“A federal judge in California has ordered U.S. immigration authorities to reunite separated families on the border within 30 days, describing the Trump administration’s handling of the crisis as attempts “to address a chaotic circumstance of the government’s own making.”
The preliminary injunction from U.S. District Judge Dana Sabraw in San Diego said children younger than 5 must be reunified within 14 days of the order issued Tuesday…
In his 24-page order, the judge also slammed the administration’s lack of preparedness in implementing its policy.
“The government readily keeps track of personal property of detainees in criminal and immigration proceedings,” Sabraw wrote. “Money, important documents, and automobiles, to name a few, are routinely catalogued, stored, tracked and produced upon a detainee’s release, at all levels – state and federal, citizen and alien. Yet, the government has no system in place to keep track of, provide effective communication with, and promptly produce alien children. The unfortunate reality is that under the present system migrant children are not accounted for with the same efficiency and accuracy as property. Certainly, that cannot satisfy the requirements of due process.”” (A)
“The order appears to set the stage for a legal clash over a crisis that was created by the White House and has sown increasing levels of fear and confusion.
Earlier Tuesday, Health and Human Services Secretary Alex Azar, testifying on Capitol Hill, said the only way parents can quickly be reunited with their children is to drop their claims for asylum in the United States and agree to be deported.
If parents pursue asylum claims, administration officials plan to hold them in custody until the hearings are complete — a process that can take months, and in some instances years, because of a backlog of several hundred thousand cases.
While that process takes place and the parents are in custody, their children would not be returned to them, Azar said, citing current rules that allow children to be held in immigrant detention for no more than 20 days.
“If the parent remains in detention, unfortunately, under rules that are set by Congress and the courts, they can’t be reunified while they’re in detention,” Azar told the Senate Finance Committee. He said the department could place children with relatives in the United States if they can be located and properly vetted.
Azar’s department has custody of 2,047 children separated from their parents after they were apprehended crossing the border illegally since May. That’s when the Trump administration began enforcing the zero tolerance policy.” (B)
(A) Immigrant children: Federal judge orders families separated at border be reunited within 30 days, by Doug Stanglin, https://www.usatoday.com/story/news/politics/2018/06/27/judge-orders-families-separated-border-reunited-within-30-days/737194002/
(B) Judge’s ruling on families separated at border sets stage for new immigration showdown. Here’s a breakdown, by Alene Tchekmedyian and Kristina Davis, http://www.latimes.com/local/lanow/la-me-border-ruling-migrants-children-explainer-20180627-story.html
“In the decades since the crack epidemic, our country has learned an important lesson: there is no arresting our way out of drug addiction. The failed “War on Drugs” put too many people in jail instead of treatment, a mistake that cost us countless lives and taxpayer dollars. Now, we’re facing a new drug crisis — and this time, we have to do better.
That said, the U.S. House of Representatives’ votes this month on a number of bills aimed at addressing the national opioid crisis should come as welcome news. Some of these measures, such as those to expand access to treatment and better monitor opioid prescriptions, are steps in the right direction. Yet those who have experienced this crisis firsthand caution leaders in Washington against thinking that addressing the opioid crisis means reverting to the “tough on crime” thinking of the 1980s. With tens of thousands of American lives on the line, we can’t afford to repeat that mistake. As Congress considers proposals to address this epidemic, Dayton and communities across the country should serve as models for the kind of support needed and approaches that emphasize treatment over punishment.” (A)
“The House spent much of the last two weeks passing dozens of bills aimed at addressing the opioid crisis, an effort top lawmakers from both parties have long identified as a priority.
Many are consensus proposals, though a few have generated controversy. Some are substantial in their scope, though many fund pilot programs or studies, or enact grants for which funding will expire within years.
Outside experts, while applauding Congress for its focus on the issue, say they believe the current package fails to match the scope of the current crisis…
The House is expected to finish its opioids work this week. Here’s a look at some of the most impactful bills, and which proposals or policy ideas didn’t make the cut.
WHAT’S IN THE PACKAGE: 1. Evidence-based treatment. 2. Waiving the IMD exclusion. 3. Expanded access to buprenorphine. 4. A movement away from opioids for pain treatment. 5. Changes to medical privacy laws stricter privacy standards have expressed concern that the change could prevent some individuals from seeking treatment.
WHAT’S NOT: 1. Harm reduction. 2. Methadone treatment expansion for Medicare and Medicaid. 3. More parity enforcement. 4. Mandatory prescriber education” (B)
“New York doctors who accepted speaking fees, honoraria, meals and other forms of payment from opioid manufacturers started writing more prescriptions for the narcotic painkillers, according to an analysis from the New York State Health Foundation.
When comparing physicians in similar specialties who historically prescribed similar amounts of opioids, the researchers found that those who started accepting pharma payments increased their opioid prescribing rates significantly more over time than those who did not…
A group of doctors who started receiving opioid-related payments in 2014 increased their prescribing rates by 37.2% from the previous year and another 24.7% between 2014 and 2015, according to the report. By contrast, a group of similar doctors who did not receive opioid-related payments in those years increased their prescribing by 15.6% in 2014 and just 1.9% in 2015.
Pharmaceutical companies paid a total of $196.4 million to New York doctors during the study period of August 2013 to December 2015. During that time 3,389 New York doctors received $3.6 million in payments specifically related to opioids. Among those doctors, the average total amount received was about $1,000.
The largest share of payments, 73.1%, came from speaking fees and honoraria. However, the most frequent payments, 87.7%, were for food and beverage…” (C)
“Dr. Elinore McCance-Katz, the Trump administration’s director of the Substance Abuse and Mental Health Services Administration, helped pioneer opioid addiction treatment with buprenorphine in clinical trials in the 1990s. She also helped create the training for doctors who want to prescribe it. What follows is a condensed interview with her.
Do you think the number of primary care providers who prescribe buprenorphine is growing fast enough? What I will say is that we have a lot of work to do. When we first thought about this treatment, it was really thought about as a way to integrate treatment of opioid use disorders, opioid addiction, into primary care. Because we know that many, many people with opioid problems have other medical problems, and sometimes they have psychiatric problems, too. Psychiatry has had much more uptake on this than has primary care. But the idea was you eliminate the stigma by just having them be another patient in the waiting room. That was the hope.
So why are primary care providers still generally reluctant to provide addiction treatment? In recent years, medical schools have been putting more hours of training on addiction in place. But for probably the majority of physicians practicing now, we had very little to no exposure to it in medical school, or even in residency. If you don’t learn how to treat what is a complex disorder, then you feel uncomfortable taking it on. And because these disorders often involve psychosocial problems, many primary care doctors feel they may not have the resources to fully assist people. I talked to my own primary care provider about it and she said, ‘You know, Ellie, I don’t think I’m the right person.’” (D)
“A newborn had arrived for his checkup, prompting Dr. Nicole Gastala to abandon her half-eaten lunch and brace for the afternoon crush. An older man with diabetes would follow, then a pregnant teenager, a possible case of pneumonia and someone with a rash.
There were also patients on her schedule with a problem most primary care doctors don’t treat: a former construction worker fighting an addiction to opioid painkillers, and a tattooed millennial who had been injecting heroin four times a day.
Opioid overdoses are killing so many Americans that demographers say they are likely behind a striking drop in life expectancy. Yet most of the more than two million people addicted to opioid painkillers, heroin and synthetic fentanyl get no treatment. Dr. Gastala, 33, is trying to help by folding addiction treatment into her everyday family medicine practice. She is one of a small cadre of primary care doctors who regularly prescribe buprenorphine, a medication that helps suppress the cravings and withdrawal symptoms that plague people addicted to opioids. If the country is really going to curb the opioid epidemic, many public health experts say, it will need a lot more Dr. Gastalas.” (E)
“What’s the right painkiller prescription to send home with a patient after gallbladder surgery or a cesarean section? That question is front and center as conventional approaches to pain control in the United States have led to what some see as a culture of overprescribing, helping spur the nation’s epidemic of opioid overuse and abuse.
The answer isn’t clear-cut. Surgeon Marty Makary wondered why and what could be done. So, Makary, a researcher and a professor of surgery and health policy at Johns Hopkins School of Medicine in Baltimore, took an innovative approach toward developing guidelines: matching the right number of opioid painkillers to specific procedures.
After all, most doctors usually make this decision based on one-size-fits-all recommendations, or what they learned long ago in med school…
“No one should have 50 tabs sitting in their medicine cabinet” for acute pain, says Dr. Marty Makary, who’s leading an effort to curb overprescribing by offering procedure-specific guidelines for opioid painkillers. (Courtesy of Johns Hopkins Medicine)” (F)
“From 1996 to 2002, Purdue pursued nearly every avenue in the drug supply and prescription sales chain—a strategy now cast as reckless and illegal in more than 1,500 federal civil lawsuits from communities in Florida to Wisconsin to California that allege the drug has fueled a national epidemic of addiction…
The marketing files show that about 75 percent of more than $400 million in promotional spending occurred after the start of 2000, the year Purdue officials told Congress they learned of growing OxyContin abuse and drug-related deaths from media reports and regulators.
These internal Purdue marketing records show the drugmaker financed activities across nearly every quarter of medicine, from awarding grants to health care groups that set standards for opioid use to reminding reluctant pharmacists how they could profit from stocking OxyContin pills on their shelves…
Purdue hoped to grow into one of the nation’s top 10 drug companies, both in sales and “image or professional standing,” according to the documents; OxyContin was the means to that end…
Purdue bombarded doctors and other health workers with literature and sales calls. Records show that in 1997 the company budgeted $300,000 for mailings to doctors who prescribed opioids liberally, based on sales data that drug companies purchase. The mailers recommended OxyContin for “pain syndromes,” including osteoarthritis and back pain. It added $75,000 for mailings “to keep in touch with our best customers for OxyContin to ensure they continue prescribing it.”” (G)
“Mandy has now been in recovery from her opioid addiction for more than two months — and she’s ready to keep that going. But the 29-year-old in the Chicago area is now dealing with a big obstacle: her health insurer.
Mandy, who asked I use only her first name, said she struggled with addiction for six years. It started with back pain, which a doctor tried to treat with Vicodin…
In March, Mandy decided she had enough. She got into an intensive outpatient addiction treatment program for eight weeks and was prescribed buprenorphine, a medication for opioid addiction that staves off withdrawal and cravings without producing the kind of high that, say, heroin or painkillers might. She’s remained on the medication as she’s transitioned to less intensive treatment.
There’s just one problem: Her insurer, Blue Cross and Blue Shield of Illinois, won’t pay for the buprenorphine. That’s left Mandy to foot the bill. Her latest bill — for a 28-day supply — was priced at $294 out of pocket, although she got it down to $222.69 with a discount. With the discount, similar bills throughout a full year would add up to nearly $2,900.” (H)
“Within the next two months, anyone who gets an acute opioid prescription filled at a Walmart will be limited to a seven-day supply of the medication, part of the company’s effort to curb the number of pills being sold illegally on the street.
Walmart announced last week it would join CVS Caremark, the nation’s largest pharmacy chain, to cap prescriptions, a move Walmart said put it in line with federal guidelines…
Walmart’s policy, which will be put into effect within 60 days, also mirrors efforts by several states that limit acute opioid prescriptions to seven days, including a bill before Pennsylvania lawmakers that would impose the one-week limit.” (I)
Dr. Kenneth Choquette, a Coordinated Health pain management specialist and physician for three decades, said he learned of Walmart’s new prescription policy from patients who use opioids and were alarmed by it…
“The addict is going to find pills or other methods no matter what,” Choquette. “But these limits by industries and insurance companies doesn’t fix anything other than to greatly inconvenience those who are already suffering and yet taking their medication properly under the care of a physician.”
Dr. John Gallagher, chairman of the Pennsylvania Medical Society’s opioid task force, said he’s open to any ideas that may help slow the opioid epidemic, but isn’t sure if limiting pain medication is the answer.
“The arbitrary refusal to fulfill a physician’s treatment plan while not cognizant of the complete clinical situation may not be appropriate,” Gallagher said. He said the better answer may be to develop clinical practical guidelines and consult with the prescribing physician.
Somewhere along the line, you need to pick a number and say this number of pills is enough to get by, but not get someone addicted. — State Sen. Gene Yaw, sponsor of a bill to limit opioid prescriptions to seven days
Pennsylvania is one of 19 states that puts limits on opioid prescriptions, including one that the dosage cannot exceed 120 milligrams of morphine or morphine equivalent per day, according to the state Department of Health. The new guidelines from Walmart limit the dosage to no more than 50 mg per day.” (J)
“Health insurer Cigna wants to cut the number of opioid overdoses among its customers by 25% within three years.
In particular, the Bloomfield, Connecticut-based company plans to address overdoses by focusing new drug prevention and treatment efforts in targeted cities around the U.S. The company also said it will work with employers, customers, clinicians, pharmacists and community-based organizations to reach its goal by December 2021.
The announcement comes just a few months after Cigna reported it reduced opioid use by 25% among its customers. However, Cigna claims data showed that despite a reduction in the number of prescriptions, opioid overdoses continue to rise.” K)
“But treatment is not the primary focus of this crop of (congressional) bills. Instead, a large number address various matters related to the prescribing of drugs; the tracking of prescribing; and the packaging and disposal of medications. Many of these measures could be helpful in preventing new cases of addiction: A recent study cited by the Department of Health and Human Services suggests that over half of those in treatment for opioid-use disorders began by using prescription medications…
Another missed opportunity, addiction experts said, is the legislative strategy to encourage creation of more treatment options for patients who need them. Earlier legislation, including the recent big spending deal passed by Congress, created short-term state grants for local anti-opioid priorities. But what health care providers and other entrepreneurs really need is a more permanent source of funding, so that those setting up clinics or companies will know they can remain in business over the long term, said Caleb Alexander, a professor at the Johns Hopkins Bloomberg School of Public Health. The shorter-term grant programs may not provide the nudge, he said.
“States are getting $500 million here or $200 million there,” he said. “At any given moment, it’s unclear whether the rug is going to be pulled out from under them.”” (L)
“For at least six months, staffers in the Office of National Drug Control Policy — often political appointees in their 20s — have crossed 17th Street, entered the Eisenhower Executive Office Building, and sat through weekly meetings of an “opioids cabinet” chaired by Kellyanne Conway.
Then they have returned to their desks and reported back to veteran career staff — who have listened, often with disappointment, to the ideas proposed by Conway and Katy Talento, a domestic policy adviser…
Frustrations with the meetings, according to officials familiar with them, are symptomatic of a broader issue: A year and a half into the Trump administration, it remains unclear who, besides Conway, is coordinating U.S. drug policy in the midst of an opioid crisis…
“I don’t understand why Trump and Kelly haven’t gotten some major figure — medical, political, you name it — to run the operation, and then funded it,” said Barry McCaffrey, formerly a four-star Army general who served as drug czar during the Clinton administration, referring to John Kelly, the president’s chief of staff.
Others inside and outside the administration have expressed concern that the agency is being used as a pasture for former Trump campaign workers and administration officials who have left previous jobs. The White House strongly contested that assertion, pointing to recent personnel moves as a sign the administration was sending valued talent to the drug policy office.” (M)
“The National Institutes of Health (NIH) has outlined its strategy to combat the opioid addiction crisis and improve pain management.
“Like most other pioneering scientific initiatives, HEAL will focus on a range of objectives, from short-term goals to research priorities that will take longer to bear fruit. Yet, all will be aimed at the same ultimate vision: a nation of people with far less disabling pain and opioid addiction,” they say.
The HEAL initiative will focus on two main areas: improving treatments for patients who misuse or are addicted to opioids and enhancing strategies for pain management.
Methadone, buprenorphine, and naltrexone are effective for opioid use disorder (OUD), but only a small percentage of people in the United States who would benefit receive these medications, Collins and coauthors point out. Even among those who start these medications, about half will relapse within 6 months. Research is needed to reformulate these medications to improve adherence, as well as to develop new, more flexible therapies for people with OUD…
Ending addiction long-term will also require finding new ways to effectively manage acute and chronic pain, they note. Therefore, the second major focus of the HEAL research plan includes a “coordinated approach to discover and validate new biologic targets for effective, nonaddictive pain management, as well as accelerate the process of discovery to develop therapies aimed at these targets,” Collins and coauthors say.” (N)
“The Addiction Solutions Campaign recently released a comprehensive policy document with recommendations for how funds from a settlement of the opioid litigation should be invested to address the epidemic.
• Begin with an inventory of community resources. The opioid epidemic resulted from broad national forces, but sustainable solutions must consider a local community’s strengths and weaknesses. This community inventory would include a list of all local prevention, treatment, recovery and harm reduction programs. This information will expose gaps in the system and inform a community response that builds on unique capacity in a local area.
• Second, examine the data. Local public health resources, as well as local public safety data, can help inform a community-based solution. For example, if prescribing data from the Centers for Disease Control and Prevention indicates that a county has higher-than-average rates of opioid prescribing, local prescribers may require training in pain management as well as in how to screen and care for people with substance-use disorders. In addition, a higher-than-average rate of overdoses in an area could indicate a need for community-based naloxone distribution.
• Third, follow the science. There is an extensive body of research on how to prevent, treat and care for people with substance-use disorders. The 2016 Surgeon General’s Report on Alcohol, Drugs and Health provides an excellent overview of evidence-based policies. The research contained in this report, along with the Addiction Solutions Campaign recommendations, should guide a local approach.” (O)
“Three years ago, with the opioid epidemic taking off, police officers in this affluent Atlanta suburb noticed an uptick in overdoses. Sgt. Robert Parsons rushed to equip his fellow officers with a lifesaving tool: the opioid antidote naloxone.
He stumbled across a drug company that was donating free cartons of naloxone auto-injectors to police agencies, and placed an order online. Within months, he had revived a man. But the following spring, when another batch of naloxone arrived, he was surprised to find that the injectors were set to expire in four months.
“You don’t know what you’re getting until the boxes show up,” said Parsons, the Dunwoody department’s naloxone coordinator. “You might as well begin filling out the paperwork [right away] to get them replaced.”..
“Is the practice of giving out soon-to-be expired drugs ethical? The answer is clearly no.” (P)
“As legislation to address the opioid epidemic gains momentum, drug makers, insurers, and other interest groups are engaging in a concerted drive to tailor the bills to their liking.
The effort, in some cases, has resulted in lawmakers softening, or entirely backing off, some of their most far-reaching proposals.
Members of Congress have advanced dozens of bipartisan bills that advocates say are needed, commonsense steps to address the public health crisis. Later this month, the House is likely to consider legislation that would speed approvals for non-opioid painkillers, strengthen drug enforcement programs, improve care for children impacted by addiction, strive to reduce prescription levels, and improve prescription monitoring programs.
But not all of the proposals have gone unopposed. The pharmaceutical trade group PhRMA, the American Medical Association, and a major drug distributor are among a handful of players maneuvering to shape the legislation, according to a review of lobbying disclosures by STAT and interviews with Capitol Hill aides, lawmakers, and lobbyists.
“This is the big time, and the price of working on major legislation is that insurance companies and pharmaceutical companies get involved,” said Andrew Kessler, a longtime advocate on addiction treatment issues who represents a number of behavioral health associations and treatment providers. “We’ve got work to do, they’ve got work to do, and let’s hope we’re better than they are.”.. (Q)
“Analyzing wastewater before it converges and mixes downstream at treatment facilities permits Biobot to measure drug use of not only an entire city but also of specific locations, down to areas of a few thousand people. The more precise method could enable city officials to first pinpoint communities that need interventions, like substance abuse programs, and to later measure the success of those programs in lowering drug use.
“Going down into the sewer system below the city is the most valuable approach compared to just looking into the influx of a big wastewater treatment plant,” said Carsten Prasse, assistant professor in the department of environmental health and engineering at Johns Hopkins University.” (R)
(A) Opioid epidemic requires a new perspective on addiction treatment and new solutions, by Nan Whaley, https://www.usatoday.com/story/opinion/2018/06/22/opioid-epidemic-needs-laws-quality-treatment-instead-punishment-column/714159002/
(B) What’s in the House Bills to Address the Opioid Crisis—and What’s Not, by Lev Facher, https://www.scientificamerican.com/article/whats-in-the-house-bills-to-address-the-opioid-crisis-and-whats-not/
(C) Docs paid by pharma increased opioid prescriptions by 37%, report finds, by Caroline Lewis, http://www.crainsnewyork.com/article/20180612/HEALTH_CARE/180619974/docs-accepting-pharma-payments-increased-opioid-prescriptions-by-37-report-finds
(D) The Trump Appointee Who’s an Addiction Specialist, by Abby Goodnough, https://www.usatoday.com/story/opinion/2018/06/22/opioid-epidemic-needs-laws-quality-treatment-instead-punishment-column/714159002/
(E) When an Iowa Family Doctor Takes On the Opioid Epidemic, by Abby Goodnough, https://www.nytimes.com/2018/06/23/health/opioid-addiction-suboxone-treatment.html
(F) Doling Out Pain Pills Post-Surgery: An Ingrown Toenail Not The Same As A Bypass, by Julie Appleby, https://khn.org/news/doling-out-pain-pills-post-surgery-an-ingrown-toenail-not-the-same-as-a-bypass/?utm_source=STAT+Newsletters&utm_campaign=62f7742e05-MR_COPY_09&utm_medium=email&utm_term=0_8cab1d7961-62f7742e05-149527969
(G) How America got hooked on a deadly drug, https://www.fiercehealthcare.com/hospitals-health-systems/how-america-got-hooked-a-deadly-drug?mkt_tok=eyJpIjoiTkRWaU9EUTBNRFkxTXpGbSIsInQiOiJ2YmRYTlFIZFwvT05Bc3BUYVVPcFp4TE9ZeGRGSE5FeWJZN2JBNk9QeXljZTBPTEljTjVZYlNOVGFrMTN0blwvc01RdlI0M01VVEdBTUF1TnRQdmhNeTBHRTFiWlBnazRVNWFBQUw1R0Y3UnE5MnpQcjB0Uit1TXJkaG5DQWc5V21DIn0%3D&mrkid=654508
(H) She paid nothing for opioid painkillers.Her addiction treatment costs more than $200 a month., by German LopezJun, https://www.vox.com/science-and-health/2018/6/4/17388756/opioid-epidemic-health-insurance-buprenorphine
(I) Walmart is limiting opioid prescriptions. Will it help stop the addiction crisis?, by Pamela Lehman, http://www.mcall.com/news/breaking/mc-nws-walmart-limits-opioid-prescriptions-20180514-story.html
(J) Walmart is limiting opioid prescriptions. Will it help stop the addiction crisis?, by Pamela Lehman, http://www.mcall.com/news/breaking/mc-nws-walmart-limits-opioid-prescriptions-20180514-story.html
(K) Cigna announces goal to cut customers’ opioid overdoses by 25% by end of 2021, by Tina Reed, https://www.fiercehealthcare.com/payer/cigna-announces-goal-to-cut-customers-opioid-overdoses-by-25-by-2022
(L) Congress Is Writing Lots of Opioid Bills. But Which Ones Will Actually Help?, by Margot Sanger-Katz, https://www.nytimes.com/2018/06/20/upshot/congress-is-writing-lots-of-opioid-bills-but-which-ones-will-actually-help.html
(M) Empty desks, squabbles, inexperienced staff: Exactly who is coordinating White House drug policy?, by Lev Facher, https://www.statnews.com/2018/06/18/opioid-crisis-response-ondcp/?utm_source=STAT+Newsletters&utm_campaign=efc86e0f32-MR_COPY_01&utm_medium=email&utm_term=0_8cab1d7961-efc86e0f32-149527969
(N) NIH Outlines New Game Planto Combat Opioid Crisis, by Megan Brooks, https://www.medscape.com/viewarticle/898045
(O) A Community Framework for Addressing the Opioid Epidemic, by Regina LaBelle, http://www.governing.com/gov-institute/voices/col-community-framework-addressing-opioid-epidemic-litigation-funds.html
(P) Donations of $4,500 overdose antidote were PR gold for drug maker — but some kits were close to expiring, by Max Blau, https://www.statnews.com/2018/06/18/kaleo-evzio-donations-near-expiration/?utm_source=STAT+Newsletters&utm_campaign=efc86e0f32-MR_COPY_01&utm_medium=email&utm_term=0_8cab1d7961-efc86e0f32-149527969
(Q) As opioids legislation gains steam, efforts to address crisis collide with moneyed interests, by Lev Facher, https://www.statnews.com/2018/06/07/opioid-crisis-legislation-moneyed-interests/?utm_source=STAT+Newsletters&utm_campaign=cd402f140c-MR_COPY_09&utm_medium=email&utm_term=0_8cab1d7961-cd402f140c-149527969
(R) Scientists can track the spread of opioids in sewers. But do cities want to know what lies below?, by Justin Chen, https://www.statnews.com/2018/06/26/wastewater-epidemiology-biobot-opioids/?utm_source=STAT+Newsletters&utm_campaign=242ec602b8-MR_COPY_08&utm_medium=email&utm_term=0_8cab1d7961-242ec602b8-149527969
“Since April, when Attorney General Jeff Sessions unveiled a “zero-tolerance” policy, the government has routinely brought federal criminal charges against migrants apprehended crossing the border without authorization, including parents traveling with children. Parents went to jail while their children were dispersed to a vast network of shelters across the country for “unaccompanied minors.”
