On the opioid overdose death map of the United States, shown above, there’s one area that really stands out: That’s western Appalachia, including southwestern Virginia, West Virginia, eastern Tennessee, eastern Kentucky, and southern Ohio. Right in the middle of that deeply forested, mountainous area sits Harlan County, Kentucky.

Right in the center of Harlan County is the town of Harlan, population 1,750 and falling, nestled in a bend in the Cumberland River along the Great Kentucky Ridge that runs from Jacksboro, Tennessee, up through High Knob, Virginia. Harlan has one of the highest opioid addiction rates in America, with five times the average per-capita OxyContin prescriptions.

Yet Harlan, Kentucky, is now setting records for something else: the successful treatment of opioid addiction. Harlan is the recipient of recent deep-dive reporting by health journalist, Virginia Hunt, in The Tennessean. The small town has been transformed by opioid settlement funds into the cradle of recovery, says Hunt:

Now, the faded buildings lining Harlan’s downtown are filled with posters for recovery groups, prevention events and nightly AA meetings in an alleyway beside the local bank.

Harlan has turned the tide on overdose deaths thanks to the distribution of naloxone and naloxone training by the now-defunded SAMHSA. Hunt also cites a 2004 Kentucky law, known as “Casey’s Law,” which allows a court to hold an adult in addiction treatment without their consent. It allows the court to avoid sentencing the addicted person for a crime, providing the option of treatment instead with no record of a conviction.

Another factor in Harlan’s success in treating substance use disorders (SUDs) is the statewide Drug Court. Begun with a pilot program in 1996, Drug Court is now available in all 120 Kentucky counties. Drug Court works with people who have been convicted of a crime where “their primary presenting problems stem from substance use disorder.”

Drug Court in Harlan, under Judge-Executive Dan Mosley, takes a firm but holistic approach toward recovery. It begins with enrollment in a mandatory SUD recovery program involving buprenorphine or methadone, inpatient and outpatient treatment, with mandatory urine and blood tests.

In addition to providing “recovery housing,” Drug Court is integrated with Harlan’s transit system, where patients can get free rides to treatment facilities, therapy sessions, and other recovery-related appointments. The court also provides job re-entry assistance with funding through Kentucky’s Department of Corrections.

Judge Mosley instituted the annual Harlan County Summit, which brings together representatives from care providers dealing with SUDs, along with concerned members of the public, to smooth transitions between programs, and brainstorm ways to improve results. The Summit now includes Operation UNITE, an opioid-settlement-funded program to bring drug court into the schools and the schools to the summit.

Drug Court provides both a carrot and a stick to help patients get off drugs. According to the Commonwealth of Kentucky’s Court of Justice, patients are:

[R]equired to make progress with their individualized program plans, which commonly include goals of obtaining employment, attaining a GED and reunifying with their children.

Those who successfully complete their programs “may have their charges dismissed,” or discharged through probation. The court claims a majority of those who complete their programs “return to productive lives and stay gainfully employed, pay child support and meet other obligations.​” Just like the addicts it now cares for, Harlan, Kentucky, is on the road to recovery.

Written by Steve O’Keefe. First published June 4, 2025.

Sources:

“A Kentucky county’s recovery from opioid crisis could be a model for Tennessee,” The Tennessean, May 26, 2025.

“Interactive Drug Overdose Map,” All Opiates Detox, retrieved May 28, 2025.

“Preventing drug abuse emphasized in Harlan summit,” WYMT Mountain News, January 11, 2024.

Image courtesy of the United States Department of Agriculture, used under Fair Use: Public Domain.