THE PROGNOSIS

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Several major cities are trying to open “safe injection sites” for drug abusers — even though they are technically illegal. 

With recent evidence that these sites can save lives and money, cities including San Francisco, Seattle and Philadelphia are considering opening public health facilities where people who acquired illegal drugs can inject them under the supervision of trained health-care providers.

They would be the first U.S. cities to adopt such an approach to combat the sweeping opioid epidemic, which has recently gained attention from the White House, Congress and policymakers across the country. 

“While overdose deaths aren’t new, the scale of them is new … and that’s leading a lot of communities to look for different solutions, to look for something new that hasn’t been tried,” said Laura Thomas, deputy California state director for the Drug Policy Alliance. 

San Francisco’s Department of Public Health says it expects to open its first sites as early as this summer, but is still working out the legal issues and location details. In King County in Washington, which includes Seattle, a task force recommended opening sites as part of a 2016 list of recommendations for combating addiction, and the county’s Board of Health unanimously voted last year to endorse opening two sites.

And in Philadelphia, city officials announced in January they want the private sector to develop such a facility, and have since hosted community forums to seek public feedback on the plans.

Outside the United States, these sites are gaining traction as a way to combat drug abuse. There are about 100 sanctioned sites that have opened in 11 countries, according to one expert, mostly in Europe as well as in Australia and Canada.

The facilities don’t provide illicit drugs, but provide a space for people to use drugs with sterile instruments and under supervision. Trained health-care workers are also available to administer opioid antidotes if users exhibit signs of an overdose, and can also offer information about long-term treatment.

In the United States, however, the federal government is against the opening of these facilities, and concerns about abuse of the law and community pushback in some cities has stalled them from getting off the ground. 

Drug Enforcement Administration spokesman Melvin Patterson said the facilities violate the federal Controlled Substances Act and are “subject to being prosecuted.” Patrick Trainor, a special agent with the DEA in Philadelphia, said these facilities are a nonstarter. “I don’t think it should come as a real surprise, but no, coming from the DEA perspective, we’re not in favor or don’t support them,” he said. 

But experts who have been observing and studying injection sites say they see a lot of positives to supervised drug use.

Alex Kral, an epidemiologist for the nonprofit research group RTI International, said the sites can decrease drug users’ risk of infections from HIV and hepatitis, reduce overdose fatalities and connect users with resources such as drug treatment programs or social services. They can also reduce the number of people injecting in public and ensure needles are properly disposed, he said. 

What’s more, he said, “We don’t see a lot of negative aspects” to the sites. “It’s surprising. As a researcher I’m interested in both the positive and the negative. And I haven’t seen a lot or heard of a lot of negative components.” 

Kral’s research has found supervised injection facilities would save money, too. In a study that looked at the cost effectiveness of opening a facility in San Francisco, he found a single 13-booth facility would lead to $3.5 million in net annual savings for the city.

Henry L. Dorkin, president of the Massachusetts Medical Society, said he was initially skeptical about supporting a facility that enables drug use, but changed his mind after looking at the research.

“The bottom line was these people already had these drugs and they were already going to inject them,” Dorkin said. “The only thing that’s being facilitated is saving their lives, and at the same time, making available to them rehabilitation facilities and people who wouldn’t be available down that proverbial dark alley where they would normally shoot up.”

Thomas, from the Drug Policy Alliance, argued drug users “want these programs.” 

“They don’t like having to inject in public; that’s very much a last resort for people,” she said. “If we could have these programs, it would give people a little bit of safety and belonging and respect, which is often what people need in order to stabilize their lives and make changes in their lives.” 

But state and local lawmakers are divided over supervised injection sites, given they’re a relatively new idea. Some are worried that law enforcement, both at the local and federal level, would come after those involved with the sites. And in some cities, residents have expressed fears that a site might cause trouble in their neighborhood.

“There’s still a lot of stigma, there’s still a lot of questions about legality of it. And I think that’s one of the things people are worried about — potential liability,” Kral said.

California State Sen. Scott Wiener said he wants the sites opened “yesterday.” Wiener, a Democrat, is working on a bill he hopes would remove some of the obstacles by authorizing certain counties in the state – including San Francisco and Los Angeles – to pilot a program.

“Obviously we can’t control federal law, but we can remove state barriers,” Wiener said.

He’s partnering with Democratic Assemblywoman Susan Eggman, who worked to pass the bill through the state Assembly. But it has stalled in the state Senate, two votes shy of passing. But Wiener feels the state should move forward even without authorization from the legislature.

Thomas pointed to the success of similar injection facilities in other countries. There have been no overdose deaths at Vancouver, B.C.’s Insite, which became the first such program in North America when it opened in 2003. Research from the Massachusetts Medical Society also found a 35 percent reduction in overdose deaths in areas surrounding the facility, and estimated that 6,440 overdose deaths have been averted since its opening.

“When you look at the thousands of people who are dying across the U.S. and think, well, we have this intervention that could potentially eliminate those deaths, why aren’t we trying it?” Thomas said. 

But Joshua Freed, chair of the Safe King County campaign in the Seattle area that has pushed to ban such sites, expressed concern about the Vancouver model, saying he visited Insite and didn’t like what he saw. 

“You can walk inside, you can pick up your heroin injection kit … everything you need is paid for and provided,” he said. Freed has been working on a ballot initiative that would ban safe injection sites and is currently waiting on an appeal after a judge prohibited the initiative from getting on the ballot.

Freed also challenged the research cited by proponents of the facilities, calling these sites a “false safety net.” He suggested while it was obvious why no one had died yet in Vancouver’s facility itself, it may not change what was happening outside its doors.

“They do exist to revive people, they have Narcan on hand, but any village idiot can have Narcan on hand and revive people from it,” he said. “But they’re going into the streets and using again.”

King County Prosecuting Attorney Dan Satterberg said he’s ready for a battle against the federal government to keep the sites open. 

“I’m prepared to defend it against any claim that might come,” Satterberg said. “It would be unfortunate and a really a political response if that’s what the Department of Justice would want to do, because the medical evidence is that these programs can help people.”

In Philadelphia, Deputy Managing Director for Health and Human Services Eva Gladstein said the city has been holding meetings to determine concerns community members may have. She said people tend to have “strong feelings” about the idea, and support has been mixed.

 “When we hear from people who are in recovery … or people who provide substance abuse treatment, they in general have been very supportive,” Gladstein said.

At community forums, she said, people often ask: “What would the impact be on the neighborhood? Would it encourage drug sales, would it encourage crime, would there be more litter?” She said some residents have questioned whether the facilities encourage treatment, or if they are just “enabling the very behavior we’re trying to address.”

Trainor echoed concerns about the long-term effects of safe injection sites on neighborhoods.

“Our issue is once you open that gate per se, you’re essentially damning the neighborhood,” he said. “You’re basically giving the neighborhood where it opens a life sentence. That’s never going to recover from that.”

AHH, OOF and OUCH

AHH: Alfie Evans, a terminally ill toddler whose case set off a high-profile legal battle and ethical questions about end-of-life care and parental rights, died early Saturday morning, The Post's Sarah Pulliam Bailey reports. 

"Pope Francis had been publicly praying and advocating for the 23-month-old boy, and the Italian government offered the child citizenship and created a plan to take the boy to a Vatican hospital," Sarah writes. "But Alfie’s doctors, who took him off life support against the parents’ wishes, said he couldn’t be healed and shouldn’t make the trip."

Earlier this week, a judge sided with his doctors, who said Alfie suffered from a rare and incurable degenerative neurological condition. The court also ruled that the parents could not seek treatment for him elsewhere because it would be against the child’s best interests.

The Pope tweeted this on Saturday:

OOF: Top Democratic Sen. Patty Murray (Wash.) is asking the Department of Health and Human Services to justify paying newly appointed CDC Director Robert Redfield a $375,000 salary, almost twice what his predecessor earned and more than past directors, The Post's Lena H. Sun reports.

In a letter Friday to HHS Secretary Alex Azar, Murray noted news reports saying Redfield was being hired under a special salary program. “Title 42, as it is known, was established by Congress to attract health scientists with rare and critical skills to government work,” Lena explains. “It grants federal agencies authority to offer salary and benefit packages that are competitive with those offered in the private sector and academia.”

Redfield has no experience running a public health agency, although he was well respected as a leading AIDS clinician and professor of medicine at the University of Maryland School of Medicine -- where he earned an annual salary of $645,676, Lena notes.

Murray wrote that it is “difficult to understand why someone with limited public health experience, particularly in a leadership role, is being disproportionately compensated for his work as compared to other accomplished scientists and public health leaders in comparable roles within the federal government.”

OUCH: U.S. prosecutors charged 10 people — including four Chinese nationals — with selling large quantities of fentanyl to Americans as part of an alleged international money-laundering conspiracy, Attorney General Jeff Sessions announced Friday.

The suspects used 30 separate aliases, such as “Phantom Pharma” and “Toxic Storm” in the five-year conspiracy, which involved encrypted communications, cryptocurrency, laundered funds and offshore accounts, The Post's Sari Horwitz reports. The Treasury Department also froze U.S. assets belonging to the conspiracy’s alleged leader, Jian Zhang (also known as “Hong Kong Zaron"), along with the assets of four other Chinese nationals charged with crimes by the Justice Department. 

“It marked the first time the United States has taken such steps against alleged fentanyl traffickers,” Sari writes. “The Chinese-based network moved more than 400 grams of fentanyl, a powerful synthetic opioid, and more than 100 grams of a fentanyl analogue in the U.S. and Canada ... Sessions said the defendants allegedly trafficked fentanyl from China to 11 states, a pipeline stretching from Oregon to Ohio to Florida.”

AGENCY ALERT

— White House physician Ronny Jackson won’t be returning as President Trump’s personal doctor after a series of allegations forced him to withdraw his nomination to lead the Veterans Affairs Department, our colleague Ashley Parker reports. Navy veteran Sean Conley, who took over as Jackson’s personal physician last month, will continue in that post. Jackson will remain on the staff of the White House medical unit.

Meanwhile, Trump has continued to defend Jackson. On Saturday, the president called on Sen. Jon Tester (D-Mont.) to step down after releasing details of allegations that led to Jackson’s withdrawal. The president suggested voters would punish Tester, who is up for reelection this fall in a state Trump won handily:

Trump also called for Tester’s ouster during a Saturday rally in Michigan, threatening to share his own secrets about the senator. “I know things about Tester that I can say, too,” Trump said at the rally. “And if I said them, he’d never be elected again.”

Unproven allegations prompting the Navy rear admiral to withdraw from consideration for the VA post include drinking on the job, improperly prescribing and handing out medications and contributing to a toxic work environment. “While Trump, Jackson and other White House officials have vehemently denied the allegations, they have been difficult to prove or disprove,” our colleagues Elise Viebeck and Amy Gardner report. “Tester’s staff has released no documentation for the accusations, offering only that each charge is supported by the accounts of at least two individuals.”

The White House said Friday it had conducted a thorough review of Jackson's vehicle records and while it found three minor incidents, there was no evidence he “wrecked” a car after drinking at a Secret Service going-away event, as was alleged in a document released last week.

“Although many news outlets, including The Washington Post, have described anonymous accounts of some of the other charges, no evidence has publicly surfaced that the crash happened since Sen. Jon Tester (D-Mont.) authorized the release of the allegations on Wednesday,” Amy and our colleague Seung Min Kim report, adding Jackson has vehemently denied the allegations.

The Secret Service also denied reports that agents intervened to stop Jackson from bothering then-President Obama during an overseas trip.

REPRODUCTIVE WARS

— Forty years ago this July, the world’s first “test tube” baby was born at a British hospital, heralding a radical change in the creation of human life. Since then, in vitro fertilization and related technologies have produced about 7 million babies who might never have existed — approximately the combined population of Paris, Nairobi and Kyoto — and the world’s fertility clinics have blossomed into a $17 billion business, The Post's Ariana Eunjung Cha reports in a lengthy look at how the religious are approaching modern fertility methods.

The procedures have amplified profound questions for the world’s theologians: When does life begin? If it begins at conception, is it a sin to destroy a fertilized egg? What defines a parent? Is the mother the woman who provides the egg or the woman who gives birth? What defines a marriage? 

“The moral questions are rapidly becoming more complex,” Ariana writes. “Researchers are working to advance gene-editing tools that would allow parents to choose or 'correct for' certain preferred characteristics; to create artificial wombs that could incubate fetuses outside the body for nine months; and to perfect techniques to produce 'three-parent' babies who share genetic material from more than two people.”

“The risks, both scientific and moral, are enormous — particularly with gene editing, which could be used to produce babies with superhuman eyesight, speed and intelligence,” she continues. " 'Off target' effects could result in fundamental changes not just to human bodies but to human nature.”

— Ariana also teamed up with The Post's Ellie Silverman to report on an event last October believed to be the largest gathering of IVF children and their parents in history. The families were all patients of Boston IVF, one of the nation’s largest fertility practices. They were celebrating the clinic’s 30th anniversary and the estimated 90,000 babies it had helped usher into the world.

“They flooded into Gillette Stadium, thousands of moms, dads and children eating hamburgers and hot dogs, tossing balls, making goofy faces and otherwise having fun,” Arianna and Ellie write. “No one would have guessed the huge obstacles they had overcome to be here. ... Some said faith kept them going through years, even decades, of fertility treatments. Several nearly died because of complications but nonetheless pursued their desire for a family. And virtually all viewed successful pregnancy — by whatever means — as evidence that their children were meant to be.” Read some individual stories here.

— A few more good reads from The Post and beyond:

TRUMP TEMPERATURE
The intercession of a well-connected Florida doctor infuriated those overseeing the $16B contract.
Politico
HEALTH ON THE HILL
Local
As the team warmed up at its first practice of the season since last year’s shooting, the House majority whip was recovering from an estimated ninth surgery.
Marissa J. Lang
MEDICAL MISSIVES
To Your Health
At least 46 people have been hospitalized in the multistate outbreak, the largest involving the bacteria in a dozen years.
Lena H. Sun and Joel Achenbach
In a meeting at the White House last month, the philanthropist said he tried to get Trump interested in helping to develop a universal flu vaccine — and also to buy into the importance of pandemic preparedness.
Stat News
OPIOID OPTICS
Facing a rising death toll from drug overdoses, state lawmakers across the country are testing a strategy to boost treatment for opioid addicts: Force drug manufacturers and their distributors to pay for it.
AP
DAYBOOK

Coming Up

  • CMS Administrator Seema Verma and HHS Secretary Alez Azar will speak at The 15th Annual World Health Care Congress this week, which continues through Wednesday.
  • The FDA’s antimicrobial drug advisory committee holds a meeting on Tuesday.
  • The Partnership for a Healthier America summit begins Wednesday.
  • Politico hosts an event on the prescription drug supply chain on Thursday.

 

SUGAR RUSH
Here's what you missed from comedian Michelle Wolf's routine at the 2018 White House correspondents' dinner

Meanwhile, President Trump remarked on skipping the dinner during his counter-programming at a rally in Michigan:

"Kanye West gets it," President Trump told the crowd during his rally: