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The Health 202

A newsletter briefing on the health-care policy debate in Washington.

Biden's drug czar wants to expand use of addiction medication

The Health 202

A newsletter briefing on the health-care policy debate in Washington.

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Good morning — The New York Tiimes has answered the covid question for the ages: Must this swab go that far up your nose?

Today, the Biden administration is rejecting a government watchdog's findings that it erred in calculating payments for Puerto Rico's Medicaid program, and the White House is investing billions to expand vaccine manufacturing. 

As the opioid crisis mounts, Rahul Gupta wants to ease treatment restrictions

The U.S. drug epidemic hit a new grim record. Drug-related deaths topped 100,000 within a 12-month period, according to data unveiled yesterday, leaving the Biden administration to grapple with a ballooning crisis. 

The Office of National Drug Control Policy (ONDCP) develops and coordinates efforts to reduce drug addiction. It has a new leader, Rahul Gupta, who has led that office for a little over two weeks and will have a ceremonial swearing in at the White House today. 

In a wide-ranging interview, Gupta said the administration is considering permanently easing long-standing restrictions on telemedicine and a medication used to treat opioid addiction. The Health 202 also asked him for the Biden administration’s stance on supervised injection sites and what changes he was making to the office, which was often sidelined under former President Donald Trump.

Here are our takeaways:

1. Some pandemic-era changes may be here to stay. 

Methadone is a tightly controlled treatment for drug addiction, and patients must go to a clinic to receive the medication. That decades-old requirement was lifted during the coronavirus pandemic when the federal government let patients take home up to a 28-day supply of methadone.

The original policy was meant to ward off diversion of the treatment, which is itself a synthetic opioid. But public health experts — and even former ONDCP officials — worry it prevents some people from seeking treatment.

President Biden may keep a version of the pandemic-related change, where people can have some supply of methadone at home. The administration is also weighing whether to maintain coronavirus policies allowing more addiction treatment to be done through telehealth.

  • “Adoption of these services did increase access to opioid and substance use disorder treatment,” Gupta said, so making the changes permanent is “under consideration and we remain pretty hopeful about it.”

2. The Biden administration is leaning in on harm-reduction strategies. 

There are three main policies here. One is to increase distribution of naloxone, an opioid overdose antidote. 

Another is a new policy allowing federal funds to pay for strips to test whether drugs are laced with fentanyl — a powerful synthetic driving up overdose death rates. That’s a contrast from the previous administration. 

  • Elinore McCance-Katz, Trump’s assistant secretary for mental health and substance abuse, wrote a 2018 blog post criticizing the use of fentanyl strips. That post has since been taken down from government websites, according to Regina LaBelle, who served as Biden’s acting ONDCP director.

The third focuses on harm reduction programs, like bolstering access to syringe exchange programs. 

  • Before Gupta was nominated, he received criticism from some who alleged the former West Virginia public health commissioner didn’t do enough to stop the city of Charleston, W.Va., from closing its program.
  • In an interview, Gupta defended his record, saying he supported and invested in such programs in West Virginia. “As [ONDCP] director, I strongly support the syringe service programs and the entirety of harm-reduction programs that we have right now and we are proposing.”

When it came to safe drug consumption sites, a controversial policy allowing people to use illegal drugs under supervision, Gupta declined to specify the White House’s position, citing ongoing litigation. 

  • He added: “The administration is also looking into ways to support research on the clinical effectiveness of emerging harm-reduction practices in real-world settings.”

3. ONDCP is going through some reshuffling.

Trump ran the drug office with “skepticism, ambivalence and a lack of focus," our colleagues Kim Bellware and Robert O’Harrow Jr. reported last year. It became a place where employees cycle out, and it failed to create a cohesive anti-drug plan.

The position isn’t a Cabinet-level post — and Biden has declined to promote it, despite insisting when he was a senator that it should have that status. When asked whether that could impact ONDCP’s influence in the administration, Gupta said he sees “no difficulty” in accomplishing the office’s work. (The White House didn't respond to a question on why it didn't make the change.)

Biden’s ONDCP had already gone through reorganizing to better focus on public health, translational research, data gathering and supply reduction, according to Gupta.

  • One data point: Gupta said officials are aiming to learn from covid-19 to develop systems to collect real-time data.

Agency alert

Not budging: The Biden administration is rejecting a government watchdog’s conclusion that it erred in calculating payments for Puerto Rico’s Medicaid program.

The Centers for Medicare and Medicaid Services continues to stand by its determination that the island should permanently receive at least $2.9 billion in federal funds each year, according to an agency spokesperson. 

  • “Federal Medicaid funds are critical to ensuring life-saving coverage for so many people in the U.S. territories,” according to the CMS spokesperson, who added the agency believes the dollars it plans to send the territory for fiscal year 2022 are “consistent with statutory requirements.”

The backstory: In late September, the Biden administration quietly interpreted language from recent laws and determined the federal government must give Puerto Rico’s Medicaid program at least $2.9 billion per year. That’s instead of the roughly $400 million per year the territory would have been set to get starting Oct. 1, unless Congress intervened.

  • In a legal opinion released Monday, the Government Accountability Office wrote those payments shouldn’t have been allowed. But the agency’s determination is nonbinding, leaving federal health officials to decide whether to ignore their conclusion. 

Coronavirus

The Biden administration will invest billions to expand vaccine manufacturing

The White House is aiming to spur the production of at least 1 billion coronavirus vaccine doses a year by investing in companies, like Moderna and Pfizer, that make mRNA vaccines. The administration will also fund facilities, equipment, training and staff — an effort to expand capacity, The Post’s Tyler Pager and Dan Diamond report.

Pfizer and Moderna said they are reviewing the proposal but have not committed to working with U.S. officials on the effort. The Biomedical Advanced Research and Development Authority (BARDA) has published a “request for information” seeking proposals from companies with experience using mRNA technology.

The reaction from global health advocates was mixed. They lauded the investment but raised concern about its timeline and reliance on pharmaceutical companies that have not always cooperated in efforts to expand global vaccine access. Some activists said that more needs to be done to distribute vaccine manufacturing around the world.

David Kessler, the administration’s chief science officer who oversees vaccine distribution, said the funds have already been allocated as part of the American Rescue Plan, signed into law in March.

Here’s what else you need to know:

  • Moderna is asking the Food and Drug Administration to authorize its booster shot for all adults, The Post’s Paulina Villegas reports.
  • More people 65 and older are going to emergency rooms as covid-19 cases increase, said Rochelle Walensky, the director of the Centers for Disease Control and Prevention. She didn’t specify whether waning effectiveness of the vaccines played a role. Only 36.6 percent of vaccinated seniors have gotten a booster shot.
  • Florida lawmakers ended a special session by passing bills that Democrats say will make it harder to combat the pandemic, The Post’s Lori Rozsa reports. For instance: The bills — backed by Republican Gov. Ron DeSantis — will fine businesses rquireing employees be vaccinated and prohibit Florida schools from imposing mask mandates.
  • Right-wing opposition to vaccine mandates is extending beyond the coronavirus and impacting vaccines for other diseases, Stat’s Lev Facher reports.

Medical missives

The University of Maryland Medical System will stop using a race-based algorithm for kidney patients

The decision by the University of Maryland Medical System and the University of Maryland School of Medicine follows a recommendation by a task force of kidney experts that health systems adopt a race-free approach in diagnosing kidney disease, The Post’s Ovetta Wiggins reports.

At issue: An equation used to determine how well the body’s kidneys are filtering waste makes it harder for Black patients to qualify for transplants. The current equation is based on levels of creatinine — a byproduct of muscle and protein metabolism — and also factors in age, gender and whether a patient is African American. Because it assumes Black patients are more muscular and therefore have more creatine in their blood at baseline, it can overestimate how well their kidneys are working. 

  • Researchers believe that about 720,000 Black patients might be treated earlier for kidney disease if race were removed from calculations of kidney function.

The broader context: “Race-based algorithms have been used for decades to diagnose and decide treatment plans for kidney disease, lung disease, pregnancy and even dementia. Researchers looking at racial health disparities are now exploring how and when race is used in diagnostic tests — if they are warranted — and how they play a role in access to care and treatment,” Ovetta writes.

Still, health professionals want to ensure there aren’t unintended consequences. Some research has questioned whether removing race from the equation could result in some patients not getting necessary medicines because the algorithm suggests their kidneys can’t handle them.

Sugar rush

Watch a bear walk into a 7-Eleven and trigger the hand sanitizer dispenser

Rachelle Ducusin, an employee at a 7-Eleven store in Olympic Valley, Calif., shouted at the bear that entered her store on Nov. 13. (Video: Rachelle Ducusin via Storyful)

Thanks for reading! See y’all tomorrow.

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