Kentucky Invests Opioid Settlement Funds in Rural Harm Reduction Hubs to Combat Addiction

In April 2026, Kentucky Attorney General Russell Coleman announced a $320,000 award to expand an innovative harm reduction initiative across four of the most impoverished counties in eastern Kentucky. The funding supports "The Hub," a network of community centers providing everything from naloxone and sterile syringes to food pantries and peer recovery support — demonstrating how states are translating opioid settlement dollars into on-the-ground services in communities hit hardest by the addiction crisis.

The Hub Model: Meeting People Where They Are

The Kentucky River District Health Department's Hub initiative now operates in four counties — Knott, Lee, Letcher, and Owsley — with a fifth location planned for Perry County. Each Hub provides a comprehensive range of services tailored to community needs: naloxone distribution, drug test strips, hepatitis C treatment, sterile syringe access, wound care, food pantries, clothing closets, laundry facilities, computer labs, and recovery peer support.

"In order for anybody to sustain recovery, they have to have financial stability, they have to have transportation, and they have to have a home," said JoAnn Fraley, Kentucky River's harm reduction program coordinator and Hub initiative director. "We try to fill those gaps."

The program's motto — "Meeting you where you are, but not leaving you there" — reflects its harm reduction philosophy: providing practical support that keeps people safe and healthy until they're ready to enter recovery, without requiring abstinence as a prerequisite for help.

From Settlement Dollars to Street-Level Services

Both the new $320,000 award and the $545,000 the Hub received in 2025 come from Kentucky's approximately $1 billion share of the national opioid settlement. The funds represent a direct pipeline from pharmaceutical company accountability to community services in a region where overdose deaths have devastated families for years.

The initiative's effectiveness has already drawn national recognition. In 2025, the Kentucky River Hub model was named one of 19 public health best practices by the National Association of County and City Health Officials (NACCHO).

"I've been in public health for 36 years, and it's one of the most effective interventions I've seen," said Scott Lockard, the district's public health director. The program's success is measured not just in services provided, but in concrete outcomes: more people entering treatment, and declining rates of communicable diseases like HIV and hepatitis C.

Real Impact, Real People

The Hub's staff includes people with lived experience of addiction — a deliberate choice that shapes the program's culture and effectiveness.

Becky Todd, a community health worker and peer support specialist at the Beattyville Hub, walked three miles from jail to The Hub in April 2024 with nowhere else to go after serving multiple sentences on drug-related charges. She's now working toward her bachelor's degree in social work at Eastern Kentucky University. "I could not have done it without this place," Todd said. "It's my saving grace."

Hannah Stamper, another staff member, was placed in foster care and began using methamphetamine at 14. Now serving through Recovery Corps, a program that trains AmeriCorps members to work in the recovery field, she says: "People today need me in a good way, and I love that."

Evidence Over Ideology

Despite recent federal policy shifts questioning harm reduction's value, research consistently supports these approaches. Studies published in the Journal of Substance Use and Addiction Treatment show that people who participate in syringe services programs are more likely to reduce or stop drug use, and more likely to enter and remain in treatment. According to the Centers for Disease Control and Prevention, syringe services programs reduce the spread of HIV and hepatitis C by about 50 percent.

The eastern Kentucky communities served by The Hub cast their ballots for President Trump in all three of his elections — yet local advocates see harm reduction services as practical, nonpartisan public health. The Kentucky River team worked to educate community members about the Hub model's potential outcomes, and program leaders say there was little resistance, just concern that the money be well spent.

"What jazzes me about it is it's a community approach to harm reduction," said Lauren Carr, who advises the Kentucky Association of Counties on opioid settlement fund utilization. "Whether that's feeding a hungry stomach, or putting clothes on somebody's back, or giving them clean [syringes], you're meeting that person's needs. It can be that lifeline."

What's Next for Kentucky's Settlement Funds

The new $320,000 award is a two-year grant specifically to develop programming for women who've been incarcerated, helping them reintegrate into society — a population with particularly high overdose risk in the weeks following release.

The expansion from two to five counties in 2025-2026 represents a significant scaling of the Hub model, one that other rural states are watching closely. With Kentucky's full $1 billion settlement share distributed over 18 years, the state has an ongoing revenue stream to sustain and expand initiatives like The Hub — provided political and community support remains strong.

For families in eastern Kentucky, the settlement isn't an abstraction. It's naloxone in a moment of crisis. It's a warm meal when hunger would otherwise drive someone back to the streets. It's a peer support specialist who has walked the same path and found a way out.

"When people see real change happening," said Mandy Parker, a Hub participant in recovery, "there's a ripple effect. It makes a difference."

For Kentucky families seeking help: The Kentucky Opioid Assistance and Resource Hotline is available at 1-800-437-7288. SAMHSA's National Helpline at 1-800-662-HELP (4357) provides free, confidential, 24/7 treatment referral and information.