Drug major Cipla is betting big on digitisation and emerging segments like biosimilars and mRNA aided medications to drive its next phase of growth. The Mumbai-based drug maker is also bullish on maximising value opportunity in the complex generics in the US market.

It is also looking to scale up its US core formulations sales on the back of respiratory and peptide franchises while monitoring upcoming complex product launches in the second half of the current fiscal.

“Digitalisation in healthcare found its rightful place during the pandemic, and there is a need to expand and support the essential backup services to enable digital healthcare to function efficiently in all primary and secondary healthcare centres,” Cipla Executive Vice-Chairperson Samina Hamied said in the company’s Annual Report for 2021-22.

The drug firm has embarked on the digital transformation of the value chain across functions, including finance, R&D, manufacturing, supply chain, HR, customer outreach and stakeholder engagement, she added.

Over the past few years, the company has set up several foundational elements to drive the digitisation and automation plans right from adopting latest trends to transform patient reach and customer care via digitalisation, Hamied stated.

“We have also been reimagining field force engagements with health care professionals (HCPs) in global markets through virtual knowledge sharing platforms. Our aspiration is to create plants of the future in a digitally native organisation, that will transform the lives of our people and all our stakeholders,” she noted.

It is time for the industry to take note of advanced tools and emerging technologies powered by advanced analytics, robotics and automation that have the potential to revolutionise every element of pharma manufacturing within the next few years, Hamied said.

“Going forward all our growth engines will be fueled by our digital transformation initiatives,” Cipla Managing Director and Global CEO Umang Vohra noted.

Elaborating further, he said that it would be important to watch out for the innovative trends in healthcare that are bringing about a paradigm shift-be it mRNA technology, vaccines with DNA sub-units or the technology around some of the antibodies and cancer reversal.

Besides, the company would also ensure that within respiratory therapy, it has a robust range of offerings comprising innovative drug-device combinations and even bio-drugs that are gaining steam in the US, Vohra said.

“We will ensure steadfast rigour in our respiratory filings and new launches and maintain market beating growth,” he added.

He noted that the company is passionate about building a strong global wellness franchise and are working towards identifying more brands with high consumer potential across India and South Africa.

“We will continue our execution on branded market portfolio including peptides, brand building and improvement in manpower productivity across markets,” Vohra stated.

Cipla, the country’s third largest drug maker, has 47 manufacturing sites around the world which cater to around 86 markets across the globe.

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President Biden’s Build Back Better agenda called for a number of reforms that did not make it into Democrats’ Inflation Reduction Act.

Evan Vucci/AP

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President Biden’s Build Back Better agenda called for a number of reforms that did not make it into Democrats’ Inflation Reduction Act.

Evan Vucci/AP

Late Saturday night and into Sunday morning, Senators voted on amendments to Democrats’ major spending bill that tackles health care, climate and taxes.

The legislation is being passed through the budget reconciliation process, which means all 50 Democrats and one tie-breaker vote from Vice President Harris are needed, since none of the 50 Republican senators will vote for the bill. It also restricts the measures in the bill to those that directly change federal spending and revenue.

Majority Leader Chuck Schumer, D-N.Y., said Saturday that despite a few cuts from the Senate parliamentarian, the bill overall is still a legislative win for Democrats.

Democrats have argued it will tackle voters’ main economic concern, naming it the Inflation Reducation Act. Republicans argue the new spending will aggravate inflation. The nonpartisan Congressional Budget Office says, though, the bill has a “negligible” effect on inflation in 2022 and into 2023.

Overall, the bill is a very scaled-down solution to what many Democrats, including President Biden, had asked for originally.

“This bill is far from perfect. It’s a compromise. But it’s often how progress is made,” Biden said at the White House last month. “My message to Congress is this: This is the strongest bill you can pass.”

After passage in the Senate, the House plans to take up the bill at the end of the week and then send it to President Biden for his signature.

Here’s a look at some of what did get included in the Democrats’ bill, and what didn’t.

You can see the entire 755-page bill here.

Tackling climate change

More than $300 billion would be invested in energy and climate reform, the largest federal clean energy investment in U.S. history.

The bill has support from many environmental and climate activists but is short of the $555 billion that Democrats had originally called for.

This portion of the bill takes on transportation and electricity generation, and it includes $60 billion for growing renewable energy infrastructure in manufacturing like solar panels and wind turbines.

It also includes several tax credits for individuals on things like electric vehicles and making homes more energy efficient.

The bill would, according to Democrats, lower greenhouse gas emissions by 40%, based on 2005 levels, by the end of the decade, which is short of the 50% Biden had originally aimed for.

“It puts us within a close enough distance that further executive action, state and local government efforts and private sector leadership could plausibly get us across the finish line by 2030,” said Jesse Jenkins from Princeton University, who leads the REPEAT Project analyzing the impact of government climate actions.

Lowering the cost of prescription drugs

On health reforms, the bill takes on making prescription drugs more affordable — but there are some limits.

The bill includes a historic measure that allows the federal health secretary to negotiate the prices of certain expensive drugs each year for Medicare.

But this won’t impact every prescription drug or every patient, and it won’t take effect quickly. The negotiations will take effect for 10 drugs covered by Medicare in 2026, increasing to 20 drugs in 2029.

The portion of the bill that tried to cap at $35 per month the price of insulin — a drug that is incredibly expensive in the U.S. compared to other countries — was ruled out of order by the Senate parliamentarian, putting it out of reach for now because it would need 60 votes to pass as regular legislation.

The parliamentarian also ruled that a measure that was in the bill to force drug companies to offer rebates if prescription prices outpaced inflation was not totally in line with the rules for budget reconciliation; she said that it could apply to Medicare patients but not those with private insurers.

The bill puts a cap of $2,000 on out-of-pocket prescription drug costs for people on Medicare, effective in 2025.

There’s also a three-year extension on healthcare subsidies in the Affordable Care Act originally passed in a pandemic relief bill last year, estimated by the government to have kept premiums at $10 per month or lower for the vast majority of people covered through the federal health insurance exchange.

That helps millions of Americans avoid spikes in their health care costs.

Tax reform

The legislation creates a 15% minimum tax for corporations making $1 billion or more in income, bringing in more than $300 billion in revenue.

A portion that got cut, though, is one that narrowed the carried interest tax loophole. Arizona Kyrsten Sinema agreed to sign onto the bill if this measure, which would have changed the way private equity income is taxed, was cut. Democrats said it would have brought in $14 billion in revenue.

Instead, a 1% excise tax on stock buybacks was introduced, and it could bring in roughly five times as much revenue as the carried interest measure. However, it wouldn’t take effect until next year, raising predictions of a rush of buybacks by some companies before 2023 rolls around.

A major portion of the bill that isn’t included, due to opposition from West Virginia Sen. Joe Manchin, is extended the Child Tax Credit. Manchin expressed last year that the cost to extend the credit was too high, but progressives, including Vermont Sen. Bernie Sanders, have continued to push for its inclusion in the bill.

Sanders planned to add it as an amendment to the legislation during the all-night voting process, even without the support he needs to pass it.

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PINE RIDGE, S.D. — In a growing number of U.S. states, people can both drink alcohol and legally smoke recreational marijuana. In others, they can use alcohol but not pot. But on the Pine Ridge Indian Reservation in South Dakota, the opposite is true: Marijuana is legal, but booze is banned.

Citizens of the Oglala Sioux Tribe overwhelmingly voted in 2020 to legalize recreational and medical marijuana on their sprawling reservation, which has prohibited the sale and consumption of alcohol for more than 100 years.

Customers visiting a dispensary on a recent Friday said they view marijuana as a safe and natural way to obtain relief from mental health disorders and chronic illnesses, which are common among tribal citizens. But they said alcohol has wreaked havoc on the health, safety and life expectancy of tribal members.

“Cannabis is a natural plant that comes from the Earth — and our people lived off the land, and they got their medicine from the land,” Ann Marie Beane said while shopping at the No Worries dispensary in the small town of Pine Ridge. “Our Indigenous people, they suffer a lot from diabetes and cancer and various other illnesses, but the cannabis really helps them.”

Koby Morrisette, a “budtender” at the No Worries dispensary, prepares a joint.Arielle Zionts for KHN

Beane and her 22-year-old daughter said they use marijuana to ease their anxiety.

Marijuana use can lead to physical and mental health problems, but shoppers at the No Worries store said it’s less dangerous than alcohol, meth and opioids. Those drugs lead to high rates of premature deaths on the reservation through car crashes, violence and disease.

The Pine Ridge Reservation, established in 1889, is spread across more than 2 million acres of small towns, ranchland, prairies, and otherworldly badland formations. The U.S. Census Bureau says about 20,000 people live there, but community members say that’s a vast undercount and that the population could be as high as 40,000.

Alcohol has been illegal there for most of the reservation’s history, but that hasn’t stopped bootlegging and abuse. “It’s killing our youth — it’s killing our future generation,” Beane said.

The Oglala Sioux Tribe said in a 2012 lawsuit that about 25% of children born on the reservation had health or behavioral problems caused by exposure to alcohol in the womb. The lawsuit was filed against now-shuttered beer stores across the border in Nebraska.

The average life expectancy is just 64.5 years in Oglala Lakota County, which includes much of the Pine Ridge Reservation, according to a 2019 estimate from the Institute for Health Metrics and Evaluation at the University of Washington. That’s the lowest of any county in the U.S. and about 15 years below the national average.

Native Americans have high rates of health problems, which experts attribute to poverty and ways their communities have been harmed and fractured by federal policies. Those who live on reservations often have limited access to health care services and healthy food, and their main health care provider is the Indian Health Service, which has been dogged by complaints of underfunding and substandard care.

On the recent Friday, Beane was among dozens of customers who pulled into the gravel parking lot at the No Worries dispensary. After displaying IDs through a ticket window, customers entered the shop to buy loose marijuana, joints and edibles prepared in a commercial-grade kitchen.

Only a few customers at No Worries said they use marijuana for purely recreational reasons. More said they use it to relieve anxiety, pain and other medical conditions.

One customer’s eyes filled with tears as she lifted her shirt to reveal an ostomy bag, which doctors attached to her midsection after removing part of her intestines.

Another customer, Chantilly Little, said she’s recovering from addiction to stronger drugs. The 27-year-old said she has seen drugs kill tribal citizens and wants to be a responsible parent. “I’d rather smoke than do other drugs because I almost gave up on my kids,” Little said.

Stephanie Bolman — a breast cancer patient, former health care worker and council member for the Lower Brule Sioux Tribe — was traveling through the area and decided to visit the No Worries shop.

Bolman doesn’t use marijuana but wanted to see the dispensary. She’s interested in legalizing medical cannabis on her reservation, situated along the Missouri River in central South Dakota, about four hours east of Pine Ridge.

“Unfortunately, the health care services provided by the Indian Health Service have failed so many in countless ways,” Bolman said. “It has left many to fend for themselves and endure so much pain and suffering that medical marijuana has proven to be lifesaving.”

In 2020, when tribal citizens approved the marijuana initiatives for the Pine Ridge Reservation, they rejected a proposal to legalize alcohol sales and consumption within the two casinos on the reservation.

In 2013, voters approved a referendum to legalize alcohol reservation-wide by a narrow margin. But the tribal council never implemented the change.

Lakota people did not use marijuana in pre-colonial times, said Craig Howe, a Lakota historian. Lakota and other Great Plains tribes also didn’t use alcohol until it was introduced by white traders in the 1800s.

Alcohol “was meant to control our people, and eventually it became a weapon of mass destruction,” said Ruth Cedar Face, an addiction treatment counselor and a member of the Oglala Sioux Tribe.

Cedar Face said that medical marijuana can be helpful for certain medical and mental health conditions but that it’s not a cure-all. “When it becomes a problem, when it becomes an addiction, that’s because they’re medicating away the things they need to deal with, like the trauma that is usually the core of any kind of addiction or unhealthy behavior,” she said.

Cedar Face said marijuana can also cause psychosis, lung damage, diminished brain development and other problems for some users, especially teenagers and young adults.

People must be 21 or older to buy or use cannabis, according to Oglala Sioux law. They can face jail time for providing marijuana to minors and fines for using the drug while driving.

Dispensaries can sell only marijuana grown on the reservation, and customers are prohibited from transporting cannabis elsewhere. But about 40% of No Worries customers live outside the reservation, with many traveling from the Black Hills of South Dakota or northwestern Nebraska, said owner Adonis Saltes.

Recreational marijuana is illegal in South Dakota, which means law enforcement officers could charge anyone caught transporting or using cannabis outside reservation boundaries. But the sheriff’s office in Pennington County, which borders the Pine Ridge Reservation, said it hasn’t arrested anyone on such charges.

That contrasts with the experience of the Flandreau Santee Sioux Tribe on the eastern side of the state. State and local law enforcement officers are charging Native Americans and non-Natives who’ve left the reservation with cannabis from the reservation’s medical dispensary, according to Seth Pearman, the tribe’s attorney general.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Follow NBC HEALTH on Twitter & Facebook. 

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San Diego: Scientists found that endothelial cells in the lymphatic vessels produce molecules that are essential for the maintenance and regulation of stem cells and tissues in the intestine. These lymphatic endothelial cells reside near specialized stem cell niches, which are microenvironments that support stem cell regeneration.

The findings were published in the peer-reviewed journal Cell Stem Cell.

“It’s important for us to understand niches and how lymphatics communicate with stem cells as part of the niche,” said Ophir Klein, MD, PhD, senior author of the study and executive director of Cedars-Sinai Guerin Children’s. “Deciphering the mechanisms that explain how the ecosystem that supports stem cells works will help to lay the foundation for future discoveries that could one day lead to therapeutic strategies to repair damaged tissue.”

The intestine undergoes continuous renewal to withstand the wear and tear that result from breakdown of foods, and from the presence of waste that can injure and kill cells. The intestine needs to replenish itself constantly with healthy cells, and fortunately, it has an exceptional capacity to regenerate cells.

The division of intestinal stem cells to make more cells is regulated by their surrounding niche, which is comprised of several cell types and is an essential source of signals. However, it is unclear which niche cells produce signals during different states of injury.

To better understand stem cell activity, the team wanted to learn which cells help the intestinal epithelial cells repair themselves–particularly lymphatic endothelial cells.

“Lymphatics are in very close proximity to the stem cells, and almost all the stem cell compartments are near lymphatics,” said Brisa Palikuqi, PhD, co-first author of the study and a postdoctoral fellow in the Klein Laboratory at UCSF.” Because the two cell types are in such proximity, this made us believe that these lymphatics may play an important role.”

Lymphatics express several factors, including a gene, Rspo3, that is known to be important for stem cells to function. To determine whether the gene played an important role in intestinal stem cell regulation, the investigators deleted the gene in mice and then used single-cell sequencing to see how stem cells in the intestine would react without Rspo3.

Initially, the stem cells did not have any response to the change in the environment. The researchers then decided to injure the system by delivering a chemotherapy drug that kills any proliferating cells wherever the drug travels through the body.

“When we did this, all of a sudden the stem cells and the intestine had to proliferate a lot more and replace a lot more cells on a daily basis,” said Jeremie Rispal, PhD, also a postdoctoral researcher in the Klein Laboratory at UCSF and the other co-first author of the study.

The loss of the Rspo3 gene led to a lower number of stem and progenitor cells, hindering recovery after the injury.

“This discovery showed us that lymphatic endothelial cells are a key component of the intestinal niche and essential for intestinal repair after cases of damage, like chemotherapy,” said Klein, who also holds the David & Meredith Kaplan Distinguished Chair in Children’s Health at Cedars-Sinai.

Klein noted that the study demonstrates how lymphatic endothelial cells play a much larger role than previously thought in stem cell regeneration and may play a role in disease, perhaps even influencing the promotion of cancer.

“We are just beginning to understand the functions of the lymphatic vasculature,” Klein said.

Klein previously directed the Institute for Human Genetics and served as chief of the Divisions of Medical Genetics and Craniofacial Anomalies at UCSF, where he remains an adjunct professor. Klein conducted the study at both USCF and Cedars-Sinai.

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FRIDAY, Aug. 5, 2022 (HealthDay News) — From 2019 to 2020, there was a decrease in smoking cessation activity among U.S. adults, according to a study published online Aug. 1 in JAMA Network Open.

Priti Bandi, Ph.D., from the American Cancer Society in Atlanta, and colleagues examined changes in smoking cessation-related behaviors in the United States during the COVID-19 pandemic in a cross-sectional study conducted using 2011 to 2020 data for 788,008 individuals who had smoked in the past year and completed the Behavioral Risk Factor Surveillance System survey.

The researchers found that for the first time since 2011, between 2019 and 2020, there was a decrease in annual past-year quit attempt prevalence, from 65.2 to 63.2 percent, with the largest relative decreases seen among individuals aged 45 to 64 years (61.4 to 57.7 percent), those with two or more comorbidities (67.1 to 63.0 percent), and Black individuals (72.5 to 68.4 percent). During 2019 to 2020, there was no change observed in recent successful cessation. The observed sales during the COVID-19 pandemic were lower than expected by 13.0, 6.4, and 1.2 percent for nicotine lozenges, patches, and gum, respectively.

“These results, when taken together with reports of increased cigarette sales during the pandemic, suggest the urgent need to reengage smokers in evidence-based quitting strategies, especially among individuals experiencing disproportionately negative outcomes during the pandemic,” the authors write.

One author disclosed financial ties to AstraZeneca.

Abstract/Full Text

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During the Covid 19 pandemic, education and lactation assistance for new parents was extremely limited. A recent study showed that over 70% of mothers reported not having the support that they needed to reach their breastfeeding goals during the lockdown. August is World Breastfeeding Month and is celebrated to raise awareness to highlight the benefits of breastfeeding not only for mother and baby but for children, families, and the environment.

This week, we’re talking with Marji Stark, lactation consultant at Saint Luke’s East Hospital, about how the pandemic impacted new mothers on their breastfeeding journey, the benefits for mom and baby, and the lactation support and resources there are for moms.

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FRIDAY, Aug. 5, 2022 (HealthDay News) — Airway lumen sizes are smaller in women than men, according to a study published online Aug. 2 in Radiology.

Surya P. Bhatt, M.D., M.S.P.H., from the University of Alabama at Birmingham, and colleagues examined whether structural differences in airways may underlie some of the sex differences in the prevalence and clinical outcomes of chronic obstructive pulmonary disease (COPD). Airway disease was quantified on computed tomography (CT) images in a secondary analysis of a multicenter study of never, current, and former smokers enrolled from January 2008 to June 2011 and followed until November 2020.

The researchers found that men had thicker airway walls than women among 420 never smokers, as quantified on CT images for segmental airway wall area percentage, whereas after accounting for height and total lung capacity, airway lumen dimensions were lower in women than men. Among 9,363 ever smokers, greater segmental airway wall area percentage was seen for men, while women had a narrower segmental lumen diameter. Lower forced expiratory volume in one second-to-forced vital capacity ratio, more dyspnea, poorer respiratory quality of life, lower six-minute walk distance, and worse survival were seen in women versus men with a unit change in each of the airway metrics (higher wall or lower lumen measure).

“The differences in airway dimensions even after adjusting for height and lung size, and the greater impact of changes in airway size on clinical outcomes in women, was remarkable in that women appear to have a lower reserve against developing airway disease and COPD,” Bhatt said in a statement.

Several authors disclosed financial ties to the pharmaceutical industry.

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People bring bags of drugs into Tapestry Health’s office if they suspect the drugs contain xylazine, a sedative that is starting to permeate illegal opioids and cocaine.

Jesse Costa/WBUR

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People bring bags of drugs into Tapestry Health’s office if they suspect the drugs contain xylazine, a sedative that is starting to permeate illegal opioids and cocaine.

Jesse Costa/WBUR

Approaching a van that distributes safe supplies for drug use in Greenfield, Mass., a man named Kyle noticed an alert about xylazine.

“Xylazine?” he asked, sounding out the unfamiliar word. “Tell me more.”

A street-outreach team from Tapestry Health delivered what’s becoming a routine warning. Xylazine is an animal tranquilizer. It’s not approved for humans, but it’s showing up in about half of the drug samples that Tapestry tests in the rolling hills of western Massachusetts. It’s appearing mostly in the illegal fentanyl supply but also in cocaine.

Kyle rocked backward on his heels at the mention of cocaine. He and his friends regularly use cocaine, but lately, they had suspected that something else was in the bag.

“The past week, we’ve all been just racking our brains, like ‘What is going on?'” he said. “Because if we cook it up and we smoke it, we’re falling asleep after.”

(NPR and KHN are using first names in this story for people who use illegal drugs.)

Kyle’s deep sleep might have been triggered by fentanyl too, but Kyle said one of his buddies used a test strip to check for the opioid and none was detected.

Xylazine surged first in some areas of Puerto Rico and then in Philadelphia, where it was found in 91% of opioid samples last year, the most recent reporting period. Data from January to mid-June shows that xylazine was in 28% of drug samples tested by the Massachusetts Drug Supply Data Stream (MADDS), a state-funded network of community drug-checking and advisory groups that uses mass spectrometers to let people know what’s in bags or pills purchased on the street.

Some areas of the state, including western Massachusetts, are seeing xylazine in 50% to 75% of samples. In Greenfield, that’s a big change from last year, when xylazine wasn’t a concern.

“We’ve seen an exponential increase during the pandemic,” said Traci Green, who oversees MADDS and directs the Opioid Policy Research Collaborative at Brandeis University. “Now the sad thing is we’re really seeing it all over the state. It’s definitely hazardous.”

There’s a lot of speculation about how and why xylazine is on the rise. It may be added to fentanyl or heroin to help extend the effects of an opioid high. Dealers also may be using this relatively inexpensive and easy-to-order sedative because of supply chain gaps with other drugs.

Whatever its path into the drug supply, the presence of xylazine is triggering warnings in Massachusetts and beyond for many reasons.

As xylazine rises, overdoses rise too

Perhaps the biggest concern is an association with more overdoses and deaths. In one study of 10 cities and states, xylazine was detected in fewer than 1% of overdose deaths in 2015, but in 6.7% in 2020, a year the U.S. set a new record for overdose deaths. That record was broken again in 2021 with more than 107,000 deaths.

The study does not claim xylazine is causing more fatalities, but study co-author Chelsea Shover said it may contribute. Xylazine, a sedative, slows breathing and heart rate, as well as decreases blood pressure, compounding some effects of an opioid like fentanyl or heroin.

“If you have an opioid and a sedative, those two things are going to have stronger effects together,” said Shover, an epidemiologist at UCLA’s School of Medicine.

Tapestry Health’s harm reduction team hands out items such as filters and pipes to people from its mobile unit.

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Tapestry Health’s harm reduction team hands out items such as filters and pipes to people from its mobile unit.

Jesse Costa/WBUR

In Greenfield, Tapestry Health is responding to more overdoses as more tests show the presence of xylazine.

“It correlates with the rise, and it correlates with Narcan not being effective to reverse xylazine,” said Amy Davis, the assistant director for rural harm-reduction operations at Tapestry. Narcan is a brand name of naloxone, an opioid overdose reversal medication.

“It’s scary to hear that there’s something new going around that could be stronger maybe than what I’ve had,” said May, a woman who stopped by Tapestry’s van. May said she has a strong tolerance for fentanyl, but a few months ago, she started getting something that didn’t feel like fentanyl, something that “knocked me out before I could even put my stuff away.”

A shifting overdose response

Davis and her colleagues are ramping up the safety messages: Never use alone, always start with a small dose and always carry Narcan.

Davis is also changing the way they talk about drug overdoses. They begin by explaining that xylazine is not an opioid. Squirting naloxone into someone’s nose won’t reverse a deep xylazine sedation — the rescuer won’t see the dramatic wake-up that is more common when giving Narcan after an opioid overdose.

With xylazine, the immediate goal is to make sure the person is getting oxygen into the brain. So Davis and others advise starting rescue breathing after giving the first dose of Narcan. It may help restart the lungs even if the person doesn’t wake up.

“We don’t want to be focused on consciousness — we want to be focused on breathing,” Davis said.

Giving Narcan is still critical because xylazine is often mixed with fentanyl, and fentanyl is killing people.

“If you see anyone who you suspect has an overdose, please give Narcan,” said Bill Soares, an emergency room physician and the director of harm reduction services at Baystate Medical Center in Springfield, Massachusetts.

Soares said calling 911 is also critical, especially with xylazine, “because if the person does not wake up as expected, they’re going to need more advanced care.”

“Profound sedation” worries health providers

Some people who use drugs say xylazine knocks them out for six to eight hours, raising concerns about the potential for serious injury during this “profound sedation,” said Dr. Laura Kehoe, medical director at Massachusetts General Hospital’s Substance Use Disorders Bridge Clinic.

Kehoe and other clinicians worry about patients sedated by xylazine who are lying in the sun or snow, perhaps in an isolated area. They could be vulnerable to compression injuries from lying in one position, or they could be attacked.

“We’re seeing people who’ve been sexually assaulted,” Kehoe said. “They’ll wake up and find that their pants are down or their clothes are missing, and they are completely unaware of what happened.”

Kehoe argues that the surge of xylazine heightens the need for supervised consumption clinics, where people can use drugs under the watch of trained staff. Legislation that would have allowed a pilot program in Massachusetts died in committee at the State House this year.

A whiteboard in Tapestry Health’s office lists information about xylazine, which is present in the drug supply in the area.

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A whiteboard in Tapestry Health’s office lists information about xylazine, which is present in the drug supply in the area.

Jesse Costa/WBUR

Newton Police Chief John Carmichael, who chairs the Massachusetts Chiefs of Police Association’s substance abuse committee, is opposed to supervised consumption. Carmichael says that in his experience, people who buy illegal drugs use them immediately and won’t take the time to travel to one of these sites.

“I just don’t see how these sites would be really effective,” Carmichael said, adding that he’d prefer to focus solely on getting people into treatment. “I think we have an obligation to do that more so.”

A study conducted in Vancouver, Canada, showed an increase in treatment as the city added overdose prevention sites.

A recent study out of France found that people who use supervised consumption clinics have fewer boils and abscesses related to injections. Clinicians say that’s especially compelling now, with xylazine.

In Greenfield, nurse Katy Robbins pulled up a photo from a patient seen in April as xylazine contamination soared.

“We did sort of go, ‘Whoa, what is that?'” Robbins remembered, studying her phone.

The image shows a wound like deep road rash, with an exposed tendon and a spreading infection. Robbins and Tapestry Health have created networks so clients can get same-day appointments with a local doctor or hospital to treat this type of injury. But it is hard to get people to go get their wounds seen.

“There’s so much stigma and shame around injection drug use,” said Robbins. “Often people wait until they have a life-threatening infection.”

That may be one reason that amputations are increasing for people who use drugs in Philadelphia.

“We’re certainly seeing a lot more wounds, and we’re seeing some severe wounds,” said Dr. Joe D’Orazio, the director of medical toxicology and addiction medicine at Temple University Hospital in Philadelphia.

D’Orazio and his colleagues are still trying to figure out why wounds are worse with xylazine use. It could be that they don’t heal as quickly because xylazine reduces blood flow. Some patients also report more skin picking with xylazine.

“Almost everybody is linking this to xylazine,” D’Orazio said.

This story is from a reporting partnership that includes WBUR, NPR and KHN (Kaiser Health News).

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Voters in Kansas told the rest of the country this week that they don’t want their state to ban abortion. In a nearly 60%-40% split, voters turned back an effort by anti-abortion activists to amend the state constitution to remove its right to abortion, which would have allowed the legislature to ban the procedure.

