While the rest of the United States reels under what has been termed an epidemic of opioid drug abuse, state records show only one drug overdose in Letcher County for all of 2016, and none for 2017.
But that doesn’t mean that the epidemic hasn’t reached Letcher County. It means that the numbers haven’t reached the state office charged with tracking drug abuse and putting programs into effect to stem the tide.
According to the Office of Drug Control Policy, Letcher County had only one overdose death in 2016, compared to eight the previous year.
Perry Fowler, who was Letcher County Coroner from September 2015 until November 2016, said he turned in seven overdose deaths to the state during that calendar year. He said he is confident that there were more than that, but the coroner isn’t called for patients who die while in the hospital, and deaths are counted in the county where they occur, not in the county where the person lives. That means if a person is transferred to a hospital in another county, the death may be reported in another county, if it is reported at all.
“There must be five different reporting agencies for that, and all of them have a slightly different criteria, so I don’t know how you would get an accurate figure,” Fowler said.
The current coroner, Renee Campbell, said more people die from alcohol than drugs here. She said she would “issue a statement,” but did not call back.
The Office of Drug Control Policy collects records from the state Medical Examiner’s office, and county coroners. Fowler said the cause of death for patients who are injured as a result of drug use — in falls, car accidents, or by whatever means — and die in the hospital may or may not be reported as drug related at all.
“Say they passed out and hit their head, the doctor may say they died from intracranial pressure,” Fowler said.
Sheriff Danny Webb agreed.
“A lot of them are not listed. They put ‘heart attack’ or something,” Webb said.
Van Ingram, executive director of the Office of Drug Control Policy, flinched at the thought that there could be many more drug deaths that go unreported.
“God, I hope not,” he said. “We’ve got too many already.”
Ingram also agreed that examples like those used by Fowler and Webb do occur, but overall, he doesn’t think there are many that slip through the cracks.
“Looking at it from a statewide view, I think the reporting is pretty accurate,” he said. “Are there pockets that can be improved? Probably.”
Ingram said the system is dependent on people filling out the right paperwork and sending it in, so there will always be some margin of error. At minimum, if coroners believes a person died of a drug overdose, they are supposed to draw blood or vitreous fluid from the eye and send it to a laboratory for testing. The toxicology report then goes to the state.
“Reporting is better than it ever has been,” he said.
Previous reports from the ODCP show the rate of drug overdose deaths declining in eastern Kentucky. In Letcher County, deaths were down to nine in 2013, from 11 in 2012, and 19 in 2011. In Perry County, ODs declined to 12 from 19 in 2011; Knott County declined to less than five from eight in 2011; and Pike declined from 37 in 2011 to 24 in 2013. Of the counties surrounding Letcher, only one, Harlan, saw an increase in the overdose deaths from 2011 to 2013. In 2011, the state recorded 10 deaths in Harlan County and 12 each in 2012 and 2013.
None of the deaths recorded for Letcher County in 2015 involved heroin or fentanyl, said Van Ingram. No one drug could be pointed to in most of the cases, Ingram said.
“(Overdoses) are rarely one drug,” he said.
Ingram attributed the decline in drug related deaths to the passage of House Bill 1 in 2012, which set new, strict standards on how doctors may prescribe pain medications.
Statewide in 2015, 59.17 percent of accidental deaths were attributed to overdoses. Morphine was the most abused drug, followed by other opioids, and gabapentin, sold under the brand name Neurontin. Alcohol was found in about half as many deaths as morphine, slightly more than fentanyl, an opioid that is 50 to 100 times stronger than morphine. Oxycodone, once a predominant street drug, was found in about a third as many deaths as morphine.
Sheriff Webb said that without looking at the statistics, it seems as though opioid abuse is going down and methamphetamines are becoming more common. Heroin abuse, while becoming more popular throughout the state and more common as a cause of overdoses nationwide, has remained relatively low here, Webb said.
The bigger worry is fentanyl, which is being imported from China in new, previously unseen compounds. The Drug Enforcement Administration has found counterfeit Percocet made from fentanyl, which caused four deaths in central Georgia last week. The drug is so strong the DEA is warning police officers to carry Narcan, a drug that blocks opioid receptors in the brain, to save themselves in case they come into contact with the powder.
Letcher County United for Substance Abuse Prevention (USAP) currently has a grant to train first responders in its use, and to buy Narcan for them