Kaiser Health News

Legal Pot Is More Potent Than Ever — And Still Largely Unregulated

Published

1 year ago

May 9, 2023

by David Hilzenrath
Tue, 09 May 2023 09:00:00 +0000

Marijuana and other products containing THC, the plant's main psychoactive ingredient, have grown more potent and more dangerous as legalization has made them more widely available.

Although decades ago the THC content of weed was commonly less than 1.5%, some products on the market today are more than 90% THC.

The buzz of yesteryear has given way to something more alarming. Marijuana-related medical emergencies have landed hundreds of thousands of people in the hospital and millions are dealing with psychological disorders linked to cannabis use, according to federal research.

But regulators have failed to keep up.

Among states that allow the sale and use of marijuana and its derivatives, consumer protections are spotty.

“In many states the products come with a warning label and potentially no other activity by regulators,” said Cassin Coleman, vice chair of the scientific advisory committee of the National Cannabis Industry Association.

The federal government has generally taken a hands-off approach. It still bans marijuana as a Schedule 1 substance — as a drug with no accepted medical use and a high chance of abuse — under the Controlled Substances Act. But when it comes to cannabis sales, which many states have legalized, the federal government does not regulate attributes like purity or potency.

The FDA “has basically sat on its hands and failed to honor its duty to protect the public health,” said Eric Lindblom, a scholar at Georgetown University's law school who previously worked at the FDA's Center for Tobacco Products.

Pot has changed profoundly since generations of Americans were first exposed to it.

Cannabis has been cultivated to deliver much higher doses of THC. In 1980, the THC content of confiscated marijuana was less than 1.5%. Today many varieties of cannabis flower — plant matter that can be smoked in a joint — are listed as more than 30% THC.

At one California dispensary, the menu recently included a strain posted as 41% THC.

Legalization has also helped open the door to products that are extracted from marijuana but look nothing like it: oily, waxy, or crystalline THC concentrates that are heated and inhaled through vaping or dabbing, which can involve a bong-like device and a blowtorch.

Today's concentrates can be more than 90% THC. Some are billed as almost pure THC.

Few people personify the mainstreaming of marijuana as vividly as John Boehner, the former U.S. House speaker. The Ohio Republican long opposed marijuana and, in 2011, reportedly declared himself “unalterably opposed” to its legalization.

Now he's on the board of Acreage Holdings, a producer of marijuana products.

And Acreage Holdings illustrates the evolution of the industry. Its Superflux brand markets a vaping product — “pure live resin in a convenient, instant format” — and concentrates such as “budder,” “sugar,” “shatter,” and “wax.” The company bills its “THCa crystalline” concentrate as the “ultimate in potency.”

Higher concentrations pose greater hazards, according to the National Institute on Drug Abuse. “The risks of physical dependence and addiction increase with exposure to high concentrations of THC, and higher doses of THC are more likely to produce anxiety, agitation, paranoia, and psychosis,” its website said.

In 2021, 16.3 million people in the United States — 5.8% of people 12 or older — had experienced a marijuana use disorder within the past year, according to a survey published in January by the federal Department of Health and Human Services.

That was far more than the combined total found to have substance use disorders involving cocaine, heroin, methamphetamine, prescription stimulants such as Adderall, or prescription pain relievers such as fentanyl and OxyContin.

Other drugs are more dangerous than marijuana, and most of the people with a marijuana use disorder had a mild case. But about 1 in 7 — more than 2.6 million people — had a severe case, the federal survey found.

Most clinicians equate the term “severe use disorder” with addiction, said Wilson Compton, deputy director of the National Institute on Drug Abuse.

Cannabis use disorder “can be devastating,” said Smita Das, a Stanford psychiatrist and chair of an American Psychiatric Association council on addiction.

Das said she has seen lives upended by cannabis — very successful people who have lost families and jobs. “They're in a place where they don't know how they got there because it was just a joint, it was just cannabis, cannabis wasn't supposed to be addictive for them,” Das said.

Medical diagnoses attributed to marijuana include “cannabis dependence with psychotic disorder with delusions” and cannabinoid hyperemesis syndrome, a form of persistent vomiting.

An estimated 800,000 people made marijuana-related emergency department visits in 2021, according to a government study published in December 2022.

‘Go Directly' to Detox

A Colorado father thought it was just a matter of time before cannabis killed his son.

