Where poppies don’t flow, fentanyl could go

The ideas and innovators shaping health care

Apr 07, 2023 View in browser   By Ben Leonard, Ruth Reader and Erin Schumaker WEEKEND READ Afghanistan's opium poppy supplies Europe's heroin. | Rahmat Gul/AP Photo A ban on poppy cultivation in Afghanistan could lead to a rise in drug overdoses across the pond, European health officials fear. How’s that? Europe has a heroin problem, and most of it comes from poppies grown in Afghanistan. Afghanistan’s heroin production is expected to drop with this month’s poppy harvest, following the Taliban’s decision to ban poppy cultivation last year. Some European health officials worry this could lead Europeans to seek fentanyl, the synthetic opioid that is more deadly than heroin and has wreaked havoc in the U.S. “It seems strange to say this, but almost in terms of synthetics, the high availability of heroin at the moment is … arguably a protective factor,” Paul Griffiths, scientific director of the European Monitoring Centre for Drugs and Drug Addiction, told POLITICO’s Noah Alcala Bach. Disparate impact: U.S. statistics reveal the danger. Fentanyl was responsible for about 70 percent of the more-than-100,000 overdose deaths in the U.S. in 2021, the most recent year for which data is available. But Europeans use much less fentanyl than Americans, and fatal overdoses there are only a fraction of the U.S. toll. Even so: Working in the Europeans’ favor is the lack of a comparable opioid addiction problem. The U.S. fentanyl crisis is driven, in large part, by the overuse of prescription opioids, which prompted addiction and the search for street alternatives. “Prescribing rates are not necessarily less than in the U.S., but it doesn't spill over to the illicit opioid use or illegally manufactured opiates,” said Arnt Schellekens, professor at Radboud University Medical School in the Netherlands.   STEP INSIDE THE WEST WING: What's really happening in West Wing offices? Find out who's up, who's down, and who really has the president’s ear in our West Wing Playbook newsletter, the insider's guide to the Biden White House and Cabinet. For buzzy nuggets and details that you won't find anywhere else, subscribe today.     WELCOME TO FUTURE PULSE Roxborough State Park, Littleton, Colo. | Shawn Zeller This is where we explore the ideas and innovators shaping health care. Share any thoughts, news, tips and feedback with Ben Leonard at bleonard@politico.com, Ruth Reader at rreader@politico.com, Carmen Paun at cpaun@politico.com or Erin Schumaker at eschumaker@politico.com. Send tips securely through SecureDrop, Signal, Telegram or WhatsApp. Today on our Pulse Check podcast, your host Ben talks with Daniel Payne about how the pandemic has negatively affected kids’ mental health and the legislation being proposed to help combat Covid’s effect. Plus, Katherine Ellen Foley provides a dispatch from this week’s World Vaccine Congress in Washington. Listen to today’s Pulse Check podcast AROUND THE NATION Medicaid rolls are set to shrink, but some states will still have more people using the program than they did before Covid hit. | AP Photo At least 16 states could soon see their Medicaid bills rise, according to a new Moody’s Investors Service projection. By examining state job markets, Moody’s predicts the 16, mostly in New England and the Midwest, will have Medicaid rolls larger than they did before Covid-19 arrived in 2020 after they reassess enrollees’ eligibility over the next year. That reassessment, ordered by Congress in December, aims to ensure recipients are still eligible for the state-federal health insurance for low- and lower-middle-income people. In a March 2020 law, Congress ordered states to halt those reassessments during the public health emergency and appropriated additional funding to cover the costs of the expected increase in enrollment. As the pandemic prompted layoffs, Medicaid rolls did increase – by 30 percent, or 20.7 million people. With the national job market now recovered, Congress decided in December to phase out the 6.2 percent increase in the federal share of Medicaid payments starting April 1. It will end entirely next year. States have a year starting this month to reassess their Medicaid rolls to determine whether people still qualify for the program or whether their incomes are now too high. Moody’s expects this process to have big implications for state budgets, a large portion of which go to Medicaid. States with lagging job markets could see rolls larger than pre-pandemic levels and will soon be on the hook for some of that increase, the Moody’s report says, while states that have smaller rolls than they did in early 2020 could see their bills decline.   LISTEN TO POLITICO'S ENERGY PODCAST: Check out our daily five-minute brief on the latest energy and environmental politics and policy news. Don't miss out on the must-know stories, candid insights, and analysis from POLITICO's energy team. Listen today.     WORLD VIEW Getting vaccines to where they're needed is a challenge in many developing countries. | AP World leaders are far from agreement on how to handle the next pandemic. POLITICO’s Ashleigh Furlong obtained a draft of the treaty the World Health Organization is shepherding and found countries are still stuck on how much responsibility rich nations owe to poor ones. Points of contention: The United States opposes language obligating it to provide medical technology to developing countries, insisting that technology transfers be “voluntary” or on “mutually agreed” terms. The U.S. is also against language that says developing countries should have “unhindered” access to pandemic products. Overall, the draft discussion is still focused on definitions, objectives and principles of the treaty instead of the meat of the proposal. Why it matters: Countries have set a goal of presenting an agreement at the May 2024 WHO meeting in 13 months. While that timeline looks ambitious, a senior WHO official told reporters Thursday it’s premature to say member countries would need more time for negotiations. “Definitely not a stalemate, definitely moving forward,” said Bruce Aylward, senior adviser to the WHO director-general.   Follow us on Twitter Ben Leonard @_BenLeonard_ Ruth Reader @RuthReader Carmen Paun @carmenpaun Erin Schumaker @erinlschumaker   Follow us

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