Kentucky saw slightly fewer drug overdose deaths in 2012, down to 1,004, possibly because of less use of prescription painkillers, according to a state report released Friday. But heroin-related deaths exploded by 550 percent, and southeastern Kentucky remained in the grip of widespread drug addiction despite years of costly intervention.
"There's no great victories here," said Van Ingram, executive director of the Kentucky Office of Drug Control Policy. Ingram's office was required by the General Assembly in 2012 to begin publishing annual reports on drug overdose fatalities in the state.
"I'm glad that we're at least seeing a leveling off and some small decline," Ingram said. "I've been in this job for nine years and have watched a steady rise in numbers that whole time."
The most frequently fatal drug in 2012 was alprazolan, sold as Xanax and used to treat anxiety and panic attacks. It was detected in victims' bodies in 41 percent of overdose deaths. Others included morphine (detected in 32 percent of deaths); the painkillers hydrocodone (26 percent) and oxycodone (24 percent); heroin (19 percent); and the painkiller oxymorphone (17 percent). Autopsies often found more than one drug present.
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The youngest overdose fatality was 16; the oldest was 72. Slightly more than half of the victims were men.
Heroin's share of the grim harvest jumped from 22 cases in 2011 to 143 cases in 2012. State officials are reporting a resurgence of heroin use in urban and rural areas throughout Kentucky because it's cheap and easier to get than prescription painkillers, following years of effort to crack down on pill abuse. As of Monday, there had been 29 heroin overdose deaths for 2013 in Fayette County alone, seven more than in all of 2012.
"This is more than just homeless people in back alleys," Ingram said. "This is a drug that takes hold in all segments of our society, just as prescription drugs have."
Most of the counties hit hardest by fatal overdoses in 2011 and 2012 are clustered around the coalfields of southeastern Kentucky.
Leslie County (population 11,170) reported the state's top per capita rate of an annualized 85 fatal overdoses for every 100,000 people. The county had 11 overdose deaths in 2012, up from 8 the previous year. In descending order, the other leading counties were Clinton, Clay, Estill, Floyd, Nicholas, Perry, Whitley, Monroe and Magoffin. (Fayette County reported 108 overdose deaths for those years, or an annualized 18 deaths per 100,000 people.)
"I think you're looking at an epidemic in this area," said Leslie County Coroner Gregory Walker.
"If I knew what the silver bullet was to solve this problem, I'd shoot it," Walker said. "The economic situation here certainly doesn't help. It's a source of frustration when so many people are idle like they are."
Nearly one-fourth of Leslie County's population lives below the federal poverty line, according to the U.S. Census. The county's unemployment rate in June stood at 17.3 percent, nearly twice the statewide rate of 8.9 percent. But the real numbers are worse: More than 60 percent of the county's adults aren't even counted in the labor force because they are not seeking work, report themselves as disabled or are elderly.
Ingram said he and others have struggled to understand why drug addiction particularly plagues southeastern Kentucky. The region's poverty plays a role, he said. So does "learned behavior," as children watch their parents abuse drugs and then do the same themselves, he said.