President Donald Trump in October promised to “liberate” Americans from the “scourge of addiction,” officially declaring a 90-day public health emergency that would urgently mobilize the federal government to tackle the opioid epidemic.
That declaration runs out on Jan. 23, and beyond drawing more attention to the crisis, virtually nothing of consequence has been done…
A senior White House official disputed the assessment of inaction, saying the emergency declaration has allowed the president to use “his bully pulpit to draw further attention to this emergency that he inherited.” The official added that the declaration has enabled federal agencies to “really change their focus and prioritize the crisis,” and that getting an effective media campaign underway “takes time.”…
In West Virginia, which has the highest drug overdose death rate in the country, Public Health Commissioner Rahul Gupta hasn’t seen any significant change under Trump’s emergency order. “His thoughts and prayers have helped,” Gupta said. “But additional funding and resources would be more helpful.”..
State health officials and policy experts say billions of dollars in new funding are needed to make a dent in the crisis. The Public Health Emergency Fund, which HHS could tap under the Trump declaration, has a balance of just $57,000, and the administration hasn’t proposed replenishing it. Rather than asking for new money, the administration can move funds around in existing agency budgets — but that just means taking money away from other health programs….
The White House official said the administration is “actively in discussion with Congress” about funding for the crisis.” (A)

Congress approved bipartisan legislation in 2016 that authorized $1 billion over two years for opioid crisis response grants to states, which was signed into law by Obama. The first $500 million was doled out last year. The rest is being held up in a larger fight over a bill to fund the government, but it is eventually expected to be appropriated and distributed to states. And other money that Trump has touted comes from the CDC and the Substance Abuse and Mental Health Services Administration — agencies whose budgets were kept mostly flat under the 2017 spending bill and would have been cut in Trump’s budget proposal for 2018…
The administration has emphasized a law-and-order approach, cracking down on drug offenses and trying to cut the flow of illegal drugs into the country. Attorney General Jeff Sessions recently challenged states that have voted to legalize marijuana.
Trump’s health department has routinely touted its “five-point” strategy to combat the opioid crisis: prevention, treatment and recovery; expanding access to the overdose reversal drug naloxone; improving data about the scope of the crisis; and supporting research on pain and how it is managed.
Nevertheless, Eric Hargan, the acting HHS secretary, said in November that the president was leaving it to Congress to decide whether more money should be appropriated. Democrats argued hypocrisy. (B)

“A majority of the public considers addiction to prescription pain medication a major problem nationally (53%) but does not deem it a national emergency (28%) (Politico–HSPH, 2017). Substantially fewer people see it as an emergency (16%) or a major problem (38%) in their own community (PBS–Marist, 2017). In a list of national health problems, abuse of prescription painkillers ranks fifth in the proportion of the public that considers it an extremely serious disease or health condition facing the country (28%; KFF, April 2016). Concern about prescription-drug abuse as a public health problem has grown over time. Nearly 4 in 10 people (38%) currently believe it’s an extremely serious public health problem, double the proportion (19%) who believed so in 2013 (Pew, 2013 and 2017). More than 6 in 10 (63%) believe that the problem of addiction to prescription pain medications has increased in the past year, 26% think it has stayed about the same, and only 2% believe it has decreased (PBS–Marist, 2017)….
An important finding from our review is that at a time when public- and private-sector leaders are seeking a substantial increase in government funding for opioid-addiction treatment programs and legislation requiring insurers to offer coverage for these treatments, polls show a large share of the public uncertain about the long-term effectiveness of treatment. Over the next few years, this impression could affect family referrals to treatment programs, as well as public support for them and for a government requirement that insurance cover their cost. There is a clear need for the medical and scientific communities to educate the public about the issues surrounding the potential effectiveness of treatment.” (C)

“Pharmaceutical manufacturers such as Purdue Pharma, Endo International plc (ENDP – Get Report) , Teva Pharmaceutical Industries Ltd. (TEVA – Get Report) , Johnson & Johnson Inc. (JNJ – Get Report) and Allergan plc. (AGN – Get Report) as well as distributors Cardinal Health Inc. (CAH – Get Report) , McKesson Corp. (MCK – Get Report) and AmerisourceBergen Corp. (ABC – Get Report) have all been challenged by various parties to take action in the opioid epidemic…
Ohio is ground zero, where ten people die every day from opioids leaving behind families and friends and creating holes in cities and towns in the Buckeye state that don’t heal easily. And there is a cost beyond the human. Children moved from addicted parents to foster care cost $45 million a year. Indeed, half the kids in foster care come from parents addicted to opioids. Counseling and medication costs $216 million a year. Treating kids who are born drug dependent adds another $130 million. Ohio estimates that work lost because of the opioid crisis, fatal overdoses, and medical expenses costs $4 billion a year. From 2011 to 2015 3.8 billion doses of opioid meds were prescribed in Ohio. The state only has 11.6 million residents. In 2016, it lost 4,050 of those residents to overdoses of opioids, heroin and fentanyl, a dangerous synthetic opioid, according to Ohio’s own data…
While the pharmaceutical companies may not be beating a path to Columbus to talk to DeWine, that doesn’t mean they aren’t responding. A spokesman for Janssen said in an email “We believe the allegations in the lawsuit against our company are both legally and factually unfounded. Responsibly used opioid-based pain medicines give doctors and patients important choices to help manage the debilitating effects of chronic pain. Janssen has acted in the best interests of patients and physicians with regard to opioid pain medicines, which are FDA-approved and carry FDA-mandated warnings about possible risks on every product label.”…
McKesson, the San Francisco-based drug distributor, has spent its share of time in the harsh glare of the media spotlight. Investigative stalwart 60 Minutes and the Washington Post teamed up on a December report that showed the infighting between the Drug Enforcement Agency and the Justice Department over how best to go after McKesson regarding allegations that the company had been careless in its distribution and sale of opioids. While the DEA felt it had a criminal case against the company and more than enough evidence of wrongdoing for federal prosecutors, the case never saw the inside of a courtroom. Prosecutors maintained the case didn’t merit criminal charges and wasn’t strong enough. At one point the DOJ allegedly suggested the DEA become friendlier with the pharmaceutical industry.
Instead the DOJ huddled with a team of lawyers defending McKesson, negotiating a settlement that included a $150 million fine and a suspension of four of McKesson’s drug warehouses and increased staffing as well as McKesson hiring an independent monitor.” (D)

