THE PROGNOSIS

U.S. border patrol agents snagged about two pounds of fentanyl in 2013. This year, they seized nearly 1,500 pounds of the deadly substance.

Fentanyl, a synthetic opioid that is many times more potent than heroin, has exploded onto the nation’s illicit drug scene over the past few years – so much so that many experts are identifying it as the most dangerous and widespread culprit in the opioid abuse crisis.

Yesterday, the Department of Homeland Security reported a dramatic spike over the past five years in seizures of fentanyl and other synthetic drugs at U.S. ports of entry. Although most of the smuggling attempts occur along the country’s border with Mexico, the agency said traffickers are increasingly using international mail, as well.

Here are the report's numbers: In this fiscal year, agents apprehended 1,485 pounds of fentanyl. That’s far less than the 5,760 pounds of heroin seized, but only in terms of weight; fentanyl is up to 50 times more powerful than heroin and a seemingly tiny amount can kill someone.

“That’s a lot of fentanyl and really quite scary,” Bryce Pardo, an analyst and drug expert at consulting firm Botec Analysis, told me.

The potency of fentanyl is one of the main reasons the drug has become so popular among drug dealers lately. The other is that it’s much cheaper than heroin; while a kilogram of heroin can cost around $90,000 (according to DEA estimates), the same amount of fentanyl costs more like $3,500 to $7,000, a real bargain in comparison.

Plus, there’s a host of Americans who are vulnerable to the drug, many of whom got hooked initially on prescription opioids, perhaps moved to heroin and are now seeking cheaper and stronger versions of heroin laced with fentanyl. We’ve already spilled a lot of Health 202 ink on prescription opioid abuse, which claims four times the lives of Americans compared to 15 years ago.

The DHS report doesn't detail how many of the fentanyl seizures are occurring at the border as opposed to in the mail. But the DEA has stated that Mexican drug traffickers are playing a prominent role in the burgeoning problem, often procuring the drug or unrefined versions of it from China (which is a top producer) and then transporting it to the United States.

In August, Mexican authorities made their largest-ever seizure of fentanyl, confiscating around 140 pounds of powder and nearly 30,000 pills that probably were on their way to the United States.

“My guess is that a lot of cartels are starting to jump on this fentanyl bandwagon because it’s more profitable,” Pardo said.

Many dealers also order fentanyl online — the drug can be used legally for palliative treatments or medical research purposes — and then mix it into a heroin supply or press it into Percocet pills.

As more policymakers focus on opioid abuse — including President Trump, who recently declared it a public health emergency — more people are slowly learning about the dangers and growing pervasiveness of fentanyl. But probably not quickly enough.

AHH, OOF and OUCH

AHH: The intricate health-care supply chain, which includes all sorts of middlemen from pharmacy-benefit managers, retailers, wholesalers and insurers, is in the spotlight as CVS Health moves to acquire Aetna. While CVS is most familiar as a corner drugstore, the company actually makes most of its money from one of the most lucrative points along that supply chain as a pharmacy-benefit manager, negotiating drug prices with health insurers and employers, The Post's Carolyn Johnson explains. The merger, which would be one of the biggest health-care deals of all time, signals the primacy of those negotiations in the health-care system.

“This is kind of uncharted territory — a pharmacy benefit manager [PBM] buying a major national health plan. I think it’s a sign of the times,” said Michael Rea, chief executive at Rx Savings Solutions ... “PBMs represented a little-known entity no one knew about not that long ago, and now they’re the controlling piece of the deal to take over a national insurer.”

CVS says it's buying Aetna to expand into managing the entire continuum of patients’ health, not just drug costs. That’s what the nation’s largest insurer, UnitedHealth Group, has done — running its own pharmacy- benefit manager as well as gaining a growing network of clinics and surgical care centers, Carolyn writes.

