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Cómo la muerte de un amigo hizo que adolescentes de Colorado se volvieran activistas contra las sobredosis

Kaiser Health News:States - March 01, 2024

Gavinn McKinney amaba las zapatillas Nike, los fuegos artificiales y el sushi. Estudiaba Potawatomi, uno de los idiomas de sus ancestros nativos americanos. Le encantaba cargar a su sobrina y oler su aroma de bebé. En su cumpleaños número 15, el adolescente de Durango, Colorado, pasó una tarde fría de diciembre cortando leña para ayudar a vecinos que no podían pagar para tener calefacción en sus hogares.

McKinney casi llegó a su cumpleaños 16. Murió a causa de envenenamiento por fentanilo en casa de un amigo en diciembre de 2021. Sus amigos dicen que era la primera vez que probaba drogas duras.

A su servicio fue tanta gente que algunos tuvieron que quedarse fuera de la funeraria.

Ahora, sus compañeros están tratando de cimentar el legado de su amigo en una ley estatal. Recientemente testificaron ante legisladores estatales en apoyo a un proyecto de ley que ayudaron a redactar para asegurar que los estudiantes puedan llevar naloxona consigo en todo momento sin miedo a que sea confiscada o a ser sancionados.

Los distritos escolares tienden a tener políticas estrictas sobre medicamentos. Sin un permiso especial, los estudiantes de Colorado ni siquiera pueden llevar sus propias medicinas de emergencia, como un inhalador, y no se les permite compartirlas con otros.

“Nos dimos cuenta de que realmente podríamos lograr un cambio si nos esforzábamos de corazón”, dijo Niko Peterson, estudiante de último año en Animas High School en Durango y uno de los amigos de McKinney que ayudó a escribir el proyecto de ley. “Ser proactivo en lugar no hacer nada va a ser la mejor solución posible”.

Algunos distritos escolares o condados en California, Maryland y en otros lugares tienen reglas que permiten expresamente a los estudiantes de secundaria llevar naloxona. Pero Jon Woodruff, abogado gerente en la Legislative Analysis and Public Policy Association, dijo que no estaba al tanto de ninguna ley estatal como la que está considerando Colorado. La organización de Woodruff, que tiene su sede en Washington, DC, investiga y redacta borradores de proyectos legislativos sobre el uso de drogas.

La naloxona es un antagonista de los opioides que puede revertir una sobredosis. Disponible sin receta como un aerosol nasal, se la considera una protagonista clave en el freno a la epidemia de sobredosis por su uso en emergencias, pero solo una herramienta en una estrategia de prevención. (La gente a menudo se refiere a la naloxona como “Narcan”, uno de los nombres de marca más reconocibles, similar a lo que pasa con los pañuelos desechables, a los que, independientemente de su marca, se los llama “Kleenex”.)

El año pasado, la administración Biden respaldó una campaña publicitaria que alentaba a los jóvenes a llevar consigo el medicamento de emergencia.

Las leyes de acceso a la naloxona en la mayoría de los estados protegen a los buenos samaritanos, incluidos los jóvenes, de la responsabilidad si dañan accidentalmente a alguien mientras administran naloxona.

Pero sin políticas escolares que la permitan explícitamente, la capacidad de los estudiantes para llevar naloxona a clase queda en un área gris.

En 2022, Ryan Christoff trabajaba en Centaurus High School en Lafayette, Colorado, adonde también estudiaba una de sus hijas. En septiembre de ese año, sus compañeros de trabajo le confiscaron la naloxona a una compañera de clase de su hija.

“Ella no tenía nada más que el Narcan consigo, y se lo quitaron”, dijo Christoff, quien le había proporcionado el Narcan confiscado a esa estudiante y a muchos otros después que su hija casi muriera por envenenamiento por fentanilo. “Deberíamos querer que cada estudiante lo lleve consigo”.

Randy Barber, vocero del Distrito Escolar del Valle de Boulder, dijo que el incidente “fue un caso aislado y desde entonces hemos trabajado para asegurarnos de que las enfermeras estén alertas”. El distrito ahora anima a todos a considerar llevar naloxona, dijo.

La devastación de una comunidad se transforma en acción

En Durango, la muerte de McKinney golpeó duro a la comunidad.

Los amigos y familiares del joven dijeron que no consumía drogas duras. La única sustancia a la que era “adicto” era la salsa picante Tapatío, incluso llevaba un poco en el bolsillo a los juegos de los Rockies.

Después de la muerte de McKinney, la gente comenzó a hacerse tatuajes de la frase por la que era conocido, que estaba estampada en su sudadera favorita: “El amor es la cura”. Incluso algunos de sus profesores se la tatuaron.

Pero fueron los compañeros de clase, junto con sus amigos de otra escuela secundaria de la ciudad, quienes convirtieron su pérdida en un movimiento político. “Estamos haciendo que las cosas sucedan en su nombre”, dijo Peterson.

La tasa de mortalidad por envenenamiento a causa del fentanilo ha aumentado en los últimos años, con más de 1,500 niños y adolescentes en el país muertos el mismo año que McKinney.

La mayoría de los jóvenes que mueren por sobredosis no tienen antecedentes conocidos de consumo de opioides, y muchos de ellos probablemente pensaron que estaban tomando opioides recetados como OxyContin o Percocet, no las píldoras falsas recetadas que contienen cada vez más una dosis letal de fentanilo.

“Lo más probable es que el grupo más grande de adolescentes que están muriendo sean realmente adolescentes que están experimentando, en lugar de adolescentes que tienen un trastorno de uso de opioides de larga data”, observó Joseph Friedman, investigador de uso de sustancias en UCLA, a quien le gustaría ver que las escuelas proporcionen una educación precisa sobre drogas falsificadas, como con el plan de estudios Safety First de Stanford.

Permitir a los estudiantes llevar un medicamento de bajo riesgo que salva vidas es, en muchos aspectos, lo mínimo que las escuelas pueden hacer, dijo Friedman.

“Yo argumentaría que lo que las escuelas deberían estar haciendo es identificar a los adolescentes de alto riesgo y darles el Narcan para llevarlo a casa y enseñarles por qué es importante”, dijo Friedman.

En un artículo en The New England Journal of Medicine, Friedman identificó a Colorado como un área crítica para las muertes por sobredosis en adolescentes de secundaria, con una tasa de mortalidad de más del doble que la del país de 2020 a 2022.

“Cada vez más, el fentanilo se vende en forma de píldoras, y esto está sucediendo en gran medida en el Oeste”, dijo Friedman. “Creo que la crisis de sobredosis en adolescentes es un resultado directo de eso”.

Si los legisladores de Colorado aprueban el proyecto de ley, “creo que es un paso realmente importante”, dijo Ju Nyeong Park, profesor asistente de medicina en la Universidad Brown, quien dirige un grupo de investigación centrado en cómo prevenir las sobredosis. “Espero que la Legislatura de Colorado lo haga y que también otros estados sigan el ejemplo”.

Park dijo que los programas integrales para analizar drogas en busca de contaminantes peligrosos, un mejor acceso a tratamientos basados en evidencia para adolescentes que desarrollan un trastorno por uso de sustancias, y la promoción de herramientas de reducción de daños también son importantes.

“Por ejemplo, hay una línea directa nacional llamada Never Use Alone (Nunca Uses Solo) a la que cualquiera puede llamar de manera anónima para ser supervisado de forma remota en caso de emergencia”, dijo.

Tomando el asunto en sus propias manos

Muchos distritos escolares de Colorado están capacitando al personal en cómo administrar naloxona y la tienen en las instalaciones escolares a través de un programa que les permite adquirirla del estado a poco o ningún costo.

Pero para Peterson y otros estudiantes de secundaria del área, fue claro que tener naloxona en la escuela no era suficiente, especialmente en lugares rurales. “Los profesores que están capacitados para usar Narcan no van a estar en las fiestas en donde los estudiantes consumen drogas”, dijo.

Y no es suficiente esperar que los adolescentes la tengan en casa.

“No va a ser útil si está en la casa de alguien a 20 minutos fuera de la ciudad. Será útil si está en su mochila siempre”, dijo Zoe Ramsey, otra amiga de McKinney y estudiante de último año en Animas High School.

Pero estudiantes del área, y administradores escolares, no estaban seguros: ¿Los estudiantes podrían meterse en problemas por llevar el antagonista de opioides en sus mochilas, o por dárselo a amigos? ¿Podría una escuela o distrito ser considerado responsable si algo saliera mal?

“Nos informaron que estaba en contra de las reglas llevar naloxona, y especialmente distribuirla”, dijo Ilias “Leo” Stritikus, quien se graduó de Durango High School el año pasado.

Ilias, junto con Ramsey y Peterson, ayudaron a formar el grupo Students Against Overdose. Juntos, convencieron a Animas, que es una escuela autónoma, y al distrito escolar cercano, de cambiar las normas. Ahora, con el permiso de los padres, y después de recibir capacitación sobre cómo administrarla, los estudiantes pueden llevar naloxona en las instalaciones escolares.

Karla Sluis, vocera del Distrito Escolar 9-R de Durango, dijo que al menos 45 estudiantes han completado la capacitación. Los distritos escolares en otras partes del país también han determinado que es importante clarificar sobre la capacidad de los estudiantes para llevar naloxona.

“Queremos ser parte de salvar vidas”, dijo Smita Malhotra, directora médica principal del Distrito Escolar Unificado de Los Ángeles en California.

El condado de Los Ángeles tuvo uno de los recuentos de muertes por sobredosis en adolescentes más altos que cualquier otro condado del país: de 2020 a 2022, murieron 111 adolescentes de 14 a 18 años.

Uno de ellos fue un joven de 15 años que murió en un baño de su escuela por envenenamiento por fentanilo. Desde entonces, el distrito de Malhotra ha actualizado su política sobre naloxona para permitir que los estudiantes la lleven y la administren.

“Todos los estudiantes pueden llevar naloxona en nuestros campus escolares sin enfrentar ninguna disciplina”, dijo Malhotra. Agregó que el distrito también está fortaleciendo el apoyo entre pares y organizando sesiones educativas para familias y estudiantes.

Las Escuelas Públicas del Condado de Montgomery en Maryland tomaron un enfoque similar. El personal escolar tuvo que administrar naloxona 18 veces durante el transcurso de un año escolar, y cinco estudiantes murieron a lo largo de un semestre.

Cuando el distrito organizó foros comunitarios sobre el tema, Patricia Kapunan, la oficial médica del distrito, dijo: “Los estudiantes fueron muy elocuentes sobre querer acceso a la naloxona. Es muy poco probable que un estudiante lleve algo en su mochila que piense que podría causarle problemas”.

Entonces, también, clarificó su política. Mientras tanto, los medios de comunicación locales informaron que estudiantes de secundaria encontraron a un joven desmayado, con los labios morados, en el baño de un McDonald’s enfrente de su escuela, y usaron Narcan para revivirlo. Fue durante el almuerzo en un día de escuela.

“Narcan no es nuestro camino para salir de la crisis de uso de opioides”, dijo Kapunan. “Pero fue crítico usarlo primero. Como conocer el número 911”. Ahora, con el apoyo del distrito y del departamento de salud del condado, los estudiantes están capacitando a otros estudiantes sobre cómo administrar naloxona. Jackson Taylor, uno de los estudiantes entrenadores, estimó que, un sábado reciente, capacitaron a unos 200 en el transcurso de tres horas.

“Fue increíble, un paso hacia la solución del problema”, dijo Taylor.

Cada aprendiz se fue con dos dosis de naloxona.

Esta historia fue producida por KFF Health News, que publica California Healthline, un servicio editorialmente independiente de la California Health Care Foundation.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Avanzan en varios estados proyectos de ley extremos sobre el uso de baños por género

Kaiser Health News:States - March 01, 2024

Legisladores republicanos en varios estados han resucitado y ampliado la lucha sobre si las personas transgénero pueden usar baños y otras instalaciones que no coincidan con su sexo asignado al nacer.

Al menos uno de los proyectos de ley es tan extremo como para proponer que se considere delito que una persona transgénero entre en una instalación que no coincida con el sexo indicado en su acta de nacimiento.

El debate ha estado surgiendo en las legislaturas estatales de todo el país en los últimos meses, especialmente en estados conservadores y rurales, incluida una audiencia del Comité de Servicios Humanos y de Salud del Senado de Arizona en febrero.

Los defensores de la SB 1628 de ese estado, que define “hombre”, “mujer” y otros términos a través de definiciones rígidas de sexo biológico, argumentaron que los derechos de las mujeres están en juego. Los opositores estuvieron en desacuerdo y dijeron que el lenguaje eliminaría a las personas transgénero de los estatutos y removería sus protecciones legales.

El proyecto de ley establece que Arizona puede proporcionar “entornos separados por sexo” para hombres y mujeres, incluidos atletismo, instalaciones para adultos mayores, vestuarios, baños, refugios para víctimas de violencia doméstica y centros de crisis por agresión sexual, lo que significa que se podría prohibir a las mujeres transgénero entrar en esos espacios destinados para mujeres.

Los investigadores han encontrado que las mujeres transgénero experimentan agresiones a una tasa casi cuatro veces mayor que las mujeres cisgénero.

La última serie de propuestas, como la de Arizona, amplía una ola anterior de “proyectos de ley sobre baños”, cuya meta era restringir el acceso de las personas transgénero a baños públicos y vestuarios. En algunos casos, las leyes propuestas se extenderían mucho más allá del acceso a las instalaciones al excluir a las personas transgénero de las leyes estatales contra la discriminación y dictar la composición de los equipos deportivos.

Expertos en leyes dicen que los nuevos proyectos de ley ponen a los estados en riesgo de violar las leyes federales contra la discriminación, lo que podría poner en peligro miles de millones de dólares en fondos federales para estados y centros de crisis que reciben subvenciones federales.

Al menos un estado — Utah — eliminó líneas que mencionaban específicamente refugios y otras instalaciones similares debido a preocupaciones sobre perder estos fondos.

Además del proyecto de ley aprobado en Utah, legisladores presentaron proyectos de ley similares en Idaho, Georgia, Arizona, Nuevo México, Iowa y West Virginia.

Las medidas reflejan un proyecto de ley modelo creado por el Independent Women’s Law Center, una organización sin fines de lucro conservadora que busca reescribir las leyes estatales basadas en el sexo asignado al nacer.

El año pasado, Kansas, Nebraska, Oklahoma y Montana aprobaron versiones de este  fueron a través de órdenes ejecutivas o legislaciones. Un proyecto de ley similar también fue presentado en el Congreso en 2023 por la senadora Cindy Hyde-Smith (republicana de Mississippi) y la representante Debbie Lesko (republicana de Arizona).

 Jennifer Braceras, vicepresidenta de asuntos legales y fundadora del Independent Women’s Law Center, testificó a favor de la propuesta en Arizona.

“Los estadounidenses comunes saben que una mujer es una hembra humana adulta”, dijo Braceras, refiriéndose a la definición en el proyecto de ley de que una hembra es “un individuo que tiene, tuvo, tendrá o tendría, de no ser por una anomalía del desarrollo o un accidente, el sistema reproductivo que en algún momento produce óvulos”.

Dijo a los legisladores estatales que los activistas buscan convencer a jueces y a otros que los hombres que se identifican como mujeres tienen derecho ilimitado a entrar en espacios de mujeres y dijo que la política es una herramienta para restringir ese acceso.

Braceras agregó que solo porque la legislación modelo no incluya el género en sus definiciones, eso no prohíbe que los legisladores estatales decidan incluirlo en sus leyes. Los defensores conservadores de la legislación enfatizan la diferencia entre sexo y género, diciendo que el primero es un hecho biológico inmutable y el segundo un conjunto de normas culturales.

La estrecha definición de sexo y las disposiciones que declaran que ciertos espacios deben protegerse como “entornos de un solo sexo”, incluidos refugios para víctimas de violencia doméstica y centros de crisis por agresión sexual en algunas versiones estatales de la política, plantean preguntas sobre el cumplimiento de las leyes federales que prohíben la discriminación basada en el sexo o el género.

Anya Marino, directora de igualdad LGBTQI en el National Women’s Law Center, dijo que si un tribunal encontrara que estos estatutos están en desacuerdo con las leyes federales, la ley federal que garantiza protección sobre la base de género prevalecería sobre las leyes estatales.

Más allá de cómo podrían interpretarse o implementarse las leyes, Marino expresó preocupación por otras consecuencias que pueden tener estos debates, incluida la violencia contra personas que “no cumplen con una visión extremista idealista de cómo deberían ser los sexos”, dijo.

“Es parte de un objetivo más amplio de controlar a las personas a través de la vigilancia corporal para determinar cómo aman y cómo navegan en su vida diaria”, opinó.

 Sin embargo, las ramificaciones legales no están claras. En Montana, donde una de estas propuestas se convirtió en ley después de que se aprobara la SB 458 durante la sesión del año pasado, los legisladores evaluaron los riesgos de violar potencialmente la ley federal y perder miles de millones en financiamiento.

Los analistas fiscales legislativos del estado determinaron que se ponían en juego $7.5 mil millones en fondos federales en el primer año, dependiendo de cómo las agencias estatales implementaran la ley y si esas acciones se consideraban violaciones de las leyes contra la discriminación.

A pesar de todo esto, el proyecto de ley fue aprobado de todos modos y fue firmado por el gobernador republicano Greg Gianforte.

Está pendiente un desafío legal del estatuto. De todos modos, el Departamento de Salud Pública y Servicios Humanos de Montana (DPHHS) citó la aprobación de la ley como justificación para resucitar una norma que prohíbe a las personas transgénero cambiar la designación de sexo en su acta de nacimiento.

Esta prohibición fue instituida originalmente en 2022 y fue anulada por un juez antes de que se aprobara la nueva ley. “

El DPHHS debe seguir la ley, y nuestra agencia, en consecuencia, procesará las solicitudes para modificar los marcadores de sexo en los certificados de nacimiento según nuestra regla final de 2022″, dijo el director del departamento, Charlie Brereton, en un comunicado del 20 de febrero anunciando el cambio.

Los legisladores en Utah eliminaron el lenguaje que identificaba específicamente a los refugios para víctimas de violencia doméstica y los centros de crisis por agresión sexual como espacios “designados por sexo” que podrían excluir a las personas transgénero después de escuchar preocupaciones de líderes locales y estatales sobre la pérdida de fondos federales.

Aunque los legisladores eliminaron la mención de esos lugares específicos en el proyecto de ley, mantuvieron disposiciones que prohíben que las personas transgénero ingresen a baños, duchas públicas o vestuarios designados por sexo que no correspondan con su sexo asignado al nacer a menos que su acta de nacimiento haya sido modificada o hayan pasado por una cirugía de afirmación de género en consecuencia.

El proyecto de ley fue acelerado, aprobado y firmado por el gobernador republicano Spencer Cox dos semanas después que comenzara la sesión legislativa. Más recientemente, los legisladores de West Virginia eliminaron el lenguaje del HB 5243 que nombraba a los refugios para víctimas de violencia doméstica y los centros de crisis por agresión sexual como lugares donde el estado podría distinguir entre los sexos.

La representante republicana Kathie Hess Crouse, patrocinadora principal del proyecto de ley, dijo que el lenguaje se eliminó porque era innecesario. “Al eliminar los ejemplos específicos, estamos dejando extremadamente claro que esta lista no es la lista completa de entornos de un solo sexo que puede tener West Virginia”, dijo. La Cámara de Representantes estatal aprobó el proyecto de ley en febrero y está pendiente de aprobación del Senado.

Cuando se le preguntó sobre los electores que testificaron en oposición al proyecto de ley con preocupaciones de que afectaría negativamente a las personas transgénero, Hess Crouse dijo que estaban mal informados. Afirmó que el proyecto de ley no crea nuevos derechos ni quita ninguno. “El proyecto de ley es un proyecto de ley definitorio para que nuestros tribunales tengan orientación al interpretar las leyes que ya existen en West Virginia”, dijo.

“Si alguien en el estado no está contento con las leyes que ya tenemos en los libros, puede trabajar con su legislador para presentar un proyecto que cambie la ley”. Hugo Polanco, abogado litigante de la oficina del defensor público del condado de Maricopa, testificó en contra del proyecto de ley en Arizona en nombre del capítulo de la Unión Estadounidense de Libertades Civiles (ACLU) del estado.

“Seamos claros”, dijo. “Los derechos trans son derechos de las mujeres. Los avances en los derechos trans derriban barreras basadas en estereotipos de género, creando la oportunidad para que cada uno de nosotros determine su propia historia de vida”.

Alex del Rosario, organizador nacional del Centro Nacional para la Igualdad Transgénero, dijo que esta serie de proyectos de ley daña a las personas transgénero al intentar eliminar protecciones.

“Vigilar los cuerpos de las personas mientras se excluye a las personas transgénero e intersexuales de usar el baño no protege la privacidad de nadie”, dijo. “Los políticos extremistas han estado aprovechándose del público estadounidense, proyectando una imagen falsa de las personas transgénero, especialmente de las mujeres transgénero, para fomentar el miedo y la desconfianza hacia una comunidad que muchas personas no entienden”.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Readout of HHS Roundtable on Congenital Syphilis with National Provider Organizations

HHS Gov News - March 01, 2024
Assistant Secretary for Health ADM Rachel L. Levine and members of the National Syphilis and Congenital Syphilis Syndemic Federal Task Force met with leaders from national provider organizations to discuss efforts to protect the health of our nation’s patients and their babies.