Meanwhile, in Washington, Congress is in its pre-recess push to pass legislation. A bill to provide health benefits to veterans injured by breathing in toxic substances from military burn pits finally made it to President Joe Biden’s desk. But talks continue on the Democrats’ health care-climate-tax bill that would, among other things, allow Medicare to negotiate some prescription drug prices and extend expanded subsidies for insurance under the Affordable Care Act.

This week’s panelists are Julie Rovner of KHN, Tami Luhby of CNN, Sandhya Raman of CQ Roll Call, and Rachel Cohrs of Stat.

Among the takeaways from this week’s episode:

• At least four other states — California, Kentucky, Montana, and Vermont — will have abortion questions on their ballots in November. Michigan is likely to have one, too, but the petitions required are still being certified.
• The Department of Justice has sued Idaho, arguing that its nearly-total abortion ban — set to take effect later in August — conflicts with federal law guaranteeing patients access to emergency medical care. If the case were to be appealed all the way to the Supreme Court, it could endanger the emergency care law, which has not faced that sort of legal challenge before.
• Biden signed an executive order this week that among other things could allow Medicaid to cover the travel expenses of women seeking out-of-state abortion care if their state restricts it. But the White House did not provide many details about how such a program would work or be paid for. The so-called Hyde Amendment, named for abortion opponent Rep. Henry Hyde, who died in 2007, forbids federal funding of most abortions. Supporters of the president’s move suggested that restriction applies only to medical care and not transportation, but any effort by Medicaid to set up such a transportation program would likely be litigated.
• New data released this week by the Department of Health and Human Services finds that the number of uninsured Americans has fallen to an all-time low of 8%. That estimate comes as the Senate is considering funding to continue enhanced premium subsidies for people who buy insurance on the Affordable Care Act’s marketplaces. If that legislation falters, the number of people without insurance is expected to rise sharply, as premiums will become unaffordable for many.
• Biden’s rebound of covid-19 symptoms reminds the country that the standards on when a patient has recovered are not firm and raises questions about how patients should handle reentry after battling the disease.

Also this week, Rovner interviews KHN’s Bram Sable-Smith, who reported and wrote the latest KHN-NPR “Bill of the Month” installment about a single-car accident that resulted in three wildly different ambulance bills. If you have an enormous or outrageous medical bill you’d like to send us, you can do that here.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Julie Rovner: KHN’s “They Lost Medicaid When Paperwork Was Sent to an Empty Field, Signaling the Mess to Come,” by Brett Kelman

Rachel Cohrs: The Washington Post’s “Thousands of Lives Depend on a Transplant Network in Need of ‘Vast Restructuring,’” by Joseph Menn and Lenny Bernstein

Tami Luhby: KHN’s “Hospices Have Become Big Business for Private Equity Firms, Raising Concerns About End-of-Life Care,” by Markian Hawryluk

Sandhya Raman: KHN’s “Nursing Homes Are Suing the Friends and Family of Residents to Collect Debts,” by Noam N. Levey

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THURSDAY, Aug. 4, 2022 (HealthDay News) — The prevalence of sinonasal symptoms is lower among regular cannabis users than nonusers, according to a study published online July 28 in JAMA Otolaryngology-Head & Neck Surgery.

Francis Reyes Orozco, from the University of Southern California in Los Angeles, and colleagues used data from the U.S. National Health and Nutrition Examination Survey (2013 to 2014) to examine the association between cannabis use and presence of sinonasal symptoms in 2,269 adults aged 20 to 69 years.

The researchers found that the prevalence of sinonasal symptoms among regular cannabis users (45.0 percent) was lower than the prevalence among never users (64.5 percent). Regular cannabis users were less likely to have sinonasal symptoms versus adults who had never used cannabis (odds ratio, 0.22), while current tobacco smokers were more likely to have sinonasal symptoms (odds ratio, 1.96). Nasal congestion (62.8 percent) and change in smell (17.8 percent) were the most common sinonasal symptoms reported.

“Understanding the association between cannabis use and sinonasal symptoms may enable health care clinicians to better counsel patients on the possible effects of cannabis use,” the authors write.

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