Brainstorm Health: Prescription Heroin, Joy of Cooking, Health Care Spending

December 6, 2018, 11:41 PM UTC

Just how bad is America’s epidemic of opioid painkiller (legal and illicit alike) addiction and overdose epidemic? A new expert analysis from the RAND Corporation suggests that prescribing heroin (yes, that heroin) could be an effective tool for combating the crisis in extreme circumstances.

“Given the increasing number of deaths associated with fentanyl and successful use of heroin-assisted treatment abroad, the U.S. should pilot and study this approach in some cities,” says Beau Kilmer, co-director of the RAND Drug Policy Research Center, in a statement. “This is not a silver bullet or first-line treatment. But there is evidence that it helps stabilize the lives of some people who use heroin.”

To be clear, the RAND analysis focuses on individuals who have severe opioid addiction – those whose disease isn’t effectively treated by the traditional methods, such as conventional medication assisted therapy and rehab through the use of products such as methadone and buprenorphine.

But the study authors point out that some of the highest-risk patients still wind up injecting illegal street opioids while undergoing treatment with those substances, substantially raising their risk of overdose death. For these people, “heroin-assisted treatment” may prove an effective, if controversial, measure, especially since prescription grade heroin is far less likely to harbor contaminants or be cut with other dangerous chemicals.

Whether or not such initiatives would be widely adopted is another question. Clean needle exchange programs for drug users and “safe injection sites” have been matters of serious controversy, and they don’t involve directly providing heroin to users.

Whatever your viewpoint, RAND’s entire analysis is worth reading in full.

Read on for the day’s news.


Have the new Apple Watch? You can take an ECG now. The Apple Watch Series 4's much-ballyhooed electrocardiogram (ECG) heart monitoring feature is officially live today, the company announced. That includes the activation of notifications that can warn users of irregular heart rhythms (if you happen to own one of the devices and are interested in checking the feature out, Apple has a guide in its press release). “We are confident in the ability of these features to help users have more informed conversations with their physicians,” said Apple Health VP Sumbul Desai in a statement. While the ECG feature is a milestone for mass market wearables, some critics have raised concerns that it could lead to unnecessary medical care through potential false positives. Apple insists the product shouldn't be regarded as a full-on medical device, but rather a tool that can guide discussions with physicians.


How do you solve a problem like CAR-T prices? BioPharma Dive has an excellent dispatch from the American Society of Hematology meeting in San Diego on the struggles doctors and hospitals have grappling with the exorbitant prices of new cancer technologies like CAR-T (the new treatments from companies like Novartis and Gilead which re-engineer patients' own immune cells to become targeted cancer hunters). Extracting, modifying, replicating, and then re-inserting immune cells through this process is, unsurprisingly, expensive. And regulators are still trying to figure out the best way to assess the value on such therapies while still providing patients access (and the innovators behind the technology their fair share). Here's what one doctor had to say the ASH conference: "None of us imagined we'd be ... reading through 1,000-page-long [Centers for Medicare & Medicaid Services] documents and rules and proposals, but that's what life has come to at times." (BioPharma Dive)


U.S. health care spending growth slows. The federal government projects that growth in U.S. health care spending (that is, a measure of medical inflation) remained modest in 2017, rising 3.9% to $3.5 trillion. That was due to relatively low spending increases in hospital care and retail prescription drugs, according to the Centers for Medicare & Medicaid Services. However, the same agency has projected that 2018 health care spending will spike 5.3%. (Reuters)

The joy of retractions. Food researcher Brian Wansink's (in)famous study on the ostensible unhealthiness of recipes in the popular Joy of Cooking cookbook has been retracted by the Annals of Internal Medicine, which cites problems with the data presented as part of the research. Wansink says the cited issues are relatively minor; but this isn't the first study of his to be retracted over data validity concerns. (Associated Press)


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