Biden-Harris Administration Restores Important Protections for Beneficiaries of Federally Funded Social Services

HHS Gov News - March 01, 2024
Biden-Harris Administration Restores Important Protections for Beneficiaries of Federally Funded Social Services

With Medical Debt Burdening Millions, a Financial Regulator Steps In to Help

When President Barack Obama signed legislation in 2010 to create the Consumer Financial Protection Bureau, he said the new agency had one priority: “looking out for people, not big banks, not lenders, not investment houses.”

Since then, the CFPB has done its share of policing mortgage brokers, student loan companies, and banks. But as the U.S. health care system turns tens of millions of Americans into debtors, this financial watchdog is increasingly working to protect beleaguered patients, adding hospitals, nursing homes, and patient financing companies to the list of institutions that regulators are probing.

In the past two years, the CFPB has penalized medical debt collectors, issued stern warnings to health care providers and lenders that target patients, and published reams of reports on how the health care system is undermining the financial security of Americans.

In its most ambitious move to date, the agency is developing rules to bar medical debt from consumer credit reports, a sweeping change that could make it easier for Americans burdened by medical debt to rent a home, buy a car, even get a job. Those rules are expected to be unveiled later this year.

“Everywhere we travel, we hear about individuals who are just trying to get by when it comes to medical bills,” said Rohit Chopra, the director of the CFPB whom President Joe Biden tapped to head the watchdog agency in 2021.

“American families should not have their financial lives ruined by medical bills,” Chopra continued.

The CFPB’s turn toward medical debt has stirred opposition from collection industry officials, who say the agency’s efforts are misguided. “There’s some concern with a financial regulator coming in and saying, ‘Oh, we’re going to sweep this problem under the rug so that people can’t see that there’s this medical debt out there,’” said Jack Brown III, a longtime collector and member of the industry trade group ACA International.

Brown and others question whether the agency has gone too far on medical billing. ACA International has suggested collectors could go to court to fight any rules barring medical debt from credit reports.

At the same time, the U.S. Supreme Court is considering a broader legal challenge to the agency’s funding that some conservative critics and financial industry officials hope will lead to the dissolution of the agency.

But CFPB’s defenders say its move to address medical debt simply reflects the scale of a crisis that now touches some 100 million Americans and that a divided Congress seems unlikely to address soon.

“The fact that the CFPB is involved in what seems like a health care issue is because our system is so dysfunctional that when people get sick and they can’t afford all their medical bills, even with insurance, it ends up affecting every aspect of their financial lives,” said Chi Chi Wu, a senior attorney at the National Consumer Law Center.

CFPB researchers documented that unpaid medical bills were historically the most common form of debt on consumers’ credit reports, representing more than half of all debts on these reports. But the agency found that medical debt is typically a poor predictor of whether someone is likely to pay off other bills and loans.

Medical debts on credit reports are also frequently riddled with errors, according to CFPB analyses of consumer complaints, which the agency found most often cite issues with bills that are the wrong amount, have already been paid, or should be billed to someone else.

“There really is such high levels of inaccuracy,” Chopra said in an interview with KFF Health News. “We do not want to see the credit reporting system being weaponized to get people to pay bills they may not even owe.”

The aggressive posture reflects Chopra, who cut his teeth helping to stand up the CFPB almost 15 years ago and made a name for himself going after the student loan industry.

Targeting for-profit colleges and lenders, Chopra said he was troubled by an increasingly corporate higher-education system that was turning millions of students into debtors. Now, he said, he sees the health care system doing the same thing, shuttling patients into loans and credit cards and reporting them to credit bureaus. “If we were to rewind decades ago,” Chopra said, “we saw a lot less reliance on tools that banks used to get people to pay.”

The push to remove medical bills from consumer credit reports culminates two years of intensive work by the CFPB on the medical debt issue.

The agency warned nursing homes against forcing residents’ friends and family to assume responsibility for residents’ debts. An investigation by KFF Health News and NPR documented widespread use of lawsuits by nursing homes in communities to pursue friends and relatives of nursing home residents.

The CFPB also has highlighted problems with how hospitals provide financial assistance to low-income patients. Regulators last year flagged the dangers of loans and credit cards that health care providers push on patients, often saddling them with more debt.

And regulators have gone after medical debt collectors. In December, the CFPB shut down a Pennsylvania company for pursuing patients without ensuring the debts were accurate.

A few months before that, the agency fined an Indiana company working with medical debt for violating collection laws. Regulators said the company had “risked harming consumers by pressuring or inducing them to pay debts they did not owe.”

With their business in the crosshairs, debt collectors are warning that cracking down on credit reporting and other collection tools may prompt more hospitals and doctors to demand patients pay upfront for care.

There are some indications this is happening already, as hospitals and clinics push patients to enroll in loans or credit cards to pay their medical bills.

Scott Purcell, CEO of ACA International, said it would be wiser for the federal government to focus on making medical care more affordable. “Here we’re coming up with a solution that only takes money away from providers,” Purcell said. “If Congress was involved, there could be more robust solutions.”

Chopra doesn’t dispute the need for bigger efforts to tackle health care costs.

“Of course, there are broader things that we would probably want to fix about our health care system,” he said, “but this is having a direct financial impact on so many Americans.”

The CFPB can’t do much about the price of a prescription or a hospital bill, Chopra continued. What the federal agency can do, he said, is protect patients if they can’t pay their bills.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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California Hospitals, Advocates Seek Stable Funding to Retain Behavioral Health Navigators

Kaiser Health News:States - March 01, 2024

Health providers and addiction experts warn the funding structure is unstable for a California initiative that steers patients with substance use disorder into long-term treatment after they are discharged from emergency rooms, which has already led some critical employees to leave their jobs.

