The opioid epidemic remains a significant public health concern, with close to 70,000 overdose fatalities in 2025 alone. [1] The National Opioid Settlement is a series of agreements between states, governments, and the major companies involved in the opioid supply chain. [2][3] These settlements will result in up to $50 billion of extra funds being distributed to local and state governments over 18 years. [4] The majority of these funds must be used to mitigate the harms of the opioid crisis. [2][3][4]
How Kentucky is using Opioid Settlement Funds
Kentucky has high opioid overdose mortality rates, with an average Opioid Use Disorder (OUD) prevalence of between 5% and 6%. [5] However, opioid use is much higher in rural and more impoverished areas in the eastern part of the state. [5] Resultingly, Kentucky has been given hundreds of thousands of dollars from the opioid settlement funds to help battle opioid use in these areas. [6]
One key program this funding has supported is the Kentucky River District Health Department's ‘Hub’ initiative. [6] This is a network of community centers in rural eastern Kentucky that helps support those struggling with OUD. [6] They provide a variety of services, including harm reduction, peer support, and training for future careers. [6][7] There are now Hubs in four Kentucky counties (Knott, Lee, Letcher, and Owsley), which are among the most impoverished in the whole country. [6]
These Hubs are embedded in local communities, allowing them to be easily accessed. [6] For example, the Hub in Whitesburg is situated on Main Street, adjacent to City Hall. [6] Additionally, many Hub staff members have lived experience of addiction or incarceration, providing valuable peer support for those currently struggling with addiction. [6]
Funding from the opioid settlement funds has helped to expand many services. This includes the provision of practical support, including cooked meals and laundry facilities, and harm reduction services, including naloxone distribution, drug test strips, and sterile needles. [6] In 2025, Kentucky River’s Hub model was recognised as one of the best public health initiatives nationally. [6]
Why rural communities face greater challenges
There are many reasons why those living in rural areas face greater challenges when it comes to substance use and addiction. Firstly, rural areas generally have fewer resources compared to urban areas. [8] This means fewer healthcare facilities, fewer physicians, and fewer harm reduction services, which combined can increase the risk of overdose fatality. [8]
To add, rural areas tend to be more impoverished with fewer economic opportunities. [8] This can lead people to turn to substances to help mask the stress from social determinants of health and associated mental health concerns. [8] This also means much of the rural population is uninsured, creating an extra barrier to accessing healthcare. [8] The stigma associated with substance use can also be higher in rural areas. [8]
The combination of lack of access to services, fewer economic opportunities, and stigma creates a uniquely high risk of substance use and overdose in rural communities. [8] This helps to explain why much of the funding from the opioid settlement funds has been used to help these rural areas.
Why harm reduction is part of the strategy
Harm reduction encompasses different strategies that help to reduce the negative consequences associated with substance use and is effective at reducing fatalities and complications associated with substance use. [9][10] Harm reduction can have many different forms, but some of the more common examples include: [9]
- Substance use education.
- Naloxone provision.
- Drug testing kits.
- Clean needles and syringes.
- Sharps disposal.
Harm reduction is particularly important as not only is it effective, but it’s something that can be implemented before an individual is abstinent. [9] By providing harm reduction, individuals can use substances more safely, allowing them to improve on other aspects of their life, like securing stable housing and gaining skills to assist with obtaining or keeping employment.
Having this base can help make long-term recovery more likely, as financial pressures or lack of stable housing can often drive continued substance use. [9] Accessing harm reduction can also allow individuals to build trust in places like the Hub, which could lead to more meaningful engagement in the future.
What other communities can learn
Kentucky River’s Hub model provides a template that other rural regions struggling with addiction can emulate. Some key features of the Hub model stand out as being most important for other communities to learn. Firstly, the location of any project is key, and initiatives in the heart of a community tend to be much more accessible to those in need. [6] Additionally, staffing with people who have lived experience of addiction or incarceration can strengthen trust between programs and the people they serve. [6]
Combining different services can also make a big difference. Rather than treating addiction in isolation, the Hub model combines it with meals, laundry, job training, and housing support. [6] Addressing these practical barriers can make long-term recovery from substance use more successful by alleviating the burden of external stressors.
Final thoughts
The National Opioid Settlement was designed to give states helpful resources to address the opioid crisis. [2][3] Kentucky River’s Hub initiative shows what that can look like, with community centers staffed with people who have lived through addiction themselves, offering everything from sterile syringes to job training. [6] So far, this has been a success that has been recognised by national awards. [6] Whether it can be sustained, expanded, or replicated elsewhere will depend not just on continued settlement funding, but on how an increasingly uncertain federal policy around harm reduction can be navigated.
