The Morning Jolt

Health Care

Ten Observations from the White House Opioid Summit

President Trump meets with members of Congress at the White House, February 28, 2018. (Kevin Lamarque/Reuters)

First of all, if you ever get a chance to visit the White House, do so.

One: The White House Opioid Summit began with a short video of Fox News personality Eric Bolling describing getting the call that his son had died of an overdose. You can see it here, and it is simply heartbreaking. He warned that “‘Not My Kid Syndrome’ is a killer.” The coroner’s report determined that Eric Chase Bolling had “cocaine, marijuana, alprazolam (commonly known as Xanax), and the opioid drugs fentanyl and cyclopropyl fentanyl in his system.” Despite a rumor at the time, there was no sign of self-harm; this was an accidental overdose, ending the life of a 19-year-old University of Colorado sophomore with his whole life ahead of him.

College students can begin by seeking out Ritalin and stimulants to handle all-night study sessions and handle an exhausting schedule, and then turn to Xanax and other opioids to calm down and relax on the weekends. We need to tell our kids not merely, “don’t do drugs.” We need to tell them, “don’t ingest any pill that didn’t come from a pharmacist, because there is a greater-than-zero risk that it could kill you.”

Two: A second video featured Daniel Goonan, the fire chief of Manchester, N.H., whose department now responds to more overdoses than fires. The city instituted a “Safe Station” program, where anyone struggling with addiction can show up, get assessed, and steered to a treatment program. “As most city hospital emergency rooms may be overwhelmed with patients, this program assists all by weeding out those individuals seeking assistance that may not need immediate medical attention but need immediate help.”

Three: Health and Human Services secretary Alex Azar was the first of five cabinet secretaries to speak, and pointed out that his department was eager to provide states with waivers from federal regulations if they felt those regulations were impeding efforts to provide addiction recovery and treatment. One good example:

One way they can be used is to allow more healthcare facilities to be reimbursed for providing treatment. By law, medical facilities are not allowed to have more than 16 beds to receive Medicaid funds. The rule, which dates to 1965 and was intended to promote the expansion of smaller community-based substance abuse treatment centers, has contributed to long wait lists for treatment. More beds are allowed for states that ask to make changes through a waiver.

Azar has urged more governors to apply for waivers so more people can have access to treatment for addiction.

“I actually berated the governors saying, ‘Why have I only gotten five of these so far?’ We are eager to work with them, we have a streamlined process for approving them, and I want more,” he said.

Four: Azar said the philosophy at HHS was to see opioid addiction as a “medical challenge, not a moral failure.” One of the parents of a young man who died of an overdose discussed the need to fight the stigma of addiction that makes people want to hide their addiction problem, and avoid getting help and treatment. That left me wondering if we can de-stigmatize addicts while keeping the stigma on the addictive substances. Perhaps we as a society are managing to do that with tobacco products. It’s much less accepted and some might even argue demonized, but no one thinks badly of a person trying to quit, and in fact almost everyone applauds it.

I notice I’ve heard about people seeing a doctor for back trouble, twisted knees, and things like that and explicitly wanting non-opioid pain relief, because of all of the discussion of the possibility of addiction.

Five: Wariness about addiction is stirring a completely different approach to prescribing opioids for pain management. Secretary of Veterans Affairs David Shulkin said that since 2012, VA hospitals have reduced the use of opioids by 40 percent and reduced the number of new prescriptions of opioids by 90 percent.

Six: It is worth noting that addiction psychiatrist Sally Satel stirred the pot recently by contending in a Politico op-ed that the current discussion overstates the role of prescription-medication abuse in the opioid crisis:

Only a minority of people who are prescribed opioids for pain become addicted to them, and those who do become addicted and who die from painkiller overdoses tend to obtain these medications from sources other than their own physicians. Within the past several years, overdose deaths are overwhelmingly attributable not to prescription opioids but to illicit fentanyl and heroin. These “street opioids” have become the engine of the opioid crisis in its current, most lethal form.

