Addiction Psychiatry


The 2015 Kentucky Overdose Fatality Report showed that fatal overdoses in our state increased from 2014 to 2015. There were 1248 fatalities in Kentucky in 2015 compared to 1078 in 2014. Of these overdose deaths, 28% were attributed to heroin alone and 34% were attributed to fentanyl alone or fentanyl with heroin. Jefferson County had the highest number of overdose deaths. Interestingly, Leslie, Bell, and Gallatin Counties had the highest per capita rate of drug overdose deaths (calculated as deaths per 100,000 people) between 2012 and 2015. This shows that drug deaths are not limited to our larger cities. Jefferson, Kenton and Fayette Counties were the top 3 counties for heroin overdose deaths, and Kenton, Fayette and Jefferson Counties were the top 3 for fentanyl overdoses.

According to the 2016 NSDUH (National Survey of Drug Use in Households), 6.9% of Americans misused psychotherapeutic drugs. Also, 97.4% of opioid misusers are using prescription opioids, not heroin. Furthermore, 3.4% of the population had both a substance use disorder and a mental illness.

A prospective 4-year study of patients with schizophrenia revealed that nearly half were active substance abusers and 67% of those who were current users were noncompliant with their psychiatric meds. Mental health and addiction have much common ground. Recently released data from the CDC shows that drug overdose rates continued to go up even in 2016. During 2016, 63,632 Americans died of drug overdoses, and this was an increase of 21% from 2015. The largest number of deaths occured in the 25-34-year-old age group. Perhaps the most disturbing fact is that the largest increase in drug overdose deaths was in the 15-24-year-old age group.

However, drug overdose deaths are not the only issue. The following report, Pain in the Nation: The Drug, Alcohol and Suicide Epidemics and the Need for a National Resilience Strategy, released by the Trust for America’s Health (TFAH) and Well Being Trust (WBT) in 2017 documents that in 2015, there were 127,000 deaths in America from drugs, alcohol and suicide. That amounts to 350 deaths per day, 14 deaths per hour and one every 4 minutes. Alcohol induced deaths increased by 37% between 2000 and 2015 and suicide increased by 28% in the same time period.

So, what happens if this trend continues? According to the same report, this could result in 1.6 million deaths in the US between 2016 and 2025 from these three causes. At this rate, we could be facing a death rate of 163,000 per year by 2025. According to this report, Kentucky is currently 7th in the nation in deaths from drugs, alcohol, and suicide and could rise to 6th by 2025 if the current rates continue.

We’ve been talking about suicide, drug and alcohol deaths for years now. The opioid crisis has been declared a national emergency, a state emergency, a county emergency, etc. Yet the rates continue to rise. Why? Where have these declarations really gotten us?

You may want to check out the excellent report at, Pain in the Nation. The report has some great suggestions for a comprehensive national approach to this epidemic. However, it doesn’t mention the barrier that is the most difficult to overcome and is probably the most significant reason why we haven’t made more progress – stigma. It’s still there for both mental health and addiction. It isn’t just treatment availability, which is an issue, but the reluctance to get the available treatment because of stigma. We can’t just blame the public for stigmatizing mental illness and addiction. Talk is cheap, and I suspect that deep down many of our government officials still believe that addiction is the fault of the addicted person though they won’t publicly acknowledge that view. Unfortunately, there is still a lot of stigma within our own medical profession. My patients have told me of many negative encounters with their primary care physicians, encounters that probably delayed their entry into treatment by years because it reinforced their guilt and shame.
Stigma is entrenched, and it doesn’t always respond to educational approaches. When people can personalize these statistics, and see them as human beings, neighbors, friends, children, children’s friends, maybe then things will begin to change. For many Americans, addiction and serious mental health issues are still experience distant. Even if they know someone suffering from addiction or severe depression, they are able to rationalize that it’s not them – until it is them or their immediate family member.

As a representative of the Kentucky Society of Addiction Medicine (a state chapter of the American Society of Addiction Medicine), as well as a member of KPMA, I hope that our organizations can work together on this and many other issues. We know that prevention and treatment do work. We must continue our mission to get people the treatment that will save their lives.

Colleen Ryan, MD
Secretary of KYSAM, APA/KPMA member

Some useful links: (Substance Abuse and Mental Health Services Administration) (American Society of Addiction Medicine) (National Institute for Alcohol Abuse and Alcoholism)