andy beshear's drug abuse plan

Ending the Drug Epidemic in Kentucky: Three Key Steps


Dear Kentuckians, When I announced my candidacy for Attorney General nearly two years ago, I identified three priorities I would address: child abuse, drug abuse, and senior scams and abuse. To date, I have released specific plans to prevent child abuse and protect Kentucky seniors. Today, I am releasing our plan to address drug abuse. I’ve been crystal clear on the issues I want to address and how I intend to do so. As Attorney General, I will focus every day on combating the spread of heroin, methamphetamines, and synthetic drugs, as well as continuing to fight the illegal trade in prescription drugs. I have met with far too many parents and grandparents who have lost loved ones to an overdose. Each of these preventable deaths is a tragedy that scars not only our families, but also our communities. Under my plan, the drug dealers selling this “death” will be held accountable for the devastation they cause. As one of the most addictive drugs on Earth,1 heroin can kill in the very first dose. It is devastating families in all parts of our Commonwealth and in all walks of life. Thanks to a much-‐needed crackdown on “pill mills,” certain abused prescription drugs have become harder or more expensive to obtain. While this is a good outcome, it has also led heroin use to skyrocket.2 According to the most recent Overdose Fatality Report, 1,087 Kentuckians died from drug overdoses in 2014.3 Two hundred and thirty-‐three of those deaths stemmed from overdoses in which heroin was confirmed to be involved.4 Use of dangerous synthetic drugs is rising as well. Meanwhile, methamphetamines and the continued illegal trade of prescription drugs continue to tear at our communities. As a tragic result, more Kentucky citizens now die from drug overdoses than car wrecks.5 We must make stopping drug abuse and its disastrous effects a statewide priority. The General Assembly made some progress by passing legislation this past session that attempts to toughen penalties on heroin traffickers, allows for the creation of local needle exchanges, creates a Good Samaritan provision to encourage abusers to seek medical attention in an emergency, and provided limited treatment funding, including increasing access to Nalaxone to save lives by preventing overdoses from turning fatal.6 But there is so much more work to be done. I’ve spoken with Kentucky legislators, police, doctors, and families from all across our Commonwealth, and, with their help, my plan will take three key steps to advance our fight against drug abuse. First, we must revise our penalties for heroin and other drug dealers so that the law correctly identifies and punishes the dealers. Second, we will improve treatment options and resources to save lives. Finally, we must educate Kentuckians to reduce drug use and experimentation before addiction takes hold. These crucial steps simply cannot wait. The threat of drug abuse is too great and the damage inflicted on our communities is too severe. I urge all Kentuckians to join me in working to eradicate this scourge. Sincerely, Andy Beshear 1 “Heroin: A Vicious Downward Spiral,” Dana Sparks, Mayo Clinic News Network, 2/10/2014 2 “Heroin surges as Kentucky cracks down on pain pills,” Laura Ungar and Chris Kenning, Courier-‐Journal, 5/16/2014 3 “Overdose Fatality Report.” Office of Drug Control Policy, July 2015 4 “Kentucky pharmacists now allowed to dispense heroin-‐fighting drug without a prescription.” Beth Musgrave, Lexington Herald-‐Leader, 5/17/15 5 In 2013, 1010 individuals died from drug overdoses in Kentucky, while 638 people were killed by traffic collisions. 6 “Heroin bill signed into law, now in effect.” Mike Wynn, Courier-‐Journal, 3/25/15


Ending the Drug Epidemic in Kentucky: Three Key Steps As Attorney General, my mission will be to eradicate drug abuse so that no Kentuckian falls victim to the scourge

of heroin, synthetic, or prescription drugs

1. Enforcement Any strategy that seeks to keep Kentuckians from falling victim to drug abuse and addiction must start by cracking down on the spread of these drugs and keeping them off our streets and inaccessible from internet marketplaces.

