SEATTLE (Legal Newsline) - The executive director of a treatment clinic for addicted opioid users said her staffers were overwhelmed by an epidemic of drug abuse to the point they became burned out and suffered from compassion fatigue.
“That’s when the problem becomes bigger than the intervention,” said Dr. Molly Carney, executive director of Evergreen Treatment Services in Seattle.
Attorneys for three opioid distributors accused of causing an opioid epidemic in Washington State by recklessly supplying drugs to doctors and clinics continued to hammer on the theme that it was illicit use such as heroin and fentanyl that caused the epidemic, not the companies legally supplying pills for prescriptions from doctors.
Prescription drug distributors McKesson, Cardinal Health and AmerisourceBergen Corp. are accused of irresponsibly over-promoting and distributing opioid drugs to pharmacies and doctors' offices that led to hundreds of overdose deaths in the state. The Washington State Department of Health estimated 1,200 in 2020.
The trial is being streamed live courtesy of Courtroom View Network.
Distributors take pills from the manufacturers and supply them to hospitals, doctor’s offices and pharmacies. The most commonly shipped opioid drugs include OxyContin, Hydrocodone, methadone and fentanyl.
Washington State Attorney General Bob Ferguson is asking for $32 billion in damages to enact anti-drug programs. A state victory could result in a much higher award when surrendered profits and penalties are added in. Plaintiff attorneys contend that the epidemic took off in the years after 2002 fueled in part by what they said was the growth in "rogue inernet pharamacies" and pill dispensing clinics referred to as "pill mills."
On Feb. 1, the three companies and Johnson & Johnson agreed in federal court to pay 400 native tribes across the country $590 billion to settle lawsuits launched by the tribes, which are considered their own sovereign entities. Attorneys for the tribes said the epidemic has hit Native Americans harder than other groups.
At trial on Thursday, Carney told attorney Nathan Bates, for the state, that Evergreen Services is an opioid treatment nonprofit and homeless outreach program. She retired in 2019.
She was asked if the clinic was able to meet the demand for its services.
“Not even close,” Carney said. “We’ve had a waiting list (up to three months) and so many need services. It (epidemic) was like a hurricane.”
“What does a three-month waiting list mean?”
“It’s a nightmare, it’s a death sentence,” Carney said. “Because of the chemical changes in the brain (caused by drugs) people need availability. Any kind of waiting list is not helpful.”
“Can a waiting list cause an overdose?”
“Absolutely, you can’t treat someone if they’re dead.”
Carney said 40% of clients are homeless people, many suffering from anxiety, depression and posttraumatic stress disorder (PTSD).
“You have to stabilize the brain chemistry through medications and identify how the person got into the addiction, and to help them stay out of it,” she said. “That’s the most difficult part.”
“Is there a risk or relapse?”
“Yes, typically a person needs several tries (at recovery).”
Carney said the age range of patients is usually 18 and up (one person was 80). The majority are users of heroin who got started on prescription opioid pills but gave them up for heroin when the pills became too expensive.
Bates asked if the organization was able to meet the demand for drug services for the homeless.
“Not even close,” Carney said. “We did our best.”
Carney added that it’s very difficult for homeless people living in a tent or on the street to get to a clinic for anti-opioid drugs like Narcan and Methadone from a nurse six days a week. She also said there is a stigma in the community against the homeless population.
Carney said salaries for staff have not kept pace with the average and that workers often leave the clinic after a few years seeking better pay.
“Staff is overwhelmed,” she said. “You get burned out. It even became difficult for me to feel empathy. I didn’t sleep very much for five years. It was the most stressful job I had.”
When asked why she did such work Carney responded, “Because how could I not do it? These (addicted) are human beings, with loved ones. It’s the amazing process of a recovery----that’s why I do it.”
On cross examination Megan Rodgers, attorney for McKesson, asked Carney if the majority of those treated were on heroin.
Carney agreed they were.
“Fentanyl includes counterfeit pills correct?” she asked.
Carney said yes.
“People were buying it off the street?”
Again Carney agreed.
Rodgers asked if 90% of treatments were covered by Medicaid.
“Correct,” Carney said.
“You also accepted private insurance?”
“Yes.”
“Do all (clinic) expenses get covered?” Rodgers asked.
Carney responded that reimbursements (Medicaid) weren't enough to cover what was needed and that staff was treating more people than was reasonable.
“The reality was that we were underfunded,” she said.
In a deposition tape recorded in 2019, U.S. Drug Enforcement Administration (DEA) deputy assistant Thomas Prevoznik indicated the three companies had not done enough to police themselves against suspicious orders and wrongful drug diversions.
Attorney Linda Singer, for the state, asked Prevoznik for his agreement, that the statement, "It's not my job to second guess the doctor," was not a legitimate excuse by the distributors for failure to prevent diversions of drugs into the wrong hands.
"Yes," Prevoznik said. "They should look at the totality of everything."
However, on cross examination, defense attorneys got Prevoznik to agree that a larger or more frequent drug order alone did not prove that drugs had been wrongly diverted.
Earlier evidence presented indicated that in past years suspicious orders red-flagged by distributor company officials and reported to the DEA had then been shipped to the customers anyway.