Funds to fight a drug epidemic cut even as abuse of medicines kills record number of Kentuckians

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Donnie Coots visits the closed and run-down drug treatment facility he started in honor of his son, Joshua. Coots says his son had kicked his addiction, but not before the drugs had done permanent damage to his organs. Joshua's Dream was his son's idea, but he never lived to see it open.

Prescription drug abuse is killing Kentuckians at record levels — with deaths more than doubling in the past decade to nearly 1,000 a year, surpassing even traffic fatalities.

The number of Kentuckians who have died from prescription drug overdoses rose from 403 in 2000 to 978 in 2009, the latest year available. By contrast, traffic crashes killed 791 Kentuckians in 2009.

But even as the state's prescription-drug problem explodes, the money to fight the epidemic is drying up, with budgets for key agencies and programs that work to prevent, control and treat drug abuse being cut by millions of dollars, a Courier-Journal investigation found.

The massive cuts have severely depleted some agencies and ended other efforts, law enforcement and advocates say, including:

The Office of Drug Control Policy, a state agency that coordinates much of Kentucky's fight against drugs, saw its state funding drop from $8.6 million in 2008 to $6.5 million in 2010, forcing its staff to shrink from 10 to four employees.

Kentucky's family and juvenile drug courts — created to help new addicts stay out of prison and mend their families — were eliminated as of Jan. 1 to save the state budget $1.5 million a year.

Operation UNITE, a nonprofit agency that U.S. Rep. Hal Rogers formed to fight chronic drug abuse plaguing his 29-county 5th District in Eastern Kentucky, saw its budget slashed from $10.3 million in 2007-08 to $4.6 million the following year after the Department of Justice pulled its funding. As a result, the agency has 23 detectives, about half as many as in 2007, and 17 school substance-abuse counselors, down from 31.

Lawmakers say there's little chance that funding will increase until the economy significantly improves.

The cuts have undermined the state's war on prescription-drug abuse, meaning fewer police on the streets, counselors in the schools and treatment programs for addicts. The result has been more crime, crowded jails and families torn apart.

That comes in a state that already was trailing much of the nation in its spending to combat drug abuse. The roughly $32 million Kentucky spends on drug treatment hasn't changed in a decade — averaging about $7.50 per resident, less than a fourth of what some states spend.

Karen Shay, a dentist in Morehead, lost her 19-year-old daughter, Sarah, to a drug overdose in 2006.

Shay said her daughter, an aspiring artist, had started pulling her life together after fighting addiction and enrolling at Morehead State University.

But she left home with friends Jan. 3, 2006, and the next morning, she was pronounced dead. Methadone, Xanax and alcohol were found in her system.

“Things will never be normal,” said Shay, a widow with one son. “It's been devastating to my family. When something like that happens, it just devastates your whole life.”

Eastern Kentucky feels the most pain.

Bell County has a prescription drug death rate of 54 per 100,000, ranking it highest in Kentucky and eighth among nearly 1,400 counties nationwide with reliable statistics. Advocates say they've seen residents in the county start abusing prescription drugs as young as 9.

Addicts “work 24/7 figuring out how to get more pills. They take food from their children's mouths. They're breaking into churches,” said Sharon Teaney, co-director of the Lighthouse Mission Center, which offers outreach services to the homeless and drug addicted in Bell County.

Breathitt County officials said they spend a quarter of the county's $4 million budget on jails, housing mostly criminals involved in prescription drug abuse. And four of the 12 participants in a recent grief support group in Lee County came because they lost loved ones to prescription drug abuse.

“It's a difficult thing to accept when we're seeing kids in the situations they're in and people dying,” said Karen Kelly, director of Operation UNITE. “We want people to understand the depth of this problem. If they really understood the depth of this issue and how many people are dying, they would be absolutely outraged.”

PAINKILLERS KILL

Throughout the United States, painkillers are driving up overdose deaths faster than any other drugs, said Sherry Green, chief executive officer of the New Mexico-based National Alliance for Model State Drug Laws.

