HUNTINGTON, W.Va. (AP) — Crumbling roofs and parking lots. Broadband glitches. Technology challenges. The priority list for Prestera Center goes beyond the mental health and addiction treatment services it provides to patients throughout West Virginia.
One thing’s for sure: In one of the epicenters of the U.S. opioid explosion, the nonprofit group really could use some money. Whether from a potential national settlement deal with big U.S. drug distribution companies or from some other source, an infusion of cash would stem the tide of losses in staffing and other areas in recent years, along with the strain caused by the coronavirus pandemic.
“Our needs are long,” Prestera addictions counselor Kim Miller said. “We need help.”
More money could be on its way to places like Prestera across the country. This week, lawyers for state and local governments announced a potential $26 billion settlement over the toll of opioids with drugmaker Johnson & Johnson and drug distribution firms AmerisourceBergen, Cardinal Health and McKesson.
But West Virginia isn't included in the deal with the three distributors because it already settled with them and other drug wholesalers for a total of $84 million in a series of deals struck from 2017 through 2019. And state Attorney General Patrick Morrisey has so far resisted sharing in the $5 billion Johnson & Johnson would contribute under the potential deal. However, the earlier deals excluded municipalities and counties, allowing for the potential of much more money to flow into the state.
Morrisey says he knows those fighting the opioid crisis need urgent support, but he’s concerned about how it would be distributed nationally. He argues that the proposed allocations are too focused on the size of each state's population and don't adequately take into account the depth of the crisis in West Virginia.
If Morrisey rejects the settlement, the state would not receive a share of the distributed funds but it could continue litigation against J&J on its own in the hopes of reaching a better deal.
Prestera CEO Lisa Zappia said she has mixed feelings about the proposed settlement and needs to see more details before she decides whether to support it.
Prestera employs 550 workers at 55 locations in southern West Virginia and provides services to more than 20,000 people annually. There are addiction recovery centers, mental health treatment facilities, youth programs and suicide awareness initiatives, to name a few.
Prestera didn’t qualify for paycheck protection loans that help businesses keep their workforce employed during the COVID-19 pandemic. It received a small amount of federal stimulus money for Medicare, but not enough to offset losses, Miller said. “We can’t afford to lose money year after year. You can’t keep the doors open. We had to scale back some services.”
During the pandemic, the nonprofit tried to make use of telehealth services instead of in-person visits. But its broadband internet connection was rocky at best.
“We’re just doing the best that we can with what we have,” Miller said.
That’s where hope that settlement money, whether from the newly announced deal or some other one, trickles down to the ground level.
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“We would want to look at all of our infrastructure needs. Increasing our broadband. Rehabilitating some of the facilities that we have not been able to rehabilitate for a long time. Things like roofs,” Miller said. “We have a long list of maintenance issues that we’ve had to just repair and Band-Aid the best we can.”
After his own struggles with prescription pain pills following a broken nose sustained in a college bar fight, Doug Leech underwent addiction treatment in Minnesota for a year because there were no residential facility beds available in his native West Virginia. The state has had the highest death rate from opioids in the country.
Initially an accountant, Leech formed Morgantown-based Ascension Recovery Services out of his basement in 2016 to help others suffering from addiction. The behavioral health consulting management organization now has 50 employees and has developed programs in 35 states.
“We know how to treat this disease,” Leech said. “But the payment model is flawed. The reimbursement rates are so low.”
If West Virginia gets a piece of the national settlement money, Leech would want to continue shifting focus away from a fragmented system of addiction care to a long-term approach that loops in everyone, including hospitals, outpatient clinics and residential facility operators.
“That’s my hope is that this money can go to help establish these systems and then we can begin working with the payers to implement a payment arrangement that will save them money and keep people sober long term,” Leech said.
At Prestera, which receives more than half of its funding from Medicaid reimbursements, the parking lot at the Huntington headquarters looks like the aftermath of an earthquake. Simply navigating Prestera's antiquated and glitchy phone system is tricky. Replacing it would cost $85,000.
At another Prestera facility in the city along the Ohio River, Zappia said the roof is being replaced at a cost of $140,000. She also fears that the building's 50-year-old boiler is on its last legs.
“I'm holding my breath,” Zappia said. "I don't have $300,000 to replace it.
"Those buildings need to be in a condition where people can come in and feel like it's a nice place to be, where it's comfortable and inviting. That's why infrastructure is important for us."
Prestera’s staffing levels are down nearly one-third in the past 10 years. There were pandemic-related furloughs and layoffs, although nearly all of those affected have been brought back. Many are still working from home.
People are also not coming in for treatment like before the pandemic started. Some are worried about contracting COVID-19 by staying in a residential substance use treatment facility.
“While we struggle financially, the importance of what we do has never been more apparent,” Miller said.
Miller pointed to statistics showing that substance abuse has increased during the pandemic. So has the public’s levels of depression, anxiety and stress, including among children.
“This pandemic is a mental health and substance use nightmare,” Miller said. “It’s going to increase people’s mental health problems. It will increase substance use. And we have to be prepared to meet that need.”