Feb 25, 2020

Axios Vitals

Good morning.

Today's word count is 841, or a 3-minute read.

1 big thing: America's addiction treatment misses the mark

Illustration: Aïda Amer/Axios

Addiction treatment in the U.S. is critically necessary yet deeply flawed.

The big picture: Drug overdoses kill tens of thousands of Americans a year, but treatment is often inaccessible. The industry is also riddled with subpar care and, in some cases, fraud.

  • As Reuters recently reported, only 15% of patients in residential drug treatment centers received medication-assisted treatment in 2015, although it's widely agreed that anti-addiction medicines are the most effective treatment for opioid abuse.

Not only do treatment centers often lack proven treatment methods, but they also often use ineffective ones.

  • As Vox's German Lopez has reported, there's really no way for patients to know whether an addiction treatment program is any good. Insurers don't communicate well about quality, and regulators don't do a good job of monitoring it.
  • "Little in medicine is as ill defined or as anecdotal as addiction treatment. Most rehab centers are not hospitals. The counsellors are often not psychologists. The medical directors can submit instructions from a distance," Colton Wooten writes in the New Yorker, recounting his own haunting experience with rehab.
  • Fraud has also been a problem. In Florida, "sober homes" for people in recovery have been caught scamming insurance companies time and again.

Insurance companies are required to cover mental health on par with their physical health coverage, but have often ignored those rules.

  • That can result in families paying huge out-of-pocket costs for treatment, or people suffering from addiction simply going untreated.
  • Additionally, as Vox's Lopez writes, "insurers often don't know what good or necessary treatment is," meaning high-quality treatment centers aren't necessarily the ones that are covered by insurance.

The bottom line: Providers, insurers and regulators all need to do a lot more if we're going to have a functioning treatment system.

Go deeper: How to change treatment for opioid addiction

2. Administration asks for new coronavirus funds

The administration has requested for Congress to give it an additional $2.5 billion to fight the novel coronavirus, Politico reports.

Yes, but: Some experts say that's not enough.

  • "The money proposed shows the Trump administration is less than half as committed to fighting the coronavirus as the Obama administration was to combating Ebola," said Chris Meekins, a Raymond James analyst and a former HHS official under the Trump administration, who had estimated an additional $15 billion would be necessary.
3. The U.S. health system, coronavirus version

A man in Miami went to the hospital to receive a test for the coronavirus after developing flu-like symptoms, only to receive the news that he didn't have it — and a $3,270 medical bill, the Miami Herald reports.

  • The man had just returned from a work trip to China, so took his symptoms more seriously than normal, which is exactly what public health experts want people to do.

The episode would be a great parody of the health care system, if it wasn't real.

  • The man has a short-term health insurance plan, which usually have skimpy benefits in exchange for lower premiums, and don't have to cover pre-existing conditions. The Trump administration has expanded them.
  • The hospital told the Herald that the patient is only on the hook for $1,400 based on his insurance, but his insurer told him that first, he must provide three years of medical records to prove that his flu didn't relate to pre-existing conditions.
  • More bills are probably coming.

The kicker: The patient works at a medical device company that doesn't offer health insurance to its employees.

4. Coronavirus "infodemic" threatens institutions

Illustration: Aïda Amer/Axios

The spread of the novel coronavirus outbreak is being matched, or even outrun, by the spread on social media of both unintentional misinformation about it and vociferous campaigns of malicious disinformation, experts tell Axios.

Why it matters: The constant battering of governments, global health organizations, nonprofits and scientists in general is furthering distrust in the very institutions that are needed to organize a global response to what may be turning into a pandemic, Axios' Eileen Drage O'Reilly reports.

Trust in public institutions and in science is key to global public health — and for the most part, many countries still retain this trust, per Wellcome Global Monitor.

  • But even this survey pointed out several months ago that misinformation on social media is itself a "real infection."
  • And — because this particular outbreak is caused by a new virus with many scientific and medical unknowns — there's a higher level of fear added to the equation.

Go deeper.

5. Opioid companies in bankruptcy

Legal and financial troubles continue to mount for two prominent opioid manufacturers, Axios' Bob Herman writes.

Driving the news: As part of its bankruptcy proceedings, Purdue Pharma launched a $24 million ad campaign to tell people how they can file claims against the company if they or family members were hurt or killed by Purdue's prescription opioids, AP reports.

  • Bankruptcy may finally be a reality for Mallinckrodt's business that sells generic oxycodone and hydrocodone pills, according to the Wall Street Journal. Mallinckrodt's branded drug business, which includes the controversial Acthar Gel, would not be affected.

The big picture: The prospect of multibillion-dollar settlements — which are still a long way from being hashed out — is bringing painkiller companies that were once immensely wealthy to their knees.

6. Old and new diseases collide

The U.S. is still grappling with old diseases like measles — as well as enduring problems like addiction and heart disease — even as it tries to combat new threats like the coronavirus, the Washington Post reports with Kaiser Health News.

Why it matters: While we race for new treatments in the wake of new threats, we're also beset by plenty of problems we know how to solve, Axios' Marisa Fernandez writes.

  • Declining vaccination rates, for example, are allowing once-vanquished diseases to come roaring back, and holes in addiction treatment keep people at risk.