Supporters of CA Bridge’s behavioral health navigator program, which launched in 2022, say its reliance on one-time funding makes it hard for hospitals to retain navigators amid a growing drug crisis. In 2022, the most recent year for which data is available, 7,385 Californians died from opioid-related overdoses, of which 88% involved fentanyl, a synthetic opioid that can be 50 times as strong as heroin.

“This should be very basic, 101 first aid for opioid use disorder, and we are truly struggling to sustain it,” said Andrew Herring, an emergency medicine physician at Alameda Health System’s Highland Hospital in Oakland, California, and a co-founder of CA Bridge. “Everyone is looking at everyone else to pay for this. The doctors, nurses, social workers, and care managers are standing by, ready to do work that is inherently compelling and wonderful, but they’re simply not being paid to do it.”

The navigator program is just one component of CA Bridge, a multilayered program aimed at expanding the use of medications for substance use disorders in ERs. CA Bridge funds training for doctors and nurses to increase the use of prescription medication, and its navigator program pays hospitals up to $120,000 to contract with behavioral health workers.

Currently, 284 navigators have been assigned to place patients into long-term treatment after they are discharged from an ER. Once a year is up, hospitals have the option to bring navigators on staff or allow those contracts to expire. CA Bridge officials confirmed more than a hundred navigators have left their positions.

In response, state officials say they are trying to expand the use of Medi-Cal, the state’s Medicaid program, which covers low-income people, to help pay for navigators by nudging managed-care plans to cover such services. Officials said the state is also trying to secure additional federal grants through March 2025. However, Democratic Gov. Gavin Newsom did not include new state funding in his latest budget in the face of a $38 billion deficit.

CA Bridge started in 2018 and has since received almost $100 million in federal and state funding as it has expanded across California. As of January 2024, 265 hospitals with emergency departments, or 83% of those in the state, are participating in the program and about 100 hospitals have hired navigators as permanent staff. According to a January 2023 CA Bridge report, 76,801 patients have been prescribed buprenorphine, and an estimated 34,560 were connected to follow-up care.

Hospital industry representatives say more of their members would join the program if they knew it would have sustainable long-term funding.

The program raises doctors’ awareness of the benefits of prescribing medications such as buprenorphine, which works by binding to the same brain receptors as more dangerous opioids, reducing withdrawal symptoms. Buprenorphine, naltrexone, and methadone are the only medications approved in the U.S. to treat opioid use disorder. Only 10% of Californians with substance use disorder received appropriate treatment in the previous year, according to a 2022 analysis by the California Health Care Foundation.

Meanwhile, CA Bridge navigators, who are trained in harm reduction, behavioral health, and community outreach, help place patients into long-term treatment after discharge, a step that can be lifesaving and that the behavioral health system often struggles to complete. One study of patients in England found they were four times as likely to die from an opioid overdose within 48 hours after a visit to the ER versus other times.

Patients who received help from a navigator were more than three times as likely to be in treatment within 30 days after they visited the ER than those who did not receive the assistance, found one study conducted from September 2021 to January 2022 in three public hospitals, including Highland.

Even though hospitals that hire navigators can be reimbursed by billing Medi-Cal for community health care services, few hospitals have negotiated that benefit with Medi-Cal’s health plans. David Simon, a spokesperson for the California Hospital Association, said the service is new and that the state has yet to provide guidance on how to bill health plans.

In the past, supporters of the navigator program have suggested reducing barriers to billing Medi-Cal and tapping various state funds.

“A statewide funding mechanism to sustain the navigators’ services on an ongoing basis has yet to be solidified,” a coalition of dozens of health providers and advocates wrote last year.

Aimee Moulin, a principal investigator and co-founder of CA Bridge, said the program needs momentum to stem an epidemic of overdose deaths. While the program has helped expand the use of medications for opioid addiction, she said, there is still work to do to bring in additional hospitals and persuade them to incorporate addiction care.

“For opioid use disorders, we have highly effective medications,” said Moulin. “It’s not like we don’t know what works. It’s just a matter of getting them out there.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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How a Friend’s Death Turned Colorado Teens Into Anti-Overdose Activists

Kaiser Health News:States - March 01, 2024

Gavinn McKinney loved Nike shoes, fireworks, and sushi. He was studying Potawatomi, one of the languages of his Native American heritage. He loved holding his niece and smelling her baby smell. On his 15th birthday, the Durango, Colorado, teen spent a cold December afternoon chopping wood to help neighbors who couldn’t afford to heat their homes.

McKinney almost made it to his 16th birthday. He died of fentanyl poisoning at a friend’s house in December 2021. His friends say it was the first time he tried hard drugs. The memorial service was so packed people had to stand outside the funeral home.

Now, his peers are trying to cement their friend’s legacy in state law. They recently testified to state lawmakers in support of a bill they helped write to ensure students can carry naloxone with them at all times without fear of discipline or confiscation. School districts tend to have strict medication policies. Without special permission, Colorado students can’t even carry their own emergency medications, such as an inhaler, and they are not allowed to share them with others.

“We realized we could actually make a change if we put our hearts to it,” said Niko Peterson, a senior at Animas High School in Durango and one of McKinney’s friends who helped write the bill. “Being proactive versus being reactive is going to be the best possible solution.”

Individual school districts or counties in California, Maryland, and elsewhere have rules expressly allowing high school students to carry naloxone. But Jon Woodruff, managing attorney at the Legislative Analysis and Public Policy Association, said he wasn’t aware of any statewide law such as the one Colorado is considering. Woodruff’s Washington, D.C.-based organization researches and drafts legislation on substance use.

