The opioid epidemic’s cruel evolution

From: POLITICO Future Pulse - Wednesday Sep 20,2023 06:01 pm
The ideas and innovators shaping health care
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Future Pulse

By Carmen Paun, Erin Schumaker, Daniel Payne and Evan Peng

DANGER ZONE

A woman suspected of acting under the influence of heroine shows arms to police on April 19, 2017 in Huntington, West Virginia. Huntington, the city in the northwest corner of West Virginia, bordering Kentucky, has been portrayed as the epicenter of the opioid crisis. On August 15, 2016, from 3:00 pm to 9:00 pm, 28 people in the city overdosed on heroin laced with fentanyl, a synthetic opioid far more powerful and dangerous than heroin. The economic incentives are powerful: one kilogram of fentanyl costs $5,000, which can make a million tablets sold at $20 each for a gain of $20 million. "This epidemic doesn't discriminate," Huntington Mayor Steve Williams said. "Our youngest overdose was 12 years old. The oldest was 77." (Photo by Brendan Smialowski / AFP) / TO GO WITH AFP STORY by Heather SCOTT, US-health-drugs-WestVirginia (Photo by BRENDAN SMIALOWSKI/AFP via Getty Images)

More fentanyl users are mixing it with cocaine or meth, heightening the danger. | AFP via Getty Images

America’s opioid overdose crisis has reached a dangerous new stage: People are dying from a combination of the illicit synthetic opioid fentanyl combined with stimulants such as cocaine or methamphetamine, according to a new study by researchers at University of California, Los Angeles.

Why it matters: The combination is much deadlier and complicates the public health response, said authors Joseph Friedman and Chelsea Shover.

“We need to do better in treating substance use disorder in people that use both stimulants and opioids,” Shover told Carmen.

That includes improving access to treatment for opioid use disorder and making naloxone, the opioid overdose reversal drug, widely available, she said.

A graphic showing an increase in drug overdoses involving fentanyl mixed with stimulants

Treatment challenge: While people who use illicit opioids have escaped addiction using buprenorphine and methadone, there’s no licensed medication to help people who use stimulants like cocaine and methamphetamine, Shover said.

Shover backs a behavioral therapy known as contingency management that offers small cash payments as an incentive to resist using the drugs.

But the therapy is hard to come by because “it’s politically unpalatable to pay people who use drugs to stop using drugs,” she said.

 

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This is where we explore the ideas and innovators shaping health care.

Octopuses and squid used in research may one day have the same protections as lab rats and monkeys, Nature reports. The National Institutes of Health proposed new guidelines this month to have an oversight board approve research projects on cephalopods — ensuring protocols avoid or minimize "discomfort, distress, and pain" to the animals — before they get federal funding.

What ethical research on octopuses looks like, however, is still an open question.

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THE LAB

Logos of OpenAI and ChatGPT

Some doctors are fretting about AI, others are trying to master it. | Lionel Bonaventure/AFP/Getty Images

Future doctors in San Antonio aren't fretting about artificial intelligence's creep into medicine — they're embracing it.

After a successful pilot program, UT Health San Antonio and the University of Texas at San Antonio are partnering to offer students a dual degree in medicine and AI.

How it works: The five-year program combines a medical degree with a master’s of science in artificial intelligence.

Students must be admitted to the program's medical school and complete one year before they're eligible to apply for the dual program.

The AI part of the degree will offer three concentration options: data analytics, computer science, or intelligence and autonomous systems.

What's next? "I believe the future of health care will require a physician to navigate the technical and clinical sides of medicine," Aaron Fanous, a fourth-year medical student in the pilot program, said in a statement.

"The experience opened my mind to the many possibilities of bridging the two fields," Fanous said, adding that he plans to use his dual degree to solve tomorrow's medical challenges.

 

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WORKFORCE

VALLEJO, CALIFORNIA - SEPTEMBER 08: A sign is posted on the exterior of the Kaiser Permanente Vallejo Medical Center on September 08, 2023 in Vallejo, California. California Attorney General Rob Bonta announced a $49 million settlement with Kaiser Foundation for unlawfully disposing of medical and hazardous waste along with paper records of over 7,700 patients. Attorney General Bonta was assisted by six California district attorneys in the investigation that discovered illegal dumping of medical and hazardous materials in dumpsters at 16 different Kaiser facilities in California. (Photo by Justin Sullivan/Getty Images)

Kaiser workers may walk off the job next month. | Getty Images

Tens of thousands of workers at health care provider Kaiser Permanente could strike, the latest sign of turbulence in the industry.

In California, Washington state, Oregon, Virginia, Maryland and Washington, D.C., workers have voted to authorize strikes, saying management needs to boost pay and hire more staff to alleviate shortages. Other Kaiser units plan to vote today.

Why it matters: The Kaiser workers’ votes come amid an increase in health industry strikes, driven by inflation, staffing shortages, a desire to define post-pandemic workplace standards, and labor unrest in other sectors.

But providers are resisting their workers’ demands because broader cost pressures are mounting.

Kaiser said in a statement it hopes to resolve negotiations before the Sept. 30 deadline the workers have set. Kaiser also pushed back against some union demands, noting that it has proposed a $21-an-hour minimum wage, hired 9,000 people this year and continues to recruit.

Even so: A recent analysis from credit rating firm Fitch Ratings found that wage growth may be leveling out for health workers.

In Congress: Liberals on Capitol Hill are lending support. Sen. Bernie Sanders (I-Vt.) attended a National Nurses United town hall last week about nurse-to-patient ratios, and Sen. Tammy Baldwin (D-Wis.) joined a local nurses’ union in Wisconsin to discuss their concerns.

Legislators on both sides of the aisle, meanwhile, believe that growing — and retaining — the health workforce is a priority coming out of the pandemic.

 

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