CHARLESTON – Testifying in the bellwether federal opioid trial, Huntington's former chief of police shared the pain he felt as watching his community be taken over by addiction.
The City of Huntington and Cabell County sued three of the nation’s largest pharmaceutical distribution companies – AmerisourceBergen, Cardinal Health and McKesson Corp. – in 2017 claiming the companies are largely responsible for fueling the current opioid epidemic that led the area to lead the nation in prescription opioid related deaths and at one-time being named the “epicenter of the opioid crisis.”
On June 17, attorney Temitope Leyimu representing the City of Huntington called Skip Holbrook, former Huntington police chief between 2007 and 2014, to the stand. Holbrook grew up in Huntington and then lived in South Carolina for some time before returning as Huntington’s police chief. He now is chief of police in Columbia, S.C.
Leyimu
Emotions were palpable during Holbrook’s testimony as he tried to hold back tears.
“I saw my town being decimated by addiction,” Holbrook said. “It’s a difficult topic for me to talk about.”
Holbrook said he watched families go into financial ruin, he attended children’s funerals, his children lost family and more.
“I’ve never experienced anything like I saw when I left Huntington,” Holbrook said. “Those challenges remain today. It had an everlasting impact on me professionally and personally.”
Holbrook immediately realized a change when he came back to Huntington.
“When I became police chief, it was evident it was not the same city I grew up in,” Holbrook said.
Holbrook said there was a crack cocaine problem in the Fairfield area and evidence of open-air drug markets, where the drugs would be exchanged hand-to-hand on the streets.
Holbrook said between about 2011 and 2014 there were three main drugs that evolved over different periods – crack cocaine, prescription pills and heroin.
“In my opinion, the prevalence of drugs relies on demand, supply and demand,” Holbrook said. “Outrageously strong appetite for drugs in Huntington. We had an addicted population, unfortunately. As far as addiction, it was clear it was an opioid addiction driving that.”
Holbrook said people were selling food stamps, WIC benefits and single cigarettes to supply their addiction.
“On top of that you would have the robberies that would occur due to drug transactions,” Holbrook said.
Holbrook testified that his team worked as an executive staff. Lt. Hank Dial maintained statistics and data on the drug-related issues. Later, they hired a professional analyst to analyze the data to help formulate solutions to the problems the officers were facing.
Holbrook said the prescription opioid epidemic was different than the drug issues the department had saw before.
“The opioid epidemic was more widespread from one end of the city to another,” Holbrook said. “It affected people from all walks of life. People were focused on fueling their addiction.
Holbrook said there were several drug trafficking organizations that came into the area targeting the vulnerable. He said the police department started to see citizens with addiction move to heroin around 2012.
“Opioid pills were expensive, people were turning to a less expensive [source] and that was heroin,” Holbrook said.
Holbrook said they followed the drug trends through analysis, drug seizures and arrests. They also followed the price trends of drugs to follow when alternative drugs were sought.
“We do pay attention to the going cost of a particular drug,” Holbrook said. “With respect to the opioids, we knew that as price would go up – at one time it was about $1 a milligram – they wouldn’t be able to pay.”
Holbrook said the department’s number one priority had to be public safety, and the threat had to be addressed.
Earlier in the day. attorney Paul Farrell Jr., representing the City of Huntington, called Thomas McGuire, a professor in health economics as in an expert witness specializing in healthcare economics of healthcare and pharmaceutical industry.
McGuire said he was asked to put “an economic evaluation of some of the harms that have been identified by previous witnesses due to prescription opioids.”
McGuire used two major harms and data numbers from Katherine Keyes, a substance abuse epidemiologist who testified on causation earlier in the week. He also used methodology and “placed value of a person” from the Council of Economic Advisers and Florence et al.
U.S. District Judge David Faber asked McGuire to clarify deaths and morbidity.
McGuire said deaths are the people who have died, and morbidity are the people who are sick from the harm.
McGuire testified that according to the economic methodology and numbers he used show an estimated cost of $2.8 million from deaths related to prescription opioid overdoses and an estimated excess in related healthcare needs of $494 million.
Attorney Ashley Hardin, representing Cardinal Health, started the cross-examination by asking a pattern of questions referencing Corey Waller’s testimony regarding the need of opioids for pain and patient health.
Waller was an expert witness specializing on pain and substance use disorder and the first witness of the trial.
“I’m an economist and am not in position to second guess clinical decisions,” McGuire said.
Hardin questioned McGuire on his knowledge of the reasoning for the hearing.
“I’m not sure I should speculate,” McGuire said. “I know what the allegations are, I think different parties have different [purposes]. The economic methodology is what I paid attention to.”
McGuire agreed with Hardin that he was not offering any opinions on money spent or to be spent as a result of the epidemic.
“My analysis is backward looking, not forward,” McGuire said. “It is harm in an economical sense. I don’t know if it’s damages in a legal sense.”
Attorney Paul Schmidt, representing McKesson, finished the cross-examination with questions about the cost of untreated pain and McGuire’s knowledge on the specific funding source.
A 2011 publication on pain was presented that stated an estimated $560-635 billion is the annual economic cost across the nation due to untreated pain.
“These are clinical issues that I am not challenging,” McGuire said.
Hardin asked to renew the Daubert challenge and strike McGuire’s testimony from the record.
The defense argued that his calculations of harms were not specific to the defendants and his expertise has no fit or relevance to the case. They claim he did a simple academic exercise. They said his testimony held no relevance to weight of cost and benefits of a public nuisance.
Farrell argued the plaintiffs were “tasked to show unreasonable interference” and a number value was trying to be shown by “virtue of mortalities and morbidities.”
Faber said he wanted to give the motion thought and would make a ruling at an appropriate time.
Attorney Anne Kearse, representing the City of Huntington, called Judith Feinburg as an expert witness in prevention and treatment of infectious diseases associated with OUD and injection drug use.
Feinburg started her expert report a summary of opioids and resulting diseases.
“Opioid overdoses are not the only life-threatening consequences of the drug epidemic – the serious infections associated with drug use and especially injection opioid use.”
Feinburg said several bloodborne infections are of concern including HIV, Hepatitis B and C, infective endocarditis and other serious bacterial infections.
She testified that there is a 1/60 chance of HIV contraction with every drug injection, making drug injection use the second most common way of contracting the disease.
Between 2014 and 2018 there was a 9 percent increase across the nation of HIV among people using injection drugs. In 2019 Cabell had 69 HIV cases, 63 were drug injection related. This is not the primary source of HIV in West Virginia.
Between 2010 and 2020, West Virginia and Kentucky have gone back and forth as the leading state of Hepatitis C (HCV).
Feinburg said 40 percent of those using injection drugs will contract HCV within the first year of use. Injection drug use is the primary contraction of HCV in most of the developing world.
In 2016, Cabell County was one of the highest counties in the state with a HCV rate of 10.3 per 100k person, which is double the state rate of 5.1 per 100k person. Feinburg said this is a high rate for a state.
Feinburg said a drop in HCV was seen in West Virginia around 2016/2017 but has since gone back up. She said with a combination of daily drugs for a period can eliminate HCV from an infected person.
“Like smallpox, you could eliminate Hepatitis C if you cured enough people,” Feinburg said.
West Virginia has the highest number of Hepatitis B – spread via blood transmission – cases in the last decade, 14x the national rate. In 2016, Cabell County reported chronic Hepatitis B at a 12.9 per 100k rate and acute Hepatitis B at a 17.6 per 100k rate.
Feinburg said one of the more serious bloodborne diseases is endocarditis, an infection of the heart lining. She said it is often caused using unsterile needles and preparation materials for drug injection.
Feinburg testified that mouth bacteria and dirty skin is a common cause of the illness and is often cause by users “lick[ing] needle before injection” into unclean skin.
There is no statewide or national data reporting of endocarditis, but Feinburg said specialists saw a significant rise in 2005.
The disease can be treated by a six-week intravenous antibiotic during a hospital stay or immediate cardiac surgery.
Feinburg said as of 2016 the estimated lifetime cost of HIV was around $450K mand drug-related-infection hospitalizations have an estimated cost of $700 million.
Feinburg said an important step to treating and reducing the diseases is reducing the stigma to encourage users to seek help. She said there is also several harm reduction programs including syringe exchange programs, overdose education, Naloxone, Fentanyl test strips, vaccinations, safer sex education and condom distribution, rapid testing and referrals for treatments.
Feinburg included 2016 harm reduction numbers from Cabell County.
The county served 1,980 individuals and had 7,836 encounters with clients. And 44 percent of those served were female, 56 percent were male, 20 percent were homeless and 34 percent were uninsured.
“There’s no question in my mind that these two things [opioid use and rise in bloodborne disease] are related,” Feinburg said.
Attorney Isia Jasiewicz, representing Cardinal Health, led the cross-examination.
Jasiewicz clarified with Feinburg that the term injection drug users were in reference to nonmedical use of injection drugs. She also clarified that more than prescription opioids can be injected.
Jasiewicz asked Feinburg if she agreed that the medical community pushed the use of pain medication.
“I’m not sure I would say it was the medical profession that moved in that direction,” Feinburg said.
Feinburg said doctors, especially ones without their own practice, felt the pressure but she knows she didn’t ask every patient if they had pain.
“Patients will tell you when they have pain,” Feinburg said.
An article was presented from an opinion article authored by Feinburg titled ‘Tackle the epidemic, not the opioids”
Feinburg explained the article was written to share her frustrations over the way Congress distributed money for fighting drugs and it was a “complex issue” and that the piece intended to show fighting the epidemic required more attention to addiction and overdose treatment.
“Multiple points in this opinion piece I talk about the flood of opioids that set off the epidemic unlike those [crack and heroin waves],” Feinburg said. “Here we are 21 years later and we’re still in the thick of it. This has been a pretty persistent problem that really started with opioids and is primarily driven by opioids.”
The trial resumes June 28. The federal courthouse is closed Friday to celebrate the new federal Juneteenth holiday, and the trial is scheduled for a recess after that.
Huntington is represented by Anne Kearse, Joseph Rice, Linda Singer and David Ackerman of Motley Rice and Rusty Webb of Webb Law Centre. Cabell County is represented by Paul Farrell Jr. of Farrell Law, Anthony Majestro of Powell & Majestro and Michael Woelfel of Woelfel & Woelfel.
AmerisourceBergen is represented by Gretchen Callas of Jackson Kelly and Robert Nicholas and Shannon McClure of Reed Smith. Cardinal Health is represented by Enu Mainigi, F. Lane Heard III and Ashley Hardin of Williams & Connolly. McKesson is represented by Mark Lynch, Christian Pistilli, Laura Wu and Megan Crowley of Covington & Burling.
U.S. District Court for the Southern District of West Virginia case numbers 3:17-cv-01362 (Huntington) and 3:17-cv-01665 (Cabell)
