"We are meeting people where they are, but not leaving them there," a philosophy that defines The Hub, a vital community-based program in Eastern Kentucky, which is proving to be a critical intervention in combating the devastating impacts of the opioid crisis through comprehensive harm reduction services.
In the heart of Eastern Kentucky, a region grappling with the pervasive and enduring consequences of the opioid epidemic, a beacon of hope and practical support has emerged. The Hub initiative, a network of community centers spread across several rural counties, is demonstrating the profound impact of harm reduction strategies in addressing substance use disorders, poverty, and a myriad of interconnected challenges. Funded significantly by opioid settlement dollars, these centers are not merely providing aid; they are fostering recovery, rebuilding lives, and challenging prevailing federal narratives that seek to curtail such essential services.
Jamie Madden’s story is a stark illustration of the deep-rooted struggles many in this region face. Her earliest memories are intertwined with the illicit drug trade, a reality that shaped her perception of how needs were met. "I grew up with the impression that that’s how you paid your bills," Madden shared, reflecting on a childhood where drug acquisition was a family affair. By adolescence, she was battling pain pill addiction, a struggle that escalated to methamphetamine use by her thirties. This descent led to the devastating loss of parental rights for two children and the adoption of two more at birth, alongside periods of incarceration. At 40, pregnant and determined to break the cycle, Madden discovered The Hub in her hometown of Whitesburg, a town of just 1,575 residents. This discovery marked a turning point, leading her to a program that would become instrumental in her recovery journey.
The state of Kentucky has allocated hundreds of thousands of dollars from opioid settlement funds to bolster initiatives like The Hub, aiming to mitigate the widespread ramifications of drug misuse in its rural eastern territories. The Hub network, a crucial component of this effort, encompasses community centers offering a spectrum of services. These range from peer support for those in recovery to essential resources like canned food and sterile syringes. This comprehensive approach underscores a philosophy of meeting individuals at their point of need, providing immediate support while simultaneously building pathways toward long-term recovery and stability.
In April, Kentucky Attorney General Russell Coleman announced a significant award of $320,000 to the Kentucky River District Health Department’s Hub initiative. This funding has enabled the expansion of Hubs into four rural eastern Kentucky counties: Knott, Lee, Letcher, and Owsley. These counties are notably among the nation’s most impoverished, facing multifaceted challenges that include substance use disorders, housing insecurity, food insecurity, and employment difficulties. The program’s innovative "Hub on Wheels" further extends its reach, delivering vital services across the entire district. In 2025, an additional $545,000 from the same settlement funds facilitated the expansion of The Hub from two to five counties, with Perry County being the newest addition. The recent $320,000 grant is specifically earmarked for a two-year program designed to assist women transitioning from incarceration back into society.
These crucial grants originate from Kentucky’s substantial 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 address the companies’ roles in fueling the devastating opioid overdose crisis that has ravaged communities nationwide. Madden, a beneficiary of these services, firmly believes that investment in harm reduction is a fiscally responsible and ethically imperative strategy, witnessing its transformative power in her own life and finding a stable foundation for recovery at The Hub.
However, the efficacy and necessity of these harm reduction services are currently facing a significant challenge from federal policy shifts. The Trump administration, in a July 24 executive order, declared an end to federal funding for such programs, disputing their perceived benefits. The order stipulated that discretionary grants from the Substance Abuse and Mental Health Services Administration (SAMHSA) should not be allocated to "so-called ‘harm reduction’" efforts, on the grounds that they "only facilitate illegal drug use and its attendant harm." This stance is met with strong disagreement from advocates in rural regions like Eastern Kentucky, many of which cast their votes for President Donald Trump in previous elections, highlighting a disconnect between federal policy and the on-the-ground realities faced by communities.
Meeting Folks Where They Live
Whitesburg, a town known for its vibrant cultural scene, including the renowned Appalshop media, arts, and education center, is a place its residents hold in high regard. The Hub’s physical presence on Main Street, nestled among local businesses and civic institutions like City Hall and the fire station, symbolizes its integration into the community fabric. Like its counterparts, the Whitesburg Hub offers a diverse array of services tailored to the specific needs of its local population.
The inaugural Hub, established in 2022 in Beattyville, the seat of Lee County, two hours northwest of Whitesburg, exemplifies the program’s holistic approach. This center provides essential daily meals, operates a food pantry, offers a clothing closet, and houses a laundry room and computer lab. Crucially, it also dispenses life-saving naloxone, a medication capable of rapidly reversing opioid overdoses, along with drug test strips, hepatitis C treatment, sterile syringes, and wound care supplies.
The program’s guiding principle, "Meeting you where you are but not leaving you there!" is rooted in the fundamental tenets of harm reduction. This philosophy prioritizes minimizing the negative consequences of drug use, ensuring the safety and well-being of individuals, and treating them with dignity and respect, all while creating an environment conducive to eventual entry into recovery. The support provided extends to fundamental needs such as housing, sustenance, healthcare, and critical overdose prevention tools.
JoAnn Fraley, the harm reduction program coordinator and Hub initiative director for the Kentucky River region, articulates the program’s core mission: "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." This comprehensive support system recognizes that addiction does not exist in a vacuum; it is often exacerbated by socioeconomic vulnerabilities that must be addressed concurrently.
Despite criticisms that exchanging clean syringes for used ones might inadvertently encourage drug use, extensive research offers a counter-narrative. Studies published in journals such as the Journal of Substance Use and Addiction Treatment consistently demonstrate that individuals participating in syringe services programs are significantly more likely to reduce their injection drug use, cease drug use altogether, and successfully enter and remain in treatment compared to those who do not. Furthermore, according to the Centers for Disease Control and Prevention (CDC), these programs are instrumental in reducing the transmission of HIV and hepatitis C by approximately 50 percent.
In recognition of its effectiveness, the Kentucky River’s Hub model was honored in 2025 as one of 19 recipients of the National Association of County and City Health Officials’ Model of Public Health Best Practices awards. Lauren Carr, who advises the Kentucky Association of Counties on the strategic deployment of opioid settlement funds, lauds The Hub’s approach: "What jazzes me about it is it’s a community approach to harm reduction. 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 emphasizes its vital role, stating, "It can be that lifeline."
Paying Back for Good
The transformative impact of The Hub is powerfully illustrated by the personal narratives of its participants and staff. Becky Todd, a community health worker and peer support specialist who leads the Beattyville Hub’s team, embodies this resilience. After being released from jail in April 2024, having served multiple sentences for drug-related offenses, she walked three miles to The Hub, her only destination. Today, Todd is pursuing her bachelor’s degree in social work at Eastern Kentucky University, a testament to the support and stability she found. "I could not have done it without this place," Todd affirmed. "It’s my saving grace."
Amber McDaniel recounts her initial experience at The Hub after more than a decade of addiction, a period that resulted in the loss of her home, her children, and her family’s support. "I didn’t know where to turn, didn’t know what to do," she recalled, describing a state of profound despair. "I mean, I was about to lose my mind." McDaniel has since become a valued member of The Hub’s staff, employed through AmeriCorps, demonstrating a full circle of impact from recipient to provider.
Hannah Stamper, who entered foster care and began using methamphetamine at 14, was initially drawn to dealing drugs because she "loved for people to need me." Now, as a staff member through Recovery Corps, a program that trains AmeriCorps members for roles in the recovery field, her purpose has been reframed. "People today need me in a good way, and I love that," she expressed, highlighting the profound shift in her sense of value and contribution.
JoAnn Fraley has observed a significant shift in community attitudes in Lee County over the past six years. Previously, discussions surrounding addiction and homelessness were often fraught with tension and avoidance. "because nobody wanted to talk about it or acknowledge it," she explained. Today, the community witnesses The Hub’s tangible impact, leading to a palpable shift: "and now they’re, like, ‘Whoa. We love you.’" This evolving perception underscores the program’s success in fostering understanding and acceptance.
Scott Lockard, the district’s public health director, points to a combination of data-driven insights and anecdotal evidence as substantiation for the initiative’s success. These include an observable increase in individuals entering treatment programs and a notable decline 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 stated, underscoring the program’s exceptional impact.
The Kentucky River team’s strategic approach involved extensive community education regarding the potential outcomes of The Hub model. Fraley reported minimal resistance, with concerns primarily focused on ensuring the judicious use of funds. A critical element of their planning process has been the consistent inclusion of individuals with lived experience of addiction at every stage. "Their voice needs to be at every table," Fraley emphasized, highlighting the importance of lived expertise in shaping effective interventions.
Lockard concurs with this participatory approach, emphasizing the need to directly engage those affected by the problem to identify the most effective solutions. "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, advocating for a data-informed and community-centered strategy.
Jannie Gatlin and Mandy Parker, both in recovery, are active participants in the Whitesburg Hub’s offerings, recently attending a crafting class. Gatlin, who began using fentanyl in Colorado following the death of her infant son, now frequents The Hub almost daily with her toddler, Hunter. Parker, who was initially prescribed opioids for a kidney disorder, turned to street drugs when her prescription became difficult to obtain, a common trajectory she describes as "just the nature of the beast."
Both women believe The Hub is instrumental in dismantling the stigma associated with substance use disorder within their community. "When people see ‘real change happening,’ there’s a ripple effect," Parker observed. "It makes a difference." She particularly values The Hub’s accessible location on Main Street, believing it is precisely where it needs to be to serve those most in need.
