Thread by @HesslerHD

I’m back for day 30 of the #opioidtrial in Charleston, W.Va. The plaintiffs are expected to wrap up their case this week. Initially they were granted 3 days, but if the trial’s pace matches that it had two weeks ago, I don’t see that happening. Catch up here:

https://twitter.com/hesslerhd/status/1404987637690212356

Dr. Caleb Alexander, a pharmacoepidemiologist at the Johns Hopkins University School of Medicine, is the first to take the stand.

He is an expert in opioid abatement interventions. He looked at programs which could be implemented in the area and how much it would cost to do that. This might be the first time we've taken a deep dive into actual dollar amount Huntington need.

Alexander says the opioid epidemic is still ongoing in Cabell/Huntington. 137 individuals died of opioid overdose in 2018. 17.6% of umbilical cords tested positive for opioids in 2016 at Cabell Huntington Hospital. He estimates 7,882 Cabell residents live with opioid use disorder

Alexander says the opioid epidemic can be abated in Cabell/Huntington.

“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.

Alexander is going over his abatement plan, which has four areas: Prevention, special populations and recovery. These are the sections of prevention which need focus.

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.

He said opioids are not the 1st line of treatment

“This is an evidence based assertion and highlights the fact that opioids have very real and not uncommon risks and there's not a lot of evidence to support their effectiveness to treat (long term pain),” he said.

This is interesting. Alexander is referring to a paper which looked at the death rate among people who have opioid use disorder and went untreated, got successful treatment or got treatment and relapsed.

Successful treatment, the death rate was 1 in 100 person-years.

For those who had not received treatment it was 5 per 100 person years.

For those who had some treatment, it was 2 per 100 person years.

I never realized how important getting someone past the front door was.

The judge is really engaged today. Taking notes and asking questions.

He says we need to expand naloxone services. They should be available widespread, maybe in boxes, like a defibrillator, he said.

Why isn’t this a thing in Huntington?

Also suggested specific overdose response teams within first responders whose focus can be on responding to and investigating overdoses to find the source of the drug to stop it.

He just said up to half of students in Cabell County (~6.4K) are being raised by someone other than a parent.

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

He says we need an expansion of our drug courts, vocational training and mental health services.

Cabell County only has three drug court programs. Nothing for veterans or families.

82% of CC’s main drug court participants don’t reoffend within 12 months of graduation

He believes by implementing his plan over a 15 year period, overdoses and the need for naloxone can be reduced by 50%. 50%?!

These are the four areas in which Alexander said Huntington/Cabell County’s focus should be, with details of how it could be emphasized. ↙️↘️

1. Prevention
- Health professional education
- Patient and public education
- Safe storage and drug disposal
- Community prevention and residency
- Harm reduction
- Surveillance

2. Treatment 
- Connecting individuals to care
- Treating opioid use disorder
- Managing complications
- Workforce expansion and resiliency 
- Naloxone distribution and training.

3. Recovery
- Public safety
- Criminal justice system
- Vocations training and job placement
- Re-engineering the workplace
- Mental health counseling and grief support

4. Special populations
- Pregnant women, new mothers and infants
- Adolescents and young adults
- Families and children
- Homeless & housing insecure individuals 
- Individuals with opioid misuse

The abatement plan calls for 3,153 people to be treated in the first year. He said the goal should be to get 40% of the estimated number of people living with opioid use disorder into treatment that first year. He said it’s achievable.

He said by year 15, 60% should be receiving treatment. The overall number of people with OUD will be lower, but the % of those treated will be up.

So over 15 years Huntington/Cabell has the hope of reducing the number of overdoses and deaths by 50% by implementing his plan, which in turn would reduce the number of people with OUD.

50% seems low to me, but he said the investments in services and programs would give the governments a gasp and control over the crisis. He said it would be significant.

I want this epidemic over with now, today, but that doesn’t seem like it’s happening.

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

But what are daily costs for recovery?

Inpatient: $78.95
Residential: $78.15
Intensive outpatient: $69.01
Routine outpatient: $63.77

We are done for the morning. Taking a lunch and will be back at 2 pm.

The defense is now questioning Alexander. They’re arguing his plan accounts for people who have never even touched a prescription pill, of which they have no control.

Alexander says it’s one epidemic (the opioid one), not two (prescription opioids pills and illicit opioids)

Treatment costs are majorly funded through Medicaid and the programs aren’t typically funded by the city or county, the defense is holding.

If I’m picking up cues right, tomorrow will be the $$$ talk in which we will hear a breakdown of the costs to abate the crisis. Huntington Mayor Steve Williams will follow Wednesday.

The defense is arguing the plan is overreaching. Alexander says the opioid crisis goes much more beyond just people who have opioid use disorder.

The trial pace is moving a lot slower this afternoon. Very repetitive.

Not a lot of information has come from the cross examination. If you want to know how it’s going, mainly the defense stretching out its cross examination, please read my week 6 recap here.

https://twitter.com/HesslerHD/status/1406590053023981576

We are done for the day. Will return with redirect of Alexander tomorrow

FINAL STORY: 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. herald-dispatch.com/news/proper-fu…