With over 1400 overdose deaths in 2016 (compared to over 1300 in 2015), opioid use disorder has reached epidemic levels in Kentucky. Addressing this epidemic is a top priority across all levels of government and public and private partners.

One thing is certain: the opioid use disorder crisis is complex and multi-factorial. There is not one, simple answer. Response will require many strategies and many partnerships.

In February 2017, Kentucky responded to a grant solicitation from the Substance Abuse and Mental Health Services Administration called the State Targeted Response to the Opioid Crisis grant (or Opioid STR grant). This is the funding made available to states by the federal legislation known as the 21^st Century Cures Act.

Kentucky’s Year 1 award is $10,528,093. Kentucky is referring to this grant initiative as the Kentucky Opioid Response Effort or KORE.

Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities (KDBHDID) within CHFS is the applicant agency.

We talked to Dr. Allen Brenzel, Clinical Director of the Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities (KDBHDID). DBHDID is Kentucky’s designated State Mental Health Authority (SMHA) and Single State Agency for Substance Abuse Services (SSA), as well as the State Opioid Treatment Authority (SOTA). Highlights from our discussion are below.

Medical News: How is the state working to coordinate efforts to address the opioid crisis?

Allen Brenzel: In my many years in state government, I have never seen such a high level of collaboration around a single public health problem.

Kentucky has established a cross-agency work group to end Kentucky’s Opioid Use Disorder Crisis. It includes representatives from within the Cabinet (the Departments for Behavioral Health, Developmental and Intellectual Disabilities, Medicaid Services, Public Health, Community Based Services, the Office of Health Policy and the Office of the Inspector General). In addition, the Justice and Public Safety Cabinet, Office of Drug Control Policy, the Kentucky Education and Workforce Development Cabinet and Governor’s Office participate in the work group.

The key to collaboration is effective data integration to allow policymakers to target prevention and intervention efforts.

MN: What was the process for developing the strategy? Who are the key players in the effort?

AB: Our work group has developed a comprehensive strategy focusing efforts in four major areas; prevention, treatment, recovery supports and harm reduction. This was prompted when federal funding was made available to Kentucky in 2017 as part of the federal 21st Century CURES Act.

In order to access the $10.5 million, Kentucky had to submit a proposal to the Substance Abuse and Mental Health Services Administration (SAMHSA).  In developing that proposal, we issued a request ideas and suggested priorities from over 200 organizations across the state.  Those ideas served as the basis for the Kentucky Opioid Response Effort (KORE).

KORE includes funding for over 30 different initiatives including; school based interventions aimed at decreasing future risk for Substance Use Disorders and promoting better prescribing practices around opioids. We are also working to enhance our prescription drug monitoring program to provide more information for prescribers of controlled substances.

Treatment priorities include programs to increase the likelihood that individuals who present to an emergency department after an overdose enter treatment; increasing access to Medication Assisted Therapies such as Buprenorphine and Naltrexone; and creating capacity for emergency departments to immediately provide treatment options to those who present to the emergency room after an overdose.

KORE also includes funding to provide services to those re-entering the community after incarceration; services for women who are pregnant and/or parenting; and harm reduction, which is critical in decreasing the likelihood of overdose death and the spread of infections such as Hepatitis C and HIV.
MN: How will Kentucky work with the healthcare community to address this crisis?

AB: Kentucky is collaborating with medical schools to improve training for new physicians regarding opioid prescribing and treatment for OUD.  We are working with large healthcare providers to improve prescribing practices for opioids for acute pain in order to decrease the likelihood an individual will progress to misuse or a use disorder.

MN: What is the role of education and workforce development in the implementation of KORE?

AB: Employers are telling us that in some cases they cannot find a sufficient number of individuals to fill positions and substance abuse can be a reason for this.  Kentucky has up to twice the number of individuals who apply for jobs that cannot pass a pre-employment drug screen.

MN: How will Kentucky monitor and measure the progress of KORE?

AB: There is a comprehensive set of outcome measures as defined by SAMHSA that will be collected by those receiving funding. Decreasing the number of opioid deaths is a high short-term priority, but we will also be measuring the number of individuals who enter treatment and who remain in treatment as key indicators.  Overall, we are looking to decrease the incredible healthcare costs associated with untreated substance use disorder.  We know the human cost are staggering and we feel compelled to act urgently and in a highly data-driven way.

Kentucky Opioid Response Effort (KORE)

Guided by the Recovery-Oriented System of Care Framework, the Kentucky Opioid Response Effort (KORE), which is being funded with $10.5 million in federal dollars, is a comprehensive targeted response to Kentucky’s opioid crisis by expanding access to a full continuum of high quality, evidence-based opioid prevention, treatment, recovery and harm reduction services and supports in high-risk geographic regions of the state.

Informed by data on populations most in need, the KORE will focus on three primary populations:

1. Pregnant and parenting women.
2. Individuals re-entering society upon release from criminal justice settings.
3. Adolescents and young adults.

KORE has three primary targets: prevention, treatment and harm reduction. Specifically, the KORE offers the state an opportunity to dedicate much needed resources to address five overarching goals:

• Preventing opioid misuse and abuse.
• Increasing access to OUD treatment services, including Medication- Assisted Treatment.
• Increasing the availability of recovery support services designed to improve treatment access and retention and support long-term recovery.
• Increasing availability of naloxone.
• Enhancing statewide coordination and evaluation of healthcare and public safety strategies targeting opioid misuse and overdose.

A comprehensive performance assessment system will support ongoing evaluation of progress against proposed goals, objectives and activities and guide continuous quality improvement efforts.