Tagged CDC

Federal Grants ‘A Lifesaver’ In Opioid Fight, But States Still Struggle To Curb Meth

In his 40 years of working with people struggling with addiction, David Crowe has seen various drugs fade in and out of popularity in Pennsylvania’s Crawford County.

Methamphetamine use and distribution is a major challenge for the rural area, said Crowe, the executive director of Crawford County Drug and Alcohol Executive Commission. But opioid-related overdoses have killed at least 83 people in the county since 2015, he said.

Crowe said his organization has received just over $327,300 from key federal grants designed to curb the opioid epidemic. While the money was a godsend for the county — south of Lake Erie on the Ohio state line — he said, methamphetamine is still a major problem.

But he can’t use the federal opioid grants to treat meth addiction.

“Now I’m looking for something different,” he said. “I don’t need more opiate money. I need money that will not be used exclusively for opioids.”

The federal government has doled out at least $2.4 billion in state grants since 2017 to address the opioid epidemic, which killed 47,600 people in the U.S. that year alone. But state officials noted that drug abuse problems seldom involve only one substance. And while local officials are grateful for the funding, the grants can be spent only on creating solutions to combat opioids, such as prescription OxyContin, heroin and fentanyl.

According to the most recent data from the Centers for Disease Control and Prevention, 11 states have reported that opioids were involved in fewer than half of their total drug overdose deaths in 2017, including California, Pennsylvania and Texas.

The money is also guaranteed for only a few years, which throws the sustainability of the states’ efforts into question. Drug policy experts said the money may not be adequate to improve the mental health care system. And more focus is needed on answering the underlying question of why so many Americans struggle with drug addiction, they said.

“Even just the moniker, like ‘the opioid epidemic,’ out of the gate, is problematic and incorrect,” said Leo Beletsky, an associate professor of law and health sciences at Northeastern University in Boston. “This was never just about opioids.”

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States received federal funds for opioids primarily through two grants: State Targeted Response and State Opioid Response. The first grant, authorized by the 21st Century Cures Act, totaled $1 billion. The second pot of money, $1.4 billion — approved as part of last year’s omnibus spending bill — sets aside a portion of the funding for states with the most drug poisoning deaths.

For states like Ohio and Pennsylvania, the need was great. Nearly 4,300 and 2,550 residents, respectively, died from opioid-related overdoses in 2017. State officials say the money enabled them to invest significantly in programs like training medical providers on addiction, more access points to treatment and interventions for special populations, like pregnant women. Ohio was awarded $137 million in grants; Pennsylvania, $138.1 million.

The grants also stipulate a minimum amount of money for every state, so even areas with reportedly low opioid-related overdose death rates now have considerable funds to combat the crisis. Arkansas, for example, reported 188 opioid-related deaths in 2017 and received $15.7 million from the federal government.

While 2,199 people in California died from opioid-related causes in 2017, its opioid death rate was one of the 10 lowest in the country. The Golden State received $195.8 million in funding, more than any other state.

“This funding is dedicated to opioids,” said Marlies Perez, a division chief at the California Department of Health Care Services, “but we’re not blindly just building a system dedicated just to opioids.”

Mounting evidence points to a worrisome rise in methamphetamine use nationally. The presence of cheap, purer forms of meth in the drug market coupled with a decline in opioid availability has fueled the stimulant’s popularity. The number of drug overdose deaths involving the meth tripled from 2011 to 2016, the CDC reported. Hospitalizations involving amphetamines — the class of stimulants that includes methamphetamine — are spiking. And it is harder to address. Treatment options for this addiction are narrower than the array available for opioids. In light of the increase in deaths related to other substances, are these grants the best way to fund states’ response to opioids?

Bertha Madras, a professor of psychobiology at Harvard Medical School and a former member of the federal Opioid and Drug Abuse Commission, said the federal government has responded well by tailoring the response to opioids because those drugs continue to kill tens of thousands of Americans per year. But, she said, as more people living with addiction are identified and other drugs rise in popularity, the nation’s focus will need to change.

Beletsky emphasized that the grants are insufficient to support fixes to the mental health care system, which must respond to patients living with an addiction of any kind.

People addicted to a particular substance typically use other drugs as well. Controlling addiction throughout a person’s life can be akin to “whack-a-mole,” said Dr. Paul Earley, president of the American Society of Addiction Medicine, because they may stop using one substance only to abuse another. But specific addictions may also require specific treatments that cannot be addressed with tools molded for opioids, and the appropriate treatment may not be as available.

“I think we have to really begin to self-examine why this country has so much substance use to begin with,” Madras said.

Why So Many Older Americans Rate Their Health As Good Or Even Excellent

A common myth about aging is that older adults are burdened by illness and feel lousy much of the time. In fact, the opposite is usually true. Most seniors report feeling distinctly positive about their health.

Consider data from the 2017 National Health Interview Survey (the most recent available), administered by the U.S. Centers for Disease Control and Prevention. When asked to rate their overall health, 82% of adults ages 65 to 74 described it as excellent (18%), very good (32%) or good (32%) — on the positive side of the ledger. By contrast, 18% of this age group had a negative perspective, describing their health as fair (14%) or poor (4%).

This trend toward positivity is also evident among adults age 75 and older: 73% of this group said their health was excellent (12%), very good (28%) or good (33%), while only 27% gave a fair (20%) or poor (7%) evaluation.

How could this be true when the majority of older adults — about 60% — have two or more chronic illnesses, such as diabetes, arthritis, hypertension, heart disease or kidney disease, and higher rates of physical impairment than other age groups?

The answer lies in how older adults think about their health. For many, good health means more than the lack of illness or disability. The components of health they tend to value more are vitality, emotional well-being, positive social relationships, remaining active and satisfaction with life, while poor physical functioning plays a less important role.

“Being healthy means being able to continue doing what I like: going to the theater, organizing programs, enjoying the arts, walking,” said Lorelei Goldman, 80, of Evanston, Ill., who has had ovarian and breast cancer. She also describes her health as “good.”

“I have all my faculties and good, longtime friendships,” Goldman continued. “I used to be a bad sleeper, but now I’m sleeping much better. Almost every day, there are moments of clarity and joy. I’m involved in a lot of activities that are sustaining.”

Even when older adults are coping with medical conditions and impairments, they can usually think of people their age who are worse off than they — those who have died or gone to nursing homes, said Ellen Idler, a professor of sociology at Emory University in Atlanta and a leading researcher in the field of “self-rated health.” By comparison, seniors still able to live on their own may feel “I’m doing pretty well.”

At some point, merely surviving can be interpreted as a sign of good health. “People hit their 80s and 90s, look around and feel pretty good about just being alive,” Idler said.

That isn’t true for younger adults, who measure their health against an ideal “there shouldn’t be anything wrong with me” standard. But expectations for what constitutes good health change as people move into later life.

“Older people expect some deterioration in health and aren’t thrown off course in the same way when it occurs,” said Jason Schnittker, a professor of sociology at the University of Pennsylvania who has studied self-rated health.

Resilience is also at play. As older adults adapt to illness and other physical changes, they tend to adjust their outlook. “I may be handicapped, but I can still walk,” one 86-year-old woman told Swiss researchers after being hospitalized due to a fall and forced to use a stick to get around. She considered herself fortunate and rated her health positively. “As long as you can get to church, as long as you can walk, you can say all’s well,” a man in his 80s declared after becoming severely disabled because of a slipped disc in his spine and an embolism. He, too, felt good about his health.

Lest you think older adults’ bias toward positivity is a sign of denial or a lack of objectivity, a large body of research shows it’s highly meaningful. “Self-rated health is very strongly predictive of longevity” as well as other outcomes such as cognitive health and use of health care services, Schnittker noted.

Idler and Yael Benyamini, a professor at Tel Aviv University’s Bob Shapell School of Social Work, were among the first scholars to highlight the association between self-rated health and mortality in a much-cited 1997 study that examined research reports from around the world. The link was consistent even when adjustments were made for respondents’ medical conditions, medication use, health care utilization, socioeconomic status and other factors.

In a phone conversation, Benyamini offered two explanations for this finding, which has been widely replicated. People may be acutely attuned to subtle changes in their bodies, like increased pain or fatigue, that end up being significant but may be hard for doctors to detect. Also, people may factor in how multiple medical conditions interact and affect them — something that medical tests don’t pick up.

“Say you have diabetes, angina and osteoarthritis. How does this affect your life? It’s very individual — no one can tell from the outside — and it’s hard to put your finger on as a physician,” she said.

Another possible explanation is that people who feel healthy are more likely to be active and take care of themselves, making it likely they’ll survive longer, Benyamini said.

Of course, this positivity isn’t universal. African Americans, Hispanics, people with lower levels of income and education, and individuals with poor social connections are more likely to rate their health negatively as they age. At younger ages, women rate their health more poorly than men, but this changes in later life, with men becoming more likely to report worse health and women becoming more optimistic.

Sometimes, surveys assess self-rated mental health separately, and results for older adults again overturn common assumptions about negativity associated with older age. The National Social Life, Health, and Aging Project, spearheaded by investigators at the University of Chicago, found that fewer than 1% of adults (ages 57 to 97) rated their mental health as poor; just under 8% considered it fair; nearly 23% thought it was good; nearly 41% believed it was very good; and 28% judged it excellent. This data, based on a representative sample of 3,101 individuals surveyed in 2015, was provided upon request and has not yet been published.

“Mental health becomes an even more important component of self-rated health with age,” Schnittker said. Depression, in particular, appears to be a negative influence, affecting how people view their circumstances.

Although Laurie Brock, 69, of Denver, has severe arthritis and systemic lupus erythematosus, she considers her health “very good” and credits her optimism, her close relationships and her “extremely active life.” Poor health would mean being bedridden, “not being able to go out or be as mobile as I am” or extended suffering, she said.

“My attitude now is ‘I’ve lived 70 good years, and I hope the next years are rich as well,” Brock said. “I think most people fear old age. But once they get there, it’s like, ‘Oh, I’m still going, I’m still OK.’ And fear becomes acceptance.”

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