Cautious optimism about overdose rates

For the first time in nearly three decades, the number of drug overdose deaths in the United States may have gone down last year from the year before.

The Centers for Disease Control and Prevention posted preliminary data for 2018 last week, reporting 68,000 drug overdose deaths compared to 2017’s all-time high of 70,000. While that number may climb a bit as officials complete investigations, the agency expects the final tally to fall short of the previous year’s total, representing the first yearly decrease since overdose deaths started ramping up in 1990.

“Lives are being saved, and we’re beginning to win the fight against this crisis,” Health and Human Services Secretary Alex Azar tweeted. “By no means have we declared victory against the epidemic or addiction in general. This crisis developed over two decades, and it will not be solved overnight.”

Opioid overdoses have claimed more than 430,000 lives in the United States since 2000, according to the CDC. The overdose death rate is still seven times higher than a generation ago. And while the number of deaths caused by heroin and prescription painkillers decreased, those involving fentanyl and non-opioid drugs like cocaine and methamphetamine continued to rise. Researchers don’t think last year’s decline is part of a trend, given the data they have analyzed from the first months of 2019, said Farida Ahmad of the CDC National Center for Health Statistics.

Additionally, the decrease is not consistent with data from several states. In both Ohio and Pennsylvania, overdose deaths were down by 1,000 or more last year, but Missouri saw an increase of about 17 percent, with more than 200 deaths over the previous year.

According to Christian addiction psychiatrist Mark Duncan, many professionals are “guardedly encouraged” by the data, adding that while any reduction is better than none, it is not entirely clear what last year’s lower numbers mean.

The biggest question for many is what drove the decrease. Valerie Hardcastle, who oversees research on regional health issues at Northern Kentucky University, suggested wider availability of Narcan, a nasal spray version of the overdose medication naloxone, played a role.

Awareness about and availability of overdose reversal medication also isn’t uniform from state to state, Duncan noted. Some states have more readily embraced treatment options than others. He also suggested that a significant drop in how many opioid prescriptions doctors write influenced the decline in overdose deaths. The CDC reported the number of opioid prescriptions peaked in 2012 and then dropped steadily until hitting its lowest rate in a decade in 2017, with a total of more than 191 million prescriptions. Duncan expressed concern that some medical clinics have swung too far the other way. He said opioid therapy is not effective for everyone but still has a “place in the tool kit for pain management.” Again, the rate of prescribing varies greatly by state.

The medical profession has undergone a “huge culture shift” when it comes to researching and treating opiate addiction, Duncan said, adding, “We’re talking about, what does it mean when a person is addicted to substances, what are some of the evidence-based treatments that we have, and there’s much more interest and acceptance around using some of these treatments.”

Here comes the neighborhood

The Federal Reserve Bank of Philadelphia and the U.S. Census Bureau released a working paper this month that challenges common assumptions about gentrification, which occurs when wealthier people move into a poor area and the neighborhood changes to suit middle-class tastes. Critics of gentrification say it hurts longtime residents by making housing unaffordable and diminishing an area’s historical character.

The authors of the new paper used data from low-income, center-city neighborhoods in the 100 largest metropolitan areas in the United States in 2000 and between 2010 and 2014. Some of the neighborhoods gentrified, and others did not. The researchers determined that renters tended to move in and out over the course of a decade with or without gentrification, and displacement from gentrification only spurred about 10 percent of the moves.

The study also found that less-educated residents who move because of gentrification were not more likely to be unemployed or live in poor neighborhoods in the future. Those who stayed experienced less exposure to poverty, which is tied to healthier outcomes for children.

“Surprisingly, gentrification has no effect on reported monthly rents paid by original resident, less-educated renters,” the paper’s authors wrote. Instead, the research showed that rising housing prices typically affected residents with more education who paid more for nicer accommodations. “Overall, we find that gentrification creates some important benefits for original resident adults and children and few observable harms,” the study concluded. —Charissa Koh

Fed up over school lunches

A school district in Pennsylvania sent a letter to parents earlier this month threatening their children could be put in foster care if the parents did not pay their school lunch debt. Families owed the Wyoming Valley West School District in Luzerne County more than $20,000 for the meals, and the frustrated school district called and sent letters repeatedly to collect the money. Eventually, officials sent a letter to the parents, saying, “You can be sent to dependency court for neglecting your child’s right to food. The result may be your child being taken from your home and placed in foster care.”

Parents complained about the letter, and the county’s child welfare authorities cautioned the school district against making such threats. “The foster care system should never be viewed as a punitive agency or weaponized to terrorize children and families,” Luzerne County Manager David Pedri told NPR.

Todd Carmichael, the CEO of Philadelphia-based La Colombe Coffee, said he offered on Monday to give the district $22,000 to wipe out the bills that generated the letter to parents, but the school board president declined, arguing that the parents who owed the money could afford to pay it. Pedri said several other donors have come forward with offers to cover the debt.

“I think you have to pay your bills,” school board President Joseph Mazur told NPR in an interview that aired Sunday. “I mean, I’ve been paying my bills all my life. So has everybody else. I mean, sometimes you have to do without something for yourself if you want to raise your kids and see that they’re taken care of.” —C.K.

Quick decisions

The Trump administration on Tuesday expanded expedited removal proceedings so that Immigration and Customs Enforcement agents can deport more illegal immigrants without a hearing. Previously, ICE agents could do so for individuals apprehended within 100 miles of the border and within two weeks of their entry by land, or if they arrived by sea and could not prove they had been in the country continuously for two years. The new notice applies the criteria for those who arrived by sea to all illegal immigrants. Under the rules, anyone may still claim asylum and receive a hearing if they can show they have a credible fear of persecution back home. —C.K.