Why It Matters
Kentucky’s rural eastern counties have faced some of the most severe opioid addiction rates in the nation, with small communities often lacking the infrastructure to support recovery. Opioid settlement dollars are now flowing into programs designed to fill that gap — though a recent federal executive order creates uncertainty over long-term funding for harm reduction efforts.
What Happened
Kentucky Attorney General Russell Coleman announced in April a $320,000 award to the Kentucky River District Health Department’s Hub initiative, funding a two-year program focused on reintegrating women following incarceration. The grant is part of the state’s broader deployment of opioid settlement funds targeted at rural eastern Kentucky.
The Hub operates community centers in four eastern Kentucky counties — Knott, Lee, Letcher, and Owsley — with a fifth location planned for Perry County. A mobile unit called Hub on Wheels extends services across the district. The program offers a wide range of services: meals, a food pantry, clothing, laundry access, computer labs, naloxone, hepatitis C treatment, drug test strips, sterile syringes, and wound care.
The flagship Hub in Whitesburg — a town of roughly 1,575 residents — served as a recovery resource for Jamie Madden, a Kentucky resident who went through the program. In Beattyville, the seat of Lee County and roughly two hours northwest of Whitesburg, the first Hub location launched in 2022.
Becky Todd’s experience illustrates the program’s reach. Released from jail in April 2024 after multiple drug-related sentences, she walked three miles directly to The Hub.
By the Numbers
$1 billion — Kentucky’s approximate share of a national opioid settlement totaling $57.8 billion to state and local governments.
$545,000 — funding The Hub received in 2025, enabling it to expand from two counties to five.
$320,000 — the new two-year grant announced in April for the women’s reintegration program.
19 — number of public health best-practices award winners nationally in 2025; the Kentucky River Hub model was among them, recognized by the National Association of County and City Health Officials.
4 — eastern Kentucky counties currently served by Hub locations, with a fifth county in progress.
Zoom Out
The Hub’s community-centered model reflects a broader shift in how rural states are deploying opioid settlement funds — moving away from strictly clinical approaches toward wraparound services that address housing, food security, and economic stability alongside addiction treatment.
JoAnn Fraley, harm reduction program coordinator for Kentucky River, described the program’s philosophy: “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. We try to fill those gaps.”
Lauren Carr, an advisor with the Kentucky Association of Counties, emphasized the program’s community-based structure, saying “what jazzes me about it is it’s a community approach to harm reduction.”
However, a July 24 executive order from the Trump administration directed that discretionary grants from the Substance Abuse and Mental Health Services Administration cannot fund harm reduction programs. The order introduces uncertainty for organizations that have relied on federal dollars alongside state settlement funds, though the Hub’s current expansion is supported by Kentucky’s opioid settlement allocation rather than SAMHSA grants.
What’s Next
The fifth Hub location in Perry County is in development. The newly funded women’s reintegration program is expected to operate over the next two years. State officials and local health departments will continue drawing on Kentucky’s approximately $1 billion settlement share, though the federal policy shift could affect how harm reduction programs are structured going forward.
Kentucky’s approach to deploying settlement funds will likely draw attention from other states navigating similar challenges — balancing federal compliance requirements with on-the-ground public health needs in communities where addiction remains a persistent crisis. For more on Kentucky health policy developments, see our coverage of how Kentucky hospitals responded to Trump administration pricing directives.