This story was originally published by KFF Health News.
Drugs and the consequences of addiction are an integral part of Jamie Madden’s life.
Her earliest memory is of standing in the passenger seat of her father’s car as a toddler, wearing a peach-colored blouse, as he drove from her home in Kentucky to Florida to pick up drugs. She met Ronald McDonald at a burger stop.
“I grew up with the impression that this is how you pay your bills,” Madden said. “That’s how your kids got things.”
At 16, she was addicted to painkillers. With 30 methamphetamine. She lost custody of two children and gave two others up for adoption at birth. She served time in county jail and state prison.
At 40, Madden was pregnant again and decided to stop drinking. That’s when she learned about The Hub in Whitesburg, a town of 1,575 people, her hometown.
Over the past two years, the state of Kentucky has sent hundreds of thousands of opioid compensation dollars to the state’s rural eastern region to minimize the consequences of drug abuse. Part of this effort is The Hub, a program that oversees a network of community centers that offer a range of services, from recovery peer support to canned goods and sterile syringes.
In April, Kentucky Attorney General Russell Coleman announced $320,000 would be awarded to the Kentucky River District Health Department’s Hub Initiative. There are now hubs in four rural eastern Kentucky counties — Knott, Lee, Letcher and Owsley, all among the poorest in the country — that address substance use disorders, housing, hunger, employment and other challenges. The program also operates The Hub on Wheels, which provides services throughout the county.
In 2025, The Hub received $545,000 from the same source, allowing it to expand from two to five counties. (The fifth hub will be in Perry County.) The new $320,000 is a two-year grant to develop a program to help incarcerated women reintegrate into society.
Both grants come from Kentucky’s roughly $1 billion share of the $57.8 billion for state and local governments from settlements with drug companies to resolve lawsuits over their role in fueling the opioid overdose crisis.
Madden believes investing in mitigation services is money well spent. She has seen how they work in her own life. She has found a solid basis for her recovery in the hub.
The Hub is based on the principles of harm reduction. Support includes shelter, nutrition, health care and overdose prevention tools. (Photo by Taylor Sisk / KFF Health News)
But the Trump administration is cutting federal funding for such efforts and denying their benefits. A July 24 executive order told programs across the country that they could no longer count on federal funding. The order stated that discretionary grants awarded by the Substance Abuse and Mental Health Services Administration should not be spent on “so-called “harm reduction efforts” because they “only encourage illicit drug use and the harms associated with it.”
Advocates for these services in this rural region, which voted for President Donald Trump in all three elections, disagree.
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Meet people where they live
Whitesburg – home to a vibrant cultural scene including Appalshop, a media, arts and education center – is a city that residents are very proud of. The hub is located in a storefront on Main Street, near City Hall, Hazard Coffee Company, Cut-Away Barber & Beauty Shop and the fire station. Like the other hubs, it offers a range of services tailored to the needs of the community.
The first hub, which opened in 2022 in Beattyville, the Lee County seat two hours northwest of Whitesburg, offers breakfast and lunch, a pantry, closet, laundry room and computer lab. Also: naloxone, a drug that can quickly reverse an opioid overdose; drug test strips; hepatitis C treatment; sterile syringes; and wound care.
The program’s motto is “Meet you where you are, but don’t leave you there!” It is based on the principles of harm reduction. Harm reduction services are designed to minimize the effects of drug use, keep people safe, and treat them with respect until they may be ready for recovery. Support includes housing, nutrition, health care and overdose prevention tools.
JoAnn Fraley is the Kentucky River Mitigation Program Coordinator and Hub Initiative Leader. “For someone to sustain recovery, they must have financial stability, transportation and a home,” she said. “We’re trying to close those gaps.”
While critics suggest that swapping clean syringes for used ones encourages drug use, research published in the Journal of Substance Use and Addiction Treatment suggests that people who participate in syringe service programs are more likely to reduce their drug use through injection syringes or stop using drugs altogether, and are more likely to enter and stay in treatment. Syringe service programs also reduce the spread of HIV and hepatitis C by about half, according to the Centers for Disease Control and Prevention.
In 2025, the Kentucky River Hub Model was named one of 19 honorees for best practices in public health by the National Association of County and City Health Officials.
“What intrigues me about this is that it is a collaborative approach to harm reduction,” said Lauren Carr, who advises the Kentucky Association of Counties on how to best utilize opioid arbitration funds. “Whether it’s satisfying a hungry stomach, putting clothes on someone’s back, or cleaning them up [syringes]you meet that person’s needs.”
“It can be a lifeline,” Carr said.
Forever paying back
Becky Todd, who leads the Beattyville Hub team, is a community health worker and peer support specialist. She was released from prison in April 2024 after serving several sentences for drug offenses. She walked 3 miles from the prison to the hub and had nowhere else to go. She is pursuing her bachelor’s degree in social work at Eastern Kentucky University.
“I couldn’t have done it without this place,” Todd said. “This is my salvation.”
Amber McDaniel remembers the first time she walked into The Hub after more than a decade of addiction, having lost her home, her children and the support of her family. “I didn’t know where to turn, didn’t know what to do,” she said. “I mean, I was about to lose my mind.” She is now a hub worker through AmeriCorps.
Hannah Stamper was placed in foster care and began using meth at age 14. She was drawn to drug dealing because “I loved it when people needed me.” She is now an employee of Recovery Corps, a program that trains AmeriCorps members to work in the recovery field. “People need me today in a good way, and I love that.”
Fraley has seen change in Lee County. A half-dozen years ago, conversations in public meetings about addiction and homelessness were tense “because no one wanted to talk about it or acknowledge it.”
The community is seeing the impact of The Hub, she said, “and now they’re like, ‘Whoa. We love you.'”
Scott Lockard, the district’s public health director, said a combination of data and anecdotal observations support the success of the initiative, including an increase in the number of people seeking treatment and a decrease in reported communicable diseases.
“I have been in public health for 36 years and it is one of the most effective interventions I have ever seen,” Lockard said.
The Kentucky River team worked to educate the community about the potential outcomes of the hub model, and Fraley said there was little resistance, just concerns that the money would be money well spent. She said the planning has always included people who have lived with addiction.
“Your voice needs to be heard at every table,” she said.
Jannie Gatlin, who is in recovery, comes to The Hub in Whitesburg, Kentucky almost every day with her son Hunter. (Photo by Taylor Sisk / KFF Health News)
Lockard agrees. To ensure the community invests that money wisely, he said, “We will talk to the people who have the problem, find out what they think would best help them, and then look for evidence-based interventions.”
Jannie Gatlin and Mandy Parker, both in recovery, recently attended a craft class at the Whitesburg Hub. Gatlin, who began using fentanyl in Colorado after her first son died of indigestion at 2 months old, comes almost every day with her toddler Hunter.
Parker was prescribed opioids for pain from kidney disease. When those pills were no longer available, she turned to street drugs. “It’s just the nature of the animal,” she said.
She believes The Hub is helping to overcome the stigma of substance use disorder in her community. When people see “real change happening,” she said, there is a ripple effect. “It makes a difference.”
She appreciates that The Hub is located here on Main Street—exactly where it should be, she firmly believes.
KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of KFF’s core operating programs – an independent source of health policy research, polling and journalism. Find out more about KFF.
Related
https://dailyyonder.com/opioid-settlement-money-pays-for-services-to-battle-addiction-in-rural-kentucky/2026/07/08/
