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Fentanyl’s toll spikes, for some

The ideas and innovators shaping health care
Oct 16, 2023 View in browser
 
Future Pulse

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

CONNECTING THE DOTS

Jaime Puerta (C), holds a portrait of his son Daniel Puerta-Johnson, who died in April 2020 at the age of 16 from a pill containing fentanyl, during a news conference outside the Roybal Federal Building on February 24, 2021 in Los Angeles, California. - The US Drug Enforcement Administration (DEA) announced Operation Engage to focus on education, prevention, and increasing public awareness surrounding the dangers of   opioids frequently found in counterfeit pharmaceutical pills - particularly fentanyl - resulting in deaths. According to the DEA, while overdose deaths began increasing prior to the Covid-19 pandemic, they accelerated significantly during the first few months of the pandemic. Family members whose relatives have died from pills containing fentanyl seek to raise awareness among parents, urge deeper law enforcement investigations, and change the language used to describe deaths away from terms such as overdose, which can place blame on victims rather than the illegal distributors and manufacturers of deadly counterfeit pills. (Photo by Patrick T. FALLON / AFP) (Photo by PATRICK T. FALLON/AFP   via Getty Images)

Fentanyl deaths have risen fast, especially among those without college degrees. | AFP via Getty Images

More people without college degrees are dying from drug overdoses than those who went to college, highlighting the need to expand treatment access and subsidize the opioid reversal drug naloxone in lower-income communities in America, a recent study by the RAND Corporation shows.

How so? In 2021, the latest year for which data is available, 9 in 100,000 people with a bachelor’s degree died from a drug overdose, compared with nearly 83 in 100,000 people who graduated high school, a ninefold difference.

People who didn’t graduate high school had an overdose death rate of nearly 80 per 100,000, while those who went to college but didn’t graduate had a rate of nearly 31 per 100,000.

Line graph showing rapid rise in overdose deaths among people without college degrees.

Why it matters: The difference in overdose deaths linked to educational attainment has existed since at least 2000, the earliest year the study looks at, but grew especially fast during the Covid-19 pandemic, the study says.

From 2019 to 2021, the overdose death rate for those with no college increased by nearly 31 per 100,000 while the overdose death rate for those with at least some college education increased by 4.5 per 100,000.

Synthetic opioids, such as illicit fentanyl, are the main culprit, the study says.

“The substantial increase in overdose death rates during the pandemic among individuals without any college education suggests that the opioid crisis has disproportionately impacted this population and that socioeconomic status has a large and growing role as the opioid crisis continues to evolve,” the paper adds.

 

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

Share any thoughts, news, tips and feedback with Carmen Paun at cpaun@politico.com, Daniel Payne at dpayne@politico.com, Evan Peng at epeng@politico.com or Erin Schumaker at eschumaker@politico.com.

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Today on our Pulse Check podcast, Daniel talks with Erin about what to expect this week as the Senate Health, Education, Labor and Pensions Committee considers Monica Bertagnolli's nomination to lead the National Institutes of Health — and what's behind the monthslong delay of the confirmation hearing.

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INVESTIGATION

A woman breastfeeds her new baby.

Breastfeeding rates are high in the U.S., thanks to a concerted public health campaign. | AP Photo/Andy Wong

People who were breastfed as infants are getting colorectal cancer at greater rates than those who weren't.

Wait, what? Researchers from Harvard Medical School and the Dana-Farber Cancer Institute reported in the journal Clinical Gastroenterology and Hepatology that women who were breastfed as infants were 23 percent more likely to develop colorectal cancer later in life.

Dr. Kimmie Ng, the associate chief of the division of gastrointestinal oncology at Dana-Farber Cancer Institute and an associate professor of medicine at Harvard Medical School, teamed with Chen Yuan, an instructor in medicine at Dana-Farber, in analyzing data from about 160,000 women aged 27 to 93.

They relied on the Harvard’s Nurses’ Health Study, which tracks nurses’ health outcomes over their lifetimes.

Using that study also allowed the researchers to examine the mothers’ diets and lifestyles, including whether they smoked or drank alcohol or were obese.

They found the link between colorectal cancer and having been breastfed remained. And those who were breastfed longer were more likely to contract the disease than those who’d been breastfed for a shorter time.

There was also an association with colorectal cancer among younger people: with a nearly 40 percent greater risk for those age 55 and younger who were breastfed.

Why it matters: Rates of colorectal cancer have skyrocketed. “A person born in 1990 now has quadruple the risk of getting colorectal cancer compared to a person born in 1950,” Ng told the Harvard Gazette.

At the same time, public health officials have strongly encouraged breastfeeding, noting the nutritional benefits for infants. That's prompted many more women to breastfeed their infants.

Even so: Of the women studied, 95 percent were white, so the researchers don’t know if the findings hold for other races and ethnicities.

The researchers also did not examine whether the nutrition received by non-breastfed infants – typically formula fortified with vitamins – may protect them against colorectal cancer.

 

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AROUND THE NATION

Tents for the homeless are seen on August 16, 2023 on a Skid Row sidewalk in Los Angeles, California, where homelessness has seen a 10 percent surge compared to last year. A recent report from the Los Angeles Homeless Services Authority reveals an estimate of 42,260 people living on the streets of Los Angeles without shelter, as the homeless population has more than doubled over the past decade. (Photo by Frederic J. BROWN   / AFP) (Photo by FREDERIC J. BROWN/AFP via Getty Images)

California is considering new approaches to solving its homelessness problem. | AFP via Getty Images

“There’s a recognition that in this nation we screwed this up, for all the goodwill and good intentions.”

California Democratic Gov. Gavin Newsom

California Gov. Gavin Newsom is asking Golden State voters to approve a plan to alleviate the state’s homelessness problem and better serve residents who have a mental illness or a substance-use disorder.

He says he sees it as a way of correcting the public policy mistakes of the past.

How so? Newsom signed laws last week that create a ballot measure asking voters to shift public health resources to the state’s sickest residents and prioritize housing them, POLITICO’s Rachel Bluth reports.

A major component of the package involves changing how counties spend tax money earmarked for behavioral health care.

The measure would require counties to spend roughly a third of their mental health budgets on housing interventions. If voters approve, counties will have to spend about another third on intensive services for people living on the street. The last third would go to a host of other mental health programs run by counties, including early interventions and workforce training.

New money: The other part of the package is a $6.38 billion bond that would be used to build more than 11,000 new treatment beds for those with severe mental health and substance use disorders. If approved, the plan is to use a portion of the money to build permanent supportive housing for veterans struggling with mental illness or addiction and who are at risk of becoming homeless.

The rest of the money would go for grants to rehabilitate or create new treatment beds in various settings.

What’s next? California voters will decide if they like the plan in March.

 

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