Sep 26, 2018

Axios Vitals

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1 big thing: Here's Congress' big opioids bill

House Speaker Paul Ryan. Photo: Mark Wilson/Getty Images

Republican and Democratic lawmakers from the House and Senate released their final opioids package last night, bridging the differences between bills the two chambers passed previously.

The big picture: This is a big bill and there are provisions in here that public health experts believe will make a difference.

  • But those same experts say Washington still needs to make substantial investments — of money as well as policymaking energy — in the treatment system for mental health and substance abuse, in order to bring this crisis under control.

What's next: Both chambers are expected to pass the agreement quickly, sending it to President Trump for his signature in a matter of days.

The details: The bill is about the same as what we reported previously, and would...

  • Temporarily lift a cap on Medicaid payments for large treatment facilities. States can allow those facilities to receive Medicaid funding, on a limited basis, for all substance abuse treatment.
  • Allow more health care providers to prescribe medication-assisted therapies.

The pharmaceutical industry didn't get the Medicare "fix" it had been lobbying for.

Read the bill.

2. The crisis is everywhere

Photo: Cory Clark/NurPhoto via Getty Images

Simply going to work in the morning puts a lot of people on the front lines of the opioid crisis, whether or not they want to be — and whether or not they’re prepared to be.

“Service workers are … the unwitting first line of medical responders,” CityLab reports, because public restrooms have become such a popular place to use opiates.

  • Boston has been running a program for three years that teaches local businesses how to recognize and respond to an overdose, including how to administer naloxone.
  • "It ... seems like a lot to ask often low-paid, young service workers to double as medical responders. That’s not what most people expect when they apply to Starbucks or Target," CityLab notes.

Employers, especially in the construction industry, also are remarkably close to their own workers' addictions.

  • Construction has the second-highest rate of opioid abuse of any industry, and addiction is an open secret on many worksites, Kaiser Health News reports. But few companies do much about it.
  • "If you drug-tested everyone, you wouldn’t find many people to work with you,” one construction worker — who went straight back to work after being revived from an overdose — told KHN.
  • Construction unions are filling some of the void by steering members toward treatment programs when they need one, and helping them find work during their recoveries, per KHN.

Go deeper: Why businesses have a stake in solving the opioid epidemic

3. Health care hacks are on the rise
Expand chart
Data: McCoy Jr. et al., 2018, "Temporal Trends and Characteristics of Reportable Health Data Breaches, 2010-2017"; Chart: Andrew Witherspoon/Axios

More than 175 million health care records have been breached since 2010, and they’re getting more vulnerable every year, according to a new analysis published in the Journal of the American Medical Association.

By the numbers: Data breaches that affect more than 500 people have to be reported to the federal government. There have been more than 2,100 of them since 2010.

  • The total number of breaches is increasing — from 99 in 2010 to 344 in 2017.
  • Doctors and hospitals are breached most frequently, but insurers’ breaches expose the most individual records.

Between the lines: A handful of high-profile hacks against large insurance companies in 2015 seems to have been especially damaging.

  • The cumulative number of records exposed from doctors and hospitals has risen steadily every year. The total number that came from insurance companies, however, skyrocketed in 2015 — then leveled off.
  • Similarly, the total number of records exposed through hacking (as opposed to other types of breaches) jumped from about 3 million in 2014 to 115 million in 2015. It's still climbing.
  • 2015 saw several big health care hacks, including a historic breach of Anthem’s records.
4. Why HHS is pulling back fetal tissue research

ICYMI, the Health and Human Services Department is undertaking "a comprehensive review of all research involving fetal tissue ... in light of the serious regulatory, moral, and ethical considerations involved."

Why it matters: STAT News has a good rundown of what it all means...

  • "Fetal tissue has been used for a wide range of research in the U.S. since the 1930s ... The tissue is obtained through elective abortions, and there are strict rules around how it can be procured and used."
  • "In [a] letter sent to Azar earlier this month, anti-abortion leaders ... asked Azar to find 'ethical alternatives' to fetal tissue in government-funded research as soon as possible."

The other side: Fetal tissue "is important or even necessary for some kinds of work" and has been instrumental in developing several vaccines, bioethicist Alta Charo told STAT.

5. Vaping crackdown may come soon

FDA Commissioner Scott Gottlieb. Photo: Chuck Kennedy/Axios

FDA Commissioner Scott Gottlieb sure sounded like a guy who's ready to bring down the hammer on e-cigarettes as he discussed the agency's next steps with Axios' Mike Allen yesterday.

What's next: The FDA is planning to release new data in November that will show sharp increases in vaping among middle and high schoolers. And with that data in hand, "at that point we’re going to be ready to take action," Gottlieb said.

  • His two main targets (or at least, the ones that scare the industry the most) are flavored products and online sales. The FDA could try to ban either or both; or seek to restrict either or both.
  • Some of the most aggressive steps would require new regulations, he said, but would still fall squarely within the FDA's powers.
“It's not like I need another six months or a year to take action.”
— Scott Gottlieb