The Needle & The Damage Done Story Archives - West Virginia Public Broadcasting

Opioids On Trial: Can Lawsuits Help Fix The Addiction Crisis?

When health care and law enforcement officials met recently at a health policy forum in Lexington, Kentucky, to share ideas about the opioid crisis, Kentucky Attorney General Andy Beshear listed some groups that have benefited from money won in a 2015 settlement with Purdue Pharma, the maker of OxyContin.

“We had Freedom House in Louisville and Independence House in Corbin. We had the Chrysalis House in here in Lexington. Hope in the Mountains, that was going to have to shut down, in Prestonsburg,” he said.

Beshear doubled down on a commitment to sue other opioid manufacturers and distributors. He claims they owe the people affected by the addiction crisis.

“I’m not looking for punishment, I’m looking for responsibility,” he said. “And if those companies won’t take responsibility, then I’m going to see them in court.”

Beshear joins a trend of state, county and municipal government officials across the country considering or filing myriad lawsuits in the past year against opioid manufacturers, distributors, pharmacies and doctors they say should take partial responsibility for the addiction crisis.

The approximately 60 plaintiffs in the Ohio Valley range from the state of Ohio, population 11.6 million, to the town of Kermit, West Virginia, population 371.

The defendants range from large opioid wholesale distributors such as Cardinal Health Inc., AmerisourceBergen Corp., and McKesson Corp., to small-town pharmacies such as Larry’s Drive-In Pharmacy in Madison, West Virginia.

The officials bringing these suits say the money earned in court would be used to cover what governments have spent to keep up with the damage done by the proliferation of opioid pain pills, and to improve treatment options for those who became addicted. But there are questions about using the courts as a fix for the addiction crisis. Some experts warn that the lawsuits might not succeed and even if they do, they might not bring a remedy in time.

The Strategy

Professor Richard Ausness researches product liability litigation at the University of Kentucky College of Law. He says the plaintiffs face a challenge in proving that the companies created a “public nuisance,” as many of the lawsuits allege.

“Historically, it has been concerned with activities on land,” he said. “A court would have to be willing to expand the traditional boundaries of public nuisance law.”

Another major hurdle will be to prove the companies bear direct responsibility. In similar cases the defense has argued that there are too many steps between selling or distributing a legal substance and the damages of the crisis.

“They clearly have a responsibility to the people they sold the drugs to. But this is a few steps removed from that,” Ausness said.

Law professor Richard Ausness sees a strong parallel between opioid lawsuits and tobacco litigation.

For example, as part of a lawsuit brought by the city of Huntington, West Virginia, Cardinal Health, a wholesale distributor of opioids, submitted a list of 2,000 organizations the company says could also be liable. This list was controversial because it included Lily’s Place, a treatment center for babies born dependent on drugs.

Ausness said he thinks this argument positions the defense for a chance at success, but it’s not a guarantee.

The plaintiffs, however, may not be looking for a successful ruling to achieve their goals.

“I’m not sure they expect to win or want to win,” Ausness said. “I think what they want to do is settle.”

The cost of litigation is expensive. And the theory is that if drug companies are hit with enough lawsuits, settlement will be a better financial decision than proceeding in court.

Settlements also allow defendants to seal potentially damaging information.

“That’s often the quid pro quo,” Ausness said. “They don’t want stuff getting out that could be used against them.”

A deposition of Purdue Pharma board member and former president Richard Sackler detailing the company’s marketing of OxyContin was put under seal in the Pike County Circuit Court as part of Kentucky’s settlement with the company.

This is believed to be the only time Sackler has spoken on record on the matter, according to STAT, which reports on the biomedical business world. The news organization is battling Purdue in court in an effort to unseal the deposition and other related records.

Following Tobacco Road?

Ausness compares the recent wave of opioid lawsuits to the tobacco industry’s landmark settlement. Industry leaders agreed to pay $206 billion in 1998 after nearly every state sued to recover Medicaid dollars spent on tobacco-related disease.

“The tobacco companies eventually threw in the towel and finally said, ‘We’re getting killed here a little at a time,’” Ausness said.

Part of the Tobacco Master Settlement Agreement prohibited future litigation against the industry.

Ausness said pharmaceutical companies could reach a point where they will opt for that. But he said there are a few key differences with the opioid lawsuits.

Opioids are regulated by the U.S. Food and Drug Administration while tobacco was not. This supports the defense in that they were selling and distributing a legal substance. And Ausenss said there is not yet any “smoking gun” evidence as there was in the tobacco lawsuits.

“They got together and conspired through their trade associations to lie about the risk of addiction and the nicotine content. And they got caught red-handed,” Ausness said.

And if lawsuits succeed, there may not be enough money to go around. There could potentially be thousands of plaintiffs in the opioid litigation as more county and municipal governments file suit.

“I think what we may end up with is something akin to an Oklahoma Land Rush,” Ausness said. “Everybody starts piling on and the ones who manage to get judgments early in the process may end up being compensated while the other ones end up not being compensated if the companies go under.”

A Timely Remedy?

The comparison to the tobacco lawsuits raises another thorny question: Would the money from opioid lawsuits really help those in need?

While smoking rates have dropped since the ’90s, critics of the tobacco settlement say much of the money promised to smoking prevention and education programs went instead into the states’ general budgets.

So far the opioid suits show mixed results in the region.

The Chrysalis House in Lexington is using some of the $24 million settlement from the 2015 agreement with Purdue Pharma to treat the alarming number of babies born drug-dependent.

“[The money is] providing necessary treatment and wrap-around services to the women and children that we serve,” Executive Director Lisa Minton said.

The $350,000 was awarded to Kentucky’s oldest and largest residential recovery program for women out of an $8 million pool through a grant process.

Minton said Chrysalis House will dedicate its share of the funds to hiring additional peer support staff, educational parenting programs and family services to the new mothers who come to one of their three facilities with their babies.

“Funding is always precarious,” Minton said. And grants like these help take some of the pressure off finding enough funding to keep up with the increase in demand for the services.

However, Kentucky’s Office of Drug Control Policy Executive Director Van Ingram cautions that even big money settlements take time to show effects on the ground.

The state’s suit against Purdue, for example, was filed in 2007, a settlement came in 2015, and organizations are just now receiving the money.

“It’ll be a decade before anything results out of these lawsuits, in my opinion,” Ingram said. “So, I don’t think it’s going to have any immediate impact.”

One to Watch

Professor Ausness agrees that these types of cases take time. He points to Chicago’s lawsuit filed against five major opioid manufacturers several years ago.

“It’s still in the pretrial phase after all the back and forth,” he said.

Out of all the similar cases filed across the country, Chicago’s is the furthest along and could have major implications for lawsuits filed in the Ohio Valley.

This means it’s still far too early to tell how the litigation will shake out, and even harder to tell if the results will have an impact in time to keep pace with the opioid crisis.

After Obamacare: Ending Affordable Care Act Could Cut Addiction Treatment

The Road To Recovery

On a recent gray winter morning Tomas Green drove the rain slick streets of Ranson in West Virginia’s Eastern Panhandle. No matter the weather, Green helps transport clients working through addiction at the Jefferson Day Report Center get to their treatment sessions and meetings.

“If they need rides, I use my own personal transportation sometimes,” he said.

As a peer coach for the center, he strives to go above and beyond for the clients. Green can relate to his passengers: He’s in recovery himself.

His experience taught him recovery can be difficult. And now he wants to help others stay on the right path.

“For me, I share with everybody it’s good to have a good support system.”

But the support offered by the day report center faces an uncertain future as Congress considers repeal of the Affordable Care Act. Pending changes could have major consequences for the availability of substance abuse treatment in a region that has become the epicenter of the nation’s opioid addiction crisis.

Care Tied to the ACA

A lot of the funding tied to services offered by the day report center is tied to the ACA. And a repeal without replacement would be damaging.

“It would impact us negatively to the point where we would have to make tough decisions about the level of care that we could provide, even to the point where we might not be able to exist,” Executive Director Ronda Eddy said.

On the road to the Day Report Center. Transportation to regular treatment sessions is important to addiction recovery

Day report centers work with non-violent drug offenders referred by the court system. They offer medication assisted treatment, counseling and other resources aimed at rehabilitation.

Local law enforcement has embraced this approach to dealing with addiction.

Charles Town Police Detective Ronald Kernes said the center is a valuable tool in the system, as they can’t arrest their way out of the epidemic.

“We understand that people have problems and addiction is a disease,” he said. “It’s nice to have an outlet where people at least have a chance to try to better themselves, and kick the habit and become a productive member of society.”

Jefferson Day Report Center Executive Director Ronda Eddy would face tough choices without the ACA.

The day report center is in the infancy of offering services. They established the current facility just a few years ago.

Medicaid expansion under the ACA helped the center build on its early success.

“It certainly has expanded access to care, more behavioral health care, all of those things that support recovery,” Eddy said.

Expanding Treatment

Treatment centers across the Ohio Valley have used the additional resources in hopes of reducing the highest opioid addiction and overdose rates in the country.

Data from a Harvard/NYU study show that in Kentucky, Ohio, and West Virginia nearly 215,000 additional people were able to seek mental health and addiction treatment after the Medicaid expansion.

And that may be a low estimate. A report from Ohio’s Department of Medicaid claims their number is 50 percent higher than what researchers in the study found.

The waiting room at Jefferson Day Report Center in West Virginia.

Republican Congressional leaders are working to repeal the ACA but have yet to agree on its replacement. This is especially true for the ACA’s Medicaid expansion provisions; reform, reduction and elimination have all been proposed.

Cautionary Tales

In Portsmouth, Ohio, Lisa Roberts works with people struggling with addiction as a Public Health Nurse for the city’s Health Department. Scioto County –where Portsmouth is located– has one of the highest rates of opioid addiction in the state.

The department offers Vivitrol shots to treat addiction and counseling to help with recovery. They refer individuals to other treatment programs if it is a better fit.

This program and others would be gone with a full repeal of the ACA, according to Roberts

“There would be people who lose access to their Vivitrol injections, a lot of people that would lose access to their addiction treatment,” she said. “It could just be catastrophic.”

Portsmouth, Ohio, public health nurse Lisa Roberts saw what happens when addiction treatment abruptly ends. “It could just be catastrophic.”

Roberts has two examples of what happens when treatment is suddenly lost: one professional and one personal.

Federal and state authorities shut down Community Counseling and Treatment Services, an opiate treatment practice operating in Scioto and Lawrence Counties on September 25, 2014, during an investigation into Medicaid fraud and other allegations. No charges have been filed and no arrests made in the investigation, but Community Counseling and Treatment Services was never again permitted to accept Medicaid, and remains closed.

That forced Roberts and the Portsmouth Health Department to scramble to quickly find clinics that would accept Medicaid for around 1,200 people who suddenly lost treatment.

“We had to triage. We had to prioritize people,” Roberts said.

Other local facilities were overwhelmed and some people had to travel up to 100 miles for treatment. Long trips proved difficult for those who lacked the transportation or the time.

Some relapsed and had to resume treatment later. Others didn’t make it.

“We did experience a spike in overdoses and we also experienced a lot of fatal overdoses,” Roberts said. “It was actually the most lethal month that we’ve seen in Scioto County.”

Scioto County had no more than three accidental fatal overdoses in a month until October, right after the clinic closed, when they had six.

Close to Home

Roberts’ personal experience with the loss of coverage for addiction treatment came as part of her daughter’s struggle with addiction.

Vivitrol injections were what helped Roberts’ daughter sustain recovery. And she was covered under the Medicaid expansion.

But when her daughter moved to Tennessee –a state that did not expand Medicaid– she suddenly lost access to the shots.

Roberts stepped in.

“I would have to drive 400 miles to give her that injection,” she said. “And eventually she was able to get it there through the Affordable Care Act.”

Her daughter later returned to Ohio and continues recovery.

But Roberts understands that others may not be as fortunate.

She says the lessons for the ACA debate remain the same even if the circumstances of her experiences are different.

She and others fear repealing the ACA without a replacement could trigger a wave of similar events across the Ohio Valley.

Waiting and Working

As Congress continues its health care debate, the people Tomas Green drives to the West Virginia treatment center wait to see what will happen to their coverage.

To Green and others on the road to recovery, the journey is already a difficult one. But he says it comes with rewards.

”First comes the lessons and then the blessin’s.”

Rebecca Kiger contributed reporting for this story as part of her work with “100 Days in Appalachia.”

After Obamacare: The Affordable Care Act And One Woman’s Struggle For Sobriety

Wendy Crites is a single mom, a Christian and a recovering addict in the Eastern Panhandle of West Virginia. She’s on parole and receiving substance abuse treatment through the Jefferson Day Report Center. Crites has been using drugs since she was 13, intravenously since she was 15.

“Everyone has some kind of addiction,” she said. “I believe it’s that hole everyone has in their heart that you’re trying to fill — I’ve filled it with drugs. I think it’s really something only God can do. And I think he uses our weaknesses to bring us to him.”

Crites has a 26-year-old daughter, Ashley, and a 12-year-old son, Devin.

“I have the sweetest son – half of his life he’s saw me be strung out on drugs. He’s getting ready be a teenager, and I just want to be a good role model for him.”

WATCH: Wendy’s Story

Crites has worked a variety of jobs since she was 16-years-old but dreams of having a stable job with benefits that would allow her to save money and provide for her kids. That’s a tall order for anyone with felony charges, albeit nonviolent charges in her case.

She relies on her faith and her desire to be a good parent to motivate her through recovery.

She also relies on the services provided through the Jefferson Day Report Center. These services include transportation, mental and behavioral health, and various forms of medically-assisted substance abuse treatment — all covered under the Affordable Care Act. Through the center, Crites receives Suboxone, a medication used to treat opioid addiction by reducing withdrawal symptoms and the urge to use.

Wendy Crites in a waiting room at the Jefferson Day Report Center, where she receives counseling and medical treatment for addiction.

“Between the meetings, the counseling, the Suboxone, and God … that program saved me.”

Without the support of these services, a simple misstep could jeopardize months or years of sobriety. Crites recently broke her ankle while working.

“My daughter, when she first found out I broke my foot, her first thought was: ‘I’m afraid mom’s gonna use again.’ ”

Wendy Crites with her 26-year-old daughter, Ashley, and 12-year-old son, Devin.

Despite having a broken foot, lacking a vehicle, being denied food stamps because she’s a drug offender, and having to build a new social support system from scratch at 50 years old, Crites is, so far, maintaining her sobriety.

This story was produced in collaboration with 100 Days in Appalachia.

Born Addicted: The Race To Treat The Ohio Valley’s Drug-Affected Babies

She asked to not be identified. And it’s understandable given the stigma attached to addiction. For this story, we’ll call her “Mary.”

Mary lives in eastern Kentucky and has struggled with an addiction that began with painkillers and progressed to heroin.

“As soon as I opened my eyes, I had to get it,” Mary said. “And even when I did get it, then I had to think of the next way that I was going to get.”

Mary was using when she learned she was pregnant with her first child. She sought treatment but the disease had a tight grip on her.

The child was born dependent on opioids and went through the pains of withdrawal shortly after delivery.

“To see that little boy go through that stuff, you’d think that I would, like, change my life around immediately but I didn’t,” Mary said. “I didn’t want to believe it. I was in complete denial that because of my choices, it was my fault that he was going through that.”

Mary sought treatment but relapsed. Then she learned she was going to have a second child.

Startling Statistics

The number of babies born suffering from neonatal abstinence syndrome — the medical term for being born dependent on a drug — is on the rise.

A study published in the Journal of the American Medical Association-Pediatrics found “incidence rates for neonatal abstinence syndrome and maternal opioid use increased nearly 5-fold in the United States between 2000 and 2012,” and appears to be most pronounced in rural areas.

In the Ohio Valley the statistics are startling. Ohio and Kentucky both have rates well above the national average. In West Virginia the most recent data show that for every thousand live births there are fifty drug-affected newborns, the highest such rate in the nation.

Health care workers across the region are responding, finding new ways to treat both babies and mothers.

‘Get Addicted to Motherhood’

Nationwide Children’s Hospital in Columbus treats babies transferred from other hospitals when the symptoms are at their most severe…excessive crying, unable to self-console, unable to eat appropriately, all the way up to seizure activity.

“Based on each symptom and the severity of it, that baby is assessed a number,” Neonatal Intensive Care Unit’s Administrative Clinical Leader Amy Thomas said. “If that number reaches a certain level, then that tells us we have to treat that baby.”

Some drug-affected babies are treated here at the Neonatal Intensive Care Unit at Nationwide Children’s Hospital.

The staff has been developing the treatment plan since 2013. This was around the time when staff noticed a correlation between increasing length of stay and drug-affected babies.

Treatment begins with non-pharmacological methods like cuddling and music therapy.

But if the withdrawal cannot be managed, morphine is administered. As the baby shows signs of improvement, the dosage is decreased until they are no longer dependent.

Educating the parents on how to care for the baby through methods like skin-to-skin comforting and breastfeeding is also important. And Thomas said treating mothers and fathers as parents, rather than as addicts, can have an impact on the baby’s life.

“I have that window of opportunity there to get her to fall in love with her baby, get her addicted to motherhood,” Thomas said.

Amy Thomas, R.N., is the NICU administrative clinical leader at Nationwide Children’s Hospital in Columbus, Ohio.

The hospital has seen its admission numbers for drug-affected babies go down as birth hospitals have improved their ability to provide care.

Improved quality of care has also decreased the length of stay for the young patients, which can also help cut costs. The Ohio Mental Health and Addiction Services found in a 2014 study that each drug-dependent newborn can cost the healthcare system $56,000 or more, and most of the patients were on Medicaid.

Lily’s Place in West Virginia

A unique facility in Huntington, West Virginia, aims to reduce the burden on hospitals.

At Lily’s Place, babies are cared for in individual nurseries where the lights are low and noise is kept to a minimum.

“These babies are born very easily overstimulated,” said Rhonda Edmunds, the director of nursing. “We feel a quieter, more homelike environment is the environment that they need.”

Rhonda Edmunds directs nursing at Lily’s Place in Huntington, W.Va.

A staff of registered nurses provides another option of care for drug-affected babies outside of hospitals.

The facility is one of only two of its kind currently operating in the U.S. and it wasn’t easy to get started.

“The state allowed us to be part of a pilot program but all the babies had to be in state custody for that, which was a hinderance to getting babies over here,” Edmunds said. “But we don’t have to do that anymore.”

Since it opened in 2014, Lily’s place has been working to help other facilities get started and get through the red tape.

A nursery where drug-affected babies are treated at Lily’s Place in Huntington, W.Va.

The group published a book in 2015 on how to start a neonatal withdrawal clinic and is updating it to reflect changes in federal regulations that came with the passage of the Comprehensive Addiction Recovery Act last year.

MOMS in Ohio

Treatment for pregnant women, meanwhile, can be difficult to come by in the Ohio Valley. The ReSource analyzed data from the Substance Abuse and Mental Health Services Administration on treatment centers across all three states and found only a quarter of those centers accepts pregnant women.

A group of organizations in Athens County, Ohio, took a collaborative approach in addressing this issue.

Several years ago the OB-GYN at OhioHealth O’Bleness Athens Medical Associates noticed an increase in the number of pregnant women coming in with addiction issues.

“I could see there was some burnout in my providers because these patients had so many other issues, social issues that we didn’t even know how to address,” Practice Manager Pam Born said.

So she reached out to the nearby Health Recovery Services organization in hopes of getting these mothers treatment.

The collaboration was so successful, they looked for other resources.

“As we identified a new problem, we would identify who in the community could meet that problem,” Born said.

Soon they were offering housing, childcare, and other services for the whole family.

Interest from lawmakers led to the creation of the Maternal Opiate Medical Support (MOMS) project. Athens County and three other areas are provided funding to assist the programs in the hopes that others would follow.

Born said collaborations can form in any community and take many forms depending on a community’s unique needs.

In Athens County, Born would like to work toward offering residential treatment for pregnant women and mothers in their program, which is difficult to find throughout the region.

Karen’s Place in Kentucky

Karen’s Place Maternity Center is filling this role for residential treatment in Louisa, Kentucky.

Addiction Recovery Care –with treatment centers throughout mostly rural Kentucky– operates the new facility offering a balance of medical treatment, counseling, and a faith-based element.

“There are no centers doing what we’re doing in this part of Central Appalachia,” CEO Tim Robinson said. “And we felt we had the infrastructure and resources to do it.”

One of the bedrooms for clients who stay at Karen’s Place Maternity Center in Louisa, Ky.

The 16-bed facility at Karen’s Place is a refurbished home in a secluded area, with 24/7 staff support and amenities for both mother and baby.

By focusing on the moms, Robinson said they are investing in the family as a whole.

“We’re not going to have true compassion for the babies until we have true compassion for the moms,” he said.

Mary’s Recovery

Karen’s Place in Louisa is where I met “Mary,” the mother of two whose first child was born drug-dependent. Mary is now in recovery. She was the first woman to come live at Karen’s Place before it was opened to the public in late January.

She sought treatment again after the birth of her first child and was able to get clean for a while. However, she relapsed around the time she found out she was pregnant again.

Mary was determined to give this baby a healthy start. She reached sobriety in October and her second child was born about a month ago with no signs of being affected by opioids.

“It’s been amazing,” she said. “He’s healthy, happy. He’s a calm little guy.”

Living at the maternity center has allowed Mary to focus on her continued recovery, motherhood and her faith. She aspires to further her education and someday help other mothers suffering with addiction.

“I’ve always encouraged people, if they’re still breathing, there’s still hope,” she said.