Canada fights overdoses by offering safer opioids. Could the U.S. do the same?

(LAURA PROCTOR FOR STAT)

Kim and Chris Fink are something like pioneers, participating in an expanding movement in Canada to counter the increasingly treacherous drug supply. At Parkdale Queen West Community Health Centre in Toronto, clients in the SOS — “safer opioid supply” — program receive government-funded, pharmaceutical-grade opioids they can use to feel the euphoric hit provided by drugs or at least ward off withdrawal, instead of having to rely on street drugs. While they don’t have to stop their illicit use, some clients have cut back or transitioned entirely to the opioids they pick up daily at pharmacies. “This program’s really saved us,” Kim Fink (above, center) told STAT’s Andrew Joseph.

Laws and minds would have to change for the model to work in the U.S., and critics in Canada do worry about clients selling the drugs they receive to others, spreading the problem. Read more about what’s involved.

Majority of children with sickle cell don’t receive recommended interventions

In 2014, experts convened by the National Heart, Lung, and Blood Institute issued recommendations to minimize the risk of stroke and other complications for kids with sickle cell disease. But years later, a majority of kids with the genetic condition are not receiving these potentially lifesaving interventions, my colleague Jason Mast reports.

According to a new CDC report, only about 40% of kids ages 2-9 and about half of kids 10-16 are receiving hydroxyurea, a treatment that is supposed to be offered to all kids with sickle cell. And less than half of kids and teenagers undergo annual transcranial doppler ultrasound, a test proven to detect and prevent strokes. Both figures were improvements from 2014 but remained far below experts’ hopes.

The findings underscore the substantial barriers to care many patients with sickle cell, a disease that in the U.S. predominantly affects African Americans, continue to face even as industry begins to talk of a cure. “Preventing complications of this disease requires strategies to reduce the impact of racism and disparities in health care,” Debra Houry, the CDC’s acting principal deputy director, told reporters yesterday.

Uganda declares outbreak of Ebola

Health officials in Uganda yesterday declared an outbreak of Ebola after the death of a 24-year-old man on Monday from a strain of the virus for which there is no known vaccine protection. The man’s death was confirmed after an investigation of six deaths in the Mubende district, in the central part of the country. Eight people suspected to also be infected with the Sudan strain of Ebola are being treated in a health facility, the WHO said. Uganda last reported an outbreak of the Sudan strain in 2012.

In 2019, Uganda had an outbreak of the Zaire strain of Ebola, imported from the neighboring Democratic Republic of the Congo where a large outbreak hit its northeastern region. The Ervebo vaccine has been effective against the Zaire strain, but another vaccine from J&J that might be effective against the Sudan strain hasn't yet been specifically tested against it.

Closer look: Buckle up for a tougher phase of CRISPR gene editing

(adobe)

CRISPR gene editing in humans has a stellar record of success — so far. A patient was apparently cured of sickle cell disease in 2019, six patients had toxic DNA knocked out of their livers last year, plus another six liver patients who had the same last week. But those cases might be the low-hanging fruit, STAT’s Jason Mast writes. That’s because their gene-editing targets are blood cells and the liver, which are easier to reach than tissues such as muscle. And the method deployed involves slicing an existing gene, the easiest thing to do with the Nobel prize-winning technology unveiled in 2012.

For the next generation of gene editing, researchers will need to figure out how to repair or replace genes, not merely snip them, in harder-to-reach places. Read more on the hurdles holding up the most ambitious forms of gene editing, and who's at work surmounting them.

Two years into pandemic, mortality disparities persist for Indigenous populations

STAT's Usha Lee McFarling has this report: A new analysis of death rates during the Covid-19 pandemic shows that many of the nation’s Indigenous populations continued to see deaths at higher rates, including among those under 65, even as mortality disparities for other racial and ethnic groups shrank as the pandemic continued.

Groups where mortality rates have remained much higher, two years into the pandemic, include American Indian, Alaska Native, and Native Hawaiian or other Pacific Islander people. The PNAS study examined all-cause mortality; emerging evidence suggests that while the majority of excess mortality was due to direct Covid-19 deaths, other causes of death that increased included cardiovascular deaths, diabetes, drug overdose, and homicide. Because race is often misclassified on death certificates, particularly among American Indian and Alaska Native, Asian, and multiracial populations, the authors think higher mortality rates for these racial and ethnic populations may still be undercounts.

The fact that mortality rates fluctuated during the pandemic suggests that disparities could be addressed through different strategies, said the authors, including long-term interventions to address housing and health care inequalities and short-term interventions like proactive patient navigation for people with multiple comorbidities and culturally tailored door-to-door vaccination campaigns.

Living through the Flint water crisis has lasting impact on mental health

Just the city’s name — Flint, Mich. — calls to mind the water crisis that battered the psyches of people in the predominantly low-income and African American community whose water had unsafe levels of bacteria, disinfection byproducts, and lead. Five years later, researchers asked 1,970 adults what it was like to live through that environmental disaster, what psychological symptoms they had over the last year, and whether they had access to and took advantage of mental health services over the five years since the water crisis began. Here’s what the study in JAMA Network Open found:

More than 1 in 5 met criteria for presumptive past-year depression
Nearly 1 in 4 met criteria for past-year PTSD
More than 1 in 10 met criteria for both depression and PTSD
34.8% were offered mental health services
79.3% of those who were offered services used them

On this week's episode of the "First Opinion Podcast," First Opinion editor Patrick Skerrett talks with Sallie Permar and Jay Varma about how to fight the spread of polio in the U.S. Listen here.

What to read around the web today

There's a shortage of Moderna Covid boosters in the U.S., Bloomberg
U.S. adults should get routine anxiety screening, panel says, Associated Press
Opinion: The case for lotteries as a tiebreaker of quality in research funding, Nature
Allergic to the world: Can medicine help people with severe intolerance to chemicals? The Guardian
Opinion: Termination is the safest course for some high-risk pregnancies. Dobbs decision threatens that care, STAT