Last night, President Trump indicated once again that he views the nation's opioid abuse crisis as more of an issue to be dealt with by law enforcement than by medical professionals.
In his State of the Union address, the president correctly described the toll overdose is taking on the country -- noting deaths from drugs caused 64,000 deaths in 2016 -- and promised to go after the problem in the coming year. But while he mentioned in passing a need for better addiction treatment, Trump offered no new details on that front. He instead emphasized the need for law enforcement to stem the supply and distribution of illegal drugs.
“We must get much tougher on drug dealers and pushers if we are going to succeed in stopping this scourge,” Trump said.
The U.S. drug supply has only gotten bigger and deaths from overdose have steadily increased over the past several decades. But during that period, U.S. officials focused mainly on waging a "war on drugs" that mostly failed. Many experts have always argued the problem of drug addiction has more to do with demand than supply, and it could be better tackled by providing better treatment and support to people struggling with addiction.
But ever since Trump declared opioid abuse a public health emergency last fall, most of the action has been taken by the Department of Justice, not the Department of Health and Human Services. Attorney General Jeff Sessions has announced several initiatives targeting drug trafficking, announcing in November a new division of the Drug Enforcement Agency to unify trafficking investigations in Kentucky, Tennessee and West Virginia.
Yesterday, Sessions said DEA agents will conduct a “surge” operation over the next 45 days to focus on pharmacies and prescribers who are dispensing unusual or disproportionate amounts of opioids, the Post's Sari Horwitz and Scott Higham report. The agency will check data from about 80 million reports it collects every year from prescription drug manufacturers and distributors.
“My administration is committed to fighting the drug epidemic and helping get treatment for those in need,” the president said in his speech. “The struggle will be long and difficult – but, as Americans always do, we will prevail.”
Now, any increased focus on opioid abuse seems like a good thing considering it's a multi-faceted problem. Pretty much everyone agrees on that. Where advocates have gotten is frustrated is in the lack of much new funding for tackling the epidemic and a dearth of details from HHS on how it might address the issue from a prevention and addiction treatment perspective.
HHS did release a list of actions it says it has taken over the past year to address the crisis, although some of them were before Trump made his emergency declaration. The agency said it has:
--Disbursed more than $800 million in grants, more than any previous year.
--Developed a five-point strategy, encompassing better treatment, prevention, and recovery services; better targeting of overdose-reversing drugs; better data on the epidemic; better research on pain and addiction, and better pain management.
--Approved new Medicaid waivers for two states to expand access to substance-abuse treatment and outlined a streamlined process for more such approvals.
--Started to release monthly provisional data from the CDC on drug overdose deaths, shortening what had been up to a two-year lag.
--Clarified privacy regulations to inform hospitals and doctors they can share information with patients’ families during crisis situations.
--Approvrf through FDA the first monthly formulation of buprenorphine, a key option for medication-assisted treatment of opioid addiction.
Trump didn’t share any further details Tuesday night, instead highlighting a New Mexico family – Ryan and Rebecca Holets -- who adopted a baby born to a woman addicted to heroin.
“Ryan and Rebecca: You embody the goodness of our nation,” Trump said. “Thank you, and congratulations.”
Alex Azar, newly instated HHS secretary, said in a statement last night that Trump deserves "tremendous credit for his leadership" on the opioid issue.
"During his first year in office, President Trump has brought a new level of awareness and commitment to this cause, and I look forward to expanding and enhancing our aggressive approach to this scourge of addiction and overdose," said Azar, who was just sworn in on Monday.
Yet Trump stopped short of asking Congress to appropriate any more funding toward the opioid epidemic, even though Democrats and even some Republicans are pouring on the pressure. Earlier in the day, Sen. Roy Blunt (R-Mo.) urged the president to address the crisis in his speech and stressed the need for certainty on the resources available to fight it.
"We need his leadership, we need to know how many resources we have to spend and get busy trying to make a difference in the lives of people who have been devastated by this epidemic," Blunt said.
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Health care didn't get a ton of airtime during last night's SOTU -- certainly not as much as in years past. Yet besides talking about opioids, Trump touched briefly on prescription drugs and the Affordable Care Act's individual mandate. A few key points:
--Trump promised to bring down the high cost of prescription drugs, pointing to recent major strides by the FDA in speeding approvals of generic drugs. “To speed access to breakthrough cures and affordable generic drugs, last year the FDA approved more new and generic drugs and medical devices than ever before in our history,” he said.
Last week, HHS released a report that the FDA approved 1,027 generic drugs in one year, more than any other single year in the agency’s history, including the previous record of 800 approvals in 2016. FDA Commissioner Scott Gottlieb has pointed to more generic drugs as a way of lowering prescription drug prices in the United States, where medications cost more than in any other developed country.
But Trump didn’t mention a much more controversial idea, one championed by Democrats: Allowing Medicare to negotiate down the price of drugs with the private companies that manufacture them. On the campaign trail, Trump bucked his party in calling for such negotiations, but has backed away from the idea since becoming president. Instead, Trump said only that he plans to focus on drug prices in the coming year – and vowed they’ll get less expensive.
“One of my greatest priorities is to reduce the price of prescription drugs,” he said. “That is why I have directed my administration to make fixing the injustice of high drug prices one of our top priorities. Prices will come down.”
--Trump also told lawmakers to pass a federal version of so-called “Right to Try” laws, already passed by multiple states to allow terminally ill patients access to potentially lifesaving medications not yet fully approved by the FDA. Vice President Pence recently tweeted support of a federal Right to Try law, and the idea appears to be gaining momentum in Congress although some experts question how useful it would be.
“People who are terminally ill should not have to go from country to country to seek a cure – I want to give them a chance right here at home,” Trump said. “It is time for the Congress to give these wonderful Americans the ‘right to try.’”
--Trump skirted one of his biggest losses: failing to repeal and replace the ACA. Instead, he pointed to how Congress did repeal the law's individual mandate to buy health coverage in its tax overhaul. “The individual mandate is now gone,” he said.
AHH: The FDA is cracking down on anti-diarrhea treatments that could be adding to the opioid epidemic's death toll. Yesterday, the agency asked manufacturers of Imodium A-D and similar medications to change the way they package their products, with the aim of curbing abuse by people with drug addictions, The Post's Laurie McGinley reports.
The target here is loperamide, the generic name for an anti-diarrheal agent sometimes referred to as “the poor man's methadone" because in large quantities it induces a cheap, mild high and relieves withdrawal symptoms for drugs like hydrocodone, morphine or heroin. People with addiction problems increasingly are turning to loperamide as prescription opioids become harder to obtain.
The FDA has asked manufacturers to refashion their packages to contain only enough medication for short-term use. For example, a single package might contain eight 2-milligram capsules, enough for just two days. The agency also wants makers to use “unit dose packaging,” such as blister packs that must be individually unpeeled per dosage, Laurie writes.
OOF: The Post's Robert Samuels chronicles the uncertainty and sense of neglect felt by parents depending on the Children's Health Insurance Program to keep their kids insured, as Congress allowed the program to go months without long-term funding. He interviewed Varina Mead, a single mom of two who works for a nonprofit in Alabama. Varina described the anxiety she felt as she watched Congress drag its feet; she depends heavily on CHIP coverage for her 10-year-old daughter, who has asthma, and her 8-year-old son, who has been diagnosed with ADHD. "They treated my kids' health insurance like it was a game," Mead told Robert.
"Nine million children use the CHIP program nationally, and many of their families across the country were scrambling in the uncertainty," Robert writes. "Some parents contemplated working more hours to afford higher health-care costs. Others discussed quitting their jobs. This way, they could lower their income enough to qualify for Medicaid. If they couldn't afford insurance, what was the point of working?"
"There was harm and foul in this limbo period," said Jim Carnes, policy director of Alabama Arise, a local advocacy organization. "Those who contend that there wasn't do not appreciate the burden it put on working parents with children with health-care needs. They don't understand how unfair the process was to say, 'We're going to toy around with your children's health insurance for a while and see what comes out of it.'"
OUCH: CDC Director Brenda Fitzgerald bought shares in a tobacco company one month after she took over the agency tasked with persuading smokers to quit. It’s one of about a dozen investments Fitzgerald made in drug and food companies since she began in her role, Politico’s Sarah Karlin-Smith and Brianna Ehley report.
