"We’re meeting people where they are, but not leaving them there." This philosophy guides The Hub, a network of community centers in rural Eastern Kentucky that are leveraging opioid settlement funds to provide comprehensive support for individuals struggling with substance use disorders, addressing critical needs from recovery services to basic necessities.
The opioid crisis has left an indelible mark on communities across the United States, and rural Eastern Kentucky, a region historically grappling with economic hardship and limited resources, has been particularly affected. In response, the state of Kentucky has channeled hundreds of thousands of dollars from national opioid settlements into innovative programs designed to mitigate the devastating consequences of addiction. At the forefront of this effort is The Hub, a vital initiative spearheaded by the Kentucky River District Health Department. This network of community centers offers a wide spectrum of services, from peer support and recovery assistance to essential resources like food pantries and sterile syringe access, embodying a pragmatic approach to public health that prioritizes saving lives and improving well-being.
Jamie Madden’s life story is a poignant illustration of the pervasive reach of addiction and the transformative power of accessible support. Her earliest memories are steeped in the illicit drug trade, a reality that shaped her understanding of how families subsist. “I grew up with the impression that that’s how you paid your bills,” Madden shared, reflecting on a childhood where drug-related activities were normalized as a means of providing for her family. This early exposure led to a cycle of substance use, with Madden becoming addicted to pain pills by age 16 and later to methamphetamine by 30. The profound consequences of her addiction included the loss of custody of two children and the relinquishment of two more for adoption at birth, alongside periods of incarceration. It was at the age of 40, pregnant and determined to break free from the grip of addiction, that Madden discovered The Hub in her hometown of Whitesburg, a community of just 1,575 residents.
The Hub’s operational framework is deeply rooted in the principles of harm reduction, a public health strategy that aims to reduce the negative consequences associated with drug use without necessarily demanding immediate abstinence. This approach acknowledges the complex realities of addiction and seeks to engage individuals with compassion and practicality. The program’s motto, "Meeting you where you are, but not leaving you there," encapsulates its commitment to providing a continuum of care. Services extend beyond immediate crisis intervention to encompass a holistic approach to well-being, addressing fundamental needs such as stable housing, nutritious food, healthcare, and vital overdose prevention tools.
In recent years, significant financial support has flowed into Eastern Kentucky to bolster these harm reduction efforts. In April, Kentucky Attorney General Russell Coleman announced an allocation of $320,000 to The Hub initiative through the Kentucky River District Health Department. This funding has been instrumental in expanding the program’s reach, establishing Hubs in four rural counties—Knott, Lee, Letcher, and Owsley. These counties are among the nation’s most impoverished, facing multifaceted challenges that often exacerbate substance use disorders, including inadequate housing, food insecurity, and limited employment opportunities. The Hub initiative, recognizing the interconnectedness of these issues, offers a comprehensive suite of services designed to address these pressing needs. Complementing the physical centers, The Hub on Wheels program extends vital services to individuals across the entire district, ensuring that geographic barriers do not prevent access to care.
Further bolstering the initiative’s capacity, The Hub received an additional $545,000 in 2025 from the same settlement funds, facilitating its expansion from two to five counties, with Perry County set to become the fifth location. The recent $320,000 grant, a two-year award, is specifically earmarked for the development of a program to assist women transitioning back into society after incarceration. These substantial financial injections stem from Kentucky’s share of the approximately $1 billion allocated to state and local governments from the landmark $57.8 billion settlement with pharmaceutical companies. This settlement was reached to resolve litigation concerning their role in fueling the devastating opioid overdose crisis that has ravaged communities nationwide.
Madden views the investment in harm reduction services as a prudent and effective use of resources, a conviction solidified by her own journey of recovery. She found a stable foundation for her sobriety at The Hub, a testament to the program’s efficacy. However, the future of such critical services faces an uncertain landscape. The Trump administration has signaled a move away from federal funding for harm reduction, with a July 24 executive order directing programs nationwide to cease expecting federal support. The order specifically stipulated that discretionary grants from the Substance Abuse and Mental Health Services Administration should not be allocated to "so-called ‘harm reduction’" efforts, asserting that these initiatives "only facilitate illegal drug use and its attendant harm." This directive stands in stark contrast to the experiences and perspectives of advocates and recipients of these services in rural regions like Eastern Kentucky, many of whom cast their votes for President Donald Trump, yet firmly believe in the life-saving value of harm reduction.
The town of Whitesburg itself, known for its vibrant cultural landscape, including the esteemed Appalshop media, arts, and education center, is a source of deep pride for its residents. The Hub’s presence on Main Street, nestled amongst local businesses and civic institutions like City Hall and the fire station, signifies its integration into the community fabric. The inaugural Hub, established in 2022 in Beattyville, the county seat of Lee County, exemplifies the program’s comprehensive approach. It provides not only daily meals and a food pantry but also essential resources such as a clothing closet, laundry facilities, and a computer lab. Crucially, it offers direct access to life-saving medications like naloxone, which can rapidly reverse opioid overdoses, alongside drug test strips, hepatitis C treatment, sterile syringes, and wound care services.
The underlying philosophy of harm reduction, as espoused by organizations like Harm Reduction International, emphasizes treating individuals with dignity and respect, aiming to minimize the immediate dangers of drug use while fostering an environment conducive to long-term recovery. This multifaceted support system, encompassing housing, sustenance, healthcare, and overdose prevention, aims to address the myriad challenges that individuals struggling with addiction often face. JoAnn Fraley, Kentucky River’s harm reduction program coordinator and Hub initiative director, underscores the critical role of stability in sustaining recovery. "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," she stated. "We try to fill those gaps."
Despite criticisms suggesting that syringe exchange programs might inadvertently encourage drug use, extensive research, including studies published in the Journal of Substance Use and Addiction Treatment, provides compelling evidence to the contrary. These studies indicate that individuals participating in syringe services programs are more likely to reduce their injection drug use, cease drug use altogether, and successfully enter and remain in treatment. The Centers for Disease Control and Prevention further supports this, reporting that syringe services programs can reduce the transmission of HIV and hepatitis C by approximately half. The effectiveness and innovative nature of The Hub model were recognized in 2025 when it was named one of 19 "Model of Promising Practice" award winners by the National Association of County and City Health Officials.
Lauren Carr, who advises the Kentucky Association of Counties on the strategic allocation of opioid settlement funds, highlights the program’s community-centric approach. "What jazzes me about it is it’s a community approach to harm reduction," Carr commented. "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 further described these services as a "lifeline" for those in need.
The personal testimonies from individuals who have directly benefited from The Hub are powerful affirmations of its impact. Becky Todd, a community health worker and peer support specialist leading the Beattyville Hub team, shared her own journey of overcoming multiple sentences on drug-related charges. Upon her release from jail in April 2024, with nowhere else to turn, she walked three miles to The Hub. She is now pursuing a bachelor’s degree in social work at Eastern Kentucky University, crediting the program with being her "saving grace."
Amber McDaniel recounted her initial visit to The Hub after more than a decade of addiction, during which she lost her home, her children, and her family’s support. "I didn’t know where to turn, didn’t know what to do," she recalled, expressing the depth of her despair. "I mean, I was about to lose my mind." McDaniel is now a valued member of The Hub’s staff, contributing to the program through AmeriCorps.
Hannah Stamper, who entered foster care and began using methamphetamine at age 14, found herself drawn to dealing drugs because she "loved for people to need me." Today, she serves on The Hub’s staff as part of Recovery Corps, a program that trains AmeriCorps members for roles in the recovery field. Her sentiment reflects a profound shift: "People today need me in a good way, and I love that."
Fraley has observed a significant shift in community attitudes in Lee County. Years ago, conversations surrounding addiction and homelessness were often fraught with tension and avoidance. "because nobody wanted to talk about it or acknowledge it." Now, with the visible impact of The Hub, the community’s perception has transformed. "The community sees The Hub’s impact, and now they’re, like, ‘Whoa. We love you,’" Fraley stated.
Scott Lockard, the district’s public health director, attests to the initiative’s success, citing both data and anecdotal evidence. He notes an increase in individuals seeking treatment and a decrease in reported communicable diseases. "I’ve been in public health for 36 years, and it’s one of the most effective interventions I’ve seen," Lockard remarked.
The Kentucky River team proactively engaged the community in the development of The Hub model, ensuring that concerns about the responsible use of funds were addressed. Crucially, individuals with lived experience of addiction have been integral to every stage of planning. "Their voice needs to be at every table," Fraley emphasized.
Lockard echoes this sentiment, stressing the importance of community input in ensuring effective resource allocation. "We’ll talk to those people who are experiencing the problem, find out what they think would help them best, and then look for those evidence-based interventions," he explained.
Jannie Gatlin and Mandy Parker, both in recovery, regularly attend crafting classes at the Whitesburg Hub. Gatlin, who began using fentanyl in Colorado after the death of her infant son, visits the Hub almost daily with her young son, Hunter. Parker, who initially received opioids for pain related to a kidney disorder, turned to street drugs when her prescription became inaccessible. "That’s just the nature of the beast," she commented, highlighting the cyclical challenges of addiction.
Parker believes The Hub is instrumental in dismantling the stigma associated with substance use disorder within her community. Witnessing "real change happening" creates a ripple effect, she said, emphasizing that "It makes a difference." The Hub’s accessible location on Main Street, she firmly believes, is precisely where it needs to be to serve those most in need.
