Kentucky has struggled in recent years with a spike in heroin abuse; a southern Indiana community is battling an HIV outbreak related to intravenous drug use.
Those issues have led Louisville area leaders to take a renewed interest in the resources available for drug addicts.
For example, Kentucky's heroin bill signed this spring by Gov. Steve Beshear allots more than $20 million each year for treatment.
But no two treatment options are the same.
In Louisville, people seeking help can get abstinence-based treatment or medication-assisted treatment.
The Healing Place uses an abstinence-based program. It's not for everyone, said Patrick Fogerty, chief program officer and certified alcohol and drug counselor at the Healing Place.
"It's one of those programs you have to be motivated to do. No one can force you to complete the 12 Steps. There has to be willingness, openness and honesty. It takes a lot of dedication," Fogerty said.
When someone goes to the Healing Place for treatment, they are placed in detox. Men typically spend three to five days in the unit; women seven to 10 days. Currently, about 600 people are being treated at the center.
Fogerty said 90 percent of their clients are addicted to heroin. He said heroin's strong euphoria and high level of dependency makes it the drug of choice for many.
Fogerty describes treatment as a social model. He said clients live at the Healing Place, but they still spend time in the community and attending 12 Step classes.
"Relapse prevention. Every time you make it back you're that much stronger," Fogerty said.
The medication-assisted treatment approach is used by the Methadone Opiate Rehabilitation & Education Center, a Louisville treatment facility
Dr. Morris Jorrisch, medical director at the Methadone Opiate Rehabilitation & Education Center, said there needs to be a continuum of care for treating addictions.
"It's the old tool box analogy. We have multiple tools and we need to be able to utilize all of them," Jorrisch said.
Methadone treatment has been shown to increase participation in behavioral therapy and decrease both drug use and criminal behavior, according to the National Institute on Drug Abuse.
The center is an outpatient program licensed to treat 200 people.Currently, 170 people are taking advantage of the services provided. All of them are addicted to some sort of opiate.
He said patients meet with a team of healthcare providers to determine whether they are appropriate for treatment. He said patients have to be able to prove that they are physiologically dependent on opioids before treatment begins.
"The benefits of methadone is that it is a very long-acting medication. It gets in slowly and it leaves slowly and these are the principles that make it a safer and usable medication for treatment," Jorrisch said.
Jorrisch said the goal of treatment at the methadone clinic is for patients not to use any illicit drugs.
"The methadone program is not an easy program. People need to be there, at least at the outset, on an every day basis," he said.
Fogerty and Jorrisch aim to help as many people as possible, and both notice the shift in demographics of people entering rehab.
Years ago the typical patient was a heroin user in their 30s or 40s, but the prescription opiate problem developed, Jorrisch said.
"We now have this younger demographic and many more women are coming in. It used to be majority men but now I would say it's 50/50," Jorrisch said.
And both say Kentucky Senate Bill 1, which cracked down on the prescribing of painkillers, has led to the increase in heroin usage.
"Senate Bill 1 was great and it shut down the over prescription of drugs but it left a huge void and all those individuals who abused those prescription drugs went to heroin," Fogerty said.
Legislators stepped in again.
This year, lawmakers approved the "heroin bill," which includes allowing local health departments to establish needle exchanges. Louisville Metro Council recently approved Metro Health's plans for a needle exchange program.
This decision also comes as an HIV outbreak related to intravenous drug use in southern Indiana spurred Indiana Gov. Mike Pence to sign an executive order temporarily legalizing a needle exchange program in Scott County.
Fogerty and Jorrisch agree that treatment is not a quick fix for addiction and other health conditions that come as a result of abusing opiates.
"Really time is an addict's best friend. Just the healing of your brain and body need all the time to heal," Fogerty said.
