Thread by @funchefchick

#WAOpioidTrial resumed earlier this morning - I'm feeling bleah so I'm late on the updates. We finally, finally wrapped up testimony/cross/re-everything with Ruth Carter with only three things which stood out. Also here's the AM link until lunch.

#WAOpioidTrial Also it's day 19.

1st: Counsel inquired about various things Ms. Carter had missed or excluded or got wrong in specific documents. There were quite a few things in various redirect/cross where that happened ... all of which painted the defense negatively. Hmm

#WAOpioidTrial Second: When Ms. Carter was asked about a benzo in a document, she replied: "Yes but that's not an opioid, it's a benzodiazepine, and those are also widely sought after by DRUG ABUSERS."

She has continually called people who use RX or illicit substances this.

#WAOpioidTrial Is it probable that DEA considers anyone who takes opioid or benzos - not people with pain, or anxiety, or untreated mental health conditions, or struggling with life, or even struggling with addiction - not 'regular people' but OTHERED as 'drug abusers"?! Gross.

#WAOpioidTrial Third, and most legally interesting - after Ms. Carter was FINALLY excused from the stand (it's been an order for her I'm sure, and the rest of us too) - McKesson's counsel MOVED TO EXCLUDE her entire testimony. !! 👀

#WAOpioidTrial Counsel cited specific case law, generally about (layperson description here) bias & exclusion, lack of specific expertise on SOMS yet she commented constantly on SOMS, & frankly -she just gave her personal opinion on things NOT backed by regulations or guidelines.

#WAOpioidTrial So counsel apparently made a motion prior to trial, and was advised to bring it up AT trial, so they did. And with a written motion. There was some discussion about specific things aaaaand the judge will review the motion later. And we're on to the next witness!

#WAOpioidTrial State of WA calls via Zoom: Dr. Caleb Banta-Green, of the UW Addictions, Drugs & Alcohol Institute (ADAI). He's the real deal. He's our local expert on HARD DATA for overdoses and whatnot.

adai.uw.edu/staff_members/…

Interestingly, Dr. Banta-Green has his own counsel also appearing via Zoom.

This is going to be interesting indeed, because - Dr. Banta-Green knows as well as anyone that our biggest problem here (like most places) is counterfeit pills and poly-pharma, w/methamphetamines. So ..

I don't see how anyone can tie counterfeit pills (all of which have been found to include illicitly-manufactured fentanyl) to the distributors of legit pharmaceutical medications. Or how methamphetamine use is in any way their responsibility. ??

This is the Washington state state-wide report from December 17, 2021. 59% of confirmed and suspected overdoses involved fentanyl or meth. (Note the color meanings change between bar and pie charts)

The majority of overdoses in WA involved multiples substances. And of those overdoses the substances involved were as follows.

WA state has a meth problem. And fentanyl. And heroin. And cocaine. And alcohol. And yes - some RX substances get in there, too. Eventually.

#WAOpioidTrial So far in the trial the state is still asking Dr. Banta-Green about his creds (which are many - and I do mean VERY many).

Thing is .. . Dr. Banta-Green knows this data maybe better than anyone else in the state. When he is asked . ..

#WAOpioidTrial When asked, Dr. Banta-Green will answer (as much as his counsel will allow) his honest opinion, based on his expertise.

Will he say RX opioids caused the overdose crisis? Because I don't know any addiction experts who believe that. Even if they once did. 🤷🏽‍♀️

#WAOpioidTrial And even if Dr. Banta-Green DOES believe that RX opioids somehow caused the 'overdose crisis' - does that somehow make the distributors legally accountable? For distributing legal medications under the direct oversight of the DEA this whole time?

#WAOpioidTrial State is asking Dr. Banta-Green about the data and charts on this page: adai.uw.edu/WAdata/deaths.…

Note that the trends chart collapses ALL opioids together. They have not asked Dr. Banta-Green about the different between RX and 'other' opioids.

#WAOpioidTrial Aha - state asks "What is included in the (red) opioid line" on that chart - Dr. Banta-Green replies that it includes - 'prescription-type opioids which to be clear includes illicit fentanyl, and heroin."

Yep. It sure does. And those last two are by far the most.

#WAOpioidTrial Oh dear - defense tries to object about this chart or (it was hard to hear) about Dr. Banta-Green's ability to testify about the accuracy/data on those charts.

DO NOT DOUBT Dr. Banta-Green's knowledge on this stuff. Just don't. Also: IT IS AN ADAI CHART.

#WAOpioidTrial Dr. Banta-Green lives and breathes ADAI.

Listen I haven't always agreed with his every opinion, but his data and credibility are beyond reproach. Stick to asking him WHAT HE THINKS. Not whether he knows his stuff. HE DOES. 😬

#WAOpioidTrial The court excused Dr. Banta-Green while they are debating about . .. I dunno. Whether he's an expert or something?

It's pretty clear I've been biased against the state's case (because it's dumb) but defense trying to argue that Dr. Banta-Green is NOT an expert?

#WAOpioidTrial I note with some amusement that Dr. Banta-Green's counsel (in a separate Zoom window, so he can hear the arguments) looks alternately slightly bored or amused.

I did not realize that being stoic/masking boredom was a legal skill.

#WAOpioidTrial The judge astutely concludes that the most wildly respected and credential expert in WA state about addiction and overdose IS, in fact, an expert.

Good grief. And we're back.

#WAOpioidTrial We're now looking at that same ADAI page, scrolling down to this chart. Light blue line is IM fentanyl, purple is heroin, folks. No surprises there.

adai.uw.edu/WAdata/deaths.…

By which I mean: the RATE of use/misuse has remained relatively flat over time.

What has changed is what substances people can access, and their lethality.

RX opioids rarely ever created NEW illicit users. Roughly 2.5% of Americans struggle w/OUD. Far less than w/alcohol.

Here's the thing. IT DOES NOT MATTER how many RX opioids were legally distributed in WA. Or in any state.

The amount of legally-distributed opioids does not correlate to overdoses and deaths. In ALL states, and in DC. (The other Washington)

pubmed.ncbi.nlm.nih.gov/33814132/

Aaaaaand we're adjourned for lunch. Back at 1:30 PT with the afternoon link, and HOPEFULLY some more interesting questions for Dr. Banta-Green. ! I will be very curious to hear what he is asked, and what counsel allows him to answer.

Because . . . HE KNOWS STUFF.

#WAOpioidTrial Day 19 is resuming this afternoon at this link. To bring you up to speed: The state called local expert Dr. Caleb Banta-Green - but NOT as an 'expert witness'. He's here as a 'fact witness' to introduce 'business records'.

Which is ..

#WAOpioidTrial Frankly, nuts. If I understand things correctly the state is trying to limit Dr. Banta-Green's testimony to JUST THE FACTs (and data). Yet they spent 20-30 minutes reviewing his MANY credentials, awards, publications, grants, etc. He IS an expert. BUT.

#WAOpioidTrial Aside from the fact that he has likely NOT reviewed the many thousands of pages of evidence for the trial - there is no one in WA more expert than Dr. Banta-Green on addiction, overdose, and drug poisoning fatalities. State is playing with fire by using him.

Because if they do not want his expert opinion? All it takes is one little slip to open the door for the defense to question him.

Also I can just imagine him later "Remember that time WA called you on the stand and then said you are NOT an expert? About overdose deaths?!" 🤣🤣

#WAOpioidTrial State is asking Dr Banta-Green about the opioid trends, & they've asked him if these trends identify mainly illicit fentanyl or prescribed, & he's clearly said crime lab records reflect that it is overwhelmingly illicit. Which we knew.

How does this help state?

#WAOpioidTrial Mainly: no one knew back then that heroin -which rapidly converts to morphine in the brain post-mortem -that many deaths reported as morphine-related (which people assumed would be RX morphine) were actually heroin-related. The science and the processes got better.

#WAOpioidTrial between 2005-2010 the rate of opioid fatalities remained flat. But RX-related went down, and heroin went up. Or vice versa. Basically the overall rate of opioid deaths stayed the same in WA: 10 per 100,000.

Because people used what they could find. 🤷🏽‍♀️

#WAOpioidTrial Dr. Caleb Banta-Green: "As RX opioid-related deaths declined, heroin and fentanyl increased."

Yep. As those who had access to safer, pharmaceutical opioids switched to heroin and illicit fentanyl, those fatalities went up. And up. And up. RX opioids were safer.

#WAOpioidTrial Now we're looking at this page and chart:

adai.uw.edu/WAdata/major_d…

We glanced briefly at this chart on that page:

And now this one. Dr. Caleb Banta-Green points out that the rate has remained relatively flat overall (LIKE I HAVE BEEN SAYING!)

#WAOpioidTrial State asks Dr. B-G if methamphetamine deaths surpass opioids (it sure looks like it on the charts, and by a LOT) but he points out 'not when you combine all the different types of opioids'.

He's right. If you add heroin and illicit fentanyl together - it's more.

#WAOpioidTrial But since the distributors don't distribute heroin or illicit fentanyl and never have . .. and they also don't distribute methamphetamines (at least not illegal ones) .. . then ... ???

#WAOpioidTrial And now we are here: adai.uw.edu/WAdata/methamp…

Here's the view of Methamphetamine-related deaths (only), and then in combination with various other substances. 48.5% of Meth fatalities in WA involve some kind of opioid (usually heroin or illicit fentanyl).

It's really handy that state is showing the URL of these sites as they pop them up. What state is showing is that more people are dying from drug poisonings.

Because the drugs in use are more lethal now. This is all true. But NOT attributable to RXs.

adai.uw.edu/WAdata/deaths.…

Adorably, Dr. Banta-Green is instructing (via Zoom) the person in the courtroom driving the mouse/onscreen display where to click on the ADAI site (HIS WEBSITE) where to find the thing State is trying to enter into evidence. Because he's helpful like that. !

And then Dr. Banta-Green corrected state's counsel about which table they were looking at - "Nope, this is not that data, you meant to show me that OTHER data, I believe." "Oh, yes - you are correct."

Do not try to tell Dr. Banta-Green about his own data, people!

So they've asked him to 'sum up' all opioid deaths in WA from 2003-2020 by having him sum up a column of data. It's 12,769 over those 18 years. Including all illicit opioid substances, of course.

Just . . hang on a sec real quick.

So I pulled up the "total deaths in WA by year" from 2003-2020, to see what's what. That number (from all causes, whole state) is 921,421. Which means drug poisoning in WA is roughly 1.3% of state deaths over time.

State DOH has a spiffy tool for that fortress.wa.gov/doh/wtn/WTNPor…

Those deaths - those drug poisonings - are all tragic. Every one. We SHOULD have better treatment, care, prevention, etc. etc.

Since nearly all of these involve NON-RX meds . . .I still do not know why we are here. 🤷🏽‍♀️

Meanwhile, the state of WA just asked Dr. Banta-Green for an expert opinion, but defense objected because, you know, STATE SAYS HE IS NOT AN EXPERT (as far as the trial is concerned) and judge said: Yeah. That sounded like an expert-type question for the witness to me, too. 🤔

So far the state has been able to contain Dr. Banta-Green's role to 'fact witness' and not 'expert witness' but it's been close .. . like 3 times now. If that door opens to 'expert witness' I predict it will go badly for state's case. Really badly.

Here we are again: Judge says outright "IF he were an expert witness, he'd be allowed to testify on these issue. But since he's not, this is hearsay testimony and the objection is sustained."

State's trying to hail-mary an explanation here. Let's see what happens.

Aaaaand the judge continues to sustain defense's objection which means NO, you cannot ask your non-expert-witness (who is literally the state's foremost expert BY A LOT) for his opinions or survey data which is hearsay unless <cites specific conditions>. Now on afternoon break.

And we're back. It's a waiting game to see how long it takes state to bump up against the "not-an-expert-witness" line again, and what the judge will do about it.

Because it's happened four times already, if I'm counting correctly.

#WAOpioidTrial State is asking Dr. Banta-Green about a survey the state conducted at the site of a needle-exchange program asking if people seeking needles had used prescription-type opioids prior to heroin.

So that's a VERY specific group to ask in ONE county, yes?

Here's the survey/publication in question. Note . . the survey was in 2009. I don't know how many people were surveyed, all in King County.

tandfonline.com/doi/abs/10.108…

There's been at least two more objections about hearsay (because Dr. Banta-Green, ironically, is NOT an expert witness) and the judge has sustained them both. State just cited a case about admitting -specifically- a survey as an exception. Then did not have that case on hand.😬

Defense just eloquently argued against the survey thing for - trust me, they were pretty good reasons - but because WestLaw is down and the judge can't look up the cases cited, we're . . a bit stuck. BTW: the Judge is SHARP. How will this go? Curious.

Here's how it went: In the courtroom there were arguments back and forth this survey of a small set of self-selected users of a syringe exchange program in one county from 12 years ago. Judge remained not convinced about it but directed counsel to file briefs in the AM. And...

In the meantime since this is a bench trial, the judge told state to go ahead and question the not-expert (ha!) witness about the survey. He'll decide whether to exclude the testimony and survey tomorrow after the pocket briefs are submitted.

And there's been (I think) two more objections about 'expert witness' questions since then. It's a lot.

There's been a lot more ... shall I say .. . sneaky work by the state to try to get Dr. Banta-Green to say 'expert witness' stuff without admitting that he is one. There's an open question about whether surveys can be admissible - so the state's entered like 4 of them so far.

The surveys and Dr. Banta-Green's testimony may all be stricken tomorrow, of course. It's pending the judge's decision.

Judge just suppressed another survey. And then added yet another to the 'pending' list. 🤷🏽‍♀️

State is showing Dr. B-G a document he published in 2017 about a survey by syringe program participants - & he does not remember the exact question on the survey. They need him to find it. We've all now scrolled through 10-11 pages of him going "Nope. Not it. Nope. Keep going..'

Aaaand we spent a lot of time looking or the equivalent 2019 survey . .. to be pulled up, not finding the file, pulling up the wrong file, requesting the wrong slide . ..

Just saying: When your judge repeatedly says how much he values efficiency ... BE EFFICIENT. 👀

#WAOpioidTrial is showing a chart with trends for "people in WA admitted to publicly funded treatment for HEROIN first (not alcohol or cannabis) and by age group" and generally: Lots more people are using heroin FIRST. Lots. And that pretty much wraps up the day.

#WAOpioidTrial Judge says he's received defense motion to completely strike Ruth Carter's testimony for review & now each side owes briefs about these surveys and whatnot. It's a lot of lawyer homework! Dr. Banta-Green will be back in the AM. Court is adjourned until tomorrow!