THE PROGNOSIS

As the Senate prepares to vote tonight on its response to the opioid crisis, a federal government study on substance abuse released Friday underscores how desperate the situation remains. 

The Senate bill is sweeping in scope, creating and expanding programs across multiple agencies. But public health advocates and experts see the latest statistics from the Substance Abuse and Mental Health Services Administration as just another indication of how little the government has done, and seems willing to do even still. 

The annual National Survey on Drug Use and Health (NSDUH) found 11.4 million Americans over 12 years old misused opioids last year, and 2.1 million Americans had opioid disorders.

Here's the good news: Those numbers are down slightly from the previous two years, and the number of new heroin users was cut in half.

Here's the bad news: The number of Americans dying from heroin overdoses continues to rise, which is consistent with Centers for Disease Control and Prevention figures released last month.

Even if slightly less people are using heroin, the drug is more fatal because it's increasingly being laced with fentanyl — an incredibly potent, inexpensive and synthetic opioid. The CDC estimates that of the 72,000 overdose-related deaths in 2017, 30,000 were caused by synthetic opioids. 

"The reason overdose deaths are skyrocketing is not because of a sudden increase in the number of people switching from prescription to heroin, the reason those deaths started going up is because of a sudden increase in the dangerousness. It's fentanyl, not more people using," Andrew Kolodny, co-director for opioid policy research at Brandeis University, told me.  

The Senate bill does address the ease with which synthetic opioids are shipped from overseas, typically from China. A provision from Sen. Rob Portman (R-Ohio) requires the U.S. Postal Service to screen packages coming from overseas and receive electronic data about the packages' content -- something that as of now only commercial carriers have to do. 

"Because of its extreme potency, deadly doses can be shipped in small packages that are almost impossible to identify without having the necessary information and screening devices," Portman said in a floor speech last week.

Here's more good news: More than 100,000 more Americans received treatment for opioid use disorder last year than the year before. 

But the bad news: Of the nearly 20 million people who needed treatment, a staggering 94 percent didn't receive it.

When asked why, 30 percent of them said they didn't have health coverage and couldn't afford it, and 10 percent didn't know where to go for treatment. 

The Senate bill, which largely mirrors a House version that passed in June, seeks to increase access to treatment, particularly through a grant for recovery centers where people getting over their addictions can find temporary housing, job training and other assistance during that transition. But this too is seen as a small response to an enormous problem.

Experts in public health say more doctors need to be allowed to prescribe buprenorphine and methadone, two drugs that when administered by a medical professional can help people with addiction wean off. Doctors must obtain a waiver to administer buprenorphine and even then they are capped at how many patients they can give it to. The Senate bill addresses this, but narrowly. For instance,  the measure increases the number of patients  doctors can prescribe such drugs to from 100 to 275.

Sarah Wakeman, the medical director for Mass General Hospital's Substance Use Disorders Initiative, said the "proposed opioid legislation doesn't go nearly far enough."

"We have historically not thought of addiction as a medical issue and so our healthcare and public health system are woefully unprepared to respond in a robust way,"  Wakeman said. "We could dramatically decrease or even stop overdose deaths. We have the tools and the science, but we don’t yet have the will. Opioid overdose is a reversible condition and the underlying illness of addiction is highly treatable however we have not made effective treatment or interventions to keep people alive widely available."

To really get at the depth of the opioid epidemic would require an infusion of federal dollars on par with the more than $20 billion a year spent on HIV/AIDs, Wakeman said. So far, despite President Trump declaring opioid use a public health emergency and a bipartisan consensus that something must be done, there hasn't been anywhere close to that kind of financial commitment. 

Moreover, the White House's changes to the Affordable Care Act could limit access to treatment. The cheaper, short-term duration plans the Trump administration will allow Americans to purchase for 2019 do not include the ACA's essential benefits, including coverage for substance abuse disorders. And the work requirements many states want to add to their Medicaid programs could result in low-income individuals with addiction losing their health coverage. 

Medicaid recipients with opioid addiction are three times more likely to receive treatment than those with private insurance, according to the Kaiser Family Foundation.

But Kolodny told me that President Obama also shares blame for the crisis. The problem, 20 years in the making, worsened around 2010, yet Obama didn't talk about it until the last year or so of his presidency. 

"Obama was no better on opioids than Reagan was on AIDs," he said. "The Obama administration, the president, really neglected the epidemic and it got a lot worse on his watch."

"Overall it’s very little, very late," Kolodny added. "We've yet to see an appropriate response."

AHH, OOF and OUCH

AHH: A California professor came forward to The Post as the writer of a confidential letter regarding Supreme Court nominee Brett Kavanaugh after the letter, which includes allegations of sexual assault three decades ago, surfaced last week.

Christie Blasey Ford, a 51-year-old research psychologist in northern California, told The Post about the alleged assault, which she said happened one summer in the early 1980s when she and Kavanaugh were both in high school. “Kavanaugh and a friend — both 'stumbling drunk,' Ford alleges — corralled her into a bedroom during a gathering of teenagers at a house in Montgomery County,” our colleague Emma Brown writes. “While his friend watched, she said, Kavanaugh pinned her to a bed on her back and groped her over her clothes, grinding his body against hers and clumsily attempting to pull off her one-piece bathing suit and the clothing she wore over it. When she tried to scream, she said, he put his hand over her mouth.”

The White House sent The Post a statement Kavanaugh issued last week. “I categorically and unequivocally deny this allegation. I did not do this back in high school or at any time,” the statement read.

Republicans initially signaled they would move ahead with his confirmation process, “even as Senate Democrats swiftly called for them to delay a vote to advance Kavanaugh’s nomination,” our Post colleague Sean Sullivan reports. But Sen. Jeff Flake (R-Ariz.)  and Bob Corker (R-Tenn.) joined Democrats in calling for a delay of the Senate Judiciary Committee’s vote until members speak with Ford, saying she “must be heard.” “I’ve made it clear that I’m not comfortable moving ahead with the vote on Thursday if we have not heard her side of the story or explored this further,” Flake said.

If Flake,  one of the panel’s 21 members, voted against Kavanaugh, it could stall the nomination. Committee Chairman Sen. Charles E. Grassley (R-Iowa) was working to set up follow-up calls with Kavanaugh and Ford, a spokesman said.

“Republicans face a potential backlash from female voters, especially suburban women, if they press ahead despite the allegation,” Sean notes. In a statement Sunday, Senate Minority Leader Charles E. Schumer (D-N.Y.) said “for too long, when women have made serious allegations of abuse, they have been ignored. That cannot happen in this case.”

There is also the question of Sens. Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska), moderates who support abortion rights and who “have broken ranks with their party in the past,” Sean writes. Representatives for the senators did not respond to The Post’s request for comment Sunday, and neither have yet said how she plans to vote on Kavanaugh.

OOF: In just the latest in legal challenges over the ACA, patient and advocacy groups on Friday filed a lawsuit attempting to stop the Trump administration’s plan to let people buy less-expensive, short-term insurance plans.

“The suit, filed in U.S. District Court for the District of Columbia, takes aim at one of the central planks of the administration’s plan to roll back the Obama-era health law, after Congress failed to repeal it last year,” the Wall Street Journal’s Stephanie Armour reports. “It sets the stage for a legal standoff that could affect coverage and premiums for millions of Americans in 2019.The Trump administration rule finalized in August loosens restrictions on a type of coverage known as short-term medical insurance—low-cost plans that cover a limited period with less-expansive benefit offerings, which are subject to fewer consumer protection regulations. The plans don’t have to cover people with pre-existing conditions, and insurers can charge higher premiums based on a consumer’s health status.”

Groups including the American Psychiatric Association and AIDS United claim the short-term plans, which don’t offer all the benefits of the ACA, will end up making patients with medical conditions pay more for coverage. That’s because healthier people, who are needed to keep premiums stable by offsetting costs for sicker individuals could opt to purchase the less comprehensive plans.

OUCH: A new study has found a low-dose aspirin regimen has no overall benefit for healthy, older people in fending off either cardiovascular disease, dementia or disability, our Post colleague Lenny Bernstein reports. Even more, such a regimen can increase the risk of bleeding in the digestive tract and brain.

While there is “good evidence” that such a treatment plan can work for people with known cardiovascular issues, it had not been shown whether there would be a benefit for healthy people over 70, Lenny writes. But the new study of more than 19,000 people in Australia and the United States over five years found no such benefit.

“The use of low-dose aspirin resulted in a significantly higher risk of major hemorrhage and did not result in a significantly lower risk of cardiovascular disease than placebo,” the researchers wrote in one of three articles published yesterday in the New England Journal of Medicine.

“The researchers did not state whether healthy older people who have been taking aspirin should stop. And the findings do not apply to black or Hispanic people younger than 65 or others younger than 70,” Lenny reports. “When the researchers looked at death, disability and dementia, they found virtually no difference between the aspirin-taking group and the group given a placebo. But the rate of bleeding was significantly higher in the aspirin group: 3.8 percent vs. 2.8 percent.”

AGENCY ALERT

— A federal advisory panel last week expressed concern about the thousands of low-income Arkansas residents who were dropped from Medicaid coverage over failing to meet state work requirements, the New York Times’s Robert Pears reports.

Penny Thompson, chairwoman of the Medicaid and CHIP Payment and Access Commission said it was  “very concerning” and “very worrisome" that 4,350 people lost coverage as a result. 

“I hope these data scare the pants off people in Arkansas,” panel member Christopher Gorton said, per Robert. He wrote that the commission met in Washington, D.C. last week, and moved to “seek more information on the Arkansas program, with the aim of making recommendations later this year.”

Thompson told the Times the commission would look into further information about the state's Medicaid program but said “it’s my sense from the commissioners that, as a group, we have a serious level of concern with the information that we are seeing.”

— The Food and Drug Administration on Friday released a proposal for a new payment system to have hospitals subscribe to antibiotics at a flat rate rather than paying for them in bulk or individually.

The new proposal is meant to encourage drugmakers to develop new antibiotics, Modern Healthcare’s Steven Ross Johnson reports.

“Drug companies and governments have sought for years to find a new market model that would incentivize pharmaceutical firms to develop new antibiotics as the pipeline tightens,” Steven writes. “Gottlieb said the agency has talked with the CMS about a subscription-based model within Medicare, but that those discussions were still in their early stages. He didn't see the subscription-based model as something that would encompass the entire healthcare market, but rather it would be reserved for the large healthcare organizations that are more likely to use the kinds of antibiotics targeted to treat multi-drug resistant pathogens.”

MEDICAL MISSIVES

— Yesterday, more than 100 dialysis patients were rescued from their homes in North Carolina that were flooded in the aftermath of Hurricane Florence, which has been downgraded to a tropical depression.

“Many of them had been rescued by boats from their homes, and some had not received treatment for as many as five days,” our Post colleagues Steven Mufson reports. Tom Cotter, a North Carolina team leader for relief group Americares waited in a shelter parking lot to provide the rescued with necessities including health screenings, medicine, adult diapers and cleaning supplies, Steven writes.

At least 17 deaths have been attributed to the storm as it continues to inch across the Carolinas, bringing devastating floodwaters and the potential for landslides. Follow the latest updates from the storm from our colleagues here. 

— Here are a few more good reads from The Post and beyond:

Maryland Politics
The 60-second spot will air in Baltimore for a week. Gov. Larry Hogan (R) has been running ads since early July.
Ovetta Wiggins
These programs aim to help patients who can’t or won’t jump through the hoops of health care bureaucracy — appointments, referrals, paperwork.
Stat
TRUMP TEMPERATURE
Far more people died from Hurricane Maria than Katrina, but the House and Senate have asked fewer questions.
Politico
HEALTH ON THE HILL
The New York Democrat, who has become a symbol of progressive activism, says she was not blind to “political realities.”
Politico
Morning Mix
The nominating contest is no longer just a fight over the rules governing the judiciary but a referendum on the #MeToo movement and the lessons of the bitter dispute over Clarence Thomas.
Isaac Stanley-Becker
STATE SCAN
These are all the ways the Centers for Disease Control and Prevention can help mitigate the damage wrought by a big storm like Hurricane Florence.
Los Angeles Times
INDUSTRY RX
Health & Science
Janet Jay describes how she “became a cyborg” using a spinal cord stimulator.
Erin Blakemore
Allergan Plc. said revenue from its medical aesthetics business could double by 2025, even as it faces increasing competition for its blockbuster wrinkle treatment, Botox.
Reuters
DAYBOOK

Coming Up

  • The Senate Health, Education, Labor and Pensions holds a hearing on reducing health care costs on Tuesday.
  • The Biden Cancer Summit begins on Thursday.
  • The FDA holds a meeting of the Pharmaceutical Science and Clinical Pharmacology Advisory Committee meeting announcement on Thursday.
SUGAR RUSH

Drone video captures Florence flooding in North Carolina:

‘Conquering one shelter at a time’: Celebrity chef José Andrés feeds people after Florence: