Thread by @HesslerHD

I’m back for day 38 of the #opioid trial in Charleston, W.Va. Testimony in the trial could wrap up this week. Get caught up on what happened last week here:

herald-dispatch.com/news/end-of-op…

First to be called to the stand is forensic accountant Robert Rufus, who works out of Huntington. linkedin.com/in/robert-rufu…

He was asked to identify and quantity investments made by the plaintiffs into the opioid crisis. So we will hear what the county and city pay for addressing the crisis.

The city has already said that they don't have a specific budget line for expenditures on the opioid crisis and said a lot of the money comes from grants, etc., but Mayor Williams said state law says its the city's responsibility to abate a public nuisance, like the crisis

We are looking at yearly costs of current programs.

He said for the Law Enforcement Assisted Diversion program (LEAD) - the city and county spent $16.6k, but it received $83k in external funds.

Harm reduction received $222k in external funds, but none from local governments.

Drug Court received about $70k in government funds, but about $500k in external funds.

A program called "Turn Around" Received $337k from external funds, none from the local governments.

QRT received $45k from city/county, but $467k external.
The Compass program received $5k from the city, but $338k from other sources.

The City and County paid about 136k, but external funding $1.9k from external funding, for a total of about $2.7 million.

He said while the city said they were overwhelmed by the crisis, he did not see any additional money being budgeted for it.

"The costs associated with the city and the budgetary process is smooth (...)," he said.

He said at the county level he did see significant increases, such as payments to the regional jail system. It went from $3 million to $5 million before dropping down to $3 million again, he said.

Aside from the jail, there was an increase in the sheriff's budget of about $500k, he said, but those were the only changes.

He said the city is on track to have $17 million in "unassigned"/unrestricted funds. It's available funding left over at the end of the year.

"The city had no intentions of paying for these programs," he said.

Looking at the abatement plan penned by Caleb Alexander, who who testified the plan would half 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.

The costs are:

Prevention - $48.7 million
Treatment - $2 billion
Recovery - $99 million
Special populations - $345.6 million
---
~$2.5 billion total

Prevention is about 2% of the total $2.5 billion
The Harm Reduction program is in that category and costs $19.5 million, but he said harm reduction isn't a prevention program, its for active users.

Health professional education would costs $5.4 million, but the city/county has never paid for such a program, he said.

If you pull those things out of prevention, Patient/public education, safe storage and drug disposal, community prevention and surveillance is left - Only about $23.7 million of the $48.7 million the county and city want.

He said Alexander's treatment cost calculations called for 365 days of outpatient treatment, but the average outpatient treatment is only 71 days, according to 2018 TEDS data, he said.

That cuts the $2 billion amount needed for the treatment category by $1.06 billion, he said.

Now we are looking at the way Alexander and Katherine Keyes estimated that 7,882 Cabell residents live with opioid use disorder.

Rufus said from 2017 to 2019, opioid overdoses deaths dropped from 182 to just 97 (a reduction of 46.7%), which means the amount of people living with OUD is dropping.

I feel like I need to add that in 2020 they started to soar again, and continue to do so to this day.

Anthony Majestro taking over questioning of Rufus for the plaintiffs. He said what the city and county spent wasn't based on what was needed, it was what they were able to pay.

Rufus disagrees.

"It's not a matter of capacity to pay, it's a matter of function," he said.

Looking at the treatment costs which Rufus said were $1 billion less by his numbers than the plaintiffs' witness (365 vs 71 days of treatment needed).

Majestro said the 365 days is a weighted average cost.

"The average is the sum of all individual observations divided by the number of observations. In contrast, the weighted average is observation multiplied by the weight and added to find a solution."

Rufus is finished with his testimony and has left the stand.

Up next is Stephenie Colston, President & CEO at Colston Consulting Group, LLC. linkedin.com/in/stephenie-c…

She was a Sr. Advisor to the Substance Abuse and Mental Health Services Administration (SAMHSA) Administrator from 2003-05

She will be an expert in systems, programs and services for people w/ OUD, and their financing and the trends in substances that are being used.

There are four buckets for substances use disorder funding from the federal government" SAPT Block Grant targeted/discretionary, Medicaid and Medicare.

SAPT (Substance abuse prevention and treatment) block grant covers 75-80% of substance abuse treatment programs across the country, she said. It covers people without insurance or whose insurance doesn't cover treatment.

Cool. Here is West Virginia's application for fiscal year 2020/2021 dhhr.wv.gov/bhhf/resources…

The money is sent to the state who divides it among 13 different comprehensive OUD treatment facilities across the state, including Prestera in Huntington. The state received $22.3 million this year, she said. Those 13 programs send it into the community.

