Early intervention and long-term programs are needed for families affected by opioid use disorder to be successful, a witness said Wednesday at the trial in which Huntington and Cabell County are seeking money from drug distributors accused of fueling the opioid epidemic.
But those distributors on trial said the programs needed are already in place, funded by other sources, such as the federal and state governments, and are not the responsibility of the municipalities, thus the county and city cannot sue for money on their behalf.
Drug distributors AmerisourceBergen, Cardinal Health and McKesson are at the center of the trial in Charleston after they were accused by Cabell County and Huntington of fueling opioid abuse by shipping 127.9 million opiate dosage units into the county from 2006-14, before users turned to illicit drugs when the number of shipped pills dropped.
The distributors counter that it was the U.S. Drug Enforcement Administration, and an increase in doctors prescribing opioids, combined with West Virginians’ history of poor health, that caused the epidemic.
Nancy Young, executive director of Children and Family Futures, a child abuse and neglect prevention group that focuses on rebuilding families affected by trauma, substance use and mental health disorders, testified Wednesday.
“All across the country, to California, I knew what was going on in West Virginia before I was even asked to look at Cabell and Huntington,” she testified.
She said they saw trends as early as 2010 that the child welfare system had been negatively affected by the opioid use and were tasked with getting a handle on it.
In West Virginia, from 2006-16 there was an increase from 970 children to 2,171 children removed over parental substance use. From 2011-16 approximately 80% of those cases were filed over substance abuse, she said. The United States removes about 50,000 infants a year from their homes.
Around 2013, there was a flip from children being placed with strangers to placement with grandparents. Another trend was an increase in the number of orphans, a situation the country has not seen since the Industrial Revolution, Young said.
Because of compassion fatigue, there also is a huge turnover in child welfare workers, she said. There is a 29% vacancy rate statewide within Child Protective Services. Region 2, which includes Cabell County, has 21 vacancies, according to a meeting earlier this month of the Legislative Oversight Commission on Health and Human Resources Accountability.
In order to change that, Young said early intervention and long-term programs are needed to heal multiple generations of families.
She said the county and city need their own programs to help abate the problem on the community level, but, to do that, they will need money. She said grants are not sustainable or sufficient to run long-term programs that would abate the epidemic.
AmerisourceBergen attorney Gretchen Callas said such programs are available and funded by the federal government or school systems, not by the county or city. While Young said there was a lack of programs, funding and many programs have waiting lists, she was unable to give specifics because it was outside of her area of expertise.
The attorney said the federal government had increased its allotment of funds dedicated to opioid use disorder treatments, pointing specifically to the American Rescue Plan Act, which added $3 billion to recovery funds to address overdose increases seen during the COVID-19 pandemic.
“The federal government funding is not free,” Young said. “That is paid for by the taxpayers of West Virginia and the United States.”
There are five populations on which Young focused to make her opinion: pregnant women with opioid use disorder; children affected by prenatal opioid exposure; infants born with opioid exposure; children involved in the Child Protective Services system; and adolescents exposed to opioid use disorder.
At the questioning of Huntington attorney Linda Singer, Young said children who live in homes where opioid use has occurred are likely to develop their own substance use, because they have not fully developed their decision-making skills or impulse control. Because of this, children in those homes need intervention before they pick up the habits.
The federal government funds programs for children until they are 5 years old, but even in that small window, children often are waitlisted because of a lack of room.
Women living with opioid use disorder need early intervention, as well, from pre-pregnancy all the way through postpartum support. The earlier intervention with the pregnancy, the better outcome for the baby, she said.
Post-pregnancy, long-term programs lasting at least one to two years have shown promising outcomes for children. Young said stability needs to be there to make sure the infant is in a safe and stable household so they have the best chance at life.
“If we wait until there’s a special education referral and the child is in third, fourth or fifth grade, we have missed the opportunity to give the child a good life,” she said.
West Virginia’s number of children born with neonatal abstinence syndrome went from 0.5 in 2000 to 33.4 in 2013. According to the state Department of Health and Human Resources, 2017 incident rates were 50.6 per 1,000 births. The number of children prenatally exposed to opioids is much higher, she said.
While children with neonatal abstinence syndrome are the most discussed in media, there are hundreds of others who were born with opioid exposure — but did not meet the neonatal abstinence syndrome threshold — who need help.
These children and their parents need extended care, as well, Young said.
“We all have a responsibility for these kids to make sure they have the life chances that others have,” she said.