‘If we pretend that everyone that has made a mistake…should get some sort of economic death penalty where they can never get a job again, we will never overcome this problem.’

• Harlan County, Kentucky, a rural part of the state with high overdose rates, is becoming a model for addiction recovery.
• The county has implemented recovery programs, drug courts, and transportation services funded by opioid settlement money.
• It may also serve as a model for other areas, including Tennessee, who are also struggling with opioid addiction and overdoses.

Mandy Gooden grew up in a town that had one of the largest addiction rates in the country, with over five times the OxyContin distribution per capita than the national average in 2000. 

After struggling with her own opiate addiction that began with a prescription after surgery in North Carolina, Gooden found recovery in that same hometown – Harlan, Kentucky.

Now, the faded buildings lining Harlan’s downtown are filled with posters for recovery groups, prevention events and nightly AA meetings in an alleyway beside the local bank.

Though the county still had a far higher overdose death rate than the national average in 2021, for the past three years, treatment efforts have increased. And the number of deaths has dropped.

Harlan has established positions devoted to recovery, a recovery-focused drug court, transport programs and reemployment services. Day after day, Gooden has been part of that change. Now in long-term recovery, she helps others recover through a position funded by opioid settlement money.

Over the next 18 years, Harlan is expected to receive over $10 million in additional funds from pharmaceutical companies and distributors who exacerbated the opioid crisis, according to the Kentucky Attorney General’s office. 

“In Harlan, sober is the new cool,” said Gooden.

Gooden manages local cases classified under Casey’s Law, shorthand for the Matthew Casey Wethington Act for Substance Abuse Intervention. It was instituted in Kentucky in 2004 after the 23-year-old Casey died from a heroin overdose. The law helps families petition courts to get treatment for loved ones who are unwilling or unable to do so themselves. 

Harlan’s success in recovery may provide a model for rural Tennessee communities as the state prepares to receive over $1.2 billion in abatement funds over the next 18 years. Dr. Stephen Patrick, former director of Child Health Policy at Vanderbilt, has been a part of efforts to outline how communities should use these funds, though guidelines for spending are lacking, he said.

More: Tennessee part of another opioid settlement. How much will it get?

In Harlan County, recovery takes a whole community

The money will aid recovery efforts. But for some, it will come too late.

As the coal industry declined through the 1990s, poverty and unemployment soared in Harlan, with over 25 percent of the county’s population of about 25,000 falling below the poverty line. 

Tom Vicini, president and CEO of drug prevention and recovery organization Operation UNITE, said some unemployed coal miners sold their prescriptions to support their families or to buy more drugs themselves.

Opinion: The opioid crisis is crushing Tennessee. Our senators can help.

As Gooden and others worked to create an anti-addiction program, Kateena Haynes, CEO of the Boys and Girls Club of Appalachia, advocated for children who’ve experienced what she calls “horrific situations and circumstances.” 

“They think that, ‘You know, my parents haven’t had a job, and I’m not going to have a job, and so why don’t I just use drugs?’” Haynes said. “I think that the greatest thing that we do is just to give kids hope.”

The Harlan drug court has also stepped in, providing rehabilitation.

The Harlan drug court provides support for those struggling with addiction

Amber Stepp said she landed her first job through the drug court in 2021 after struggling with an OxyContin addiction.

“[Drug court workers] taught me how to grocery shop; they got me to get a bank account; they just taught me to live a normal and productive life,” said Stepp. “They inspired me to find something I wanted to do and something that I’m passionate about and make that my career.”

She became a peer support specialist, someone who is in successful recovery, trained to support others struggling with addiction. 

She also helps run local recovery meetings and Harlan’s coalition of Operation UNITE, organizing community outreach events to prevent addiction.

Through efforts led by Dan Mosley, Harlan has further advanced opportunities for people who may not otherwise be able to access recovery.

As Harlan’s Judge-Executive, Mosley helped establish the Harlan County Drug Summit in 2019. He developed Ride for Recovery, which pays community action agencies or private transit providers to transport someone to recovery if they are unable to. Harlan also provides job reentry services.

“If we pretend that everyone that has made a mistake as it relates to their addiction should get some sort of economic death penalty where they can never get a job again, we will never overcome this problem,” said Mosley.

 “They were loved back to life here.”

Originally from Nashville, Virginia Hunt is currently a journalism and biology student at Northwestern University with a special interest in public health reporting.