Though the HHS and DHS have bungled the reunification effort beyond comprehension, the blame ultimately lies with the Trump White House. Officials were well aware that the “zero tolerance” policy would result in family separation, but no consideration was given as to how to reunite parents with their children. Federal agencies tasked with cleaning up the mess caused by the administration’s recklessness have been overwhelmed and underprepared. The system at the border wasn’t designed to hold unaccompanied toddlers in custody, and no apparatus was put in place for reuniting scared children with parents who may have been deported, may have been released into the United States or may still be in custody.” (A)
“The government’s top health official could barely conceal his discomfort.
As Health and Human Services secretary, Alex Azar was responsible for caring for migrant children taken from their parents at the border. Now a Democratic senator was asking him at a hearing whether his agency had a role in designing the Trump administration’s “zero tolerance” policy that caused these separations.
The answer was no.
“We deal with the children once they’re given to us,” responded Azar. “So we don’t — we are not the experts on immigration.”
Separating families while sidelining the agency responsible for caring for the children was only one example of a communication breakdown in the federal government that left immigrant children in limbo, parents in the dark about their whereabouts and enraged Americans across the country.
Today, the Trump administration is still dealing with the fallout: It’s still not clear how officials will implement the policy or comply with a court order requiring that families be reunited within 30 days.
Instead, the administration is hoping Congress will fix the mess, despite its recent failure to pass immigration legislation.
“We are happy to change the policy when Congress gives us the tools to do it. That’s what we’re asking for,” Marc Short, White House director of legislative affairs, said on MSNBC.” (B)
“Federal officials are struggling to reunite migrant children with their families despite a court deadline, and agencies do not have the resources or procedures to help thousands of children detained at the border back into the arms of their parents, according to a dozen current and former officials, advocates and experts.
With a July 10 deadline looming, staffers at the Office of Refugee Resettlement, the division within HHS that oversees the care of unaccompanied children, have received no instructions on how to proceed, the sources say.
“It’s been really difficult to start the reunification process because we just don’t have a lot of direction from leadership,” said one official at the refugee office, who spoke on the condition of anonymity. “That’s been slowing things up, because there’s just been a lot of confusion.”
U.S. District Court Judge Dana Sabraw ruled last week that the Trump administration had until July 10 to reunite migrant children under 5 with their parents, and until July 26 to reunite the rest. But the refugee office is still struggling to answer basic questions such as how many children in its custody were separated from their parents.” (C)
“One thing that has been the case for many, many years that is particularly problematic as it relates to reuniting families is that ICE tends to move people in its custody frequently. In the time that a parent is in ICE custody, he or she might be in four different facilities in very, very different parts of the country, moved with no warning, without having any sort of attorney that’s tracking their whereabouts. I am familiar with an attorney who was representing an ICE detainee who couldn’t locate their own client. This has been a common practice within ICE. I am trying to facilitate communication right now between a dad and his daughter. He has already been in a couple of different facilities and doesn’t have anyone that is representing him, and therefore his daughter, who is currently across the country from where he is located, hasn’t been able to get in touch with him. She has a caseworker through the Office of Refugee Resettlement who has called ICE multiples times, left ICE multiple messages, and nobody has called back.” (D)
“Relatives of migrant children who were separated from their parents at the US-Mexico border are being forced to cover huge airfare costs in order to be reunited…
But for a migrant child to leave one of these facilities, parents and other relatives are required to pay hundreds or even thousands of dollars to cover the one-way plane ticket and a return ticket for an adult escort, according to report from The New York Times.
Marlon Parada, a construction worker in California, was told by authorities his cousin’s 14 year-old-daughter, who was separated from her mother at the border, couldn’t travel by bus and instead he had to pay the $1,800 airfares from Houston to Los Angeles. “They notified me a day before her release,” Parada told The Times. “I had no choice.”..
But the recent separation of migrant families has meant parents are often still being held in detention. It is now falling to relatives, many who earn just a few hundred dollars a week, to use their savings or rely on donations to be able to have the children released into their custody…
Aside from airfares, The Times also reported that all family members who will live in the home of a migrant child are also being forced to provide fingerprints to Immigration and Customs Enforcement (ICE).” (E)
“After a court order to reunite more than 2,000 migrant children who were separated from their parents in May and June, the Trump administration has instructed immigration agents to give those parents two options: leave the country with your kids — or leave the country without them, according to a copy of a government form obtained by NBC News.
The new instructions to agents do not allow parents who were separated from their children under President Donald Trump’s “zero tolerance” policy to reunite with their children while they await a decision on asylum, a protection sought by thousands of migrant families fleeing violence in Central America.
Advocates say that even migrants who have already passed their initial asylum screenings are being presented with the form. “We are seeing cases where people who have passed credible fear interviews and have pending asylum claims are being given this form,” said Lee Gelernt, a lawyer with the American Civil Liberties Union who is leading a class action lawsuit for family reunification.” (F)
(A) Meanwhile, at the Border, Migrant Families Are Still Separated, by Ryan Bort, https://www.rollingstone.com/politics/politics-news/family-separation-stats-
(B)Trump administration agencies confused over border separations, by Jae C. Hong,https://www.nbcnews.com/health/health-news/trump-administration-agencies-confused-over-border-separations-n888276
(C) As deadline looms, Trump officials struggle to reunite migrant families, by TED HESSON and DAN DIAMOND, https://slate.com/news-and-politics/2018/07/child-separation-now-why-its-still-so-difficult-for-immigrant-families-to-be-reunited.html
(D) “This Entire System Is Designed to Make Things Impossible for Immigrants”, by ISAAC CHOTINER, https://slate.com/news-and-politics/2018/07/child-separation-now-why-its-still-so-difficult-for-immigrant-families-to-be-reunited.html
(E) Immigrant families are being forced to pay massive airfares to reunite with children separated by the Trump administration, by Tara Francis Chan,
https://www.msn.com/en-us/news/politics/immigrant-families-are-being-forced-to-pay-massive-airfares-to-reunite-with-children-separated-by-the-trump-administration/ar-AAzspJf
(F) New Trump admin order for separated parents: Leave U.S. with kids or without them, by Julia Ainsley and Jacob Soboroff, https://www.nbcnews.com/politics/immigration/new-trump-admin-order-separated-parents-leave-u-s-kids-n888631
From 1967 to 1970, during the Vietnam War, I served first as a 2nd Lieutenant and Chief Administrative Officer of the 4th Casualty Staging Flight attached to Wilford Hall USAF Medical Center, Lackland AFB in San Antonio, Texas. We received combat casualties still in battlefield bandages, often within 24 hours of injury, and either admitted them to Wilford Hall or further transported them to hospitals near home.
Here’s what hospital care looked like during the Revolutionary War period.
“When the Revolutionary War began its actual skirmishes in 1776, early attempts to prepare for the medical needs related to War were made in the City of New York. During the spring and summer of 1776, Samuel Loudon was publishing his newspaper the New York Packet, in which he included numerous articles and announcements regarding the Continental Army. On July 29, for example, came the following announcement written by Thomas Carnes, Stewart and Quartermaster to the General Hospital of King’s College, New York. Anticipating an increase demand for medically trained staff, he filed the following request for volunteers:
“GENERAL HOSPITAL New-York, July 29, 1776 Wanted immediately in the General Hospital, a number of women who can be recommended for their honesty, to act in the capacity of nurses: and a number of faithful men for the same purpose…King’s College, New York” (A)
“One of the most famous surgeons, and the first, was Cornelius Osborn. He was recruited in the Spring of 1776 and had little training even as a physician. The Continental Congress was even concerned about the well-being of the troops and the militia. They passed several ordinances and helped establish the order for the several field Hospitals during the War. The hospitals served about 20,000 men in the fight. Each hospital was required for each surgery to have at least one physician or surgeon, and one assistant, which was usually and apprentice of some sort. Each hospitals staff numbers varied on how many wounded it served and the severity of the wounds….
Most of the deaths in the Revolutionary War were from infection and illness rather than actual combat. The common practice if a limb was badly infected of fractured was amputate it. Where most amputees died of gangrene a result of not properly cleaning instruments after surgeries. Only 35% of amputees actually survived surgery. There was no pain killers quite developed back then. So at most the patient were given alcohol and a stick to bite down on while the surgeon worked. Two assistant would hold him down, a good surgeon could perform the entire process in a mere 45 seconds, after which the patient usually went into shock and fainted. This allowed the surgeon to stich up the wound, and prepare for the next amputation. Another way they decided to clean wounds, disease, or infection was by applying mercury directly to the cut of injured space, and letting it run through the blood stream which usually resulted in death.” (B)
“To seek treatment for any serious ailment, a soldier would have had to go to a hospital of sorts. Military regiments had a surgeon on staff to care for the men, so the soldier’s first stop would be with the surgeon. During battles, the surgeon could be found in a makeshift or “flying” hospital that consisted of a tent, an operating table, and some medical equipment. If the surgeon could not treat the soldier, he might be sent to a hospital. Many regimental hospitals were in nearby houses, while general hospitals for more in-depth treatment were sometimes set up in barns, churches, or other public buildings. The conditions were often cramped, which resulted in the rapid spread of contagious illnesses and infections….
Woe to the soldier who required surgery after being wounded on the battlefield! The conditions in “flying” hospitals were deplorable. Not only was the operating room simply a table in a tent, but there was little thought given to keeping the table and tools clean. In fact, wounds were sometimes cleaned using plain water from a bucket, and the used water would be saved to clean out the next soldier’s wounds as well. (C)
Hospitalization was a serious problem during the American Revolutionary War. Plans were made quite early to care for the wounded and sick, but at the best they were meager and inadequate. However on April 11, 1777 Dr. William Shippen Jr., of Philadelphia was chosen Director General of all the military hospitals for the army. Consequently the reorganization of hospital conditions took place.
Four hospital districts were created: Easter, Northern, Southern and Middle. The wage scale was as follows: Director General’s pay $6.00 a day and 9 rations; District Deputy Director $5.00 a day and 6 rations; Senior Surgeon $4.00 a day and 6 rations; Junior Surgeon $2.00 and 4 rations; Surgeon mate $1.00 and 2 rations.
After the battle of Brandywine, September 11, 1777, hospitals were established at Bethlehem, Allentown, Easton and Ephrata. After the battle of Germantown, October 4, 1777, emergency hospitals were organized at Evansburg, Trappe, Falkner Swamp and Skippack. Hospitals at Litiz and Reading were also continued. By December 1777, new hospitals were opened at Rheimstown, Warwick and Shaeferstown. Yellow Springs (now Chester Springs) an important hospital was organized under the direction of Dr. Samuel Kennedy. At Lionville, Uwchlan Quaker Meeting House was also made a hospital for a time. Apothecary General Craigie’s shop, Carlisle, was the source of hospital drugs….
It seems there was carelessness in making necessary health reports, consequently Washington ordered on January 2, 1778: “Every Monday morning regimental surgeons are to make returns to the Surgeon Gen’l. or in his absence to one of the senior surgeions, present in camp or otherwise under the immediate care of the regimental surgeons specifying the mens names Comps. Regts. and diseases.” [Weedon’s Valley Forge Orderly Book, p. 175]
January 13, 1778. “The Flying Hospitals are to be 15 feet wide and 25 feet long in the clear and the story at least 9 feet high to be covered with boards or shingles only without any dirt, windows made on each side and a chimney at one end. Two such hospitals are to be made for each brigade at or near the center and if the ground permits of it not more than 100 yards distance from the brigade.” [Weedon’s Valley Forge Orderly Book, p. 191] The Commander-in-Chief always solicitous about the comfort of his soldiers issued the following order January 15, 1778: “The Qr. Mr. Genl. is positively ordered to provide straw for the use of the troops and the surgeons to see that the sick when they are removed to huts assigned for the hospital are plentifully supplied with this article.” [Weedon’s Valley Forge Orderly Book, pp. 192-199-204-216] “ (D)
(A) https://brianaltonenmph.com/6-history-of-medicine-and-pharmacy/hudson-valley-medical-history/revolutionary-war-doctor/
(B) https://prezi.com/uwl_a877t2ia/hospitals-and-medicine-during-the-revolutionary-war/
(C) http://www.dosespot.com/medicine-in-the-revolutionary-war
(D) http://www.ushistory.org/valleyforge/served/surgeons.html
“Just seven weeks after an Ebola outbreak was discovered in the Democratic Republic of Congo, it’s already looking like the end is in sight.
According to the DRC’s health ministry, as of June 28, all people who were potentially exposed to the Ebola virus have finished a 21-day incubation period. It can take that long for a person exposed to Ebola to show symptoms of the disease. All those people remaining healthy means the epidemic is under control.
Oly Ilunga Kalenga, the DRC’s health minister, said in a statement, “This is an important milestone in the Ebola response, as it marks the start of the countdown towards the end of the ninth Ebola outbreak in the Democratic Republic of Congo.”
It’s also a testament to what can happen when national and international health officials work together to swiftly stop the virus from harming and killing people. We know how to stop outbreaks of Ebola, and we just proved it again in the DRC.
What this means is that with some effort and coordination, the world can rapidly stamp out an Ebola outbreak. What this doesn’t mean is that the world is ready for the next pandemic…
Still, it’s too early to declare total victory over Ebola or any other pandemic threat for several reasons…
This combination of experience with a known virus, a vaccine, and a relatively convenient geography won’t be there in every outbreak. That’s why it’s too early” (A)
“The DRC’s previous experiences with Ebola has also proved useful. The MSF rapidly employed 470 trained experts in the field, mainly locals – who all knew how to deal with an outbreak. Extensive surveillance, rapid detection and diagnosis are key, as well as comprehensive tracing of contacts, prompt patient isolation, supportive clinical care and rigorous efforts to prevent and control infection. And then there is the question of safely engaging local and remote communities with appropriate and dignified burial of the victims.
The response “has been swift and rigorous”, says professor Peter Piot, director of the London School of Hygiene and Tropical Medicine and part of the team that first discovered the virus. “The DRC has a strong record of containing Ebola outbreaks, and I am not surprised the Congolese are once again doing a good job,” he adds.
Crucially, in the DRC there has been no deadly delay in administering intravenous fluids. The DRC Ministry of Health, MSF and other NGOs quickly set up several Ebola treatment centres. There is a 12-bed unit in Mbandaka and a 20-bed centre in Bikoro, which also has a survivors’ clinic for post-Ebola complications and mental health issues. Further afield in Kinkole, the suburbs of the capital Kinshasa, there is a ten-bed unit that was completed with training of health care workers covering personal protection measures, treatment procedures and transport of patients. There is also a unit in Itipo.” (B)
“Ebola is endemic to Congo’s rain forests. Because of its prevalence in the country, Congo’s health officials have had more practice than anyone else in containing the virus, and they are generally reputed to be the most skilled at it in the world.
But Ebola is not a virus that one simply contains and forgets about.
“As Ebola is a virus whose natural reservoir is located in the Equatorial Forest, we must prepare ourselves for the 10th Ebola outbreak,” said Ilunga.
“Moreover, with the greater mobility of the population, we can expect to have other outbreaks in urban zones in the future. We must learn the lessons from this response and strengthen our system in order to detect and respond even more efficiently to the next outbreak.”” (C)
“On average, in one corner of the world or another, a new infectious disease has emerged every year for the past 30 years: mers, Nipah, Hendra, and many more. Researchers estimate that birds and mammals harbor anywhere from 631,000 to 827,000 unknown viruses that could potentially leap into humans. Valiant efforts are under way to identify them all, and scan for them in places like poultry farms and bushmeat markets, where animals and people are most likely to encounter each other. Still, we likely won’t ever be able to predict which will spill over next; even long-known viruses like Zika, which was discovered in 1947, can suddenly develop into unforeseen epidemics.” (D)
“The first confirmed human case of Keystone virus has been diagnosed in a Florida teen, but it’s likely that infection with the mosquito-borne disease is common among state residents, researchers report.
The virus can cause a rash and mild fever. It’s named after the location in the Tampa Bay area where it was first identified in 1964. It has been found in animals along U.S. coastal regions from Texas to the Chesapeake Bay.
University of Florida researchers describe the case of a teenage boy who went to an urgent care clinic in North Central Florida with a rash and fever in August 2016, during the Zika virus epidemic in Florida and the Caribbean.
Tests on the patient were negative for Zika or related viruses, but did reveal Keystone virus infection, according to the study published June 9 in the journal Clinical Infectious Diseases.
“Although the virus has never previously been found in humans, the infection may actually be fairly common in North Florida,” said corresponding author Dr. J. Glenn Morris. He is director of the university’s Emerging Pathogens Institute.
“It’s one of these instances where if you don’t know to look for something, you don’t find it,” he added in a university news release.”” (E)
“A bird flu that started in China five years ago has slowly started to spread. Some experts worry it could be this year’s “Disease X.”
New fears are starting to grow as there’s a strain of bird flu that’s killed over one-third of those it infects. Some experts warn that it has the potential to be the next pandemic.
As of June 15, 1,625 people in China have become infected with this virus and 623 are now dead — a total of 38 percent…
However, one good piece of news is that the virus doesn’t infect humans very easily. Most bird flu infections are transmitted between birds and only spread to humans who have close contact with the animals…
Although this virus was found in China, experts worry that in today’s globalized world it can have ramifications across continents.
This year, experts have already detected cases of global spread: Two cases of the virus were seen in Canada and one case in Malaysia. The CDC also reported that two cases of H7N9 were found on farms in Tennessee last year, despite having weaker features for human transmission.” (F)
“Reports are now emerging that these efforts succeeded and officials are cautiously optimistic that the outbreak is over. Health workers used a “ring vaccination” strategy in which all contacts of known patients were vaccinated to stop the spread. Surprisingly, the acceptance of the vaccine was very high with almost everyone offered the vaccine agreeing to be vaccinated. Furthermore, the supply of Merck’s vaccine is far from exhausted. The company has a stockpile of 300,000 emergency use doses.
J&J is still pushing forward with their vaccine efforts as well. While Merck’s vaccine is ideal for “ring vaccination”, J&J’s approach uses a two-part vaccine which could enable it to be longer lasting. Thus, these vaccines could complement each other. J&J has already tested its vaccine on 5,000 volunteers in 11 different trials and has confirmed both its safety and its ability to generate an immune response.
Here are two of the world’s largest pharmaceutical companies working on an Ebola vaccine – a vaccine that offers NO potential for financial return. These same R&D efforts could easily be used to find vaccines that are needed in the western world, vaccines that certainly would prove to be financially rewarding…” (G)
“The next global epidemic is likely around the corner—and no amount of U.S. retrenchment from globalization will halt that outbreak at the U.S. border…
Klain identified several large gaps in U.S. preparedness for the next global outbreak.
• A leadership gap. “There is no one at the White House right now who is in charge of this problem,” Klain said.
• A funding gap. “We’re underfunding, underinvesting” in preparedness, he said.
• A facilities and training gap. Klain said that there was exhaustive training of first responders carried out right after the Ebola outbreak in 2014. But there are other diseases for which they are still unprepared. “Training needs to be renewed. People need to be drilled,” he said. “Our first responders need to be trained. We need better and more facilities.”
• A science gap. “We haven’t yet developed all the vaccines and the therapeutics we need,” Klain added.
• A policy gap. “The holes in American law that we need to fill about licensing people in medical emergencies to practice in other states or,” he said, “using the Stafford Act”—the federal law that governs relief and emergency assistance for state and local governments during a natural disaster—“to respond to emergencies.”
But the biggest gap, he said, is the global gap: “We can’t be safe here in America when there’s a risk of pandemics around the world,” Klain said. “The world’s just too small. Diseases spread too quickly. … There is no wall we can build that is high enough to keep viruses and the disease threat out of the United States. We have to engage in the world.”” (H)
“Ebola is one of a series of previously unknown diseases – others include Sars and Zika – that have recently appeared without warning and devastated communities, having jumped from animal populations to humans. HIV spread to humans from chimpanzees, for example.
And in future new killers will emerge as humans spread into previously inaccessible areas and come into contact with infected creatures, causing deadly new pandemics.
Now a group of scientists believe they have solution. They have launched a remarkable new project which aims to spot the next pandemic virus. The international initiative is known as the Global Virome Project (GVP) and it aims to pinpoint the causes of fatal new diseases before they start to make people ill.
Advocates of the project say they will achieve this remarkable task by genetically characterising viruses found in wild animals – particularly those that have been major sources of viruses deadly to humans. By pinpointing viruses at greatest risk of infecting humans,, counter-measures, such as vaccines can be prepared.” (I)
“The big picture: The total number of outbreaks every 10 years “has more than tripled since the 1980s,” Yong says. Bill Gates told Yong that if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days.
“Boy, do we not have our act together.” — Bill Gates” (D)
(A) Good news: the Ebola outbreak in DRC is contained, by Julia Belluz, https://www.vox.com/2018/6/29/17518144/ebola-outbreak-drc-contained
(B) How science beat Ebola, by Alexander Kumar, http://www.wired.co.uk/article/ebola-vaccine-outbreak
(C) We Have Some Great News About The Ebola Outbreak in Congo, https://www.sciencealert.com/congo-ebola-outbreak-may-be-finally-contained
(D) The Next Plague Is Coming. Is America Ready?, by Ed Yong, https://www.theatlantic.com/magazine/archive/2018/07/when-the-next-plague-hits/561734/
(E) Florida teen first human case of another mosquito-borne virus, https://medicalxpress.com/news/2018-06-florida-teen-human-case-mosquito-borne.html
(F) This Strain of Bird Flu Kills One-Third of Patients, by Rajiv Bahl, https://www.healthline.com/health-news/this-strain-of-bird-flu-kills-one-third-of-patients#5
(G) Big Pharma Rises To The Ebola Challenge, by John LaMattina, https://www.forbes.com/
(H) How Will Trump Lead During the Next Global Pandemic?, Krishnadev Calamur, https://www.theatlantic.com/health/archive/2018/06/the-next-epidemic/563546/
(I) Scientists aim to stop the devastation of Zika-like pandemics, by Robin McKie, https://www.theguardian.com/science/2018/jun/24/global-pandemic-prevented-map-animal-virus-ebola-sars-zika
Congress goes on vacation again without addressing immigrant family separation
“The House rejected the GOP’s compromise immigration measure Wednesday following weeks of negotiations and a last-minute endorsement from President Donald Trump.
Lawmakers overwhelmingly rejected the bill in a 121-301 vote, falling short of the roughly 218 votes needed to pass. No Democrats voted in favor of the bill.
While 121 Republicans voted in favor of the bill, 112 Republicans voted against it even after the president called on them to support the measure this morning. A number of those who opposed the legislation are members of the conservative Freedom Caucus…
The compromise bill would have provided nearly $25 billion in funding for Trump’s border wall, limited legal and illegal immigration, provided protection from deportation and a path to citizenship for 1.8 million Dreamers, and keep undocumented families together who had crossed the border if the parents were facing prosecution.” (A)
“The government was separating migrant parents from their kids for months prior to the official introduction of zero tolerance, running what a U.S. official called a “pilot program” for widespread prosecutions in Texas, but apparently did not create a clear system for parents to track or reunite with their kids…
A DHS official told NBC News that the practice of dividing parents and kids predates the Trump presidency. “DHS has continued a long-standing policy by the previous administration,” said the official, listing risk to the child and criminal prosecution of the parent as among the reasons for separation…
The idea of separating migrant children from their mothers was discussed during the earliest days of the administration as a way to deter asylum-seekers, according to notes from an asylum officers’ meeting.” (B)
“… The past few weeks in the family separation crisis, which led on Tuesday to a District Court judge in California ordering the Trump administration to cease the practice and immediately reunite separated families, should mark a clarifying moment for the citizens of this country…
This is just an order, though. We have to see how the Trump administration responds to it. Given recent history—the government has been waging a bitter campaign to defend its child separation practice and avoid family reunification—it seems as though this president will try to get away with anything he can. Further, reunification may be nearly impossible in some cases—as the judge noted, there have been reports of parents being deported without their children, and the government has taken many infants who may not even be able to say their parents’ names.
In the midst of this crisis, the congressional majority has wholly abdicated its constitutional responsibility to conduct oversight of the Trump administration; its failure to hold emergency hearings is the point of abject disaster. That these crimes against humanity didn’t prompt Congress to act tells us nothing ever will. Only a dead heart is unstirred by the intentional infliction of suffering on children and babies as a weapon of deterrence.” (C)
“Congress members have left town for a week-long Fourth of July recess without taking action to stop the continuing crisis of family separations at the U.S.-Mexico border.
House and Senate leaders had expressed hope that Congress could act quickly this week to pass a narrow bill that would allow migrant children to remain with their parents at detention centers beyond the current 20-day limit. At least five bills have been offered so far, but lawmakers have been unable to unite around any one of them.
Both chambers adjourned Thursday without a solution. They will return on July 9.” (D)
(A) House overwhelmingly rejects compromise immigration bill despite Trump support, by Rebecca Shabad, https://www.nbcnews.com/politics/congress/reversing-course-last-minute-trump-calls-house-gop-pass-immigration-n886916
(B) Trump admin ran ‘pilot program’ for separating migrant families in 2017, by Lisa Riordan Seville and Hannah Rappleye, https://www.nbcnews.com/storyline/immigration-border-crisis/trump-admin-ran-pilot-program-separating-migrant-families-2017-n887616
(C) Will President Trump Ignore the Court Order Against His Lawless Family Separation Policy?, by WALTER M. SHAUB JR., https://slate.com/news-and-politics/2018/06/will-president-trump-ignore-the-court-order-against-his-family-separation-policy.html
(D) Congress leaves town without voting on fix to stop family separations at border, by Erin Kelly, https://www.usatoday.com/story/news/politics/2018/06/29/congress-leaves-town-without-voting-fix-stop-family-separations/745304002/
“Alex M. Azar II, the secretary of health and human services, told a Senate committee on Tuesday that his department had custody of 2,047 migrant children who had been separated from their parents.
Before releasing the children to parents or other relatives, he said, the government must “vet them.” That task can take weeks, officials said.
“These children are often being captured by traffickers, gangs, cartels,” Mr. Azar said. “That journey through Mexico is a horrific journey of rape and violence and deprivation. We do see traffickers and very evil people sometimes claiming to be the parents of children.”..
“We’re not allowed to have a child be with the parent who is in custody of the Department of Homeland Security for more than 20 days,” Mr. Azar said. “And so, until we can get Congress to change that law to — the forcible separation of the family units — we’ll hold them or place them with another family relative in the United States.”
“We need Congress to fix that,” Mr. Azar said.
Mr. White said the Department of Health and Human Services was also holding, in its shelters, about 9,000 children who did not have a legal immigration status and were not accompanied by parents or guardians.” (A)
“Dozens of law enforcement officials from both parties wrote an open letter to top lawmakers on Wednesday urging them to adopt alternatives to the Trump administration’s policy of detaining immigrant families…
The officials wrote that while they were encouraged by President Trump’s order ending the policy of separating immigrant families at the border, they “do not believe that across-the-board family detention is the solution to family separation.”
“Most families do not pose a threat to the community at large and, accordingly, our juvenile detention system is designed around keeping the family together,” the letter reads.
The letter noted “risks to children’s physical and emotional development posed by prolonged detention,” and stated that “most” families “pose no threat to their communities.”
The officials also highlighted a cancelled Obama-era pilot program meant to keep immigrant families together and out of detention as a possible solution. The Trump administration cancelled the program last year, citing high costs.” (B)
“The Department of Health and Human Services’ (HHS) inspector general is launching a review of the conditions at the agency’s shelters for unaccompanied migrant children.
The probe will only focus on safety and health concerns, the Office of Inspector General (OIG) said Wednesday.
“Specifically, this review will focus on a variety of safety- and health-related issues such as employee background screening, employees’ clinical skills and training, identification and response to incidents of harm, and facility security,” the OIG said.
The inspector general’s office said it will review the efforts of HHS’s Office of Refugee Resettlement (ORR) “to ensure the safety and health of children placed at ORR facilities, especially when the program experiences a sudden increase in the number of children placed in its care.”
The federal watchdog said it will deploy teams of evaluators, auditors, investigators and lawyers on site-visits to ORR facilities across the country.” (C)
“HHS Secretary Alex Azar on Tuesday defended the administration’s tracking system, claiming that parents should be able to locate their children “within seconds” using an online government database. He said hundreds of children separated at the border have been placed with a parent or relative, though more than 2,000 kids remain in his department’s care.
The agencies also face logistical challenges as they work to put families back together. Bob Carey, who ran ORR under President Barack Obama, told POLITICO’s “Pulse Check” podcast on Tuesday that “all the systems” in the refugee office were developed to reunite children with parents who were already in the United States.
That’s very different from trying to reunify a child with a parent who may be in a detention facility,” he said.” (D)
“IN THE FACE of the Trump administration’s neglect and indifference toward the reunification of the thousands of immigrant families it has forcibly separated, some lawmakers, activists, and celebrities have called for the use of DNA testing, along with other biometrics, as a means to return some 3,700 children to their parents. So far, at least two direct-to-consumer genealogy companies have heeded those calls. MyHeritage and 23andMe have both offered to donate DNA sampling kits for the purposes of verifying kinship…
The founder of Silicon Valley startup 23andMe, Anne Wojcicki, tweeted that the company had reached out to RAICES, a prominent Texas-based immigrant aid group, who has been working on family reunifications for over 30 years. RAICES, however, sees the well-intentioned offer as potentially creating more problems than it solves.
“We appreciate the offer, but that’s not a strategy that we really agree with,” Jennifer Falcon, communications director at RAICES, told The Intercept. “These are already vulnerable communities, and this would potentially put their information at risk with the very people detaining them. They’re looking to solve one violation of civil rights with something that could cause another violation of civil rights.” (E)
“Melania Trump boarded a plane in Washington, D.C, Thursday morning en route to Arizona where she met with Border Patrol officials and visited a Phoenix shelter for migrant children…
“I’m here to support you and give my help wherever I can,” Trump said.
After a round-table discussion, during which the first lady heard from officials who work along the border, the first lady was given a tour of the US Customs and Border Protection Facility in Tucson.
Similar to her visit to Tucson, the first lady took part in a round table where she heard from officials at the Phoenix facility.
“It’s great to be here,” Trump said to the group. “I wanted to come here and see your facility and meet the children. And wanted to thank all of you for what you do.”
Trump said she was there to “support” them, adding “let me know what I can do to help you.”
The first lady asked several questions regarding the children: how many were there in the facility, what are their ages and how long do they typically stay in the facility.” (F)
“The Trump administration has more than 2,000 children it separated from their parents in its custody. In a six-day span, that number only went down by six children.
It’s still unknown, though, whether those children were reunited with parents, other family or otherwise transferred out of Health and Human Services custody, and the government has not answered questions about the circumstances of their release.” (G)
(A) Trump Administration Cites Difficulties in Meeting Judge’s Timetable for Family Reunification, https://www.nytimes.com/2018/06/27/us/politics/trump-immigration-borders-family-separation.html
(B) Police chiefs group opposes Trump policy detaining immigrant families, by JACQUELINE THOMSEN, http://thehill.com/latino/394508-police-chiefs-come-out-against-trump-policy-detaining-immigrant-families
(C) HHS watchdog launches probe into conditions at child detention centers, http://thehill.com/homenews/administration/394507-hhs-ig-launches-investigation-into-conditions-at-child-detention?utm_source=Sailthru&utm_medium=email&utm_campaign=Issue:%202018-06-28%20Healthcare%20Dive%20%5Bissue:15973%5D&utm_term=Healthcare%20Dive,
(D) Federal officials launch two reviews into Trump’s handling of migrant children, by DAN DIAMOND, https://www.politico.com/story/2018/06/27/trump-border-migrant-children-investigation-680626
(E) DNA TESTING MIGHT HELP REUNITE FAMILIES SEPARATED BY TRUMP. BUT IT COULD CREATE A PRIVACY NIGHTMARE, by Ava Kofman, https://theintercept.com/2018/06/27/immigration-families-dna-testing/
(F) From Tucson to Phoenix: Melania Trump tours immigration facilities in Arizona, https://www.wusa9.com/article/news/from-tucson-to-phoenix-melania-trump-tours-immigration-facilities-in-arizona/75-568631380
(G) In 6 Days, Trump Admin Reunited Only 6 Immigrant Children With Their Families, http://ktla.com/2018/06/27/in-6-days-trump-admin-reunited-only-6-immigrant-children-with-their-families/
“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
