription Electronic Reporting System (KASPER) tracks controlled substance prescriptions dispensed within the state. A KASPER report shows all scheduled prescriptions for an individual over a specified time period, the prescriber and the dispenser.”
According to amfAR’sOpioid and Health Indicators database (http://opioid.amfar.org), Kentucky has implemented legislation to permit syringe exchange programs in 23 locations around the state. There are 326 facilities that provide substance abuse counseling and services in Kentucky.
A survey by researchers at the Institute for Social Research at the University of Michigan, Ann Arbor, under the National Institute on Drug Abuse, found that 4.2 percent of 12th graders in 2017 misused opioids, other than heroin. They found hat 0.4 percent of 12th graders misused heroin.
Sherry’s son, Matt, had been dating his girlfriend for only three months when the couple decided to get married. The couple moved to Jessamine County, Kentucky. Several months later, Matt called his mom and said he had caught his wife cheating on him and using drugs.
According to Sherry, their family endured a cycle of drug abuse from her daughter-in-law that affected them financially and emotionally. Her use started with marijuana and prescription pain killers and moved to heroin.
The couple have two young children. At one point, when they lived with Sherry and her husband, Sherry found needles a packet of white powder, a spoon and matches. After finding all of these supplies, she asked them to move out, worried about other grandchildren who visit.
“He said that he loved her and she was his soulmate and he felt like God was telling him he needed to stay with her and help her,” Sherry said about her son and his wife.
Eventually Matt checked his wife into rehab and later filed for divorce.
Sherry said her son told her: “Mom, 10 years of my life are gone and I have nothing to show for it.”
The CDC, Centers for Disease Control and Prevention, identifies four distinct risk factors for opioid pain reliever abuse that are likely to lead to overdose. The first factor is overlapping prescriptions from more than one doctor/and or pharmacy. Second, having a history of alcohol abuse or another substances. Third, taking high doses of prescription opioids daily. The fourth is living in rural regions which generally results in having low income.
Pertaining to low income rates, the CDC shows that Medicaid patients are more likely than private insurance holders to obtain opioid prescriptions. In a study done in 2010, 40 percent of Medicaid participants with prescription opioids have an indicator of misuse of their prescriptions.
There are certain actions to be taken when someone is experiencing an overdose to reverse the affects. One form is a medication called Naloxone, also known as Narcan. According to the Office of Drug Control Policy, Narcan is a prescription medication that can reverse the effects of an opioid-caused overdose.
When Narcan is administered, through an injection or nasal spray, to a person who is overdosing, the medicine will stop the opioids from entering the brain and resume normal breathing.
The Kentucky Medical Examiner’s Office found from official coroner’s reports that morphine was the most detected controlled substance in overdose deaths (approximately 45 percent) in these cases. Fentanyl was found in approximately 47 percent of cases, heroin in 34 percent of cases, alprazolam in 26 percent, oxycodone in 19 percent, and hydrocodone in 16 percent of cases.
Today Josh Justice is 38 years old and 12 years sober. He has used his personal battle with addiction and turned it into a career path that allows him to help others going through the same hardships we faced.
“Addiction invades every part of your life,” said Justice.
During his own treatment, he thought that the counselors he worked with were unqualified to be doing this scope of work. This led to him going back to school and earning a Master’s Degree in Education with a focus in Mental Health Counseling from Lindsey Wilson College, School of Professional Counseling in Colombia, Kentucky.
He worked as the director of a training assistant program at Ohio Valley Physicians, for four years until November 2017. He said working with his clients makes his job worth it and validates what he does. He still works for the same company as a substance abuse counselor for recovering addicts. He switched to this position because he was able to make more money and switching to a four-day work week.
Justice continues his work with recovering addicts through his weekly visits to AA meetings.
In 2016, Kentucky had the 5th highest rate of opioid-related overdoses resulting in death. West Virginia ranks as the state with the highest rate of opioid-related fatalities. The following graph shows a comparison of rates between the two states over the last 17 years.