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New England Governors Converge To Address Opioid Epidemic

Seated from left are Vermont Gov. Peter Shumlin, Rhode Island Gov. Gina Raimondo, Connecticut Gov. Dannel P. Malloy, Maine Gov. Paul LePage, Hassan, and Massachusetts Gov. Charlie Baker. The governors met Tuesday in Boston to discuss strategies to deal with the opioid addiction problem in all their states. (Michael Dwyer/AP)

Seated from left are Vermont Gov. Peter Shumlin, Rhode Island Gov. Gina Raimondo, Connecticut Gov. Dannel P. Malloy, Maine Gov. Paul LePage, Hassan, and Massachusetts Gov. Charlie Baker. The governors met Tuesday in Boston to discuss strategies to deal with the opioid addiction problem in all their states. (Michael Dwyer/AP)

Pressing for the same or nearly the same limits on opioid prescriptions is one of the ways New England’s Republican and Democratic governors are working together to address the drug epidemic.

The six regional governors gathered in Boston Tuesday for an opioid panel.

There are some signs that efforts to slow the surge of opioid overdoses are working, but the death toll is grim. Narcan, or naloxone, the drug that reverses the effects of many overdoses, is becoming more widely available — and that’s a good thing, says Gov. Charlie Baker.

“We lost 1,500 people in Massachusetts in 2015, but my own speculation, based on the data I’ve seen, makes me think the number without Narcan would have been north of 5,000,” he said. “And it has a ton of, still, negative momentum.”

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Birth Control’s Next Frontier? Health Center Aims For Quick And Easy IUDs And Implants

Family Health Center of Worcester. (Jesse Costa/WBUR)

Family Health Center of Worcester. (Jesse Costa/WBUR)

Come in to the Family Health Center of Worcester for just about any reason and, if you’re a woman of child-bearing age, you’re all but certain to be asked “the one key question.” In Portuguese, if that’s what you speak, or Albanian or Vietnamese — or English:

“Are you planning to become pregnant in the next year?”

If you’re not, that’s an opening for a conversation about birth control options. Vietnamese medical interpreter Annie Huynh says that after just a few months of those conversations, she’s already seeing a dramatic shift away from the many accidental pregnancies she was seeing a couple of years ago.

“Now, I hardly ever hear [it’s] an accident anymore,” she says. “It’s something either they plan for, or they don’t get pregnant anymore because of the education that I got that I’m able to pass on to them.”

That education includes training on how to talk about birth control, says Jennifer Averill Moffitt, the health center’s perinatal services manager.

“Whereas before, perhaps the counseling was, ‘Here are these 12 methods, choose which one is best for you,’ ” she says. “Now, we’re saying, ‘Here’s the most effective method, and here are some other choices. Choose what’s best for you.’ ”

The most effective method is long-acting birth control. That includes intrauterine devices, or IUDs, and the Nexplanon hormonal implant — a matchstick-sized rod that’s implanted in a woman’s arm and prevents pregnancy for three years. They’re not for everyone, but for typical users, both have failure rates of well under 1 percent, compared to an annual pregnancy rate of 9 percent for women who take the pill. (That’s due mainly to user error: Pills are easy to miss, while the long-acting methods are “set and forget.”)

The long-acting methods are on the rise nationwide — about 12 percent of women on birth control now use them — and they’re getting a lot of the credit for the recent drop in unintended pregnancies to a 30-year low. But the rate is still strikingly high: Forty-five percent of all American pregnancies are unplanned.

“If we had a stent that was 20 times more effective than another stent, it would be an outrage that we weren’t offering them.”

– Mark Edwards, co-founder of Upstream USA

So why aren’t even more women using IUDs and implants, especially now that Obamacare makes them much more likely to be covered?

For one thing, they’re not always easy and quick to get — particularly for low-income women, whose unplanned pregnancy rate can be five times the rate of high-income women.

Enter Upstream USA. It’s a nonprofit that aims to remove the health care system’s remaining barriers to long-acting birth control.

“There are many health centers we work with that are literally not offering IUDs and implants at all. Period. So literally zero percent of women are getting access to these methods,” says Mark Edwards, the Boston-based co-founder of Upstream USA.

“From our point of view, that’s unconscionable,” he adds. “This is a method of contraception which research studies have shown is actually 20 times more effective than the pill in terms of real-world use, and yet health centers are not making these methods available. In any other form of medicine it would just be an outrage. If we had a stent that was 20 times more effective than another stent, it would be an outrage that we weren’t offering them.”

Upstream goes into health clinics like the Family Health Center of Worcester and helps them up their birth-control game. That means training just about the entire staff on birth control counseling, from the medical assistants and interpreters to the schedulers. Continue reading

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At ‘Pain School,’ Veterans Learn To Manage With Fewer Pills

Robert, a veteran who injured his back several times during a dozen years in the Navy, stopped using opioids to treat his pain and is now a student at the Bedford VA's Pain School. (Jesse Costa/WBUR)

Robert, a veteran who injured his back several times during a dozen years in the Navy, stopped using opioids to treat his pain and is now a student at the Bedford VA’s Pain School. (Jesse Costa/WBUR)

Today’s topic: stress. Psychologist Tu Ngo looks out at a small group of veterans seated around a classroom table. “Why would we be talking about stress when we’re here because of your pain?” she asks seriously, then smiles. “Lil’ pop quiz now.”

A man who’s sitting near the door, in case his PTSD flares up and he needs to leave, is ready with an answer. “Stress may increase your anxiety, the anxiety may increase your feeling of pain,” says Tom Schatz, “the feeling of pain may increase depression, etc. etc.”

“Very good, that’s a great description of the vicious cycle we know happens when you have pain,” says Ngo, who heads the pain program at the Bedford VA Medical Center. “Pain is a stress response, it’s a signal to the brain saying, ‘Hey, there’s something wrong.’ ” Continue reading

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Deal Would Take Controversial Hospital Pricing Question Off Ballot

It was to be a game of high stakes politics with hundreds of millions of health care dollars on the line. But on Wednesday the players negotiated a truce — with help from unified leaders on Beacon Hill — to prevent a November ballot question on hospital prices.

“It is my hope that this plan will avert a costly and divisive ballot initiative and lend assistance to our community hospitals,” said House Speaker Robert DeLeo in a statement.

The ballot initiative that brought DeLeo, Senate President Stan Rosenberg and Gov. Charlie Baker together aimed to close the gap between high and low cost hospitals. It proposed cutting $463 million in payments to the state’s more expensive hospitals and redistributing that money to struggling community hospitals and to consumers through lower premiums.

The Massachusetts Hospital Association opposed the plan. MHA President Lynn Nicholas is relieved to hear voters won’t be asked to adjust price differences between her members.

“The most important aspect of this resolution is not doing complicated public policy through a blunt instrument at the ballot box,” Nicholas said.

The ballot question was proposed by a health care workers union, 1199SEIU. Estimates showed the state’s largest private employer, Partners Healthcare, would have lost more than $400 million a year.

The influential union and the top employer have been in and out of offices on Beacon Hill for weeks, negotiating roughly a half dozen different plans that would have legislators instead of voters settle the hospital price gap problem.

“The most important aspect of this resolution is not doing complicated public policy through a blunt instrument at the ballot box.”

– Lynn Nicholas

The consensus deal announced Wednesday includes some more money for community hospitals — at least $20 to $25 million a year, divided between several dozen hospitals. Some hospitals would benefit and some would lose if an additional hospital assessment of $250 million is approved and distributed through Medicaid payments. The union says it is pleased. Continue reading

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The Promise And Price Of New Addiction Treatment Implant

Amid a raging opioid epidemic, there’s a plea for more treatment options. The Food and Drug Administration expects to have a decision on one by May 27.

It’s an implant. Four rods, each about the size of a match stick, inserted in the upper arm. This new device, called Probuphine, delivers a continuous dose of an existing drug, buprenorphine, but with better results, says implant maker Braeburn Pharmaceuticals.

A graphic shows how the implant is placed inside the skin of a person's upper arm. (Courtesy Braeburn Pharmaceuticals)

A graphic shows how the implant is placed inside the skin of a person’s upper arm. (Courtesy Braeburn Pharmaceuticals)

In clinical trials, 88 percent of patients with the implants abstained from opioids, as compared to 72 percent of those taking buprenorphine as a daily pill. (Buprenorphine is commonly referred to by its brand name, Suboxone.)

“I felt completely normal all the time,” said Dave, a paramedic in a small town outside Boston who was on the implant during a clinical trial. He does not want his last name made public so that coworkers won’t find out he is addicted to opioid pain pills.

Dave, 47, has been in recovery for four years with the help of buprenorphine. Dave said he prefers the implant to the pills for several reasons. With the pills he would sometimes feel the drug wear off. He worried about his 2-year-old granddaughter getting into the bottle. And sometimes Dave would just forget to take his medication, which he’s supposed to do in the morning, 15 minutes before he has anything to eat or drink.

“With the implant you didn’t have to worry about that, you just, it was just there and you felt good all the time,” Dave said.

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Boston Medical Center Launches First Comprehensive Transgender Medical Center In Northeast

Dr. Joshua Safer speaks at a press briefing at Boston Medical Center as Kate Walsh, president and CEO of BMC, Dr. Gerard Doherty, chief of surgery, and Dr. Jaromir Slama, chief of plastic surgery, look on. (Jesse Costa/WBUR)

Dr. Joshua Safer speaks at a press briefing at Boston Medical Center as Kate Walsh, president and CEO of BMC, Dr. Gerard Doherty, chief of surgery, and Dr. Jaromir Slama, chief of plastic surgery, look on. (Jesse Costa/WBUR)

Boston Medical Center CEO Kate Walsh was in a meeting a few years ago when something about gender identity and health came up. She turned to Dr. Joshua Safer, who was treating many of the hospital’s transgender patients.

“I said, ‘So you really believe patients are born in the wrong bodies?’ ” Walsh recalls, looking at Safer across a conference room table as she tells the story. “You said, ‘Yes,’ and that’s how we started on this journey to help people live the lives they were meant to live.”

The journey lead to the creation of the Center for Transgender Medicine and Surgery at BMC, the first such comprehensive service in the Northeast. It brings together services the hospital has been building out for several years: primary care, hormone therapy and mental health support, as well as chest and facial reconstruction procedures. Later this summer, as part of the comprehensive center, the hospital will begin genital surgery for men transitioning to women.

“This is very exciting for me to see us stepping up to do this,” said Safer, who will direct the center. “If you look across North America, there are only a handful of surgeons doing this sort of thing.”

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MIT Researchers Aim To Create An On-Demand Pharmacy

Students and postdocs at MIT who were part of the pharmacy on demand (a small scale pharmaceutical manufacturing unit) team. (Courtesy of MIT)

Students and postdocs at MIT who were part of the pharmacy on demand (a small scale pharmaceutical manufacturing unit) team. (Courtesy of MIT)

Hundreds of thousands of bright pink, white or blue tablets and capsules in all colors of the rainbow drop into bottles on sleek conveyors every hour in a sprawling building — somewhere. Each batch of pills may take a month or more to make.

But now, in a lab near Kendall Square, a team of MIT researchers can turn out 1,000 pills in 24 hours in a device the size of your kitchen refrigerator. It’s a whole new way of making drugs.

“We’re giving them an alternative to traditional plants, and we’re reducing the time it takes to manufacture a drug,” said Allan Myerson, professor of chemical engineering at MIT.

The Defense Department is funding this project for use in various places like field hospitals serving troops, jungles to help combat a disease outbreak, and strategic spots throughout the U.S.

“These are portable units so you can put them on the back of a truck and take them anywhere,” Myerson said. “If there was an emergency, you could have these little plants located all over. You just turn them on and you start turning out different pharmaceuticals that are needed.”

Sound simple? It’s not. This mini plant represents a sea of change in both size and operation. Continue reading

State’s Opioid Epidemic Is Vividly Seen On Boston’s ‘Methadone Mile’

On “Methadone Mile,” a one-mile stretch of Massachusetts Avenue in Boston, it is not uncommon to witness people using drugs. Here, we’ve digitally blurred this person’s face to prevent identification. (Jesse Costa/WBUR)

On “Methadone Mile,” a one-mile stretch of Massachusetts Avenue in Boston, it is not uncommon to witness people using drugs. Here, we’ve digitally blurred this person’s face to prevent identification. (Jesse Costa/WBUR)

The ravages of the state’s opioid epidemic are perhaps nowhere more visible than in an area of Boston known as “Methadone Mile” — a one-mile stretch of Massachusetts Avenue in the shadow of Boston Medical Center. Continue reading

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Health Care And Civic Leaders Launch Serious Illness Care Coalition

Dr. Atul Gawande, a co-chair of the Serious Illness Care coalition, is a surgeon at Brigham and Women’s Hospital and a professor at Harvard Medical School and the Harvard School of Public Health. (Courtesy)

Dr. Atul Gawande, a co-chair of the Serious Illness Care coalition, is a surgeon at Brigham and Women’s Hospital and a professor at Harvard Medical School and the Harvard School of Public Health. (Courtesy)

A group of health care and civic leaders meets at the Kennedy Library Thursday morning with a mission: ensuring that Massachusetts residents live their final weeks or months as they choose. They’re launching a new statewide effort called the Serious Illness Care coalition.

The aim of the group is to encourage patients, doctors and family members to talk about what type of care they want when facing a serious illness — the kind that could lead to death within a year.

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Policies For Transgender High School Athletes Vary From State To State

Justin Bonoyer stands in the athletic fields at Ponaganset High School in North Scituate, Rhode Island. Justin was Elise to his coaches until a few weeks ago. (Jesse Costa/WBUR)

Justin Bonoyer stands in the athletic fields at Ponaganset High School in North Scituate, Rhode Island. Justin was Elise to his coaches until a few weeks ago. (Jesse Costa/WBUR)

Crack. A bright pink aluminum bat connects with a fluorescent yellow softball, sending it toward woods that border Ponaganset High School in northwest Rhode Island. The left fielder runs in and makes the catch.

“Two down ladies, two down,” a player calls.

This is home field for Ponaganset’s Lady Chieftains, except, it seems, the team is not all ladies.

Justin Bonoyer, a stocky 5-foot-5-inch player with a shock of blonde hair, plays right field. Justin was Elise to his coaches until a few weeks ago, although he’d already come out as transgender to most of his teammates.

“I’m a guy,” Justin says. “It’s the same as if a guy who’s not trans went and played on a girl’s softball team.”

Well, sort of. There are separate rules for transgender athletes. Rules so different from state to state that some high school athletes like Justin can try out for any team they choose while others need sex reassignment surgery before they can sign up.

There’s a lot of attention on bathrooms in the debate about transgender rights. The next battleground may be locker rooms, basketball courts and soccer fields. For high school students, the debate centers on Title IX, the federal law that bans discrimination based on gender. Does it also ban discrimination based on gender identity?

We’ll lay out the arguments in a minute. First, a little more about Justin. Continue reading