But on Wednesday…President Donald Trump signed an executive order effectively halting the family separations that his own administration had instituted.
The president’s about-face came after a firestorm of protest about the callousness and upheaval of separating 2,300 kids from their parents, but the shift brought fresh confusion of its own.
Overwhelmed courts dismissed cases. Migrants who had been apprehended as the order went into place still faced immigration proceedings, but avoided being separated. In the chaos, the numbers arriving quickly outstripped the capacity to detain families together. Agencies at the border began to process and release families with ankle monitors, much as they had before “zero-tolerance” went into effect.
Mothers, fathers and children boarded buses and planes to reunite with friends and family while their cases work their way through the system, which can take years.” (A)
“President Donald Trump has hit on a new exit strategy as he struggles to mitigate the most disorientating political crisis of his presidency: the splitting up of undocumented migrant families.
His obvious conclusion is that even though his hardline populism got him into the mess, only a more unfiltered dose of Trumpism will finally sweep it away.
Trump fired off some of his most raw and authoritarian tweets about immigration yet Sunday and is also cranking up his trade war rhetoric to solidify the safe space where he always returns when he’s in trouble: the embrace of his political base.
“We cannot allow all of these people to invade our Country,” Trump wrote in a tweet that hammered undocumented migrants on Sunday.
“When somebody comes in, we must immediately, with no Judges or Court Cases, bring them back from where they came. Our system is a mockery to good immigration policy and Law and Order,” he wrote.” (B)
“U.S. Border Patrol agents have stopped handing parents over to the Justice Department for prosecution when they are caught crossing the border illegally with their children, the head of the U.S. Customs and Border Protection agency said Monday.
The statement by Commissioner Kevin McAleenan marked a significant, if temporary, step back from the “zero tolerance” policy that the Trump administration has pursued for the last two months, which has led to more than 2,000 children being taken from their parents. President Trump issued an order Wednesday to stop separating families.
“I directed the temporary suspension of prosecutions for families in that category while we work through a process … where we can maintain family unity while enforcing prosecution efforts,” McAleenan said…
His statement came as White House Press Secretary Sarah Huckabee Sanders said the government was starting to “run out of space” to house people apprehended crossing the border. “We’re simply out of resources,” Sanders said.
The country’s three family detention centers can house 3,326 immigrants, according to an April report by the Government Accountability Office. As of last week, they housed 2,623, according to a spokeswoman for Immigration and Customs Enforcement. ICE officials did not respond to requests for comment Monday…” (C)
“After failing to pass a conservative immigration bill last week, the House is scheduled to vote Wednesday on a Republican-sponsored compromise bill that may not pass — and is almost certainly a nonstarter in the Senate even if it does.
The decision to push a broad immigration package gives lawmakers little time to address the immediate crisis of immigrant children separated from their parents at the border. Lawmakers are set to leave Thursday for a weeklong holiday break… “ (D)
(A) In the chaos of Trump’s policy reversal, families aren’t split but monitored, https://www.nbcnews.com/storyline/immigration-border-crisis/lucky-ones-maria-her-son-crossed-border-perfect-moment-n886106
(B) After family separation crisis, Trump returns to his tried-and-true tactic: ratchet up the rhetoric, by Stephen Collinson, https://www.cnn.com/2018/06/25/politics/trump-immigration-trade-rhetoric/index.html
(C) Border Patrol stops handing over most immigrant parents for prosecution, but won’t say when families will be reunified, by Molly Hennessy-Fiske and Jazmine Ulloa, http://www.latimes.com/nation/la-na-family-separation-20180625-story.html
(D) House to vote on an immigration bill Wednesday, but it’s unlikely to help separated families at the border, by Sarah D. Wire, http://www.latimes.com/politics/la-na-pol-immigration-house-vote-20180626-story.html
“Under cover of darkness and in the custody of the federal government, migrant children have been coming in waves to New York, taken from their parents after crossing the southern border.
Even as President Trump signed an executive order on Wednesday ending his administration’s policy of separating parents and children who have illegally crossed the border, the crisis was already spreading to a city some 2,000 miles away.
Speaking outside Cayuga Centers in Harlem, one of a group of social service agencies in the state that contract with the federal government to take in unaccompanied minors, Mayor Bill de Blasio on Wednesday afternoon said 350 children had come through the center and that 239 of them were currently in Cayuga’s care; the agency is not residential, but places children in temporary foster care and runs day programs.
The children included a 9-year-old boy from Honduras who had come alone on a bus from Texas, and a child as young as 9 months old, Mr. de Blasio said, as he issued a scathing rebuke of the Trump administration.
