Axios Vitals: States' stockpile

Plus, an international fentanyl fight is brewing | Monday, April 17, 2023

Open in app View in browser     Axios Vitals By Tina Reed · Apr 17, 2023 Welcome back to the work week, Vitals readers. Today's newsletter is 989 words or a 3½ minute read. What we're watching this week: Supreme Court Justice Samuel Alito ordered that the lower court rulings on abortion pills are stayed until Wednesday and gave anti-abortion groups until Tuesday to respond to the Justice Department's appeal.     1 big thing: Blue states stockpile abortion pills Illustration: Shoshana Gordon/Axios   The high-stakes legal battle over a widely used abortion pill has left some blue states stockpiling the medication, in anticipation of when it may no longer be easily accessible, Axios' Oriana González writes. The big picture: At least two states say they are creating reserves of mifepristone to continue enabling access to the two-pill regimen for medication abortion that's at the center of the legal battle. Two others are focusing on the second pill, misoprostol, which isn't currently under legal threat. Driving the news: Last week, the Supreme Court temporarily blocked lower court rulings that would have curbed access to mifepristone by reimposing restrictions on its use that the FDA had lifted, and barring teleprescribing of the drug. Mifepristone is still available without limitations until at least Wednesday. But courts have yet to settle anti-abortion groups' challenge to the FDA's overall authorization, and the case could well wind up at the high court again. What's happening: The states that have said are stockpiling abortion pills have laws protecting abortion access. Massachusetts Gov. Maura Healey (D) requested the University of Massachusetts purchase around 15,000 doses of mifepristone and has directed individual health providers to do so as well. In Washington state, Gov. Jay Inslee (D) purchased a three-year supply of mifepristone through the state's Department of Corrections, which has a pharmacy license. New York Gov. Kathy Hochul (D) stockpiled 150,000 doses of misoprostol. In California, Gov. Gavin Newsom (D) said the state "secured an emergency stockpile" of up to 2 million doses of misoprostol. What they're saying: Once the drugs are in the hands of the states, officials in consultation with state boards of medicine and pharmacy have discretion to lawfully distribute and allow prescribing, said Susan Lee, an attorney at Goodwin who specializes in the FDA's regulation of drugs and biologics. Go deeper.     2. U.S., Mexico and China fentanyl fight Photo: Eric Lee/Washington Post via Getty Images   The fentanyl crisis is hitting a boiling point, with the U.S., Mexico and China each trading accusations over who's to blame, Axios' Dave Lawler reports. Driving the news: Republicans, including former President Trump, are proposing military strikes against Mexican cartels. The Biden administration is urging Mexico and China to clamp down. Meanwhile, the leaders of those countries are making clear they see this as an entirely American problem. Why it matters: Synthetic opioids like fentanyl can be 100 times more potent than morphine and 50 times more powerful than heroin. They're also relatively cheap to produce — ideal for traffickers but dangerous for users, who often don't realize a drug they're taking has been laced with fentanyl. The quantities seized at the border keep hitting new record highs, but it appears the amount reaching the U.S. is climbing as well. The "only limit" on production is the availability of precursor chemicals, according to DEA administrator Anne Milgram. The big picture: U.S. officials say those precursors come almost entirely from China, with much smaller amounts coming from India. "Criminal elements" in China ship the chemicals to Mexico, where most production takes place, according to White House drug control policy chief Rahul Gupta. The DEA says the "vast majority" of the fentanyl that crosses the border is smuggled by the powerful Jalisco and Sinaloa cartels. It's hidden in vehicles, by individuals, or in cross-border tunnels. In addition to blaming China and Mexico, Republicans are blaming President Biden for failing to secure the border. The latest: The Biden administration made several announcements on fentanyl on Friday, including sanctions on two Chinese producers of fentanyl precursors, charges against leaders of the Sinaloa cartel and efforts to coordinate with Mexico and Canada to disrupt fentanyl production. What to watch: As the 2024 presidential election cycle heats up, the inter-party and international accusations around fentanyl will likely intensify.     3. Bias in drug testing pregnant patients Illustration: Lindsey Bailey/Axios   Pregnant Black patients were subjected to drug testing more often than white patients before delivery, a JAMA Health Forum analysis of patients in a large Pennsylvania health system from March 2018 to June 2021 found, Axios' Arielle Dreher writes. Black patients were no more likely to test positive for using substances while pregnant, but even those with no history of substance use were asked to get urine toxicology testing more often than other racial groups, the study of more than 37,000 patients found. Why it matters: Federal and some state laws require providers to report patients to child welfare agencies if their toxicology report reveals substance use. But not applying the practices evenly across groups can amount to medical racism, said Marian Jarlenski, lead researcher and professor at the University of Pittsburgh School of Public Health. By the numbers: Black patients without a history of substance abuse had a 6.9% mean probability of being drug tested at delivery compared to a 4.7% mean probability for white patients. Among patients with documented substance use, Black patients had a 76% mean probability of being drug tested compared to 68% of white patients. Read the rest.     A message from Axios The latest policy insights and reporting     Axios Pro: Policy cuts through the noise and provides you the most accurate, trusthworthy policy news. Subscribe today.     4. Bird flu showed concerning adaptations Samples taken from a Chilean man diagnosed with bird flu showed two mutations that show signs of adaptation to mammals, the New York Times reports. Why it matters: Officials from the Centers for Disease Control and Prevention emphasize the risk to the public remains low and that these mutations are not enough to allow human-t0-human transmission of the virus. But it is a concerning development, experts said. "We understand them to be a step on the path to adaptation to humans and increased risk to humans," Anice Lowen, an influenza virologist at Emory University told the Times. "So certainly it's concerning to see them." What's happening: The U.S. is starting testing for bird flu vaccines in poultry after record outbreaks, Reuters reports.     5. While you were weekending Illustration: Aïda Amer/Axios   💉 Moderna and Merck show progress toward cancer vaccines. (Wall Street Journal) 🏥 Adults with Down syndrome face a health care system that often treats them as kids. (NBC News) 👀 A beauty treatment promised to zap fat. For some, it brought disfigurement. (The New York Times) 💰 Merck plans to buy Prometheus Biosciences for about $11 billion. (Reuters)     A message from Axios The latest policy insights and reporting     Axios Pro: Policy cuts through the noise and provides you the most accurate, trusthworthy policy news. Subscribe today.   Thanks for reading, and thanks to senior health care editor Adriel Bettelheim and senior copy editor Bryan McBournie for the edits. Dive deeper into the future of health care Axios Pro is your personal health care industry analyst, here to help you make the news actionable and anticipate future outcomes. Subscribe today.   Axios thanks our partners for supporting our newsletters. Sponsorship has no influence on editorial content. Axios, 3100 Clarendon B‌lvd, Arlington VA 22201   You received this email because you signed up for newsletters from Axios. To stop receiving this newsletter, unsubscribe or manage your email preferences.   Was this email forwarded to you? Sign up now to get Axios in your inbox.   Follow Axios on social media: