The Washington PostDemocracy Dies in Darkness

The Health 202: Trump administration claims credit for some bright spots in the opioid epidemic

with Paulina Firozi


The Trump administration is eagerly touting some progress in combating the nation’s epidemic of drug abuse on the heels of recent findings that its drug control office is falling down on the job.

Trump counselor Kellyanne Conway and other White House officials held a press call yesterday to argue there are concrete results from significant steps taken by the administration and Congress in the year since President Trump laid out his plan to combat the opioid epidemic.

"In President Trump's first year in office, overdose deaths grew by 10 percent, having grown by 22 percent the year before," Conway told reporters. "So the rate of death increased at a rate less than half of what had increased just the year before."

Conway pointed to a sharp decline in prescriptions for opioid painkillers, stepped-up government efforts to reduce the flow of illegal fentanyl and increased availability of treatment beds through Medicaid waivers, per my colleague Lenny Bernstein, who was on the call. She also said 58 percent of young Americans and 1.4 billion viewers have seen ads highlighting the dangers of opioids.

Officials also pointed to bills enacted by Congress to help children born addicted to opioids and beef up screening of mail coming into the country from abroad for illegal fentanyl. Most notably, lawmakers in October passed, and Trump signed, the wide-ranging SUPPORT Act that includes measures to curb the worst drug epidemic in U.S. history — although critics said it was too little, too late and lacked a large infusion of new federal dollars for treatment.

Conway, who coordinates the White House’s anti-drug efforts, said the administration would “continue to focus on implementing” the law, which she called “the single most comprehensive piece of legislation on any one drug crisis in our nation’s history.”

Yet there’s little evidence that the White House Office of National Drug Control Policy — whose leaders have said they meet regularly with Conway — has done much on its own to combat the crisis. In a report issued earlier this month, the Government Accountability Office said ONDCP didn’t lay out specific, measurable objectives in the strategic plan it released in January.

In a House Oversight panel hearing on the same day, ONDCP's acting director, Jim Carroll, faced scathing questions about that GAO finding, reports of turnover within the office, and its apparent failure to implement several dozen recommendations from the president’s opioids commission.

Furthermore, it’s difficult to distinguish whether progress in combating addiction can be largely credited to the Trump administration's actions over the past year or from efforts that began before the president announced his efforts. And provisional CDC data through August 2018 shows that the number of overdose deaths from all drugs remains stubbornly high. The 2018 total is likely to be close to the record of 70,237 set in 2017.

Yet a spokesman for ONDCP argued the office has achieved several goals in the past year, pointing to its designation of Alaska as a High Intensity Drug Trafficking Area (known as a HIDTA designation, which allows the state to receive more federal resources), its addition of 10 new areas to existing HIDTAs and improvements in the number of youth reporting no substance use in the past 30 days in the office's Drug Free Communities report.

And the administration is right in noting there are a few bright spots in the fight against opioid abuse. For example, the number of opioid prescriptions has been falling since their peak of more than 255 million in 2012, according to the Centers for Disease Control and Prevention. The sharpest one-year decline in that period was in 2017, when the number of prescriptions dropped from 214.8 million in 2016 to 191.2 million.

Conway said 17 states have applied for waivers that allow Medicaid to fund more beds for opioid treatment in hospitals, and the administration continually encourages others to seek the same authority. Distribution of the overdose antidote naloxone also has increased sharply in the past year, she said.

Still only a small portion of the more than 2 million Americans with an opioid-use disorder receive the medically assisted treatment — methadone, buprenorphine and other drugs —that offer them the best chance of recovery.


AHH: The Food and Drug Administration has approved the first drug meant for postpartum depression.

The drug needs to be administered intravenously for 60 continuous hours, and the manufacturer, Sage Therapeutics, said it would probably cost $20,000 to $35,000 for a course of treatment, as our colleagues Laurie McGinley and Lenny Bernstein report. The drug will have to be administered under the supervision of a health-care professional in a physician’s office or clinic and under an FDA safety program linked to the approval.

The disorder, which affects an estimated 400,000 women nationwide each year, is characterized by feelings of guilt, worthlessness or thoughts of suicide, and can impact a mother’s ability to bond with her child. The newly approved medication, called brexanolone, will be marketed under the name Zulresso.

Currently, women suffering from postpartum depression are treated with antidepressants and psychotherapy, which can take one to two months to take effect and may have only a small-to-moderate impact. Comparatively, the new treatment works quickly and lasts at least 30 days, based on clinical studies.

OOF: The National Portrait Gallery in London has given up a donation from the prominent Sackler family, which owns Purdue Pharma and has become increasingly linked to the ongoing opioid crisis in the United  States. It’s the first major art institution to make such a move, The Guardian’s Nadeem Badshah and Joanna Walters report.

A gallery spokesman told the publication that it “jointly agreed” with the family's organization not to move forward with the 1-million-pound, or about $1.3 million, donation. Our Post colleague Peggy McGlone reported last month about numerous cultural institutions dealing with backlash surrounding funding from the family that has, for more than five decades, donated to museums around the world.

“With some leading members of the Sackler family facing a growing number of lawsuits over their alleged role in the deadly US opioid crisis, the family — which vigorously denies the allegations — claimed the donation to the gallery’s Inspiring People project had been dropped to avoid creating a ‘distraction’ for the gallery,” Nadeem and Joanna write. “But while both parties insisted that the decision was mutual, it will be seen as a major blow to the family’s status as leading philanthropists and evidence that a campaign against the Sacklers . . . has been effective.”

OUCH: In 2015, New York passed one of the strongest laws in the nation to prevent surprise medical bills, and it’s now at the center of national attention from lawmakers and health-policy experts who are zeroing in on the issue, Vox’s Sarah Kliff reports.

“Last year, New Jersey passed a law modeled on New York’s, and Congress is now eying the New York law as a promising base for national legislation,” she writes.

The law uses a unique process of arbitration, a negotiation process forcing doctors and insurers to negotiate a price on a service, which is determined with the help of a neutral arbiter. The process can “force insurers and doctors to make honest guesses about what the price should be.”

Sarah detailed the experience of Claudia Knafo, a New Yorker and professional piano player who helped push for the bill after she was hit with a surprise $101,000 charge for a spinal surgery.

“New York’s law passed in 2015. It had the support of the emergency room doctors and the insurance plans, two lobbies that often find themselves at loggerheads in these type of debates,” Sarah writes. “Now when a New York doctor thinks a health plan has underpaid, this law will often prevent the doctor from turning to the patient for the additional money in the way Knafo’s surgeon did. Under the baseball-style arbitration law, the doctor can go to the state and request an arbitration process. The state will bring in a neutral arbiter to pick one of two prices: what the doctor is charging or what the insurer is paying.”


— Health and Human Services secretary Alex Azar backed needle exchange during remarks at the National HIV Prevention Conference, saying it could help bring down the rate of new HIV infections for drug users.

Azar acknowledged such support is a shift for a Republican administration, The Hill’s Jessie Hellmann reports.

“Syringe services programs aren’t necessarily the first thing that comes to mind when you think about a Republican Health secretary, but we’re in a battle between sickness and health, between life and death,” Azar said during his speech. “The public health evidence for targeted interventions here is strong, and supporting communities when they need to use these tools means fewer infections and healthier lives for our fellow Americans.”

But Azar added the administration is still opposed to safe injection sites, facilities that give drug users a space to use illicit drugs with clean instruments and under the supervision of trained health-care workers. He said such sites “raise entirely different legal concerns.”

— Outgoing FDA commissioner Scott Gottlieb suggested the agency could remove pod-based nicotine products from the market temporarily as it continues efforts to try to curb youth vaping.

At a Brookings Institution event in Washington, Gottlieb explained he had recently had a “difficult” meeting with representatives of e-cigarette maker Juul Labs and Marlboro maker Altria Group, which has a nearly $13 billion stake in Juul, as Bloomberg’s Anna Edney reports.

Anna conducted the interview at the Brookings event.

Gottlieb said his agency is “is going to have to very carefully calculate its action against the entire category of pod-based products.” “All the dramatic gains we’ve made reducing smoking in this country, particularly among youth, will be reversed by these products,” he added.

“The FDA is concerned that Altria’s decision to take a $12.8 billion stake in Juul contradicts commitments both companies previously made to address what health officials have called an epidemic of youth vaping,” Anna reports. “Both companies have said their devices are intended for adults who are trying to quit smoking traditional cigarettes.”

“I continue to have concerns that some of the activities they’re taking in the market are not necessarily consistent with what they are telling us, but certainly not consistent with what we think the broader public health objectives should be,” Gottlieb said at the event.


— Senate Finance Chairman Chuck Grassley (R-Iowa) announced his scheduled April 3 hearing with leaders of top pharmacy benefit managers has been postponed because of the NATO secretary-general’s scheduled joint address to Congress that day. The hearing is now set for April 9.

Four of the five pharmacy benefit managers have agreed to appear before the committee, but Grassley’s office has not specified which companies have volunteered. Grassley and top committee Democrat Sen. Ron Wyden (D-Ore.) sent letters to Cigna, Prime Therapeutics, OptumRx, Humana, and CVS Health and CVS Caremark.

— A jury in the U.S. District Court in San Francisco has found Bayer AG’s popular Roundup weedkiller caused a man’s cancer. It’s the latest blow to the company after another jury reached a $289.2 million verdict in a similar case last year, the Wall Street Journal’s Sara Randazzo and Ruth Bender report. That decision in August came soon after the German pharmaceutical giant completed its acquisition of Monsanto.

This first phase of the trial focused on whether the company’s weedkiller and active ingredient glyphosate causes cancer. Now, the jury will hear evidence and separately determine whether Bayer’s Monsanto division is liable.

“Bayer faces lawsuits in the U.S. from about 11,200 farmers, home gardeners and landscapers claiming its glyphosate-based herbicides cause non-Hodgkin lymphoma and other cancers,” Sara and Ruth write. “Bayer said Tuesday that it is disappointed with the jury’s decision but ‘we continue to believe firmly that the science confirms that glyphosate-based herbicides do not cause cancer’ and that the second phase of the trial “will show that Monsanto’s conduct has been appropriate.’”

— And here are a few more good reads: 


Gottlieb: Insurers must be willing to adopt biosimilars (Modern Healthcare)

‘I was never a fan of John McCain, and I never will be’: Trump lashes out at the late senator from the Oval Office (John Wagner)

U.S. to Stop Detaining Some Migrant Families at Border Under New Policy (Wall Street Journal )


Survey: About 1 in 10 US adults rationing medicine in effort to lower costs (The Hill )

Her son died. And then anti-vaxxers attacked her (CNN)

God, country and chickenpox: How an outbreak entangled one school in a vaccine showdown (Katie Mettler)

Reports of Breast Implant Illnesses Prompt Federal Review (New York Times)

A mom gave birth to a 15-pound baby and ‘felt like I had been hit by two tractor-trailers’ (Lindsey Bever)


Coming Up

  • The CATO institute holds an event on harm reduction on Thursday.
  • The Bipartisan Policy Center holds an event on overcoming health care challenges in immigrant communities on Thursday.
  • The Brookings Institution holds an event on emerging policy solutions to surprise medical bills on Friday.

Sen. Lindsey Graham (R-S.C.)calls Trump's attacks on McCain 'a huge mistake'

Sen. Lindsey O. Graham (R-S.C.) said that former Sen. John McCain (R-Ariz.) is "an American hero, and nothing will change that in my eyes." (Video: Reuters)