“How is it possible that none of us knew that there were 239 kids right here in our own city?” he asked. “How is the federal government holding back that information from the people of this city and holding back the help these kids could need?”..
“There is no system whatsoever to track these family separations, no efforts systematically to reunite these families,” Mr. Enriquez said. “There is no supervisor, there is no database saying, ‘child here, parent there,’ so they can come back together.” (A)
A social services agency located in southern New Jersey has received 20 immigrant children within the past month, according to a new report from NJ.com. The shelter, called the Center for Family Services, now holds a total of 27 children, with three being victims of the Trump administration’s recently halted policy of separating families at the border.
The center has a contract for $4 million with the Department of Health and Human Services to house the children. On average, children passing through the Center for Family Services stay 30 days, after which they are hopefully reunited with family members in the area. Prior to the Trump administration’s implementation of a policy prosecuting all illegal entries and breaking up migrant families, the center housed minors who had crossed the border unaccompanied.
Jen Hammill, the associate vice president of development and public relations for the agency, told NorthJersey.com: “These children have needed a safe place to live while teams are working on family reunification, and we are providing that safe home as we do for any child who comes to us who is vulnerable, who is disadvantaged, who needs a safe place to live while we work on family reunification.” (B)
“Frankly, our expectation is nothing different is going to happen for the kids” compared to before Trump’s executive order, said Kay Bellor, the vice president of programs at the Lutheran Immigration and Refugee Services,..
For now, foster care programs plan to continue taking care of these kids (the Department of Health and Human Services stipulates unaccompanied children must be transferred to foster homes or shelters funded by the Office of Refugee Resettlement within 72 hours). Caring for those children means finding members of their families already based in the U.S., temporary foster parents or counseling them in shelters with other children…
Keeping business as usual isn’t so easy. Some non-profit, faith-based foster care organizations — funded through the Office of Refugee Resettlement — struggled to keep up with the influx of children and found themselves adjusting to accommodate for younger, traumatized children.”
“You can’t just turn the spicket on and suddenly have 80 new foster parents,” Bellor, of the Lutheran Immigration and Refugee Services, said. “It’s not like if we can build capacity we can build it overnight.”..
… “Our foster care programs are having to respond to that immediate trauma of separation on top of everything else before they can move on to case management and other needs,”.. (C)
“A system designed for abused and neglected kids now must handle thousands who have been forcibly separated from their parents…
Today, the American foster care system is bracing for an influx of children whose lives have been disrupted by the Trump administration itself. According to a Monday report from the Washington Examiner, approximately 250 migrant children are being taken from their parents or guardians per day as a result of Trump’s new family separation policy. If that trend continues, as officials expect it to, around 30,000 children would be in the government’s custody by August. That figure doesn’t include the thousands of minors who show up at the border without a guardian every month, a number that has increased significantly in 2018…
But the foster care system is already struggling to provide stable living situations for the 500,000 children who need assistance. The number of kids entering the system has increased every year for the last four years, but there hasn’t been a concomitant increase in social workers to help them and group homes or families willing to take them in. “American foster care,” the Post reported last year, “is in crisis.”.. (D)
“Children held at Shiloh Treatment Center, a government contractor south of Houston that houses immigrant minors, described being held down and injected, according to the federal court filings. The lawsuit alleges that children were told they would not be released or see their parents unless they took medication and that they only were receiving vitamins…
An investigation by Reveal from The Center for Investigative Reporting found that nearly half of the $3.4 billion paid to those companies in the last four years went to homes with serious allegations of mistreating children. In nearly all cases reviewed by Reveal, the federal government continued contracts with the companies after serious allegations were raised.
At Reveal’s request, forensic psychiatrist Mark. J. Mills assessed materials from 420 pages of children’s medical records and statements filed in California federal court this April.
“You don’t have to be a rocket scientist here; it looks like they’re trying to control agitation and aggressive behavior with antipsychotic drugs,” said Mills, who practices in the Washington, D.C., area and was an expert witness for a lawsuit that in 2008 stopped the federal government from forcibly administering antipsychotic drugs to deportees.” (E)
“The fear of family separation is nothing new for many immigrants already living in the U.S. In fact, that fear, heightened in recent weeks, has been forcing a tough decision for a while. Advocates say a growing number of American children are dropping out of Medicaid and other government programs because their parents are not citizens.
Marlene is an undocumented resident of Texas and has two children who are U.S. citizens who qualify for Medicaid, the federal-state program for low-income people. (Kaiser Health News is not using Marlene’s last name because of her immigration status.) One of her children has some disabilities.
“My son is receiving speech therapy,” she said in Spanish. “But it’s been difficult.”
..Because she’s undocumented, she’s extremely nervous about filling out applications for government programs like this.
Already, she has decided to stop receiving food stamps, now known as SNAP, which her children, as citizens, are entitled to based on the family’s income…
“It’s out of fear of deportation,” … “It’s out of fear of having their children being penalized in some way and potentially losing a parent that until this point has been their fierce advocate.”..
Approximately 10 million citizen children in the U.S. have at least one non-citizen parent.” (F)
“The reality on the southern U.S. border was so difficult to reconcile with Americans’ vision of themselves that Trump did not even make the effort. The President’s first mention of the order to separate children from their parents was a May 26 Twitter post calling it “horrible” even though he had personally authorized it. Three weeks later, his motives were fully in the open: by driving attention to the border, his signature campaign issue, Trump aimed to force a vote on his long-promised border wall before midterm elections can undo the GOP majority in Congress…
Which leaves us facing a question: What kind of country are we? The world has been nervously asking that since November 2016. And while Trump ultimately capitulated on the forced separation of children, his new order suggested that families would be detained not only together, but perhaps indefinitely. For many Americans, the forced separation of immigrant families left them looking into the void from which the brutal policy emerged: the dark space left by the words Trump does say…
“Without a Border, you don’t have a Country,” the President wrote on June 19. Everyone knows that. The question is, what kind of country? (G)
“Pope Francis has criticized the Trump administration’s policy of separating migrant families at the Mexican border, saying populism is not the answer to the world’s immigration problems.
Speaking to Reuters, the Pope said he supported recent statements by U.S. Catholic bishops who called the separation of children from their parents “contrary to our Catholic values” and “immoral.”
“It’s not easy, but populism is not the solution,” Francis said on Sunday night…
One of his most pointed messages concerned President Donald Trump’s zero-tolerance immigration policy, in which U.S. authorities plan to criminally prosecute all immigrants caught crossing the Mexican border illegally, holding adults in jail while their children are sent to government shelters…
The pope said populists were “creating psychosis” on the issue of immigration, even as aging societies like Europe faced “a great demographic winter” and needed more immigrants.
Without immigration, he added, Europe “will become empty.”” . (H)
American Airlines and United Airlines said Wednesday that they asked the Trump administration not to use their flights to carry migrant children who were separated from their parents by immigration authorities.
Facing growing opposition to his administration’s recent policy of separating migrant families, President Donald Trump signed an order later in the day to keep families together at the nation’s southern border.
The issue had galvanized flight attendants, some of whom took to social media to post young children on flights whom they believed to be migrants separated from their parents.
“We have no desire to be associated with separating families, or worse, to profit from it,” American said in a statement.
United then issued a statement in which CEO Oscar Munoz said the company’s purpose is to connect people. “This policy and its impact on thousands of children is in deep conflict with that mission and we want no part of it,” he said.” (I)
“There’s a fight on inside Microsoft. White-collar tech workers who have traditionally shied away from political activism starting to mobilize in their workplaces.
In the midst of last week’s growing uproar over the Trump administration’s family separation policy, Twitter users began circulating a blog post from earlier this year in which the company proclaimed how “proud” it was to support ICE, the agency responsible for immigration enforcement…
Alerted to the relationship by the blog post, Microsoft workers expressed outrage over the company’s $19.4 million contract with ICE. The company briefly edited the post to remove the glowing language about ICE, according to Gizmodo, then posted a statement describing its “dismay” at the administration’s family-separation policy. Microsoft did not address whether it would cancel the contract.
It wasn’t nearly enough. By Tuesday, an open letter signed by more than 100 Microsoft employees had been posted to company’s internal message board, the New York Times reported. The letter, addressed to CEO Satya Nadella, called for the cancellation of the contract and the creation and enforcement of a “clear policy stating that neither Microsoft nor its contractors will work with clients who violate international human rights law” — as well as greater transparency on contracts the company signs with any government… “ (J)
“This isn’t just traumatic for the children either. Take the story of a Honduran woman whose child was ripped away from her by federal immigration officials quite literally while she was breastfeeding, according to her lawyer.
There is an actual physical effect of that separation, on top of the psychological damage. To understand it, you need to understand what’s called the oxytocin effect. As Vox’s Julia Belluz explained:
Breasts full of milk can be painful. Latching can also be painful, especially in the early days and months after the baby’s birth. But when a baby suckles a mom’s breasts, the mother’s brain’s posterior lobe secretes oxytocin, and some of that pain is relieved with the release of milk…
This highly refined and intricate system of hormones during breastfeeding is essential to keeping moms and babies healthy, and “it explains why the mother and baby should be kept together and why they should have skin-to-skin contact,” the WHO explained.
It also helps explain why the story of the Honduran migrant is so inhumane.” (K)
“Pediatric oncologist Manuela Orjuela-Grimm, MD, an assistant professor of Epidemiology, studies the long-term health risks of migrant youth who cross the border with Mexico. “All of the young people I speak with remember being detained by Homeland Security in what they call the ‘hielera’ or icebox,’” she says. “Years later, the experience is still vivid in their minds and remains what they remember as one of the worst parts of their journey: the chill of the air conditioning, terrible and insufficient food, guards yelling at crying children.”” (L)
(A) Hundreds of Separated Children Have Quietly Been Sent to New York, by Liz Robbins, https://www.nytimes.com/2018/06/20/nyregion/children-separated-border-new-york.html
(B) More Immigrant Children Arrive at New Jersey Shelter, by Cybele Mayes-Osterman, http://observer.com/2018/06/immigrant-children-new-jersey-shelter/?utm_campaign=new-jersey-politics&utm_content=2018-25-06-13670496&utm_source=Sailthru&utm_medium=email&utm_term=channel-new-jersey-politics-distribution
(C) ‘They’re Anxious.’ Separated Migrant Children in Foster Care Are Now in Limbo After Trump’s Immigration Order, by JENNIFER CALFAS, http://time.com/5317693/foster-care-family-separation-policy/
(D) The Uncertain Fate of Migrant Children Sent to Foster Care, by Emily Atkin, https://newrepublic.com/article/149161/uncertain-fate-migrant-children-sent-foster-care
(E) Immigrant children forcibly injected with drugs, lawsuit claims, by Matt Smith and Aura Bogado, https://www.revealnews.org/
(F) Fearing Deportation, Immigrant Parents Are Opting Out Of Health Benefits For Kids, by Ashley Lopez, https://khn.org/news/fearing-deportation-immigrant-parents-are-opting-out-of-health-benefits-for-kids/?utm_source=STAT+Newsletters&utm_campaign=e9293fc4a6-MR_COPY_08&utm_medium=email&utm_term=0_8cab1d7961-e9293fc4a6-149527969
(G) A Reckoning After Trump’s Border Separation Policy: What Kind of Country Are We?, by KARL VICK, http://time.com/5318229/donald-trump-border-separation-policy/
(H) Pope criticizes Trump’s policy of separating immigrant children from parents at the Mexican border, https://www.cnbc.com/2018/06/20/pope-criticizes-trumps-policy-of-separating-immigrant-children-from-parents-at-the-mexican-border.html
(I) 2 airlines ask US not to put migrant children on flights, by david koenig, https://abcnews.go.com/Business/wireStory/american-asks-us-put-migrant-children-flights-56033522
(J) How Silicon Valley workers are revolting against Trump’s immigration policy, by Alex Press, https://www.vox.com/the-big-idea/2018/6/25/17500620/family-separation-policy-border-silicon-valley-microsoft-google-amazon
(K) ‘They’re Anxious.’ Separated Migrant Children in Foster Care Are Now in Limbo After Trump’s Immigration Order, by JENNIFER CALFAS, http://time.com/5317693/foster-care-family-separation-policy/
(L) Mailman Faculty Discuss Public Health Impacts of Family Separation, https://www.mailman.columbia.edu/public-health-now/news/mailman-faculty-discuss-public-health-impacts-family-separation
That’s largely thanks to the multi-pronged approach health officials in the port city of Mbandaka took to stop the disease, before it could spread to other cities and countries…
Dr. Alhassane Touré, one of the health officials behind the vaccination drive, explained how his team targeted people who shared social circles with known and suspected Ebola victims. They used an “investigational vaccine” that worked to curb the 2013-2016 epidemic in West Africa…
Besides the selective vaccinations, other parts of the containment strategy included performing ‘secured burials’ of Ebola victims, educating moto-taxi drivers how to safely transport passengers, and installing hand-wash stations at some of the busiest bushmeat markets throughout town.
