Daily on Healthcare: Drug overdose death rates in cities outpace rural areas

By | August 2, 2019

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DRUG OVERDOSE DEATH RATES IN CITIES OUTPACE RURAL AREAS: A government study released Friday reveals a more complicated picture of the U.S. opioid crisis that is often painted as a plague affecting white, rural males.

The study, from the Centers for Disease Control and Prevention, shows that death rates from drugs in cities are now outpacing rural areas. It finds the rate of drug overdoses for men was higher in cities, while for women it was higher in rural areas.

The CDC data provided dates back to 1999, and over that time the rates of death were sometimes higher in cities and sometimes higher in rural areas. A chart accompanying the study shows death rates in urban areas were higher in cities from 1999 to about 2004. For about three years after that, rates were roughly the same in both communities, but then rural areas started outpacing urban areas from 2007 until 2015. After that, death rates in urban areas increased faster than rural ones through 2017, where the chart ends.

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Drug overdoses were tied to 70,237 deaths in 2017, largely driven by synthetic opioids such as fentanyl, which is a drug 50 times more powerful than heroin. From the CDC data provided, fentanyl appears to be responsible for the surge of death rates in cities. In total, 61,712 people were killed by drug overdoses in urban areas, which amounts to a rate of 22 per 100,000 people. In rural areas, 8,525 people died from drug overdoses, a rate of 20 per 100,000 people.

Preliminary data from 2018, which were not included in Friday’s study, suggest some signs that the opioid crisis may have taken fewer lives that year, but it will take several more years for public health officials to determine whether what they’re seeing will become a longer downward trend.

The data out Friday are a reminder that the opioid crisis is far from just a rural public health problem. Deaths among rural whites include not just drugs but suicide, alcohol overdoses, chronic liver disease, and cirrhosis. The trend had been widely referred to in the media and among academic circles as “deaths of despair,” with many researchers attributing them to economic anxiety.

Good morning and welcome to the Washington Examiner’s Daily on Healthcare! This newsletter is written by senior healthcare reporter Kimberly Leonard (@LeonardKL) and healthcare reporter Cassidy Morrison (@CassMorrison94). You can reach us with tips, calendar items, or suggestions at dailyonhealthcare@washingtonexaminer.com. If someone forwarded you this email and you’d like to receive it regularly, you can subscribe here.

EBOLA ONE YEAR LATER: The Ebola outbreak in the Democratic Republic of the Congo has been spreading there for a year, and American federal officials reported Thursday that the deadly virus is showing no sign of abating. “It appears the outbreak continues at the same pace, so we don’t see evidence of slowing,” Dr. Henry Walke, who is leading the response for the CDC, said in a call with reporters. “We remain concerned and continue to try to have an impact on the response.”

The outbreak has been difficult to control. As of July 30, at least 2,698 people had been infected, and 1,813 among them have died. Outbreaks of violence have made it hard to address Ebola, and people living in the Congo have been skeptical not just of the vaccine but about following other medical advice.

But Ebola is unlikely to hit the U.S.: The risk of Ebola coming to the U.S. remains low. Only 16,000 people travel from the Congo to the U.S. every year, and more than 79 million people have been screened at airports and at various border entries.

In a follow up phone call with the Washington Examiner, a CDC official explained further that a spread to the U.S. was not impossible but was “highly unlikely.” The official pointed out that the symptoms of Ebola were so dire that people who become infected would be likely to immediately go to the emergency room, where medical workers would isolate them quickly and treat them, and public health officials would track down others they had come in contact with.

Migrants from the Congo have been traveling to Latin America and then to the U.S., but would be far too ill to make the journey if they had Ebola. Even if men who were migrating had traces of Ebola in their sperm for two years after being infected, the spread of Ebola through sexual contact is more rare than through direct contact, the official explained.

RICK SCOTT EXPANDS ON HIS BILL WITH VAN HOLLEN TO LOWER DRUG PRICES: Republican senator Rick Scott from Florida told the Washington Examiner that his latest push to pressure pharmaceutical companies to lower drug prices is a “commonsense” measure to return money to the taxpayers who fund drug research projects.

“The way I look at this bill, is that we are taking your tax dollars and we are putting it into basic research. And if it becomes a drug that’s making a profit, we have two options: you can get a return on your investment just like any other investment, or I’m going to make sure the prices are reasonable,” Scott said.

Scott’s We PAID Act, drafted with Democrat Chris Van Hollen of Maryland, would place price caps on prescription medications which use taxpayer dollars in research and development. A new Drug Affordability and Access Committee would determine whether prices set by drug companies are fair based partly on what went into developing the drugs.

Scott said the bill was not a departure from GOP orthodoxy but instead was a means for him to use the kinds “bargaining tools” he used in his career in the healthcare industry — he ran the extensive Columbia Hospital Organization from 1987 to 1997. He said he also plans to use his business acumen to whip GOP votes for the bill and ultimately to lower drug prices.

TRUMP PROMISES TO END AIDS EPIDEMIC, CHILDHOOD CANCER ‘VERY SHORTLY’: At a Cincinnati rally Thursday night, President Trump promised the crowd that his administration “will be ending the AIDS epidemic shortly in America, and curing childhood cancer very shortly.”

SANDERS PROMISES TO BEGIN DRUG IMPORTATION ON DAY ONE IN WHITE HOUSE: Democratic 2020 hopeful Bernie Sanders said Thursday he would initiate drug importation on his first day in the West Wing. Sanders said he would direct his officials in Health and Human Services and the Food and Drug Administration to immediately verify that drugs to come in from foreign countries are perfectly safe, “Not a hard thing to do,” Sanders said to MSNBC’s Mike Barnicle. Sanders’ initiative to bring in foreign drugs as a means of lowering prescription prices comes just one day after the Trump administration proposed plans to import prescription drugs.

BIDEN IS PUT ON THE HOT SPOT OVER OBAMA’S HEALTHCARE AND IMMIGRATION POLICIES: Joe Biden said he was “surprised” at the amount of grilling he received over with work alongside Barack Obama over healthcare policy and immigration.

It’s a marker of how the Democratic Party’s rhetoric on healthcare has shifted in recent years. When the Affordable Care Act was signed into law in 2010, Democrats saw it as fulfilling a goal they’d pursued for decades, and spent years defending it from GOP attacks. Now, 2020 Democrats are eager to focus on the shortfalls of the extant system — and apparently willing to see Obama’s legacy become collateral damage in the process.

“I’m proud of the job [Obama] did. I don’t think there’s anything he has to apologize for. And I think, you know, it kind of surprised me, the degree of the criticism,” Biden said Thursday.

ANTI-ABORTION GROUP PRAISES PASSAGE OF BUDGET WITHOUT ABORTION RIDERS: The Susan B. Anthony List applauded Congress for passing a two-year budget deal Thursday that keeps the Hyde Amendment and would allow the administration’s Title X rule to take effect. The rule prohibits doctors who receive Title X grants from directly referring for abortions, and the Hyde Amendment prohibits federal dollars from paying for abortions except in cases of rape, incest, or when a woman’s pregnancy threatens her life.

The budget passed Congress with fiscal hawks wary of an increase to the deficit: Over 20 conservative senators objected to the budget sent to Trump’s desk Thursday, on the grounds that the deficit could increase by $ 1.7 trillion over the next decade. “This may well be the most fiscally irresponsible thing we have done in the history of the United States,” Rand Paul of Kentucky declared ahead of the vote. The budget will greenlight additional federal borrowing through July 2021.

DEMOCRAT-LED ENERGY & COMMERCE COMMITTEE QUESTIONS TRUMP’S RELIGIOUS EXEMPTION RULE: House Energy and Commerce Committee Democrats fired back at a Trump administration rule, finalized by HHS’ Office of Civil Rights in May, protecting healthcare workers who decline to provide or refer services if it contradicts their religious beliefs.

Democrats say that the rule will increase “the ways in which patients could face discrimination or otherwise face barriers to care under this rule.” They claim that it would, for example, allow federally funded providers to refuse to offer HIV testing, permit hospital schedulers to refuse to book rooms for women seeking abortions, or allow pharmacists to refuse to fill prescriptions for patients suffering miscarriages.

IF ROE V. WADE IS OVERTURNED, MORE THAN 100K WILL LOSE ABORTION ACCESS IN THE FIRST YEAR: STUDY: The Guttmacher Institute, a research group that supports abortion rights, reported Thursday that if Roe vs. Wade is overturned or weakened by the Supreme Court, then between 93,000 and 143,000 women will be prevented from obtaining abortion services because they would need to travel long distances.

The Rundown

The Hill Almost three-quarters say minimum age to buy tobacco should be 21: Gallup

The Washington Post Doctors urge probe of child migrant deaths: ‘Poor conditions’ at border increase risk of spreading flu

The Advocate First batch of Louisiana’s medical marijuana cleared for release Tuesday to pharmacies by regulators

The Wall Street Journal Meatless burgers stoke sales and questions about nutrition

The New York Times A blood test for Alzheimer’s? It’s coming, scientists report


FRIDAY | Aug. 2

Aug. 2-6. Walter E. Washington Convention Center. American Veterinary Medical Association annual meeting. Details.

MONDAY | Aug. 5

Congress in August recess.