Ohio's overdose crisis has been heavily linked to the use of prescription painkillers or heroin, but it is not the case anymore. Health officials now warn historic levels of overdose deaths are being exacerbated by the availability of counterfeit pills laced with fentanyl, a potent and deadly synthetic drug.

Shabbir Imber Safdar, executive director of the Partnership for Safe Medicines, said fake pills are being sold as prescription painkillers such as OxyContin, the anxiety drug Xanax, and stimulant medications.

"There's a lot of young people who take Adderall, and they're not particularly careful about where they get their pills," Safdar pointed out. "I think we're going to see a rise in deaths in the 16-24 age range from fake Adderall made with fentanyl."

In May, two Ohio State University students died from suspected use of fake Adderall pills laced with fentanyl. Ohio is expected to report more than 5,200 overdose deaths for 2021, compared with just 327 in 1999.

Counterfeit medications are commonly sold through social media, on hidden sites on the "dark web" or in person by someone claiming they are real. Safdar noted an estimated four in 10 pills with fentanyl contains a potentially deadly dose.

"Even the first fake pill you ever take might kill you because if it has too much fentanyl, there's no time to get addicted, that first pill will kill you," Safdar stressed. "So it's really a game of Russian roulette when you take one of these pills that did not come from a pharmacy, which is the only safe source."

The Drug Enforcement Administration recently issued a Public Safety Alert about the rise in the lethality and availability of fake prescription pills containing fentanyl, and is encouraging people to only use prescription medications as directed by a medical professional and dispensed by a licensed pharmacist.

A statewide program in Kentucky aims to provide credentialing and pathways to a career in social work for people in substance use disorder recovery. Advocates say the Career Ladders in Mental and Behavioral Health or CLIMB-Health program is vital for the state to boost the mental health and social services workforce.

Carl Wilson, senior fellow for healthcare development and initiatives with the Kentucky Council on Secondary Education, said it also provides opportunities for those in recovery to make a living and expand their career horizons.

"You can gain both occupation credentials and or employment all the way up through a professional level within this program. So the program offers individuals with lived experience a tailored pathway," he said.

Community colleges across the state serving more than 100,000 residents are now working with people who have been state-certified peer support specialists, to transfer their training toward Bachelor of Social Work degrees. The CLIMB-Health program began on Kentucky Community & Technical College System campuses in counties with the highest overdose deaths.

Wilson said residents in drug court programs in all 120 counties face barriers to employment.

"When they get to that employer interview, and that employer runs that background, and they see the addiction issue, they see in most cases, the justice involvement, they're locked out of opportunities," he added.

The goal is to fill urgent gaps in the state's healthcare system and boost long-term economic stability for people living in recovery.

"We have approximately 50,000 to 0,000 untapped workers for our workforce in Kentucky that have not been given that opportunity to have a specialized program which addresses them," Wilson continued.

While overdose rates in other states are declining Kentucky ranks among the top ten states in the nation for drug overdose deaths, according to the CDC.

While overdose deaths in the Commonwealth have declined, deaths among Black Kentuckians have increased by 5%, according to data from the latest Kentucky Overdose Fatality Report.

Organizations across the state are working to stem overdose deaths among residents of color. In Bowling Green, the nonprofit HOTEL INC. is focused on harm reduction.

Rebecca Troxell, HOTEL INC. lead navigator, explains the group's street teams go into homeless encampments and provide Narcan, fentanyl strips, hygiene packets and medical care.

"We have volunteer doctors, EMTs and nurses who go out with us, so we're able to provide medical care on site. We're able to provide educational components with that, as well, helping people understand what harm reduction really is," she said.

She added a recent SHIFT grant from the Foundation for a Healthy Kentucky will allow the street teams to reach more people. The program, which awards funding up to $50,000, aims to reduce disparities and other inequities worsened by the drug crisis.

In Lexington, the nonprofit agricultural organization Black Soil KY is adding Narcan boxes and educational materials to its farmers markets. They are also working to improve access to fresh food among Kentuckians in recovery.

Ashley Smith, co-founder and CEO of Black Soil, said farmers will also receive harm-reduction training: "We know having that unbarriered access to local goods, like seasonal produce, local meat within your recovery housing, just really provides an advantage for the overall outcome."

Kayla Migneron, director of the Louisville-based maternal health program Granny's Birth Initiative, said the SHIFT grant funding will help expand stigma-reduction training for doulas.

"Our main goal is that any person would be comfortable coming to get assistance from us, whether it's accessing resources using our stuff, even just asking for connections to other programming," explained Migneron.

Nationwide, overdose deaths among mostly younger Black women nearly tripled between 2015 and 2021.

In Robeson County, the opioid crisis is exposing the need for increased addiction support. The Southeastern Prevention and Addiction Recovery Resource Center is tackling the issue by bringing together more than 70 organizations into a unified recovery network.

Jackie Davis, SPARC director, says its goal is to streamline services and improve access to comprehensive support.

"Robeson County has a high rate of usage, and so one of the main challenges has been services and then organizations and agencies working in silos," Davis said.

She added that before SPARC, local agencies were isolated in their efforts. Now with funding and support in part from the Kate B. Reynolds Charitable Trusts, she said community-based initiative is fostering cooperation to better serve the people of Robeson County, with plans to secure ongoing funding and improve access to care.

Davis said SPARC provides critical resources such as training, educational support and help securing opioid settlement funds. She said these efforts have improved patient care and developed long-term recovery strategies tailored to the community's needs.

"Health disparities here, we just want to reduce or even eliminate if we can, because we know that there are major differences from rural areas to urban areas or larger cities, and we just want better for our community," she said.

She noted that future goals include addressing transportation barriers to ensure access to services and ensuring sustainability through continued funding and support for member organizations.