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Opioid Trial Main

Huntington Mayor Steve Williams, left, and lawyer Rusty Webb enter the federal courthouse in Charleston for the opioid trial.

HUNTINGTON — While Huntington prides itself on being a city of solutions and recovery, an expert witness at an opioid trial Monday said its resources are far from what is needed to abate the opioid crisis.

In fact, Caleb Alexander, a pharmacoepidemiologist at the Johns Hopkins University School of Medicine who testified at the opioid trial Monday, penned an abatement plan he said would significantly improve the crisis by halving the number of overdoses, deaths and number of people with substance use disorder over the next 15 years by increasing focus on prevention, treatment, recovery and special populations.

But to put the plan into effect, the governments need stable, reliable money, which grant funding does not provide.

“With these investments and these programs and services, the community will be in a much better place and much better able to manage ongoing harms that would be at a much lower level than they are now,” he said.

For that to happen, Cabell County and Huntington argue they need $2.7 billion from those they accuse of creating the crisis to begin with.

Cabell County and Huntington are in the final days of their presentation at a trial in which they are accusing AmerisourceBergen Corp., Cardinal Health and McKesson Co. of fueling the region’s opioid crisis by shipping excessive doses of opioids to the communities for years before a reduction in shipments made people with substance use disorder turn to illicit drugs.

The distribution companies maintain that the Drug Enforcement Administration, doctors’ prescribing habits and West Virginians’ history of poor health necessitated the shipments.

At the questioning of City of Huntington attorney Linda Singer, Alexander said several things show the opioid epidemic is still happening in Cabell County, including 37 deaths caused by opioid overdoses in 2018 and 17.6% of umbilical cords testing positive for opioids in 2016 at Cabell Huntington Hospital. He estimates 7,882 Cabell residents live with opioid use disorder.

But the crisis can be fixed, he said, by expanding current programs and adding more to fill in those gaps.

“I think it’s really clear that the current programs, while important and the local community deserves credit for them, are inefficient to abate the opioid epidemic,” he said.

The plan calls for the first few years to be an intensive attack on the crisis while gradually decreasing the level of services needed over time.

Defense attorneys said the plan was overreaching. The defense said his plan accounts for people who have never touched a prescription pill, which is out of their control, and people who have not yet developed opioid use disorder. Alexander said there is only one epidemic: the opioid epidemic; not two: prescription opioid pills and illicit opioids, adding that the problem goes far beyond just people with substance use disorder.

A majority of treatment costs are funded through Medicaid, they added.

Alexander said 3,153 of an estimated 7,882 people living with opioid use disorder should be treated in the first year of the plan, about 40% of that population. He said by the 15th year, the number should be increased to 60%. The overall number of people with opioid use disorder will be lower, but the percentage of those treated will be up.

He said it would be significant, but it is attainable with sustainable funding, unlike grants, which leave the future of programs up in the air.

Among the programs he highlighted, he said doctors need to be educated by a non-biased source who can better teach them how to prescribe pain pills. Specifically, the county’s top opioid prescribers who prescribe disproportionality should be singled out and re-educated.

They need to know opioids have very real and not uncommon risks, he said.

He said treatment infrastructure should be expanded and include four areas: inpatient care, residential rehabilitation care, intensive outpatient treatment and routine outpatient care (where the vast majority of treatment would be given).

Routine outpatient care is the least costly of the four, averaging about $63.77 a day, followed by intensive outpatient at $69.01, residential at $78.15 and inpatient at $78.95 a day.

The goal is to get those with the disorder through the door, he said.

To do that, he said, they need to have better access to treatment care, which ranges from having more round-the-clock availability and an expansion of naloxone distribution and harm reduction programs. Naloxone, he said, should be available in lock boxes across the county.

Alexander pointed to a paper that researched the death rate among people who have opioid use disorder and either went untreated, got successful treatment or got treatment and relapsed. People who have not entered recovery are more than twice as likely to succumb to substance use disorder than those who have been successful in their treatment.

He said public safety is an important aspect of the recovery subsection, suggesting a specific overdose response team within first responders, the focus of which can be on responding to and investigating overdoses to find the source of the drug to stop it.

Vocational training and better mental health counseling services are also needed.

An expansion of drug court services, which have shown 82% of Cabell’s program graduates do not reoffend within a year, is needed as well, he said. Drug courts for families and veterans are not available within the county.

In looking at special populations, he said up to half of students in Cabell County — about 6,400 — are being raised by someone other than a parent. In 2017, 54 of every 1,000 children in West Virginia were affected by the crisis, nearly twice the national average. Nearly 1 in 5 had a parent die.

“It’s hard to find a place in the United States that has been impacted as heavily as Cabell County and Huntington,” he said.

Pregnant women and families also need intensive help, he said.

The plaintiffs are expected to bookend their seven-week presentation of evidence with Huntington Mayor Steve Williams on Wednesday. George Barrett, a forensic economist, will testify Tuesday.

Follow reporter Courtney Hessler at and via Twitter @HesslerHD.

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