With more than a billion in opioid settlement dollars coming to Ohio, advocates argued it must be directed to evidence-based strategies.

Ohio ranked fourth among states in 2020 for drug overdose mortality, with a majority of deaths caused by opioids.

Beth Macy, a journalist, wrote the best-selling book "Dopesick," which examined the origins of the opioid epidemic. She said real change can happen at the community level with a shift in mindset, with addiction viewed as a treatable medical illness rather than a moral failure and crime.

"In the middle of the worst drug epidemic in the nation's history, we need to start figuring out where all these bureaucratic, unnecessary hurdles are," Macy urged. "Only 12% of folks with OUD (opioid use disorder) even managed to get treatment in the last year. As the wealthiest nation in the world, that's horrendous."

Ohio will get about $1 billion dollars over 18 years in a major opioid settlement, but additional money is expected from pending lawsuits. Macy speaks Friday at the Prevention Action Alliance's annual breakfast in Columbus about her upcoming book "Raising Lazarus," which dives deeper into the issue of opioid addiction and highlights successful treatment practices.

In her research, Macy discovered the opioid treatment landscape lacks coordination and structure, but she noted some communities and organizations are seeing success.

"Even if you have, say, a conservative community that maybe historically has only viewed addiction through a drug-war lens, even some of those communities are figuring out how to make positive change," Macy pointed out.

Ohio's new Relapse Reduction Act increases penalties for selling drugs near treatment facilities and to those undergoing treatment. Opponents argued it approaches addiction as a crime. Macy countered harm-reduction practices such as medications to stave off cravings or needle exchange can get people on the path to recovery.

"Once they start to make these incremental changes, they can actually see, 'Oh, maybe I can get better.' " Macy explained. "But it's this matter of 40% of folks with opioid use disorder don't want to even try to get better because they've tried before, and they've been stigmatized, or they haven't been able to access it. "

Sometimes it is as simple as needing a ride to a local clinic, or getting help to apply for Medicaid. She added expanding access to treatment medications is needed, as certain practitioners need special certification to prescribe medications to treat opioid use disorder.

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.