Targeted category can be split among the department of justice and correctional facilities, The Health Resources and Services Administration and West Virginia's local SAMHSA.

SAMHA has the bulk of funding she said, a lot of it goes to the state opioid response grants. We are now looking for the States’ Use of Grant Funding for a Targeted Response to the Opioid Crisis oig.hhs.gov/oei/reports/oe…

Within the "targeted" category is the State Targeted Response grants. The report said: "More than $300 million—almost 1/3 of the total
nationwide grant funding for the State Targeted
Response to the Opioid Crisis grant program (STR
grant program)—remained unspent after 2 years."

AmerisourceBergen attorney Shannon Mcclure said the report shows West Virginia had only spent 34.% of its 2-year STR grant by end of its time period. Colston said the state typically requests a no-cost extension for the left over money and gives an explanation why it was needed

Colston said she made $350 an hour for non-testimony work and estimates she had spent more than 500 hours on the case. That's more than $175k+ for her testimony alone.

West Virginia pays only 20% of Medicaid costs, Colston said, with the federal government covering 80%. Medicaid is a more stable source of funding than grants, she said.

Medicaid serves 1/3 of West Virginia's 1.8 million population. The Affordable Care Act expanded the number of eligible people.

The federal government pays 94% for the expanded population, she said.

Affordable Care Act expanded opioid use disorder treatment funding, Colston said. In 2013, 5,837 people were receiving $7 million in funding. In 2017, it expanded to 34.4k and $85 million in funding.

A section 1115 waiver, which gives flexibility of the government to approve experimental, pilot, or demonstration projects

This section waiver was used in 2015 to allow states to expand substances use treatment services that would be covered by the federal government.

She said Cabell County and Huntington do not fund medicaid.

Medicare (insurance for people above an age, or disabled people) has also expanded its OUD services in the last 10 years, she said. Medicare pays for in/out patient programs, medications, partial hospitalization, opioid treatment programs and counseling an therapy.

Cabell and Huntington do not pay for Medicare, she said.

We are at lunch now. Will return at 2.

Somehow the thread got broke. Click here for the rest

https://twitter.com/hesslerhd/status/1414576490415542277

We are back with Colston. State data shows between 2015 to 2020, overdoses from psychostimulants, like methamphetamines or cocaine, were the leading cause of overdoses, she said.

There is a psychostimulant problem today, not a prescription opioid one.

“I believe it is a substance use disorder crisis,” she said.

McClure said Christina Mullins, the Commissioner for the West Virginia Department of Health and Human Resources, Bureau for Behavioral Health, wrote to a congressman in 2019 the state had not spent $148 million, with only $65 million being allocated.

When Cabell attorney Paul T. Farrell Jr. asked if the state and federal money was going to abate the opioid crisis, Colston said the money had been a “response”.

Colston said the substance use crisis shifts from drug to drug. While today it might be psychostimulants, the next it could be an opioid. She added most people with opioid use disorder use multiple drugs.

She is pushing back to Farrell's line of questioning, but in the end, she agreed there was a public health crisis in Cabell and Huntington which includes opioid abuse.

She said there is currently not a substance use epidemic in the United States, but instead a series of crises. Same answer for West Virignia, which she said have occurred over years.

Is there a substance use crisis in Huntington which significantly interferes with public health, Farrell asked. She gave a longwinded answer which led to saying its a polydrug problem, not just opioids.

Is the polysubstance abuse problem significantly interfering with public health, Farrell asked.

"Absolutely," she said.

After 8 weeks and 38 days of testimony, both sides have rested their case in the Huntington, Cabell opioid bellweather trial in Charleston, West Virginia. We will hear closing arguments July 27 and 28, at which time Judge Faber will start deliberating.

The court is going through housekeeping matters right now

Faber said he is excited to hear closing arguments and the attorneys’ interpretation of the evidence. They’re now doing the equivalent of post-game handshakes.

I’m working on my story now.

Everyone seemed a bit surprised by the abrupt ending today. Last Friday the defense said they had six witnesses left and today we only heard from two. There case spanned only 1.5 weeks compares to the plaintiffs’’ 7.5 weeks. It’s truly interesting.

FINAL STORY: The defense said Hunt. and Cabell have adequate grant funded substance use treatment programs, but the plaintiffs have held the communities are hanging on by a thread and the programs squabble over small allotments of unstable grant funding.
herald-dispatch.com/news/final-tri…