Seven: Jim Carroll, the newly appointed acting director of the White House Office of National Drug Control Policy, made his first major remarks at the summit and revealed that someone in his family is currently struggling with addiction.

Eight: Bruce Carroll — no relation — was in attendance and showed me a fascinating device from his company, Proteus Digital Health. It is a monitor/sensor roughly the size of a grain of sand that can be attached to a pill and ingested. The monitor sends out a signal communicating if the pill was consumed, when it was consumed, and helps a doctor know if a patient is taking the right amount of medication at the right time. For example, if a doctor is worried about a patient passing along or selling painkiller pills, the electronic record would show if the patient was given twelve pills and only ingested two.

Nine: Bolling was in attendance, and toward the end of the summit, he described a phone call from President Trump on Thanksgiving Day, the first major holiday for his family without his son. Bolling said he knew that sitting down for the dinner, and seeing the empty chair, would be a devastating moment for everyone gathered. That moment that afternoon was interrupted by the phone ringing — the president of the United States was calling, checking in, offering his sympathies, and asking if there was anything he could do.

Ten: At the conclusion of the event, President Trump joined us.

“I’ve also spoken with Jeff [Sessions] about bringing a lawsuit against some of these opioid companies,” Trump said. “I mean, what they’re doing and the way — the distribution. And you have people that go to the hospital with a broken arm, and they come out and they’re addicted. They’re addicted to painkillers, and they don’t even know what happened. They go in for something minor, and they come out and they’re in serious shape.”

After the remarks, Trump stepped off the stage to applause and started shaking hands with the people on the aisle, and then did something of a double-take when he saw Bolling, sort of a “I didn’t know you would be here!” response. He pulled him in to a half-embrace, heads close, and they exchanged a few words. Trump’s older brother Freddy died in 1981 as a result of alcoholism, and that influenced Trump greatly; Trump doesn’t drink. There are many times Trump has lashed out and seemed to be lack empathy, but the consequences of addiction may bring out the president’s softer side. Several times in his remarks, standing before assembled families of those struggling with addiction and those who lost their battles, Trump said, “I know what you’re going through.”

If you read yesterday’s Jolt, you know what I think of the man. But seeing him in the flesh, I felt some sympathy. The president looks exhausted. The presidency comes with far-reaching responsibilities that are hard to imagine. Men who step into the job start to age as quickly as the guy who drinks from the wrong cup in Indiana Jones and the Last Crusade.

Oh, Hey, We’re Starting a Trade War. Happy Friday, Everybody!

That was the good Trump at the White House yesterday; bad Trump appeared a short time earlier at a separate event, where he apparently shocked his advisors by announcing a plan for tariffs on imported steel and aluminum.

Q: How long, do you think, on the tariffs?

THE PRESIDENT: Unlimited period. Unlimited.

Q: Twenty-five on steel?

THE PRESIDENT: Twenty-five percent for steel. It will be 10 percent for aluminum. And it will be for a long period of time.

Our Ramesh: “The new tariffs on aluminum and steel products that may or may not be coming — but seem, as I write, to be walloping stocks either way — are a bad idea. They will hurt the industries that use steel and aluminum, which employ many more people and add more to our economy than the steel and aluminum industries themselves. And they will invite retaliation.”

Molson-Coors warned in a statement, “Like most brewers, we are selling an increasing amount of our beers in aluminum cans and this action will cause aluminum prices to rise and is likely to lead to job losses across the beer industry.” The company contends that domestically, “there simply isn’t enough supply to satisfy the demands of American beverage makers.”

ADDENDA: The National Review Institute is continuing to hold events in the coming weeks to mark ten years since the passing of William F. Buckley Jr. and celebrate his legacy. The upcoming events will be held March 6th in Dallas, Texas; March 7th in Houston, Texas; March 27th in San Francisco, Calif.; March 28th in Newport Beach, Calif., and April 12th in Chicago, Ill. Details can be found here.

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