Kentuckians Agree—It’s Time to End Discrimination in Health Care for People with Substance Use Disorders

by Sally Friedman, Sr. Vice President of Policy Advocacy at the Legal Action Center and Amanda Hall, Senior Director of National Campaigns

Recent polling confirms what many Kentuckians already know: substance use disorder (SUD) is a crisis that touches nearly every family. An overwhelming 99% of Kentuckians recognize it as a serious issue, and more than two-thirds personally know someone affected. Even more significantly, 77% say it’s time to treat SUD as the health condition it is–not as a criminal issue. With 68% of Republicans, 84% of Democrats, and 80% of Independents in agreement, this is not a partisan viewpoint.

These numbers send a clear message: Kentuckians are ready to move away from stigma and punishment toward compassion and care. Now, our policies and health care system needs to catch up.

Few states have felt the devastation of the opioid crisis as deeply as Kentucky. From Appalachia to our urban centers, families have lost loved ones far too soon. Between 1999 and 2017, as overdose deaths tripled nationally, Kentucky was consistently ranked among the hardest-hit states. By 2019, nearly 6% of Kentuckians were estimated to be living with an opioid use disorder — and in some counties, especially in Eastern Kentucky, the number climbed as high as 17%. The COVID-19 pandemic only worsened the crisis, driving record overdose deaths statewide. In total, we have lost more than 27,000 Kentuckians to overdose since the turn of the century.

Thanks to the relentless work of advocates, health care providers, and people in recovery, we’re beginning to see signs of hope. In 2024, overdose deaths dropped by 30% statewide. Expanded access to medications for opioid use disorder (MOUD), peer support services, and harm reduction strategies such as syringe service programs, Narcan, and fentanyl test strips are saving lives.

Still, barriers remain — and stigma is one of the biggest. People with SUDs, especially those taking MOUD such as buprenorphine or methadone (which are gold-standard, FDA-approved treatments backed by science), often face discrimination when seeking healthcare. Reports show that individuals are denied health care due to providers’ outdated views on these lifesaving medications. Such discrimination yields enormous consequences. One study found that 1 in 10 people who knew they needed care didn’t seek it, due to fears about the stigma they might encounter.

Kentuckians are ready to change this. Public opinion research commissioned by the Legal Action Center found that 86% of Kentuckians not only support expanding access to affordable SUD treatment, but 81% also believe that no one should be denied health care because they take MOUD. This includes strong support from Republicans, Democrats, and Independents alike.

Acting with urgency is essential. While overall overdose rates are dropping, progress hasn’t reached everyone. Since 2018, for example, overdose deaths have increased by 8% among Black Kentuckians. We must act now to ensure recovery is possible for every Kentuckian — no matter their race, zip code, or income. Everyone deserves the opportunity to recover.

So, what can we do?

First, we must protect access to Medicaid. Nearly 1.5 million Kentuckians rely on this program, including nearly 80,000 with opioid use disorder. It will be critical for the state’s Medicaid administrators to implement the recent cuts and changes enacted at the federal level in a way that protects coverage for these individuals, specifically for those with SUDs.

Second, we must remove outdated policies that exclude people from treatment or recovery housing simply because they take MOUD. These are evidence-based medications, not a barrier to recovery.

Third, we must directly confront the stigma that still surrounds SUD. That means educating health providers, challenging discriminatory practices, and treating SUD like any other chronic illness – with evidence-based care and compassion.

The people of Kentucky are united in their desire for change. It’s time for the policymakers to act - together, we can build a Kentucky where recovery is possible for everyone.

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Sally Friedman is the Sr. Vice President of Policy Advocacy at the Legal Action Center, a legal and policy organization dedicated to fighting discrimination, building health equity, and restoring opportunities for people impacted by the criminal legal system, substance use, and/or HIV/AIDS. 

Amanda Hall, an Eastern Kentuckian and person in recovery, is the Senior Director of National Campaigns at Dream.org, where she leads efforts to modernize drug policy, strengthen the justice system, and expand opportunities for those impacted by the criminal legal system.