German Lopez reports in Vox that the imperiled Senate healthcare bill, the Better Care Reconciliation Act (BCRA), would substantially undermine efforts to address opioid misuse. Among other things, the BCRA would decrease the number of people covered by Medicaid and other insurance; allow states to opt out of including addiction care as an “essential benefit;” and seriously underfund drug treatment and mental health care. (The New York Times also details how the proposed $45 million for states to spend on addressing the opioid epidemic comes up short.) In a related article, Lopez looks at how and why the US, by far, has the highest rate of drug overdose deaths in the world. Among the reasons: our relative wealth (and ability to buy drugs); poor social supports and access to care (see above); and less sense of spiritual or existential meaning.
Meanwhile, the White House opioid crisis commission headed by Gov. Chris Christie has delayed publication of its preliminary report, citing the ambitious 90-day deadline; and Health and Human Services Secretary Tom Price is taking heat for proposed Medicaid cuts and for his comment that using medications to treat opioid addiction is “just “substituting one opioid for another,” according to STAT. But President Trump’s nominee for Surgeon General, Jerome Adams, made his mark addressing HIV and opioid misuse, NPR reports. Adams, Health Commissioner from Vice President’s home state of Indiana, is credited with initiating a syringe exchange to reduce the spread of HIV and hepatitis cases; increasing access to naloxone, the overdose antidote; and limiting opioid prescriptions.
STAT interviewed public health experts, who predicted that the opioid crisis, currently claiming nearly 100 lives a day, likely will get worse before it improves. The analysis includes an interactive graphic forecasting death rates based on a variety of potential interventions. On a more positive note, STAT features some promising efforts to address opioid addiction and overdose deaths, from making the antidote naloxone available in public places to integrating addiction treatment with prenatal care.
In an interview with Mother Jones, Nadine Burke Harris of the Center for Youth Wellness describes the potential developmental and physiological effects on children of parents who are misusing opioids, as well as some potential responses to the problem.
The Washington Post looks at the effects of opioid misuse on the foster system, where many children are placed as their parents struggle to address addiction.
Writing in Slate, Jen Simon offers a personal account of why offering affordable mental health care coverage is critical to addressing opioid misuse. She cites an Atlantic article that explores how depression may bring people to misuse opioids.
A study out of the University of Calgary finds that women who experience adversity in early childhood are more likely to experience mental and physical health problems during and after pregnancy and have children who are in turn more likely to experience health problems. Researchers say the study results illuminate the potential generational consequences of adverse childhood experiences (ACEs), which include physical and emotional abuse, losing a parent, and having a parent who misuses drugs or alcohol.
In the small rural Pennsylvania town of Selinsgrove, where a recent surge of heroin overdoses landed 51 people in the hospital over 48 hours, the family of a 23-year-old girl published an obituary that includes an entry from her journal that chronicles her struggles with addiction.
If it becomes law, the Senate health care bill (BCRA) could lead to a loss of 1.45 million U.S. jobs by 2026 and trigger an economic downturn in virtually every state, according to a report published by Milken Institute School of Public Health and The Commonwealth Fund. The CBO has estimated the bill would cause 14 million people to lose health insurance in 2018 and 22 million to lose it by 2026. It is unlikely the Senate will get around to voting on the BCRA bill next week; end of July looks more likely, Politico reports. The CBO must finish its review of legislative language; the Senate parliamentarian must opine on controversial proposals; and reportedly there are not yet 50 votes in support of the bill.
Fourteen senators from the HELP Committee sent out a “Dear Colleague” letter last week on the Prevention Fund along with state fact sheets (see here). PI sent thank you notes to the health legislative analysts and spread the word on social media.
The Washington Post reports on a study finding that 30% of young people, ages 14 to 30, who vape begin smoking traditional cigarettes, making e-cigarette users four times more likely than nonusers to become smokers.
The Georgetown Law Center on Poverty and Inequality found that adults perceive black girls as young as age five to be older and less in need of support and protection than their white peers.
Slate reports on a new study finding that, without major action to mitigate the effects of climate change, climate change will widen inequities of wealth, health, and region.
Black men appear to be more susceptible than black women to long-term mental health consequences of experiencing racial discrimination, according to a study published in Frontiers in Public Health. The study, conducted in Flint, Michigan by researchers from the University of Michigan and Tehran University of Medical Science, looked at connections between discrimination and anxiety and depression among 681 black males and females over an 18-year period from 1994-2012. The study found that while experiencing racial discrimination is associated with negative mental health effects for both men and women, perceived racial discrimination, such as being overlooked or not given service at a business or not being hired for a job, was associated with more anxiety and depression symptoms among black men over the long term. Women did not experience an increase in symptoms in the long term, according to the study. The authors cite previous studies that show that black males report higher rates of discrimination and also tend to process the experience differently. While black women are more likely to use “avoidant” coping mechanisms and make better use of social supports, studies suggest men are more likely to confront the discrimination. The authors state: “Further research is warranted to scrutinize the mechanisms behind the heightened effects in Black men. Some potential suspects are masculinity, ineffective coping, vigilance, and racial attribution, or racial identity that may alter men’s response and vulnerability to discrimination. It may be especially useful if this line of research went beyond individual level variables to capture structural factors such as poverty, racism, police brutality, neighborhood disorder, and blocked opportunity.”