But in few places are the stakes higher than in Kentucky — which a Forbes report last year ranked as the fourth most-medicated state in the nation.

The state's prescription drug deaths in 2003-07 ranked Kentucky 12th among all states, according to federal statistics the newspaper analyzed.

While the Louisville region hovers around the national average for such deaths, the state's Appalachian region has a fatal overdose rate of 26.3 deaths per 100,000 — nearly twice as high as the rest of the nation.

Appalachia is particularly hard-hit because a lack of recreation and employment opportunities have created a sense of inevitability about drug abuse, officials say.

Poverty is high and graduation rates are low. For example, 43.3 percent of residents in Clay County live in poverty and 41.2 percent over age 25 have not graduated from high school, the Census Bureau reports. The numbers are only slightly better in nearby counties.

Beyond the stark environment, Rogers and others point at pharmaceutical companies — such as Purdue Pharma, maker of OxyContin — as a culprit.

Court records have documented how the company sought out doctors who prescribed high numbers of pain pills, sometimes with limited training in treating serious pain — a strategy that made Appalachia a target. According to court records, the company misled doctors and patients by claiming the drug was less likely to be abused than traditional narcotics.

Through a federal case brought by the Justice Department, a company affiliated with Purdue Pharma and three top Purdue executives pleaded guilty in 2007, paid millions in fines and acknowledged misleading physicians in a plea deal.

Along with OxyContin, some of the drugs most frequently found in the blood of overdose victims are Xanax, methadone and morphine.

A typical addict takes four 80-milligram OxyContin pills a day, which at roughly $120 each on the street means a weekly habit costing $3,360 — much more than other drugs, said Dan Smoot, director of law enforcement for Operation UNITE, which stands for Unlawful Narcotics Investigations, Treatment and Education.

Pam and Steve Sulfridge, who both became addicted to painkillers after they were prescribed them, said they soon had a $500-a-day habit that drained their savings, their retirement, their 401(k) — a total of half a million dollars in five years.

Addiction “is just a devil waiting for you to give it half an opportunity, half a chance,” said Pam Sulfridge, who is sober now.

Many addicts turn to theft and trafficking to feed their increasingly expensive habit.

According to the most recent report from the Kentucky Justice & Public Safety Cabinet, prescription drug-related offenses rose 14 percent to 3,082 from 2007 to 2008 — almost a third of them thefts. Prescription drug-related cases in Kentucky's circuit and district courts rose 8 percent to 7,466 between 2004 and 2008, the report said.

The cost of jailing prescription drug criminals is siphoning money from other needs in many small, poor communities.

In Bell County, for example, the largest local allocation of tax dollars, $1.1 million, pays for the county jail, which officials say mostly houses people convicted of prescription drug and methamphetamine-related crimes.

Officials worry that the problem will continue to grow because pills are easy to get. Most often, they come from street dealers, unattended medicine cabinets or doctors in other states, officials and addicts say.

Kentucky has made some inroads in ensuring that doctors prescribe pills properly.

The state has what experts call a model online database that doctors, police and pharmacists can use to find a patient's prescription history of controlled substances. It's called Kentucky All Schedule Prescription Electronic Reporting, or KASPER, and helps combat doctor shopping — when an addict moves from doctor to doctor, seeking more medication.

Also, the Kentucky Board of Medical Licensure has cracked down on pill-pushing doctors; Public Citizen ranked the board third-toughest in the nation for its rate of serious disciplinary actions.

But KASPER is under-used; 27.5 percent of doctors and 16 percent of pharmacists used it in 2009 even though it's free to them.

And a growing number of addicts get around the increased scrutiny by taking Interstate 75 to Florida, where the regulation of pain-pill prescriptions and the doctors who prescribe them is much more lax.

