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Wednesday, December 8, 2021

POLITICO NIGHTLY: Biden’s big decision on the opioid crisis

 


 
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BY RENUKA RAYASAM

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UnitedHealth Group

A deposit box for used hypodermic needles stands in a park in the South Bronx in New York City.

A deposit box for used hypodermic needles stands in a park in the South Bronx in New York City. | Spencer Platt/Getty Images

JUST SAY MAYBE Last week New York City became home to the first two sites in the country where drug users can take illegal drugs under the supervision of staff trained to reverse overdoses. Rhode Island plans to open a similar site next year, under a two-year pilot program. And about a dozen localities are considering the controversial idea, which advocates say can lower overdose deaths but which critics say promotes illegal drug use.

The Trump administration vocally opposed such supervised injections, saying they violated the “crack house statute” — legislation that Joe Biden crafted as a senator in the 1980s. So far, the Biden administration has remained silent on whether it would allow the sites to operate.

But in the coming weeks, a lingering Trump administration case against a proposed Philadelphia injection site called Safehouse could force the Biden administration to decide whether it is willing to quietly condone the practice. The Department of Justice is supposed to file a brief stating its position in the case by Jan. 5 — the department refused to comment to Nightly on its plans. If the Biden administration drops its opposition to Safehouse in court, that would pave the way for more such sites to open up around the country.

Supervised injection sites are just the newest example of how the ongoing overdose death crisis is fraying the bipartisan resolve that developed during the first wave of opioid deaths in the 1990s and 2000s. The sites are also testing the Biden administration’s willingness to dismantle “war on drugs” policies that often interfere with localities’ efforts to lower deaths from drug overdoses.

The opioid crisis is worse than it has ever been, but as it has moved from a prescription drug crisis to a street drug one, it’s become far more complicated — and controversial — to solve.

When the opioid overdose crisis was rooted in the realm of prescription drugs there was an easy, agreed-upon villain. Federal and state officials, Republicans and Democrats alike, wanted to crack down on the doctors and pharmacies running pill mills and to file lawsuits against pharma companies for flooding towns with addictive painkillers. The nation directed its ire — and investigative, award-winning stories, books and documentaries — at the Sackler family.

Now, the problem has migrated from brand-name pain pills like Oxycontin to illicit street drugs like heroin and, now, mostly fentanyl. Opioid prescriptions plummeted 44.4 percent between 2011 and 2020, yet overdose deaths soared as people suffering from addiction migrated to deadlier alternative highs. Overdose deaths topped 100,000 between April 2020 and April 2021 — the highest level ever recorded. Deaths are surging among Black and Indigenous populations, in big cities across the country.

Policies designed to stop the pharmaceutical drug crisis could now be backfiring, driving people to street drugs, addiction experts say. That approach of limiting access to powerful painkillers has also made medications used to treat opioid addiction, like methadone and buprenorphine, which are forms of opioids themselves, harder to get.

“My patients have gotten arrested for buprenorphine that I have prescribed for them,” said Daliah Heller, director of drug use initiatives at Vital Strategies. Meanwhile fentanyl is cheap, powerful and ubiquitous, making it a more attractive alternative to someone in withdrawal.

The supervised injection sites in New York and Rhode Island fall into a broad category of policy called harm reduction, which adopts the guiding philosophy of just keeping drug users alive so that they have a chance to seek addiction treatment before they die. Addiction experts say these sorts of policies — like supplying fresh needles for heroin addicts and strips that help users determine whether their narcotics are laced with fentanyl — are the country’s best shot of reducing deaths from overdoses. The bulk of the evidence is on their side, they say.

“It works and it improves outcomes,” Nora Volkow, director of the National Institute on Drug Abuse, told Nightly about harm reduction broadly. Volkow was optimistic about safe injection sites but said they still needed to be studied.

Even so, backlash to such policies is mounting. The Safehouse site in South Philadelphia is facing opposition in the neighborhood where it was planning to locate.

The Biden administration is trying to tread cautiously, though it is the first administration to embrace harm reduction. Biden’s drug czar, Rahul Gupta, has been criticized for his role in shutting down the state’s largest syringe services program when he ran West Virginia’s health department. These are programs that often get their start underground, operating in legal gray areas first, making them politically problematic, said Leo Beletsky, a health law professor at Northeastern University School of Law.

It’s one thing for policymakers to agree to crack down on overprescribing doctors or misleading pharma companies, but it’s far more politically risky for them to take steps that condone illegal drug use.

“We’re not ambitious enough,” said Paul Joudrey, an assistant professor in the Yale School of Medicine who is a drug use, addiction, and HIV research scholar. “We don’t propose changes that match the scale of the epidemic.”

Treating addiction is hard and complicated. The fundamental challenge is dealing with the things that drive people to take painkillers in the first place. People use drugs to cope with loneliness, lasting trauma and other psychological wounds. That is part of the reason why drug deaths soared during pandemic lockdowns, and why the numbers are likely to stay persistently high for years to come, Heller said.

“I started my career during the AIDS epidemic,” said Judith Feinberg, professor of behavioral medicine and psychiatry at West Virginia University. “This is the same kind of tragedy. It’s worse really. It’s horrendous.”

Welcome to POLITICO Nightly. Reach out with news, tips and ideas at nightly@politico.com. Or contact tonight’s author at rrayasam@politico.com, or on Twitter at @RenuRayasam.

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WHAT'D I MISS?

— McConnell secures GOP support for new debt strategy: Mitch McConnell believes he’s convinced a skeptical Senate Republican Conference to allow Democrats to more easily raise the debt ceiling , a critical development as the country faces a mid-December debt cliff. The Senate minority leader spent today selling his members on a convoluted strategy that would require at least 10 Republicans to approve legislation that would later allow Senate Democrats to raise the debt ceiling by a simple majority vote. After a leadership meeting and a Senate GOP lunch, McConnell said he’d done enough work to clinch the deal in a vote expected on Thursday.

— Biden warns Putin on call against Ukraine invasion: Biden warned Russian President Vladimir Putin today that the United States and European allies would join together to impose “strong” economic penalties and other punitive actions on Russia should it mount an invasion of Ukraine . In a highly anticipated secure video call, Biden “voiced the deep concerns of the United States and our European Allies about Russia’s escalation of forces surrounding Ukraine and made clear that the U.S. and our Allies would respond with strong economic and other measures in the event of military escalation,” according to a White House readout.

— Biden bank cop nominee withdraws after pushback from moderate Dems: Biden’s choice for a key role policing the nation’s banks withdrew her nomination today after facing pushback from several moderate Democrats, a rare defeat for the president on one of his personnel choices. Saule Omarova’s nomination as comptroller of the currency also met with fierce resistance from Republicans and business groups over her advocacy for a dominant role for government in finance, views that didn’t sit well with some Democrats either.

 

BECOME A GLOBAL INSIDER: The world is more connected than ever. It has never been more essential to identify, unpack and analyze important news, trends and decisions shaping our future — and we’ve got you covered! Every Monday, Wednesday and Friday, Global Insider author Ryan Heath navigates the global news maze and connects you to power players and events changing our world. Don’t miss out on this influential global community. Subscribe now.

 
 

— Judge sets July 18 for Bannon ‘contempt of Congress’ trial: President Donald Trump’s former adviser Steve Bannon will go to trial July 18 on criminal charges that he defied a subpoena from the House committee exploring the causes of the Jan. 6 attack on the Capitol and Trump’s attempt to subvert the 2020 election, a judge ordered today. Judge Carl Nichols set the mid-summer schedule after Bannon’s lawyers and Justice Department attorneys wrangled over how quickly the contempt of Congress case should move.

— Lawmakers rush to avert looming Medicare cuts: Congress reached a deal today to avert billions of dollars in impending Medicare cuts to hospitals, doctors and other providers that are set to take effect early next year. The Supporting Health Care Providers During the Covid-19 Pandemic Act, which has bipartisan support from leadership in the House and Senate, would blunt some of the cuts — but not all. The deal comes amid the uncertainty of the Omicron variant and a fresh wave of Covid infections that has put nearly 60,000 people in hospitals.

— Suspect in Jamal Khashoggi murder arrested in Paris: French authorities have arrested one of the men suspected of involvement in the murder of journalist Jamal Khashoggi, according to local media reports. Khaled Aedh Al-Otaibi, a former member of the Saudi royal guard, was taken into custody this morning at Paris’ Charles de Gaulle airport, where he was traveling under his own name on the way to Riyadh, the Saudi capital.

 

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AROUND THE WORLD

Olaf Scholz (C) of the German Social Democrats, Robert Habeck (L) of the Greens Party and Christian Lindner (R) of the German Free Democrats arrive to speak to the media following the official signing of the coalition agreement between the three parties  in Berlin.

Olaf Scholz (C) of the German Social Democrats, Robert Habeck (L) of the Greens Party and Christian Lindner (R) of the German Free Democrats arrive to speak to the media following the official signing of the coalition agreement between the three parties in Berlin. | Carsten Koall/Getty Images

SCHOLZ TALKS TOUGH ON RUSSIA Incoming German Chancellor Olaf Scholz urged Russia today to respect the “integrity” of Ukraine’s borders and stressed that “a threat to Ukraine” would be “unacceptable,” Hans von der Burchard writes.

One day ahead of his formal election as chancellor, Scholz spoke at a press conference in Berlin during which he vowed to advance Europe’s interests and called on Russia to de-escalate tensions with Ukraine but shied away from bluntly criticizing China.

Reacting to the Russian troop build-up at the Ukrainian border and concerns about a potentially imminent invasion, Scholz demanded that “the integrity and invulnerability of borders” must be ensured.

“It’s very important that no one pores over history books to redraw borders,” he said, adding: “Of course, we in Germany, just like everyone else in Europe and the United States, are very concerned about the troop movements that we are seeing on the Ukrainian border. Therefore, it must be very clear that this would be an unacceptable situation if there were a threat to Ukraine.”

One aspect of the tense situation is the Russia-to-Germany Nord Stream 2 gas pipeline, which Kyiv warns could decrease Moscow’s barriers to invasion since Russia currently relies on transiting gas through Ukraine. Pressed on the matter, Scholz said he felt bound to outgoing Chancellor Angela Merkel’s commitments on the near-ready pipeline, including her insistence that Germany could sanction Russia if it uses natural gas “as a geopolitical weapon” against Ukraine.

 

STEP INSIDE THE WEST WING: What's really happening in West Wing offices? Find out who's up, who's down, and who really has the president’s ear in our West Wing Playbook newsletter, the insider's guide to the Biden White House and Cabinet. For buzzy nuggets and details that you won't find anywhere else, subscribe today.

 
 
NIGHTLY NUMBER

9:45 a.m. Thursday

The arrival time for former Sen. Bob Dole’s body to the Capitol to lie in state, according to a schedule from Nancy Pelosi and Chuck Schumer. Biden is scheduled to deliver remarks at a congressional tribute ceremony Thursday morning.

PARTING WORDS

A Christmas tree stands illuminated outside number 10 Downing Street in London.

A Christmas tree stands illuminated outside number 10 Downing Street in London. | Dan Kitwood/Getty Images

NO. 10 FOR THE HOLIDAYS — Boris Johnson’s staff joked about a Christmas party at Downing Street at the height of last year’s coronavirus lockdown in England, newly released video footage shows.

It comes after the U.K. prime minister’s office spent days denying claims, first reported in the Mirror, that a party was held for staff last Christmas, Esther Webber writes. The film — published by ITV News today — shows senior No.10 employees taking part in a December 2020 rehearsal for a press briefing.

Ed Oldfield, adviser to the prime minister, asks Johnson’s then-spokesperson Allegra Stratton: “I’ve just seen reports on Twitter that there was a Downing Street Christmas party on Friday night. Do you recognize those reports?”

In the footage, Stratton replies “I went home,” before composing herself and telling colleagues to “hold on” as she appears to consider what her answer should be. Oldfield then asks: “Would the prime minister condone having a Christmas party?”

Stratton laughs, looking down, before responding, “What’s the answer?” Staff then attempt to help the PM’s then-spokesperson formulate a response. “It wasn’t a party, it was cheese and wine,” suggests one.

The Times carried a story today saying a party in No. 10 had been organized by civil servants and included a secret Santa. Press reports suggest 30 to 40 people were in attendance, at a time when social events including parties were strictly banned under England’s coronavirus restrictions.

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