Thursday, October 26, 2017

On Trump's declaration of a public health emergency over opioids--and rural angles on same

I heard several radio stories today on Trump's public health emergency declaration, stories that mentioned particular challenges associated with the crisis in rural America.  Several mentioned the shortage of physicians there, and the first report I heard on NPR this morning shortly after Trump's announcement mentioned a loosening of the restrictions on telemedicine to respond to this fact.  But searching around the Internet, I can now find very little "in writing" on these issues.  Here's a short excerpt from the New York Times coverage, which gets to rural in the eighth paragraph:
The designation of a public health crisis, formally made by Eric D. Hargan, the acting health secretary, would allow for some grant money to be used to combat opioid abuse, permit the hiring of specialists to tackle the crisis, and expand the use of telemedicine services to treat people in rural areas ravaged by opioid use, where doctors are often in short supply.
I also found this from In These Times, which reports regularly on rural issues:
CDC reports rising rates of drug overdose deaths in rural areas 
Rates of drug overdose deaths are rising in nonmetropolitan (rural) areas, surpassing rates in metropolitan (urban) areas, according to a new report in the Morbidity and Mortality Weekly Report (MMWR) released today by the Centers for Disease Control and Prevention (CDC). 
Drug overdoses are the leading cause of injury death in the United States, resulting in approximately 52,000 deaths in 2015. This report analyzed trends in illicit drug use and disorders from 2003-2014 and drug overdose deaths from 1999-2015 in urban and rural areas. In 1999, drug overdose death rates for urban areas were higher than in rural areas (6.4 per 100,000 population versus 4.0 per 100,000). The rates converged in 2004, and in 2006 the rural rate began trending higher than the urban rate. 
In 2015, the most recent year in this analysis, the rural rate of 17.0 per 100,000 remained slightly higher than the urban rate of 16.2 per 100,000. 
Urban and rural areas experienced significant increases in the percentage of people reporting past-month illicit drug use. … The new findings also show an increase in overdose deaths between 1999 and 2015 among urban and rural residents. This increase was consistent across sex, race, and intent (unintentional, suicide, homicide or undetermined).
That story also quotes CDC Director Brenda Fitzgerald, MD: 
The drug overdose death rate in rural areas is higher than in urban areas.  We need to understand why this is happening so that our work with states and communities can help stop illicit drug use and overdose deaths in America.
I'm looking forward, in the coming days, to more analysis of rural issues/rural health care delivery.  Meanwhile, here is part of the New York Times editorial criticizing Trump for not doing more to counter the opioid crisis:
He declared the opioid epidemic a national public health emergency, which sounds urgent but doesn’t free any significant new money to fight it. In doing so, he ignored the plea of his own opioids commission to declare a full-on national emergency, which would immediately free billions of dollars for emergency response, addiction treatment and efforts to stop the flow of illegal opioids into the country — a comprehensive approach that is so far missing.
Here is the New York Times news coverage of Trump's announcement and here is NPR's.  Here's more coverage from the Times on the crisis, an op-ed from late September, and this feature mapping the crisis and its acceleration in recent years.

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