“It does highlight that pharmacy benefit management is taking on a more significant role in a world that, even 10 years ago, was completely dominated by major medical health insurance,” said Mark Merritt, president of the Pharmaceutical Care Management Association, the lobbying organization for PBMs.

OOF: Does the Trump administration have a science problem? The administration is filling its science, environment and health jobs with people who hold fewer science-related academic degrees than their predecessors under former President Barack Obama, a new Associated Press analysis has found. The AP revealed that of 43 Trump nominees in science-related posts, almost 60 percent of them didn't have a master’s degree or doctorate in a science or health field. By comparison, more than 60 percent of their predecessors had advanced science degrees. 

Let’s break it down: In the Trump administration, the number of political appointees with a doctorate in science or a medical degree dropped 21 percent compared to Obama's tenure. Under Obama there were 19 such doctorate holders; under Trump, there are 15. There were 27 Obama appointees with master’s degrees but 18 under Trump.

The contrast is especially acute in the Energy Department, the AP writes. Out of seven Trump nominees for energy-science oriented positions, none have a master's degree in a science field (although some hold advanced law or business degrees). Five of their predecessors had master's degrees in a science field and four had science-related doctorates.

OUCH: There may be billions of unused opioid pills lying forgotten in American homes. Most of the about 200 million opioid prescriptions doled out in the United States each year won’t be used up by the intended patient, Keith Humphreys writes for The Post. But the programs in place to eliminate this unused supply aren’t making a big difference.

On the most recent prescription take-back day -- which the DEA runs twice yearly -- the agency accrued 456 tons of pills, only a fraction of which are actually opioids. And while Congress passed 2010 legislation enabling pharmacies, hospitals and clinics to conduct drug dropoffs year-round, only 2.5 percent of eligible organizations are participating.

More funding is needed to make such programs sustainable. But who pays for it? Opioid manufacturers could be one option, Keith suggests.

“Given opioid manufacturers’ billions of dollars in revenue and the fact that at least some of them played a significant part is starting the opioid epidemic, they seem an obvious deep pocket to tap for supporting return of excess opioids,” he writes.

TRUMP TEMPERATURE

--Yesterday, President Trump promised that a health-care bill is next on the table after Congress finishes its tax overhaul. Speaking to business owners and families at the White House, Trump characterized their health care as "terrible." "Frankly, their health care is terrible -- Obamacare -- and that'll be next," the president said. "We're a long way toward getting rid of that and getting something very good and very much more affordable."

HEALTH ON THE HILL

--Some Republican Senate moderates -- chiefly Susan Collins (R-Maine) -- think they have extracted a promise from GOP leadership of passing two bills aimed at stabilizing the Obamacare marketplaces. But House Speaker Paul Ryan (R-Wis.) has a different take, with his office yesterday telling The Hill's Peter Sullivan the speaker wasn't involved in any kind of deal to pass those measures before the end of the year.

The bills in question include the bipartisan measure from Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) to provide two years of CSRs, the cost-sharing reduction payments made to insurers for discounts they give to the lower-income customers. Another bill, from Collins and Sen. Bill Nelson (D-Fla.) would fund reinsurance to compensate insurers for sick and therefore costly Obamacare enrollees in order to reduce premiums.

Peter notes that Ryan’s office didn't say the speaker is opposed to the bipartisan pair of bills. Yesterday, Ryan told reporters at a news conference that lawmakers were still discussing them.

“Well of course I think [repealing the individual mandate is] the best way we can go, but we’re going to have continued discussions with our members here in the House and across the aisle about the best way forward,” Ryan said. “We think health care is deteriorating. We think premiums are going up through the roof, insurers are pulling out and that’s not a status quo we can live with.”

REPRODUCTIVE WARS

--Yesterday a dozen or so reproductive and civil-rights organizations delivered more than half a million public comments to the Department of Health and Human Services, protesting its proposal to dramatically expand exemptions for employers with moral objections to paying for birth control coverage. If the rule is finalized, employers will be excused from the requirement (set up under the Affordable Care Act) by citing a religious or moral objection to contraception.

