Tagged opioids

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! Apologies for unexpectedly going MIA last week, but your girl here decided she needed some firsthand experience with the health care system via a trip to the emergency room. (Hot tip: Stay hydrated during stomach bug season, folks!) Many thanks to the wonderful Damon Darlin (also known as KHN’s executive editor) for filling in last week. Make sure to check it out if you missed it.

Onward to this week, though, where we’re finally starting to slow down as we drift toward the holidays.

“I hate to panic, but …” was a quote from NPR’s coverage of the health law enrollment numbers that pretty much summed up the atmosphere the day before the sign-up deadline. The big number to focus on here is that there are nearly 20 percent fewer new enrollees than at about this same time last year. The lag has advocates pointing nervous fingers at the Trump administration’s efforts to chip away at the health law.

But some experts eschew Chicken Little predictions (at least quite yet), saying that fewer sign-ups don’t necessarily mean more people will be uninsured. For one, the unemployment level is the lowest in decades (although that has nuances that are too complex to get into right here) so people who used to get health law plans might be covered by their employers. Secondly, the sign-up numbers don’t reflect anyone who is sticking with the plan they currently have.

Either way, we won’t have long to wait to see how it shakes out.

NPR: Enrollment in HealthCare.Gov Plans May Be Down for 2019

The Associated Press: Health Law Sign-Ups Lagging As Saturday Deadline Is Looming

Amid all that talk of sabotage and low numbers came a study that found 4.2 million Americans are actually eligible to get what amounts to free health care through the exchanges, as an unintended consequence of President Donald Trump nixing key health law payments last year.

The Hill: Study: 4.2 Million Uninsured People Eligible for Free ObamaCare Coverage


A quietly simmering debate over fetal tissue research brewing the past few months has started to come to a boil this week. (Although, if you’ve been reading your Morning Briefing regularly, this won’t come as a surprise.) Back in September, the administration launched an audit of all federally funded research that uses fetal tissue. The far-reaching ramifications were felt recently when a lab that has played an integral role in testing for HIV cures was put on notice that its funding could be canceled.

The sides are firmly drawn here and have deep roots in abortion politics (as witnessed in this quote from CQ’s coverage of Thursday’s heated House hearing on the topic: “Obviously the 800-pound gorilla in the room is that we know aborted tissue is being used,” said Georgia Republican Rep. Jody Hice).

With the National Institutes of Health signaling interest in pumping $20 million into finding an alternative to fetal tissue for research purposes, I don’t think this topic is going away anytime soon.

The New York Times: Fetal Tissue Research Is Curtailed by Trump Administration

The Hill: NIH to Fund Research Into Fetal Tissue Alternatives


The death of a 7-year-old Guatemalan girl who had been taken into Border Patrol custody is likely to intensify scrutiny of the care immigrants detained by the U.S. government are receiving. U.S. Customs and Border Protection said the girl had not eaten or consumed water in several days, and it’s unclear whether the agents had tried to rectify that situation. Advocates are saying the death is reflective of a “culture of cruelty” within the agency.

Meanwhile, there are nearly 15,000 migrant children in detention facilities in the country, where issues with background checks, abuse and neglect continue to make headlines.

The Washington Post: 7-Year-Old Migrant Girl Taken Into Border Patrol Custody Dies of Dehydration, Exhaustion

NPR: Almost 15,000 Migrant Children Now Held at Nearly Full Shelters

More voices are starting join the growing chorus of advocates, doctors and city leaders who oppose the administration’s proposed policy to penalize immigrants who are accepting government aid (such as Medicaid). It’s not just about public health, they say. The policy would also take a heavy financial toll.

Dallas Morning News: Dallas Mayor Says Trump Administration’s Proposed ‘Public Charge’ Rules Would Harm City’s Immigrants, Economy


There was some shade being thrown at the Supreme Court this week, when the justices declined to take up a case on state Medicaid funding and Planned Parenthood. Justice Clarence Thomas called out his conservative colleagues Chief Justice John Roberts and Justice Brett Kavanaugh for dodging the case. “So what explains the court’s refusal to do its job here? I suspect it has something to do with the fact that some respondents in these cases are named ‘Planned Parenthood,’” he wrote. The case itself was somewhat complex, but essentially the decision leaves in place Medicaid patients’ right to sue over provider issues.

The Associated Press: Justices Won’t Hear States’ Appeal Over Planned Parenthood


The maker of a device that reverses overdoses recently drew fire for jacking up the list price of its injector from $575 to $4,100 during a span of time that opioid-related deaths were also accelerating rapidly. As you can imagine, this did not go over well with either lawmakers or the public when it came to light. Now Kaleo, in damage-control mode, is releasing a generic version that comes with a $178 price tag. The whole journey is quite the snapshot of what’s going wrong with high health care costs.

Stat: Kaleo, Maker of $4,100 Overdose Antidote, to Offer Generic For $178

Speaking of, you have to check out the salacious details emerging in this case that started as an antitrust lawsuit against just two drugs and has ballooned into this sweeping investigation into price-fixing allegations in the generics marketplace.

The Washington Post: Generic Drug Price-Fixing Investigation Expands to 300 Drugs and 16 Companies

Pharma, meanwhile, is sweating over the Democrats taking power in the House. Once a political powerhouse of nearly mythological proportions, the industry has lost clout in recent years, and companies don’t think the new power structure will work in their favor.

Stat: Will Democrats in Congress Keep the Door Open for Pharma — or Slam It?


Whew! That was not as short as expected. Just in case you want some more great reads for your weekend, check out the miscellaneous file:

• What happens to your life when millions of people have witnessed you hit rock bottom? As the opioid epidemic dug deep roots into the country, there was this trend where videos and photos of people overdosing would go absolutely viral. Public health officials and cops at the time justified putting them up because the videos could act as a deterrent for drug use. For the people used as the face of the crisis, however, it was deeply life-altering.

The New York Times: How Do You Recover After Millions Have Watched You Overdose?

• Baby boomers are now aging alone more than any other generation in U.S. history. That isn’t just a sad statistic — it’s also a looming public health crisis. Loneliness has been as closely linked to early mortality as smoking up to 15 cigarettes or consuming more than six alcoholic drinks a day.

The Wall Street Journal: The Loneliest Generation: Americans, More Than Ever, Are Aging Alone

• A rash of recent headlines explores whether trauma is passed down through genes. It’s a very buzzy idea, but the evidence that trauma can leave a signature that lasts generations is circumstantial at best.

The New York Times: Can We Really Inherit Trauma?

 

I’ll leave you with some bah-humbug! warnings about not eating that raw cookie dough this holiday season (even though it’s clearly the best part of making cookies). Have a great weekend!

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! Apologies for unexpectedly going MIA last week, but your girl here decided she needed some firsthand experience with the health care system via a trip to the emergency room. (Hot tip: Stay hydrated during stomach bug season, folks!) Many thanks to the wonderful Damon Darlin (also known as KHN’s executive editor) for filling in last week. Make sure to check it out if you missed it.

Onward to this week, though, where we’re finally starting to slow down as we drift toward the holidays.

“I hate to panic, but …” was a quote from NPR’s coverage of the health law enrollment numbers that pretty much summed up the atmosphere the day before the sign-up deadline. The big number to focus on here is that there are nearly 20 percent fewer new enrollees than at about this same time last year. The lag has advocates pointing nervous fingers at the Trump administration’s efforts to chip away at the health law.

But some experts eschew Chicken Little predictions (at least quite yet), saying that fewer sign-ups don’t necessarily mean more people will be uninsured. For one, the unemployment level is the lowest in decades (although that has nuances that are too complex to get into right here) so people who used to get health law plans might be covered by their employers. Secondly, the sign-up numbers don’t reflect anyone who is sticking with the plan they currently have.

Either way, we won’t have long to wait to see how it shakes out.

NPR: Enrollment in HealthCare.Gov Plans May Be Down for 2019

The Associated Press: Health Law Sign-Ups Lagging As Saturday Deadline Is Looming

Amid all that talk of sabotage and low numbers came a study that found 4.2 million Americans are actually eligible to get what amounts to free health care through the exchanges, as an unintended consequence of President Donald Trump nixing key health law payments last year.

The Hill: Study: 4.2 Million Uninsured People Eligible for Free ObamaCare Coverage


A quietly simmering debate over fetal tissue research brewing the past few months has started to come to a boil this week. (Although, if you’ve been reading your Morning Briefing regularly, this won’t come as a surprise.) Back in September, the administration launched an audit of all federally funded research that uses fetal tissue. The far-reaching ramifications were felt recently when a lab that has played an integral role in testing for HIV cures was put on notice that its funding could be canceled.

The sides are firmly drawn here and have deep roots in abortion politics (as witnessed in this quote from CQ’s coverage of Thursday’s heated House hearing on the topic: “Obviously the 800-pound gorilla in the room is that we know aborted tissue is being used,” said Georgia Republican Rep. Jody Hice).

With the National Institutes of Health signaling interest in pumping $20 million into finding an alternative to fetal tissue for research purposes, I don’t think this topic is going away anytime soon.

The New York Times: Fetal Tissue Research Is Curtailed by Trump Administration

The Hill: NIH to Fund Research Into Fetal Tissue Alternatives


The death of a 7-year-old Guatemalan girl who had been taken into Border Patrol custody is likely to intensify scrutiny of the care immigrants detained by the U.S. government are receiving. U.S. Customs and Border Protection said the girl had not eaten or consumed water in several days, and it’s unclear whether the agents had tried to rectify that situation. Advocates are saying the death is reflective of a “culture of cruelty” within the agency.

Meanwhile, there are nearly 15,000 migrant children in detention facilities in the country, where issues with background checks, abuse and neglect continue to make headlines.

The Washington Post: 7-Year-Old Migrant Girl Taken Into Border Patrol Custody Dies of Dehydration, Exhaustion

NPR: Almost 15,000 Migrant Children Now Held at Nearly Full Shelters

More voices are starting join the growing chorus of advocates, doctors and city leaders who oppose the administration’s proposed policy to penalize immigrants who are accepting government aid (such as Medicaid). It’s not just about public health, they say. The policy would also take a heavy financial toll.

Dallas Morning News: Dallas Mayor Says Trump Administration’s Proposed ‘Public Charge’ Rules Would Harm City’s Immigrants, Economy


There was some shade being thrown at the Supreme Court this week, when the justices declined to take up a case on state Medicaid funding and Planned Parenthood. Justice Clarence Thomas called out his conservative colleagues Chief Justice John Roberts and Justice Brett Kavanaugh for dodging the case. “So what explains the court’s refusal to do its job here? I suspect it has something to do with the fact that some respondents in these cases are named ‘Planned Parenthood,’” he wrote. The case itself was somewhat complex, but essentially the decision leaves in place Medicaid patients’ right to sue over provider issues.

The Associated Press: Justices Won’t Hear States’ Appeal Over Planned Parenthood


The maker of a device that reverses overdoses recently drew fire for jacking up the list price of its injector from $575 to $4,100 during a span of time that opioid-related deaths were also accelerating rapidly. As you can imagine, this did not go over well with either lawmakers or the public when it came to light. Now Kaleo, in damage-control mode, is releasing a generic version that comes with a $178 price tag. The whole journey is quite the snapshot of what’s going wrong with high health care costs.

Stat: Kaleo, Maker of $4,100 Overdose Antidote, to Offer Generic For $178

Speaking of, you have to check out the salacious details emerging in this case that started as an antitrust lawsuit against just two drugs and has ballooned into this sweeping investigation into price-fixing allegations in the generics marketplace.

The Washington Post: Generic Drug Price-Fixing Investigation Expands to 300 Drugs and 16 Companies

Pharma, meanwhile, is sweating over the Democrats taking power in the House. Once a political powerhouse of nearly mythological proportions, the industry has lost clout in recent years, and companies don’t think the new power structure will work in their favor.

Stat: Will Democrats in Congress Keep the Door Open for Pharma — or Slam It?


Whew! That was not as short as expected. Just in case you want some more great reads for your weekend, check out the miscellaneous file:

• What happens to your life when millions of people have witnessed you hit rock bottom? As the opioid epidemic dug deep roots into the country, there was this trend where videos and photos of people overdosing would go absolutely viral. Public health officials and cops at the time justified putting them up because the videos could act as a deterrent for drug use. For the people used as the face of the crisis, however, it was deeply life-altering.

The New York Times: How Do You Recover After Millions Have Watched You Overdose?

• Baby boomers are now aging alone more than any other generation in U.S. history. That isn’t just a sad statistic — it’s also a looming public health crisis. Loneliness has been as closely linked to early mortality as smoking up to 15 cigarettes or consuming more than six alcoholic drinks a day.

The Wall Street Journal: The Loneliest Generation: Americans, More Than Ever, Are Aging Alone

• A rash of recent headlines explores whether trauma is passed down through genes. It’s a very buzzy idea, but the evidence that trauma can leave a signature that lasts generations is circumstantial at best.

The New York Times: Can We Really Inherit Trauma?

 

I’ll leave you with some bah-humbug! warnings about not eating that raw cookie dough this holiday season (even though it’s clearly the best part of making cookies). Have a great weekend!

Nurse Denied Life Insurance Because She Carries Naloxone

Bloodwork was supposed to be the last step in Isela’s application for life insurance. But when she arrived at the lab, her appointment had been canceled.

“That was my first warning,” Isela said. She contacted her insurance agent and was told her application was denied because something on her medication list indicated that Isela uses drugs. Isela, a registered nurse who works in an addiction treatment program at Boston Medical Center, scanned her med list. It showed a prescription for the opioid-reversal drug naloxone — brand name Narcan.

“But I’m a nurse, I use it to help people,” Isela told her agent. “If there is an overdose, I could save their life.”

That’s a message public health leaders aim to spread far and wide. “Be prepared. Get Naloxone. Save a life,” was the message at the top of a summary advisory from the U.S. surgeon general in April.

But some life insurers consider the use of prescription drugs when reviewing policy applicants. And it can be difficult, some say, to tell the difference between someone who carries naloxone to save others and someone who carries naloxone because they are at risk for an overdose.

Primerica is the insurer Isela said turned her down. (NPR and KHN have agreed to use just Isela’s first name because she is worried about how this story might affect her ongoing effort to get life insurance.) The company said it can’t discuss individual cases. But in a prepared statement, Primerica noted that naloxone has become increasingly available over the counter.

“Now, if a life insurance applicant has a prescription for naloxone, we request more information about its intended use as part of our underwriting process,” said Keith Hancock, the vice president for corporate communications. “Primerica is supportive of efforts to help turn the tide on the national opioid epidemic.”

After Primerica turned her down, Isela applied to a second life insurer and was again denied coverage. But the second company told her it might reconsider if she obtained a letter from her doctor explaining why she needs naloxone. So, Isela did contact her primary care physician — and then realized that her doctor had not prescribed the drug.

Isela bought naloxone at a pharmacy. To help reduce overdose deaths, Massachusetts and many other states have established a standing order for naloxone — one prescription that works for everybody. Isela couldn’t just give her insurer that statewide prescription; she had to find the doctor who signed it. As it happens, that physician — Dr. Alex Walley — also works at Boston Medical Center.

Walley is an associate professor of medicine at Boston University; he also works in addiction medicine at Boston Medical Center and is the medical director for the Opioid Overdose Prevention Pilot Program at the Massachusetts Department of Public Health.

“We want naloxone to be available to a wide group of people — people who have an opioid use disorder themselves, but also [those in] their social networks and other people in a position to rescue them,” Walley said.

He said he has written a half-dozen letters for other BMC employees denied life or disability insurance because of naloxone, and that troubles him.

“My biggest concern is that people will be discouraged by this from going to get a naloxone rescue kit at the pharmacy,” Walley said. “So this has been frustrating.”

The life insurance hassle — and threat of being turned down — has discouraged Isela and some of her fellow nurses. She is not carrying a naloxone kit outside the hospital right now because she doesn’t want it to show up on her active medication list until the life insurance problem is sorted out.

“So if something were to happen on the street, I don’t have one — just because I didn’t want another conflict,” Isela said.

BMC has alerted the state’s Division of Insurance, which has said in a written response that it is reviewing the cases and drafting guidelines for “the reasonable use of drug history information in determining whether to issue a life insurance policy.”

But Isela isn’t a drug user. And yet, she is being penalized as if she were.

Michael Botticelli, who runs the Grayken Center for Addiction Medicine at BMC, said friends and family members of patients with an addiction must be able to carry naloxone without fear that doing so will send them to the insurance reject pile.

“It’s incumbent on all of us to make sure that we try to kind of nip this in the bud,” he said, “before it is any more wide-scale.”

Botticelli said increased access to naloxone across Massachusetts is one of the main reasons overdose deaths are down in the state. The most recent state report showed 20 fewer fatalities through the first nine months of 2018 compared with the same period in 2017.

Botticelli relayed his concerns in a letter to Dr. Jerome Adams, the U.S. surgeon general, who says he contacted the National Association of Insurance Commissioners. That group says it has not heard of any cases of life insurance applicants being denied because they purchased naloxone.

Adams said it’s good to — as Botticelli suggests — nip the problem in the bud.

“Naloxone saves lives,” Adams said, “and it is important that all Americans know about the vital role bystanders can play in preventing opioid overdose deaths when equipped with this lifesaving medication.”

Isela said the second company that rejected her has agreed to let her reapply, in light of Walley’s letter stating that she carries the drug so that she can reverse an overdose. Isela is in the process of reapplying.

This story is part of a partnership that includes WBUR, NPR and Kaiser Health News.