How does naloxone distribution relate to opioid overdose deaths?

The $64,000 question — or however much money has been spent on naloxone, the lifesaving medication that rescues opioid overdose victims — is whether the distribution of the medication has an effect on overdose deaths.     

The nation's drug problem is commercial recreational pharmacology

Overdose deaths, overprescribing of opioids, illicit production of fentanyl, a resurgence of methamphetamine and cocaine, and an epidemic of vaping‐related illnesses and substance use disorders cover the nation's headlines today, as they have for years. These problems are manifestations of commercial recreational pharmacology, the personally controlled use of psychoactive drugs that super‐stimulate brain reward for pleasure. While substance use and addiction have been known throughout history, the recent increasingly greater acceptance of commercial recreational pharmacology in the United States is exacting a toll on the public health of the nation. The most dramatic example is a decline in U.S. life expectancy, which fell three years in a row from 2016–2018 as a result of overdose deaths.     

Implementation of a collaborative model for opioid overdose prevention on campus

Abstract

Drug overdose is the leading cause of death for Americans under the age of 50, a crisis that is driven by an increasingly potent supply of illicit opioids. College-aged adults are more likely than any other age group to engage in opioid misuse. Naloxone, the antidote for an opioid overdose, can save the life of an opioid overdose victim if it is readily available and administered quickly. The University of Texas at Austin implemented a collaborative model for proactive opioid overdose prevention in 2016. This model includes stocking naloxone in residence halls and providing it to police officers, training resident advisors and police officers to respond to suspected overdoses, and engaging student pharmacists in a service learning program to increase naloxone access and awareness among university students. Programmatic experiences and key recommendations for U.S. campuses are shared by faculty, student, and community leaders.     

Supplemental SOR grants released to states

Last month, the federal Department of Health and Human Services (HHS) released an additional $487 million to states and territories in its State Opioid Response (SOR) grant program, bringing the 2019 total to $1.4 billion, including the $933 million in second‐year, continuation SOR grants to be provided later this year. The SOR grants increase access to medication‐assisted treatment (MAT), reduce unmet treatment need and reduce opioid‐related overdose deaths.     

Physicians,hospital face $9 million lawsuit following fatal OD

Two years ago, Victor Williams, a 56‐year‐old Black man, died from a fatal overdose of fentanyl and fentanyl analogs. He was at home, but his family didn't have any naloxone, because he had not been given any by his treatment provider, despite multiple previous ODs. He had an opioid use disorder (OUD) and instead of being prescribed methadone or buprenorphine, he was prescribed Schedule II analgesics in the hospital. Just hours before his fatal OD, the hospital discharged him after an accidental heroin poisoning.     

A new evaluation of impacts of prevailing wage law repeal

A recent academic study claims that repeal of the Davis-Bacon Act, the federal prevailing wage law covering construction of public works, would cost more in lost taxes than could be recovered in lower construction expenditures and would also result in an increased number of construction injuries and deaths. Those claims are not supported by the facts. Indeed, the opposite is true. The facts support savings to the federal government from repeal of Davis-Bacon in excess of $1.5 billion annually, and, if anything, a lower rather than a higher frequency of construction injuries. Furthermore, states still having prevailing wage laws would also realize significant savings from repeal. Aggregate savings from eliminating all prevailing wage laws could exceed $4 billion a year. The author gratefully acknowledges the assistance of David Denholm, President, Public Service Research Council, and Derrick Max, Staff Economist, U.S. House of Representatives, in finding sources of data and helping structure this paper, and of Dr. Herbert R. Northrup, Professor Emeritus, University of Pennsylvania, for his guidance and advice.     

STR grants: How one physician in rural Florida is trying to help

If the State Targeted Response (STR) and State Opioid Response (SOR) grants from the Substance Abuse and Mental Health Services Administration (SAMHSA) grants are like an elephant — large, especially relative to funding for addiction treatment in general — they are also almost impossible to generalize about. But seeing one piece in context of the whole is essential in trying to find out where the money is actually going. The money goes to the single state authority (SSA) in charge of the Substance Abuse Prevention and Treatment (SAPT) block grant in each state, the person who knows most about what is needed in that state. The funding comes from the Substance Abuse and Mental Health Services Administration (SAMHSA). These grants added $2 billion‐plus to addiction treatment services for opioid use disorders for four years — and many expect this number to be doubled. For perspective, the entire SAPT block grant is under $2 billion and has been for decades.     

What does $8 billion for coronavirus say about opioid funding?

Last week, Congress gave $8 billion to the fight against coronavirus, seemingly overnight. Certainly, compared to the extra $2 billion a year for addressing the opioid epidemic, the money came much faster. It took years for the State Targeted Response to the Opioid Crisis (STR) grant to be included, as it was in the Cures Act passed by Congress in 2016 and signed into law by President Obama in December of that year. The State Opioid Response (SOR) grants continue. How did the coronavirus $8 billion — $6 billion more than the White House had asked for — materialize so quickly? We asked two Capitol Hill experts.     

NY AG ends Emergent's exclusivity for Narcan nasal spray

Narcan, the lifesaving opioid overdose reversal drug, has been the only naloxone spray allowed on the market due to an exclusivity agreement between the pharmaceutical company that owns it — Emergent BioSolutions — and the company that makes the spray device. This deal is ending thanks to New York Attorney General Letitia James, who has made it possible, via an agreement with Emergent, for other companies to use the patented, proprietary spray technology. Emergent, which bought Adapt, the creator of Narcan, will have to renegotiate these terms, James announced on Jan. 2. “Given the tragic, devastating effects of the opioid crisis, and the urgent need for additional drugs for the emergency treatment of opioid overdoses, my office will do whatever possible to ensure that there are no unnecessary impediments to the development of additional lifesaving opioid overdose reversal drugs,” she said. “I'm proud to announce that, starting today, additional companies will be able to gain access to these nasal spray devices. With more companies able to access this easy‐to‐use technology, our hope is that we can reduce the number of opioid overdose deaths across New York and this nation and save millions of additional lives.” A little history here: Adapt Pharma launched Narcan in February 2016, a year before the State Targeted Response (STR) grants were issued. Narcan is patented, but naloxone had been used for decades in the emergency treatment of opioid overdoses, by first responders and medical workers. In October 2018, in the middle of the lucrative STR (which no longer had to be 80% treatment) and State Opioid Response funding cycles, Emergent bought Adapt — for Narcan. Adapt had already entered into the contract with the nasal spray device manufacturer. Other pharmaceutical companies had been trying to develop a nalmefene overdose reversal drug using the device.     

Health savings accounts and health reimbursement arrangements: assets, account balances, and rollovers, 2006-2011

ASSET LEVELS GROWING: In 2011, there was $12.4 billion in health savings accounts (HSAs) and health reimbursement arrangements (HRAs), spread across 8.4 million accounts, according to data from the 2011 EBRI/MGA Consumer Engagement in Health Care Survey, sponsored by EBRI and Matthew Greenwald & Associates. This is up from 2006, when there were 1.3 million accounts with $873.4 million in assets, and 2010, when 5.4 million accounts held $7.3 billion in assets. AFTER LEVELING OFF, AVERAGE ACCOUNT BALANCES INCREASED: After average account balances leveled off in 2008 and 2009, and fell slightly in 2010, they increased in 2011. In 2006, account balances averaged $696. They increased to $1,320 in 2007, a 90 percent increase. Account balances averaged $1,356 in 2008 and $1,419 in 2009, 3 percent and 5 percent increases, respectively. In 2010, average account balances fell to $1,355, down 4.5 percent from the previous year. In 2011, average account balances increased to $1,470, a 9 percent increase from 2010. TOTAL AND AVERAGE ROLLOVERS INCREASE: After declining to $1,029 in 2010, average rollover amounts increased to $1,208 in 2011. Total assets being rolled over increased as well: $6.7 billion was rolled over in 2011, up from $3.7 billion in 2010. The percentage of individuals without a rollover remained at 13 percent in 2011. HEALTHY BEHAVIOR DOES NOT MEAN HIGHER ACCOUNT BALANCES AND HIGHER ROLLOVERS: Individuals who smoke have more money in their accounts than those who do not smoke. In contrast, obese individuals have less money in their account than the nonobese. There is very little difference in account balances by level of exercise. Very small differences were found in account balances and rollover amounts between individuals who used cost or quality information, compared with those who did not use such information. However, next to no relationship was found between either account balance or rollover amounts and various cost-conscious behaviors. When a difference was found, those exhibiting the cost-conscious behavior were found to have lower account balances and rollover amounts. DIFFERENCES IN ACCOUNT BALANCES: Men have higher account balances than women, older individuals have higher account balances than younger ones, account balances increase with household income, and education has a significant impact on account balances independent of income and other variables. DIFFERENCES IN ROLLOVER AMOUNTS: Men rolled over more money than women, and older individuals had higher rollover amounts than younger individuals. Rollover amounts increase with household income and education, and individuals with single coverage rolled over a slightly higher amount than those with family coverage.     

The hard and soft sides of union political money

We reach several conclusions. First, to the extent that soft money per se and issue advertising are the primary targets of campaign-finance reformists, unions contribute little, overall, to the perceived or real problem. Union soft money pales in comparison not only to total interest-group expenditures of this type but also to the hard money that labor dispenses. Moreover, with their relatively limited treasuries, unions are in no position to compete with the corporate sector. It has been estimated that the total assets of labor unions, at the combined local, regional, and national/international levels, barely exceeded $10 billion in 1995 (Masters and Atkin, 1997). Revenues were less than $13 billion.     

The SIF debate: Lines drawn with Rosenstein op‐ed,but truth may lie in the middle

The federal Department of Justice is not going to allow supervised injection facilities (SIFs) to go forward, with Rod J. Rosenstein, deputy attorney general, drawing a clear line in the sand in an Aug. 27 op‐ed in The New York Times ( https://www.nytimes.com/2018/08/27/opinion/opioids‐heroin‐injection‐sites.html ). “Advocates euphemistically call them ‘safe injection sites,’ but they are very dangerous and would only make the opioid crisis worse,” he wrote, calling them “B.Y.O.D.” facilities (for “bring your own drugs,” which they are). In SIFs, people can be revived by naloxone if they overdose; if they inject alone, which happens often, they can't.     

IMF Gold and the World Bank's Unfunded HIPC Deficit

The World Bank is to forgive $12.24 billion in IDA debt payments from HIPC borrowers. It has received $1 billion from the HIPC Trust Fund to help offset these losses, but still has a $11.6 billion unfunded liability. The IMF has gold worth $38 billion on hand for which it has no actual use. This article proposes that a small portion of IMF gold be sold annually, just enough to offset IDA's annual HIPC deficit, over the next twenty years. The new money would be additional and predictable, and would eliminate the prospect that IDA would have to cut back its future flow of aid because the HIPC programme had drained its resources.     

Health savings accounts and health reimbursement arrangements: assets, account balances, and rollovers, 2006-2010

ASSET LEVELS GROWING: In 2010, there was $7.7 billion in health savings accounts (HSAs) and health reimbursement arrangements (HRAs), spread across 5.7 million accounts. This is up from 2006, when there were 1.2 million accounts with $835.4 million in assets, and 2009, when 5 million accounts held $7.1 billion in assets. AFTER LEVELING OFF, AVERAGE ACCOUNT BALANCE DROPS SLIGHTLY: Increases in average account balances leveled off in 2008 and 2009, and fell slightly in 2010. In 2006, account balances averaged $696. They increased to $1,320 in 2007, a 90 percent increase. Account balances averaged $1,356 in 2008 and $1,419 in 2009, 3 percent and 5 percent increases, respectively. In 2010, average account balances fell to $1,355, down 4.5 percent from the previous year. AVERAGE ROLLOVER DECLINES, WHILE TOTAL ROLLOVERS INCREASE: Despite a decline in the average rollover amount in 2010, total assets being rolled over have been increasing. $4.2 billion was rolled over in 2010, up from $4 billion in 2009. The average rollover increased from $592 in 2006 to $1,295 in 2009, and fell to $1,029 in 2010. The percentage of individuals without a rollover decreased from 23 percent in 2006 to 10 percent in 2009 and increased slightly to 13 percent in 2010. HEALTHY BEHAVIOR MEANS HIGHER ACCOUNT BALANCES AND HIGHER ROLLOVERS: Individuals who exercised, those who did not smoke, and those who were not obese had higher account balances and higher rollovers than those with less healthy behaviors. It was also found that individuals who used cost or quality information had higher account balances and higher rollovers compared with those who did not use such information. However, no relationship was found between either account balance or rollover amounts and various cost-conscious behaviors such as checking pricing before getting services or asking for generic drugs instead of brand names, among other things. DIFFERENCES IN ACCOUNT BALANCES: Men have higher account balances than women, older individuals have higher account balances than younger ones, account balances increase with household income, and education has a significant impact on account balances independent of income and other variables. DIFFERENCES IN ROLLOVER AMOUNTS: Men rolled over more money than women, and older individuals had higher rollover amounts than younger individuals. Rollover amounts increase with household income and education, and individuals with single coverage rolled over a higher amount than those with family coverage.     

‘It’s so scary how common this is now:’ frames in media coverage of the opioid epidemic by Ohio newspapers and themes in Facebook user reactions

ABSTRACT

Deaths from opioid overdose in the US have increased five-fold since 1999. Ohio ranks second among states in drug overdose deaths, with more than 39 deaths for every 100,000 people. In light of this, opioid addiction and related issues have garnered substantial media attention. However, few studies have examined the content and framing of opioid-related media coverage or explored ways that audiences react to coverage of the crisis within their communities. This study attempts to fill this gap through an analysis of opioid-related posts and comments on the public-facing Facebook pages of 42 Ohio newspapers between 2013 and 2017 (N?=?397). Content analysis was used to identify frames in posted newspaper content and themes in comments. Four frames were identified in posted stories: (1) Awareness of the Opioid Epidemic and Affected Populations (34.0% of all posted content; n?=?135); (2) Programs, Policies, and Interventions (29.5%; n?=?117); (3) Crime, Punishment, Legal Cases, and Law Enforcement (28.2%; n?=?112); and (4) Narratives of Addiction and the Long Road to Recovery (8.3%; n?=?33). Analyses of Facebook user comments on posted newspaper content revealed five themes: Emotion and Support, Choice and Responsibility, Disease and Treatment, Worthiness, and Attention and Action. Findings indicate both the intensive and diverse efforts of newspapers to cover the epidemic as well as the varied reactions of community members to opioid use and addiction.     

Naloxone administration for suspected opioid overdose: An expanded scope of practice by a basic life support collegiate-based emergency medical services agency

Opioid abuse is a growing and significant public health concern in the United States. Naloxone is an opioid antagonist that can rapidly reverse the respiratory depression associated with opioid toxicity. Georgetown University's collegiate-based emergency medical services (EMS) agency recently adopted a protocol, allowing providers to administer intranasal naloxone for patients with suspected opioid overdose. While normally not within the scope of practice of basic life support prehospital agencies, the recognition of an increasing epidemic of opioid abuse has led many states, including the District of Columbia, to expand access to naloxone for prehospital providers of all levels of training. In particular, intranasal naloxone is a method of administering this medication that potentially avoids needlestick injuries among EMS providers. Universities with collegiate-based EMS agencies are well positioned to provide life-saving treatments for patients acutely ill from opioid overdose.