NORMAN, Okla. (Legal Newsline) – An idea of how much money Oklahoma wants to abate the opioid drug epidemic was realized on Friday as a state health officer walked officials through a 65-page list of abatement services she said were needed, collectively projected to cost in the billions.
“Do you believe these services are necessary to the state?” asked Lisa Baldwin the attorney hired by the State of Oklahoma.
“Yes, they are reasonable and necessary,” said Jessica Hawkins, senior director of prevention services for the Oklahoma Dept. of Mental Health and Substance Abuse Services.
A trial to determine if Johnson & Johnson and its opioid drug subsidiary Janssen Pharmaceuticals helped to cause an opioid drug epidemic is being streamed live courtesy of Courtroom View Network.
Oklahoma Attorney General Mike Hunter alleges that J&J and its prescription drug subsidiary Janssen Pharmaceuticals carried out a fraudulent advertising campaign to over-supply opiates in Oklahoma for profits leading to an epidemic Hunter called the worst in the state's history. J&J's opioid brands are Duragesic, which dispenses opioids by the use of a timed-release patch, and a pill called Nucynta.
Thousands of cases are still pending around the country and the Oklahoma case is being followed nationwide. It's also the first opioid trial under the "public nuisance" legal theory, attempting to hold pharmaceutical companies, distributors and pharmacies liable for the nation's addiction crisis. Critics of the nuisance claim say the state’s case is in reality a products liability case.
Two other co-defendant pharmaceutical companies, Purdue Pharma of Connecticut and Teva Pharmaceutical based in Israel, earlier settled with Oklahoma, $270 million from Purdue and $85 million from Teva. That left J&J (and Janssen) as sole defendants in the case.
In the Purdue Pharma settlement, private attorneys took in $60 million, while about $200 million went to a research project at Oklahoma State University, which is Hunter's alma mater.
Purdue officials pleaded guilty in 2007 of misleading the public about the risk of addiction from their opioid pain killer OxyContin and agreed to pay $600 million, at the time one of the largest pharmaceutical settlements in U.S. history.
The cost to abate the drug crisis officials called the worst health emergency in the state’s history could cost $17.5 billion, a yearly average of $767 million.
Hawkins worked to develop the abatement plan with Oklahoma Mental Health and Substance Abuse Commissioner Terri L. White. Hawkins described each program and exhibited a chart for each, showing a breakdown of costs and services provided.
An adult treatment services program with halfway and recovery housing for addicts and mental health counseling as well as additional services had a projected 30-year cost of $767 million. An addiction mental helpline (phone) to give people round-the-clock crisis support and added services would run $96.5 million over 30 years.
A medical drug disposal system to crush discarded drugs with compactors and remove them easily from homes into disposal boxes would cost an estimated $3.3 million over 30 years.
Technical assistance to provide training for support services and to hold an annual conference to discuss progress and best practices among other goals would run $22.3 million over 30 years.
Hawkins said the expansion of family drug courts are necessary due to the crisis placed on child welfare by the drug epidemic.
“These are children removed from their homes or through neglect,” she said. “The program will assist with family reunification between children and their parents and result in less days separated.”
The program would also develop participation in drug treatment programs; the cost; $374.2 million over 30 years ($15.8 million in 2019).
A K-12 school education program aimed at six and seven-year-olds in 4,926 classrooms, training for counselors and teachers, would cost $424 million over 30 years.
“I believe this is essential to abating the crisis,” Hawkins said.
A Naloxne (anti-opioid drug) distribution and education program would cost $42 million over 30 years and a syringe program to prevent HIV infection and hepatitis B and C through the improved disposal of dirty syringes and the provision of clean ones would run $693 million for 30 years.
Transportation services to help people get to appointments for drug treatments, doctor visits and medications would also be provided as well as a standardized university screening program to identify substance abuse risks and provide referrals. The cost of the university program, $1.3 billion over 30 years ($974 million over 20 years).
A pharmacy disposal program allowing more numerous drug disposal sites at pharmacies including smaller outlets in rural areas would run $219 million over 30 years. A pain prevention services program in part to develop alternatives to opioid use such as yoga and physical therapy is projected at $2.4 billion over 30 years ($103 million in 2019).
Other services included prenatal screening of pregnant and postpartum women at 150 birthing hospitals and obstetrics and gynecology (OB-GYN) offices, an opiate overdose review board budgeted at $3.8 million, a prescription monitoring system costing $38.8 million and a program management and monitoring/evaluation arm with a price tag of $55 million over 30 years.
Hawkins reiterated the plan needs to be in place for 30 years.
“I don’t believe we will see a marked improvement soon,” she said. “This is a significant crisis we have not seen before. Someone who has an opioid disorder could have it for the rest of their life, it is a chronic and relapse condition. In my opinion it will not begin to abate for some time.”
On cross-examination Steve Brody, the attorney for Janssen with the O’Melveny & Myers law firm, sought to gain an answer from Hawkins on when the crisis would be abated.
“What’s going to happen in 2049 that will allow the dollars to go to zero?” Brody asked.
“We understand it (plan) will abate the problem, but there will be continual costs over time,” Hawkins said.
“It’s January 1, 2049,” Brody said. “We don’t need the money anymore?”
“It’s difficult to predict what 30 years from now looks like,” Hawkins said. “In my opinion the plan has to be for 30 years.”
“How will we know we’ve abated the crisis?” Brody asked.
“An evaluation plan will be set up measuring (progress) over time,” Hawkins said. “That part has not been developed.”
“We don’t know at this point, right?” Brody asked.
“The costs are continuous to get the (abatement) result,” Hawkins said.
“The (abatement) measures have not yet been set up?” Brody asked.
“Correct,” Hawkins said.
“Are you unable to tell me how we will know we've abated (the crisis)?” Brody said.
“We can predict abatement will occur,” Hawkins said.
Hawkins said the testing of interventions and monitoring of program results would provide the answer.
“What constitutes abating the crisis?” Brody asked.
“To abate back to the pre-1996 (opioid use) levels, minimally,” Hawkins said.