These groups -- which say all women should have access to birth control without copayments -- are also fighting the proposed rule change online using the hashtag #HandsOffMyBC. They include Planned Parenthood, the American Civil Liberties Union, the Center for American Progress, the National Abortion Federation and the National Women’s Law Center, among others.

“These rules are offensive and are about denying women our right to make decisions about our health and our lives,” said Nancy Northup, president of the Center for Reproductive Rights, a group that collected nearly 100,000 of the comments. "Today, hundreds of thousands of people across the country made it known that women will wholeheartedly challenge any infringement on our rights."

--Federal rules require ACA marketplace insurers to disclose to consumers whether their plans cover abortions, yet at least eight carriers haven't done so, according to the research arm of the antiabortion group Susan B. Anthony List. Last night the group sent letters to acting HHS secretary Eric Hargan and HHS Inspector General Daniel Levinson, asking them to crack down on the noncompliant plans in the final week of the open enrollment season.

Because abortion coverage in subsidized marketplace plans was so controversial when the ACA was passed, insurers can't use federal subsidies to pay for abortions (except those obtained under the Hyde Amendment exemptions of rape, incest or if the woman's life is at stake), must disclose abortion coverage in their summary of benefits, and must collect an extra fee of at least $1 per month from consumers who choose a plan with abortion coverage.

Yet compliance with these requirements has been spotty, health-law professor Tim Jost wrote recently in the journal Health Affairs. In 2014, the Government Accountability Office found that two of 18 marketplace plans surveyed failed to collect the extra fees from consumers while four failed to notify enrollees that they cover abortions.

SBA List, which has also set up a website showing which marketplace plans do or don't cover abortion services, is asking HHS to review the noncompliant insurers and force them to follow the rules -- and give consumers in affected states extra time to enroll. The group says the oversight is affecting at least 151 marketplace plans in five states sold by Bright Health in Colorado, Elevate by Denver Health Medical, Health Alliance Medical Plans in Illinois, Independent Health in New York, Fidelis Care in New York, Sendero Health Plans in Texas, Boston Medical Center HealthNet Plan in Massachusetts and MVP Health Plan in New York.

--A few other good reads from The Post and beyond:

MEDICAL MISSIVES
Congress last year created an NIH task force to study why women can't get reliable answers on medication use during pregnancy — and to recommend solutions.
Stat News
STATE SCAN
A children’s health insurance program popular with both Republicans and Democrats is in limbo because of partisan rancor that has stymied legislative action in Washington.
New York Times
Health & Science
Programs ignore warnings about legality and safety in helping workers buy medicines from Canada and overseas.
Phil Galewitz | Kaiser Health News
DAYBOOK

Today

  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on the “Implementation of the 21st Century Cures Act: Responding to Mental Health Needs."
  • The Senate Special Committee on Aging holds a hearing on “America’s Aging Workforce."

Coming Up

  •  The Senate Health, Education, Labor and Pensions Committee holds a hearing on the “Implementation of the 21st Century Cures Act: Progress and Path Forward for Medical Innovation” on Thursday.
  • The House Veterans Affairs Committee holds a hearingon the VA Medical Surgical Prime Vendor Program on Thursday.
SUGAR RUSH

White House press secretary Sarah Huckabee Sanders faced repeated questions from reporters about President Trump’s endorsement of Roy Moore, the Republican nominee for U.S. Senate in Alabama:

Late-night comedians react to President Trump's endorsement of Roy Moore:

Rep. Cathy McMorris Rodgers (R-Wash.) says Congress must 'walk the talk' on sexual harassment:

‘I was a victim of childhood sexual abuse’: CNN host Don Lemon shares his story:

On Jimmy Kimmel Live, Tracee Ellis Ross talks about the sexual harassment scandals in Hollywood: