Axios Vitals: Polysubstance crisis

Plus, the next phase of the global HIV/AIDs fight | Tuesday, February 21, 2023

Open in app View in browser   Presented By AHCA/NCAL   Axios Vitals By Tina Reed · Feb 21, 2023 Welcome back from the long weekend, Vitals readers. Today's newsletter is 991 words or a 3½-minute read. 🍻 On tap this week: A federal court decision on whether to temporarily block the FDA's authorization of the abortion pill mifepristone could come as soon as this Friday.     1 big thing: The next phase of the global HIV/AIDS fight Reproduced from KFF; Chart: Axios Visuals The President's Emergency Plan for AIDS Relief  — the biggest effort by one nation to address a particular disease — is hitting a milestone anniversary. But advocates worry the U.S. may take its foot off the gas. Why it matters: 20 years after then-President George W. Bush launched PEPFAR in his 2003 State of the Union address, the $7 billion-a-year program is up for reauthorization in Congress. Despite past bipartisan support, PEPFAR has been flat-funded for years and could fall victim to partisan fights and shifting public health priorities. This five-year renewal partly hinges on whether there are any basic changes to the program, or whether lawmakers opt for a "clean" reauthorization. "Too many times, I think we start patting ourselves on the back before we're done," said Deborah Birx, former White House coronavirus response coordinator, drawing a parallel to the U.S. COVID-19 response. "We still have a long way to go," Birx said. The details: PEPFAR, whose architects include former NIAID director Anthony Fauci, was started at a time when communities in Africa were being devastated by HIV/AIDS, said Birx, who led the effort from 2014 through January 2021. Congress has since allocated more than $100 billion globally for access to tools like antiretroviral medications, preventative pre-exposure prophylaxis drugs, HIV counseling and testing, voluntary male circumcision, as well as health care worker training. What they're saying: "By pretty much any measure, it's been a success. It's saved millions of lives in what was a death sentence," Jen Kates, senior vice president and director of global health and HIV policy at KFF told Axios. "Not only has PEPFAR had this impact on HIV outcomes, but it's had a spillover impact on other areas, and even an economic impact," she said. What to watch: Partnerships and programs created by PEPFAR were able to be used almost immediately to respond to COVID globally, said Mitchell Warren, executive director of AVAC, a non-profit focused on HIV prevention. They've also been used in responses to H1N1 and Ebola. "That is something we can't backtrack on," Warren said. "This is not just about HIV. It's about how global health gets delivered." Yes, but: While remarkable progress has been made, a majority of countries missed 2020 global targets for identifying HIV patients and getting them on effective treatment. Go deeper.     2. Cancer screenings returned post-COVID The dropoff in cancer screenings during the pandemic didn't result in significantly more breast, cervical and colon cancer cases, or how advanced those cases were, according to a review of nearly 375,000 diagnoses in electronic health records, Axios' Adriel Bettelheim writes. Why it matters: The findings from Epic Research could ease some of the concerns about the consequences of millions of missed screenings during the height of the pandemic. Previous research showed the decline in primary care visits and routine tests early in the pandemic resulted in a 94% decrease in both breast cancer and cervical cancer screenings and an 86% decrease in colon cancer screenings before rebounding somewhat in 2021. What they found: There was a clear drop in cancer cases early in the pandemic that accompanied the decrease in screening. However, as screening rates returned to normal, cancer detection rates did, too. There wasn't a significant increase in the rate of cancer diagnoses in 2020-2022 compared to pre-pandemic, and new diagnoses of advanced cancers also didn't rise. Yes, but: It could take years to fully assess the impact of missed screenings, especially for cancers with longer intervals between screenings, researchers said.     3. The growing polysubstance use crisis Illustration: Megan Robinson/Axios   Nearly every person that tested positive for fentanyl last year also had signs of other substances including methamphetamine and heroin, according to a new report from Millennium Health. That's a more than 60% increase from 2019 and an all-time high, Axios' Sabrina Moreno writes. Why it matters: Multiple substances in one's body can increase overdose risk and complicate treatment options, researchers told Axios. "It's not really opioid use disorder," said Eric Dawson, Millennium Health's vice president of clinical affairs. "It's polysubstance use disorder. And that's a complex picture." By the numbers: The analysis of 4.5 million drug tests from over 600,000 patients in substance use treatment centers found that more than 43% of fentanyl-positive tests were positive for up to three additional drugs. The most common were methamphetamine, prescription opioids, cocaine and heroin. But overall use of heroin and prescription pills — two substances that drove the earlier days of the addiction crisis — is declining. Zoom in: Every single part of the U.S. is seeing an increase in fentanyl drug use since 2019, but the West saw spikes 10 to 11 times higher than those reported in 2019, per the report. Read the rest.     A message from AHCA/NCAL The domino effect of failing to support long term caregivers     The long term care labor shortage has created bottlenecks in hospitals as patients wait for beds in nursing homes. What you need to know: A federal staffing mandate will worsen the strain by forcing nursing homes to limit their number of residents. We need solutions now.     4. Health care system rethinks obesity Illustration: Shoshana Gordon/Axios   Doctors and medical experts are leading a rapid cultural shift around obesity, viewing it as a disease rather than a lifestyle choice, Axios' Caitlin Owens writes. Why it matters: That shift is opening new treatments and better care — but also new controversies over who can access those treatments and how best to use them. Zoom in: The treatment landscape is changing rapidly for children as well as adults. New guidance released last month by the American Academy of Pediatrics recommends against delaying obesity treatment for children, and argues that doctors should be proactive about approaches like intensive health behavior and lifestyle treatment and, in some cases, prescription drugs or surgery. But the guidance is already drawing pushback. Eating disorder specialists, for example, are warning that it could backfire, NPR reported this week. "We run the risk of doing significant harm to kids who are 6 or 8 by telling them that they have a disease ... simply based on their weight status," Kim Dennis, an eating disorder specialist, told NPR.     5. While you were weekending Illustration: Aïda Amer/Axios   🍼 The infant formula crisis could happen again. (Food Fix) ⌚️ Why the Apple Watch patent fight matters. (Axios) 🧑‍⚕️ Walgreens CEO bets on doctors over drugstores in search for growth (WSJ) 🫀 Senators demand answers about "alarming" reports of excessive and risky artery procedures on veterans. (ProPublica)     A message from AHCA/NCAL Long term care needs hiring help, not impossible mandates     Nursing homes are working hard to recruit caregivers, but they can't find workers. The solution: We need investments in our long term care workforce — not unfunded staffing mandates — to offer better wages, build a pipeline of nurses and bolster staff retention. Learn more.   Have a news tip? Just reply to this email. Did someone forward this email? Subscribe here. Thanks for reading, and thanks to senior editor Adriel Bettelheim and senior copy editor Bryan McBournie for the edits. Your personal policy analyst is here. Track health care policy formation at every step of the process with Axios Pro. Talk to our sales team today.   Axios thanks our partners for supporting our newsletters. 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