A. Toughening Penalties and Treating Dealers as Dealers Law enforcement and prosecutors from across the Commonwealth have voiced their concern that, even with the passage of the new heroin bill and other laws, drug dealers are often treated as users – and not dealers -‐ and are released back onto the streets shortly after any arrest. Many of our sheriffs and police therefore continually arrest the same know dealers. We must work to revise our drug laws so those who traffic heroin, methamphetamines, and other dangerous drugs are held accountable and cannot “game” the system by simply carrying below a certain amount of a given drug at any one time. When a dealer sells heroin or other drugs to a youth or adult, they commit a violent crime, and that’s how we have to treat it.

B. Zero-‐in on Heroin We need a multi-‐pronged approach that focuses resources on targeting and stopping the distribution and sale of heroin, particularly to young people. This past legislative session, the General Assembly made some progress by focusing on heroin, but it was not nearly enough.7 We must be relentless. First, we must revise our penalties so that anyone who sells heroin – no matter the amount – is held accountable. Second, we must create multi-‐state cooperation, especially with Ohio, that allows law enforcement to pursue dealers across state lines. Finally, we need a further coordinated statewide effort involving law enforcement, first responders and medical personnel, legislators, and prosecutors that targets the movement of heroin in our state and sends a clear message that we will not allow this dangerous drug to continue devastating our communities.

C. Toughen penalties for synthetic drugs

Synthetic drugs — often sold over the internet from places such as China8 or in some cases even legally in gas stations — are presenting a growing threat to Kentuckians. These drugs are created with the goal of circumventing the laws we have in place to stop the spread of dangerous drugs, and we have not yet caught up to the dangers they present. They are difficult to police due to loopholes in the law from which manufacturers take advantage, and science still does not fully understand just how deadly they can be. Yet, in many cases they are treated more leniently than marijuana.9 Kentucky emergency rooms have already seen cases involving synthetic drugs, which can have symptoms including psychosis or paranoid delusions while raising body temperatures up to 106 degrees.10 We must immediately toughen laws that target the sale or possession of synthetic drugs such as Flakka or K2 — the effects of many of which can be just as damaging as heroin, but carry much lesser penalties. Currently, possession of synthetic drugs carries only misdemeanor penalties in Kentucky, while even a

7 “The scariest thing about synthetic drugs is everything that’s unknown.” Abigail Hauslohner and Peter Hermann, Washington Post, 7/18/15 8 “The scariest thing about synthetic drugs is everything that’s unknown.” Abigail Hauslohner and Peter Hermann, Washington Post, 7/18/15 9 “The scariest thing about synthetic drugs is everything that’s unknown.” Abigail Hauslohner and Peter Hermann, Washington Post, 7/18/15 10 “Dangerous synthetic drug 'flakka' now in Kentucky.” Christina Mora, WLKY, 7/14/15


first trafficking offense is a misdemeanor.11 This must change and we must do more to protect Kentuckians from these deadly drugs.

D. Crack down Improperly-‐Run Suboxone clinics

Suboxone can be an effective alternative to methadone and has a place as a legitimate treatment option for heroin and other opioid abusers. To end the current drug abuse crisis in Kentucky, we can leave no stones unturned as we help those addicted end their dependency and get their lives back on track. But Suboxone is still a dangerous drug that needs to be carefully regulated and administered by a responsible physician, especially since it is has led to overdoses and death when used improperly.12 Prescriptions for Suboxone and its generic equivalent have risen by 63 percent in Kentucky from the first quarter of 2012 to the first quarter of 2015, yet tragically not all this use is legitimate and overseen by responsible doctors.13 As Kentucky has targeted pill mills, the spread of Suboxone clinics that seek profits over treatment has grown. According to the Louisville Courier-‐Journal, 14 percent of the Kentucky physicians authorized to prescribe Suboxone have previously been disciplined by the state medical board, and more and more addicts are seeking Suboxone not as a means of treatment but as a drug itself.14 We need to root out cash-‐only Suboxone clinics that exist not to aid drug abusers on their path to recovery, but instead take advantage of their addictions to make money and stop them from contributing to Kentucky’s opioid abuse epidemic. Too many lives are at stake.

E. Empower law enforcement

Whether stopping heroin traffickers, arresting drug dealers, or administering an emergency dose of Nalaxone to save a life, Kentucky law enforcement officers are on the front lines of our battle against drug abuse. They need an advocate in the Attorney General’s office who will not only work to empower patrol officers who encounter the effects of heroin and opioid abuse daily, but also supports drug task forces that target traffickers and dealers. I will make sure that law enforcement is confident that every time they take a dealer or trafficker off the streets, prosecutors are able to put them away using tools given them by effective laws made by the legislature. Police will have the backing they need to do their jobs and the Attorney General’s office will push the General Assembly to toughen laws on heroin, synthetic drug, and opioid dealing and trafficking to have a meaningful impact in taking these drugs off our streets.

F. Stand up to Naloxone price gouging

Naloxone saves lives. Working in just seconds, it can stop some of the worst effects of an overdose when administered in an emergency situation. The legislation passed by the General Assembly this past session was a key step in expanding access to Naloxone that will allow friends and family of addicts to obtain the drug and not be forced to wait for emergency personnel in the event of an overdose.15 And now authorized pharmacists can dispense it without a prescription if deemed necessary.16

11 “Fighting flakka; Tougher synthetic drug laws sought.” Kristina Goetz, Courier-‐Journal, 7/15/15 12 “Addiction medicine Suboxone now being abused.” Laura Ungar, Courier-‐Journal, 7/5/14 13 “Addiction medicine Suboxone now being abused.” Laura Ungar, Courier-‐Journal, 7/5/14 14 “Addiction medicine Suboxone now being abused.” Laura Ungar, Courier-‐Journal, 7/5/14 15 “Naloxone expansion in Ky part of national wave.” Laura Ungar, Courier-‐Journal, 3/29/15 16 “Naloxone expansion in Ky part of national wave.” Laura Ungar, Courier-‐Journal, 3/29/15


However, as distribution of the drug has spread widely, prices have risen as well. In some places across the country, such as Georgia and Baltimore, prices have roughly doubled.17 This expansion of Naloxone access does little good if select sellers increase prices beyond what Kentuckians can afford in order to profit off of a family’s determination to keep their loved ones safe. As Kentucky’s top consumer protection advocate, I will be vigilant in protecting Kentucky from Naloxone price gouging and crack down on those outlets that charge more than fair market rates.

2. Treatment

Enforcement alone cannot solve Kentucky’s heroin and opioid problem —we must ensure that all Kentuckians who fall victim to these dangerous and addictive drugs find the medical and personal support they need to beat their addiction and get their lives back on track.

A. Better fund treatment options This past legislative session, the General Assembly boosted funding for drug treatment by $10 million.18 This funding is an important start in improving and expanding the types and quality of care offered in our state, and the Governor has apportioned $2.6 million for community substance abuse treatment programs, $1.5 million for treatment programs aimed at incarcerated Kentuckians, and $1.5 million to provide Vivitrol upon release from prison to guard against relapses.19 Each of these areas is crucial for our fight against the drug epidemic, but this funding is not enough. While new laws require some drug treatment to be covered by health insurance, many covered treatments are too short, and don’t work for many addicts leaving them to seek help from state or local programs.20 Yet, we still do not have enough treatment beds for addicts that badly need them,21 and we need more funding that seeks to help those who have fallen victim to addiction and are not in jail. Funding is projected to rise to $22 million each year starting next July,22 and we must continue to increase funding as needed so we are providing quality and varied treatment options that reaches the Kentuckians that need them. Until we help each and every addict recover, our drug crisis will not be over.

B. Prioritize treatment for pregnant addicts

No casualties of our drug abuse epidemic are more tragic than the innocent children who enter this world already addicted to opiates or other drugs at birth because they’ve been born to addicted mothers. Statewide, 1,409 newborns were hospitalized for drug dependency in 2014, a 48 percent jump from the year before.23 At one Kentucky hospital, over 10 percent of total births were babies born to addicted mothers.24 These children then face a harrowing recovery that can require them to stay in a nursery for as long as 30 days as they go through withdrawal, incurring hospital costs of up to $35,000.25 They barely have a chance. We must give them better odds.

17 “Naloxone, a Drug to Stop Heroin Deaths, Is More Costly, the Police Say.” J. David Goodman, New York Times, 11/30/14; “Price Soars For Key Weapon Against Heroin Overdoses.” NPR, 9/10/15 18 “Gov. Beshear reveals state's $10M plan to fight heroin use.” Associated Press, 6/16/15 19 “Gov. Beshear reveals state's $10M plan to fight heroin use.” Associated Press, 6/16/15 20 “Heroin addicts face barriers to treatment,” Associated Press, 4/7/2014 21 “Gov. Beshear reveals state's $10M plan to fight heroin use.” Associated Press, 6/16/15 22 “Gov. Beshear reveals state's $10M plan to fight heroin use.” Associated Press, 6/16/15 23 “Born into suffering: More babies arrive dependent on drugs.” Laura Ungar, USA Today, 7/8/15 24 “Born addicted: more than 10 percent of babies born at Ephraim McDowell are addicted.” Pam Wright, Advocate Messenger, 2/3/15 25 “Born addicted: more than 10 percent of babies born at Ephraim McDowell are addicted.” Pam Wright, Advocate Messenger, 2/3/15


This summer, Kentucky allocated $1 million in additional funding to support these infants.26 While that funding is badly needed, we also need to target the source of the problem and get pregnant women who are addicted into effective treatment as soon as possible. We must boost funding for programs that identify and prioritize pregnant addicts to make sure they do not suffer their addictions alone and none are turned away from treatment centers due to a lack of beds.

C. Coordinate with the non-‐profit community

Kentucky is home to countless non-‐profit organizations, volunteers, and community leaders dedicated to helping end our drug abuse epidemic. Serving on the front lines of the crisis, they play a crucial role in helping drug addicts with treatment and each and every one of these organizations needs to be included in our efforts. By working together, we can enhance state and non-‐profit work to reach addicts, nurture them through treatment, and guide them as they rebuild their lives. We need to not only work together to help addicts avoid relapses, but also incorporate our non-‐profit community’s valuable experience and insight into state plans and initiatives. I’ll work to oversee efforts that combine the resources of the Attorney General’s office with the best practices and local expertise developed by our non-‐profit experts to ensure the most effective and efficient methods of policing, treatment, and recovery are employed in Kentucky.

D. Begin treatment earlier within our jails and prisons

A study by the National Center on Addiction and Substance Abuse at Columbia University (CASA) found that 65 percent of all inmates nationally satisfy the DSM-‐IV medical standards for substance abuse or addiction.27 That accounts for roughly 1.5 million Americans.28 And an additional 458,000 had histories of past drug abuse.29 Yet only 11 percent of inmates with substance abuse issues were able to receive treatment while in prison.30 If left untreated, those with substance abuse issues are much more likely to re-‐offend and face more difficulty holding steady jobs after release.31 We need to reach this sector of Kentuckians who are often most in need of treatment and present the greatest strain on state resources without it. I’ll work with corrections officials to boost treatment programs inside our jails and prisons so that inmates who are badly in need of treatment can start programs earlier and receive help to better position themselves on pathways toward sobriety. This will create benefits for our state far beyond ending our drug abuse epidemic. According to CASA, if such programs could spur just 10 percent of those with substance abuse problems to remain sober, employed, and on the straight and narrow after release they would pay for themselves as future welfare, recidivism, and court costs are reduced.32 And each inmate able to hold a job while staying sober and out of trouble beyond that 10 percent would produce a national economic benefit of $90,953 annually.33 Helping inmates get back on their feet and live productively after release will have a tangible

26 “Gov. Beshear reveals state's $10M plan to fight heroin use.” Associated Press, 6/16/15 27 “NEW CASA* REPORT FINDS: 65% OF ALL U.S. INMATES MEET MEDICAL CRITERIA FOR SUBSTANCE ABUSE ADDICTION, ONLY 11% RECEIVE ANY TREATMENT.” CASA Columbia, 2/16/10 28 “NEW CASA* REPORT FINDS: 65% OF ALL U.S. INMATES MEET MEDICAL CRITERIA FOR SUBSTANCE ABUSE ADDICTION, ONLY 11% RECEIVE ANY TREATMENT.” CASA Columbia, 2/16/10 29 “NEW CASA* REPORT FINDS: 65% OF ALL U.S. INMATES MEET MEDICAL CRITERIA FOR SUBSTANCE ABUSE ADDICTION, ONLY 11% RECEIVE ANY TREATMENT.” CASA Columbia, 2/16/10 30 “NEW CASA* REPORT FINDS: 65% OF ALL U.S. INMATES MEET MEDICAL CRITERIA FOR SUBSTANCE ABUSE ADDICTION, ONLY 11% RECEIVE ANY TREATMENT.” CASA Columbia, 2/16/10 31 “Drug Addiction Treatment in the Criminal Justice System.” National Institute on Drug Abuse, 4/14 32 “NEW CASA* REPORT FINDS: 65% OF ALL U.S. INMATES MEET MEDICAL CRITERIA FOR SUBSTANCE ABUSE ADDICTION, ONLY 11% RECEIVE ANY TREATMENT.” CASA Columbia, 2/16/10 33 “NEW CASA* REPORT FINDS: 65% OF ALL U.S. INMATES MEET MEDICAL CRITERIA FOR SUBSTANCE ABUSE ADDICTION, ONLY 11% RECEIVE ANY TREATMENT.” CASA Columbia, 2/16/10


impact on our Commonwealth. It will not only relieve pressure on our overburdened prisons and criminal justice system, but will also strengthen our communities by reducing costs and freeing police and prosecutorial resources to be used for the worst offenders.

3. Education

The best and most sustainable way to create a drug-‐free Kentucky for future generations is to stop or reduce the likelihood of an individual falling victim to drug abuse before it even occurs. We must educate both Kentucky children and adults that taking heroin, opiates, or abusing prescription drugs – even just one time – can ruin your life and devastate the lives of those around you. If we can effectively reach Kentuckians both young and old who are most at risk of addiction, we can make major gains toward ending the drug epidemic while also freeing up treatment resources for those who need it most.

A. Create a Drug Education Task Force Our 13 state Drug Task Forces34 have made an impact in taking drugs off our streets and identifying and stopping traffickers. After meeting with almost every Drug Task Force in the state, I know that we can use the same organizational strategies we’ve used for law enforcement and policing to guide our drug education efforts. We’ll bring together non-‐profit experts and educators, psychologists, law enforcement, and community leaders to conduct a top to bottom review of our current prevention efforts to determine exactly what is working, what’s not, and where our efforts can best be concentrated. And, once this review is completed, this Drug Education Task Force will continue to work to study the effects of our drug education efforts, review the latest scholarship, and refine our best practices so that we effectively drive home the message that drugs kill.

B. Prioritize the most at-‐risk individuals We can put into place the best drug education strategies devised, but it will do only limited good if we’re not reaching the kids and adults who are most affected by the drug abuse crisis. We need to get to these Kentuckians before they are tempted by the gateway drugs that can put them on the tragic path toward addiction. We need to educate those individuals with both the most effective methods, but also at the right time before its too late. When allocating resources for drug education efforts, it’s important that we study which geographical areas are most affected and surge efforts to those locations accordingly. Effective education strategies will reduce the likelihood of Kentuckians falling victim to addiction, which in turn cuts the strain on over-‐stretched treatment programs in areas such as Floyd County, Pike County, or Campbell County that have been hardest hit by the epidemic.35 This allows us to prevent new addictions, while most effectively treating those already suffering.

Creating a Kentucky free of drug abuse

In recent years, our state has faced enormous challenges as the drug epidemic has taken a heavy toll on our cities, towns, and communities. Too many Kentuckians have fallen victim to the scourge of heroin, opiates, synthetic drugs, and prescription drug abuse. It’s time for that to end. For generations, resiliency has been a hallmark of our state, and this plan will draw on the collective efforts of Kentuckians from all backgrounds and all walks of life who are determined to build a better Kentucky for our children. By working together through these policy initiatives, we can build on the work that has been done to fight drug abuse and aid addicts in their recovery, finally creating a Kentucky that is free of drug abuse.

34 “Kentucky Drug Task Forces.” Office of Drug Control Policy 35 “Overdose Fatality Report.” Office of Drug Control Policy, July 2015