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Biden Rule Cleared Hurdles to Lifesaving HIV Drug, but in Georgia Barriers Remain

ATLANTA — Latonia Wilkins knows she needs to be on PrEP due to her non-monogamous lifestyle. But the 52-year-old Atlanta mother has faced repeated challenges getting the lifesaving drug that can prevent new HIV infections.

Years ago, Wilkins was dating a man newly diagnosed with HIV and went to get tested, she said, but was not offered PrEP.

Since then, Wilkins said, doctors either have told her she doesn’t need the drug or were reluctant to prescribe it. Her insurance through work would not cover a long-acting injectable form that tends to have better results than the original pill form. Getting to appointments across Atlanta for the pills was a challenge. She is now enrolled in a drug trial for a promising PrEP injection but worries about future access and cost.

Preexposure prophylaxis, known as PrEP, reduces the risk of new HIV infections through sex by 99% and among injectable drug users by at least 74%, according to the Centers for Disease Control and Prevention.

Among states, Georgia has the highest rate of new HIV infections, but residents — especially women and Black patients like Wilkins — are often not getting PrEP, data shows.

A rule enacted by the Biden administration that took effect for many Affordable Care Act plans on Jan. 1 should make it easier for people like Wilkins to get long-acting PrEP injectable drugs.

A new Trump administration adds an X factor to this and other federal health programs. On Jan. 27, the White House announced a federal funding freeze, which sent shudders through health agencies and nonprofits. By Jan. 29, it had reversed the order.

Federal initiatives like the Ryan White HIV/AIDS Program and HIV prevention funding seemed to be affected — and “blocking access to PrEP would have deadly consequences,” said Wayne Turner, a senior attorney at the National Health Law Program.

Georgia has big racial and gender discrepancies in PrEP uptake, said Patrick Sullivan, who is an epidemiology professor at Emory University and leads AIDSVu and PrEPVu, which track HIV data and access to the drug — work that is backed by Gilead Sciences, a PrEP drug manufacturer.

Public health experts use what’s called a “PrEP-to-need ratio” to measure how many people at risk of HIV are getting the drug. A higher number is better. In Georgia for 2023, the statewide ratio was 6, while it was nearly 167 in Vermont, according to PrEPVu.

While the ratio for white people in Georgia was roughly 22, it was about 3 for Black people and just over 3 for Hispanic people. And while it was 7 for men, it was just over 2 for women.

“Black people generally are underserved by PrEP, and women are underserved by PrEP relative to men,” Sullivan said.

Increasing PrEP uptake would help the state cut its new HIV diagnoses, said Dylan Baker, associate medical director at Grady Health’s HIV Prevention Program.

Georgia’s rate of new HIV diagnoses was 27 per 100,000 in 2022, according to the most recent available data. That’s second only to Washington, D.C., and more than double the national rate of 13 per 100,000. That amounts to about 2,500 new cases diagnosed in Georgia in a year.

Globally about 3.5 million people used PrEP in 2023, up from 200,000 in 2017 but short of the United Nations’ 2025 target of 21.2 million people, according to a 2024 report by the United Nations Program on HIV/AIDS.

PrEP users in Atlanta report many challenges in getting the drug, including cost, medical providers who don’t prescribe it, stigma, a lack of inclusive marketing, and transportation. Wilkins said she has run up against all of those.

“Here I am telling you that I’m here to get tested because I have come into contact with someone who was living with HIV, and we had a sexual relationship, and you’re not even mentioning PrEP to me,” Wilkins said. “That was a disservice.”

Insurers Now Required To Cover PrEP

Cost has long been a barrier. The Biden administration last fall issued guidance requiring most insurers to cover the full cost of all forms of PrEP, without prior authorization, along with certain lab work and other services. This includes pills as well as Apretude, an injection given every two months.

That means insured PrEP users should not face out-of-pocket costs, said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, which lobbied for the rule.

It applies to those on the federal marketplace plans and most large private health plans. A similar rule exists for Medicare and Medicare Advantage plans.

Schmid said he does not think the Trump administration will repeal the rule, but he is concerned the U.S. Supreme Court could end coverage for preventive services, including PrEP, when it issues a decision in Braidwood Management v. Becerra, anticipated this summer.

The rule will not help the uninsured. In Georgia, which did not expand Medicaid under the ACA, about 1 million adults under age 65 are uninsured.

“The cost is also a struggle, especially given different people are part of the gig economy, a lot of folks don’t always have access to health insurance,” said Maximillian Boykin, an Atlanta PrEP user.

Expanding Medicaid would help. States that have done so, Sullivan said, “have higher levels of PrEP uptake.”

Winning the PrEP Lottery

Since getting on PrEP in 2019, Wilkins has encountered two doctors who did not want to prescribe it.

One female OB-GYN told her “‘Girl, at our age, we should know better.’” Wilkins said she “fired” that doctor, telling her that such comments are stigmatizing.

When Wilkins moved, she looked for a nearby primary care provider so she would not have to pay for transportation to get PrEP.

But the doctor she found, Wilkins said, told her to find an infectious disease specialist for PrEP.

“‘You’re not treating an infectious disease,’ I say. ‘This is preventive care,’” Wilkins recalled.

Wilkins’ fortunes turned when she was selected to join a study for a twice-yearly injectable form of PrEP.

A photo of Latonia Wilkins posing next to a Southern AIDS Coalition banner at an event. — Latonia Wilkins, an Atlanta mother, has faced several challenges accessing PrEP, an HIV prevention drug.(Darriyhan Edmond)

Lenacapavir, already approved for HIV treatment, showed promising results for HIV prevention in two earlier Gilead trials. Wilkins is part of a trial in Atlanta including about 250 cisgender women nationally who have sex with men.

