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  • Blinken under pressure to push China on role in lethal fentanyl trade when he visits Beijing | CNN Politics

    Blinken under pressure to push China on role in lethal fentanyl trade when he visits Beijing | CNN Politics

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    CNN
     — 

    Members of Congress are urging Secretary of State Antony Blinken to pressure China to do more to curb the flow of fentanyl and synthetic opioids into the United States on his visit to the country which is expected to take place in the next few days.

    On Wednesday, a group of 14 Republican senators led by Marco Rubio of Florida wrote to Blinken ahead of his trip highlighting China’s role in the “fentanyl crisis” as one of many issues they wanted him to address.

    More than 100,000 Americans died of drug overdoses from July of 2021 to July of 2022 and two thirds of those deaths were fueled by synthetic opioids, primarily fentanyl, according to the CDC.

    An extremely powerful synthetic drug, fentanyl is 50 to 100 times more potent than morphine and 30 to 50 times more potent than heroin.

    The Chinese government cracked down on the manufacture and distribution of fentanyl in 2019, in a move that was hailed by the Trump administration. As a result, China it is no longer the primary source of fentanyl getting into the US. But it’s still the key source of precursor chemicals which are often shipped to Mexico and used by cartels to produce fentanyl which is brought over the border.

    “China is the leading producer of these precursor chemicals and is shipping and selling them to the two major Mexican cartels (Sinaloa and New Generation) producing fentanyl,” explained David Luckey, a senior international and defense researcher at RAND Corporation.

    “Virtually 98% of the precursor chemicals that are made used to make fentanyl are coming from China,” Democratic Rep. David Trone of Maryland told CNN. Getting China to engage on this crisis “has got to be Secretary Blinken’s number one mission when he gets there.”

    Experts and lawmakers say the production of precursor chemicals in China is a primary factor fueling the ongoing opioid crisis.

    “Synthetic opioid trafficking is an area where even a few meaningful steps from the PRC (People’s Republic of China) can play a significant role in combating this worsening epidemic and saving American lives,” Trone wrote in a letter to Blinken last month. He urged Blinken not to negotiate with Chinese officials on other topics until he has secured a commitment from Beijing to do more to stem the fentanyl crisis.

    Trone, whose nephew died of a fentanyl overdose, believes China should commit to adopting rules requiring drug companies to know who their customers are, put into place and enforce export regulations on the chemical sector, and cooperate with US agencies including the Drug Enforcement Administration and Office of National Drug Control Policy to crack down on the fentanyl trade.

    Blinken has directed his team at the State Department to work with interagency partners to do “everything possible” to address this deadly crisis which is the leading killer of Americans between the ages of 18 to 49, State Department spokesperson Ned Price said earlier this year.

    But it’s unclear what direct asks he will make of the Chinese government during his visit.

    “Though its past action has helped to counter illicit synthetic drugs, we continue to urge the PRC to take additional meaningful concrete action to curb the diversion of precursor chemicals and equipment used by criminals to manufacture fentanyl and other synthetic drugs,” Price said.

    Some lawmakers believe that Blinken should offer trade talks with China if it engages on efforts related to stemming the fentanyl crisis. Yet other congressional aides say that China will only respond to pressure and believe that the administration should consider steps including additional sanctions related to the dangerous substances – to force their engagement.

    Todd Robinson, the top State Department official for international narcotics and law enforcement affairs, said that the effective way to approach the challenge will be through “collaboration and cooperation.”

    “China has its own problems with narcotics. Mexico has problems has its problems with narcotics. Colombia also has a problem. And what we’ve been saying is, this is no longer an issue where you can solely use one or the other. Everybody’s got a problem.”

    But the need for Chinese engagement is clear: reducing the supply of precursor chemicals from China would have a “huge” impact on the crisis and would “mean a dramatic decrease” in US deaths resulting from drug overdoses, Robinson said.

    China is the largest producer of chemicals that are in everyday products such as cleaning supplies. Many Chinese companies have begun producing and selling the precursor chemicals in addition to the chemicals they have already been producing.

    Challenges to tackling the root of the problem persist when China and other countries often turn the tables on the US and blame Americans for the addiction problem which drives the demand.

    “It’s not as simple as saying, ‘China, stop producing and exporting these chemicals’. There are several sides to this issue. In response, China, for example, could counter with, ‘Americans, stop buying and using drugs,’” said Luckey.

    Many Americans with a direct connection to the crisis are watching Blinken’s trip closely.

    West Virginia – which had more than 1,300 deaths due to synthetic opioids from March of 2021 to March of 2022, according to the CDC – is an epicenter of the domestic crisis.

    Jordan Dennison lives in the state, grew up with parents who were drug addicts, and developed his own opioid addiction in his teens. A few years ago – after more than 10 overdoses – he finally got clean. The 30-year-old now works at an outreach program to get addicts into treatment.

    “Drugs led me to lose everything. Every relationship I ever had. I came to learn that what I was using was not heroine it was fentanyl. I was getting it off the street, I would go anywhere to get it,” he told CNN. “I never knew where it came from, but I always assumed it was coming from China.”

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  • Attorneys for Keenan Anderson’s estate file $50 million claim of damages against city of Los Angeles | CNN

    Attorneys for Keenan Anderson’s estate file $50 million claim of damages against city of Los Angeles | CNN

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    Los Angeles
    CNN
     — 

    Attorneys representing the estate of Keenan Anderson, who died from cardiac arrest after he was repeatedly tased by Los Angeles Police Department officers, filed a $50 million claim of damages against the city of Los Angeles for his death, they announced in a news conference Friday. 

    The claim is the first step needed to file a lawsuit against the city, attorney Carl Douglas said.

    The claim requests $35 million due to damages against Anderson’s son and $15 million for Anderson’s estate, saying the city “failed to properly train the involved officers” who ultimately used “unreasonable deadly force.” 

    Anderson, who is the cousin of Black Lives Matter co-founder Patrisse Cullors, was tased repeatedly as officers struggled to arrest him at the scene of a traffic collision on January 3, edited body-worn camera footage released by police shows.

    The English teacher from Washington, DC was in Los Angeles visiting family.

    The Los Angeles city attorney’s office told CNN it has no comment on the lawsuit, and the Los Angeles Police Department said it does not comment on pending litigation. CNN also has reached out to the Los Angeles mayor’s office.  

    The city has 45 days to either accept or deny the claim, Douglas said, and if it denies the claim the estate’s legal team will move forward with a state lawsuit. The lawsuit would claim wrongful death and negligence, among other claims, the filing says.

    The edited video from body-worn cameras shows Anderson at first talking with one officer, and when the video resumes, he jogs into the street as the officer pursues him and orders him to lay down on his stomach.

    Anderson does not appear to comply immediately, and two other officers arrive and move him to lie prone on his stomach on the street, telling Anderson to “relax.” As officers struggle on top of him, Anderson can be heard screaming, “Help, they’re trying to kill me” and “Please, don’t do this.”

    Then, an officer deploys a taser multiple times on Anderson, who says, “I’m not resisting.”

    Later in the video, the Los Angeles Fire Department places Anderson, who appears conscious, onto a gurney near an ambulance. Police said in a news release that Anderson was given medical care at the scene before being transported to a local hospital.

    “While at the hospital, Anderson went into cardiac arrest and was pronounced deceased,” the release says. 

    A preliminary toxicology-blood screen of Anderson’s blood samples tested positive for cocaine and marijuana, police said, adding the Los Angeles County coroner’s office was expected to conduct its own independent toxicology tests.

    “Having to hear Keenan cry out for help the way he did and to watch him be hurt by the very people who are supposed to protect him is something I will never get over,” Gabrielle Hansell, the administrator of Anderson’s estate and the mother of Anderson’s 5-year-old son, said at the news conference announcing the legal action on Friday.

    Since Anderson was “an African American man,” the claimants in this case “believe that because of implicit bias, each of the unknown involved police officers assumed Mr. Anderson presented a serious threat to someone’s safety, and then assaulted, battered and tased him at least six times in response,” the claim says. 

    “Mr. Anderson had not posed any objectively reasonable threat to anyone, but was grabbed, compressed against the hardened surface, and repeatedly tased on account of his African American race,” the claim adds.  

    “We will make sure that Keenan Anderson’s name will not go away in vain,” Douglas said during the news conference.  

    The legal team is also planning to request that the Department of Justice’s Civil Rights Division investigate the case, attorney Benjamin Crump said.

    Anderson’s death is the third officer-involved death in Los Angeles this year.

    Detectives from the police department’s Force Investigation Division responded to the scene where Anderson was taken into custody and are investigating the use of force, police said.

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  • Locally caught freshwater fish contain PFAS toxins, study finds | CNN

    Locally caught freshwater fish contain PFAS toxins, study finds | CNN

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    Editor’s Note: Sign up for CNN’s Life, But Greener newsletter. Our limited newsletter series guides you on how to minimize your personal role in the climate crisis — and reduce your eco-anxiety.



    CNN
     — 

    Fish caught in the fresh waters of the nation’s streams and rivers and the Great Lakes contain dangerously high levels of PFOS, short for perfluorooctane sulfonic acid, a known synthetic toxin phased out by the federal government, according to a study of data from the US Environmental Protection Agency.

    The chemical PFOS is part of a family of manufactured additives known as perfluoroalkyl and polyfluoroalkyl substances, or PFAS, widely used since the 1950s to make consumer products nonstick and resistant to stains, water and grease damage.

    Called “forever chemicals” because they fail to break down easily in the environment, PFAS has leached into the nation’s drinking water via public water systems and private wells. The chemicals then accumulate in the bodies of fish, shellfish, livestock, dairy and game animals that people eat, experts say.

    “The levels of PFOS found in freshwater fish often exceeded an astounding 8,000 parts per trillion,” said study coauthor David Andrews, a senior scientist at Environmental Working Group, the nonprofit environmental health organization that analyzed the data.

    In comparison, the EPA has allowed only 70 parts per trillion of PFOS in the nation’s drinking water. Due to growing health concerns, in 2022 the EPA recommended the allowable level of PFOS in drinking water be lowered from 70 to 0.02 parts per trillion.

    “You’d have to drink an incredible amount of water — we estimate a month of contaminated water — to get the same exposure as you would from a single serving of freshwater fish,” Andrews said.

    “Consuming even a single (locally caught freshwater) fish per year can measurably and significantly change the levels of PFOS in your blood,” Andrews said.

    Chemicals in the PFAS family are linked to high cholesterol, cancer and various chronic diseases, as well as a limited antibody response to vaccines in both adults and children, according to a report by the National Academies of Sciences, Engineering, and Medicine.

    “This is an important paper,” said toxicologist Linda Birnbaum, former director of the National Institute for Environmental Health Sciences and the National Toxicology Program.

    “To find this level of contamination in fish across the country, even in areas not close to industry where you might expect heavy contamination, is very concerning. These chemicals are everywhere,” she said.

    Read more: Doctors should test levels of PFAS in people at high risk, report says

    It’s nearly impossible to avoid PFAS, experts say. Manufacturers add the chemicals to thousands of products, including nonstick cookware, mobile phones, carpeting, clothing, makeup, furniture and food packaging.

    A 2020 investigation found PFAS in the wrapping of many fast foods and “environmentally friendly” molded fiber bowls and containers.

    A 2021 study found PFAS in 52% of tested cosmetics, with the highest levels in waterproof mascara (82%), foundations (63%) and long-lasting lipstick (62%). Polytetrafluoroethylene, the coating on nonstick pans, was the most common additive.

    Read more: Makeup may contain potentially toxic chemicals called PFAS, study finds

    In fact, PFAS chemicals have been found in the blood serum of 98% of Americans, according to a 2019 report using data from the US Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey.

    “These chemicals are ubiquitous in the American environment. More than 2,800 communities in the US, including all 50 states and two territories, have documented PFAS contamination,” Dr. Ned Calonge, an associate professor of epidemiology at the Colorado School of Public Health and chair of the Academies committee that wrote the report, told CNN previously.

    Read more: Dangerous chemicals found in food wrappers at major fast-food restaurants and grocery chains, report says

    Scientists at the Environmental Working Group used data from the EPA’s own monitoring programs — the National Rivers and Streams Assessment, which has been periodically testing stream conditions since 2008, and the Great Lakes Human Health Fish Fillet Tissue Study, which tests lake water every five years.

    “The analysis focused on EPA wild-caught fish in rivers, streams and throughout the Great Lakes from 2013 to 2015 as that was the latest data available,” Andrews said.

    The contamination was widespread, impacting “nearly every fish across the country,” he said. “I believe there was one sample without detected levels of PFOS.”

    The EWG created an interactive map of the results with details for each state. Fish caught near urban areas contained nearly three times more PFOS and overall PFAS than those caught in nonurban locations, the study found. The highest levels were found in fish from the Great Lakes.

    The analysis showed PFOS accounted for an average 74% of the contamination in the fish. The remaining 25% was a mixture of other PFAS known to be equally damaging to human health, Andrews said.

    CNN reached out to the EPA for comment but did not hear back before this story published.

    Based on the study’s findings, people who fish for sport might “strongly” consider releasing their catch instead of taking the fish home for a meal, Andrews said.

    Yet many people in lower socioeconomic groups, indigenous peoples and immigrants in the US rely eating freshly caught fish.

    “They need it for food or because it’s their culture,” Birnbaum said. “There are Native American tribes and Burmese immigrants and others who fish because this is who they are. This is key to their culture. And you can’t just tell them not to fish.”

    Read more: Water- and stain-resistant products contain toxic plastics, study says. Here’s what to do

    The predominant chemical in the fish, PFOS, and its sister perfluorooctanoic acid, or PFOA, are known as “long-chain” PFAS, made from an 8-carbon chain.

    Read more: Plastics and pesticides: Health impacts of synthetic chemicals in US products doubled in last 5 years, study finds

    Manufacturers agreed in the early 2000s to voluntarily stop using long-chain PFAS in US consumer products, although they can still be found in some imported items. Due to growing health concerns, the use of PFOS and PFOA in food packaging was phased out in 2016 by the US Food and Drug Administration.

    However, industry reworked the chemicals by making them into 4- and 6-carbon chains — today over 9,000 different PFAS exist, according to the CDC. Experts say these newer versions appear to have many of the same dangerous health effects as the 8-chain PFAS, leaving consumers and the environment still at risk.

    Many of these longer-chain PFAS can be stored for years in different organs in the human body, according to the National Academies report. Scientists are examining the impact of newer versions.

    “Some of these chemicals have half-lives in the range of five years,” National Academies report committee member Jane Hoppin, an environmental epidemiologist and director of the Center for Human Health and the Environment at North Carolina State University in Raleigh, told CNN previously.

    Read more: FDA must do more to regulate thousands of chemicals added to your food, petitioners say

    “Let’s say you have 10 nanograms of PFAS in your body right now. Even with no additional exposure, five years from now you would still have 5 nanograms,” she said. “Five years later, you would have 2.5 and then five years after that, you’d have one 1.25 nanograms. It would be about 25 years before all the PFAS leave your body.”

    That’s why it’s “no surprise” to find such high levels of PFOA in freshwater fish, said the director of environmental pediatrics at NYU Langone Health, Dr. Leonardo Trasande, who was not involved in the new study.

    “These truly are ‘forever chemicals,’” Trasande said. “This reinforces the reality that we need to get all PFAS out of consumer products and people’s lives.”

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  • Russian figure skater Kamila Valieva cleared by RUSADA, WADA to review doping decision and consider appeal | CNN

    Russian figure skater Kamila Valieva cleared by RUSADA, WADA to review doping decision and consider appeal | CNN

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    CNN
     — 

    The Russian Anti-Doping Agency (RUSADA) found figure skater Kamila Valieva violated anti-doping rules but bore no “fault or negligence” for the transgression, according to the World Anti-Doping Agency (WADA).

    The ruling in effect clears Valieva of wrongdoing and administers no punishment beyond the disqualification of her results from December 25, 2021 – the date of her sample collection.

    The decision, made by a RUSADA tribunal, would allow the Russian Olympic Committee (ROC) to earn the gold medals won in the team figure skating event at the Beijing Olympics in 2022.

    CNN has reached out to RUSADA for comment.

    The World Anti-Doping Agency (WADA) released a statement implying it is likely to appeal the verdict.

    “WADA notes this outcome and has requested a copy of the full reasoned decision, which it will review together with the case file in order to determine whether the ruling is in line with the terms of the World Anti-Doping Code,” it said in a statement.

    “However, based on the elements of the case with which WADA is already familiar, the Agency is concerned by the finding of ‘no fault or negligence’ and will not hesitate to exercise its right of appeal to the Court of Arbitration for Sport, as appropriate.

    “Following a full review of the RUSADA decision, WADA will consider what its next steps will be so that the matter is dealt with as quickly as possible and without further undue delay.”

    Travis Tygart, CEO of the US Anti-Doping Agency (USADA), said in a statement to CNN: “WADA and the ISU [International Skating Union] have to appeal this decision, for the sake of the credibility of the anti-doping system and the rights of all athletes.

    “The world can’t possibly accept this self-serving decision by RUSADA, which in the recent past has been a key instrument of Russia’s state sponsored doping fraud and is non-compliant. Justice demands a full, fair, public hearing outside of Russia.”

    Valieva, who is now 16, was suspended by RUSADA the day after she guided the Russian Olympic Committee (ROC) to victory in the team event in Beijing, where she became the first woman to land a quadruple jump in the Winter Olympics.

    She tested positive for a banned substance – the heart medication trimetazidine, which can enhance endurance – in December 2021. But the results of the failed December drug test only came to light during the Olympics when it was analyzed and reported to RUSADA.

    Valieva has not publicly explained the positive test results.

    Team USA finished second in the team event in Beijing, Japan in third, and Canada fourth. As a result of the doping controversy, no medal ceremony was held during the Games.

    CNN has reached out to the ISU and the International Olympic Committee (IOC) for comment.

    In a statement to CNN, the US Olympic and Paralympic Committee said: “As we approach the one-year anniversary of the Beijing Games, it remains very important that the figure skating team event athletes who competed in Beijing get the resolution they deserve.

    “We thank WADA for their commitment to reviewing this issue and moving the process forward as expeditiously as possible.”

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  • CBP seizes $9.1 million worth of cocaine at the Pan American Dock in Puerto Rico | CNN

    CBP seizes $9.1 million worth of cocaine at the Pan American Dock in Puerto Rico | CNN

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    CNN
     — 

    US Customs and Border Protection officers seized 877 pounds of cocaine on board the San Juan-Santo Domingo Ferry at the Pan American Dock in Puerto Rico last month.

    The drugs, which have an estimated value of $9.1 million, were spotted on December 26 during a routine cargo inspection. Officers removed a board covering the floor of a cargo platform to reveal 355 packages that tested positive for cocaine, the CBP said in a statement.

    “Our experienced CBP officers remain vigilant, utilizing their training and available tools to stop dangerous drugs from entering the country,” Roberto Vaquero, director of field operation for Puerto Rico and the US Virgin Islands, said in the statement.

    Homeland Security Investigations took custody of the contraband for further investigation, according to the CBP.

    CBP has seized 77,000 pounds of drugs in the first two months of fiscal year 2023, according to the CBP Data Portal.

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  • From increases in minimum wage to recreational marijuana, these new laws take effect in 2023 | CNN Politics

    From increases in minimum wage to recreational marijuana, these new laws take effect in 2023 | CNN Politics

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    CNN
     — 

    As President Joe Biden scored several legislative wins last year, voters across the country headed to the polls in November to decide on local measures.

    The passage of several of those measures will lead to new state laws this year. And Americans in 2023 will also feel the impact of several provisions in the Inflation Reduction Act that was enacted over the summer.

    Here are some of the state and federal measures set to take effect in 2023.

    Nearly half of all US states will increase their minimum wages in 2023.

    The hike went into effect in the following states on January 1: Arizona, California, Colorado, Delaware, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, New Jersey, New Mexico, Ohio, Rhode Island, South Dakota, Vermont and Washington.

    Minimum-wage workers in Connecticut will have to wait until June 1 to see the increase, while the change goes into effect in Nevada and Florida on July 1 and September 30, respectively. The hike went into effect in New York on Saturday for workers outside New York City, Long Island and Westchester County.

    Of all states, Washington state has the highest minimum wage at $15.74, up from $14.49, followed by California, which now has a minimum wage of $15.50 for all workers, up from $14 for employers with 25 or less employees and $15 for employers with 26 or more employees.

    However, Washington, DC, continues to have the highest minimum wage in the country. The increase from $16.10 to $16.50 went into effect Sunday and another hike to $17 is set for July 1.

    The push for a higher wage across the country comes as the federal minimum wage has remained the same since 2009, the longest period without change since a minimum wage was established in 1938, according to the Department of Labor.

    Efforts by Democrats to pass a $15 minimum wage bill stalled in the Senate in 2021.

    Jeenah Moon/Bloomberg/Getty Images

    Five states – Arkansas, Maryland, Missouri, North Dakota and South Dakota – had recreational marijuana on the ballot in the November midterm elections, and voters in Maryland and Missouri approved personal use for those 21 and older.

    While legalization has taken effect in Missouri with an amendment to the state constitution, the Maryland law goes into effect on July 1.

    The law will also allow those previously convicted of cannabis possession and intent to distribute to apply for record expungement.

    Starting January 1, the amount of cannabis a person can possess in Maryland for a fine instead of a criminal penalty increases – from just over a third of an ounce, or 10 grams, to 2.5 ounces.

    One of the most significant victories for Biden in 2022 was the Inflation Reduction Act, a $750 billion health care, tax and climate bill, which he signed into law in August.

    As part of the legislation, the price of insulin for Medicare beneficiaries will be capped at $35 starting January 1.

    About 3.3 million Medicare beneficiaries used insulin in 2020 and spent an average of $54 per insulin prescription the same year, according to the Kaiser Family Foundation.

    The cap does not apply to those with private insurance coverage after Senate Democrats failed to get at least 10 Republican votes to pass the broader provision.

    02 new laws in 2023

    Keith Srakocic/AP

    There will be changes to the tax credits for those with electric vehicles, also thanks to the Inflation Reduction Act.

    The new rule stresses the use of vehicles that were made in North America, requiring much of their battery components and final assembly to be in the continent to be eligible for tax credits. It also mandates at least 40% of the minerals used for the battery to be extracted from the United States or a country that has free trade with the US.

    Upon meeting the requirements, new vehicles are eligible for a tax credit of up to $7,500.

    Those purchasing used electric vehicles can receive up to $4,000 in credits but it may not exceed 30% of the vehicle’s sale price.

    Initially, buyers who purchase vehicles in 2023 will need to wait to receive the tax credit when they file their tax returns for the year in 2024. But starting on January 1, 2024, electric vehicle buyers will be able to receive the money immediately, at the point of sale, if they agree to transfer the credit to their dealership.

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  • Justice Department sues pharmaceutical company for allegedly failing to report suspicious opioid sales | CNN Politics

    Justice Department sues pharmaceutical company for allegedly failing to report suspicious opioid sales | CNN Politics

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    Washington
    CNN
     — 

    The Justice Department on Thursday alleged that the AmerisourceBergen Corporation, one of the country’s largest pharmaceutical distributors, and two of its subsidiaries failed to report hundreds of thousands of suspicious prescription opioid orders to pharmacies across the country.

    The lawsuit, which spans several states, alleges that AmerisourceBergen disregarded its legal obligation to report orders of controlled substances to the Drug Enforcement Agency for nearly a decade. The company ignored “red flags” that pharmacies in West Virginia, New Jersey, Colorado and Florida were diverting opioids into illegal drug markets, the suit says.

    “The Department of Justice is committed to holding accountable those who fueled the opioid crisis by flouting the law,” Associate Attorney General Vanita Gupta said in a statement Thursday.

    “Companies distributing opioids are required to report suspicious orders to federal law enforcement. Our complaint alleges that AmerisourceBergen – which sold billions of units of prescription opioids over the past decade – repeatedly failed to comply with that requirement,” she added.

    If AmerisourceBergen is found liable at trial, the company faces billions of dollars in financial penalties, the Justice Department said.

    Lauren Esposito, a spokesperson for AmerisourceBergen, countered on Thursday in a statement that said the Justice Department’s complaint rested on “five pharmacies that were cherry picked out of the tens of thousands of pharmacies that use AmerisourceBergen as their wholesale distributor, while ignoring the absence of action from former administrators at the Drug Enforcement Administration – the DOJ’s own agency.”

    She added: “With the vast quantity of information that AmerisourceBergen shared directly with the DEA with regards to these five pharmacies, the DEA still did not feel the need to take swift action itself – in fact, AmerisourceBergen terminated relationships with four of them before DEA ever took any enforcement action while two of the five pharmacies maintain their DEA controlled substance registration to this day.”

    Yet AmerisourceBergen was allegedly aware that in two of the pharmacies, drugs it distributed were likely being sold in parking lots for cash, the Justice Department said. In another pharmacy, the company was allegedly warned that patients likely suffering from addiction were receiving opioids, including some people who later died of a drug overdose.

    The Justice Department also noted in its lawsuit that AmerisourceBergen’s reporting systems for suspicious opioid orders were deeply inadequate, and that the company intentionally changed its reporting systems to reduce the number of orders flagged as suspicious amid the opioid epidemic.

    Even when orders were flagged as suspicious, AmerisourceBergen often didn’t report those orders to the DEA, according to the complaint.

    Opioids are involved in the vast majority of drug overdose deaths, though synthetic opioids – particularly fentanyl – have played an outsized role. Synthetic opioids – excluding methadone – were involved in more than 72,000 overdose deaths in 2021, about two-thirds of all overdose deaths that year and more than triple the number from five years earlier.

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  • New York recreational cannabis sales begin | CNN

    New York recreational cannabis sales begin | CNN

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    CNN
     — 

    The first public sales of regulated cannabis in New York began at a dispensary in Manhattan’s East Village on Thursday at 4:20 p.m., hours after the first sale was made to a city official, New York Governor Kathy Hochul announced.

    Housing Works Cannabis Company became the first licensed dispensary in the state to open its location for business.

    The dispensary is operated by Housing Works, a non-profit that services people living with HIV/AIDS and those who are homeless and formerly incarcerated, Hochul said. The store will be open seven days a week and all proceeds will be directed to Housing Works, which runs a “network of charitable retail storefronts,” according to the release.

    “We set a course just nine months ago to start New York’s adult-use cannabis market off on the right foot by prioritizing equity, and now we’re fulfilling that goal,” Hochul said.

    The measure will attempt to address the racial disparities in cannabis-related arrests with a social and economic equity program to “facilitate individuals disproportionally impacted by cannabis enforcement,” city officials have said.

    The program includes “creating a goal of 50% of licenses to go to a minority or woman owned business enterprise, or distressed farmers or service-disabled veterans to encourage participation in the industry,” a city news release said.

    “Today marks a major milestone in our efforts to create the most equitable cannabis industry in the nation,” said New York City Mayor Eric Adams in a statement on Thursday.

    “The legal cannabis market has the potential to be a major boon to New York’s economic recovery – creating new jobs, building wealth in historically underserved communities, and increasing state and local tax revenue,” Adams said.

    In March 2021, former New York Gov. Andrew Cuomo signed a bill allowing recreational marijuana use across the state by adults 21 and older after the state Senate and Assembly voted to approve the legislation. The New York State Cannabis/Marijuana Regulation & Taxation Act also expunges previous marijuana convictions for actions that would be legal under the new law.

    The bill allows adults 21 and older to buy cannabis from authorized sellers. Adults can also possess up to 3 ounces of cannabis and 24 grams of cannabis concentrate. Eighteen months after the first sales begin, the law will allow adults to grow six mature and six immature plants at home per household.

    It also establishes the Office of Cannabis Management, an independent office operating as part of the New York State Liquor Authority, to implement a regulatory framework. The office was designed to have a two-tier licensing structure that would separate growers and processors from those owning retail stores, Cuomo’s office previously said.

    The law will also add a 13% tax to retail sales for state and local tax revenue.

    The development of a regulated cannabis industry in New York has the potential to create 30,000 to 60,000 jobs and the ability to earn $350 million annually in tax collections, CNN previously reported.

    New York’s Cannabis Control Board issued the first 36 adult-use retail licenses on November 21, including 28 for qualifying businesses and eight for non-profits, according to Hochul’s office.

    Housing Works received over 2,000 responses to its invitation to RSVP for the grand opening. The line outside the store was already stretching down the block hours before 4:20 p.m., Charles King, the chief executive officer of Housing Works, told CNN on Thursday. King says the nonprofit is hoping to have a total of three marijuana dispensaries in Manhattan by the end of 2023.

    “I don’t know that we’re actually going to be able to serve everyone in the three hours that we’re open,” King said. “People are eager.”

    New York state has contracted with various laboratories to test all cannabis products to be sold for adult recreation, King says. The biggest challenge, he adds, was finding enough products to sell.

    Members of the media take pictures before the opening of the first legal cannabis dispensary in New York City, on December 29, 2022.

    Patrons must show their state or federal identification to make a purchase at the dispensary.

    “We’re required by regulation to card everyone who enters the store to make sure they’re over the age of 21 and take documentation that we’ve actually done that carding,” King said.

    Kenneth Woodin, who waited in line to enter the store for four hours, told CNN affiliate ABC 7, “I want to be part of history. I like the idea of regulated weed.”

    The federal ban on marijuana has not slowed down one of the fastest-growing industries in the United States. More than two-thirds of US states have legalized cannabis in some capacity. California was the first to legalize medical marijuana in 1996. Since then, the medical use of cannabis has been legalized in 39 states and the District of Columbia. Recreational cannabis use is legal in DC and 21 states.

    Ballot measures in Missouri and Maryland to legalize recreational marijuana passed in the 2022 midterm elections, as momentum has grown nationwide to push for lifting penalties once associated with cannabis.

    A poll by the Pew Research Center conducted in October found that 59% of adults believe marijuana should be legal for medical and recreational use, while 30% believe it should be legal for only medical use. However, just 10% of adults say marijuana use should not be legal, the survey found.

    In October, President Joe Biden took the first significant steps by a US president toward removing criminal penalties for possessing marijuana by pardoning all prior federal offenses of simple marijuana possession, a move that senior administration officials said would affect thousands of Americans charged with that crime.

    Biden has also tasked the Department of Health and Human Services and Attorney General Merrick Garland to “expeditiously” review how marijuana is scheduled under federal law.

    New York’s bill follows marijuana legalization in neighboring New Jersey. In February 2021, New Jersey Gov. Phil Murphy signed bills to legalize and regulate marijuana use for those 21 and older, decriminalize possession of limited amounts of marijuana and clarify marijuana and cannabis use and possession penalties for those younger than 21.

    There are wide racial disparities in marijuana-related arrests nationwide, according to a study by the American Civil Liberties Union.

    “On average, a Black person is 3.64 times more likely to be arrested for marijuana possession than a white person, even though Black and white people use marijuana at similar rates,” the ACLU said in a 2020 report.

    “In every single state, Black people were more likely to be arrested for marijuana possession, and in some states, Black people were up to six, eight, or almost 10 times more likely to be arrested,” the report said.

    Policymakers and industry members should not lose sight of how individuals, especially people of color, continue to be criminalized for activities that are now legal at the state level, Amber Littlejohn, CEO of the Minority Cannabis Business Association, previously told CNN.

    “First and foremost, we need to get people out of prison, and we need to stop arresting people for doing things that folks are making lots of money doing,” Littlejohn said.

    People of color also face tremendous barriers operating within the industry. Attempts have been made to create paths into the industry for those with non-violent marijuana convictions whose communities were negatively impacted from the War on Drugs. But these efforts have largely been unsuccessful due to state policies that limit licenses, fail to offer financial and business resources to people of color and that benefit deeper-pocketed multistate operators, Littlejohn says.

    “I think one of the biggest problems is there seems to be an incredible disconnect between what people say they support and believe in and what [becomes law],” she said. “It’s up to us, the collective us, to be holding folks accountable.”

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  • Beijing to distribute Pfizer antiviral drug as Covid wave strains health system | CNN

    Beijing to distribute Pfizer antiviral drug as Covid wave strains health system | CNN

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    Beijing
    CNN
     — 

    Beijing will begin distributing Pfizer’s Covid-19 drug Paxlovid to the city’s community health centers in the coming days, state media reported Monday.

    The report comes as the city grapples with an unprecedented wave of infections that has severely strained its hospitals and emptied pharmacy shelves.

    The state-run China News Service reported Monday that after receiving training, community doctors will administer the medicine to Covid-19 patients and give instructions on how to use them.

    “We have received the notice from officials, but it is not clear when the drugs will arrive,” it cited a worker at a local community health center in Beijing’s Xicheng district as saying.

    Paxlovid remains the only foreign medicine to treat Covid that has been approved by China’s regulator for nationwide use, but access is extremely difficult to come by. When a Chinese healthcare platform offered the antiviral drug earlier this month, it sold out within hours.

    Azvudine, an oral medicine developed by China’s Genuine Biotech, has also been approved.

    After nearly three years of lockdowns, quarantines and mass testing, China abruptly abandoned its zero-Covid policy this month following nationwide protests over its heavy economic and social toll.

    The sudden lifting of restrictions sparked panic buying of fever and cold medicines, leading to widespread shortages, both at pharmacies and on online shopping platforms. Long lines have become routine outside fever clinics and hospital wards overflowing with patients in the capital Beijing and elsewhere in the country.

    An emergency room doctor in Beijing told the state-run People’s Daily on Thursday that four doctors on his shift did not have time to eat or drink. “We have been seeing patients nonstop,” he said.

    Another emergency room doctor told the newspaper he had been working despite having developed fever symptoms. “The number of patients is high, and with fewer medical staff, the pressure is multiplied,” said the doctor.

    In a sign of the strain on Beijing’s medical system, hundreds of health professionals from across China have traveled to the city to assist medical centers.

    As the capital, Beijing has some of the best medical resources in the country. However, the abrupt zero-Covid u-turn has left people and health facilities ill-prepared to deal with a surge in infections.

    China’s official Covid case count has become meaningless after it rolled back mass testing and allowed residents to use antigen tests and isolate at home. It has stopped reporting asymptomatic cases, conceding it was no longer possible to track the actual number of infections.

    According to an internal estimate from the National Health Commission, almost 250 million people in China have caught Covid in the first 20 days of December – accounting for roughly 18% of the country’s population.

    Experts have warned that as people in big cities return to their hometowns for the Lunar New Year next month, the virus could sweep through China’s vast rural areas, where vaccination rates are lower and medical resources are severely lacking.

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  • Here’s what’s in the $1.7 trillion federal spending bill | CNN Politics

    Here’s what’s in the $1.7 trillion federal spending bill | CNN Politics

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    CNN
     — 

    Senate leaders unveiled a $1.7 trillion year-long federal government funding bill early Tuesday morning.

    The legislation includes $772.5 billion for non-defense discretionary programs and $858 billion in defense funding, according to a bill summary from Democratic Sen. Patrick Leahy, chair of the Senate Committee on Appropriations.

    The sweeping package includes roughly $45 billion in emergency assistance to Ukraine and NATO allies, boosts in spending for disaster aid, college access, child care, mental health and food assistance, more support for the military and veterans and additional funds for the US Capitol Police, according to Leahy’s summary and one from Sen. Richard Shelby of Alabama, the top Republican on the Senate Appropriations Committee.

    However, the bill, which runs more than 4,000 pages, left out several measures that some lawmakers had fought to include. An expansion of the child tax credit, as well as multiple other corporate and individual tax breaks, did not make it into the final bill. Neither did legislation to allow cannabis companies to bank their cash reserves – known as the Safe Banking Act. Also, there was also no final resolution on where the new FBI headquarters will be located.

    The spending bill is the product of lengthy negotiations between top congressional Democrats and Republicans. Lawmakers reached a “bipartisan, bicameral framework” last week following a dispute between the two parties over how much money should be spent on non-defense domestic priorities. They worked through the weekend to craft the legislation.

    The Senate is expected to vote first to approve the deal this week and then send it to the House for approval before government funding runs out on December 23. The bill would keep the government operating through September, the end of the fiscal year.

    Congress originally passed a continuing resolution on September 30 to temporarily fund the government in fiscal year 2023, which began October 1.

    More aid for Ukraine: The spending bill would provide roughly $45 billion to help support Ukraine’s efforts to defend itself against Russia’s attack.

    About $9 billion of the funding would go to Ukraine’s military to pay for a variety of things including training, weapons, logistics support and salaries. Nearly $12 billion would be used to replenish US stocks of equipment sent to Ukraine through presidential drawdown authority.

    Also, it would provide $13 billion for economic support to the Ukrainian government.

    Other funds would address humanitarian and infrastructure needs, as well as support European Command operations.

    Emergency disaster assistance: The bill would appropriate more than $38 billion in emergency funding to help Americans in the west and southeast affected by recent natural disasters, including tornadoes, hurricanes, flooding and wildfires. It would aid farmers, provide economic development assistance for communities, repair and reconstruct federal facilities and direct money to the Federal Emergency Management Agency’s Disaster Relief Fund, among other initiatives.

    Overhaul of the electoral vote counting law: A provision in the legislation aims at making it harder to overturn a certified presidential election, in a direct response to the January 6 attack on the US Capitol.

    The changes would overhaul the 1887 Electoral Count Act, which then-President Donald Trump tried to use to overturn the 2020 election.

    The legislation would clarify the vice president’s role while overseeing the certification of the electoral result to be completely ceremonial. It also would create a set of stipulations designed to make it harder for there to be any confusion over the accurate slate of electors from each state.

    Higher maximum Pell grant awards: The bill would increase the maximum Pell grant award by $500 to $7,395 for the coming school year. This would be the largest boost since the 2009-2010 school year. About 7 million students, many from lower-income families, receive Pell grants every year to help them afford college.

    Increased support for the military and veterans: The package would fund a 4.6% pay raise for troops and a 22.4% increase in support for Veteran Administration medical care, which provides health services for 7.3 million veterans.

    It would include nearly $53 billion to address higher inflation and $2.7 billion – a 25% increase – to support critical services and housing assistance for veterans and their families.

    The bill also would allocate $5 billion for the Cost of War Toxic Exposures Fund, which provides additional funding to implement the landmark PACT Act that expands eligibility for health care services and benefits to veterans with conditions related to toxic exposure during their service.

    Beefing up nutrition assistance: The legislation would establish a permanent nationwide Summer EBT program, starting in the summer of 2024, according to Share Our Strength, an anti-hunger advocacy group. It would provide families whose children are eligible for free or reduced-price school meal with a $40 grocery benefit per child per month, indexed to inflation.

    It would also change the rules governing summer meals programs in rural areas. Children would be able to take home or receive delivery of up to 10 days worth of meals, rather than have to consume the food at a specific site and time.

    The bill would also help families who have had their food stamp benefits stolen since October 1 through what’s known as “SNAP skimming.” It would provide them with retroactive federal reimbursement of the funds, which criminals steal by attaching devices to point-of-sale machines or PIN pads to get card numbers and other information from electronic benefits transfer cards.

    More money for child care: The legislation would provide $8 billion for the Child Care and Development Block Grant, a 30% increase in funding. The grant gives financial assistance to low-income families to afford child care.

    Also, Head Start would receive nearly $12 billion, an 8.6% boost. The program helps young children from low-income families prepare for school.

    Help to pay utility bills: The bill would provide $5 billion for the Low Income Home Energy Assistance Program. Combined with the $1 billion contained in the earlier continuing resolution, this would be the largest regular appropriation for the program, according to the National Energy Assistance Directors Association. Home heating and cooling costs – and the applications for federal aid in paying the bills – have soared this year.

    Enhance retirement savings: The bill contains new retirement rules that could make it easier for Americans to accumulate retirement savings – and less costly to withdraw them. Among other things, the provisions would allow penalty-free withdrawals for some emergency expenses, let employers offer matching retirement contributions for a worker’s student loan payments and increase how much older workers may save in employer retirement plans.

    More support for the environment: The package would provide an additional $576 million for the Environmental Protection Agency, bringing its funding up to $10.1 billion. It would increase support for enforcement and compliance, as well as clean air, water and toxic chemical programs, after years of flat funding.

    It also would boost funding for the National Park Service by 6.4%, restoring 500 of the 3,000 staff positions lost over the past decade. This would be intended to help the agency handle substantial increases in visitation.

    Plus, the legislation would provide an additional 14% in funding for wildland firefighting.

    Additional funding for the US Capitol Police: The bill would provide an additional $132 million for the Capitol Police for a total of nearly $735 million. It would allow the department to hire up to 137 sworn officers and 123 support and civilian personnel, bringing the force to a projected level of 2,126 sworn officers and 567 civilians.

    It would also give $2 million to provide off-campus security for lawmakers in response to evolving and growing threats.

    Investments in homelessness prevention and affordable housing: The legislation would provide $3.6 billion for homeless assistance grants, a 13% increase. It would serve more than 1 million people experiencing homelessness.

    The package also would funnel nearly $6.4 billion to the Community Development Block Grant formula program and related local economic and community development projects that benefit low- and moderate income areas and people, an increase of almost $1.6 billion.

    Plus, it would provide $1.5 billion for the HOME Investment Partnerships Program, which would lead to the construction of nearly 10,000 new rental and homebuyer units and maintain the record investment from the last fiscal year.

    Increased health care funding: The package would provide more money for National Institutes of Health, the Centers for Disease Control and Prevention and the Assistant Secretary for Preparedness and Response. The funds are intended to speed the development of new therapies, diagnostics and preventive measures, beef up public health activities and strengthen the nation’s biosecurity by accelerating development of medical countermeasures for pandemic threats and fortifying stockpiles and supply chains for drugs, masks and other supplies.

    More resources for children’s mental health and for substance abuse: The bill would provide more funds to increase access to mental health services for children and schools. It also would invest more money to address the opioid epidemic and substance use disorder.

    Tiktok ban from federal devices: The legislation would ban TikTok, the Chinese-owned short-form video app, from federal government devices.

    Some lawmakers have raised bipartisan concerns that China’s national security laws could force TikTok – or its parent, ByteDance – to hand over the personal data of its US users. Recently, a wave of states led by Republican governors have introduced state-level restrictions on the use of TikTok on government-owned devices.

    Enhanced child tax credit: A coalition of Democratic lawmakers and consumer advocates pushed hard to extend at least one provision of the enhanced child tax credit, which was in effect last year thanks to the Democrats’ $1.9 trillion American Rescue Plan. Their priority was to make the credit more refundable so more of the lowest-income families can qualify. Nearly 19 million kids won’t receive the full $2,000 benefit this year because their parents earn too little, according to a Tax Policy Center estimate.

    New cannabis banking rules: Lawmakers considered including a provision in the spending bill that would make it easier for licensed cannabis businesses to accept credit cards – but it was left out of the legislation. Known as the Safe Banking Act, which previously passed the House, the provision would prohibit federal regulators from taking punitive measures against banks for providing services to legitimate cannabis businesses.

    Even though 47 states have legalized some form of marijuana, cannabis remains illegal on the federal level. That means financial institutions providing banking services to cannabis businesses are subject to criminal prosecution – leaving many legal growers and sellers locked out of the banking system.

    FBI headquarters: There was also no final resolution on where the new FBI headquarters will be located, a major point of contention as lawmakers from Maryland – namely House Majority Leader Steny Hoyer – pushed to bring the law enforcement agency into their state. In a deal worked through by Senate Majority Leader Chuck Schumer, the General Services Administration would be required to conduct “separate and detailed consultations” with Maryland and Virginia representatives about potential sites in each of the states, according to a Senate Democratic aide.

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  • Venezuela and Chevron sign oil contract in Caracas | CNN

    Venezuela and Chevron sign oil contract in Caracas | CNN

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    CNN
     — 

    The Venezuelan government and American oil company Chevron have signed a contract in Caracas on Friday to resume operations in Venezuela, according to the country’s state broadcaster VTV.

    “This contract aims to continue with the productive and development activities in this energy sector, framed within our Constitution and the Venezuelan laws that govern oil activity in the country,” said Venezuelan oil minister Tareck El Aissami, who was slapped with United States sanctions in 2017.

    He attended the signing ceremony along with representatives from Venezuelan state-owned oil and natural gas company PDVSA and Chevron.

    April 2023 will mark Chevron’s 100th anniversary in Venezuela, El Aissami said at the event.

    The move comes after the United States granted Chevron limited authorization to resume pumping oil from Venezuela last week, following an announcement that the Venezuelan government and the opposition group had reached an agreement on humanitarian relief and will continue to negotiate for a solution to the country’s chronic economic and political crisis.

    The US has been looking for ways to allow Venezuela to begin producing more oil and selling it on the international market, thereby reducing the world’s energy dependence on Russia, US officials told CNN in May.

    A 6-month license was granted to Venezuela by the US Treasury Department’s Office of Foreign Assets Control (OFAC) last week, and the US can revoke it at any time. Additionally, any profits earned will go to repaying debt to Chevron and not to the Maduro regime, according to a senior official.

    In 2017, OFAC said El Aissami had played a “significant role in international narcotics trafficking,” according to a news release.

    The Treasury Department said he “facilitated shipments of narcotics from Venezuela to include control over planes that leave from a Venezuelan air base, (and) narcotics shipments of over 1,000 kilograms from Venezuela on multiple occasions, including those with the final destinations of Mexico and the United States.”

    In addition, the department said El Aissami is linked to coordinating drug shipments to Los Zetas, a violent Mexican drug cartel, and provided protection to a Colombian drug lord.

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  • Biden administration moves ahead with Medicare drug price negotiations amid industry lawsuits | CNN Politics

    Biden administration moves ahead with Medicare drug price negotiations amid industry lawsuits | CNN Politics

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    CNN
     — 

    Undeterred by a growing number of lawsuits, the Biden administration on Friday released revised guidance for Medicare’s new drug price negotiation program.

    The latest guidance outlines how the Centers for Medicare and Medicaid Services will negotiate with drugmakers to reach agreement on a maximum fair price for a selected medicine, the agency said. It was informed by public input on the initial guidance the agency released in March, which explained how it will select the drugs and how the negotiations will be conducted.

    The program, which was authorized by the Inflation Reduction Act that congressional Democrats passed last year, has prompted a fierce backlash from the pharmaceutical industry. Two drug manufacturers and two industry groups have filed lawsuits, arguing the measure is unconstitutional.

    But the administration is not backing down from implementing its historic new power. It intends to keep its timeline of announcing the first 10 drugs that will be selected for negotiation by September 1. CMS and the drugmakers will negotiate during 2023 and 2024. The prices will be effective starting in 2026.

    “The Biden-Harris Administration isn’t letting anything get in our way of delivering lower drug costs for Americans,” Secretary of Health and Human Services Xavier Becerra said in a statement. “Pharmaceutical companies have made record profits for decades. Now they’re lining up to block this Administration’s work to negotiate for better drug prices for our families. We won’t be deterred.”

    The initial set of drugs will be chosen from the top 50 Part D drugs that are eligible for negotiation that have the highest total expenditures in Medicare. CMS will consider multiple factors when developing its initial offer, including the drugs’ clinical benefits, the price of alternatives, research and development costs and patent protection, among others.

    If drugmakers don’t comply with the process, they will have to pay an excise tax of up to 95% of the medications’ US sales or pull all their drugs from the Medicare and Medicaid markets. The pharmaceutical industry contends that the true penalty can be as high as 1,900% of sales.

    CMS said it received more than 7,500 comments on its initial guidance from patient groups, drug companies, pharmacies and others.

    The changes it is making are aimed at improving transparency while keeping confidentiality in mind, as well as fostering “an effective negotiation process,” the agency said.

    They include revising the confidentiality process to state that CMS will release information about the negotiations when it publishes the explanations of the prices. Also, drug companies may publicly discuss the negotiations – the prior secrecy requirement had been a point of contention among manufacturers that was mentioned in the lawsuits. And they won’t be required to destroy data relating to the negotiations.

    In addition, CMS will hold patient-focused listening sessions to provide drug companies and the public more opportunities to engage with the agency. The sessions – which will give patients, caregivers and others the chance to share input on how a medication addresses unmet needs, how it impacts specific populations and what therapeutic alternatives exist – will be held in the fall for the first round of drugs.

    Merck, Bristol Myers Squibb, the Pharmaceutical Research and Manufacturers of America, known as PhRMA, and the US Chamber of Commerce have all recently filed lawsuits in federal courts across the US. They each argue the program is unconstitutional in various ways.

    The challengers also say that the negotiation provision will harm innovation and patients’ access to new drugs.

    Among the arguments are that the program violates the Fifth Amendment’s “takings” clause because it allows Medicare to obtain manufacturers’ patented drugs, which are private property, without paying fair market value under the threat of serious penalties.

    Plus, the negotiations process violates the First Amendment, the challengers say, because it coerces manufacturers into saying that they agree to the price that the government has dictated and that it’s fair.

    Another argument is that the process violates the Eighth Amendment by levying an excessive fine if drugmakers refuse to negotiate and continue selling their products to the Medicare market.

    Merck expects its diabetes drug Januvia to be among the drugs named in September and its blockbuster cancer treatment Keytruda and diabetes drug Janumet to be subject to negotiation in the future. Bristol Myers Squibb believes its blood thinning medication, Eliquis, will be subject to negotiations this year, and its cancer medication, Opdivo, will be selected in a subsequent round.

    The changes in the revised guidance did not allay the complaints of the pharmaceutical industry. PhRMA said that transparency remains “severely limited,” patients’ views are not being taken into account and Medicare beneficiaries could have less access to drugs.

    “The very few substantive changes to the final guidance demonstrate CMS saw this as a box checking exercise, not an opportunity to mitigate the negative impacts this price setting policy will have on patients or the broader health care sector,” PhRMA said in a statement.

    “The approach CMS took in this final guidance confirms what we claimed in our lawsuit – Congress’ unconstitutional shortcuts taken in the law have given the administration far too much flexibility to set prices at their whim without any oversight or accountability to anyone,” the group continued.

    The Biden administration will “vigorously defend” the drug price negotiation program, said CMS Administrator Chiquita Brooks-LaSure.

    “We feel the law is on our side,” she said in a call with reporters Friday.

    This story has been updated with additional information.

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  • 14 promises Donald Trump has made in his campaign for a second term | CNN Politics

    14 promises Donald Trump has made in his campaign for a second term | CNN Politics

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    CNN
     — 

    Former President Donald Trump has hit the 2024 campaign trail and is giving voters a preview of what a second Trump presidency could look like if he’s elected. He’s made many campaign promises – many of which are often vague and lacking in details or specifics – including ending the war in Ukraine, building 10 new cities and giving drug smugglers the death penalty.

    Here are some of the policies he says he would enact if elected for a second term.

    “The drug cartels are waging war on America—and it’s now time for America to wage war on the cartels,” former President Donald Trump said in a January campaign video.

    If elected, Trump said in his November 2022 campaign announcement that he would ask Congress to ensure that drug smugglers and human traffickers can receive the death penalty for their “heinous acts.” The former president also vowed to “take down” drug cartels by imposing naval embargos on cartels, cutting off cartels’ access to global financial systems and using special forces within the Department of Defense to damage the cartels’ leadership.

    “When I am president, we will put parents back in charge and give them the final say,” Trump said in a January campaign video, speaking about education

    The former president said he would give funding preferences and “favorable treatment” to schools that allow parents to elect principals, abolish teacher tenure for K-12 teachers, use merit pay to incentivize quality teaching and cut the number of school administrators, such as those overseeing diversity, equity and inclusion initiatives.

    Trump also said in the campaign video that he would cut funding for schools that teach critical race theory and gender ideology. In a later speech, Trump said he would bring back the 1776 Commission, which was launched in his previous administration to “teach our values and promote our history and our traditions to our children.”

    Lastly, the former president said he would charge the Department of Justice and the Department of Education with investigating civil rights violations of race-based discrimination in schools while also removing “Marxists” from the Department of Education. A second Trump administration would pursue violations in schools of both the Constitution’s Establishment and Free Exercise clauses, which prohibit the government establishment of religion and protect a citizen’s right to practice their own religion, he said.

    “I will revoke every Biden policy promoting the chemical castration and sexual mutilation of our youth and ask Congress to send me a bill prohibiting child sexual mutilation in all 50 states,” Trump said at the 2023 Conservative Political Action Conference in March.

    Trump added in a campaign video that he would issue an executive order instructing federal agencies to cut programs that promote gender transitions, as well as asking Congress to stop the use of federal dollars to promote and pay for gender-affirming procedures. The former president added that his administration would not allow hospitals and healthcare providers to meet the federal health and safety standards for Medicaid and Medicare if they provide chemical or physical gender-affirming care to youth.

    Trump said in two February campaign videos that, if “Marxist” prosecutors refuse to charge crimes and surrender “our cities to violent criminals,” he “will not hesitate to send in federal law enforcement to restore peace and public safety.”

    Trump added that he would instruct the Department of Justice to open civil rights investigations into “radical left” prosecutors’ offices that engaged in racial enforcement of the law, encourage Congress to use their legal authority over Washington, DC, to restore “law and order” and overhaul federal standards of disciplining minors to address rising crimes like carjackings.

    Addressing policies made in what Trump calls the “Democrats’ war on police,” the former president vowed in a campaign video that he would pass a “record investment” to hire and retrain police, strengthen protections like qualified immunity, increase penalties for assaulting law enforcement officers and deploy the National Guard when local law enforcement “refuses to act.” The former president added that he would require law enforcement agencies that receive money from his funding investment or the Department of Justice to use “proven common sense” measures such as stop-and-frisk.

    “Shortly after I win the presidency, I will have the horrible war between Russia and Ukraine settled,” Trump said at a New Hampshire campaign event, adding in another speech that it would take him “no longer than one day” to settle the war if elected. Trump offered no details on how he would end the war in Ukraine.

    Trump further addressed his strategy of stopping the “never-ending wars” by vowing to remove warmongers, frauds and “failures in the senior ranks of our government,” and replace them with national security officials who would defend America’s interests. The former president added in a campaign video that he would stop lobbyists and government contractors from pushing senior military officials towards war.

    Trump said he would restore his “wonderful” travel ban on individuals from several majority-Muslim countries to “keep radical Islamic terrorists out of our country” after President Joe Biden overturned the ban in 2021.

    Trump said in multiple campaign videos that he would spearhead an effort to build Freedom Cities to “reopen the frontier, reignite American imagination, and give hundreds of thousands of young people and other people, all hardworking families, a new shot at home ownership and in fact, the American Dream.”

    In his plan, the federal government would charter 10 new cities on federal land, awarding them to areas with the best development proposals. The former president said in a campaign video that the Freedom Cities would bring the return of US manufacturing, economic opportunity, new industries and affordable living.

    In the March video, Trump added that the US under a second Trump administration would lead in efforts to “develop vertical-takeoff-and-landing vehicles for families and individuals,” not letting China lead “this revolution in air mobility.” The former president said these airborne vehicles would change commerce and bring wealth into rural communities.

    “When I am president, this whole rotten system of censorship and information control will be ripped out of the system at large. There won’t be anything left,” Trump said in a January video.

    To address the “disturbing” relationship between technology platforms and the government, the former president said he would enact a seven-year cooling off period before employees at agencies such as the FBI or CIA can work for platforms that oversee mass user data.

    Trump added in multiple campaign releases that he would task the Department of Justice with investigating and prosecuting the online censorship “regime,” ban federal agencies from “colluding” to censor citizens, fire bureaucrats who are believed to engage in federal censorship and suspend federal money to universities participating in “censorship-supporting activities.”

    On false information, the president would ban the use of taxpayer dollars to label any domestic speech as mis- or disinformation, as well as stopping federal funding of nonprofits and academic programs that study mis- or disinformation.

    Under the proposed Trump Reciprocal Trade Act, the former president said if other countries impose tariffs in the US, “we charge THEM – an eye for an eye, a tariff for a tariff, same exact amount.”

    Trump vowed in a campaign video to impose the same tariffs that other countries may impose on the US on those countries. The goal, the former president said, is to get other countries to drop their tariffs.

    As part of a larger strategy to bring jobs back into the US, Trump said he would also implement his America First trade agenda if elected. Setting universal baseline tariffs on a majority of foreign goods, the former president said Americans would see taxes decrease as tariffs increase. His proposal also includes a four-year plan to phase out all Chinese imports of essential goods, as well as stopping China from buying up America and stopping the investment of US companies in China.

    “With victory, we will again build the greatest economy ever,” Trump said in his November campaign announcement. “It will take place quickly. We will build the greatest economy ever,” though he didn’t provide specific policy proposals or explain how he would improve the economy.

    Trump said he would repeal Biden’s tax hikes, “immediately tackle” inflation and end what he called Biden’s “war” on American energy production.

    At CPAC, Trump promised to, “fire the unelected bureaucrats and shadow forces who have weaponized our justice system like it has never been weaponized before…” Trump also said in a campaign video that he would reinstate a 2020 executive order to remove “rogue” bureaucrats and propose a constitutional amendment for term limits on members of Congress.

    Trump also pledged to “appoint US Attorneys who will be the polar opposite of the Soros District Attorneys and others that are being appointed throughout the United States.” The former president added on to this message, vowing to end the “reign” of such investigations and district attorneys and overhaul the Department of Justice and the FBI.

    “I will take Biden’s executive order directing the federal government to target the firearms industry, and I will rip it up and throw it out on day one,” Trump said at the 2023 National Rifle Association Institute for Legislative Action leadership forum in April.

    The former president also promised in the speech that the government would not infringe on citizens’ Second Amendment rights and that he would push Congress to pass a concealed carry reciprocity.

    “I will create a special team to rapidly review every action taken by federal agencies under Biden’s ‘equity’ agenda that will need to be reversed. We will reverse almost all of them,” Trump said in a campaign video.

    Trump added in multiple campaign videos that he would revoke Biden’s equity executive order that required federal agencies to deliver equitable outcomes in policy and conduct equity training. If elected, Trump said he would also fire staffers hired to implement Biden’s policy, and then reinstate his 2020 executive order banning racial and sexual stereotyping in the federal government.

    “When I’m president, I will ensure that America’s future remains firmly in American hands just as I did when I was president before,” Trump said in a campaign video.

    Trump vowed to restrict Chinese ownership of US infrastructure such as energy, technology, telecommunications and natural resources. The former president also said he would force the Chinese to sell current holdings that may put national security at risk. “Economic security is national security,” he said.

    Trump vowed in a June campaign video to reinstate his previous executive order that the US government would pay the same price for pharmaceuticals as other developed countries to “end this global freeloading on American consumers for once and for all.”

    Some of the former presidents’ pharmaceutical policies were overturned by Biden. Trump said in the video his administration would pay the best prices offered to other countries, who he said often pay lower pharmaceutical prices than Americans. This policy, Trump believes, would cause the pharmaceutical industry to raise prices for other countries while lowering costs for Americans.

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  • Top Treasury sanctions official to visit southern border as it ramps up efforts to crack down on deadly fentanyl trade | CNN Politics

    Top Treasury sanctions official to visit southern border as it ramps up efforts to crack down on deadly fentanyl trade | CNN Politics

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    CNN
     — 

    Treasury’s top sanctions official Brian Nelson will travel to the southern border Tuesday as part of the department’s ongoing push to crack down on the cartels and illicit financial networks fueling the deadly fentanyl trade, Treasury officials told CNN.

    Nelson’s trip – his second in sixth months – and a spate of recent sanctions activity is the latest indicator that Treasury is ramping up efforts to tackle the illegal fentanyl trade through actions that disrupt the supply chains funneling “precursor” chemicals from China to producers in Mexico where much of the deadly drug is made.

    Nelson and Treasury officials will meet with fellow law enforcement representatives, including from the Department of Homeland Security and U.S. Customs and Border Protection, as well as private financial institutions and local officials.

    “What we are doing is trying to be as effective as we possibly can in combining Treasury’s tools with the efforts that other US government agencies and allied governments are deploying in this space,” said Nelson, the under secretary for terrorism and financial intelligence at Treasury, in an interview with CNN.

    The engagements over the 48-hour trip will provide officials an opportunity to discuss how Treasury’s tools and information can complement law enforcement and to learn about the big issues and patterns that agents are seeing on the ground. The trip is also aimed at exploring how trends and information from the extensive financial information Treasury collects can be helpful to the broader government-wide effort to quell the synthetic opioid epidemic.

    Nelson, who will also be joined by the acting director of the Financial Crimes Enforcement Network (FinCEN) Himamauli Das, will visit Laredo and San Antonio in Texas on Tuesday and Wednesday.

    In Laredo, Nelson will receive briefings on border operations from CBP officials at the city’s port of entry as well as discuss cargo processing and inspections.

    “There’s a credible value in seeing that in person,” Nelson said.

    In San Antonio, Nelson and Das will host a “FinCEN Exchange,” which is a public-private information sharing forum where Treasury can share the different patterns and connections they’re seeing with financial institutions, as well as discuss further ways the federal government can partner with the private sector to better spot red flags and identify illicit financial networks.

    The department has been involved in the counter-narcotics business for decades, using its tools and financial expertise to both starve criminal organizations of critical financing through sanctions and blocking assets, as well as providing crucial financial data to other law enforcement and federal agencies.

    “We can help disrupt financial flows and target the whole supply chain, starting with the precursor chemicals all the way down to distributors bound for US markets. And it’s not just sanctions,” Nelson said, pointing also to FinCEN’s financial mapping tools as well as Treasury’s focus on cooperating with Mexico to improve their capacity to trace and combat illicit finance.

    “These tools, combined with financial mapping that our FinCEN team does, is very, very powerful insight,” he added.

    Investigators from the Treasury, especially those at FinCEN, can access and share powerful financial data with enforcement bodies like the Drug Enforcement Agency, the Department of Homeland Security and others as they work to track and disrupt the fentanyl trade and drug suppliers.

    Nelson also said that Treasury is “absolutely” looking to build on US Secretary of State Antony Blinken’s latest engagements in China, which included discussing where the two nations could cooperate on curbing the flow of precursor chemicals from China. Blinken, who traveled to Beijing last month, said both sides agreed to “explore” establishing a working group on the precursor chemicals used to produce the deadly synthetic drug.

    There has been a government-wide push to curb synthetic opioids like fentanyl, which are the main driver of overdose deaths in the US. According to the US Centers for Disease Control and Prevention, there has been a more than seven-fold increase overall in deaths from 2015-2021, and despite a recent slowing, overdose deaths still hover near record levels and remain the third leading cause of death in adolescents aged 19 and younger.

    In April, the Biden administration announced a broad effort to target the production and distribution of fentanyl, which included criminal charges from the Department of Justice and a host of new Treasury sanctions.

    It was an announcement that built off of an executive order signed in 2021 that expanded Treasury’s authorities to target the distribution chains of fentanyl and other narcotics, which Nelson said has been critical to helping Treasury “increase the pace at which we are able to target and designate the key nodes in fentanyl distribution.”

    Since then, Treasury has continued to issue sanctions against precursor chemical supply networks, particularly in China, as well as other corrupt activity like arms trafficking and money laundering that helps support the trade.

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  • Juul seeks authorization on a new vape it says can verify a user’s age. Here’s how it works | CNN Business

    Juul seeks authorization on a new vape it says can verify a user’s age. Here’s how it works | CNN Business

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    CNN
     — 

    E-cigarette company Juul Labs is seeking US authorization to sell a “next-generation” vape with age verification capabilities in the United States.

    To verify a user’s age, the proposed vape pairs with a phone app, requiring a customer to either upload their government ID and a real-time selfie or input personal information and allow a third-party database to verify their identity, according to a Juul spokesperson.

    A unique Pod ID chip within the Juul device can also detect counterfeit cartridges made by other companies, many of which have flooded the market with illegal fruity flavors that appeal to minors.

    The mission of the new platform is twofold, according to the company: Encourage adult smokers to switch from combustible cigarettes to e-cigarettes while restricting underage access.

    The legal age to purchase e-cigarettes in the United States is 21.

    “We look forward to engaging with FDA throughout the review process while we pursue this important harm-reduction opportunity,” Juul’s Chief Regulatory Officer Joe Murillo said in a company news release.

    If authorized by the US Food and Drug Administration, Juul Labs hasn’t yet decided on the name to market their new product in the US. In the UK and Canada, where it’s already for sale, it’s called the JUUL2.

    Advertising itself as an alternative nicotine product, Juul publicly advises that adults vape only as a replacement for combustible cigarettes.

    But Juul has a troubled history in US markets.

    “They were the spark that ignited the flame,” said Robin Koval, CEO of the nonprofit Truth Initiative, organizers of the nation’s largest campaign for youth to quit vaping. “This is not a company known to tell the truth.”

    Juul Labs has settled more than 5,000 cases brought by approximately 10,000 plaintiffs since its vaping devices initially skyrocketed in popularity in 2016, with some alleging the company deceived or failed to warn consumers about the risks of its products. The e-cigarette maker also agreed to pay $462 million to six US states and Washington, DC, in April after a lawsuit accused Juul Labs of directly promoting its products to high school students. In total, Juul Labs has agreed to pay more than $1 billion in its various legal settlements.

    Juul dominated over 70% of the US e-cigarette market at its peak in late 2018. In the same year, 27% of high school students and 7.2% of middle school students said they used tobacco for one or more days in the month, according to the 2018 National Youth Tobacco Survey.

    Juul is now a less favored brand among youth. When asked what e-cigarette brands they used in the past 30 days, youth e-cigarette users in the 2022 National Youth Tobacco Survey answered Puff Bar most frequently (29.7%), followed by Vuse (23.6%) and then Juul (22%), with the first two being disposable vaping products.

    In 2019, Juul suspended all flavors other than tobacco and menthol and suspended broadcast, digital and print publication marketing.

    Even with limited flavors, the FDA banned Juul products in the US last year after reviewing Juul’s applications seeking marketing authorization for their devices. The FDA determined that the applications lacked “sufficient evidence” within the toxicological profile of the vaporizers to prove that marketing the products would be in the interest of public health.

    The FDA has placed the ban on hold while Juul Labs appeals.

    Juul's new device is currently marketed as JUUL2 in the UK and Canada.

    Juul Labs submitted its most recent application to the FDA on July 19, as all e-cigarette manufacturers are required to do before their product can be marketed and sold legally in the United States. This first filing concerns just one flavor, Virginia Tobacco, with a nicotine concentration of 18 mg per mL.

    Although Juul’s new platform has age verification capabilities, the company does not intend to lock all their new pods before use. For example, the Virginia Tobacco pods will not come automatically locked. The spokesperson for Juul said doing so could create “friction” for the adult smokers the tobacco flavor is most likely to target.

    “If you’re an adult smoker and you go to buy a cigarette, it’s pretty easy to use the product,” a Juul spokesperson told CNN. “If you add in another barrier before product use, that creates some level of friction.”

    Using the new Pod ID feature, Juul’s new vaping device could tell a Virginia Tobacco pod apart from a menthol-flavored pod. It could then require age verification to activate only the latter, according to the spokesperson.

    Juul has researched other flavors that combine tobacco and menthol with fruity tones to potentially submit to the FDA following this filing. Juul currently sells the flavor Autumn Tobacco in the UK, which contains “tangy apple notes,” according to its website.

    Just because e-cigarette companies are required to comply with the FDA doesn’t mean all of them do. In fact, most don’t. To date, the FDA has authorized only 23 specific e-cigarette products, all of which are tobacco flavored.

    Yet more than 2.5 million US middle and high school students said they use e-cigarettes as of last year, according to the 2022 National Youth Tobacco Survey. Almost 85% consume fruity, candy or other flavored products, despite them being illegal.

    Koval of Truth Initiative said the tobacco industry “floods the market” with products such that the FDA can’t keep up.

    “It is a little bit like Whac-a-Mole for the FDA and for those of us who are trying to promote healthier behaviors for young people,” Koval said. The total number of e-cigarette brands increased by 46.2% between January 2020 and December 2022, from 184 to 269, according to a study from the Centers for Disease Control and Prevention.

    To gain FDA authorization for its latest platform, Juul must prove to the FDA that in aiding the public health crisis of adult smoking, it is not further exacerbating the spread of youth vaping.

    “This is only the beginning of new tech being developed and refined for the US market and abroad to eliminate combustible cigarettes and combat underage use,” Juul’s Chief Product Officer Kirk Phelps said.

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  • There aren’t enough facilities to treat all kids hooked on opioids | CNN Politics

    There aren’t enough facilities to treat all kids hooked on opioids | CNN Politics

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    A version of this story appears in CNN’s What Matters newsletter. To get it in your inbox, sign up for free here.



    CNN
     — 

    After writing several previous newsletters on the stunning rise in opioid overdoses in the US, including among adolescents, I thought it was worth taking a look at what happens after an overdose, particularly for adolescents.

    I talked to Dr. Sivabalaji Kaliamurthy about what he’s encountering. A child and adolescent addiction psychiatrist who is board certified in general psychiatry, child psychiatry and addiction psychiatry, Kaliamurthy is also the director of the addiction clinic at Children’s National Hospital in Washington, DC.

    He told me that his clinic, which he set up in early 2022, has gone from getting one or two opioid use referrals per month to eight or more per month now, a year later.

    He particularly wanted to discuss some major news: The opioid overdose antidote naloxone, sold as Narcan, got approval from the US Food and Drug Administration on March 29, the day we talked, to be sold over the counter.

    Excerpts from our conversation, edited for flow, are below.

    WOLF: What is your reaction to Narcan being available over the counter?

    KALIAMURTHY: When I do an evaluation (of a patient), regardless of the substance use, you’re always talking about naloxone, brand name Narcan. …

    The message that I present parents with is always that it’s kind of like having a fire extinguisher at home. You hope you never need to use it, but you’re glad that you have it if you need to use it.

    Access is important. There are some controversies around increasing access to naloxone and fears that this may encourage more substance use. We have scientific research looking into this very specific question.

    And overall, there’s one study that came out this month that found that across 44 states where they increased access to naloxone for adolescents, it did not increase the rates of substance use in this population. And in some states, it actually decreased opioid use among adolescents. …

    The FDA approved the over-the-counter sale of naloxone, specifically the brand Narcan, because of how easily it can be administered. Naloxone also comes in other formulations, like injections, but Narcan is a nasal spray. We’re hoping that it will be out later this summer.

    The challenge remains how much is it going to cost? On average, it can cost anywhere between $50 to $100 right now. If it becomes over-the-counter, we don’t want insurances to stop covering [it].

    It will be interesting to see how the manufacturer goes about introducing it over the counter.

    WOLF: You said it’s like a fire extinguisher. Should everybody have it, or just people whose kids have demonstrated addictive behavior?

    KALIAMURTHY: Everyone should have it. Naloxone is not a treatment; it is more of an antidote. It reverses opioid overdoses, and the person who has the opioid overdose is never the one who’s going to use it somewhere in the community.

    WOLF: I’ve reported on a surge in overdoses. What are you seeing at Children’s?

    KALIAMURTHY: We are seeing an increase in the number of kids presenting to the hospital after experiencing an opioid overdose, and in general, opioid overdose deaths in the DMV (Washington, DC, Maryland, Virginia) region have significantly increased in the last two years. That aligns with a national trend we are seeing with regards to opioid overdoses.

    WOLF: Is there a profile for who these kids are? Do they share any traits?

    KALIAMURTHY: Yes. Let me talk about the kids we do see for opioid-related concerns first.

    At Children’s National, children often present after experiencing an overdose or having a medical complication because of using these M30, or the fake Percocet pills. We’ve had kids come in following conditions such as preliminary hemorrhage, where they were bleeding into their lungs, and overdose is not the only concern.

    Apart from that, we also have had kids presenting actively using these pills. They haven’t overdosed yet but they’re asking for help to stop using these pills.

    Some things that we have noticed, and this is the trend across the DMV region … the kids who are presenting to treatment, these are kids who are motivated to stop – they predominantly identify as Hispanic in ethnicity. Most of them have Medicaid for insurance.

    A lot of them, you know, they come to us – the average age is about 16, 16½ and their first use of opioids, these pills, was about a year ago. So the average first use was about 15 to 15½ years of age. They are really struggling, and they want to get better.

    KALIAMURTHY: Another common trait: cannabis use is quite common in this population. Pretty much every patient that I’ve come across started off around age 12 using cannabis products. This includes the flower and bud, vapes or edibles. Soon they transition to using the M30 pills.

    There are various different reasons, one of which is just access. A lot of other kids are using it. They’re using it in schools. They try it, they like it, and then it escalates and they stop using other substances.

    Most of these kids start off with crushing and try it nasally by snorting it and then they transition to smoking. What they do is they put these pills on a piece of aluminum foil, heat it up and inhale the fumes that come up. We haven’t had anyone come in who reported using any of these pills intravenously.

    WOLF: How is treatment for adolescents different than treating adult users who are seeking help?

    KALIAMURTHY: We have to take into consideration their developmental age and the psychological development that’s happening in adolescence, which is very different from adults.

    Oftentimes, this is the first point of entry into opioid use for these kids. Fentanyl, which is one of the most powerful opioids of abuse out there, is the first point of entry into opioid use for these children.

    Where for adults, they might have been prescribed pain medications. Or they might have started on opioids through other routes and might have used less potent products before transitioning to fentanyl.

    KALIAMURTHY: Historically, adolescents were not always the most motivated to seek treatment for substance use. What we would see was they would start off with experimenting, there would be a problem, it would take a few years and they’re adults by the time they’ve entered treatment and they’re trying different things to treat themselves before they enter treatment.

    With adolescents, now we are seeing that they can tell that they need help, and they are motivated and they are entering treatment.

    We have to take into account the presence of parents or guardians, how the school system interacts with them, what else do they do in their communities. There’s an increased association of violence and legal trouble that some of these patients end up in that we need to address while treating them. And these are some differences when it comes to treating adolescents versus adults.

    WOLF: One local community’s opioid response coordinator stressed to me that lack of availability of treatment is a real problem. Is that something that you agree with?

    KALIAMURTHY: Absolutely. That is a real problem at this point, because there is a huge discrepancy between the number of kids who need treatment and the available resources.

    The challenge is we can limit access and prevent these kids from getting the pills. But then you have a huge population of kids who are dependent on these pills, who can’t tolerate withdrawal symptoms, who have what we call opioid use disorder. That is going to perpetuate the problem if we’re not treating them. We need to do more in terms of increasing access to care for these kids.

    WOLF: Can you illustrate that capacity issue for me, through numbers or data? Or is it more anecdotal?

    KALIAMURTHY: Treatment is across different realms.

    For example, when a child is using these pills, and they have a problem with substance use, they need to go and be evaluated by a professional who has expertise in both addressing and evaluating mental health and addiction problems. And we don’t have very many people being able to do that.

    KALIAMURTHY: The first-time response is usually a counselor or social worker, sometimes physicians.

    But generally, there’s very little expertise in the pediatric health space with regards to addressing substance use-related problems. Screening is the point of entry.

    KALIAMURTHY: Then, say they need detox beds. Once they’ve entered treatment, we want to help them get through those initial days when their body is kind of adjusting to not using these pills, and we refer to that as detox.

    At Children’s National Hospital, when the kids come to the emergency room, we are not able to admit them for detoxes all the time. Sometimes we do end up admitting them.

    This depends on the availability of beds. The number of pediatric beds is very small to begin with. And beds may not always be available when somebody presents to the emergency room detox.

    And then there’s who is on call? Who’s available to treat these kids? I spoke about the lack of expertise in general, across the pediatric health space, so all that will determine whether a child is able to get access to detox services.

    That’s the detox part of treatment, which can be anywhere between two to five days.

    Detox doesn’t always mean somebody needs to be admitted. I also do outpatient detox where we are helping kids stop by providing them with medications and guiding their parents or guardians and the child on how to go through detox.

    KALIAMURTHY: Once you go through detox, depending on the extent of the problem, a child may require admission to a rehabilitation facility for anywhere between a month to six months.

    When we look at the number of facilities in the DMV region that provide this kind of rehab, I don’t think Virginia has any, DC doesn’t have any, Maryland has two. One is Sandstone Treatment Center, which is a private institution. The other is a treatment center, which is closer to Baltimore. There’s a limitation on who they can take.

    WOLF: Let me interrupt you. In a region that has millions of people, there are only two facilities that will take adolescents for one to six months’ treatment for substance use?

    KALIAMURTHY: Yes. For substance use.

    WOLF: Is that just a function of there’s more demand for those kinds of facilities among older people who are more likely to face addiction problems? Is that something the system is pivoting to address right now?

    KALIAMURTHY: It’s unclear. The system wants to help, but the challenge is historically adolescents are not always the most eager and motivated to get help.

    When we look at treatment programs, that didn’t exist in the past. They often relied on the judicial system, where some of these kids might have been mandated to treatment.

    Now we know that substance use disorders are chronic disorders and mandates don’t always work. Courts have stopped mandating treatment, because it’s like you mandate it for a month and then they come out and then what happens? There’s a lot of issues with mandating treatment.

    Now, most of the programs that were present prior to the pandemic also shut down during the pandemic because the needs also declined.

    This is not financially lucrative. That’s one reason why they’re having a huge issue with finding systems and having the county or the state take over with regards to creating the system.

    WOLF: I cut you off there. You were moving from the one-to-six-month facility to the next step in the process.

    KALIAMURTHY: So the next step is really engaging these kids in treatment. Not all kids require one to six months. Some kids might be OK with just completing detox and engaging in regular outpatient level of care. This might involve what we call intensive outpatient combined with medication.

    Which is where I would come in. A lot of what I do is provide medications for addiction treatment. These medications, the first part is for the detox to help with the child’s symptoms, but once you go through withdrawals, you can still have significant cravings to go back to using.

    The challenge, again, is the number of facilities. There are more options for intensive outpatient, but again, they are packed. The wait times to get in are longer now, and some of them are just virtual-only options, which may be good for some kids, but some kids might need more inpatient help.

    KALIAMURTHY: After this step, we have regular outpatient therapy and recovery support services, which is also lacking.

    The recovery support services are services which help kids get back on track academically. Catch up with your credit, get up on your grades and form a healthy, functioning resume. Get help finding part-time jobs. Keep these kids engaged in activities outside of school so that they are less likely to go back to the path that they were on which led to the substance use.

    WOLF: What’s your message to parents who are trying to keep an eye on their kids?

    KALIAMURTHY: Let’s look at the national-level data that we have collected up to 2021. Substance use is actually on the decline.

    Which is interesting because what is happening is that even though substance use among kids is on the decline – that’s both in middle school and high school – the substances that kids are using have become so much more potent.

    Take cannabis, which if you measure the potency by the percentage of THC content, has gone up significantly. The average THC percentage in the ’60s and ‘70s was like 2-5%. And now it’s like 20-25%. And kids are more likely to use what they call the concentrates, which is like 80% or more THC.

    When I talk to parents, the first thing I’m telling them about is the landscape of different substances that are out there, and kids are more likely to start off with cannabis or alcohol before they transition to the M30 pills.

    KALIAMURTHY: If you think about modifiable and non-modifiable risks, some risks just cannot be changed. These are things like genetics, family history and also if a child has a history of any traumatic experiences. Those are not things you can necessarily change. There are modifiable risk factors, like if a child has ADHD, they’re more likely to be at risk for developing substance use problems.

    If there are untreated mental health conditions, such as depression, anxiety, they’re more likely to have problems. We know that. The kids who identify as LGBTQ+, they also tend to have more risk factors in terms of initiating substances that transition into a problem.

    But also, we need to rethink how families address substances in the household. Kids learn by modeling they see from adults in their life and also the direct conversations we have. What are their values as a family around use of substances? These are not just legal and illegal – all substance use can have some harm. And early initiation is going to lead to more likelihood of having a problem.

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