with Alexandra Ellerbeck

Early data indicate President Biden faces an even worse opioid abuse epidemic than former president Donald Trump.

Biden's administration has signaled some initial indications of how it intends to approach the problem of drug abuse — a crisis that will get renewed attention as the threat of the coronavirus recedes.

Overdose deaths in the United States last year may have topped 90,000.

Final data won’t be available until near the end of this year. But an analysis of preliminary data by the Commonwealth Fund found that shortly after the pandemic started, monthly overdose deaths spiked 50 percent to more than 9,000 deaths in May.

Based on additional estimates from the Centers for Disease Control and Prevention suggesting that deaths remained elevated for much of the rest of 2020, Commonwealth researchers estimated the year’s total overdose deaths could have exceeded 90,000 — up from 70,630 in 2019. That would be the largest single-year percentage increase in the past two decades.

“Coronavirus will stabilize, but you’re going to see overdoses go up, sadly,” said Gary Mendell, founder of the group Shatterproof, which seeks to reduce stigma around seeking help for opioid use disorder.

The cause seems intuitive. The very intervention that helped slow the spread of the coronavirus — staying away from other people — is exactly what makes it more likely that people will start abusing drugs and stop seeking help for it.

“Isolation is needed to stop covid, but it makes the opioid crisis worse,” Mendell said.

The Biden administration appears open to more controversial approaches to helping people with opioid addiction.

Last week, the Office of National Drug Control Policy released an 11-page paper outlining its approach to drug abuse. Many of its approaches, including medication-assisted treatment and reducing the supply of illicit substances, were also part of the Trump administration’s strategy.

But the paper notably includes “harm reduction” in a list of drug policy priorities for Biden’s first year as president. 

Generally speaking, harm reduction refers to practices that help people use drugs more safely, such as providing them with sterile syringes or making the overdose antidote naloxone available. One controversial way this has been carried out is with supervised injection sites in several cities around the country — efforts the Trump administration fought in court.

It’s unclear exactly where the administration stands on these injection sites. The paper doesn’t mention them explicitly but does support more research on “the clinical effectiveness of emerging harm reduction practices in real world settings.”

It also praises the idea of harm reduction broadly, saying such services “meet people where they are” and promising to advance syringe services programs and make naloxone more widely available.

Activists praised the paper, but there’s a more immediate action they want from the administration.

Mendell’s group, Shatterproof; the American Medical Association; and numerous other groups expressed deep disappointment back in January when the Biden administration canceled a plan that would have let more physicians prescribe an opioid-treatment drug.

The plan, conceived by the Trump administration, would have loosened requirements for prescribing the drug buprenorphine. Physician groups had hailed the move, saying the tough requirements had slowed their response to the opioid crisis.

“It is ridiculous that I, as a pediatric allergist, can prescribe opioids all day long, but I’m not qualified to prescribe buprenorphine for substance use disorder,” AMA President Susan Bailey told me yesterday.

At the time, officials told my colleague Dan Diamond the rule was rescinded because it was plagued by legal and operational problems. Bailey said she’s hopeful the administration will issue another rule lifting barriers to physicians prescribing the drug, which has been shown to be highly effective in helping people stop abusing opioids.

“We are hopeful that the unnecessary barriers can be removed, however they are removed,” Bailey said.

Biden has yet to appoint a “drug czar.”

Rahul Gupta, the top health official at maternal-and-child advocacy group March of Dimes, is favored to lead the Office of National Drug Control Policy, my colleagues Dan Diamond, Matt Viser and Lenny Bernstein reported last month.

“Gupta, who was previously West Virginia’s health commissioner and led Biden’s transition efforts for the drug policy office, has a strong working relationship with Sen. Joe Manchin III, the West Virginia Democrat who has emerged as a key swing vote in a narrowly divided Senate,” they wrote.

Yet some anti-addiction advocates have argued Gupta did too little to ensure safe-needle exchange during a 2017 outbreak in West Virginia. Some have suggested that Biden pick Santa Clara University professor H. Westley Clark, who is viewed as another finalist for the job.

Ahh, oof and ouch

AHH: Biden says all American adults should be eligible for a coronavirus vaccine by April 19.

Biden announced that the United States will cut by two weeks the deadline by which all states should open up vaccine eligibility. The original deadline was May 1, but many states have already opened up eligibility or moved their deadlines to do so earlier, the Associated Press's Darlene Superville and Alexandra Jaffe report.

The new target comes just after the United States administered a record 4 million doses in a single day last week. Over 40 percent of all adults and over 75 percent of people older than 65 have received at least one shot, according to the CDC. 

President Biden warned about rising coronavirus cases in the U.S. on April 6 and urged precautions to guard against the coronavirus. (The Washington Post)

But there's a big difference between being eligible for a vaccine and actually receiving one. Officials have urged seniors who have not yet been vaccinated to get inoculated as soon as possible before the lines become longer. 

The pace of vaccines is raising hopes for a normal summer. California Gov. Gavin Newsom (D) announced that the state plans to lift all coronavirus-related restrictions by June 15 as long as there are sufficient shots for those who want them, and hospitalizations remain stable.

Not every state has as much reason for optimism. Nearly 44 percent of coronavirus cases reported last week came from just five states: New York, Michigan, Florida, Pennsylvania and New Jersey. Officials have blamed the surge in cases on pandemic fatigue and the spread of more-contagious variants of the virus.

OOF: One in three covid-19 survivors received a neurological or psychiatric diagnosis within six months of infection.

That's according to a new study published by Britain’s Lancet Psychiatry journal. The study examined more than 230,000 patient health records and found a “robust” association between covid-19 and diagnoses such as dementia, Parkinson’s disease, stroke and anxiety disorder, Erin Cunningham reports.

“Given the size of the pandemic and the chronicity of the many diagnoses and their consequences, substantial effects on health and social care systems are likely to occur,” the authors said.

“The study also added that the risks of receiving a neurological or psychiatric diagnosis within six months of contracting the virus were greatest in patients who suffered severe covid-19, including those who required hospitalization or experienced ‘delirium and other altered mental states’ during their illness period,” Erin writes.

“To our knowledge, we provide the first meaningful estimates of the risks of major neurological and psychiatric conditions in the 6 months after a COVID-19 diagnosis, using the electronic health records of over 236 000 patients with COVID-19,” the authors wrote.

OUCH: The United States invested heavily in a Baltimore vaccine manufacturer, despite warning signs.

Maryland biotech firm Emergent BioSolutions announced last week that it would destroy 15 million doses’ worth of contaminated Johnson & Johnson vaccine.

A New York Times investigation reveals that was not the first red flag from the company's Baltimore facility, or even the first time it had to destroy doses. Between October and January, the manufacturer discarded five lots of AstraZeneca vaccine, each equivalent to 2 million to 3 million doses, out of concern over suspected contamination, the Times’s Chris Hamby, Sharon LaFraniere and Sheryl Gay Stolberg report.

The reporters describe a “corporate culture that often ignored or deflected missteps,” with audits finding that the company “had not followed some basic industry standards at the Baltimore plant.”

The Baltimore facility is the main U.S. location for manufacturing coronavirus vaccines from Johnson & Johnson and AstraZeneca. But so far, none of the 150 million doses it has produced have been approved for use because regulators have not yet certified the factory.

More in coronavirus news

The GOP is requiring proof of a negative coronavirus tests for entry into its spring donor retreat.

Some of the Republican Party's most influential contributors will gather later this week in Palm Beach for the Republican National Committee's spring retreat. But to gain entry to the event, part of which will be hosted by Trump at his private club, Mar-a-Lago, participants must first “take a COVID-19 PCR or Rapid Antigen test and receive a negative result,” according to an email from the RNC obtained by the Washington Examiner. The requirement also applies to individuals who have been fully vaccinated.

The move comes even as many Republican politicians wage a battle over so-called “vaccine passports.” On Friday, Florida Gov. Ron DeSantis (R) issued an executive order banning businesses from requiring customers to show proof of vaccination to receive services. Texas followed suit Tuesday, with Gov. Greg Abbott (R) banning state agencies and organizations receiving public funds from requiring proof of vaccination.

The White House has ruled out any mandatory federal vaccine passports.

“The government is not now, nor will we be, supporting a system that requires Americans to carry a credential,” White House press secretary Jen Psaki told reporters at the White House on Tuesday. “There will be no federal vaccinations database and no federal mandate requiring everyone to obtain a single vaccination credential.”

  • Researchers at Oxford University have paused a trial of the AstraZeneca coronavirus vaccine in children, pending a safety review by regulators in the United Kingdom, who are investigating rare cases of brain blood clots in people who have been vaccinated, The Post’s Carolyn Y. Johnson reports. The trial was not paused because of any safety concerns in the trial, but to allow the review to finish.
  • Even as states expand vaccine access, prisoners are still going without shots. Data collected by the Marshall Project and the Associated Press suggest that nationwide less than 20 percent of state and federal prisoners have been vaccinated,  the AP’s Kimberlee Kruesi and the Marshall Project’s Katie Park and Ariel Goodman report.

Troubling outbreaks

Youth sports may be fueling an uptick in outbreaks of the B.1.1.7 coronavirus variant.

An outbreak in Carver County, Minn., was linked to infections in 189 people with cases spanning 18 hockey, four basketball, three lacrosse and one soccer teams, The Post’s Ariana Eunjung Cha reports. The outbreak was driven by the  B.1.1.7 variant, which was first seen in the United Kingdom and has been confirmed in several studies to be more infectious.

“Until now we haven’t seen transmission like this in kids in the pandemic,” said Michael Osterholm, an infectious-disease specialist at the University of Minnesota who served as an adviser to Biden.

In Nevada, the same variant has been linked to an outbreak at a youth volleyball tournament. In Michigan, cases among those ages 10 to 19 have jumped 133 percent in the past month, a development that the state’s leading epidemiologists says is linked to activities “including sports, but not limited to sports.” 

Children are significantly less likely to die or to become severely ill from covid-19 compared to adults, and the outbreaks have not been linked to increases in pediatric hospitalizations. But experts worry that cases among kids could spread to vulnerable adults interacting with them. 

A Medicaid holdout

Medicaid expansion is hanging in the balance in Missouri.

In August, Missouri voters approved a constitutional amendment that would expand Medicaid in the state through the Affordable Care Act. The change could mean an additional 275,000 Missourians would receive health insurance. But some Republican lawmakers are fighting to keep it from going into effect. The House, which sent its version of the state budget to the Senate last week, refused to provide funding for the expansion. GOP lawmakers argue that voters were mislead when they approved the expansion, KBIA's Sebastián Martínez Valdivia reports.

“Even though my constituents voted for this lie, I am going to protect them from this lie.” Republican state Rep. Justin Hill said during a floor debate last week.

Democrats have argued that the legislature is legally obligated to fund the expansion now that it’s in the constitution. They may have support from Missouri Gov. Mike Parson (R), who opposed expansion in the run-up to the vote but has since said that he has to carry out the will of the voters to prevent legal challenges.

“The big legal question of what happens if the legislature defies the constitutional amendment could still be rendered moot,” Sebastián writes. The budget is now in the hands of Senate Republicans, who “are split over what to do.”

Sugar rush

The Washington Nationals welcomed 5,000 fans for opening day, days after their original date was postponed due to players testing positive for coronavirus. (Ashleigh Joplin, Alice Li/The Washington Post)