Tagged Substance Abuse

Facebook Live: Confronting Opioid Addiction

Three medications have been approved by the Food and Drug Administration to treat opioid addiction: methadone, buprenorphine and naltrexone. But access to them depends largely on where you live.

Methadone and buprenorphine are the two most popular options. But many California communities, particularly rural ones, have neither a methadone clinic nor a doctor who can prescribe buprenorphine.

More than 2,000 Californians died of opioid overdoses in 2016. About 12 percent of those deaths involved fentanyl, a deadly synthetic opioid painkiller that is 30 to 50 times more powerful than heroin.

On Tuesday, California Healthline columnist Emily Bazar and contributor Brian Rinker discussed the medications used to treat opioid addiction and the challenges of getting access to them. Among those challenges: Doctors must undergo eight hours of training before they can prescribe buprenorphine. Even then, they face limits on the number of patients they can treat.

To watch the discussion, which was recorded live, click on the video above.

Must-Reads Of The Week From Brianna Labuskes

Welcome back to the Friday Breeze, where I can offer you a break from the Comey memos with a quick look at what you need to know about this week’s health care news.

Some recent abortion laws and legislative proposals in the states seem so strict they’re almost begging for a court challenge. Activists who think the Supreme Court is one Donald Trump-appointed justice away from overturning Roe v. Wade want to have a legal challenge in the pipeline ready to go. Others in the movement would rather focus on incremental changes, which is getting on the nerves of the more aggressive activists. “They’re standing in the way,” Rep. Steve King (R-Iowa) says in Politico’s story. “I’ve said, ‘Please lead, or get out of the way.’”

• Politico: Abortion Foes Seize On Chance To Overturn Roe


Tying performance and costs is a bit of a Hot Strategy these days, as everyone talks about ways to bring down health care spending. But Italy, which has been trying this approach for more than a decade, serves as a cautionary tale that, at least for drug prices, the efforts don’t really move the needle. Mostly because there’s a wide range of opinions on what exactly “success” looks like.

And in a look ahead: President Donald Trump is planning a big speech on drug prices next week. But don’t get excited— no new policies are expected to be announced.

• The Wall Street Journal: Italy Serves Cautionary Lesson For New Trump Drug Plan

• Politico: Trump Plans First Major Speech On Drug Prices Next Week


There was a lot of movement on the opioid crisis again this week (nursing homes turning away patients who are recovering from addiction; Sen. Bernie Sanders (I-Vt.) wanting pharma execs to go to jail; and scientists working on a drug that could end addiction). But a deeper recurring theme was how ethics would play into combating the epidemic. What role does the industry that helped create the crisis play in fixing it? Does it matter that advocates who are lobbying for more spending are going to profit from that newly opened congressional wallet? It’s a tricky minefield to navigate.

• Stat: NIH Abruptly Changes Course On Industry Opioids Partnership After Ethics Flags Raised

• Politico: Patrick Kennedy Profits From Opioid-Addiction Firms


Dr. Ronny Jackson, Trump’s nominee for VA secretary, is eager to please, well-liked and ambitious, according to a telling background profile by The Washington Post. But notably absent from the heaping of bipartisan praise were endorsements on his ability to lead the sprawling, troubled agency.

• The Washington Post: ‘He Knows How To Read A Room Really, Really Well’: How White House Physician Ronny L. Jackson Became Trump’s Nominee To Lead VA


In the miscellaneous file for this week: There’s a disturbing pattern of leniency and forgiveness toward doctors who are accused of sexual assault, and not even the #MeToo movement seems to be changing it; livers like to be kept “warm and happy” instead of put on ice (which led to my favorite lede from the week about how livers are not beers that you pack in a cooler for your camping trip); nefarious profiteers are persuading women to get surgeries they might not need just because that makes them better plaintiffs; and what happens when the teaching hospitals that are supposed to train new doctors instead pass off their bad habits?

• The Associated Press: AP Investigation: #MeToo Has Little Impact On Medical World

• Stat: A ‘Breakthrough In Organ Preservation’ Raises Hopes For Transplants

• The New York Times: How Profiteers Lure Women Into Often-Unneeded Surgery

• Stat: Doctors May Learn Bad Habits At Teaching Hospitals With Safety Violations


And former first lady Barbara Bush’s decision to stop medical treatment and seek comfort care this week stirred a debate over the emotionally charged topic of end-of-life decisions.

Kaiser Health News: Barbara Bush’s End-Of-Life Decision Stirs Debate Over ‘Comfort Care


Have a great weekend, and maybe skip the salad? I know, such a hardship.

And let us know what you think of The Friday Breeze here.

Nation’s Top Doc Wants The Overdose Antidote Widely On Hand. Is That Feasible?

When Surgeon General Jerome Adams issued an advisory calling for more people to carry naloxone — not just people at overdose risk, but also friends and family — experts and advocates were almost giddy.

This is an “unequivocally positive” step forward, said Leo Beletsky, an associate professor of law and health sciences at Northeastern University.

And not necessarily a surprise. Adams, who previously was Indiana’s health commissioner, was recruited to be the nation’s top doctor in part because of his work with then-Gov. Mike Pence, now the vice president. In Indiana, Adams pushed for harm-reduction approaches, which included expanded access to naloxone and the implementation of a needle exchange to combat the state’s much-publicized HIV outbreak, which began in 2015 and was linked to injection drug use.

Others cautioned, though, that his have-naloxone-will-carry recommendation is at best limited in what it can achieve, in part because the drug is relatively expensive.

Kaiser Health News breaks down what the advisory means, experts’ concerns and what policy approaches may be in the pipeline.

Many public health advocates applaud the surgeon general’s position.

Naloxone, which is a drug that can keep drug users alive by reversing opioid overdoses, is viewed by many as the cornerstone of the harm-reduction approach to the epidemic. Experts say people with addiction problems should carry it, and so should their family, friends and acquaintances.

“We want to put it more in reach,” said Traci Green, an associate professor of emergency medicine and community health sciences at Boston University, who has extensively researched the opioid abuse crisis. “It could not have been a better endorsement.”

Others, including Diane Goodman, who penned a recent Medscape commentary reflecting on the advisory, wonder whether this is a “rational” response to the scourge, since opioid addiction is one of many health problems people might encounter in everyday life and for which treatment options are still limited.

“I’m not sure it makes much more sense than any of us carrying a bottle of nitroglycerin to treat patients with end-stage angina,” wrote Goodman, an acute-care nurse practitioner, referring to chest pain.

“What, exactly, are we offering to addicts once their condition has been reversed?” she asked, noting that without treatment and therapy programs that help wean people from addiction “the odds of survival for any length of time remain low, no matter how much reversal medication is kept nearby.”

Results would likely be limited by naloxone’s price tag.

Take Baltimore, which has been hit particularly hard by the opioid epidemic. Its health department already has pushed for more people to carry naloxone.

But the drug’s price is an issue, said Dr. Leana Wen, the city’s health commissioner, and an emergency physician. She suggested that the federal government negotiate directly for a lower price, or give more money to organizations and agencies like hers so they can afford to maintain an adequate supply.

“Every day, people are calling us at the Baltimore City Health Department and requesting naloxone, and I have to tell them I can’t afford for them to have it,” Wen said.

The drug is available in generic form, which can be stored in a vial and injected via a needle, as well as in patented products, such as the nasal spray Narcan, sold by ADAPT Pharmaceuticals, and Kaleo’s Evzio, a talking auto-injector.

Generic naloxone costs $20 to $40 per dose. Narcan, the nasal spray, costs $125 for a two-dose carton, according to ADAPT’s website. A two-pack of Evzio costs close to $4,000, according to GoodRx.

Health departments and first responders qualify for a discounted rate of $75 per carton of Narcan. Kaleo has made Evzio coupons available to consumers, so that some will not have a copay, and it advertises a discount for federal and state agencies.

Skeptics point out that similar methods have been used to build brand loyalty and potentially make a particular product a household name. That’s how Epi-Pen became synonymous with epinephrine for the treatment of anaphylactic shock.

“There’s clearly some overlap” here between the pricing strategies used by naloxone manufacturers and Epi-Pen distributor Mylan, said Richard Evans, co-founder of SSR Health, which tracks the pharmaceutical industry.

But it’s not a perfect comparison. The presence of low-cost generics changes the calculus, he said, as does the different level of demand.

Nonprofit organizations and health care providers keenly feel the pressures of increasing demand and cost.

Experts say price breaks on naloxone are not sufficient to cover the costs on the ground.

“Sixty-four thousand people lost their lives [nationally in 2016] — that’s someone every 12 minutes,” said Justin Phillips, executive director of Overdose Lifeline, an Indianapolis-based nonprofit. “Ten free kits is not going to be enough.”

Phillips said her organization relies on generic naloxone, which is the least expensive formulation. It’s the only feasible option, using dedicated grant money the group received from the state attorney general’s office as part of a program funded by a settlement with pharmaceutical companies.

But that money is almost dried up. “We need to be able to access naloxone — which I’m told is pennies to make — for the pennies it cost to make it,” Phillips said.

Phillips, who worked with Adams when he ran Indiana’s health department, said she has discussed the need for naloxone funding with the surgeon general, but never its price.

Pharmacies assess the hurdles of distribution.

Local pharmacies are key in this chain, but the overdose antidote is new territory for many pharmacists, said Randy Hitchens, the executive vice president of the Indiana Pharmacists Alliance. He said in 2015, when Adams began his push to get naloxone into the hands of drug users and their families, only one or two retail pharmacies carried it.

“This has always been an emergency room drug. Retail pharmacists typically were not used to dealing with [it],” Hitchens said. “A lot were probably saying, ‘What in the devil is naloxone?’”

Today, he estimates 60 to 70 percent of Indiana’s more than 1,100 retail pharmacies carry the drug. Walgreens, the pharmacy chain, has committed to stocking Narcan.

Access, though, is always subject to retail pressures.

“If pharmacies are not seeing a steady stream coming in asking for it, they won’t be incentivized to carry it on their shelves,” said Daniel Raymond, the deputy director of policy and planning for the Harm Reduction Coalition.

A patchwork of other decentralized sources for naloxone exist: syringe-exchange vans, county and state health departments, churches and community centers, all trying to find ways to get overdose medication into the hands of people who need it.

That supply stream “meets people where they are,” Raymond said, but those little programs don’t have the muscle to negotiate discounted prices.

“Individual health programs are trying to navigate the crisis on their own, but when you see … growing demand and limited supply, it’s a role for federal intervention,” Raymond said.

He’d like to see the federal government step in to negotiate prices where smaller programs can’t.

The surgeon general’s message is one part of Washington’s broader response to the epidemic. But even as Congress crafts an opioid epidemic response package, it’s not clear it will tackle these concerns.

In the House of Representatives’ Energy and Commerce Committee, one bill being discussed would require all state Medicaid programs to cover at least one form of naloxone. Currently, not all state Medicaid programs do so.

A Senate bill would authorize $300 million annually to equip first responders with naloxone.

But critics say those approaches still don’t address the underlying problems: cost and funding.

“You can either make naloxone available, at a much discounted price, or we need to have a lot more resources in order to purchase it,” Wen said. “I don’t care which one. My only concern is the health and well-being of our residents.”

Great Weekend Reads From KHN

Happy Friday! Welcome back to The Friday Breeze, where I (KHN’s newsletter editor) wade through hundreds of health articles from the week so you don’t have to.

Health certainly was not at the top of mind for this week’s news cycle (what with the House speaker announcing he would not seek re-election and a raid here or there), but there were still some stories that are worth the read. Here’s what you need to know.

Following on the heels of Minnesota’s success, states are starting to eye publicly funded reinsurance pools (which essentially protect insurers when they’re hit with an unexpectedly high claim) as an answer to stabilizing the health law marketplace. But in the era of tight budgets, states have only so much money to throw at the problem. Also, a comprehensive look at where exchanges stand after the past couple topsy-turvy months.


The growing popularity of retail clinics and urgent care centers (as well as low pay and long hours for the physicians themselves) are nudging the traditional primary care doctor toward extinction. Physicians are worried all these mergers and movement in the industry are a slippery slope. What’s next, asks one: “Are Aetna patients going to be mandated to go to a CVS MinuteClinic?”

Over in pharmaceutical land, the once-powerful industry’s rare defeat in the “doughnut hole” battle with Congress doesn’t speak well of its current clout on the Hill. And, believe it or not, there are some arguing that certain drug prices are too low.


In the war on opioids, you won’t get far without hearing about naloxone. It’s been a lifesaver for thousands, and the surgeon general just last week urged Americans to start carrying it. But it has its flaws, it’s expensive and, right now, there aren’t any realistic alternatives. Scientists want to change that.

And drug distributors are about to be summoned to Congress in a move some are likening to the tobacco executive hearings in the 1990s.


There were a few things out of the states to keep an eye on from this week: the California bill that would let the state set certain health prices (like hospital stays); how beliefs on single-payer are coming to define the California gubernatorial race (in a microcosm of the Democratic Party); and the fact that not one patient has utilized D.C.’s aid-in-dying law.


In the miscellaneous file of smart, funny or insightful reads from the week: a heartbreaking dive into the crisis facing black women and their babies; juicy takeaways from a book on Theranos (including how staffers would “get disappeared” by the company’s mysterious No. 2); the thousands of vacancies the VA just can’t seem to fill (because there aren’t enough HR people to do the hiring); and the lawyer who’s at the center of the battle over young immigrants seeking abortions.


Have a fantastic weekend (but not too fantastic, because apparently one extra glass of wine a day takes 30 minutes off your life). And make sure to let us know what you think of the Friday Breeze.

The Friday Breeze

Happy Friday! Welcome back to The Friday Breeze, where I (KHN’s newsletter editor) wade through hundreds of health articles from the week so you don’t have to.

Health certainly was not at the top of mind for this week’s news cycle (what with the House speaker announcing he would not seek re-election and a raid here or there), but there were still some stories that are worth the read. Here’s what you need to know.

Following on the heels of Minnesota’s success, states are starting to eye publicly funded reinsurance pools (which essentially protect insurers when they’re hit with an unexpectedly high claim) as an answer to stabilizing the health law marketplace. But in the era of tight budgets, states have only so much money to throw at the problem. Also, a comprehensive look at where exchanges stand after the past couple topsy-turvy months.


The growing popularity of retail clinics and urgent care centers (as well as low pay and long hours for the physicians themselves) are nudging the traditional primary care doctor toward extinction. Physicians are worried all these mergers and movement in the industry are a slippery slope. What’s next, asks one: “Are Aetna patients going to be mandated to go to a CVS MinuteClinic?”

Over in pharmaceutical land, the once-powerful industry’s rare defeat in the “doughnut hole” battle with Congress doesn’t speak well of its current clout on the Hill. And, believe it or not, there are some arguing that certain drug prices are too low.


In the war on opioids, you won’t get far without hearing about naloxone. It’s been a lifesaver for thousands, and the surgeon general just last week urged Americans to start carrying it. But it has its flaws, it’s expensive and, right now, there aren’t any realistic alternatives. Scientists want to change that.

And drug distributors are about to be summoned to Congress in a move some are likening to the tobacco executive hearings in the 1990s.


There were a few things out of the states to keep an eye on from this week: the California bill that would let the state set certain health prices (like hospital stays); how beliefs on single-payer are coming to define the California gubernatorial race (in a microcosm of the Democratic Party); and the fact that not one patient has utilized D.C.’s aid-in-dying law.


In the miscellaneous file of smart, funny or insightful reads from the week: a heartbreaking dive into the crisis facing black women and their babies; juicy takeaways from a book on Theranos (including how staffers would “get disappeared” by the company’s mysterious No. 2); the thousands of vacancies the VA just can’t seem to fill (because there aren’t enough HR people to do the hiring); and the lawyer who’s at the center of the battle over young immigrants seeking abortions.


Have a fantastic weekend (but not too fantastic, because apparently one extra glass of wine a day takes 30 minutes off your life). And make sure to let us know what you think of the Friday Breeze.