Eastern Kentucky Overdoses: The Numbers, The Why, and What Works (2025 Update)

TL;DR: Kentucky overdose deaths dropped hard in 2024, but Eastern KY still carries a heavier load. Fentanyl and meth are the main drivers. The playbook that’s working: naloxone everywhere, quick access to treatment, and no-questions-asked 911 calls.

Where we are now (and yeah, it’s finally trending down)

Kentucky recorded 1,410 overdose deaths in 2024 — down 30.2% from 2023. That’s the third straight annual decline and a big deal for families here. Fentanyl showed up in 62.3% of deaths and methamphetamine in 50.8%. Translation: synthetic opioids and meth are still steering the crisis, even as totals fall.

Zooming out, the U.S. also fell sharply in 2024 (roughly −27%), so our state isn’t an outlier; we’re part of a broader downshift. That’s good — but it’s not “mission accomplished.” (CDC)

Why Eastern Kentucky gets hit harder

The Appalachian part of Kentucky — i.e., our eastern counties — consistently has higher overdose death rates than the rest of the state. In 2023, the age-adjusted overdose death rate in Appalachian KY was 62.5 per 100,000, vs 40.2 in non-Appalachian counties. That gap is real.

And in 2024, several of the highest-rate counties were in Eastern KY: Lee, Knott, Breathitt, Powell, Estill. If you live here, you don’t need a chart to feel it — these are neighbors, classmates, church folks.

What’s driving deaths here

• Fentanyl (cheap, potent, everywhere) + meth (often mixed) = most fatalities. Polysubstance use is the norm, not the exception.

• Emerging adulterants (like xylazine) are showing up in Kentucky monitoring — another reason fast reversal and quick medical care matter. (PubMed)

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What’s actually working (keep doing this)

• Naloxone saturation. Kentucky pushed out ~170,000 doses of Narcan in 2024 and supported 84 syringe service sites that reached 27,799 people — basic harm reduction that keeps folks alive long enough to choose recovery.

• Rapid treatment access. “Find Help Now KY” maps real-time openings for treatment, recovery housing, and naloxone. Fewer dead ends = more people in the door. (findhelpnow.org)

• 911 without fear. Kentucky’s Good Samaritan law (KRS 218A.133) p

• rotects people from possession charges when they seek medical help for an overdose. Call 911. Stay with them. Period. (Kentucky Legislative Research Commission)

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How to help right now (save a life, then change a life)

• Carry naloxone. Anyone in Kentucky can get it — no personal prescription needed under the statewide pharmacist protocol. Find free/community options on FindNaloxoneNowKY or ask your local pharmacy. (Pharmacy Kentucky, findnaloxone.ky.gov)

• Get someone into care fast. Use FindHelpNowKY to locate live treatment openings (inpatient, outpatient, MOUD, recovery housing). It’s built for speed. (findhelpnow.org)

• Call for guidance. KY HELP (Operation UNITE) at 1-8338-KY-HELP (1-833-859-4357) connects people and families to resources statewide. Human beings answer. (Operation UNITE |)

• Dispose of leftover meds. Hit a prescription drug drop box (tons of locations across southern/eastern KY via Operation UNITE and statewide via ODCP). Don’t keep pills at home “just in case.” (Operation UNITE |, odcp.ky.gov)

• If an overdose happens:

  1. Call 911 (Good Samaritan law has your back),

  2. Give naloxone,

  3. Rescue breathe/CPR as directed by dispatch,

  4. Stay until help arrives. (Kentucky Legislative Research Commission

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The bottom line

Eastern Kentucky is seeing real progress — and we earned it the hard way. But the risk hasn’t vanished; it’s just shifting. Keep naloxone within reach, keep treatment doors open, and keep calling 911 without hesitation. We can respect our roots and build a future where fewer families get that 2 a.m. call.