“Buying shares of tobacco companies raises even more flags than Fitzgerald’s trading in drug and food companies because it stands in such stark contrast to CDC’s mission to persuade smokers to quit and keep children from becoming addicted,” Sarah and Brianna wrote. “Critics say her trading behavior broke with ethical norms for public health officials and was, at best, sloppy. At worst, they say, it was legally problematic if she didn't recuse herself from government activities that could have affected her investments.”
“You don’t buy tobacco stocks when you are the head of the CDC. It’s ridiculous, it gives a terrible appearance,” Richard Painter, George W. Bush’s chief ethics lawyer, told Politico.
An HHS spokesman confirmed the stock purchase, calling it “potentially conflicting,” and noted the stock had subsequently been sold. Politico reports documents show Fitzgerald sold the tobacco shares on Oct. 26, and any other stock holdings above $1,000 by Nov. 21. At that point, she had been CDC director for more than four months.
--This caught our eye (and the eye of everyone else in the health-care world). Amazon (whose owner Jeff Bezos also owns The Post), Berkshire Hathaway and JP Morgan Chase announced yesterday they're partnering to create an independent company aimed at reining in health-care costs for their U.S. employees. Few details are available so far, but it's clear the companies (which collectively employ more than 1 million workers worldwide) have a real interest in taking on the tricky task of ratcheting down their spending on health-care, our colleague Carolyn Y. Johnson reports.
"Major health company stock prices tumbled on the news, and the announcement stirred excitement — and questions — about how the three companies could bring their clout to containing costs in the massive employer-sponsored health insurance market, which provides coverage to approximately 160 million Americans," Carolyn writes.
A person at one of the companies said specific plans will take shape over time, but the joint venture is not currently expected to be a direct replacement for existing health-care insurers, hospitals or pharmaceutical companies, Carolyn reports. Rather, the plans are for the effort to result in a company that can bring technology tools to bear on making health care more transparent, affordable and simple, the person said.
“The ballooning costs of healthcare act as a hungry tapeworm on the American economy. Our group does not come to this problem with answers. But we also do not accept it as inevitable,” Warren Buffett, Berkshire Hathaway chairman, said in a statement.
--But the White House wants to be seen as the winner on tamping down health-care spending. The Trump administration has already made moves to lower health-care costs by allowing for the expansion of association health plans, Gary Cohn, director of the National Economic Council, told CNBC yesterday, shortly after the three companies made their announcement.
"Earlier last year, we created association health-care plans, which is the exact same thing that those three companies did," Cohn told CNBC. "Smaller businesses could pool their employees together to get more purchasing power, so they could save money on health care."
We will venture so far as to say that the administration is touting a bigger win on association health plans than is backed up by evidence at this point. It remains to be seen how many health associations are formed under the new rule, how many people such plans would cover and what the coverage would even look like. In The Health 202, we've explored past problems with association-like plans.
--This week, Post filmmaker Nicole Ellis is exploring her own decision to use technology to postpone having children. In her first article and episode, she tells of how she decided to freeze her eggs after realizing she'd be in her mid-30s before trying to conceive, given her life circumstance at the time.
"In a world where my uterus is pitted against me, freezing my eggs could level the playing field by giving me more control over my reproductive life span," Nicole writes. "Yet I need a concrete understanding of how my body works and how egg-freezing works in order to take the helm of my reproductive health. I knew the basics — for example that women experience a decline in fertility in their 30s."
"But why does that happen? Is it the same for every woman?," Nicole asks. "And why are conversations about our fertility couched in comparisons to a man’s seemingly never-ending supply of sperm? I soon discovered that it might have something to do with the origins of the now-infamous term 'biological clock.'"
--A few more good reads from The Post and beyond:
- The Bipartisan Policy Center holds an event on “A Policy Roadmap for Individuals with Complex Care Needs."
- Health Affairs holds an event on health spending on Thursday.
- The Senate Health, Education, Labor and Pensions committee holds a hearing on the opioid crisis on Feb. 8.
Watch the second and third episode of the series “Should I Freeze My Eggs?" from The Post's Nicole Ellis:
Watch President Trump clap at his own State of the Union lines:
Here are lawmakers' reactions — the good and the bad — during Trump's first State of the Union: