News, public health

State health experts ask Congress for help combating opioid crisis

WASHINGTON — North Carolina and other states need sustained, flexible federal funding to support programs working to reduce deaths and addiction from opioids and other drugs, state health officials told Congress today.

Public health officials asked lawmakers for continued commitment to Medicaid and programs that help states address drug addiction problems. A panel of the U.S. House Energy and Commerce Committee held a hearing on the issue.

“Moving an entire system of care is a monumental task. We’re working diligently and we’ve made staggering progress, but please don’t give up,” Jennifer Smith, secretary for the Pennsylvania Department of Drug and Alcohol Programs, told lawmakers. “It depends on sustained funding and support.”

States, particularly North Carolina, have been trying to respond to a growing problem of addiction and overdose to opioids and other drugs. From 1999 to 2017, nearly 400,000 people across the United States died from opioid overdoses, according to the Centers for Disease Control and Prevention.

Federal lawmakers passed a collection of bipartisan bills in 2018 aimed at fighting the crisis. The legislation provided states billions of dollars in federal funding to assist with response, treatment and recovery.  

State public health officials from Pennsylvania, Massachusetts, Rhode Island and West Virginia also credited Medicaid expansion in their states for giving them the ability to pay to treat many of those who face addiction.

Rep. Diane DeGette (D-Colo.), who chaired the hearing, said states are now facing a “fourth wave” of the opioid crisis: a large increase in methamphetamine use.  

“In 2018, there were more than twice as many deaths involving meth as 2015, and meth is increasingly turning up in overdose deaths and drug busts across the country,” DeGette said. 

“Given the complexity of the epidemic and its ability to evolve, states, federal government agencies and Congress must remain vigilant.”

“This is not a crisis that we can resolve overnight, and it requires ongoing federal and state attention,” said Energy and Commerce Committee Chairman Frank Pallone (D-N.J.). “States are on the front lines of this national emergency, providing much of the support for those in need.  They are our eyes and ears on what is occurring on the ground, and that’s why this hearing is so important.”

Over the past two decades, North Carolina has had 12,000 deaths due to opioid overdose, according to the North Carolina Department of Health and Human Services (DHHS).  In 2016, North Carolina was in the top eight states for fentanyl overdose deaths alone.

“North Carolina was hard hit by the opioid crisis. The consequences have been large, and far reaching,” said Kody Kinsley, a DHHS deputy secretary.

In 2016, 1,407 people died in North Carolina due to unintended overdoses. For each death, there were six more hospitalizations, Kinsley said. But in 2018, North Carolina saw its first decline in deaths in five years. 

“The most significant thing you can do would be to give us more time. Sustaining funding over longer windows of time or permanently would allow states to be ready for the next wave of the epidemic,” Kinsley said. 

Kinsley asked for lawmakers to increase the substance abuse and treatment block grants, which have stayed constant for North Carolina even though the population is growing. 

Kinsley said an even bigger boost would be for North Carolina lawmakers to expand Medicaid. More than half of the people who come to North Carolina hospitals with an overdose are uninsured, so much of the extra federal funding for opioids in North Carolina goes directly to their treatment. North Carolina provided treatment to 12,000 uninsured persons with the federal programs.

But that also means that money is not available to start new programs like other states that rely on Medicaid to treat their patients, like Pennsylvania and Rhode Island.

“At present, more than two-thirds of our federal opioid response grants are just going for treatment and expanding care for those that are uninsured,” Kinsley said. “So we do not have those dollars available to expand workforce and treatment.”

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Education, News, public health

Editorial: Time to roll up our sleeves and strengthen the laws that require vaccinations for school children

With a new school year right around the corner, the editorial board of the Greensboro News & Record reminds us of the need to listen to our medical professionals when it comes to vaccinating our children.

The numbers won’t be crunched for a few months, but officials fear that the disturbing trend of the last few years will continue. The percentage of children who have not been vaccinated is rising, despite the efforts of public health and school officials and despite reams of evidence from medical professionals showing that vaccinations are safe and effective.

Exemptions to the law are allowed for two reasons: medical and religious. Medical exemptions require documentation that the child has an allergy or some other condition that makes vaccination unsafe. Only about 1 in 1,000 children have a medical exemption.

The alarming increase is in the exemptions for religious reasons. All parents need to do to obtain a religious exemption is write a statement of their religious objections.

Last year, about 1 out of 300 North Carolina students were granted such exemptions.

We’ve already seen what can happen. Buncombe County, with the highest rate of parents requesting religious exemptions, had the largest outbreak of chickenpox in North Carolina since that vaccine became available. Buncombe County also had an outbreak of pertussis, called whooping cough in the bad old days when it was sometimes fatal to infants.

Officials consider the vaccines that prevent many childhood diseases to be one of the greatest public health success stories of recent decades. These diseases are not to be taken lightly.

Measles used to kill children and leave others blind or with neurological problems. Chickenpox can necessitate amputations, cause shingles later in life, and even kill infants and people with weakened immune systems. The list goes on.

Why would parents deliberately not take advantage of vaccines to prevent these diseases? Sincere religious beliefs probably figure in a few cases, but it’s likely that junk science, conspiracy theories and social media play a much bigger role.

Many of the so-called anti-vaxxers have bought in to the misinformation campaign started by the thoroughly discredited research of Andrew Wakefield, a former British physician who in 1998 published a “study” in The Lancet, a medical journal, claiming a link between the vaccine for measles, mumps and rubella — often simply called MMR — and autism. The Lancet later retracted the “study” as false, and Wakefield lost his medical license. But the myths keep circulating, despite extensive new research showing there is no link, and that the MMR vaccination saves lives.

Some parents selfishly decide not to have their children vaccinated, believing that since most others are vaccinated, their children will be safe. That’s a false assumption, as the outbreaks in Asheville prove.

The very success of vaccinations makes some parents think they aren’t necessary. Today’s parents grew up without experiencing those diseases or having known friends who died or were permanently damaged by them. They don’t see the diseases as a real threat, despite what public health officials try to tell us.

But skipped vaccinations endanger not just their own children but also others — infants, pregnant women and those who legitimately can’t take vaccines.

State officials should strengthen the sensible laws that require vaccinations for children to attend any school, whether public, charter or private.

Today’s children face enough dangers; why add an easily preventable disease to the list?

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Environment, News, public health

Scientists recommend expanding investigation of suspected thyroid cancer clusters in NC

Source: National Cancer Institute

North Carolina health officials should expand their investigations of suspected thyroid cancer clusters, including potential environmental causes such as coal ash, according to recommendations by a panel of doctors, scientists and medical investigators. 

The panel, many members of which are from North Carolina, convened in May and issued its report last week.

The state’s Central Cancer Registry statistics show that for the past 23 years Iredell County has reported statistically higher incidences of papillary thyroid cancer than the state average, as much as double or three times greater. In May 2018, state and county health officials designated two zip codes near Lake Norman — 28115 and 28117 — as suspected cancer clusters.

There were 260 cases of thyroid cancer diagnosed in those two zip codes from 1995 to 2016; statistically, the expected number was 124.  From 2012 to 2016, 110 cases were reported, compared to 46, the number expected.

Many of the thyroid cancer cases in Iredell County were reported among teenage girls. Although thyroid cancer rates are rising nationwide, it is still largely a disease of middle age, afflicting primarily women over 50. It is unusual for young women to develop it.

Sen. Vickie Sawyer, a Republican from Iredell County, co-sponsored Senate Bill 297, which directs the NC Policy Collaboratory to assemble a research team to help determine whether cancer clusters exist in the state, and where. The bill had bipartisan support, including several Democratic secondary sponsors, and passed both chambers. The measure was sent to the governor on July 11.

Source: National Cancer Institute

Although North Carolina as a whole ranks low among states for thyroid cancer incidences among women under 50, several counties are outliers. Elevated rates of thyroid cancer have also been reported in Rowan County, directly east of Iredell, and in five counties in southeastern North Carolina: Brunswick, New Hanover, Pender, Onslow and Duplin.

Cancer clusters are hard to pinpoint, especially in areas where people move frequently. Other environmental, lifestyle and genetic factors can also play a role in the development of cancer. The only known environmental risk factor for thyroid cancer is radiation.

Nonetheless, the panel identified ways to at least partially overcome some of those obstacles, including more detailed population studies to compare areas with elevated cancer rates and those without. These studies should also involve neighboring states to account for possible patterns in border counties.

Calculating cancer rates is dependent on accurate data. The panel said doctors should be encouraged to provide timely, consistent reporting of cancer cases to the state registry. And access to health care can also skew the results. The panel advised that future investigations should examine the role of health care access plays in cancer diagnoses.

“Areas with strong access to health care and cancer screening sometimes report higher rates of cancer than areas without such services,” the recommendations read. “Identifying areas where there are many medical practices can provide insight into how medical surveillance may contribute to thyroid cancer diagnosis.”

University scientists have already begun studying possible environmental links to the high rate of thyroid cancer in Iredell County. Heather Stapleton and Kate Hoffman, scientists at Duke University, found three homes where people had been recently diagnosed with thyroid cancer also had significantly elevated levels of compounds used in flame retardants.

Susan Wind’s teenage daughter was among the 110 people diagnosed with thyroid cancer in the affected zip codes within the last five years. Wind raised $110,000 for Stapleton’s study and has been an outspoken proponent for a detailed study of the clusters. “I believe the state should fund this research, too,” said Wind, whose family recently moved out of North Carolina because of concerns about the number of cancer cases — of several types — in their neighborhood. “It should not have to be from a private citizen whose kids got cancer. So once this study runs out of money, what is the state going to do next?”

The budget bill, still hung up over Medicaid expansion and other matters, contains no funding for studying suspected thyroid cancer clusters, though it does include $100,000 for a study of a suspected cancer cluster involving ocular melanoma in the Mecklenburg County town of Huntersville.

The panel advised the state to also investigate “potential associations” between exposure to coal ash, coal burning emissions, and papillary thyroid cancer. The two affected zip codes in Iredell County are close to Lake Norman, the site of Duke Energy’s Marshall Steam Plant. Coal ash was also widely used as structural fill throughout Iredell County.

“Given the concerns in North Carolina communities about the potential health effects of exposure to coal ash,” whose compounds can emit radiation when they decay, the recommendations read, more study is warranted. “Such studies should consider the most likely ways that people are exposed to harmful chemicals associated with coal ash: breathing them in or drinking contaminated water.”

Wind said the amount of coal ash used as fill in Iredell County was not fully documented. “It was a common practice to use coal ash like dirt, dumped in fields and sold as top soil for flower beds,” she said. “This sounds like a good hypothesis to test.”

UNC and Virginia Tech researchers recently found that more than three-quarters of 786 drinking water wells tested in Iredell County had levels of Chromium 6 above the state health advisory level of 0.07 parts per billion. Chromium 6 both occurs naturally and is present in coal ash.

Eighty-five percent of Iredell County wells had levels of vanadium, also naturally occurring and found in coal ash, above 0.3 ppb, the state’s interim maximum concentration for groundwater.

A spokeswoman for the Department of Health and Human Services said the agency “is reviewing the input from the panel and identifying the role we can play in helping to move these recommendations forward.”

[Note: This story has been updated to make clear that the proposed budget bill includes funding to study a suspected cancer cluster involving ocular melanoma in the town of Huntersville.]

News, public health

Remembering a voice who spoke for those in dire need of healthcare

Dr. Charles van der Horst

On Tuesday, friends and family gathered at Beth El Synagogue in Durham to honor the life and legacy of Dr. Charles van der Horst.

Van der Horst, who died unexpectedly over the weekend in a swimming accident in New York, was a prominent voice for the uninsured and for Medicaid expansion in North Carolina.

The Raleigh News & Observer noted his career spanned decades and made a lasting impact:

Van der Horst was a preeminent UNC researcher and clinician who helped develop groundbreaking treatment protocols for HIV/AIDS and, after that once-terrifying virus had been tamed to a manageable disease, inspired a new generation of scientists to tackle Ebola. He was a compassionate doctor who turned a community service stint into a campaign to eradicate Hepatitis C in Wake County. He was a social justice advocate willing to go to jail to draw attention to the needs of the state’s uninsured.

NC Policy Watch got to know van der Horst in that last role, as a social justice advocate.

In 2017, he appeared on Policy Watch’s News & Views to discuss the wrongheaded approach by Republicans in Washington to gut the Affordable Care Act. Here’s an excerpt of that interview:

Governor Roy Cooper also remembered the doctor this week on Facebook: “Dr. Charlie Van Der Horst’s life and work were defined by compassion. From his time volunteering in North Carolina’s free clinics to his efforts on the front lines of the HIV/AIDS epidemic, he made our state and our world better.”

Van der Horst was 67.

Governor Roy Cooper, News, public health

At Opioid Summit, experts call for Medicaid expansion

A new “Opioid Action Plan 2.0” unveiled Wednesday by North Carolina officials aims to combat the lingering narcotic crisis with new, youth-targeted programs, tougher laws and greater access to the drug naloxone, used to treat or reverse opioid overdoses.

“I’m going to work with all of you to make sure that we reduce opioid deaths in North Carolina and that we meet this problem head on,” said Governor Roy Cooper at the opening of the 2019 Opioid Misuse and Overdose Prevention Summit, a conference supported by the North Carolina Department of Health and Human Services (DHHS).

The updated plan uses “feedback from partners and stakeholders,” according to a press release by the Governor’s Office.

The original N.C. Opioid Action Plan, released in 2017, identified the steps that the DHHS aimed to take in order to reduce the number of deaths from the opioid epidemic.

Officials introduced the new plan during the second and final day of the Opioid Summit.

At the opening of the summit Tuesday, Cooper highlighted the progress made since the plan was launched. According to Cooper, since 2017, the number of prescriptions for opioids has decreased by 24 percent and the number of emergency department visits for opioid overdoses decreased by nearly 10 percent from 2017 to 2018.

But the most important step, according to the DHHS? Medicaid expansion.

“We need to close the coverage gap if we are to make serious headway against this epidemic, as they have done in other states,” said Dr. Mandy Cohen, Secretary of the NC DHHS.

Numerous studies have shown that expanding Medicaid and closing the coverage gap has led to a decline in opioid overdoses by increasing substance use disorder treatment. According to the Opioid Action Plan 2.0, an estimated 89 percent of people who are in need of substance use disorder treatment do not receive it.

“The progress we’ve made shows what we can achieve when we partner across agencies and organizations and with those on the ground in communities,” said Cohen in a press release. “But there is much more to do. Moving forward we need to work even harder to focus on prevention, reduce harm and connect people to care.”