In spring 2021, the teen ran a red light, crashed into another car — injuring himself and the other driver — and fled the scene, the father recalled in interviews.

In the wreckage, the father later found joints, empty containers of a high-potency THC concentrate known as wax, and a THC vape pen.

On his son's cellphone, he found text messages and scores of references to dabbing and weed. The teen said he had been dabbing before the crash and had intended to kill himself.

Weeks later, police arranged for him to be held involuntarily at a hospital for psychiatric evaluation. According to a police report, he thought cartel snipers were after him.

The doctor who evaluated the teen diagnosed “cannabis abuse.”

“Stop doing dabs or wax as they can make you extremely paranoid,” the doctor wrote. “Go directly to the detox program of your choice.”

By the father's account, over the past two years the teen logged several other involuntary holds, dozens of encounters with police, repeated jailings, and a series of stays in inpatient treatment facilities.

At times out of touch with reality, he texted that God spoke to him and gave him superpowers.

The damage was also financial. Health insurance claims for his treatment totaled nearly $600,000, and the family's out-of-pocket expenses came to almost $40,000 as of February.

In interviews for this article, the father spoke on the condition of anonymity to avoid undermining the son's recovery.

The father is convinced that his son's mental illness was a result and not a cause of the drug use. He said the symptoms receded when his son stopped using THC and returned when he resumed.

His son is now 20, off marijuana, and doing well, the father said, adding, “I have absolutely no doubt in my mind that cannabis use is what caused his psychosis, delusions, and paranoia.”

Uneven State Regulation

Medical use of marijuana is now legal in 40 states and the District of Columbia, and recreational or adult use is legal in 22 states plus D.C., according to MJBizDaily, a trade publication.

Early in the covid-19 pandemic, while much of America was in lockdown, marijuana dispensaries delivered. Many states declared them essential businesses.

But only two adult-use states, Vermont and Connecticut, have placed caps on THC content — 30% for cannabis flower and 60% for THC concentrates — and they exempt pre-filled vape cartridges from the caps, said Gillian Schauer from the Cannabis Regulators Association, a group of state regulators.

Some states cap the number of ounces or grams consumers are allowed to buy. However, even a little marijuana can amount to a lot of THC, said Rosalie Liccardo Pacula, a professor of health policy, economics, and law at the University of Southern California.

Some states allow only medical use of low-THC products — for instance, in Texas, substances that contain no more than 0.5% THC by weight. And some states require warning labels. In New Jersey, cannabis products composed of more than 40% THC must declare: “This is a high potency product and may increase your risk for psychosis.”

Colorado's marijuana rules run more than 500 pages. Yet its disclosure underscores the limits of consumer protections: “This product was produced without regulatory oversight for health, safety, or efficacy.”

Figuring out the right rules may not be simple. For example, warning labels could shield the marijuana industry from liability, much as they did for tobacco companies for many years. Capping potency could limit options for people who take high doses for relief from medical problems.

Overall, at the state level, the cannabis industry has blunted regulatory efforts by arguing that onerous rules would make it hard for legitimate cannabis businesses to compete with illicit ones, Pacula said.

Pacula and fellow researchers have called for the federal government to step in.

Months after ending his term as FDA commissioner, Scott Gottlieb issued a similar plea.

Complaining that states had gotten “far down the field while the feds sat on the sidelines,” Gottlieb called for “a uniform national scheme for THC that protects consumers.”

That was in 2019 and little has changed since then.

Where's the FDA?

The FDA oversees food, prescription drugs, over-the-counter drugs, and medical devices. It regulates tobacco, nicotine, and nicotine vapes. It oversees tobacco warning labels. In the interest of public health and safety, it also regulates botanicals, medical products that can include plant material.

Yet, when it comes to the marijuana that people smoke, the cannabis-derived THC concentrates they vape or dab, and edibles infused with THC, the FDA appears very much on the sidelines.

The medical marijuana sold at dispensaries is not FDA-approved. The agency hasn't vouched for its safety or efficacy or determined the proper dosage. It doesn't inspect the facilities where the goods are produced, and it doesn't assess quality control.

The agency does invite manufacturers to put cannabis products through clinical trials and its drug approval process.

The FDA's website notes that THC is the active ingredient in two FDA-approved drugs used in cancer treatment. That alone apparently places the substance under FDA jurisdiction.

The FDA has “all the power it needs to regulate state-legalized cannabis products much more effectively,” said Lindblom, the former FDA official.

At least publicly, the FDA has focused not on THC concentrates derived from cannabis or weed smoked in joints, but rather on other substances: a THC variant derived from hemp, which the federal government has legalized, and a different cannabis derivative called cannabidiol or CBD, which has been marketed as therapeutic.

“The FDA is committed to monitoring the marketplace, identifying cannabis products that pose risks, and acting, within our authorities, to protect the public,” FDA spokesperson Courtney Rhodes said.

“Many/most THC products meet the definition of marijuana, which is a controlled substance. The Drug Enforcement Administration (DEA) regulates marijuana under the Controlled Substances Act. We refer you to the Drug Enforcement Administration for questions about regulation and enforcement under the provisions of the CSA,” Rhodes wrote in an email.

The DEA, part of the Justice Department, did not respond to questions for this article.

As for Congress, perhaps its most consequential step has been limiting enforcement of the federal prohibition.

“Thus far, the federal response to state actions to legalize marijuana has largely been to allow states to implement their own laws on the drug,” a 2022 Congressional Research Service report said.

In October, President Joe Biden directed the secretary of Health and Human Services and the attorney general to review the federal government's stance toward marijuana — whether it should remain classified among the most dangerous and tightly controlled substances.

In December, Biden signed a bill expanding research access to marijuana and requiring federal agencies to study its effects. The law gave agencies a year to issue findings.

Some marijuana advocates say the federal government could play a more constructive role.

“NORML does not opine that cannabis is innocuous, but opines that its potential risks are best mitigated via legalization, regulation, and public education,” said Paul Armentano, deputy director of the group formerly known as the National Organization for the Reform of Marijuana Laws.

“Products have to be tested for purity and potency,” he said, and “the federal government could have some oversight in licensing the labs that test those products.”

In the meantime, said Coleman, adviser to the National Cannabis Industry Association, states are left “having to become USDA + FDA + DEA all at the same time.”

And where does that leave consumers? Some, like Wendy E., a retired small-business owner in her 60s, struggle with the effects of today's marijuana.

Wendy, who spoke on the condition that she not be fully named, started smoking marijuana in high school in the 1970s and made it part of her lifestyle for decades.

Then when her state legalized it, she bought it in dispensaries “and very quickly noticed that the potency was much higher than what I had traditionally used,” she said. “It seemed to have exponentially increased.”

In 2020, she said, the legal marijuana — much stronger than the illicit weed of her youth — left her obsessing about ways to kill herself.

Once, the self-described “earth-mother hippie” found camaraderie passing a joint with friends. Now, she attends Marijuana Anonymous meetings with others recovering from addiction to the stuff.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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By: David Hilzenrath
Title: Legal Pot Is More Potent Than Ever — And Still Largely Unregulated
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Kaiser Health News

The Lure of Specialty Medicine Pulls Nurse Practitioners From Primary Care

Published

20 hours ago

May 17, 2024

Staff Editor

Michelle Andrews
Fri, 17 May 2024 09:00:00 +0000

For many patients, seeing a nurse practitioner has become a routine part of primary care, in which these “NPs” often perform the same tasks that patients have relied on doctors for.

But NPs in specialty care? That's not routine, at least not yet. Increasingly, though, nurse practitioners and physician assistants are joining cardiology, dermatology, and other specialty practices, broadening their skills and increasing their income.

This development worries some people who track the health workforce, because current trends suggest primary care, which has counted on nurse practitioners to backstop physician shortages, soon might not be able to rely on them to the same extent.

“They're succumbing to the same challenges that we have with physicians,” said Atul Grover, executive director of the Research and Action Institute at the Association of American Medical Colleges. The rates NPs can command in a specialty practice “are quite a bit higher” than practice salaries in primary care, he said.

When nurse practitioner programs began to proliferate in the 1970s, “at first it looked great, producing all these nurse practitioners that go to work with primary care physicians,” said Yalda Jabbarpour, director of the American Academy of Family Physicians' Robert Graham Center for Policy Studies. “But now only 30% are going into primary care.”

Jabbarpour was referring to the 2024 primary care scorecard by the Milbank Memorial Fund, which found that from 2016 to 2021 the proportion of nurse practitioners who worked in primary care practices hovered between 32% and 34%, even though their numbers grew rapidly. The proportion of physician assistants, also known as physician associates, in primary care ranged from 27% to 30%, the study found.

Both nurse practitioners and physician assistants are advanced practice clinicians who, in addition to graduate degrees, must complete distinct education, training, and certification steps. NPs can practice without a doctor's supervision in more than two dozen states, while PAs have similar independence in only a handful of states.

About 88% of nurse practitioners are certified in an area of primary care, according to the American Association of Nurse Practitioners. But it is difficult to track exactly how many work in primary care or in specialty practices. Unlike physicians, they're generally not required to be endorsed by a national standard-setting body to practice in specialties like oncology or cardiology, for example. The AANP declined to answer questions about its annual workforce survey or the extent to which primary care NPs are moving toward specialties.

Though data tracking the change is sparse, specialty practices are adding these advanced practice clinicians at almost the same rate as primary care practices, according to frequently cited research published in 2018.

The clearest evidence of the shift: From 2008 to 2016, there was a 22% increase in the number of specialty practices that employed nurse practitioners and physician assistants, according to that study. The increase in the number of primary care practices that employed these professionals was 24%.

Once more, the most recent projections by the Association of American Medical Colleges predict a dearth of at least 20,200 primary care physicians by 2036. There will also be a shortfall of non-primary care specialists, including a deficiency of at least 10,100 surgical physicians and up to 25,000 physicians in other specialties.

When it comes to the actual work performed, the lines between primary and specialty care are often blurred, said Candice Chen, associate professor of health policy and management at George Washington University.

“You might be a nurse practitioner working in a gastroenterology clinic or cardiology clinic, but the scope of what you do is starting to overlap with primary care,” she said.

Nurse practitioners' salaries vary widely by location, type of facility, and experience. Still, according to data from health care recruiter AMN Healthcare Physician Solutions, formerly known as Merritt Hawkins, the total annual average starting compensation, including signing bonus, for nurse practitioners and physician assistants in specialty practice was $172,544 in the year that ended March 31, slightly higher than the $166,544 for those in primary care.

According to forecasts from the federal Bureau of Labor Statistics, nurse practitioner jobs will increase faster than jobs in almost any other occupation in the decade leading up to 2032, growing by 123,600 jobs or 45%. (Wind turbine service technician is the only other occupation projected to grow as fast.) The growth rate for physician assistants is also much faster than average, at 27%. There are more than twice as many nurse practitioners as physician assistants, however: 323,900 versus 148,000, in 2022.

To Grover, of the AAMC, numbers like this signal that there will probably be enough NPs, PAs, and physicians to meet primary care needs. At the same time, “expect more NPs and PAs to also flow out into other specialties,” he said.

When Pamela Ograbisz started working as a registered nurse 27 years ago, she worked in a cardiothoracic intensive care unit. After she became a family nurse practitioner a few years later, she found a job with a similar specialty practice, which trained her to take on a bigger role, first running their outpatient clinic, then working on the floor, and later in the intensive care unit.

If nurse practitioners want to specialize, often “the doctors mentor them just like they would with a physician residency,” said Ograbisz, now vice president of clinical operations at temporary placement recruiter LocumTenens.com.

If physician assistants want to specialize, they also can do so through mentoring, or they can receive “certificates of added qualifications” in 10 specialties to demonstrate their expertise. Most employers don't “encourage or require” these certificates, however, said Jennifer Orozco, chief medical officer at the American Academy of Physician Associates.

There are a number of training programs for family nurse practitioners who want to develop skills in other areas.

Raina Hoebelheinrich, 40, a family nurse practitioner at a regional medical center in Yankton, South Dakota, recently enrolled in a three-semester post-master's endocrinology training program at Mount Marty University. She lives on a farm in nearby northeastern Nebraska with her husband and five sons.

Hoebelheinrich's new skills could be helpful in her current hospital job, in which she sees a lot of patients with acute diabetes, or in a clinic setting like the one in Sioux Falls, South Dakota, where she is doing her clinical endocrinology training.

Lack of access to endocrinology care in rural areas is a real problem, and many people may travel hundreds of miles to see a specialist.

“There aren't a lot of options,” she said.

——————————
By: Michelle Andrews
Title: The Lure of Specialty Medicine Pulls Nurse Practitioners From Primary Care
Sourced From: kffhealthnews.org/news/article/nurse-practitioners-trend-primary-care-specialties/
Published Date: Fri, 17 May 2024 09:00:00 +0000

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Clean Needles Save Lives. In Some States, They Might Not Be Legal.

Published

22 hours ago

May 17, 2024

Staff Editor

Ed Mahon, Spotlight PA and Sarah Boden, WESA
Fri, 17 May 2024 09:00:00 +0000

Kim Botteicher hardly thinks of herself as a criminal.

On the main floor of a former Catholic church in Bolivar, Pennsylvania, Botteicher runs a flower shop and cafe.

In the former church's basement, she also operates a nonprofit organization focused on helping people caught up in the drug epidemic get back on their feet.

The nonprofit, FAVOR ~ Western PA, sits in a rural pocket of the Allegheny Mountains east of Pittsburgh. Her organization's home county of Westmoreland has seen roughly 100 or more drug overdose deaths each year for the past several years, the majority involving fentanyl.

Thousands more residents in the region have been touched by the scourge of addiction, which is where Botteicher comes in.

She helps people find housing, jobs, and health care, and works with families by running support groups and explaining that substance use disorder is a disease, not a moral failing.

But she has also talked publicly about how she has made sterile syringes available to people who use drugs.

“When that person comes in the door,” she said, “if they are covered with abscesses because they have been using needles that are dirty, or they've been sharing needles — maybe they've got hep C — we see that as, ‘OK, this is our first step.'”

Studies have identified public health benefits associated with syringe exchange services. The Centers for Disease Control and Prevention says these programs reduce HIV and hepatitis C infections, and that new users of the programs are more likely to enter drug treatment and more likely to stop using drugs than nonparticipants.

This harm-reduction strategy is supported by leading health groups, such as the American Medical Association, the World Health Organization, and the International AIDS Society.

But providing clean syringes could put Botteicher in legal danger. Under Pennsylvania law, it's a misdemeanor to distribute drug paraphernalia. The state's definition includes hypodermic syringes, needles, and other objects used for injecting banned drugs. Pennsylvania is one of 12 states that do not implicitly or explicitly authorize syringe services programs through statute or regulation, according to a 2023 analysis. A few of those states, but not Pennsylvania, either don't have a state drug paraphernalia law or don't include syringes in it.

Those working on the front lines of the opioid epidemic, like Botteicher, say a reexamination of Pennsylvania's law is long overdue.

There's an urgency to the issue as well: Billions of dollars have begun flowing into Pennsylvania and other states from legal settlements with companies over their role in the opioid epidemic, and syringe services are among the eligible interventions that could be supported by that money.

The opioid settlements reached between drug companies and distributors and a coalition of state attorneys general included a list of recommendations for spending the money. Expanding syringe services is listed as one of the core strategies.

But in Pennsylvania, where 5,158 people died from a drug overdose in 2022, the state's drug paraphernalia law stands in the way.

Concerns over Botteicher's work with syringe services recently led Westmoreland County officials to cancel an allocation of $150,000 in opioid settlement funds they had previously approved for her organization. County Commissioner Douglas Chew defended the decision by saying the county “is very risk averse.”

Botteicher said her organization had planned to use the money to hire additional recovery specialists, not on syringes. Supporters of syringe services point to the cancellation of funding as evidence of the need to change state law, especially given the recommendations of settlement documents.

“It's just a huge inconsistency,” said Zoe Soslow, who leads overdose prevention work in Pennsylvania for the public health organization Vital Strategies. “It's causing a lot of confusion.”

Though sterile syringes can be purchased from pharmacies without a prescription, handing out free ones to make drug use safer is generally considered illegal — or at least in a legal gray area — in most of the state. In Pennsylvania's two largest cities, Philadelphia and Pittsburgh, officials have used local health powers to provide legal protection to people who operate syringe services programs.

Even so, in Philadelphia, Mayor Cherelle Parker, who took office in January, has made it clear she opposes using opioid settlement money, or any city funds, to pay for the distribution of clean needles, The Philadelphia Inquirer has reported. Parker's position signals a major shift in that city's approach to the opioid epidemic.

On the other side of the state, opioid settlement funds have had a big effect for Prevention Point Pittsburgh, a harm reduction organization. Allegheny County reported spending or committing $325,000 in settlement money as of the end of last year to support the organization's work with sterile syringes and other supplies for safer drug use.

“It was absolutely incredible to not have to fundraise every single dollar for the supplies that go out,” said Prevention Point's executive director, Aaron Arnold. “It takes a lot of energy. It pulls away from actual delivery of services when you're constantly having to find out, ‘Do we have enough money to even purchase the supplies that we want to distribute?'”

In parts of Pennsylvania that lack these legal protections, people sometimes operate underground syringe programs.

The Pennsylvania law banning drug paraphernalia was never intended to apply to syringe services, according to Scott Burris, director of the Center for Public Health Law Research at Temple University. But there have not been court cases in Pennsylvania to clarify the issue, and the failure of the legislature to act creates a chilling effect, he said.

Carla Sofronski, executive director of the Pennsylvania Harm Reduction Network, said she was not aware of anyone having faced criminal charges for operating syringe services in the state, but she noted the threat hangs over people who do and that they are taking a “great risk.”

In 2016, the CDC flagged three Pennsylvania counties — Cambria, Crawford, and Luzerne — among 220 counties nationwide in an assessment of communities potentially vulnerable to the rapid spread of HIV and to new or continuing high rates of hepatitis C infections among people who inject drugs.

Kate Favata, a resident of Luzerne County, said she started using heroin in her late teens and wouldn't be alive today if it weren't for the support and community she found at a syringe services program in Philadelphia.

“It kind of just made me feel like I was in a safe space. And I don't really know if there was like a come-to-God moment or come-to-Jesus moment,” she said. “I just wanted better.”

Favata is now in long-term recovery and works for a medication-assisted treatment program.

At clinics in Cambria and Somerset Counties, Highlands Health provides free or low-cost medical care. Despite the legal risk, the organization has operated a syringe program for several years, while also testing patients for infectious diseases, distributing overdose reversal medication, and offering recovery options.

Rosalie Danchanko, Highlands Health's executive director, said she hopes opioid settlement money can eventually support her organization.

“Why shouldn't that wealth be spread around for all organizations that are working with people affected by the opioid problem?” she asked.

In February, legislation to legalize syringe services in Pennsylvania was approved by a committee and has moved forward. The administration of Gov. Josh Shapiro, a Democrat, supports the legislation. But it faces an uncertain future in the full legislature, in which Democrats have a narrow majority in the House and Republicans control the Senate.

One of the bill's lead sponsors, state Rep. Jim Struzzi, hasn't always supported syringe services. But the Republican from western Pennsylvania said that since his brother died from a drug overdose in 2014, he has come to better understand the nature of addiction.

In the committee vote, nearly all of Struzzi's Republican colleagues opposed the bill. State Rep. Paul Schemel said authorizing the “very instrumentality of abuse” crossed a line for him and “would be enabling an evil.”

After the vote, Struzzi said he wanted to build more bipartisan support. He noted that some of his own skepticism about the programs eased only after he visited Prevention Point Pittsburgh and saw how workers do more than just hand out syringes. These types of programs connect people to resources — overdose reversal medication, wound care, substance use treatment — that can save lives and lead to recovery.

“A lot of these people are … desperate. They're alone. They're afraid. And these programs bring them into someone who cares,” Struzzi said. “And that, to me, is a step in the right direction.”

At her nonprofit in western Pennsylvania, Botteicher is hoping lawmakers take action.

“If it's something that's going to help someone, then why is it illegal?” she said. “It just doesn't make any sense to me.”

This story was co-reported by WESA Public Radio and Spotlight PA, an independent, nonpartisan, and nonprofit newsroom producing investigative and public-service journalism that holds power to account and drives positive change in Pennsylvania.

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Kaiser Health News

Watch: John Oliver Dishes on KFF Health News’ Opioid Settlements Series

Published

24 hours ago

May 17, 2024

Staff Editor

Fri, 17 May 2024 09:00:00 +0000

Opioid manufacturers, distributors, and retailers are paying tens of billions of dollars in restitution to settle lawsuits related to their role in the nation's overdose epidemic. A recent broadcast of “Last Week Tonight With John Oliver” examined how that money is being spent by state and local governments across the United States.

The segment featured reporting from the KFF Health News series “Payback: Tracking the Opioid Settlement Cash.” You can learn more about the issue and read our collection of articles by Aneri Pattani here.

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Title: Watch: John Oliver Dishes on KFF Health News' Opioid Settlements Series
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