Kentucky Counties Form Regional Collaboration to Maximize Opioid Settlement Impact

Published: April 16, 2026
Source: Kentucky Association of Counties

---

As Kentucky prepares to receive approximately $1 billion in opioid settlement funds over the coming years, twenty counties across the state have joined a new collaborative network designed to help local governments navigate the complexities of deploying these resources effectively. The Kentucky Association of Counties (KACo) Opioid Solutions Network represents one of the first statewide efforts to coordinate settlement fund spending at the regional level, recognizing that the opioid crisis respects no county borders — and neither should the solutions.

The initiative comes as Kentucky, like every state in the nation, begins receiving payments from the National Settlement Agreement that will ultimately distribute nearly $50 billion to communities affected by the prescription opioid epidemic. While the funds offer unprecedented opportunities to expand prevention, treatment, and recovery services, they also present significant challenges for local officials who may lack experience managing large-scale public health investments.

Why Counties Are Collaborating

All 120 Kentucky counties receive opioid settlement funds under the national agreement, with 50 percent flowing to state government and the remaining half distributed directly to local jurisdictions. But as Lauren Carr, KACo Opioid Settlement Adviser and leader of the new cohort, explains, capacity to deploy those funds varies dramatically across the commonwealth.

"Some counties have the infrastructure and expertise to attack this crisis head-on," Carr notes. "Others are smaller, more rural, with limited public health staff and no existing addiction treatment providers. We're trying to break down complex information into digestible pieces that any county can understand and act upon."

The twenty participating counties, including Graves County and Trigg County in western Kentucky, will work together to develop strategic action plans, form advisory committees, and pursue Recovery Ready Community certification — a state designation that signals a county has built comprehensive capacity to serve people seeking help for substance use disorders.

The Recovery Ready Framework

Only 39 of Kentucky's 120 counties currently hold Recovery Ready certification from the state. To earn this designation, counties must demonstrate capacity across three critical domains: prevention programs that stop substance use before it starts, treatment services that help people recover, and support systems that sustain long-term wellness.

McCracken County, certified in 2024, offers a model for what this looks like in practice. Though not part of the current KACo cohort, Site Administrator Nathan Brockett of Turning Point Recovery Community Center says collaboration with neighboring counties played a crucial role in their certification process.

"Working with other agencies and community partners — bouncing ideas off each other, finding ways that if we can't make something work, another agency can assist — that's been essential," Brockett explains. "Nobody has all the answers, but together we can piece together solutions."

Turning Point has used opioid settlement funding to launch a mobile access to recovery program, purchasing a van that brings services directly to people who might never walk through a clinic door. The vehicle travels to rural areas, homeless encampments, and other locations where people with substance use disorders congregate, offering naloxone distribution, peer support, and connections to treatment.

"The opioid abatement funding allows us to be flexible," Brockett says. "We're not constrained by rigid program requirements. We can meet people where they're at, literally and figuratively."

The Scale of Kentucky's Challenge

Kentucky has been among the states hardest hit by the opioid epidemic. For years, the commonwealth ranked near the top nationally for overdose mortality rates, with rural Appalachian counties experiencing some of the highest death tolls in the country. The crisis has touched virtually every family, every workplace, every community institution.

The prescription opioid wave that began in the late 1990s hit Kentucky particularly hard. Aggressive marketing by pharmaceutical companies, combined with high rates of physically demanding employment in mining and manufacturing that led to workplace injuries, created perfect conditions for widespread opioid dependence. When regulatory crackdowns limited pill availability, many people transitioned to heroin and, more recently, illicitly manufactured fentanyl.

The settlement funds now arriving represent both accountability and opportunity. The pharmaceutical manufacturers and distributors who profited from deceptive marketing practices that downplayed addiction risks are paying billions in restitution. But the money also offers a chance to build systems that might have prevented the crisis had they existed earlier — robust prevention programs, accessible treatment, recovery housing, peer support networks.

