A woman’s death, Kentucky’s opioid crisis

Jenny Fulton’s brief life and brutal death hold important lessons, especially for Kentuckians in positions of public trust.

The 27-year-old woman died in 2014 in the Mason County jail where she was sent because she had relapsed into heroin use, violating her parole.

Despite widespread recognition that incarceration is not the solution, Kentucky still spends millions of dollars jailing people who have drug use disorders when that money could be better spent on evidence-based treatment.

After two years clean, Fulton relapsed following gall bladder surgery. The medicines she was prescribed to ease post-surgical pain may have re-triggered her opioid abuse. The opioid crisis confronts prescribers with many complicated challenges, including how to treat pain without inviting addiction and relapse.

Pills are cheaper than physical therapy and other non-opioid treatments. But there is no evidence that opioids are effective against chronic non-cancer pain while some data suggest they worsen outcomes. Insurers should be required to pay for non-addictive pain treatments. Long-term savings would justify the short-term costs.

Kentucky also needs more doctors who are trained and certified to treat drug use disorders. The Medicaid expansion, now at risk of repeal by Congress, expanded treatment, but access to treatment still pales beside the threat to public health. “If this were a communicable disease, we would be wearing hazmat suits to combat it,” Kentucky Justice Secretary John Tilley recently told a congressional committee.

Kentucky recorded 1,404 overdose deaths in 2016, most due to opioids, legal and illegal. Kentuckians need on-demand access to medically-assisted treatment and mental health therapy. Recovery specialists should be on call in emergency rooms.

In Kentucky, overdose death rates are highest in some rural areas where jails are least prepared for medical complications. Half of state inmates are housed in county jails. If we are locking up people who are sick, we owe them care.

The callous neglect of Jenny Fulton as she suffered for four days beggars belief. The Mason County Detention Center employed a nurse and nurse practitioner and knew that Fulton suffered from Crohn’s disease. Opioid withdrawal causes dehydration. As Valarie Honeycutt Spears recently reported, after days of vomiting and diarrhea, Fulton was so dehydrated that her hands curled inward and she could hold a Gatorade bottle only between her knuckles. A jail sergeant predicted to a deputy, “They’re going to fool around and let her lay there and die.” They did — then got off easy with a $750,000 settlement with Fulton’s family.

An early victim of the opioid crisis, Kentucky has responded in smart ways, including increasing treatment slots in state prisons by 1,100 percent (to 5,901) since 2004 and launching a pilot program to prevent fatal overdoses among parolees by making naltroxone treatment available. Thirty counties have needle exchanges.

As one of the hardest hit, Kentucky still has a long way to go.

The changes in insurance that Republicans are trying to push through Congress would devastate recovery efforts in places already reeling.

Jenny Fulton could be anyone’s neighbor. Kentucky owes our neighbors better; that will require inspired leadership and commitment from health care and government.