Naloxone is an opioid antagonist that can halt an overdose. Available over the counter as a nasal spray, it is considered the fire extinguisher of the opioid epidemic, for use in an emergency, but just one tool in a prevention strategy. (People often refer to it as “Narcan,” one of the more recognizable brand names, similar to how tissues, regardless of brand, are often called “Kleenex.”)

The Biden administration last year backed an ad campaign encouraging young people to carry the emergency medication.

Most states’ naloxone access laws protect do-gooders, including youth, from liability if they accidentally harm someone while administering naloxone. But without school policies explicitly allowing it, the students’ ability to bring naloxone to class falls into a gray area.

Ryan Christoff said that in September 2022 fellow staff at Centaurus High School in Lafayette, Colorado, where he worked and which one of his daughters attended at the time, confiscated naloxone from one of her classmates.

“She didn’t have anything on her other than the Narcan, and they took it away from her,” said Christoff, who had provided the confiscated Narcan to that student and many others after his daughter nearly died from fentanyl poisoning. “We should want every student to carry it.”

Boulder Valley School District spokesperson Randy Barber said the incident “was a one-off and we’ve done some work since to make sure nurses are aware.” The district now encourages everyone to consider carrying naloxone, he said.

Community’s Devastation Turns to Action

In Durango, McKinney’s death hit the community hard. McKinney’s friends and family said he didn’t do hard drugs. The substance he was hooked on was Tapatío hot sauce — he even brought some in his pocket to a Rockies game.

After McKinney died, people started getting tattoos of the phrase he was known for, which was emblazoned on his favorite sweatshirt: “Love is the cure.” Even a few of his teachers got them. But it was classmates, along with their friends at another high school in town, who turned his loss into a political movement.

“We’re making things happen on behalf of him,” Peterson said.

The mortality rate has spiked in recent years, with more than 1,500 other children and teens in the U.S. dying of fentanyl poisoning the same year as McKinney. Most youth who die of overdoses have no known history of taking opioids, and many of them likely thought they were taking prescription opioids like OxyContin or Percocet — not the fake prescription pills that increasingly carry a lethal dose of fentanyl.

“Most likely the largest group of teens that are dying are really teens that are experimenting, as opposed to teens that have a long-standing opioid use disorder,” said Joseph Friedman, a substance use researcher at UCLA who would like to see schools provide accurate drug education about counterfeit pills, such as with Stanford’s Safety First curriculum.

Allowing students to carry a low-risk, lifesaving drug with them is in many ways the minimum schools can do, he said.

“I would argue that what the schools should be doing is identifying high-risk teens and giving them the Narcan to take home with them and teaching them why it matters,” Friedman said.

Writing in The New England Journal of Medicine, Friedman identified Colorado as a hot spot for high school-aged adolescent overdose deaths, with a mortality rate more than double that of the nation from 2020 to 2022.

“Increasingly, fentanyl is being sold in pill form, and it’s happening to the largest degree in the West,” said Friedman. “I think that the teen overdose crisis is a direct result of that.”

If Colorado lawmakers approve the bill, “I think that’s a really important step,” said Ju Nyeong Park, an assistant professor of medicine at Brown University, who leads a research group focused on how to prevent overdoses. “I hope that the Colorado Legislature does and that other states follow as well.”

Park said comprehensive programs to test drugs for dangerous contaminants, better access to evidence-based treatment for adolescents who develop a substance use disorder, and promotion of harm reduction tools are also important. “For example, there is a national hotline called Never Use Alone that anyone can call anonymously to be supervised remotely in case of an emergency,” she said.

Taking Matters Into Their Own Hands

Many Colorado school districts are training staff how to administer naloxone and are stocking it on school grounds through a program that allows them to acquire it from the state at little to no cost. But it was clear to Peterson and other area high schoolers that having naloxone at school isn’t enough, especially in rural places.

“The teachers who are trained to use Narcan will not be at the parties where the students will be using the drugs,” he said.

And it isn’t enough to expect teens to keep it at home.

“It’s not going to be helpful if it’s in somebody’s house 20 minutes outside of town. It’s going to be helpful if it’s in their backpack always,” said Zoe Ramsey, another of McKinney’s friends and a senior at Animas High School.

“We were informed it was against the rules to carry naloxone, and especially to distribute it,” said Ilias “Leo” Stritikus, who graduated from Durango High School last year.

But students in the area, and their school administrators, were uncertain: Could students get in trouble for carrying the opioid antagonist in their backpacks, or if they distributed it to friends? And could a school or district be held liable if something went wrong?

He, along with Ramsey and Peterson, helped form the group Students Against Overdose. Together, they convinced Animas, which is a charter school, and the surrounding school district, to change policies. Now, with parental permission, and after going through training on how to administer it, students may carry naloxone on school grounds.

Durango School District 9-R spokesperson Karla Sluis said at least 45 students have completed the training.

School districts in other parts of the nation have also determined it’s important to clarify students’ ability to carry naloxone.

“We want to be a part of saving lives,” said Smita Malhotra, chief medical director for Los Angeles Unified School District in California.

Los Angeles County had one of the nation’s highest adolescent overdose death tallies of any U.S. county: From 2020 to 2022, 111 teens ages 14 to 18 died. One of them was a 15-year-old who died in a school bathroom of fentanyl poisoning. Malhotra’s district has since updated its policy on naloxone to permit students to carry and administer it.

