Kentucky's 'Hub' Model Shows How Opioid Settlement Funds Can Transform Rural Addiction Care

In the small Appalachian town of Whitesburg, Kentucky, a storefront on Main Street has become something extraordinary. Neighboring City Hall and the local coffee shop, The Hub provides naloxone, sterile syringes, hepatitis C treatment, food pantry access, and perhaps most importantly, a space where people struggling with addiction are treated with dignity rather than judgment.

The Hub represents a growing network of community centers across rural eastern Kentucky that are transforming how addiction services reach underserved populations. Funded through the state's approximately $1 billion share of the $57.8 billion national opioid settlement, these centers demonstrate how pharmaceutical litigation proceeds can be deployed to address the overdose crisis at the community level—even as federal funding for harm reduction faces unprecedented uncertainty.

From Settlement to Services

In April, Kentucky Attorney General Russell Coleman announced $320,000 in additional opioid settlement funding for the Kentucky River District Health Department's Hub initiative, building on $545,000 awarded in 2025. The network has expanded from two to five counties—Knott, Lee, Letcher, Owsley, and soon Perry—all among the nation's most impoverished regions.

The funding model is straightforward: settlement dollars flow directly to local health departments that have developed comprehensive, evidence-based approaches to addiction. Rather than siloed programs focused narrowly on abstinence or medication alone, The Hubs embrace what public health experts call "low-threshold" care—meeting people wherever they are in their relationship with drugs, without prerequisites or judgment.

"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," explains JoAnn Fraley, Kentucky River's harm reduction program coordinator and Hub initiative director. "We try to fill those gaps."

What Harm Reduction Actually Looks Like

The Beattyville Hub, launched in 2022 in Lee County, offers a glimpse of the comprehensive services made possible by settlement funding. Visitors can access breakfast and lunch, a food pantry, clothing closet, laundry facilities, and a computer lab. They can also receive naloxone, drug test strips, hepatitis C treatment, sterile syringes, and wound care.

The program's motto—"Meeting you where you are but not leaving you there!"—encapsulates the harm reduction philosophy that has guided its development. Rather than requiring abstinence as a precondition for assistance, harm reduction services aim to minimize the negative consequences of drug use while building trust that can eventually lead to treatment engagement.

Research supports this approach. Studies published in the Journal of Substance Use and Addiction Treatment indicate that people who participate in syringe services programs are more likely than non-participants to reduce their injection drug use or stop entirely, and are more likely to enter and remain in treatment. According to the CDC, these programs reduce HIV and hepatitis C transmission by approximately half.

In 2025, Kentucky River's Hub model was recognized as one of 19 public health best practices by the National Association of County and City Health Officials—a validation that rural communities can implement sophisticated harm reduction infrastructure when provided adequate resources.

Lives Transformed

The impact of The Hubs extends beyond statistics. Becky Todd, who leads the Beattyville Hub's team as a community health worker and peer support specialist, walked three miles from jail to The Hub in April 2024 after serving multiple sentences on drug-related charges. She had nowhere else to go. Today, she's pursuing a bachelor's degree in social work at Eastern Kentucky University.

"I could not have done it without this place," Todd says. "It's my saving grace."

Amber McDaniel recalls her first visit to The Hub after more than a decade of addiction, having lost her home, her children, and her family's support. "I didn't know where to turn, didn't know what to do," she remembers. "I mean, I was about to lose my mind." Now she works at The Hub through AmeriCorps, helping others navigate the same challenges she faced.

Hannah Stamper, another staff member placed through Recovery Corps, began using methamphetamine at 14 after being placed in foster care. She was drawn to dealing drugs because "I loved for people to need me." Today, she says, "People need me in a good way, and I love that."

Community Buy-In

Scott Lockard, the district's public health director, notes that The Hubs have achieved something remarkable in conservative rural communities: genuine community acceptance. A half-dozen years ago, public conversations about addiction and homelessness were strained "because nobody wanted to talk about it or acknowledge it."

Now, Lockard says, the community sees The Hub's impact "and now they're, like, 'Whoa. We love you.'"

This transformation didn't happen by accident. The Kentucky River team worked deliberately to educate the community about the Hub model, and planning always included people with lived experience of addiction. "Their voice needs to be at every table," Fraley emphasizes.

The data supports the community's enthusiasm. Lockard reports increases in the number of people entering treatment and declines in reported communicable diseases. "I've been in public health for 36 years," he says, "and it's one of the most effective interventions I've seen."

Federal Headwinds

The Kentucky model's success comes at a precarious moment for harm reduction funding nationwide. The Trump administration has moved to eliminate federal support for syringe services programs and other harm reduction initiatives, with a July 2024 executive order stipulating that SAMHSA discretionary grants should not be spent on "so-called 'harm reduction'" efforts.

The order claims such programs "only facilitate illegal drug use and its attendant harm"—a characterization that contradicts decades of research and the lived experience of communities like those served by The Hubs.

Kentucky's opioid settlement funding provides a buffer against federal cuts, but the tension highlights a fundamental question about how the nation will sustain the progress that has seen overdose deaths decline 14% nationally over the past three years. If harm reduction infrastructure disappears just as it begins to demonstrate measurable impact, those gains could prove fragile.

A Model for Other States

Lauren Carr, who advises the Kentucky Association of Counties on opioid settlement fund utilization, sees The Hubs as demonstrating what's possible when communities take a comprehensive approach to addiction. "Whether that's feeding a hungry stomach, or putting clothes on somebody's back, or giving them clean [syringes], you're meeting that person's needs," she says. "It can be that lifeline."

The model offers lessons for other states receiving settlement funds. Rather than diverting litigation proceeds to general budget shortfalls or law enforcement equipment—practices documented in jurisdictions across the country—Kentucky has directed resources toward evidence-based interventions delivered by trusted community institutions.

The results speak for themselves: people entering treatment, communicable diseases declining, and communities that once rejected addiction services now embracing them.

For Jamie Madden, who found recovery at The Hub in Whitesburg after decades of addiction and incarceration, the investment represents something simple but profound: a chance to rebuild a life. "I grew up with the impression that that's how you paid your bills," she says of her early exposure to drug trafficking. "That's how your kids got things."

Today, through The Hub, she's learning a different way—one that Kentucky's opioid settlement funds are making possible for thousands of others across the Appalachian region.