A community health initiative in rural eastern Kentucky is using pharmaceutical company settlement money to address opioid addiction not as an isolated medical condition, but as a crisis embedded in a web of poverty, housing instability, food insecurity, and unemployment. The program — called The Hub — is now operating in four of Kentucky's most impoverished counties and has drawn national attention as a replicable model for other rural regions devastated by the opioid epidemic.
In April, Kentucky Attorney General Russell Coleman announced $320,000 would be awarded to the Kentucky River District Health Department's Hub initiative. There are now Hubs in four rural eastern Kentucky counties — Knott, Lee, Letcher, and Owsley, all of which are among the nation's most impoverished — addressing substance use disorders, housing, hunger, employment, and other challenges. The program also operates The Hub on Wheels, which provides services throughout the district.
In 2025, The Hub received $545,000 from the same source, facilitating expansion from two to five counties. Both grants are from Kentucky's approximately $1 billion share of the $57.8 billion for state and local governments from the settlement reached with pharmaceutical companies to resolve litigation for their role in fueling the opioid overdose crisis.
Why This Matters
The dominant model for addressing substance use disorders in the United States has historically been treatment-focused: medication-assisted treatment (MAT), detox programs, and residential rehabilitation. The research on what makes recovery sustainable, however, consistently points to factors that are not strictly medical: stable housing, food security, employment, and social connection.
Eastern Kentucky is the region where the modern opioid epidemic hit earliest and hardest. Overdose death rates in some Appalachian counties peaked at several times the national average. The region's economic conditions — high poverty, limited employment, weak social safety nets, and a healthcare infrastructure that was insufficient before the epidemic struck — made addiction recovery particularly difficult to sustain.
The Hub model attempts to address that full cluster of conditions simultaneously rather than treating substance use disorder as if it were independent of the social circumstances that sustain it.
What We Know So Far
The inaugural Hub launched in 2022 in Beattyville, the Lee County seat. Like the other Hubs, it provides a range of services targeted to the needs of the community: breakfast and lunch, a food pantry, a clothing closet, a laundry room, and a computer lab. Also: naloxone, a medication that can quickly reverse an opioid overdose; drug test strips; hepatitis C treatment; sterile syringes; and wound care.
The program's working motto is: "Meeting you where you are but not leaving you there."
JoAnn Fraley is the Kentucky River District Health Department's harm reduction program coordinator and Hub initiative director. "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," Fraley said. "We try to fill those gaps."
The new $320,000 grant announced in April 2026 is specifically designated as a two-year award to develop a program helping women who have been incarcerated reintegrate into society — a population that faces compounded vulnerabilities at the intersection of addiction, incarceration history, and poverty.
Where the Model Is Being Deployed
The current Hub network serves four eastern Kentucky counties: Knott, Lee, Letcher, and Owsley. A fifth location in Perry County is planned as part of the ongoing expansion. The Hub on Wheels provides mobile outreach across the broader Kentucky River district.
Kentucky overdose deaths declined in 2025 in what the Kentucky Lantern reported as a four-year downward trend. In 2024, 1,410 people died from drug overdoses in the state, down from 1,984 in 2023 and 2,135 in 2022. While the trend is encouraging, officials note that more than 1,000 Kentuckians continue to die each year from drug overdoses.
What Doctors and Experts Say
Research published in the Journal of Substance Use and Addiction Treatment indicates that people who participate in syringe services programs are more likely than those who do not to reduce their injection-drug use or stop using drugs altogether, and that they are more likely to enter and remain in treatment.
According to the CDC, syringe services programs also reduce the spread of HIV and hepatitis C by about half.
The Hub model is built on harm reduction principles — a framework that prioritizes keeping people safer during active substance use, reducing disease transmission, and maintaining connection to services until a person is ready to pursue recovery. The research literature does not support the claim that harm reduction facilitates drug use rather than preventing it.
In 2025, Kentucky River's Hub model was named one of 19 public health best practices award winners by the National Association of County and City Health Officials.
However, the Hub model currently faces a funding threat. A federal executive order directed programs across the country that they could no longer expect federal funding for "so-called harm reduction" efforts. The grants currently sustaining The Hub come from state-level opioid settlement funds — not from the federal programs targeted by the order — but the broader federal posture creates uncertainty for the long-term funding environment.
What the Evidence Shows — and What It Does Not
MedicalDaily Evidence Check
- Program type: Community-based harm reduction and wraparound services, funded by opioid settlement money
- Geographic scope: Four eastern Kentucky counties (Knott, Lee, Letcher, Owsley), expanding to Perry County
- Funding source: Kentucky's share of the $57.8 billion pharmaceutical company opioid settlement
- What the evidence supports: Syringe services participation is associated with reduced injection drug use and higher rates of treatment entry, per peer-reviewed research
- What is not yet established: Long-term outcome data specific to The Hub network is not yet published in peer-reviewed form
- What readers should know: The model addresses addiction within the social context that sustains it — an approach supported by addiction medicine research but facing federal funding headwinds
What You Can Do Now
- For policymakers and public health advocates in other rural regions affected by the opioid epidemic:
- Review your state's opioid settlement spending plans. Most states have received or are receiving significant settlement funds. Review how those dollars are being allocated — and whether harm reduction and wraparound services are included.
- Learn about the Hub model. The Kentucky River District Health Department has published program details that other communities can reference.
- Consult SAMHSA resources for evidence-based harm reduction guidance. SAMHSA's National Helpline at 1-800-662-HELP provides referrals to local treatment and harm reduction services.
- For individuals seeking help in eastern Kentucky, The Hub's services are available through the Kentucky River District Health Department.
Cost and Access: What Patients Should Know
The Hub's services are provided at no cost to participants. The program is funded through opioid settlement money, not patient fees. For individuals in other regions seeking similar services, SAMHSA's National Helpline at 1-800-662-HELP can provide referrals to local harm reduction and recovery support services at no cost.
NEXT Distro (nextdistro.org) distributes naloxone and harm reduction supplies by mail in many states. Many county and city health departments also distribute naloxone free of charge.
The Bottom Line
The Hub network in eastern Kentucky represents one of the most concrete and evidence-aligned uses of opioid settlement money currently operating in the United States. By addressing housing, food, employment, and health care simultaneously — rather than treating substance use disorder in isolation — the program reflects what addiction medicine researchers and clinicians have long understood: that sustainable recovery requires conditions for a survivable life. The model is currently expanding, is funded through settlement money rather than federal grants, and is serving some of the most economically distressed communities in the country.