Strategic Spending in a Complex Environment

The challenge for counties is translating dollars into outcomes. Settlement funds arrive through a multi-year payment structure, meaning counties must plan for sustained investment rather than one-time spending sprees. The money comes with broad flexibility — unlike some federal grants with restrictive requirements — but also with expectations that it will be used for opioid-related services rather than diverted to unrelated priorities.

The KACo Opioid Solutions Network addresses this complexity by providing participating counties with technical assistance, peer learning opportunities, and access to evidence-based strategies that have worked elsewhere. Carr encourages counties to form advisory groups representing diverse stakeholders — treatment providers, law enforcement, people in recovery, family members, educators — to guide spending decisions.

"We want counties to think strategically," Carr says. "This isn't just about spending money quickly. It's about building systems that will outlast the settlement payments."

Mobile Outreach as a Rural Solution

For rural counties, geographic isolation represents one of the most formidable barriers to treatment access. Kentucky's Appalachian regions, in particular, have historically lacked addiction treatment infrastructure, with residents sometimes driving hours to reach the nearest medication-assisted treatment provider.

Mobile outreach programs like Turning Point's van offer one solution. These programs bring naloxone, peer support, and treatment connections directly to underserved areas, eliminating transportation barriers that prevent many people from seeking help. The model has gained traction across rural America as communities recognize that traditional clinic-based services don't reach everyone who needs them.

Settlement funds are well-suited to support mobile programs, which require upfront investments in vehicles, equipment, and staff but can then operate with relatively modest ongoing costs. For counties with limited existing treatment infrastructure, mobile outreach can provide immediate capacity while longer-term solutions — brick-and-mortar clinics, workforce development, telehealth infrastructure — are developed.

The Role of Peer Support

A distinctive feature of Kentucky's emerging response is the emphasis on peer recovery support — people with lived experience of addiction and recovery who help others navigate the treatment system. Organizations like Turning Point are led by and employ people in recovery, bringing authentic understanding to work that requires more than clinical expertise.

Peer specialists can establish rapport with people who might distrust traditional healthcare providers, offer practical guidance based on personal experience, and provide ongoing support that extends beyond formal treatment episodes. Research consistently shows that peer support improves treatment engagement, retention, and outcomes.

Settlement funds that support peer organizations represent a strategic investment in workforce capacity that didn't exist a decade ago. As the peer support field professionalizes — with certification requirements, training standards, and career pathways emerging — these organizations can become sustainable fixtures in community health systems.

Looking Ahead

The KACo Opioid Solutions Network is in its first year, and Carr hopes to see it expand to include more counties in future cohorts. The twenty current participants will serve as learning laboratories, testing approaches that can then be adapted by other jurisdictions.

For Kentucky as a whole, the $1 billion in settlement funds represents both a significant resource and a profound responsibility. The money cannot bring back the thousands of Kentuckians who have died from opioid overdoses over the past two decades. It cannot undo the damage that prescription opioid marketing inflicted on communities already struggling with economic transition and limited healthcare access.

But deployed strategically, the funds can support the programs, providers, and peer specialists who help people find their way to recovery. They can expand prevention efforts that stop substance use disorders before they start. They can build recovery housing that gives people stable environments to rebuild their lives. They can fund mobile outreach that reaches rural communities historically left behind.

The collaboration now forming among Kentucky counties recognizes that these goals require coordination, not competition. The opioid crisis has already demonstrated how interconnected communities are — how drug supply chains cross county lines, how economic conditions in one region affect neighboring areas, how the loss of productive citizens ripples through entire regions.

The response, these counties are betting, must be equally interconnected. By sharing knowledge, pooling resources where appropriate, and learning from each other's successes and failures, Kentucky's local governments hope to ensure that settlement funds achieve their intended purpose: addressing the crisis that caused so much suffering, and building systems that prevent similar tragedies in the future.

---

If you or someone you know is struggling with substance use, contact SAMHSA's National Helpline at 1-800-662-HELP (4357) for free, confidential, 24/7 treatment referral and information.