Tentative opioid lawsuit settlement announced as deaths from drug overdose climb

Cities and county governments are in line to receive most of North Carolina’s share of the $26 billion opioid lawsuit settlement announced this week.

A bipartisan group of state attorneys general agreed to settle lawsuits with drug maker Johnson & Johnson and drug distributors AmerisourceBergen, Cardinal Health, and McKesson. The three distributors together will pay $21 billion over 18 years, and the Johnson & Johnson would pay $5 billion over nine years, with $3.7 billion paid in the first three years.

North Carolina Attorney General Josh Stein was one of the chief negotiators.

At least 44 states, 95% of cities and counties suing, and others suing the companies must sign on to the agreement to get part of the money, according to The Council of State Governments. States have a month to sign on, and cities and counties have 150 days.

North Carolina would be eligible for up to $750 million, with 80% going to all counties and 17 municipalities, 15% going to the state, which the legislature would use to address the opioid epidemic, and 5% going into an incentive fund to get local governments to sign on. The NC Association of County Commissioners is urging counties to sign.

Each local government would have to create a separate fund for the money and use it for opioid-related expenses.

The first payments are expected to arrive in April 2022, according to Stein’s office.

Lawsuits claimed that drug makers and distributors hold responsibility for helping fuel the opioid epidemic. The companies deny responsibility.

Even as this group of  lawsuits connected to opioid sales and distribution took a step toward conclusion, hospitalizations and deaths from drug overdose climbed.

Shortly before the tentative settlement was announced, the Centers for Disease Control and Prevention released data showing a sharp rise in overdose deaths last year. Drug overdose death in the US increased more than 29% in 2020. In North Carolina, the increase was nearly 35%, with more than 3,000 reported deaths from overdose.

The COVID-19 pandemic has overshadowed the opioid epidemic, but the NC Department of Health and Human Services continues to update the Opioid Action Plan it first released in 2017.

The May 2021 update says that 62% of overdose deaths in 2019 involved two or more substances. While overdoses from commonly prescribed opioids are declining, overdoses from heroin, fentanyl, and fentanyl-type drugs are spiking, according to the updated report.

In the first three months of 2021, emergency hospital visits for opioid overdoses in the state were 22% higher than the first three months of 2020, according to preliminary data.

The updated action plan widens the focus to include substances in addition to opioids, and looks to expand drug treatment, prevention, and harm reduction for historically marginalized communities.

The Senate’s proposed budget takes a step to tackle period poverty

As a new student at NC A&T State University, Lena Vann learned how difficult it was to find affordable menstrual supplies.

“As a college student, they were not always accessible or available to me,” she said.

That experience and attending a school with activism in its DNA led Vann to start The Black Period Project, an organization that provides supplies to schools – mostly to Title 1 middle schools in the Triad. The Black Period Project started in 2019 and since that time has delivered hundreds of packs of pads, liners, and wipes along with a resource card so students would know which adults in the school were storing them.

When school buildings were closed in the pandemic, the project delivered hygiene packs to student food pick-up points.

Vann, now a rising senior, said she always keeps hygiene kits in her car for homeless menstruators.

“As someone who feels privileged to attend school, I thought, what about people who can’t advocate for themselves? What about young girls or trans boys? Who is helping them? When I looked at the period advocacy space, there were not a lot of Black women or young Black women. I decided in March 2019 it was going to be me.”

While period poverty for years has been framed as an international problem, there’s more awareness of its impact in the United States. Realizing that some students are missing school because they cannot afford period products, states have begun taking steps to ease some of the financial burden.

The Georgia legislature put $1.5 million in its budget this year for menstrual supplies for schools and community centers in low-income areas, the Atlanta Journal-Constitution reported.

A new Vermont law requires schools make the products free in female and gender-neutral bathrooms.

A handful of other states require schools to make supplies freely available in all public school bathrooms or in low-income schools.

In North Carolina, the Senate budget proposes to make $250,000 in grants available to schools for feminine hygiene products.

State Sen. Natalie Murdock, a Durham Democrat, proposed a bill that would make the money available. The state Department of Public Instruction supports the line item. Murdock said that GOP Sen. Deanna Ballard, who helps lead the Senate’s education budget committee, advocated for including the money in the Senate spending plan.

Murdock said she considers the $250,000 funding a pilot project to see who applies for the money. An immediate focus is trying to keep the proposal in the version of the budget the House is writing.

“This pilot program is the first step. We need to take this issue of period poverty seriously, and follow our neighbors such as Georgia,” she said.

Diaper Bank of North Carolina started On the Spot in 2016, delivering period products to schools that want them. Diaper Bank executive director Michelle Old said it would probably cost about $500,000 to supply all the schools.

Teachers in middle and high schools know some menstruating students miss school because they cannot afford hygiene products, Old said.

“We really feel that period supplies are school supplies and dignity is not a privilege and it is not something that menstruating individuals should have to make a choice about,” Old said.

Report: Black patients get more bed sores and infections than white patients at the same hospital

Image: Robert Wood Johnson Foundation

Black patients are more likely to suffer hospital injuries such as bed sores and post-surgery health problems than are white patients treated at the same hospital.

An Urban Institute report released Tuesday on disproportionate rates of injury among Black patients is based on discharge records from hospitals in 26 states including North Carolina. The Urban Institute is a nonprofit research organization based in Washington, DC.

The study looked at differences in seven surgery-related complications and four general safety measures. Black patients fared worse for four of the seven surgery-related complications and two of the four general indicators.

“Even when admitted to the same hospital, Black patients experience higher rates of hospital acquired injuries or illnesses occurring during or shortly after surgical procedures relative to white patients,” the report says.

Compared to white patients, Black patients had statistically significant higher rates of respiratory failure after surgery, sepsis, dangerous blood clots in leg veins or lung arteries, and bleeding. Black patients were 18% more likely to go into respiratory failure after surgery and 27% more likely to develop sepsis than white patients treated at the same hospitals.

Black patients were more likely to get bed sores and blood-stream infections related to catheters that reach close to or go inside the heart.

The analysis is based on 2017 data and does not include information from some big states, including Texas, New York, or California.

Racism is at the root of these disparities, said Anuj Gangopadhyaya, the report’s author.

“There’s no way that it’s not,” he said. “The question is, who is the actor? This is a symptom not of one or a handful of actors. It’s a system of racism executed across institutions, across providers, and across payers.”

Other researchers have found that Black children are more likely than white children to die after major surgery. Black patients are more likely to have surgery at hospitals that have higher mortality rates and are located in segregated areas.

The latest Urban Institute report found disparities in how Black and white patients fared when they used the same type of insurance. And hospitals’ overall patient demographics didn’t matter. Black patients had higher rates of surgery-related health problems in hospitals that treated larger shares of Black patients, hospitals that treated smaller shares of Black patients, and in hospitals that had higher proportions of patients with private insurance.

Insurers could play a part in reducing racial disparities, Gangopadhyaya said in an interview.

The federal Centers for Medicare & Medicaid Services has a pay-for-performance program that links Medicare payments to hospital quality. It reduces payments to hospitals with low performance based in part on how often their patients get infections.

Gangopadhyaya said insurers could develop policies that more directly address racial inequities.

Some data on patient outcomes at specific hospitals is publicly available, but information comparing outcomes for patients of different races isn’t easy to find, Gangopadhyaya said.

“If I’m a Black patient, what are the measures for Black patients?” he said. “It’s hard to determine where quality of care is good for patients that look like you or are insured like you.”

NC Senate leader wants to ban consideration of race in UNC admissions and government contracting

Senate leader Phil Berger said the Senate will propose a state constitutional amendment similar to a California ballot initiative that triggered a decline in underrepresented minority students earning undergraduate and graduate degrees and resulted in fewer public contracts going to minority- and women-owned businesses.

At news conference Wednesday centered on critical race theory in public schools, Berger said the Senate would propose a constitutional amendment similar to what were called civil rights initiatives in California and Michigan.

California in 1996 passed a constitutional ban on affirmative action in school admissions and public contracting. The proposed North Carolina constitutional amendment in Berger’s Medium post is identical to the California amendment language:

“The state shall not discriminate against, or grant preferential treatment to, an individual or group on the basis of race, sex, color ethnicity, or national origin in the operation of public employment, public education or public contracting.”

Berger, a Republican, said the intent was for the proposed amendment to appear on the next primary ballot.

The president of the North Carolina NAACP, in a statement, condemned the proposal.

“The continued frontal assaults on humanity levied by the rogue leader of the Senate is evidence of a man leading from his fears,” said the Rev. Dr. T. Anthony Spearman.  “It is apparent that the more wrenches he can toss into an already broken democratic system the better off he thinks they are. Perhaps this will be the catalyst that will cause the eyes of NC to pop open and exercise their right to vote.”

Gov. Roy Cooper, a Democrat, signed an executive order in 2017 stating a goal of obtaining 10% of state purchases from historically underutilized businesses. The order also established an advisory council on under-utilized businesses.

A 2015 study for the Equal Justice Society found that the California amendment resulted in a minority- and women-owned businesses losing $1 billion to $1.1 billion a year in state and local contracts, in 2015 dollars.

Students for Fair Admissions is suing UNC-Chapel Hill in federal court for  considering race in admissions. UNC-Chapel Hill considers race as one of many factors, according to the university.

Edward Blum, an affirmative-action opponent, started Students for Fair Admissions. It is also suing  Harvard University. The First Circuit Court of Appeals upheld Harvard’s admissions process in a decision last November.

A federal District Court judge held a hearing in the UNC-Chapel Hill case last year.

The NC Justice Center is co-counsel representing alumni of color who have intervened in the lawsuit. NC Policy Watch is a project of the NC Justice Center.

After California passed its ban, applications by Black, American Indian, Chicano, and other Latinos to University of California schools dropped, according to a 2015 study by authors at UC-Riverside and the Civil Rights Project at UCLA.

Most under-represented minority students became at least 40% less likely to be admitted to the more selective UC-Berkeley and UCLA campuses, according to a 2020 study from an economist with the Center for Studies in Higher Education at UC-Berkeley. That started a cascade of under-represented minority student enrollment in less-selective colleges.

“Prop 209 caused a substantial decline in the number of high-earning early-career URM Californians that persists more than 20 years later,” the study concluded.

If North Carolina were to ban consideration of race, admissions of students of color would decline at UNC-Chapel Hill,  said Jack Holtzman, an NC Justice Center attorney.

UNC does not use a quota system, he said.

“No specific seats are reserved. That is long gone. Everybody is reviewed with the same process. It is a matter of whether a university would be allowed to look at the whole student, including whether they have experienced racism,” he said.

Experiencing diversity at the university “is part of the complete education of our students,” he said.

Ongoing COVID-19 emergency declaration is keeping thousands of NC residents better fed

Image: AdobeStock

Enhanced SNAP benefits are taking a bite out of hunger

The extended COVID-19 state of emergency in North Carolina declared by Gov. Cooper means that people who need help buying food will continue to receive enhanced benefits from the federal nutrition program.

Residents of states with emergency declarations receive “emergency allotments” from the Supplemental Nutrition Assistance Program (SNAP), which used to be called food stamps.

The American Rescue Plan extended the emergency allotments to September 1. The boost in food purchasing power hinges on both federal and state declarations of emergency remaining in place.

According to information North Carolina provided the federal government, the state expected 784,261 households to receive emergency allotments in June that total $134.7 million. The state estimated that 797,102 households would receive emergency allotments in July that would total $138.4 million.

Some states have canceled their emergency declarations, triggering the end of their supplemental SNAP benefits.

All SNAP households receive emergency allotments that added at least $95 to their monthly benefits. The additional benefits were included in the March 2020 federal coronavirus response act. Some households were excluded by the Trump administration. The Biden administration made all SNAP households eligible. Additionally, federal legislation from December 2020 added 15% to the maximum benefit. The US Department of Agriculture, which administers SNAP, estimated that the 15% increase for North Carolinians amounts to an average of $28 per month for each person.

SNAP benefits were temporarily increased after the Great Recession. USDA researchers found that low-income households increased spending on food by 5.4% and that food insecurity declined by 2.2 percentage points from 2008 to 2009.

Food insecurity increased as the COVID-19 pandemic forced people out of work. Eighteen percent of people who responded to an NC Central University poll last fall said they had been running short of food.

As infections drop with vaccine distribution, some routines of pre-pandemic life have returned. But people still need help getting all the food they need, said Jacquelyn Blackwell, co-coordinator of End Hunger Durham and executive director of the food bank Feed My Sheep.

The increased SNAP benefit has especially helped older people who without the extra emergency money often must choose between buying vegetables and fruits and buying meat, Blackwell said.

“It’s really helped stretch their budgets,” she said.

Feed My Sheep is open every second and fourth Saturday. In June, the food bank was continuing to see 100 to 125 people come in on those days, numbers largely unchanged from the height of the pandemic. More people come to the food bank at the end of the month when federal benefits are depleted, she said.

Lindsey Haynes-Maslow

The increased food benefit can have a huge impact on people’s lives, said Lindsey Haynes-Maslow, associate professor and extension specialist at NC State University.

The USDA ran a demonstration project starting in 2011 that provided monthly food benefits of $30 a month or $60 a month to children in the summertime when they did not receive free or reduced-price meals at school. It found that as little as $30 a month reduced food insecurity and resulted in the children eating more fruits, vegetables and whole grains.

A nutritious diet is key to maintaining good health, Haynes-Maslow said. Unhealthy diets have been linked to heart disease, high blood pressure, and strokes.

“If we don’t end up investing in the prevention side, we might end up paying on the insurance side,” she said. “You pay a little now, or you can pay a lot later, if there are health related issues.”

In the American Journal of Clinical Nutrition last August, California researchers wrote that increased food insecurity in Black, Hispanic, and low-income households will likely outlast COVID-19 pandemic restrictions.

More people in North Carolina reported sometimes or often not having enough food in June than they did in April this year, according to the US Census Household Pulse Survey.

The California researchers said the deeper and longer-lasting food insecurity brought on by the pandemic could result in increased illness and death.

A food program called P-BET that provides additional food benefits for children who are eligible to receive free or reduced-price school meals has been extended through the summer in North Carolina.

Researchers at the Sanford Center for Public Policy at Duke University in research published in 2018 found a connection between performance on standardized tests and the timing of food benefits.

They said their findings suggested that increasing benefits would help improve academic achievement for low-income students.

Looking at North Carolina students’ end-of-grade test scores, they found that test performance peaked  for children whose families used SNAP a few weeks after their families received their benefit transfers. EBT (Electronic Benefit Transfer) cards, which look like debit cards, are used to buy groceries.

The test score peaks were at 19 days post-transfer for math and at 17 days for reading.

Students were more likely to achieve scores showing grade-level proficiency when they took the reading test 16 days after benefit transfers. They were most likely to show grade-level proficiency in math when they took the test 20 days after benefit transfers.

The findings suggested that increasing benefits would improve academic achievement for low-income students, the researchers wrote.