Interview with Van Ingram, September 11, 2018

Partial Transcript: --want to start off by just, um, stating your name and your title.

Segment Synopsis: Van Ingram talks about beginning his role as the Executive Director of the Kentucky Office of Drug Policy in 2004, as well as the start of his career at 19 years-old as a police dispatcher in Maysville, Kentucky. He became a police officer at 21, eventually becoming Chief of Police several decades later. He talks about traveling to 16 different sites in Kentucky in 2004 with Governor Ernie Fletcher, listening to people talk about substance abuse issues.

Keywords: Governor Ernie Fletcher; Law enforcement; Maysville (Ky.); Methamphetamines; Opioid misuse

Subjects: Drug abuse.; Drug addiction; Maysville (Ky.); Opioid abuse; Opioid use; Substance abuse.

Partial Transcript: Now, when I went to eastern Kentucky in 2004 with Governor Fletcher on these listening things, I heard that their, their experience in eastern Kentucky and central Appalachia was much different than it was in northern Kentucky where I was.

Segment Synopsis: Van Ingram talks about how in the early 2000s, when prescription painkiller addiction swept through central and eastern Appalachia, it was extremely difficult to get national attention, and how in the beginning, the opioid epidemic was a class issue. He also talks about how overprescribing of opioid painkillers was linked to the most economically depressed areas in Kentucky and West Virginia.

Keywords: Appalachia; Eastern Kentucky; Methamphetamine; Northern Kentucky; Opioid misuse

Subjects: Drug abuse.; Drug addiction; Drugs--Prescribing.; Opioid abuse; Opioid use; Substance abuse.

Partial Transcript: One of the things I have l--uh, noticed in my interviews is a lot of people tell me they had--they--well, these are people in recovery...

Segment Synopsis: Van Ingram talks about how there was already a lot of overprescribing for depression and pain medication in regions where coal mining injuries and economic depression were pervasive. He discusses how pharmaceutical companies then targeted these already heavy prescribing regions with Oxycontin and other opioids. He also talks about the first pill mill, which was run by a doctor in South Shore, Kentucky. Van Ingram explains that although police knew what was going on, at the time law enforcement were not trained on how to handle doctors over-prescribing pills, since there was no precedent.

Keywords: "Pill mills"; Central Appalachia; Coal mining; Doctors; Law enforcement; Pharmaceutical companies; Prescription painkillers

Subjects: Drug abuse.; Drug addiction; Drugs--Prescribing.; Medication abuse.; Opioid abuse; Opioid use; South Shore (Ky.); Substance abuse.

Partial Transcript: Yeah, which, you know, as bad as prescription pills are, if you're injecting needles, now you have problems with Hepatitis C and HIV...

Segment Synopsis: Van Ingram explains how progressive opioid addiction is; how once your body is accustomed to the drug, people spend years trying to chase the initial feeling they had when they first used the drug, often leading to injection drug use and combining opioids with other drugs. He also talks about how injection drug use has led Kentucky to have the fastest growing rate of Hepatitis C in the country.

Keywords: Addiction; Hepatitis C; Heroin abuse; Opioid misuse; Recovery

Subjects: Drug abuse--Psychological aspects.; Drug abuse.; Drug addiction; Drug addiction--Psychological aspects.; Drug paraphernalia.; Drug tolerance.; Drugs--Prescribing.; Intravenous drug abuse.; Medication abuse.; Needle sharing.; Opioid abuse; Opioid use; Substance abuse--Psychological aspects.; Substance abuse.

Partial Transcript: So one of the things I, I wanted to ask you was, in my interviews I'm hearing a lot about...

Segment Synopsis: Van Ingram talks about medication-assisted treatment, in particular how early on in his career as a police officer, he would deal with people who left the methadone clinic in Morehead and would come to Maysville and commit crimes, leading him to associate methadone with criminals. Ingram then makes the point that he never saw the people who dosed and then went to work, or to take care of their children. He states that medication-assisted treatment is the one of the best ways we have to keep people alive. He also talks about how the Office of Drug Control Policy will be focusing on transitional housing and job support for individuals in recovery.

Keywords: Intravenous drug use; Law enforcement; Medication-assisted treatment; Methadone; Opioid misuse

Subjects: Drug abuse--Treatment.; Drug abuse.; Drug addiction; Drug addiction and recovery; Drug addiction--Treatment.; Medication abuse.; Opioid abuse; Opioid use; Substance abuse--Treatment.; Substance abuse.

Partial Transcript: And, uh, uh, it--we, we, we--I think we ran the first, first, uh, amendment to a bill in 2013, we did it again in '14, and finally, through a conference committee, got it passed in 2015.

Segment Synopsis: Van Ingram talks about how the Office of Drug Control Policy helped pass a law legalizing needle exchange programs in Kentucky. He also talks about how he began to look at the opioid issue more from a public health standpoint and less from a law enforcement standpoint, and states that we will never arrest our way out of this problem.

Keywords: Heroin abuse; Intravenous drug use; Needle exchange programs; Opioid misuse; Opioid use; Syringe exchange

Subjects: Drug abuse--Treatment.; Drug abuse.; Drug addiction; Drug addiction and recovery; Drug addiction--Treatment.; Heroin abuse; Intravenous drug abuse.; Medication abuse.; Needle sharing.; Opioid abuse; Substance abuse--Treatment.; Substance abuse.

Partial Transcript: I have two questions for you. One is the fentanyl issue. Um, I would like to you to, uh--what--when is your first recollection of that being something on your radar?

Segment Synopsis: Van Ingram describes when he first discovered that fentanyl was being driving overdose deaths, particularly in 2015. He describes calling the medical examiner, and the two of them began to trace fentanyl production to China, India, and Thailand. The fentanyl is then sold to drug cartels, and ends up in the local heroin supply. He also talks about how a very tiny amount of fentanyl can be potent enough to trigger overdose, and how more than half of all overdose deaths as of late in Kentucky involved fentanyl. He also describes how some drug dealers make fake pills, designed to look identical to Percocet, but really contain fentanyl. Some people may think they are buying a prescription pill, and end up overdosing.

Keywords: China; Drug overdose; Fentanyl; Intravenous drug use; Opioid misuse; Oxycodone/paracetamol

Subjects: Drug abuse.; Drug addiction; Drug traffic.; Drugs--Overdose.; Heroin abuse; Intravenous drug abuse.; Medication abuse.; Opioid abuse; Substance abuse.

Partial Transcript: So what you're--what you just said to me actually, some people I've interviewed, when I asked them...

Segment Synopsis: Van Ingram talks about how the future of the opioid epidemic depends on China setting laws and regulations surrounding the shipment of fentanyl and fentanyl precursors. He also states that the solution to this problem is much more complicated, and involves looking at the reasons why people use drugs, such as ACE (Adverse Childhood Event) scores. He also talks about the creation of Gethelpnowky.org, a website people can use to find real-time openings at residential treatment centers around the state.

Keywords: Adverse childhood event (ACE); China; Drug overdose; Drug policy; Fentanyl; Heroin abuse; Kentucky; Opioid misuse; Recovery

Subjects: Drug abuse--Treatment.; Drug abuse.; Drug addiction; Drug addiction and recovery; Drug addiction--Treatment.; Drug traffic.; Intravenous drug abuse.; Medication abuse.; Opioid abuse; Opioid use; Substance abuse--Treatment.; Substance abuse.

Partial Transcript: Now, you want to talk about medical marijuana...

Segment Synopsis: Van Ingram discusses the issue of marijuana legalization. He states that within a decade, most states, including Kentucky, will likely legalize marijuana, but he doesn't think that is a good thing. He talks about the issues of price, availability, perception of risk, and public attitudes. He explains that these four factors drove the opioid crisis, and says that the same thing will happen as the price of marijuana in drops, and its use becomes even more normalized. However, he believes this will open up a new generation of even younger people who will start using marijuana and possibly become addicted. He stresses that he does not think legalizing marijuana is the right decision for the state of Kentucky.

Keywords: Kentucky; Legalizing marijuana; Marijuana legalization; Opioid abuse; Opioid misuse; Opioid use; Public attitudes

Subjects: Drug abuse.; Drug addiction; Marijuana; Substance abuse.