It’s much better than a daily pill or even a shot once every two months, Wilkins said.

She hopes to stay on the drug, but the U.S. list price for lenacapavir as an HIV treatment averages about $40,000 a year.

Gilead last year announced it signed royalty-free licensing agreements with six manufacturers to make generic lenacapavir for 120 primarily low- and lower-middle-income countries.

It’s not clear where it falls with the Biden rule. “We believe it should be covered,” Schmid said, “but want the federal government to state that clearly.”

For many patients, challenges remain. Most people are willing to travel about 30 minutes for routine health care, Sullivan said, but in cities like Atlanta, those relying on public transportation may face longer commutes to PrEP providers. Some who need PrEP have unstable housing without firm mailing addresses.

Privacy is another concern. “Everybody should be able to find a place that’s comfortable,” Sullivan said. “More of that can go on in primary health care.”

Others agree that public health messaging around PrEP services should target more diverse audiences. Dázon Dixon Diallo is the founder of SisterLove, an HIV, sexual, and reproductive health organization focused on Black women in the Southeast.

“You’re not going to get to us by giving us a 3-second cameo in a commercial about PrEP,” she said. “There’s no story in there for me, right?”

Healthbeat is a nonprofit newsroom covering public health published by Civic News Company and KFF Health News. Sign up for its newsletters here.

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

California Housing Officials Recommend State Protect Renters From Extreme Heat

Citing the hundreds of lives lost to extreme heat each year, California state housing officials are urging lawmakers to set residential cooling standards long opposed by landlords and builders who fear such a measure would force them to make big-ticket upgrades.

In a 60-page report sent Monday to the legislature, the California Department of Housing and Community Development recommended lawmakers set a maximum safe indoor air temperature of 82 degrees Fahrenheit for the Golden State’s estimated 14.6 million residential dwelling units.

“This is a big deal,” said C.J. Gabbe, an associate professor of environmental studies at Santa Clara University. “We’re seeing more and more concerns about the increase in heat-related morbidity and mortality in California, which is leading to these kinds of maximum indoor temperature guidelines.”

If the housing proposal is adopted, California could have the most comprehensive requirements in the nation, Gabbe said. Some local jurisdictions, including Phoenix, Dallas, and New Orleans, have set their own standards, and the city and county of Los Angeles are exploring their own protections.

Last year was the planet’s warmest on record, and extreme weather is becoming more frequent and severe, according to the National Oceanic and Atmospheric Administration. Even though most heat deaths and illnesses are preventable, about 1,220 people in the United States are killed by extreme heat every year, according to the Centers for Disease Control and Prevention. Heat stress can cause heatstroke, cardiac arrest, and kidney failure, and it’s especially harmful to the very young and the elderly.

State law protects renters in the winter by requiring all rental residential dwelling units to include functioning heating equipment that can keep the indoor temperature at a minimum of 70 degrees, but there is no similar standard giving renters the right to cooling.

The release of this report is a key milestone, but it’s just the first step of a long road, vulnerable to legislative politics and an influential housing industry that has successfully delayed similar proposals in the past. In 2022, state lawmakers directed the housing department to issue cooling recommendations after proposed legislation stalled when landlords, real estate agents, and builders raised concerns such a standard would be cost-prohibitive.

Those concerns remain. Many California rental units are older homes, sometimes 90 to 100 years old, and installing air conditioning would require expensive changes, including upgrading the electrical system, said Daniel Yukelson, CEO of the Apartment Association of Greater Los Angeles.

“These types of government mandates, absent some kind of financing or significant tax breaks, would really put a lot of smaller owners out of business,” said Yukelson, who added that he’s concerned it would lead to housing getting bought by large corporations that would spike rent prices.

The report recommends lawmakers provide incentive programs for owners to retrofit residential units so the cost isn’t passed along to renters. It also suggested a variety of strategies that could be deployed to keep homes cool: central air conditioning, window units, window shading, fans, and evaporative room coolers.

For new construction, housing officials suggested new standards incorporating designs to keep indoor temperatures from topping 82 degrees, such as cool roofs and cool walls designed to reflect sunlight, or landscaping to provide shade.

Whether the legislature will take up the housing department’s recommendations is unclear. Spokespeople for Democratic Assembly Speaker Robert Rivas and Sen. Henry Stern, a Democrat who co-authored the 2022 cooling standard bill, declined to comment.

Californians largely stand behind the idea, according to a 2023 poll from the University of California-Berkeley Institute of Governmental Studies and co-sponsored by the Los Angeles Times. Sixty-seven percent of voters said they supported the concept of the state establishing cooling standards for residential properties.

As temperatures rise and heat waves become longer and more intense, the report cautions, deaths in California could rise to 11,300 a year by 2050. And deaths from all causes “may be up to 10% higher on hot nights compared with nights without elevated temperatures,” according to a February presentation by the Los Angeles County Department of Public Health.

That’s because it can be particularly dangerous when people can’t cool off at night during extended heat waves, said David Konisky, a professor of environmental policy at Indiana University.

“When you can’t count on evening cooling off and allowing the body to readjust,” he said, “that’s when things get really dangerous for people’s health.”

Funcionarios de California recomiendan que el estado proteja a los inquilinos del calor extremo

Citando las cientos de vidas que se pierden cada año por el calor extremo, funcionarios del área de vivienda de California están instando a los legisladores a establecer estándares de refrigeración residencial. Propietarios y constructores se han estado negando desde siempre a estas medidas porque temen que los obligue a tener que hacer reformas costosas.