“You have flocks of people from Kentucky who flock down to Florida,” said Sgt. Stan Salyards with the Louisville Metro Police Department's narcotics unit. “We've got video of these people with Kentucky license plates actually sitting in the doctors' lots.”

MONEY GETS TIGHT

It's impossible to know exactly how much is spent fighting prescription drug abuse in Kentucky because dozens of agencies are involved — from local, state and federal law enforcement to professional licensing boards to courts and nonprofits — and the money is often tied in with funds to fight illegal drugs.

Sometimes budgets aren't broken down by state, as in the case of the U.S. Drug Enforcement Agency.

“So many people own a piece of the problem; it's hard to get a handle on how much money we're spending,” said Van Ingram, executive director of the Kentucky Office of Drug Control Policy.

But no one disputes that many key agencies in Kentucky, including his, have seen big cuts. Ingram's office — charged with coordinating Kentucky's substance abuse enforcement, treatment, prevention and education — saw its state allocation drop $2.1 million from 2008 to $6.5 million in 2010.

Drug task forces in various Kentucky communities experienced deep reductions as federal grants funneled through the state drug policy office were cut.

The Somerset-based Lake Cumberland Area Drug Task Force, for example, saw a continual decline in its budget, which is $162,000 this year, down from $180,000 the year before. Director David Gilbert said he expects to lay off one of four federally funded agents in the spring, which he says will lead to a large drop in the 300-350 cases a year agents now handle and less emphasis on street-level dealers in favor of mid-level ones.

That will surely upset residents, he said, because from the public's perspective, “the worst drug dealer in the country is the one on your block. It affects your quality of life.”

Operation UNITE also gets far less money than it used to.

At its height in 2006-2007, its budget was almost $11 million; in fiscal 2009-10, it was $5.6 million.

Director Karen Kelly said they've had to eliminate a diversion team that investigated doctor-shopping and over-prescribing; its members were among 15 employees laid off in one day in 2008.

They've also halved the budget for community coalitions that run programs such as fishing and archery initiatives designed to give young people alternatives to drugs — meaning fewer programs serving fewer kids.

Also, there are now five counties without UNITE-funded drug counselors in the schools; in the past, each county that UNITE serves had at least one.

CREATIVE CHOICES

Agencies set priorities in effort to keep going

“Obviously, it's frustrating,” the agency's Smoot said, but the remaining staff is pushing on. “We've just tightened our belts and got back to work, quite frankly.”

Officials with Attorney General Jack Conway's office say they've done much the same, though his budget has been cut 25 percent since he took over in 2008.

Although officials couldn't separate how much is spent on prescription drug abuse in particular, the money it gets from the state general fund dropped from $14.3 million in 2008 to $10.8 million budgeted for 2012. The office lost one of its six drug investigators.

Still, like other agencies, the office has tried to find creative ways to get around its budget losses. For example, it sought and received a $50,000 grant from a national nonprofit agency in 2009 to launch a statewide drug diversion task force.

Other hard-hit programs include a special drug court within some family and juvenile court systems. A budget shortfall this year forced the state to abolish the much-touted program that provided intensive help for parents with drug issues.

Judge Eleanore Garber, of Jefferson County Family Court, said the program there served about 40 clients a year and included meetings with the court, counseling, parenting classes and drug screenings. Clients who could work also had to get jobs.

“There was a far lower rate of petitions for abuse or neglect for people who went through drug court,” she said. “People got jobs faster and were self-sufficient. … It was the most successful drug program for those seeking reunification with their children because it was stricter than others.”

A few programs, such as KASPER, have managed to hold their own financially. After a one-time capital expenditure in 2008 to upgrade the system, its budget has hovered around $1.5 million a year.

The money the Kentucky State Police spent on criminal investigations — 98 percent of which is spent on drug-related crimes — has actually risen in the past five years, Lt. David Jude said. It was $1.06 million in fiscal 2009 and $1.33 million in 2010.

Still, the number of investigators looking into drug crimes has gone down through attrition, said Trooper John Hawkins, of the agency's public affairs branch. Roughly 800 troopers are on the road today, he said, compared with almost 1,000 five years ago.

“Not only are our posts not fully staffed, but our investigation sections aren't fully staffed,” he said. “We're not utilizing the money we have on salaries. We're using it for investigations … to maintain the things we have.”

To lessen the impact, the state police have partnered with local departments, deputizing 27 local officers statewide in the past four years — 13 in Eastern Kentucky — to work on drug task forces, with statewide jurisdiction, Hawkins said.

But overall, Ingram said, “resources are getting harder to find.” And lawmakers say there's no immediate restoration of funds on the horizon.

Gov. Steve Beshear said his focus has been “set on attracting and growing jobs in Kentucky and on keeping our state budget balanced while still protecting our core priorities of education and helping our families survive this devastating economic downturn. As revenues increase and this recession subsides, my administration will continue to take a holistic approach to the issue of fighting prescription drug abuse. That may include reviewing funding for programs targeting prescription drug abuse, and will certainly include a continued focus on education, job creation and public health — all areas which will have a dramatic impact on the problem.”

State Rep. Tom Burch, D-Louisville, said the biggest priority in Frankfort now is, by far, “jobs, jobs, jobs,” and money will only be put toward the prescription drug fight “if the economy improves and we have money available.”

Rogers said he knows of no efforts in Congress to put more money toward the prescription drug fight, although he said UNITE has a strong, national reputation and can compete for existing grant money and private donations.

“We are in a very, very austere mode right now,” Rogers said, noting that earmarks, which have partly funded UNITE in the past, are out of the question. “The national interest has got to come first. We're in a federal budget crisis.”

HEAVY IMPACT

'Unbelievably low' spending spells misery

Resources have long been lacking when it comes to drug treatment in Kentucky.

Robert Walker, an assistant professor at the University of Kentucky's Center on Drug and Alcohol Research, said funding for treatment has been “virtually static for well over a decade,” with $32 million from a federal block grant program, the federal portion of Medicaid and state funds going into publically funded substance abuse treatment in Kentucky.

That amounts to about $7.50 per resident, about a fourth of the per-person spending in Delaware and a seventh of per-person spending in Washington, D.C. — two places with high spending.

“The budget picture for Kentucky has been truly weak for several years,” Walker said. “Our funding is so unbelievably low.”

Walker said waiting lists for residential treatment average two to three weeks and can be up to three months. And a federal survey indicated that less than 8 percent of Kentuckians who likely need substance-abuse treatment get it in a state-funded program.

The Rev. Donnie Coots of Viper, Ky., pastor of the Mason's Creek Church of God, tried to boost the treatment options in his community. With his family, he founded a treatment center in honor of his son, Joshua Coots, who died in 2002 of health problems related to his prescription drug addiction.

They called it Joshua's Dream.

The orphanage-turned-rehab center was built on 21 acres atop a mountain. Coots said about 500 clients went through there and many benefitted from the tough love.

But Joshua's Dream closed in 2008, partly because of funding issues. A fire recently ripped through its remains.

In September, Coots stood among the smoldering ruins of his family's dream — a singed chimney and pieces of the foundation were all that remained of the once-impressive facility for male clients. In the rubble were signs of those who once stayed there, including a weathered card from the game of “Life.”

“It breaks your heart,” said Coots, a former coal miner who said the center's setting was part of its allure. Against the mountains, he said, “problems get very much smaller.”

He worries what will happen if the state fails to put a greater emphasis on the prescription drug problem — he fears more people will be lost, and the sad succession of funerals will continue.

As a pastor, “I've done too many of them. I can't do anymore,” Coots said. “We've just about lost a generation.”

Reporter Laura Ungar can be reached at (502) 582-7190 or lungar@courier-journal.com. Reporter Emily Hagedorn can be reached at (502) 582-7086 or ehagedorn@courier-journal.com.