THE PROGNOSIS

The White House office responsible for coordinating the response to the nation’s drug abuse epidemic has done little in the Trump administration’s first two years, even as drug addiction kills tens of thousands of Americans every year.

But as its director sat Thursday before the House Oversight Committee, Republicans instead used the opportunity to argue passionately for President Trump’s national emergency declaration to build a border wall.

The hearing about rampant opioid and drug addiction — and the administration’s response to it so far — highlighted how easily these days even a problem of widespread bipartisan concern can become mired in Washington’s bitter political disputes. Lawmakers spent most of the hearing arguing about at which precisely which locations on the U.S.-Mexican border drugs are smuggled into the United States, with Republicans trying to buttress their support for Trump’s pursuit of a wall with claims that many drugs enter in between ports of entry (even though data suggests otherwise).

“In your judgment … is there an illegal drug crisis on our southern border?” committee ranking Republican Jim Jordan (Ohio) asked Jim Carroll, director of the Office of National Drug Control Policy. “My guess is a lot of drugs are moving across the border where there aren’t any good guys to stop them … it’s an emergency, and there’s no way around it.”

Jordan: 

Democrats tried to turn the focus onto troubling questions hanging over ONDCP in the year-and-a-half since Trump declared the opioid crisis a public health emergency and promised his administration would work to halt abuse in its tracks. Congress has since passed — and Trump has signed — a bill to help treat and prevent opioid addiction. But it’s unclear how or whether the White House office has done much to move the needle on a problem that has prompted widespread public consternation.

Last year, the office let go a 24-year-old Trump campaign worker who rose to a senior position despite virtually no professional experience (a story on which The Post led coverage). Carroll couldn’t answer questions from lawmakers about how many of several dozen recommendations from the president’s opioid commission have been implemented so far.

And in a report issued Thursday, the Government Accountability Office said ONDCP didn’t lay out specific, measurable objectives in the strategic plan it released in January — a plan the office failed to even complete for the past two years.

“Unfortunately, in contrast to our bipartisan urgency here in Congress, the White House office charged with leading our nation’s efforts to combat the drug crisis has been missing in action as deaths continued to mount,”House Oversight Committee Chairman Elijah Cummings (D-Md.) said.

“There’s both a leadership vacuum and a competence vacuum at the head of ONDCP,” Cummings continued. “It pains me to even say that, but that’s what I truly believe.”

It’s certainly been unclear exactly who is leading the opioid response effort. For the past year, ONDCP has been headed by Carroll, a former deputy White House chief of staff with little experience in drug policy. Charmaine Yoest, who came over from the Department of Health and Human Services, stayed only one year as the office’s associate director of external affairs before departing in February for the Heritage Foundation. Multiple staffers have cycled through key positions, as Stat News reported.

But Republicans didn’t spend much time yesterday trying to investigate all these moving parts. Instead, they pressed Carroll to affirm their claims that the border wall Trump is pursuing is the key to combating the drug abuse epidemic (a claim my Post colleague Glenn Kessler has checked and debunked).

Rep. Paul Gosar (R-Ariz.) said the amount of illegal drugs flowing into the country in between ports of entry is “exponentially bigger” than the data shows. Rep. James Comer (R-Ky.) said that “what occurs at the border touches even the smallest rural communities you don’t hear about.”

In one exchange, Rep. Jody Hice (R-Ga.) asked how much of the highly lethal drug fentanyl comes through the southern border. When Carroll explained that more than 90 percent comes from China, Hice switched his line of questioning to focus on Mexican drug trafficking organizations.

Rep. Bradley Byrne (R-Ala.): 

The GOP tactics frustrated Democrats, who pointed to the magnitude of the problem. Drug overdoses are now the leading cause of accidental death in the United States, killing about 70,000 annually.

“Shame on you,” Rep. Jackie Spier (D-Calif.) said to her Republican colleagues.

“It is absolutely shameful we would sit here and conflate a continuing debate about a border wall with the fact that 70,000 Americans are dying every single year in this country and we want to turn this into some political food fight,” she added.

Rep. Stephen Lynch (D-Mass.): 

Rep. Carolyn B. Maloney (D-N.Y.): 

AHH, OOF and OUCH

AHH: Public health advocates are worried about what Food and Drug Administration Commissioner Scott Gottlieb’s departure will mean for his more ambitious initiatives, our Post colleague Lenny Bernstein and Laurie McGinley report. As one of the most activist recent commissioners in the role, Gottlieb advocated for efforts like banning menthol in cigarettes and smaller opioid packaging to prevent overdose, as well as cracked down on youth vaping.

Now the question is: Will Gottlieb’s successor – if one is appointed at all -- embrace the same initiatives?

“Tobacco-control activists are among the most worried,” our colleagues write. “While they sometimes pressed Gottlieb to go further on e-cigarette and tobacco issues, they are now anxious his successor will have neither the interest – nor the political or bureaucratic clout – to make the issue a top priority.”

“Among those who have been mentioned as possible candidates for the top job are Norman ‘Ned’ Sharpless, director of the National Cancer Institute, and Brett Giroir, assistant secretary for health at [HHS],” they add. “Amy Abernethy, Gottlieb’s principal deputy commissioner, has been mentioned as a possible acting FDA chief, but her short tenure — she recently joined the agency — is thought to be a strike against her.”

The Trump administration is expected to name an acting commissioner to take over at FDA before Gottlieb leaves in about a month, but it's unclear whether Trump, who has mentioned he doesn’t mind having members of his administration in acting capacities, will nominate someone to replace him permanently.

OOF: The number of deaths related to alcohol, drugs and suicide reached its highest point on record in 2017, according to new analysis. Two public health nonprofits, Trust for America’s Health and the Well Being Trust,  analyzed data from the Centers for Disease Control and Prevention, the New York Times’s Adeel Hassan reports.

That year, more than 150,000 Americans died as a result of alcohol, drugs and suicides, including 47,173 suicides.

The dire statistics are in part driven by the ongoing opioid crisis, Adeel reports. Compared with two decades ago, when fewer than 1,000 deaths were caused by fentanyl and other synthetic opioids, there were 28,000 synthetic opioid overdoses in 2017.

John Auerbach, president and chief executive of one of the groups, the Trust for America’s Health, pointed a finger directly at the pharmaceutical industry.

“The numbers are driven in no small way by pharmaceutical companies creating addicting drugs and clinicians inappropriately oversubscribing opioids,” he told the Times.

OUCH: More than 800 students who are considered exposed to measles were told to stay away from classrooms in Washington’s Clark County, which is at the center of the state’s worst measles outbreak in two decades.

Hundreds of students have been told to stay away for up to three weeks. “More than a dozen Clark County schools — most in Vancouver — had students sit out of class after a directive from health officials. After the date of exposure, students are supposed to be kept out for 21 days, but in many cases, schools don’t know of the exposure until days or weeks later, which shortens the amount of time children have to stay out of school,” the Seattle Times’s Jake Goldstein-Street reports.

“School exclusions are a critical tool and public health strategy to control outbreaks of disease in school settings,” Dr. Scott Lindquist, the state’s health department epidemiologist, said in a statement. “We have to be aggressive in identifying cases, isolating them and reducing public exposure to slow the spread and protect Washington residents.”

— In an effort to combat address concerns about anti-vaccine misinformation on its platform, Facebook announced it will lower the ranking of pages and groups spreading anti-vaccination misinformation, block advertisements that include false vaccine information and stop recommendations of anti-vaccination content on Instagram. In a blog post, the company also said it’s looking into ways to share information to educate people about vaccines.

“Leading global health organizations, such as the World Health Organization and the US Centers for Disease Control and Prevention, have publicly identified verifiable vaccine hoaxes,” Monika Bickert, Facebook’s head of global policy management wrote in the blog post. “If these vaccine hoaxes appear on Facebook, we will take action against them.

The plan from Facebook follows a contentious hearing before the Senate Health, Education, Labor and Pensions Committee this week where “18-year-old Ethan Lindenberger testified that his mother, an anti-vaccine evangelist, relies on Facebook or Facebook-linked sites for all of her information on the subject,” our Post colleague Reis Thebault writes. “The changes in Facebook and Instagram recommendation systems, along with the company’s proposed fact offensive, may also ease the concerns of the growing number of researchers who have noted the fast spread of misinformation online and especially on social media.

AGENCY ALERT

— The Trump administration is calling for public comment on whether it should require hospitals, physicians and other health-care providers to publicize the rates they negotiate and charge insurers for services, the Wall Street Journal’s Stephanie Armour and Anna Wilde Mathews report.

The requirement would “expose for the first time the actual cost of care,” they write. “Mandating public disclosure of the rates would upend industry control of price negotiations, and put more decision-making power in the hands of patients. Hospitals and insurers typically treat specific prices for medical services as closely held secrets, with contracts between the insurers and hospital systems generally bound by confidentiality agreements.”

The invitation for public comment was included in a little-noticed part of a patient data proposal last month, Stephanie and Anna write.

“It’s an effort by the president to help put Americans back in control of price data,” Don Rucker, HHS’s national coordinator for health information technology, told them. “We’ve had extensive discussions with the White House on this … Our interest is on how can we empower the American public to shop for their care and control it.”

STATE SCAN

— The state House in Tennessee advanced a bill by a vote of 65-to-21 that would ban abortions after a fetal heartbeat is detected. That can be as early as six weeks, before some women realize they are pregnant.

The bill is likely to face a tough challenge in the state Senate, the Nashville Tennessean’s Joel Ebert and Natalie Allison report, adding that Tennessee Right to Life has opposed the bill, ”maintaining that the organization is focused on advocating for abortion restrictions it believes can survive legal challenges.” Courts have struck down similar laws in other states.

Two Democrats voted with Republicans to pass the measure, and seven Republicans declined to vote, Joel and Natalie write.

Meanwhile, the American Civil Liberties Union and Planned Parenthood of Tennessee and Northern Mississippi said they plan to pursue legal action in the case that bill becomes law.

— The Tennessee vote came just one day after a House committee in Georgia passed its own fetal heartbeat bill. If the measure is ultimately approved, it would be a drastic change for a state that currently allows women to seek an abortion in the first 20 weeks of pregnancy.

“Wednesday's hearing was tense and emotional with several outbursts slowing proceedings and activists and citizens moved to tears on both sides of the issue,” the Associated Press reports. “The House Health and Human Services Committee approved the anti-abortion measure on a party-line vote of 17 to 14. Thirteen Republican men and four Republican women voted for it. Seven Democratic men and seven Democratic women voted against.”

— And here are a few more good reads: 

HEALTH ON THE HILL
Long before the #MeToo movement brought sexual violence and harassment to the fore, women in the military and their advocates had highlighted such misconduct in the armed forces.
New York Times
House Democrats are poised to approve new funding for gun violence research in the face of what they say is a “public health emergency” killing thousands of Americans every year.
The Hill
Politics
Brown had been touring early-voting states, arguing that he could lure back the blue-collar Democrats who flipped to Donald Trump in 2016.
David Weigel and Chelsea Janes
MEDICAL MISSIVES
Retropolis
Once used as a combat zone anesthetic, the psychedelic drug has a long, strange history.
Steve Hendrix
The city’s Department of Health had issued an order requiring schools to prohibit unvaccinated students from attending. A yeshiva in Brooklyn ignored it.
New York Times
The head of Doctors Without Borders said outside groups, including hers, had alienated Congo residents, prompting communities to spurn treatment and even attack medical centers.
New York Times
International president Dr. Joanne Liu says continuing the current approach — with ramped-up security — is unlikely to end the 7-month-old outbreak.
Stat
Health
Pancreatic cancer has the highest mortality rate of all major cancers.
William Wan
INDUSTRY RX
The billionaire family that controls OxyContin maker Purdue Pharma, already facing mounting legal and financial pressure, has been tossed out of a large hedge fund for its alleged role in fueling the opioid crisis.
Wall Street Journal
REPRODUCTIVE WARS
DAYBOOK

Coming Up

  • Veterans Affairs Secretary Robert Wilkie and Sanford Health CEO Kelby Krabbenhoft announce a major precision medicine partnership on March 12.
SUGAR RUSH
First lady Melania Trump presented the 2019 International Women of Courage Awards at the State Department

House Speaker Nancy Pelosi (D-Calif.) spoke about the caucus's disagreements over a measure condemning anti-Semitism in light of controversy around Rep. Ilhan Omar (D-Minn.):