For now, the comprehensive approach appears to have paid off. But while the WHO is optimistic, they know they can’t rest until the disease has been completely contained. (A)
(A) Here’s how the DRC fought off an Ebola outbreak, by Angad Singh, https://news.vice.com/en_us/article/bj34p3/heres-how-the-drc-fought-off-an-ebola-outbreakgment
Still, some say the legislation is not enough to make the large-scale changes needed to fight the epidemic.
Addiction advocates largely praise the measures as good steps forward, but say that much more work and funding is needed to tackle the issue’s scale…
The legislation, passed Friday, includes a range of measures to fight the epidemic, including lifting some limits on prescribing Buprenorphine, a drug used to treat opioid addiction. The bill also requires health-care professionals to write prescriptions for Medicare beneficiaries electronically in order to better track prescriptions and to allow Medicare to cover treatment at addiction treatment clinics.
The measure’s passage comes days after the House passed additional bills aimed at combatting opioid addiction, some of which included lifting certain limits on Medicaid’s contribution for opioid care at treatment facilities and cracking down on imports of illicit opioids into the United States via mail.” (A)
‘For years, we got the scraps. And now we’re the big time,’ says an anti-addiction consultant.
The House is touting passage of dozens of bills that could help combat the national opioid crisis — but a small handful of companies that have spent millions lobbying Congress could reap a windfall if any of the bills become law.
In a two-week legislative blitz, the House cleared several narrowly tailored measures that would spur sales for companies that have ramped up their influence game in Washington, according to a review of the more than five dozen bills up for votes.
Those poised to benefit include:
• Alkermes, which spent $1 million lobbying in part to support a bill to fund full-service centers where people can detox, receive medical care and start treatment — a setup that could boost the fortunes of its best-selling product, anti-addiction treatment Vivitrol, which has been held back by the need for patients to fully detox before taking the drug.
• Indivior, an Alkermes rival that spent $180,000 largely in support of a bill that eases restrictions on certain controlled substances used in injectable anti-opioid treatments — a change that would make it easier for doctors to buy Indivior’s once-a-month injectable Sublocade.
• Pennsylvania drugmaker Braeburn Pharmaceuticals, which spent $100,000 lobbying and backed the same bill because it is developing a competing injectable.
• A group of drugmakers that produce non-opioid pain relief medications, including California-based Heron Therapeutics, which spent hundreds of thousands to lobby for legislative changes to create an additional Medicare payment for non-opioid pain drugs…
“When you hear they’re investing $3 billion in this in 2018 and $3 billion in 2019, everyone’s ears are going to perk up,” said Andrew Kessler, the founder of behavioral health consulting firm Slingshot Solutions. “For years, we got the scraps. And now we’re the big time.” (B)
(A) House passes bipartisan bill to fight opioid crisis, by Peter Sullivan and Juliegrace Brufke, https://www.politico.com/story/2018/06/22/house-opioid-bills-lobbying-637695
(B) Opioid bills could net millions for companies, by ADAM CANCRYN, https://www.politico.com/story/2018/06/22/house-opioid-bills-lobbying-637695
Then there are children who may not yet be verbal, and who aren’t able to articulate their needs, and that will have to be addressed.”
“Earlier this week, news broke that some of the nearly three thousand immigrant children who have been taken from their parents at the border are being transferred to “tender-age” shelters run by the Office of Refugee Resettlement (O.R.R.), an office within the Department of Health and Human Services (H.H.S.)…
Converting a facility meant to house teen-agers into one meant for toddlers is not a straightforward task. “Staffing up to care for toddlers and preverbal kids is a time-consuming process, because of licensing requirements, and because of the extra training that staff need,” the former official said. “It’s not just taking folks who have been dealing with sixteen- and seventeen-year-old boys and saying, ‘It’s your job to change a diaper and try to comfort a kid ripped from his or her mom.’ ” Carey told me, “When you’re talking about children who have been forcibly removed from a parent, the trauma is going to be greater, and so are the challenges of caring for those children.”..
Now, amid reports that H.H.S. has agreed to share sponsors’ information with ICE, undocumented adults have reason to fear stepping forward. “If we’re saying to people, ‘Come pick up your children, and, by the way, we need to know how to reach you, and we’re going to use that information to deport you,’ not very many people are going to come forward to pick up their kids,” Cancian said…
“To provide settings that are appropriate for adults that also meet human-rights standards for children, and to ramp those up to the scale demanded by the current crisis, is neither cost-effective nor feasible. We can’t create a housing situation that is heinous enough to get parents who are worried about their children’s well-being not to come. So how is this a solution?”
to read the full New Yorker article highlight and click on
The Office of Refugee Resettlement Is Completely Unprepared for the Thousands of Immigrant Children Now in Its Care, by Alexandra Schwartz, https://www.newyorker.com/news/news-desk/the-office-of-refugee-resettlement-is-completely-unprepared-for-the-thousands-of-immigrant-children-now-in-its-care?mbid=nl_Daily%20062318&CNDID=50144682&spMailingID=13744569&spUserID=MjAxODUyNTc3Mjk4S0&spJobID=1422054528&spReportId=MTQyMjA1NDUyOAS2