“A federal judge on Tuesday set a goal of doing something about the nation’s opioid epidemic this year, while noting the drug crisis is “100 percent man-made.”
Judge Dan Polster urged participants on all sides of lawsuits against drugmakers and distributors to work toward a common goal of reducing overdose deaths. He said the issue has come to courts because “other branches of government have punted” it.
The judge is overseeing more than 180 lawsuits against drug companies brought by local communities across the country, including those in California, Illinois, Kentucky, Ohio and West Virginia. Municipalities include San Joaquin County in California; Portsmouth, Ohio; and Huntington, West Virginia.
Polster said the goal must be reining in the amount of painkillers available.
“What we’ve got to do is dramatically reduce the number of pills that are out there, and make sure that the pills that are out there are being used properly,” Polster said during a hearing in his Cleveland courtroom. “Because we all know that a whole lot of them have gone walking, with devastating results.”
The judge said he believes everyone from drugmakers to doctors to individuals bear some responsibility for the crisis and haven’t done enough to stop it…
Polster likened the epidemic to the 1918 flu which killed hundreds of thousands of Americans, while pointing out a key difference.
“This is 100 percent man-made,” Polster said. “I’m pretty ashamed that this has occurred while I’ve been around.” (E)

“The epidemic of drug overdose deaths is a national disaster. It claimed more than 64,000 lives in 2016, many of them by opioid overdoses. That’s far more than the number of deaths from HIV/AIDS in the peak year of 1995…
About half of opioid overdose deaths occur among men and women ages 25 to 44; it’s reasonable to assume that many are parents. Imagine the impact on a child when a parent overdoses at home or in a grocery store. Statistics can’t tally the trauma felt by a seven-year-old who calls 911 to get help for an unconscious parent, or the responsibility undertaken by a twelve-year-old to feed and diaper a toddler sibling, or the impact of school absences and poor grades on a formerly successful high school student.
Parental overdoses have an immediate impact on children. There’s also a cumulative impact as these children become adults and are themselves at risk from the same influences that drove their parents to drugs, overdoses, and early deaths.
Who are these children and adolescents? Newborns whose mothers are addicted to opioids. These babies may undergo withdrawal themselves and need special treatment. Children of all ages at risk for accidental ingestion or inhalation of toxic substances. Children living with an addicted parent, dealing with constant uncertainty and fear. Children who have taken over the role of family caregiver for younger siblings or for their addicted parents. Children who are removed from their homes and placed in foster or kinship care. Some of these children have unmet mental health care needs. Very young children exposed to toxic levels of stress that impair brain development.
No one knows how many of these vulnerable children there are in the U.S. because no one is counting. As a point of comparison, an advisory group to the British government estimated that there are between 250,000 and 350,000 children of drug abusers in the U.K. — about one for every drug user. The title of its report, Hidden Harm, applies equally well to American children. They remain hidden in families with addiction until a crisis erupts and law enforcement or child welfare agencies get involved.” (F)

“Policymakers mistakenly focus on doctors treating their patients in pain. By intruding on the patient-doctor relationship they impede physician judgment and increase patient suffering. But another unintended consequence is that, by reducing the amount of prescription opioids that can be diverted to the illicit market, they have driven nonmedical users to heroin and fentanyl, which are cheaper and easier to obtain on the street than prescription opioids, and much more dangerous.
Data from the Centers for Disease Control and Prevention show that from 2006 to 2010 the opioid prescription rate tracked closely with the opioid overdose rate, at roughly 1 overdose for every 13,000 prescriptions. Then, after 2010, when the prescription rate dropped and it became more difficult to divert opioids for nonmedical use, the overdose rate began to climb as nonmedical users switched over to heroin and fentanyl. There is a dramatic negative correlation between prescription rate to overdose rate of -0.99 since 2010.
The overdose rate is not a product of doctors and patients abusing prescription opioids. It is a product of nonmedical users accessing the illicit market.
The problem will not get better—it will probably only get worse—as long as we continue to call this an “opioid crisis.” The title is too nonspecific. This is a crisis caused by drug prohibition—an unintended consequence of nonmedical drug users accessing the black market in drugs. Policymakers should stop harassing doctors and their patients and shift the focus to reforming overall drug policy. A good place to start would be to implement harm reduction measures, such as safe syringe programs, making Medication Assisted Treatments like methadone and suboxone more readily available, and making the opioid antidote naloxone available over-the-counter, so it can be easier for opioid users to obtain. Even better would be a sober reassessment of America’s longest war, the “War on Drugs.”
Renaming the problem a “heroin and fentanyl crisis” might be a way to trigger a refocus.” (G)

“Attorney General Jeff Sessions’ reversal of an Obama-era policy that let legalized marijuana proliferate in many states across the U.S. may affect states that have medical marijuana and recreational pot use laws. It’s too early, though, to tell just how significant the impact will be.
On Thursday, Sessions rescinded a decision made in 2013 that adopted a policy of non-interference with marijuana-friendly state laws, the New York Times reported…
“Federal law normally trumps state law, so a violation of a federal criminal statute could result in significant penalties including imprisonment, even if the act is lawful under state law,”…With Sessions’ decision, people selling or using marijuana for medical purposes could be prosecuted. “As a result, it would pose a chilling effect on the use of marijuana for needed medical purposes, even if prescribed by a doctor in accordance with state law,”.
While medical marijuana can’t be legally prescribed, possessed, or sold under federal law, its use to treat some medical conditions is legal under many state laws, according to the American Cancer Society. Currently, 29 states have medical marijuana laws. The Sessions decision could put the kibosh on many of those “compassionate use” laws, though.
“It could exclude one of the key ways that physicians can help their patients and reduce suffering. It might also result in greater use of less effective and more addictive medications such as opioids,” Gostin says.
Currently, the U.S. is experiencing an opioid epidemic. Since 1999, the number of overdose deaths involving opioids quadrupled, and prescription opioids are a driving factor in the increase, according to the U.S. Centers for Disease Control and Prevention…
Under the Sessions policy reversal, a cancer patient currently using a marijuana-based drug to ease pain or nausea may have that right taken away.” (H)

“The opioid epidemic is now a full-blown national crisis, yet the federal government continues to dawdle. President Donald Trump declared opioid addiction a public health emergency, and he talks a tough game. But he has not taken forceful action. If he will not lead, Congress must — and now, before the crisis grows even worse…
This is a solvable problem, and through philanthropy we can make some progress. But real success requires much bolder leadership — and a far greater sense of urgency — from both elected officials and industry leaders…
We must stop doctors from over-prescribing opioids, especially when non-addictive pain medications (such as ibuprofen or acetaminophen) would be just as effective. More aggressive action is needed.
The Food and Drug Administration should allow only doctors who complete specialized education in pain management to prescribe opioids for more than a few days, a move FDA Commissioner Scott Gottlieb is considering. ..
Insurers and pharmacy benefit managers must better oversee opioid prescriptions. CVS Caremark has moved to limit coverage for opioid prescriptions. Others should follow its lead. These companies exist to help people lead better, healthier lives, and they should not be complicit actors in an addiction and overdose epidemic…
We must hold pharmaceutical companies accountable for the supply of prescription opioids.,,
We must start treating those with addiction disorders when they come in contact with emergency rooms, hospitals and clinics. …
We must stop stigmatizing the medications that have been proven to help people recover…
The federal government should incentivize cities and states to offer treatment to inmates, as New York City and a handful of other localities do…
We must develop better data. Existing statistics on misuse and overdose are out of date and often inaccurate….
We must do more to block the importation of heroin — and of fentanyl, much of which originates in China….” (I)

“What can health care providers do to address these problems?..
Researchers called persistent prescription opioid use “one of the most common complications after elective surgery.”
This is not to say that patients should be left writhing in pain in their hospital beds: We need to start using a multi-disciplinary and multi-modal approach to pain management. Surgeons need to engage in early education with their patients about post-operative pain management and the risks of medications, as well as setting realistic expectations about what post-surgery pain will be like.
Additionally, health care providers need to identify those most vulnerable to opioid addiction, including those with mental health issues or pre-existing substance abuse, and establish more sensitive processes that ensure they experience as little pain as possible without relying on potentially dangerous opioids.
We also need to rely more heavily on other medications in our arsenal, such as acetaminophen, non-steroidal anti-inflammatories, muscles relaxants and nerve agents. And health care providers need to be innovative and creative and find different ways to implement pain medication delivery, using methods like steroid injections and epidural catheters.
Providers must also work harder to encourage those who do develop addictions to enlist in rehabilitation, and they should involve more frequently other specialists in crafting and carrying out treatment plans, especially pain management doctors and psychologists.
Most importantly, all providers need to look in the mirror and ask themselves if we are being good stewards of prescribing practices, or if we are part of the problem we see in the news.” (J)

“The USC-Brookings Schaffer Initiative for Health Policy’s Jason N. Doctor and Michael Menchine also say that emergency rooms are playing a significant role in the opioid crisis. First, emergency room visits are a notable source of the over-prescription of opioids—often with deadly consequences. Narcotic overdose is the eighth leading cause of death within one week of an emergency room visit.
Additionally, emergency rooms are often on the frontlines of treating those harmed by the epidemic. Currently, there are over 300,000 estimated annual emergency department visits for opioid overdose.
To address the crisis, Doctor and Menchine explain Congress and the Trump administration will have to focus on reducing population exposure to opioids, creating demand for safe and effective treatments, and the effective use of emergency departments. They recommend that the current administration and Congress fund additional resources to emergency rooms, including:
The development of opioid dependence screening tools for the emergency department;
Training to emergency department staff on how to address potentially opioid dependent individuals in an ethically neutral manner;
The expansion of referral sources for outpatient addiction specialty clinics (particularly for uninsured patients or those with Medicaid insurance);
Reduced administrative barriers to becoming a Buprenorphine prescriber; and
The development of a financial reimbursement model for prescription opioid screening or treatment in emergency room settings.” (K)

“Doctors at some of the country’s largest hospital chains admit they went overboard with opioids to make people as pain-free as possible.
Now the doctors shoulder part of the blame for the country’s opioid crisis. In an effort to be part of the cure, they’ve begun to issue an uncomfortable warning to patients: You’re going to feel some pain…
Opioid addiction is a reality that has been completely disconnected from where it often starts — in a hospital….
So the nation’s largest private hospital chain is rolling out a new protocol prior to surgery. It includes a conversation Schlosser basically never had when he was practicing medicine.
“We will treat the pain, but you should expect that you’re going to have some pain. And you should also understand that taking a narcotic so that you have no pain really puts you at risk of becoming addicted to that narcotic,” Schlosser tells patients.
Besides issuing the uncomfortable warning, sparing use of opioids also takes more work on the hospital’s part — trying nerve blocks and finding the most effective blend of non-narcotics. Then after surgery, the nursing staff has to stick to it. If someone can get up and walk and cough without doubling over, maybe they don’t need potentially addictive drugs, or at least not high doses of them.” (L)

Five Big Ideas to Confront the Opioid Crisis
1. Stop overprescribing
2. Treat opioid addiction as the public health crisis that it is
3. Stop the deaths
4. Guarantee Access to Treatment
5. Invest in data and knowledge” (M)

“In New York City, opioid addiction treatment is sharply segregated by income, according to addiction experts and an analysis of demographic data provided by the city health department. More affluent patients can avoid the methadone clinic entirely, receiving a new treatment directly from a doctor’s office. Many poorer Hispanic and black individuals struggling with drug addiction must rely on these highly regulated clinics, which they must visit daily to receive their plastic cup of methadone…
This is what opioid addiction recovery is like for more than 30,000 patients enrolled in New York City’s approximately 70 methadone-based treatment programs, which provide medication-assisted treatment, counseling and other social services. Hundreds of thousands of patients across the country are enrolled in similar programs, which often receive government funding and are covered by Medicaid in New York.
For more than 40 years, methadone was the most effective method for people addicted to heroin to keep their cravings in check. But in 2002, the Food and Drug Administration approved another medication to treat opioid addiction: buprenorphine, sold most widely in a compound called Suboxone. Both methadone and buprenorphine are extremely effective in keeping recovering users from relapsing, according to medical research, but Suboxone is engineered to reduce the possibility of abuse and overdose. Crucially, the medication can be prescribed in doctors’ offices and then taken at home.
Many hoped that buprenorphine could mean an end to the daily hurdles to receiving treatment for tens of thousands of patients: no additional commute, no security check, no waiting, no line for the plastic cup.
But today in the city, that is primarily true only for middle-class or upper-middle-class patients seeking help with their addiction.” (N)

“In May 2016, Taylor Weyeneth was an undergraduate at St. John’s University in New York, a legal studies student and fraternity member who organized a golf tournament and other events to raise money for veterans and their families.
Less than a year later, at 23, Weyeneth, was a political appointee and rising star at the Office of National Drug Control Policy, the White House office responsible for coordinating the federal government’s multibillion dollar anti-drug initiatives and supporting President Donald Trump’s efforts to curb the opioid epidemic. Weyeneth would soon become deputy chief of staff.
Weyeneth’s brief biography offers few clues that he would so quickly assume a leading role in the drug policy office, a job recently occupied by a lawyer and a veteran government official. His only professional experience after college and before becoming an appointee was working on Trump’s presidential campaign.
Weyeneth’s ascent from a low-level post to deputy chief of staff is due in large part to staff turnover and vacancies. The story of his appointment and remarkable rise provides insight into the Trump administration’s political appointments and the troubled state of the drug policy office.” (O)

(A) Trump declared an opioids emergency. Then nothing changed, by BRIANNA EHLEY, https://www.politico.com/story/2018/01/11/opioids-epidemic-trump-addiction-emergency-order-335848
(B) How can we solve the opioid crisis?, by Sarah Karlin-Smith, https://www.politico.com/video/2017/11/02/how-can-we-solve-the-opioid-crisis-064251
(C) The Public and the Opioid-Abuse Epidemic, by Robert J. Blendon, and John M. Benson, http://www.nejm.org/doi/full/10.1056/NEJMp1714529#t=article
(D) America’s Opioid Crisis Looks a Lot Like Big Tobacco Spats of Yesteryear, by Bill Meagher, https://www.thestreet.com/story/14397159/1/how-opioid-crisis-of-today-resembles-big-tobacco-lawsuits-battles.html
(E) Judge urges action on ‘100 percent manmade’ opioid crisis, by ANDREW WELSH-HUGGINS, http://abcnews.go.com/Health/wireStory/judge-urges-action-100-percent-manmade-opioid-crisis-52235186
(F) The statistics don’t capture the opioid epidemic’s impact on children, by CAROL LEVINE, https://www.statnews.com/2018/01/02/opioid-epidemic-impact-children/?utm_source=STAT+Newsletters&utm_campaign=073963a01b-First_Opinion&utm_medium=email&utm_term=0_8cab1d7961-073963a01b-150519373
(G) Stop Calling it an Opioid Crisis—It’s a Heroin and Fentanyl Crisis, by JEFFREY A. SINGER SHARE, https://www.cato.org/blog/stop-calling-it-opioid-crisis-its-heroin-fentanyl-crisis
(H) Could Jeff Sessions’ Marijuana Ruling Make the Opioid Crisis Even Worse?, by MARY BROPHY MARCUS, https://www.menshealth.com/health/jeff-sessions-marijuana-policy-opioid-crisis
(I) A Seven-Step Plan for Ending the Opioid Crisis, by Michael R. Bloomberg, https://www.bloomberg.com/view/articles/2018-01-10/a-seven-step-plan-for-ending-the-opioid-crisis
(J) Dr. Jacquelyn Corley To fix the opioid crisis, doctors like me may have to let patients be in pain, https://www.nbcnews.com/think/opinion/fix-opioid-crisis-doctors-me-may-have-let-patients-be-ncna836141
(K) The far-reaching effects of the US opioid crisis, by Brennan Hoban, https://www.brookings.edu/blog/brookings-now/2017/10/25/the-far-reaching-effects-of-the-us-opioid-crisis/
(L) Hospitals Brace Patients For Pain To Reduce Risk Of Opioid Addiction, by BLAKE FARMER, https://www.npr.org/sections/health-shots/2018/01/09/576584541/hospitals-brace-patients-for-pain-to-reduce-risk-of-opioid-addiction
(M) CONFRONTING OUR NATION’S OPIOID CRISIS, https://assets.aspeninstitute.org/content/uploads/2018/01/AHSG-Final-Report-2017_compressed-2.pdf
(N) Opioid Addiction Knows No Color, but Its Treatment Does, by JOSE A. DEL REAL, https://www.nytimes.com/2018/01/12/nyregion/opioid-addiction-knows-no-color-but-its-treatment-does.
(O) Trump’s response to opioid epidemic includes 24-year-old helping lead drug policy office, by Robert O’Harrow Jr., http://www.chicagotribune.com/news/nationworld/politics/ct-trump-drug-policy-office-20180113-story.html

“We wonder what it will take to shake the faith of Trump’s fans. His subservience to Russia’s ongoing cyber-invasion? Nope. His relentless assaults on the integrity of our law enforcement and intelligence agencies? Nope. Shooting someone in broad daylight on Fifth Avenue? Probably nope.
But his failure to tackle the opioid epidemic — his big talk and dearth of meaningful action — might conceivably dampen their ardor.
This prescription drug plague has hit their world hard. More than 100 people die each day from opioid ODs; the victims are disproportionately young and middle-aged working-class men in small towns and rural communities — the heart of Trump’s constituency. The worst epidemic state is West Virginia, which Trump won by 43 points. He spoke to their despair when he promised to alleviate it. During the campaign he repeatedly referenced the opioid scourge: “If I win, I’m going to stop it …. We’re gonna spend the money. We’re gonna get that habit broken.”
And not long ago, as president, he vowed to cure the “worst drug crisis in American history” by declaring “a national emergency,” a legal designation that automatically frees up massive federal funds. He promised action that would be “really tough, really big, really great.”
He hasn’t done squat.” (A)

“The average American life expectancy ticked downward for the second straight year in 2016, on the back of surging drug overdose deaths, according to data released Thursday by the National Center for Health Statistics at the U.S. Centers for Disease Control and Prevention. And while the nation hasn’t experienced a back-to-back drop in life expectancy since the 1960s, the CDC says the opioid crisis is shaping up to extend this decline for a third consecutive year, a milestone that hasn’t been seen since the Spanish flu pandemic in 1918.
U.S. life expectancy fell to an average of 78.6 years in 2016, dropping 0.1 for the second year in a row, according to the CDC report. The slide was driven by higher death rates among young and middle-aged Americans, with those aged 25-34 experiencing the largest increase. The death rate among Americans aged 65 and older actually inched downward between 2015 and 2016.
The overall decline in longevity came as drug overdose deaths exploded in 2016 to a total of 63,600, around 42,000 of which involved opioids, according to CDC data. Although these numbers have been rising steadily since 1999, the 21 percent jump in deaths over 2015 was the largest annual increase so far. Drug overdose deaths involving synthetic opioids like fentanyl and fentanyl analogs have increased an average of 88 percent each year from 2013 to 2016, helping to drive the surge.” (B)

“Over the past few years, economists have struggled to explain why so many people appear to be dropping out of the workforce. The most telling measure of that is the labor-force participation rate—which measures the percentage of the population that is employed or actively looking for work—which now sits around 62.7 percent. That’s low by historical standards. For example, between 1986 and 2001, labor-force participation grew fairly steadily, to between 65 and 67 percent….
The economist Alan Krueger’s work has shown that there’s a striking relationship between these missing workers and increasing opioid addiction. According to an analysis done by Krueger, over the past 15 years, labor-force participation among prime-age workers has declined the most in U.S. counties where opioids prescriptions are the most plentiful. He is sure to mention that cause and effect aren’t clear: It’s hard to say whether addiction breeds joblessness, or vice versa. “Regardless of the direction of causality, the opioid crisis and depressed labor force participation are now intertwined in many parts of the U.S.,” Krueger writes.” (C)

The U.S. foster care system is overwhelmed, in part because America’s opioid crisis is overwhelming. Thousands of children have had to be taken out of the care of parents or a parent who is addicted.
Indiana is among the states that have seen the largest one-year increase in the number of children who need foster care. Judge Marilyn Moores, who heads the juvenile court in Marion County, which includes Indianapolis, says the health crisis is straining resources in Indiana.
“We’ve gone from having 2,500 children in care, three years ago, to having 5,500 kids in care. It has just exploded our systems,” Moores says.
While laws in all U.S. states require that child welfare agencies make “reasonable efforts” to reunify parents with their children, Moores says that process can be especially traumatic for children whose parents often relapse.
She says that more legal consideration should be paid to the child’s rights and safety and that “right now, that balance does not tip legally in favor of the child.”
Earlier this year, President Trump declared the opioid epidemic a public health emergency. But that designation “didn’t come with money,” Moores says. “And that is sadly what the necessity is.” She says reform is needed, and it should focus on “how much in the way of resources should be devoted to trying to reunify children with parents who cannot conquer their addiction.”” (D) (E)

“In “Communities in Crisis: Local Responses to Behavioral Health Challenges,” a report from Manatt Health, we highlight how cities and counties are responding to the opioid crisis and untreated mental illness by developing community-driven programs that connect individuals to treatment and social support services. Successful initiatives are creating systems of care that bridge multiple programs to provide coordinated services to individuals with SUD.
Here are five elements of successful local programs: 1.Collaboration and alignment of local resources. 2.Establishment of a holistic system of care. 3.Navigation across care settings. 4.Community engagement and advocacy. SUD that combines traditional drug court services with behavioral health counseling and treatment. 5.Leveraging both public and private financing.” (F)

“UPMC Hamot’s new Pregnancy Recovery Center looks a lot like the orthopedic office it is replacing on the third floor of 300 State St.
The walls of the office’s waiting room remain covered with nautical drawings and pictures, while the exam rooms still look the same. But starting Jan. 2, the office will see expectant women who are addicted to opioids instead of people with broken bones and damaged joints.
“Our goal is to get these women into treatment as early in their pregnancy as possible and reduce the number of babies born who require neonatal withdrawal,” said Emma Mack, R.N., the center’s outreach coordinator.
Erie County’s opioid epidemic has spurred local hospitals to increase their efforts to help pregnant women who are addicted to these drugs. Saint Vincent Hospital opened its Growing Hope program in September 2016 and now Hamot is creating its program, which is based on a similar one Magee Women’s Hospital of UPMC started in 2014.
Pregnant women with addictions are referred to these programs by their obstetrician-gynecologist, an emergency department physician or a drug-treatment facility. An initial appointment is scheduled and an effort is made to switch the patient to the treatment drug Subutex to wean the woman off opioids and control her withdrawal symptoms.” (G)

“Rochester Regional Health expects by April to open a crisis center at the St. Mary’s Campus in the city. The crisis center will evaluate and treat people coping with an acute behavioral or chemical dependency problem, and arrange follow-up care.
The urgent care model is appropriate for someone who is not a danger to themselves or others, or in the midst of an overdose, said Kathy McGuire, senior vice president of behavioral health and home and community services for Rochester Regional.
“Somebody having an anxiety attack would have gone to the emergency room,” she said. “People go to the emergency room when they’re intoxicated. People who haven’t taken their medication in a bunch of days, they need to talk to somebody and get back on their meds.”
Planning started in 2014, and the idea originally was to treat just mental health episodes. But increasing opioid abuse forced a second look.
“The more the opioid crisis came into full view, the more we said there’s such a tie between chemical dependency and mental health,” McGuire said. “We should be thinking about how we should be using this urgent care center to deal with this crisis as well.” (H)

“The paramedics find them everywhere – slumped over car steering wheels, barely breathing in doughnut shop bathrooms or dead in derelict apartments and expensive mansions.
For the Cataldo Ambulance Service crews outside Boston on the front lines of the U.S. opioid epidemic, the flood of overdose calls is a grim daily reality, despite expanded access to overdose reversal drugs.
“When I started, this was a rare thing. You did one or two here and there. Now, we do quite a few,” said Dave Franklin, 44, a supervisor at the private service that contracts with cities who has worked in the field for more than 20 years.
In Massachusetts, EMS opioid overdose calls hit 20,978 in 2016, up from 8,389 in 2013, according to a state report.
Amid wider use by bystanders and police of naloxone, a drug that reverses overdose symptoms, state figures showed a small drop in opioid deaths in the first nine months of 2017 compared with 2016. But Franklin does not yet see a turning point….
At the ambulance, he checks to make sure there is enough naloxone. They carry more than double the amount they once did because stronger opioids mean that multiple doses of naloxone are often required for someone who is barely breathing.” (I)

“The Chicago Urban League recently issued a paper titled “Whitewahed: The African-American Opioid Epidemic,” outlining the drug’s toll on that community: African-Americans make up 15 percent of the state’s population but account for 24 percent of opioid-related deaths.
At the same time, the researchers said, African-Americans are less likely to get help because Cook County, home to about 2 out of 3 black Illinoisans, has a relative scarcity of clinics providing buprenorphine — the medication many experts believe is among the most effective treatments.
Stephanie Schmitz Bechteler, a co-author of the report, said those grim facts have been missing from the public deliberation over heroin, which often focuses on white users in suburban and rural areas.
“On the one hand, the change in narrative has brought a broader awareness to the issue, but it has come at the expense of the comprehensive set of people who are affected by this,” she said.” (J)

“Based on his latest study, Dartmouth-Hitchcock’s Chief of Surgery Dr. Richard Barth is offering surgeons specific guidelines for post-surgery prescriptions for pain-relieving opioids.
Barth said as a surgeon he wanted to see if there was something he could do to curb the opioid crisis.
Many states, including New Hampshire, have adopted laws that prohibit doctors from prescribing more than a seven-day supply of opioids — but a seven-day supply can range from 20 pills to 80 pills, Barth said.
“I know I prescribe opioids for patients that I operate on I was just wondering if I could do that better and optimize that and help to diminish this epidemic,” Barth said. “The Surgeon General has said if doctors keep prescribing more pills than are actually needed, then this crisis is going to go on unabated.”
The study was published in the Journal of the American College of Surgeons on Dec. 15 and is based on a series of studies Barth conducted at Dartmouth-Hitchcock.
According to the peer-reviewed Journal article, this is the first time specific guidelines have been proposed for prescribing opioids after surgery patients are discharged from the hospital.
The studies took a look at patients who did not have issues with chronic pain, and so were not on opioid medications on a regular basis.” (K)

“New Jersey Gov. Chris Christie says the U.S. finally addressed the HIV/AIDS crisis in the 1980s because affected Americans paraded down the streets of Washington and other major cities, saying it was time for power brokers to take the epidemic seriously.
It’s time to start marching again, he recently told Congress — this time to erase widespread stigma that is holding back the fight against an opioids epidemic that kills about 100 people per day in the U.S.
“We will have seen that we’ve begun to remove the stigma of this disease when the people who are impacted are willing to show their face and march and demand, from their government, a response,” said Mr. Christie, a Republican who led President Trump’s commission on opioids addiction. “They don’t march today because they are ashamed to march, because they don’t want to be identified.”
As federal and state leaders try to catch up with the opioids crisis, analysts say too many people still treat drug addiction as a personal failing instead of a disease and that it’s keeping too many Americans from getting the help they need.
Only 1 in 10 people who need treatment for a substance use disorder are getting it — a ratio that would be unfathomable for conditions such as diabetes or kidney cancer…
Mr. Christie’s commission called for a nationwide awareness campaign to focus on the dangers of opioid use and to remove stigma attached to addiction.
Congress is still debating how much funding to devote to the campaign and overall fight, but in the meantime, it is investigating what role opioid manufacturers may have played in aggressively marketing pain pills or downplaying their addictive qualities in the late 1990s and early 2000s.” (L)

“That should be a wake-up call for the Trump administration, which has talked a fine game about the opioid epidemic but done too little to address it. A far greater sense of urgency is needed to address what has become one of the gravest public-health threats to the United States in living memory…
It would be a mistake to see the fall in life expectancy as part of a broad decline in American public health. Infant mortality continues to drop, and death rates from heart disease, cancer, flu, diabetes, kidney disease and other causes are mainly flat or falling. Rather, the main culprits are known as “diseases of despair” — especially drug overdoses and suicide. And the main victims are men, especially working-class young and middle-aged men, for whom the overdose death rate is twice that of women.
Mindful of the soaring toll, President Trump appointed a presidential commission on combating drug addiction and the opioid crisis, which recommended last summer that the president declare a national emergency, as he has pledged to do. That would have freed up funding from the national Disaster Relief Fund. Instead, in October he declared a public-health emergency, a lesser designation and one that has not unlocked game-changing amounts of federal dollars.
At the highest levels, the administration’s response to the crisis has been sluggish, characterized by boastful rhetoric but stagnant funding. Mr. Trump has spoken of the government producing “really tough, really big, really great advertising,” as if a Nancy Reagan just-say-no approach were adequate to the task of tackling a complex public-health scourge. He said the administration would crack down on the synthetic opioid fentanyl, manufactured in China, and endeavor to develop nonaddictive painkillers as an alternative to opioids. But where is the funding?” (M)

“Democrats, especially in the Senate, have called for including some opioid funding in any major government funding package. Some Republicans whose states have been hit hardest by the crisis, like Sens. Rob Portman of Ohio and Shelley Moore Capito of West Virginia, have also called for more spending.
There are already small signs that Congress might sign off on more spending in 2018. Kellyanne Conway, the White House adviser who has been leading a kind of “opioids cabinet,” told STAT she is working with the Office of Management and Budget on a request for more funds. Outside groups have also said there may be more motivation to pass funding to address the opioid crisis in an election year.
House Energy and Commerce Committee Greg Walden of Oregon told STAT he is hoping to work on an opioids measure in the new year. And Rep. Tom MacArthur (R-N.J.), who is co-chair of the Bipartisan Task Force to Combat the Heroin Epidemic, said the group delivered a host of new policy proposals to Republican leadership that are aimed at addressing the crisis. He said that effort should also be paired with new funding.” (N)

“In the wake of the opioid crisis, hospitals in the Nashville area are now warning patients that they may have to deal with some pain following surgery or other procedures.
David Alfery, M.D, a Nashville anesthesiologist and part of the working group at the regional consulting firm Health Trust, told Nashville Public Radio that patients have developed unrealistic expectations about post-surgical pain management. As a result, the Hospital Corporation of America-owned TriStar Centennial Medical Center has implemented a new protocol that requires surgeons to have difficult conversations with their patients about opioid addiction.
Mike Schlosser, M.D., chief medical officer for HCA National Group, told the publication that he explains to patients that he will treat their pain but they should expect some level of discomfort because narcotics that eliminate all pain will put them at risk for addiction.
It’s not easy for physicians to strike a balance between meeting the pain management needs of patients and preventing addiction. Many doctors have not had training on effective pain management, and may be confused by guidelines to reduce prescriptions for powerful painkillers. Another wrinkle is that patient satisfaction surveys, like the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), include pain management questions.” (O)

“There are a series of actions that need to be taken if we are going to affect the opioid crisis.
Educate physicians, nurses, pharmacists, medical students, residents and the public on the treatment of acute and chronic pain.
Pharmaceutical companies need to recognize their role in creating this crisis and work with the medical profession to address it.
Educate patients regarding treatment approaches to both acute and chronic pain.
Implement a group model for patients who present to primary pain clinics with complaints of chronic pain. This model is well suited to educate patients regarding the clinic’s approach to the use of opioid analgesics, central and peripheral mechanisms involved in pain, non-medication approaches to pain and empowerment to support each other in dealing with chronic medical conditions involving pain.
Encourage physicians to take the online training in the use of buprenorphine, an often lifesaving medication.” (P)

“The Justice Department has awarded over $70 million during 2017 to help fight the opioid crisis nationwide and set up drug courts. It has directed U.S. Attorneys to aggressively prosecute drug dealers, and just last week established a new office to help oversee the implementation of Justice Department initiatives and coordinate with state and local law enforcement.
Violent drug dealers are not the only ones being prosecuted. As the number of drug-related deaths escalates, law enforcement officials are under growing pressure to prosecute and lock up not only criminal drug dealers, but also doctors, pharmaceutical company officials, and even friends and family of the victims if they’ve aided in an overdose death….
It is unlikely that the opioid crisis will be brought under control in the near future. Prevention and compassionate treatment are important, but even more crucial is for law enforcement to use the proven tools it has at its disposal to prosecute those responsible for the deaths of thousands of Americans. (Q)

“While some insurers have become part of the solution, many continue to contribute to the epidemic. Four out of five heroin users start with prescription painkillers, and our commonwealth and country have been flooded with unnecessary, highly addictive prescription opioids.
Despite no change in reported pain levels, sales of prescription opioids quadrupled form 1999 to 2014 and continue at a staggering pace. In 2015, U.S. doctors wrote 300 million pain prescriptions — and insurance companies approved nearly every single one of them, typically without questioning the need or offering meaningful coverage for alternatives.
Insurers decide which treatments and medications we can afford and which will remain out of reach due to high prices. Aetna is helping by eliminating its copay for Narcan and by limiting the amount of opioid medication approved for short-term pain. Independence Blue Cross also has acted to limit opioid prescriptions. More insurers should take similar steps.
It’s long past time to change the corporate cultures of pharmaceutical and insurance companies so that they value the health and safety of their customers as much as their bottom lines.” (R)

“Gov. Chris Christie still hopes to make tackling opioid addiction his signature accomplishment as he prepares to leave office on Jan. 16.
Christie announced grants in excess of $35 million Tuesday for qualified health care providers to care for patients with severe opioid use disorders, pregnant and postpartum mothers, and older adults with opioid dependencies…
“To ensure treatment is successful, it is essential that systems of care join seamlessly to treat the whole individual,” Christie said in a press release. “This funding supports the type of integration of behavioral and primary health care I envisioned when transferring the Division of Mental Health and Addiction Services from the Department of Human Services to the Department of Health.”” (S)

“Attorney General Jeff Sessions on Thursday rescinded a trio of memos from the Obama administration that had adopted a policy of non-interference with marijuana-friendly state laws.
The move essentially shifts federal policy from the hands-off approach adopted under the previous administration to unleashing federal prosecutors across the country to decide individually how to prioritize resources to crack down on pot possession, distribution and cultivation of the drug in states where it is legal.
While many states have decriminalized or legalized marijuana use, the drug is still illegal under federal law, creating a conflict between federal and state law. Thursday’s announcement is a major decision for an attorney general who has regularly decried marijuana use as dangerous.” (T)

“The remaining members of the Presidential Advisory Council on HIV/AIDS were fired en masse this week.
Months after a half-dozen members resigned in protest of the Trump administration’s position on health policies, the White House dismissed the rest through a form letter.
The notice “thanked me for my past service and said that my appointment was terminated, effective immediately,” said Patrick Sullivan, an epidemiologist at Emory University who works on HIV testing programs. He was appointed to a four-year term in May 2016.
The council, known by the acronym PACHA, has advised the White House on HIV/AIDS policies since its founding in 1995. Members, who are not paid, offer recommendations on the National HIV/AIDS Strategy, a five-year plan responding to the epidemic.
The group is designed to include “doctors, members of industry, members of the community and, very importantly, people living with HIV,” said Scott Schoettes, a lawyer with the LGBT rights organization Lambda Legal. “Without it, you lose the community voice in policymaking.”” (U)

(A) Trump on the opioid crisis: Big talk, little action (big surprise), by Dick Polman, https://whyy.org/articles/trump-opioid-crisis-big-talk-little-action-big-surprise/
(B) Opioid Crisis Could Be Biggest Hit To U.S. Life Expectancy In A Century, CDC Says, by Nick Wing, https://www.huffingtonpost.com/entry/opioid-deaths-life-expectancy_us_5a3bfdeee4b0b0e5a7a09e0b
(C) The Opioid Crisis Comes to the Workplace, by GILLIAN B. WHITE, https://www.theatlantic.com/business/archive/2017/12/workers-dying-overdoses/549008/
(D) The Foster Care System Is Flooded With Children Of The Opioid Epidemic, by SCOTT SIMON, https://www.npr.org/2017/12/23/573021632/the-foster-care-system-is-flooded-with-children-of-the-opioid-epidemic
(E) Ohio Child Advocates: Opioid Crisis Straining Foster Care, https://www.usnews.com/news/best-states/ohio/articles/2017-12-21/ohio-child-advocates-opioid-crisis-straining-foster-care
(F) Five key elements of successful local initiatives to combat the opioid crisis, byJonah Frohlich, Chris Cantrell, http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/five-key-elements-successful-local-initiatives-combat-opioid-crisis
(G) Opioid crisis spurs Erie hospitals to help addicted pregnant women, by David Bruce, http://www.goerie.com/news/20171225/opioid-crisis-spurs-erie-hospitals-to-help-addicted-pregnant-women
(H) Rochester Regional opening crisis center to apply urgent care model to mental health, Patti Singer, http://www.democratandchronicle.com/story/news/2017/12/23/rochester-regional-mental-health-crisis-opioid/978831001/
(I) Boston-Area Paramedics on Front Lines of U.S. Opioid Crisis, https://www.usnews.com/news/us/articles/2017-12-22/boston-area-paramedics-on-front-lines-of-us-opioid-crisis
(J) Black victims of heroin, opioid crisis ‘whitewashed’ out of picture, report finds, http://www.chicagotribune.com/news/local/breaking/ct-met-heroin-crisis-african-american-impact-20171220-story.html
(K) NH surgeon offers opioid-prescription guidelines to try to help curb opioid crisis, By MEGHAN PIERCE, http://www.unionleader.com/health/nh-surgeon-offers-opioid-prescription-guidelines-to-try-to-help-curb-opioid-crisis-20171226
(L) Chris Christie calls for campaign to take opioid epidemic seriously and break stigma of addiction, https://www.washingtontimes.com/news/2017/dec/25/opioid-epidemic-fighters-aim-break-addiction-stigm/
(M) America’s opioid epidemic saps life expectancy while the White House sleepwalks, https://www.washingtonpost.com/opinions/americas-opioid-epidemic-saps-life-expectancy-while-the-white-house-sleepwalks/2017/12/26/ac997b2c-e697-11e7-a65d-1ac0fd7f097e_story.html?utm_term=.74284d88bd2a
(N) 3 legislative battles to watch in 2018, by Erin Mershon, https://www.statnews.com/2018/01/02/legislative-battles-2018/
(O) Nashville hospitals take aim at opioid crisis by adjusting approach to pain management, by Paige Minemyer, https://www.fiercehealthcare.com/healthcare/opioid-crisis-drug-addiction-hospital-corporation-american-lifepoint-health?mkt_tok=eyJpIjoiTkdNeE9HVTJPV1V4Wm1SaSIsInQiOiJoZlg5SXN6dzJPc2lHa3FFckV3UElIT0dVREtRR3Fid3hwSmhjQjVyZzdMZ2VIMkcxc1YrYVRPYVNyTUtxaVNBQzlVcjVtdDZ5RFo5Y1wvQStTV1dYZ1k0UTlSam1EY2VQeCtocXM4YUkyQVkrSFZmZm4yNmZ4WittY25rWGRUdjAifQ%3D%3D&mrkid=654508
(P) The U.S. Opioid Crisis: How Can We Remedy?, by Walker Ray, MD and Tim Norbeck , https://www.forbes.com/sites/physiciansfoundation/2018/01/03/the-u-s-opioid-crisis-how-can-we-remedy/#140cd2803768
(Q) The opioid crisis, by Alfred S. Regnery, https://www.washingtontimes.com/news/2018/jan/4/opioid-crisis-is-public-health-emergency-but-its-a/
(R) Opioid crisis: Drug companies, health insurers must step up, by JOSH SHAPIRO, https://www.newsitem.com/articles/opioid-crisis-drug-companies-health-insurers-must-step-up/
(S) Christie grants $35M toward opioid treatment, by Vince Calio, http://www.njbiz.com/article/20180103/NJBIZ01/180109968/christie-grants-35m-toward-opioid-treatment
(T) Sessions nixes Obama-era rules leaving states alone that legalize pot, by Laura Jarrett, https://www.fiercehealthcare.com/healthcare/antibiotic-resistance-research-superbugs-alternative-therapies?mkt_tok=eyJpIjoiTVRFMU4ySTROemM0WWpVNSIsInQiOiJPYWdRdHZEaUZWSXZrVEluUWE5OTRuZVVoMTJGdmhaMVdJbFFUVUtYZjFHUzJmRFI0ZWlyWkVBeWdkUmJCQ2NOVmY3OTlyZTdZUzl0eEc5Zk12N2U5VW1ld0tseFF4YVJsRjFHenI4R25VZ0ZQUG1hNjdOamdjY2crSTZDYmNmTiJ9&mrkid=654508
(U) Trump administration fires all members of HIV/AIDS advisory council, by Ben Guarino, https://www.washingtonpost.com/news/to-your-health/wp/2017/12/29/trump-administration-fires-all-members-of-hivaids-advisory-council/?utm_term=.fcc415cc633c