En un informe de 60 páginas enviado el lunes 3 de febrero a la Legislatura, el Departamento de Vivienda y Desarrollo Comunitario de California recomendó a los legisladores establecer una temperatura máxima segura del aire interior de 82 grados Fahrenheit para las cerca de 14,6 millones de unidades de vivienda residencial del estado.

“Es un gran problema”, dijo C.J. Gabbe, profesor asociado de estudios ambientales en la Universidad de Santa Clara. “Estamos viendo cada vez más preocupaciones sobre el aumento de la morbilidad y la mortalidad relacionadas con el calor en California, lo que está llevando a este tipo de pautas de temperatura máxima interior”.

De adoptarse la propuesta de vivienda, California podría tener los requisitos más completos del país, dijo Gabbe. Algunas jurisdicciones locales, incluidas Phoenix, Dallas y Nueva Orleans, han establecido sus propios estándares, y la ciudad y el condado de Los Ángeles están explorando sus propias protecciones.

El año pasado fue el más cálido registrado en el planeta, y los fenómenos meteorológicos extremos se están volviendo más frecuentes y severos, según la Administración Nacional Oceánica y Atmosférica (NOOA). Aunque la mayoría de las muertes y enfermedades causadas por el calor se pueden prevenir, alrededor de 1.220 personas mueren cada año en el país por esta causa, según los Centros para el Control y Prevención de Enfermedades (CDC). El estrés térmico puede causar insolación, paro cardíaco e insuficiencia renal, y es especialmente perjudicial para los muy jóvenes y los adultos mayores.

La ley estatal protege a los inquilinos en el invierno al exigir que todas las unidades residenciales de alquiler incluyan equipos de calefacción que funcionen y puedan mantener la temperatura interior a un mínimo de 70 grados, pero no existe una norma similar que otorgue a los inquilinos el derecho a la refrigeración.

La lanzamiento de este informe es un hito clave, pero es solo el primer paso de un largo camino, vulnerable a la política legislativa y a una influyente industria de bienes raíces que ha retrasado con éxito propuestas similares en el pasado. En 2022, los legisladores estatales ordenaron al departamento de vivienda que emitiera recomendaciones sobre refrigeración después que la legislación propuesta se estancara cuando propietarios, agentes inmobiliarios y constructores plantearan la preocupación de que la norma resultaría prohibitiva en términos de costos.

Esas preocupaciones persisten. Muchas unidades de alquiler de California son casas antiguas, a veces de entre 90 y 100 años, e instalar un sistema de aire acondicionado requeriría cambios costosos, incluida la actualización del sistema eléctrico, dijo Daniel Yukelson, director ejecutivo de la Apartment Association of Greater Los Angeles.

“Este tipo de mandatos gubernamentales, en ausencia de algún tipo de financiación o exenciones fiscales significativas, realmente dejarían sin trabajo a muchos propietarios más pequeños”, dijo Yukelson, quien agregó que le preocupa que esto lleve a que las grandes corporaciones compren viviendas, lo que aumentaría los precios de los alquileres.

El informe recomienda que los legisladores ofrezcan programas de incentivos para que los propietarios modernicen las unidades residenciales para que el costo no se traslade a los inquilinos. También sugirió una variedad de estrategias que podrían implementarse para mantener las casas frescas: aire acondicionado central, unidades en ventanas, persianas, ventiladores y enfriadores de habitación por evaporación.

Para las nuevas construcciones, los funcionarios de vivienda sugirieron nuevos estándares que incorporen diseños para evitar que las temperaturas interiores superen los 82 grados, como techos y paredes frescos diseñados para reflejar la luz solar, o paisajismo para tener sombra.

No está claro si la Legislatura aceptará las recomendaciones del departamento de vivienda. Voceros del presidente de la Asamblea demócrata Robert Rivas y del senador Henry Stern, demócratas que fueron coautores del proyecto de ley de estándares de refrigeración de 2022, no quisieron hacer comentarios.

Los californianos en gran medida respaldan la idea, según una encuesta de 2023 del Instituto de Estudios Gubernamentales de la Universidad de California-Berkeley y co-patrocinada por Los Angeles Times. El 67% de los votantes dijeron que apoyaban el concepto de que el estado estableciera estándares de refrigeración para propiedades residenciales.

Según el informe, a medida que las temperaturas aumenten y las olas de calor se hagan más largas e intensas, las muertes en California podrían aumentar a 11.300 al año para 2050. Y las muertes por todas las causas “pueden ser hasta un 10% más altas en las noches calurosas en comparación con las noches sin temperaturas elevadas”, según una presentación de febrero del Departamento de Salud Pública del condado de Los Ángeles.

Esto se debe a que puede ser particularmente peligroso cuando las personas no pueden refrescarse por la noche durante las olas de calor prolongadas, dijo David Konisky, profesor de política ambiental en la Universidad de Indiana.

“Cuando no se puede contar con que las personas se refresquen por la noche y permitan que el cuerpo se reajuste, es cuando las cosas se ponen realmente peligrosas para la salud de las personas”, agregó.

Trump’s Already Gone Back on His Promise To Leave Abortion to States

Abortion foes worried before his election that President Donald Trump had moved on, now that Roe v. Wade is overturned and abortion policy, as he said on the campaign trail, “has been returned to the states.”

Their concerns mounted after Trump named Robert F. Kennedy Jr., a longtime supporter of abortion rights, to lead the Department of Health and Human Services — and then as he signed a slew of Day 1 executive orders that said nothing about abortion.

As it turns out, they had nothing to worry about. In its first two weeks, the Trump administration went further to restrict abortion than any president since the original Roe decision in 1973.

Hours after Trump and Vice President JD Vance spoke to abortion opponents gathered in Washington for the annual March for Life, the president issued a memorandum reinstating what’s known as the Mexico City Policy, which bars funding to international aid organizations that “perform or actively promote” abortion — an action taken by every modern Republican president.

But Trump also did something new, signing an executive order ending “the forced use of Federal taxpayer dollars to fund or promote elective abortion” in domestic programs — effectively ordering government agencies to halt funding to programs that can be construed to “promote” abortion, such as family planning counseling.

Dorothy Fink, the acting secretary of Health and Human Services, followed up with a memo early last week ordering the department to “reevaluate all programs, regulations, and guidance to ensure Federal taxpayer dollars are not being used to pay for or promote elective abortion, consistent with the Hyde Amendment.”

The emphasis on the word “promote” is mine, because that’s not what the Hyde Amendment says. It is true that the amendment — which has been included in every HHS spending bill since the 1970s — prohibits the use of federal dollars to pay for abortions except in cases of rape or incest or to save the mother’s life.

But it bars only payment. As the current HHS appropriation says, none of the funding “shall be expended for health benefits coverage that includes coverage of abortion.”

In fact, for decades, the Hyde Amendment existed side by side with a requirement in the federal family planning program, Title X, that patients with unintended pregnancies be given “nondirective” counseling about all their options, including abortion. Former President Joe Biden reinstated that requirement in 2021 after Trump eliminated it during his first term.

So, what is the upshot of Trump’s order?

For one thing, it directly overturned two of Biden’s executive orders. One was intended to strengthen medical privacy protections for people seeking abortion care and enforce a 1994 law criminalizing harassment of people attempting to enter clinics that provide abortions. The other sought to ensure women with pregnancy complications have access to emergency abortions in hospitals that accept Medicare even in states with abortion bans. The latter policy is making its way through federal court.

Trump’s order is also leading government agencies to reverse other key Biden administration policies implemented after the fall of Roe v. Wade. They include a 2022 Department of Defense policy explicitly allowing service members and their dependents to travel out of states with abortion bans to access the procedure and providing travel allowances for those trips. (The Pentagon officially followed through on that change on Jan. 30, just a few days after Defense Secretary Pete Hegseth took over the job: Service members are no longer allowed leave or travel allowances for such trips.) The order is also likely to reverse a policy allowing the Department of Veterans Affairs to provide abortions in some cases, as well as to provide abortion counseling.

But it could also have more wide-ranging effects.

“This executive order could affect other major policies related to access to reproductive health care,” former Biden administration official Katie Keith wrote in the policy journal Health Affairs. These include protections for medication abortion, emergency medical care for women experiencing pregnancy complications, and even in vitro fertilization.

“These and similar changes would, if and when adopted, make it even more challenging for women and their families to access reproductive health care, especially in the more than 20 states with abortion bans,” she wrote.

Anti-abortion groups praised the new administration — not just for the executive orders, but also for pardoning activists convicted of violating a law that protects physical access to abortion clinics.

“One after another, President Trump’s great pro-life victories are being restored and this is just the beginning,” Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, said in a statement.

Abortion rights groups, meanwhile, were not surprised by the actions or even their timing, said Clare Coleman, president and CEO of the National Family Planning & Reproductive Health Association. The association represents grantees of Title X, which has been a longtime target of abortion opponents.

“We said we didn’t think it would be a Day 1 thing,” Coleman said in an interview. “But we said they were coming for us, and they are.”

HealthBent, a regular feature of KFF Health News, offers insight into and analysis of policies and politics from KFF Health News chief Washington correspondent Julie Rovner, who has covered health care for more than 30 years.

Wash, Dry, Enroll: Finding Medicaid Help at the Laundromat

SUITLAND, Md. — At a SuperSuds Laundromat just south of Washington, D.C., a steady stream of customers loaded clothes into washers and dryers on a recent Sunday morning, passing the time on their phones or watching television.

Amid the low hum of spinning clothes, Adrienne Jones made the rounds in a bright yellow sweatshirt, asking customers about their health needs. “Do you have health coverage?” Jones, an outreach manager for Fabric Health, asked Brendan Glover, 25, who was doing laundry with his toddler in tow.

Glover works in law enforcement, but he lost his coverage in 2024 when a job ended. “I am young, so I don’t think about it, but I know I will need it,” he said.

Jones collected his contact information, gave him a gift card for a future laundromat visit, and promised to help him find affordable coverage.

State Medicaid and Affordable Care Act coverage programs have long struggled to connect with lower-income Americans to help them access health care. They send letters and emails, place phone calls, and post on social media platforms such as Facebook and X.

Some of these state programs are trying an alternative approach: meeting people at the laundromat — where they regularly go and usually have time to chat.

Fabric Health, a Washington, D.C.-based startup, sends outreach workers into laundromats in Maryland, Pennsylvania, New Jersey, and — as of January — the District of Columbia, to help people get and use health coverage, including by helping schedule checkups or maternity care. The workers, many of whom are bilingual, visit the laundromats also to establish relationships, build trust, and connect people with government assistance.

A photo of Brendan, Glover, a young man seated across from Adrienne Jones, who has a laptop in front of her. They are at a laundromat. — Brendan Glover chats with Fabric Health worker Adrienne Jones inside a laundromat in Suitland, Maryland. Glover was uninsured at the time, and Jones said the company would help him find coverage.(Phil Galewitz/KFF Health News)

Medicaid health plans including those run by CareFirst BlueCross BlueShield in Maryland, UPMC in Pittsburgh, and Jefferson Health in Philadelphia pay Fabric Health to connect with their enrollees. The company was paid by the Maryland Managed Care Organization Association, the state’s Medicaid health plan trade group, to help people recertify their Medicaid eligibility after covid pandemic-era coverage protections expired.

Since 2023, the company has connected with more than 20,000 people in Maryland and Pennsylvania alone, collecting contact information and data on their health and social needs, said Allister Chang, a co-founder and the chief operating officer. Chang also serves on the D.C. State Board of Education as Ward 2’s elected representative.

Fabric Health would not disclose its fees to KFF Health News. The company is structured as a public benefit corporation, meaning it is a for-profit business created to provide a social benefit and is not required to prioritize seeking profits for shareholders.

Pennie, Pennsylvania’s ACA marketplace, which opened in 2020, pays Fabric Health to talk to people in the Philadelphia and Pittsburgh areas about coverage options and enroll them.

A survey last year found that two-thirds of uninsured people in the state have never heard of Pennie, said Devon Trolley, Pennie’s executive director.

“Fabric’s approach is very novel and creative,” she said. “They go to where people are sitting with time on their hands and develop grassroots relationships and get the word out about Pennie.”

For enrollees, the laundromat chats can be easier and quicker than connecting with their health plans’ customer service. For the health plans, they can increase state performance payments, which are tied to enrollee satisfaction and effectiveness at getting them services such as cancer screenings.

“Our pitch is: People spend two hours a week waiting around in laundromats and that idle time can be incredibly productive,” said Courtney Bragg, a co-founder and the CEO of Fabric Health.

CareFirst began working with the company last year to help people in Maryland renew coverage, schedule checkups, and sign up for other benefits including energy assistance and food stamps.

Sheila Yahyazadeh, chief external operations officer for the CareFirst plan, said the initiative shows the importance of human interaction. “There is a misconception that technology will solve all, but a human face is absolutely fundamental to make this program successful because at the end of the day people want to talk to someone and feel seen and cared for,” she said.

On a previous visit to SuperSuds, Jones, the Fabric Health outreach worker, met Patti Hayes, 59, of Hyattsville, Maryland, who is enrolled in the Medicaid health plan operated by CareFirst but had not seen a primary care physician in over a year. She said she preferred to see a Black physician.

After they met at the laundromat, Jones helped her find a new doctor and schedule an appointment. She also helped her find a therapist in her plan’s network.

“This is helpful because it’s more of a personal touch,” Hayes said.

A photo of Adrienne Jones standing while holding a laptop and speaking to Patti Hayes, seated. A laundry machine is behind them. — Adrienne Jones, an outreach manager for Fabric Health, talks to Patti Hayes, a Medicaid enrollee, inside a laundromat in Suitland, Maryland.(Phil Galewitz/KFF Health News)

Fabric Health also texts people to stay in touch and tell them when the outreach workers will be back at their laundromat so they can meet again in person.

Paola Flores, 38, of Clinton, Maryland, told a Fabric Health worker she needed help switching Medicaid plans so she could get better care for her autistic child. Communicating with her in Spanish, the worker said she would help her, including by making an appointment with a pediatrician.

“Good help is hard to find,” Flores said.

Ryan Moran, Maryland’s Medicaid director, said Fabric Health helped keep people enrolled during the Medicaid “unwinding,” when everyone on the program had to get renewed after the expiration of pandemic-era coverage protections that lasted three years.

Outreach workers there focused on laundromats in towns that had high rates of people being disenrolled for paperwork reasons.

“There is no question about the value of human-to-human interaction and the ability to be on the ground where people are, that removes barriers and gets people to engage with us,” Moran said.

Rutgers Center for Recovery and Wellbeing Dedicated in Plainfield

Original post: February 4, 2025 6:25 pm Newswise - Substance Abuse Rutgers Center for Recovery and Wellbeing Dedicated in Plainfield

Each year since 2021, more than 3,000 New Jerseyans – eight people per day on average – have died from unintentional overdoses. For those trying to escape this cycle, inpatient withdrawal management, more commonly referred to as “detox,” is often their best hope.

But in many parts of the state, wait times for a bed could be too long for someone on the edge of sobriety.

The Rutgers Center for Recovery and Wellbeing, in Plainfield, N.J., aims to help fill this need.

“In New Jersey, there is a significant need for new providers to increase access to services, particularly within the inpatient and withdrawal management sector,” said Caitlin Simpson, senior director of addiction services at Rutgers University Behavioral Health Care (UBHC), which partners with RWJBarnabas Health Behavioral Health Services in offering a comprehensive network of mental health services in the state. “The Rutgers Center for Recovery and Wellbeing strives to fill the existing gap in services and the needs of the community.”

Located at the former Muhlenberg Hospital, the four-story, 20,000-square-foot renovated building in the Muhlenberg Medical Arts Complex will be led by Simpson and colleague Josephine Schettino, program director for the Center, who will oversee daily operations.

Once fully operational later this year, the center will offer holistic and integrated diagnostic and clinical care to individuals and their families affected by substance use and co-occurring disorders.

Four levels of care will be available. Twenty of the 44-bed center are designated for individuals in need of medically monitored inpatient withdrawal management services. Clients may choose to transition to one of 24 short-term inpatient beds, with therapy and round-the-clock nursing and monitoring. For those not needing withdrawal management, inpatient care will be the first step.

Following successful completion of inpatient treatment, clients will have the opportunity to transition to the center’s intensive outpatient program, which will offer up to 12 hours of group/individual therapy per week to include medication management and case management services, in addition to traditional outpatient services. For those individuals who live a distance from the Plainfield location, appropriate referrals will be made for outpatient care in their home communities.

The key to the center’s success will be accessibility, said Simpson, adding that the access team will try to schedule clients within 72 hours of contact, if not immediately.

“When someone calls seeking treatment and is experiencing withdrawal symptoms, they often will require the support and interventions from our medical team, and quick access to treatment can be a world of difference for the overall success of the individual,” Simpson said.

Rutgers purchased the building in May 2020, and a certificate of occupancy was issued by the city in June 2022. Rutgers assumed title of the building in November 2022. Construction of the complex is now complete. The center is currently licensed for outpatient and intensive outpatient care and is awaiting licensure for medically monitored withdrawal management and short-term inpatient treatment.

Rutgers Health University Behavioral Health Care operates substance use disorder treatment services to include intensive outpatient and traditional outpatient programs in New Brunswick, Newark, Cherry Hill and a small program at the Middlesex County Jail. The addition of the Plainfield center will enable Rutgers to provide services to clients across New Jersey with the goal to seamlessly coordinate ongoing care as clinically indicated upon completion of treatment.

“With the Rutgers Center for Recovery and Wellbeing, we will have a great opportunity to support individuals and loved ones on their path to an improved quality of life and long-term recovery,” Simpson said.

Neurosurgery Submits Comment to Senate Judiciary Hearing on Controlled Substances

Original post: February 4, 2025 5:35 pm Newswise - Substance Abuse Neurosurgery Submits Comment to Senate Judiciary Hearing on Controlled Substances

Washington, DC—Today, the American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS), and seven other leading medical organizations sent a joint letter to Senate Judiciary Committee Chairman Chuck Grassley (R-Iowa) and Ranking Member Dick Durbin (D-Ill.) ahead of the Committee’s hearing titled, The Poisoning of America: Fentanyl, its Analogues, and the Need for Permanent Class Scheduling, scheduled for February 4, 2025. The hearing aims to examine the public health and safety threats posed by illicit fentanyl and its analogues and to evaluate the need for permanent class-wide scheduling of these substances under the Controlled Substances Act (CSA).

“The fentanyl crisis has devastated families and communities across the country. We thank Chairman Grassley and Ranking Member Durbin for the opportunity to provide our clinical perspective on this critical issue and urge Congress to advance a solution before the current authority expires next month,” said Alexander A. Khalessi, MD, MBA, chair of the AANS/CNS Washington Committee. “As physicians and DEA registrants, we are committed to the responsible stewardship of controlled substances, ensuring patients have access to evidence-based pain management. While supporting efforts to combat this public health crisis, we urge Congress to address regulatory barriers that limit access to certain FDA-approved opioid therapies—often the last line of relief for patients with advanced cancer, complex surgical needs, and neurological disorders.”

The letter outlines key clinical considerations related to the permanent scheduling of fentanyl-related substances, focusing on physician compliance with the CSA and the importance of maintaining patient access to necessary treatments. Additionally, the organizations highlighted an unintended consequence of the SUPPORT Act, which has been misinterpreted to prevent pharmacies from dispensing controlled substances for use in intrathecal pain pumps—a critical therapy for patients with severe, chronic pain conditions such as advanced cancer, spinal cord injuries, and neurological disorders. This misinterpretation has created significant logistical barriers, forcing patients and physicians to rely on complex and burdensome workarounds that jeopardize patient safety, disrupt continuity of care, and increase the risk of medication errors and diversion. The letter urges Congress to enact a targeted legislative correction to restore clear, consistent access to these therapies while maintaining appropriate oversight of controlled substances.

In addition to AANS and CNS, the letter was signed by:

American Academy of Pain Medicine (AAPM)
American Academy of Physical Medicine & Rehabilitation (AAPM&R)
American Society of Anesthesiologists (ASA)
American Society of Neuroradiology (ASNR)
American Society of Regional Anesthesia and Pain Medicine (ASRA Pain Medicine)
North American Neuromodulation Society (NANS)
North American Spine Society (NASS)

To read the letter, click here.

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The American Association of Neurological Surgeons (AANS), founded in 1931, and the Congress of Neurological Surgeons (CNS), founded in 1951, are the two largest scientific and educational associations for neurosurgical professionals in the world. These groups represent over 10,000 neurosurgeons worldwide. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment, and rehabilitation of disorders that affect the entire nervous system, including the spinal column, spinal cord, brain, and peripheral nerves. For more information, please visit www.aans.org, www.cns.org, and www.neurosurgery.org.

Does drinking alcohol really take away the blues? It’s not what you think

A new study from the University of Chicago Medicine reveals that people with alcohol use disorder (AUD) and depression experience high levels of stimulation and pleasure when intoxicated, similar to drinkers who do not have depression.

The findings counter the long-held belief that the pleasure people experience when drinking alcohol decreases with addiction and that drinking to intoxication is mainly to reduce negative feelings as a form of self-medication.

“We have this folklore that people drink excessively when they’re feeling depressed and that it’s really about self-medicating,” said Andrea King, PhD, Professor of Psychiatry and Behavioral Neuroscience at UChicago and lead author of the study. “In this study of natural environment drinking and smart phone-based reports of the effects of alcohol in real-time, participants with AUD and a depressive disorder reported feeling acute, sustained positive and rewarding alcohol effects — just like their non-depressed counterparts.”

Published February 1 in the American Journal of Psychiatry, the research challenges conventional notions about alcohol’s effects in depressed people who drink excessively and could improve treatment approaches by focusing medication and behavioral approaches more on alcohol’s pleasure reward pathways and less on stress-responsive systems.

“Currently, the focus of treatment is often on resolving stress and symptoms of depression, but that is only addressing one side of the coin if we don’t also address the heightened stimulation, liking and wanting more alcohol that occur in both depressed and non-depressed people with AUD,” said King, who has been conducting human research for decades to test responses to alcohol that lead to addiction.

The effects of alcohol on the brain are complex, and improved understanding of the factors that affect an individual’s vulnerability to AUD and depression is critical to identify and initiate early, effective treatment. However, few studies have examined how people with AUD respond to alcohol either in controlled laboratory settings or the natural environment; including individuals with AUD and another co-morbid diagnosis adds to the complexity.

The research followed 232 individuals across the U.S. between the ages of 21 to 35, corresponding to the period when most heavy drinking occurs in a person’s lifetime. Half of the study group met criteria for AUD in the past year and were evenly divided in terms of those who had or had not experienced a major depressive disorder in the past year. Individuals who had suicidal ideation were excluded for safety reasons, as were people who had severe alcohol withdrawal symptoms.

Through their smartphones, participants answered questions every half hour for three hours during one typical alcohol drinking episode and a non-alcohol episode. The researchers found that alcohol consumption reduced negative feelings, although the reduction was small and nonspecific to their depression or AUD status. The positive effects of alcohol were much higher in individuals with AUD than those without AUD and contrary to lore, similar in those with AUD and depression and those without depression.

“For nearly a decade, our group has been improving methods to use mobile technologies to measure real time clinically meaningful outcomes in people with AUD and those at risk for alcohol-related problems,” said study co-author Daniel Fridberg, PhD, Associate Professor of Psychiatry and Behavioral Neuroscience at UChicago. “These approaches allow us to bridge the gap between the lab and real life and have led to new insights that could one day result in better treatments.”

The study’s findings call into question the predominant theory that alcohol addiction arises from the brain’s attempt to maintain stability despite repeated heavy drinking. That theory describes a “dark side of addiction” where repeated heavy drinking over time leads to changes in the brain systems involved in stress and reward. As a result of those changes, it is hypothesized that individuals shift from drinking for pleasure to drinking to avoid withdrawal and stress.

King says this theory does not account for the high levels of stimulation and pleasure that she likens to an accelerator pedal fueling more dependency.

“As treatment providers, we’re taught people with AUD are drinking to self-medicate and feel better,” said King. “But what exactly are they feeling? From our study, it seems to be high levels of stimulation and pleasurable effects, with a modest decrease in negative states.”

King’s next study examines whether adults between 40 to 65 years old who have had AUD for decades also experience similar heightened feelings of pleasure when drinking versus older drinkers without AUD. The prevailing theory would suggest these individuals would show blunted positive responses and high levels of tolerance to alcohol. King will examine whether they show a long-term sensitivity to alcohol’s enjoyable effects, much like in this study of depressed drinkers.

Declining US Drug Overdose Deaths: Evidence-Based Prevention and Treatment Working

Newswise — WASHINGTON, DC — A new editorial in the BMJ suggests that a 22% decrease in overall U.S. drug overdose deaths over 2023/2024 signals that investments in overdose prevention and substance use disorder treatment are working. In Avoiding a new US “war on drugs”: Declining US drug overdose deaths show that evidence-based public health approaches work (Vincent Guilamo-Ramos, Adam Benzekri, Loftin Wilson, and Marissa D. Abram), the authors call for more investment in treatment and prevention to accelerate progress — and to reject calls for a return to “War on Drugs” tactics that bipartisan experts believe didn’t work.

“Evidence-based prevention and treatment are working in communities across the entire country. There’s also a growing sense across the ideological divide that this is the smartest approach, while the ‘War on Drugs’ simply wasn’t — because it was law enforcement-focused, disproportionately harmed communities of color, was a waste of money, and it just didn’t work. In an era of increased appetite for criminalizing health and social problems, we have already learned that addiction is best addressed with care, not convictions. Bottom line: a return to ‘War on Drugs’ tactics could reverse the progress made in the overdose crisis and make the situation much worse,” said Dr. Vincent Guilamo-Ramos, IPS Executive Director and the Leona B. Carpenter Chair in Health Equity and Social Determinants of Health at Johns Hopkins School of Nursing.

The editorial explores what is most likely driving the welcome decline in deaths – and why in some states overdoses are rising. It looks at how more “tough on crime” messaging could lead to a more law enforcement-driven response to drug taking and overdoses – pushing back progress, especially in communities of color where the decline has been slower. It explores existing prevention and treatment successes – such as major changes in opioid medication prescription policies and practices, expanded access to opioid use disorder medications, and the scaling-up of community-based harm reduction services. Finally, it notes promising new strategies to further eliminate substance related prevention and treatment inequities such as: community and family-based models of prevention and treatment service delivery in marginalised communities and achieving a health workforce more representative of the populations served.

“Making the right call at this moment-of-opportunity is key to save and improve more lives. The wrong call is for approaches that are ineffective and unjust; this would fail all US communities — especially those in which overdose deaths continue to rise. It’s time to get tougher FOR prevention and treatment, for MORE targeted investment in prevention and treatment – and not to repeat the mistakes of the past,” Guilamo-Ramos stressed.

ENDS

Notes to editors

A: Overdose Death Rate per 100,000 (age-adjusted)

B: Number of Overdose Deaths

Online Curriculum Aids Prescribers in Fighting Opioid Addiction Across Appalachia

BYLINE: Steven Infanti

The Appalachian region continues to experience disproportionately higher opioid overdose rates and related fatalities. According to the most recent Center for Disease Control and Prevention, fully one-half of the 16 states with the highest overdose death rates are Appalachian states. West Virginia tops the list, and is joined by, in descending order, Tennessee, Kentucky, Ohio, South Carolina, North Carolina, Pennsylvania, and Maryland. And although the CDC’s data shows a 4% overall overdose death rate decline, the statistics for Appalachia remain stubbornly high.

A Philadelphia-based non-profit foundation is combating the opioid addiction epidemic at the source by educating frontline allied health professionals on various aspects of the nation’s opioid crisis, specifically in Pennsylvania and the Appalachian region.

The Rothman Orthopaedic Institute Foundation for Opioid Research and Education (aka, Rothman Opioid Foundation) is a leader in opioid-related research and education. Thanks to a three-year grant from the federal Appalachian Regional Commission and support from the Pennsylvania General Assembly, the Foundation has used its expertise to educate allied health professionals in Pennsylvania and the broader Appalachian region on proper opioid prescribing and use.

Rothman Opioid Foundation has created and distributes opioid education curricula at no cost for the 75 allied healthcare professional training programs, such as nurse practitioners and physician assistants, at collegiate institutions across the Appalachian Region. In particular, the Foundation has produced an 8-module online pain management curriculum designed to complement any training program focusing on evidence-based pain management using opioid-sparing strategies.

“Physician assistants and nurse practitioners are valued professionals and are often on the front line of primary care and pain management, and they will greatly benefit from formal training in opioid pharmacology, use, abuse, and safe evidenced-based pain management strategies,” says Dr. Asif Ilyas, MD, MBA, FACS, President of the Rothman Opioid Foundation in Philadelphia, PA. The Foundation has developed its curriculum as a prescriber-training program and is offering this eight-hour course free of charge. It is an online, self-paced certificate program designed to effortlessly complement students’ current curriculum in the clinical phases of their training and prescribers in practice. The targeted allied health professionals include nurse practitioners (NPs) and physicians’ assistants (PAs). The curriculum’s training includes, but not be limited to, opioid prescribing guidelines and indications, pain management alternatives to opioids, identification of potential opioid abuse, and intervention strategies. Additional educational programs will include online webinar series and in-person events when feasible. The curriculum is designed to complement the clinical phase of NP and PA training programs but can be implemented at any stage in training. While designed specifically for NP and PA students, the Rothman Opioid Foundation submitted the course material to a rigorous national accreditation process. As a result, the curriculum has been accredited for up to 13.5 Continuing Medical Education (CME) credit hours. It satisfies the Federal Drug Enforcement Agency Medication Assisted Treatment Education (DEA MATE) Act 8-hour training requirement on the treatment and management of patients with opioid or other substance use disorders. That means any licensed prescriber, physician, NP, or PA can obtain the required CME or DEA MATE opioid training through this vital course material. While most opioid-related education currently targets physicians, Ilyas says, NPs and PAs often interact more with individuals who are suffering from or are susceptible to opioid misuse.

“NPs and PAs have prescribing rights. They are vital physician extenders who need to be educated and recruited in the fight against the opioid addiction crisis across the Appalachian region,” says Ilyas. “This information will be tailored specifically to these allied health professionals to mitigate the rate of opioid addiction at the source by teaching proper opioid use and early symptoms of misuse to decrease the risk of opioid dependency and abuse. “The Rothman Opioid Foundation plans to partner with colleges and universities to distribute this information to as many healthcare students as possible in the Appalachian Region. This project’s ultimate goals are to ensure that PAs and NPs have the proper resources and education to advise on proper opioid use and its alternatives, recognize the initial symptoms of opioid misuse and abuse, and understand when and how to intervene when substance abuse occurs.“The opioid addiction crisis has taken a drastic toll on the Appalachian region and the country. To lower the chance of misuse and overdose in patients, it is imperative that our local frontline healthcare workers are adequately trained and educated in the pathophysiology of opioid addiction, and they have resources available to guide effective and safe pain management,” says Ilyas.

According to the Centers for Disease Control and Prevention (CDC), 130 Americans die every day from opioid overdose. This includes prescription and illicit opioids. Low-income and rural areas are among the most likely to experience the opioid addiction crisis’s adverse effects, as evidenced by data published by the Appalachian Regional Commission. Rural residents are at greater risk in part due to a lack of resources or healthcare services to address their addiction. These regions often lack accessible health services, especially those considered “specialized” services, such as addiction treatment.In addition, communities with a high uninsured population are at greater addiction risk as individuals without healthcare insurance are much less likely to receive treatment than those who are insured. These individuals are more likely to seek primary care through an urgent care setting, generally staffed by a physician extender (PAs and NPs).

As noted above, these allied health professionals have not always received the opioid-related education that their physician counterparts have.“Therefore, it is essential that professional education, designed to provide allied health professionals with the tools necessary to both manage pain in an evidenced-based opioid-sparing manner as well as screen for and identify addiction in the primary care setting visit, is available across Appalachia’s rural regions,” says Ilyas. Rothman Opioid Foundation is committed to providing the educational tools needed by our allied health professionals across the Appalachian region as they serve and treat on the front line of the opioid crisis. Information on the curriculum is found here: https://www.rothmanopioid.org/opioids-pain-management

About the Rothman Orthopaedic Institute Foundation for Opioid Research and Education.

The Rothman Orthopaedic Institute Foundation for Opioid Research & Education, www.rothmanopioid.org , is a non-profit 501c3 organization dedicated to raising awareness of the risks and benefits of opioids, educating physicians/physicians/policymakers on safe opioid use, and supporting research and education aimed to advance innovate pain management strategies that can decrease opioid use. The Foundation supports and advances the highest quality research on opioids and alternative pain modalities to yield findings that can better inform patients, physicians, and the greater healthcare community in the most evidenced-based pain management strategies.

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