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Opioid trial expert: Treatment, therapy, counseling can help addicts

Dr. Michael Caplan, ex-chief medical examiner for Suffolk

Dr. Michael Caplan, ex-chief medical examiner for Suffolk County, in March of 2020. Credit: James Carbone

There is hope for people who struggle with opioid addiction, a New York state drug treatment specialist testified Monday at Touro College in Central Islip.

Medication-assisted treatment, counseling and other therapies can help patients addicted to opioids live full and healthy lives, Dr. Marc Manseau told jurors as an expert witness for Nassau, Suffolk and New York State, which have sued pharmaceutical companies for allegedly causing the opioid epidemic that has claimed thousands of lives on Long Island in recent years.

"It is important to know that addiction really ruins lives and that people who have addiction have a disease, they have a brain disorder, they don’t have control over it and it can ruin their life. In fact, it has ruined many, many lives in New York State. It has touched every community across New York state," said Manseau, the former medical director for the New York State Office of Addiction Services and Supports and now the clinical director at the South Beach Psychiatric Center in Staten Island.

Under direct examination by New York Assistant Attorney General Monica Hanna, Manseau said it is very difficult for patients to stop using opioids such as oxycodone, heroin, morphine and fentanyl without intensive treatment. Those who try to go cold turkey suffer from extreme physical and psychological pain, he said.

Opioid addiction can be managed with medications such as methadone, buprenorphine and naltrexone, Manseau testified, and patients can live full and healthy lives — even if they've lost jobs, homes, friends and family.

"It just takes a lot of work and dedicated effort and creativity and resources to try to get the addiction treatment system and other parts of the health care system to where we need them to be," Manseau testified.

While at OASAS, Manseau said, he mandated that treatment centers operated or regulated by the agency offer medication-assisted treatment and to admit patients on the same day they requested treatment. Waiting one or two days, he said, could result in fatal overdoses.

Manseau did not address what role if any the defendants played in fueling the opioid epidemic that has ravaged communities across the United States, and under cross-examination by Timothy Knapp, an attorney for drug manufacturer Allergan Finance, he acknowledged that he did not know how many people who had suffered overdoses or entered treatment had used legally prescribed opioids.

Earlier in the day, former Suffolk County Medical Examiner Michael Caplan testified under redirect from Jayne Conroy, an attorney for Suffolk, that patients who stop using opioids for limited periods of time continue to feel intense cravings but their tolerance decreases — often with fatal consequences.

"All of your priorities and energies are really designed toward getting that next high and that is what makes you vulnerable. In doing that, you are going to seek out whatever source of opioids you can," Caplan said. "The cheapest ones, the most available ones, you are in a desperate state. Your vulnerability is greatly increased and unfortunately when that happens, the end result is that sometimes these people end up on my autopsy table."

State and county officials say they hope to hold the defendants accountable for the death and misery caused by the opioid epidemic and to recoup millions of dollars for treatment, recovery and prevention.

Attorneys for the drugmakers and distributors have said their clients are not responsible for the opioid epidemic, arguing that they followed all regulations and are being made scapegoats for the actions of health regulators who encouraged opioid use, doctors who overprescribed the painkillers and other forces beyond their control.

Drug distribution companies Cardinal Health, Amerisource Bergen and McKesson were dismissed as defendants in the lawsuit last week after they reached an agreement to a $1.1 billion settlement with New York State, Nassau and Suffolk. The deal is part of a proposed $26 billion national settlement with manufacturers and distributors of opioids.

Allergan, Teva Pharmaceutical Industries and Endo International remain as defendants, along with distributor ANDA Pharmaceutical. ANDA was sued by the counties but not the state.

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