“All students can carry naloxone in our school campuses without facing any discipline,” Malhotra said. She said the district is also doubling down on peer support and hosting educational sessions for families and students.

Montgomery County Public Schools in Maryland took a similar approach. School staff had to administer naloxone 18 times over the course of a school year, and five students died over the course of about one semester.

When the district held community forums on the issue, Patricia Kapunan, the district’s medical officer, said, “Students were very vocal about wanting access to naloxone. A student is very unlikely to carry something in their backpack which they think they might get in trouble for.”

So it, too, clarified its policy. While that was underway, local news reported that high school students found a teen passed out, with purple lips, in the bathroom of a McDonald’s down the street from their school, and used Narcan to revive them. It was during lunch on a school day.

“We can’t Narcan our way out of the opioid use crisis,” said Kapunan. “But it was critical to do it first. Just like knowing 911.”

Now, with the support of the district and county health department, students are training other students how to administer naloxone. Jackson Taylor, one of the student trainers, estimated they trained about 200 students over the course of three hours on a recent Saturday.

“It felt amazing, this footstep toward fixing the issue,” Taylor said.

Each trainee left with two doses of naloxone.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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This story can be republished for free (details).

KFF Health News' 'What the Health?': Alabama’s IVF Ruling Still Making Waves

Kaiser Health News:States - February 29, 2024
The Host Julie Rovner KFF Health News @jrovner Read Julie's stories. Julie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.

Reverberations from the Alabama Supreme Court’s first-in-the-nation ruling that embryos are legally children continued this week, both in the states and in Washington. As Alabama lawmakers scrambled to find a way to protect in vitro fertilization services without directly denying the “personhood” of embryos, lawmakers in Florida postponed a vote on the state’s own “personhood” law. And in Washington, Republicans worked to find a way to satisfy two factions of their base: those who support IVF and those who believe embryos deserve full legal rights.

Meanwhile, Congress may finally be nearing a funding deal for the fiscal year that began Oct. 1. And while a few bipartisan health bills may catch a ride on the overall spending bill, several other priorities, including an overhaul of the pharmacy benefit manager industry, failed to make the cut.

This week’s panelists are Julie Rovner of KFF Health News, Rachel Cohrs of Stat, Riley Griffin of Bloomberg News, and Joanne Kenen of Johns Hopkins University’s schools of nursing and public health and Politico Magazine.

Panelists Rachel Cohrs Stat News @rachelcohrs Read Rachel's stories. Riley Griffin Bloomberg @rileyraygriffin Read Riley's stories. Joanne Kenen Johns Hopkins Bloomberg School of Public Health and Politico @JoanneKenen Read Joanne's articles.

Among the takeaways from this week’s episode:

  • Lawmakers are readying short-term deals to keep the government funded and running for at least a few more weeks, though some health priorities like preparing for a future pandemic and keeping down prescription drug prices may not make the cut.
  • After the Alabama Supreme Court’s decision that frozen embryos are people, Republicans find themselves divided over the future of IVF. The emotionally charged debate over the procedure — which many conservatives, including former Vice President Mike Pence, believe should remain available — is causing turmoil for the party. And Democrats will no doubt keep reminding voters about it, highlighting the repercussions of the conservative push into reproductive health care.
  • A significant number of physicians in Idaho are leaving the state or the field of reproductive care entirely because of its strict abortion ban. With many hospitals struggling with the cost of labor and delivery services, the ban is only making it harder for women in some areas to get care before, during, and after childbirth — whether they need abortion care or not.
  • A major cyberattack targeting the personal information of patients enrolled in a health plan owned by UnitedHealth Group is drawing attention to the heightened risks of consolidation in health care. Meanwhile, the Justice Department is separately investigating UnitedHealth for possible antitrust violations.
  • “This Week in Health misinformation”: Panelist Joanne Kenen explains how efforts to prevent wrong information about a new vaccine for RSV have been less than successful.

Also this week, Rovner interviews Greer Donley, an associate professor at the University of Pittsburgh School of Law, about how a 150-year-old anti-vice law that’s still on the books could be used to ban abortion nationwide.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: ProPublica’s “Their States Banned Abortion. Doctors Now Say They Can’t Give Women Potential Lifesaving Care,” by Kavitha Surana.

Rachel Cohrs: The New York Times’ “$1 Billion Donation Will Provide Free Tuition at a Bronx Medical School,” by Joseph Goldstein.

Joanne Kenen: Axios’ “An Unexpected Finding Suggests Full Moons May Actually Be Tough on Hospitals,” by Tina Reed.

Riley Griffin: Bloomberg News’ “US Seeks to Limit China’s Access to Americans’ Personal Data,” by Riley Griffin and Mackenzie Hawkins.

Also mentioned on this week’s podcast:

Credits Francis Ying Audio producer Emmarie Huetteman Editor

To hear all our podcasts, click here.

And subscribe to KFF Health News’ “What the Health?” on SpotifyApple PodcastsPocket Casts, or wherever you listen to podcasts.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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This story can be republished for free (details).

Biden-Harris Administration Issues Final Guidance to Help People with Medicare Prescription Drug Coverage Manage Prescription Drug Costs

HHS Gov News - February 29, 2024
The Centers for Medicare & Medicaid Services (CMS) released the final part one guidance for the new Medicare
Prescription Payment Plan

In Wake of Alabama Supreme Court IVF Decision, U.S. Health and Human Services Secretary Xavier Becerra Visits Birmingham

HHS Gov News - February 29, 2024
In Birmingham, Secretary Becerra hears from families and health care professionals impacted by the court’s decision

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