Kaiser Health News
How a Friend’s Death Turned Colorado Teens Into Anti-Overdose Activists
Rae Ellen Bichell
Fri, 01 Mar 2024 10:00:00 +0000
Gavinn McKinney loved Nike shoes, fireworks, and sushi. He was studying Potawatomi, one of the languages of his Native American heritage. He loved holding his niece and smelling her baby smell. On his 15th birthday, the Durango, Colorado, teen spent a cold December afternoon chopping wood to help neighbors who couldn't afford to heat their homes.
McKinney almost made it to his 16th birthday. He died of fentanyl poisoning at a friend's house in December 2021. His friends say it was the first time he tried hard drugs. The memorial service was so packed people had to stand outside the funeral home.
Now, his peers are trying to cement their friend's legacy in state law. They recently testified to state lawmakers in support of a bill they helped write to ensure students can carry naloxone with them at all times without fear of discipline or confiscation. School districts tend to have strict medication policies. Without special permission, Colorado students can't even carry their own emergency medications, such as an inhaler, and they are not allowed to share them with others.
“We realized we could actually make a change if we put our hearts to it,” said Niko Peterson, a senior at Animas High School in Durango and one of McKinney's friends who helped write the bill. “Being proactive versus being reactive is going to be the best possible solution.”
Individual school districts or counties in California, Maryland, and elsewhere have rules expressly allowing high school students to carry naloxone. But Jon Woodruff, managing attorney at the Legislative Analysis and Public Policy Association, said he wasn't aware of any statewide law such as the one Colorado is considering. Woodruff's Washington, D.C.-based organization researches and drafts legislation on substance use.
Naloxone is an opioid antagonist that can halt an overdose. Available over the counter as a nasal spray, it is considered the fire extinguisher of the opioid epidemic, for use in an emergency, but just one tool in a prevention strategy. (People often refer to it as “Narcan,” one of the more recognizable brand names, similar to how tissues, regardless of brand, are often called “Kleenex.”)
The Biden administration last year backed an ad campaign encouraging young people to carry the emergency medication.
Most states' naloxone access laws protect do-gooders, including youth, from liability if they accidentally harm someone while administering naloxone. But without school policies explicitly allowing it, the students' ability to bring naloxone to class falls into a gray area.
Ryan Christoff said that in September 2022 fellow staff at Centaurus High School in Lafayette, Colorado, where he worked and which one of his daughters attended at the time, confiscated naloxone from one of her classmates.
“She didn't have anything on her other than the Narcan, and they took it away from her,” said Christoff, who had provided the confiscated Narcan to that student and many others after his daughter nearly died from fentanyl poisoning. “We should want every student to carry it.”
Boulder Valley School District spokesperson Randy Barber said the incident “was a one-off and we've done some work since to make sure nurses are aware.” The district now encourages everyone to consider carrying naloxone, he said.
Community's Devastation Turns to Action
In Durango, McKinney's death hit the community hard. McKinney's friends and family said he didn't do hard drugs. The substance he was hooked on was Tapatío hot sauce — he even brought some in his pocket to a Rockies game.
After McKinney died, people started getting tattoos of the phrase he was known for, which was emblazoned on his favorite sweatshirt: “Love is the cure.” Even a few of his teachers got them. But it was classmates, along with their friends at another high school in town, who turned his loss into a political movement.
“We're making things happen on behalf of him,” Peterson said.
The mortality rate has spiked in recent years, with more than 1,500 other children and teens in the U.S. dying of fentanyl poisoning the same year as McKinney. Most youth who die of overdoses have no known history of taking opioids, and many of them likely thought they were taking prescription opioids like OxyContin or Percocet — not the fake prescription pills that increasingly carry a lethal dose of fentanyl.
“Most likely the largest group of teens that are dying are really teens that are experimenting, as opposed to teens that have a long-standing opioid use disorder,” said Joseph Friedman, a substance use researcher at UCLA who would like to see schools provide accurate drug education about counterfeit pills, such as with Stanford's Safety First curriculum.
Allowing students to carry a low-risk, lifesaving drug with them is in many ways the minimum schools can do, he said.
“I would argue that what the schools should be doing is identifying high-risk teens and giving them the Narcan to take home with them and teaching them why it matters,” Friedman said.
Writing in The New England Journal of Medicine, Friedman identified Colorado as a hot spot for high school-aged adolescent overdose deaths, with a mortality rate more than double that of the nation from 2020 to 2022.
“Increasingly, fentanyl is being sold in pill form, and it's happening to the largest degree in the West,” said Friedman. “I think that the teen overdose crisis is a direct result of that.”
If Colorado lawmakers approve the bill, “I think that's a really important step,” said Ju Nyeong Park, an assistant professor of medicine at Brown University, who leads a research group focused on how to prevent overdoses. “I hope that the Colorado Legislature does and that other states follow as well.”
Park said comprehensive programs to test drugs for dangerous contaminants, better access to evidence-based treatment for adolescents who develop a substance use disorder, and promotion of harm reduction tools are also important. “For example, there is a national hotline called Never Use Alone that anyone can call anonymously to be supervised remotely in case of an emergency,” she said.
Taking Matters Into Their Own Hands
Many Colorado school districts are training staff how to administer naloxone and are stocking it on school grounds through a program that allows them to acquire it from the state at little to no cost. But it was clear to Peterson and other area high schoolers that having naloxone at school isn't enough, especially in rural places.
“The teachers who are trained to use Narcan will not be at the parties where the students will be using the drugs,” he said.
And it isn't enough to expect teens to keep it at home.
“It's not going to be helpful if it's in somebody's house 20 minutes outside of town. It's going to be helpful if it's in their backpack always,” said Zoe Ramsey, another of McKinney's friends and a senior at Animas High School.
“We were informed it was against the rules to carry naloxone, and especially to distribute it,” said Ilias “Leo” Stritikus, who graduated from Durango High School last year.
But students in the area, and their school administrators, were uncertain: Could students get in trouble for carrying the opioid antagonist in their backpacks, or if they distributed it to friends? And could a school or district be held liable if something went wrong?
He, along with Ramsey and Peterson, helped form the group Students Against Overdose. Together, they convinced Animas, which is a charter school, and the surrounding school district, to change policies. Now, with parental permission, and after going through training on how to administer it, students may carry naloxone on school grounds.
Durango School District 9-R spokesperson Karla Sluis said at least 45 students have completed the training.
School districts in other parts of the nation have also determined it's important to clarify students' ability to carry naloxone.
“We want to be a part of saving lives,” said Smita Malhotra, chief medical director for Los Angeles Unified School District in California.
Los Angeles County had one of the nation's highest adolescent overdose death tallies of any U.S. county: From 2020 to 2022, 111 teens ages 14 to 18 died. One of them was a 15-year-old who died in a school bathroom of fentanyl poisoning. Malhotra's district has since updated its policy on naloxone to permit students to carry and administer it.
“All students can carry naloxone in our school campuses without facing any discipline,” Malhotra said. She said the district is also doubling down on peer support and hosting educational sessions for families and students.
Montgomery County Public Schools in Maryland took a similar approach. School staff had to administer naloxone 18 times over the course of a school year, and five students died over the course of about one semester.
When the district held community forums on the issue, Patricia Kapunan, the district's medical officer, said, “Students were very vocal about wanting access to naloxone. A student is very unlikely to carry something in their backpack which they think they might get in trouble for.”
So it, too, clarified its policy. While that was underway, local news reported that high school students found a teen passed out, with purple lips, in the bathroom of a McDonald's down the street from their school, and used Narcan to revive them. It was during lunch on a school day.
“We can't Narcan our way out of the opioid use crisis,” said Kapunan. “But it was critical to do it first. Just like knowing 911.”
Now, with the support of the district and county health department, students are training other students how to administer naloxone. Jackson Taylor, one of the student trainers, estimated they trained about 200 students over the course of three hours on a recent Saturday.
“It felt amazing, this footstep toward fixing the issue,” Taylor said.
Each trainee left with two doses of naloxone.
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
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By: Rae Ellen Bichell
Title: How a Friend's Death Turned Colorado Teens Into Anti-Overdose Activists
Sourced From: kffhealthnews.org/news/article/teen-overdose-fentanyl-naloxone-narcan-state-legislation/
Published Date: Fri, 01 Mar 2024 10:00:00 +0000
Did you miss our previous article…
https://www.biloxinewsevents.com/bathroom-bills-are-back-broader-and-stricter-in-several-states/
Kaiser Health News
Watch: John Oliver Dishes on KFF Health News’ Opioid Settlements Series
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
Sourced From: kffhealthnews.org/news/article/watch-john-oliver-kff-health-news-payback-opioid-settlements-series/
Published Date: Fri, 17 May 2024 09:00:00 +0000
Kaiser Health News
KFF Health News’ ‘What the Health?’: Bird Flu Lands as the Next Public Health Challenge
Thu, 16 May 2024 18:30:00 +0000
The Host
Julie Rovner is chief Washington correspondent and host of KFF Health News' weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.
Public health officials are watching with concern since a strain of bird flu spread to dairy cows in at least nine states, and to at least one dairy worker. But in the wake of covid-19, many farmers are loath to let in health authorities for testing.
Meanwhile, another large health company — the Catholic hospital chain Ascension — has been targeted by a cyberattack, leading to serious problems at some facilities.
This week's panelists are Julie Rovner of KFF Health News, Rachel Cohrs Zhang of Stat, Alice Miranda Ollstein of Politico, and Sandhya Raman of CQ Roll Call.
Panelists
Rachel Cohrs Zhang
Stat News
Alice Miranda Ollstein
Politico
Sandhya Raman
CQ Roll Call
Among the takeaways from this week's episode:
- Stumbles in the early response to bird flu bear an uncomfortable resemblance to the early days of covid, including the troubles protecting workers who could be exposed to the disease. Notably, the Department of Agriculture benefited from millions in covid relief funds designed to strengthen disease surveillance.
- Congress is working to extend coverage of telehealth care; the question is, how to pay for it? Lawmakers appear to have settled on a two-year agreement, though more on the extension — including how much it will cost — remains unknown.
- Speaking of telehealth, a new report shows about 20% of medication abortions are supervised via telehealth care. State-level restrictions are forcing those in need of abortion care to turn to options farther from home.
- And new reporting on Medicaid illuminates the number of people falling through the cracks of the government health system for low-income and disabled Americans — including how insurance companies benefit from individuals' confusion over whether they have Medicaid coverage at all.
Also this week, Rovner interviews Atul Grover of the Association of American Medical Colleges about its recent analysis showing that graduating medical students are avoiding training in states with abortion bans and major restrictions.
Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:
Julie Rovner: NPR's “Why Writing by Hand Beats Typing for Thinking and Learning,” by Jonathan Lambert.
Alice Miranda Ollstein: Time's “‘I Don't Have Faith in Doctors Anymore.' Women Say They Were Pressured Into Long-Term Birth Control,” by Alana Semuels.
Rachel Cohrs Zhang: Stat's “After Decades Fighting Big Tobacco, Cliff Douglas Now Leads a Foundation Funded by His Former Adversaries,” by Nicholas Florko.
Sandhya Raman: The Baltimore Banner's “People With Severe Mental Illness Are Stuck in Jail. Montgomery County Is the Epicenter of the Problem,” by Ben Conarck.
Also mentioned on this week's podcast:
- Stat's “My Rendezvous With the Raw Milk Black Market: Quick, Easy, and Unchecked by the FDA,” by Nicholas Florko.
- The Stamford Advocate's “Dan Haar: Hackers Stole a Disabled CT Couple's SNAP Food Aid. Now They're Out $1,373,” by Dan Haar.
- WKRN's “‘Chaos': Nurses, Visitors Describe Conditions Inside Ascension Hospitals After Cyberattack,” by Stephanie Langston.
- KFF Health News' “Medicaid ‘Unwinding' Decried as Biased Against Disabled People,” by Daniel Chang.
- KFF Health News' “Why Medicaid's ‘Undercount' Problem Counts,” by Phil Galewitz.
Credits
Francis Ying
Audio producer
Emmarie Huetteman
Editor
To hear all our podcasts, click here.
And subscribe to KFF Health News' “What the Health?” on Spotify, Apple Podcasts, Pocket Casts, or wherever you listen to podcasts.
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Title: KFF Health News' ‘What the Health?': Bird Flu Lands as the Next Public Health Challenge
Sourced From: kffhealthnews.org/news/podcast/what-the-health-347-bird-flu-next-public-health-challenge-may-16-2024/
Published Date: Thu, 16 May 2024 18:30:00 +0000
Kaiser Health News
California’s $12 Billion Medicaid Makeover Banks on Nonprofits’ Buy-In
Angela Hart
Thu, 16 May 2024 09:00:00 +0000
TURLOCK, Calif. — For much of his young life, Jorge Sanchez regularly gasped for air, at times coughing so violently that he'd almost throw up. His mother whisked him to the emergency room late at night and slept with him to make sure he didn't stop breathing.
“He's had these problems since he was born, and I couldn't figure out what was triggering his asthma,” Fabiola Sandoval said of her son, Jorge, now 4. “It's so hard when your child is hurting. I was willing to try anything.”
In January, community health workers visited Sandoval's home in Turlock, a city in California's Central Valley where dust from fruit and nut orchards billows through the air. They scoured Sandoval's home for hazards and explained that harsh cleaning products, air fresheners, and airborne dust and pesticides can trigger an asthma attack.
The team also provided Sandoval with air purifiers, a special vacuum cleaner that can suck dust out of the air, hypoallergenic mattress covers, and a humidity sensor — goods that retail for hundreds of dollars. Within a few months, Jorge was breathing easier and was able to run and play outside.
The in-home consultation and supplies were paid for by Medi-Cal, California's Medicaid health insurance program for low-income residents. Gov. Gavin Newsom is spearheading an ambitious $12 billion experiment to transform Medi-Cal into both a health insurer and a social services provider, one that relies not only on doctors and nurses, but also community health workers and nonprofit groups that offer dozens of services, including delivering healthy meals and helping homeless people pay for housing.
These groups are redefining health care in California as they compete with businesses for a share of the money, and become a new arm of the sprawling Medi-Cal bureaucracy that serves nearly 15 million low-income residents on an annual budget of $158 billion.
But worker shortages, negotiations with health insurance companies, and learning to navigate complex billing and technology systems have hamstrung the community groups' ability to deliver the new services: Now into the third year of the ambitious five-year experiment, only a small fraction of eligible patients have received benefits.
“This is still so new, and everyone is just overwhelmed at this point, so it's slow-going,” said Kevin Hamilton, a senior director at the Central California Asthma Collaborative.
The collaborative has served about 3,650 patients, including Sandoval, in eight counties since early 2022, he said. It has years of experience with Medi-Cal patients in the Central Valley and has received about $1.5 million of the new initiative's money.
By contrast, CalOptima Health, Orange County's primary Medi-Cal insurer, is new to offering asthma benefits and has signed up 58 patients so far.
“Asthma services are so difficult to get going” because the nonprofit infrastructure for these services is virtually nonexistent, said Kelly Bruno-Nelson, CalOptima's executive director for Medi-Cal. “We need more community-based organizations on board because they're the ones who can serve a population that nobody wants to deal with.”
Newsom, a Democrat in his second term, says his signature health care initiative, known as CalAIM, seeks to reduce the cost of caring for the state's sickest and most vulnerable patients, including homeless Californians, foster children, former inmates, and people battling addiction disorders.
In addition to in-home asthma remediation, CalAIM offers 13 broad categories of social services, plus a benefit connecting eligible patients with one-on-one care managers to help them obtain anything they need to get healthier, from grocery shopping to finding a job.
The 25 managed-care insurance companies participating in Medi-Cal can choose which services they offer, and contract with community groups to provide them. Insurers have hammered out about 4,300 large and small contracts with nonprofits and businesses.
So far, about 103,000 Medi-Cal patients have received CalAIM services and roughly 160,000 have been assigned personal care managers, according to state data, a sliver of the hundreds of thousands of patients who likely qualify.
“We're all new to health care, and a lot of this is such a foreign concept,” said Helena Lopez, executive director of A Greater Hope, a nonprofit organization providing social services in Riverside and San Bernardino counties, such as handing out baseball cleats to children to help them be active.
Tiffany Sickler runs Koinonia Family Services, which offers California foster children mental health and other types of care, and even helped a patient pay off parking tickets. But the program is struggling on a shoestring budget.
“If you want to do this, you have to learn all these new systems. It's been a huge learning curve, and very time-consuming and frustrating, especially without adequate funding,” she said.
Brandon Richards, a Newsom spokesperson, defended CalAIM, saying that it was “on the cutting edge of health care” and that the state was working to increase “awareness of these new services and support.”
For nonprofits and businesses, CalAIM is a money-making opportunity — one that top state health officials hope to make permanent. Health insurers, which receive hefty payments from the state to serve more people and offer new services, share a portion with service providers.
In some places, community groups are competing with national corporations for the new funding, such as Mom's Meals, an Iowa-based company that delivers prepared meals across the United States.
Mom's Meals has an advantage over neighborhood nonprofit groups because it has long served seniors on Medicare and was able to immediately start offering the CalAIM benefit of home-delivered meals for patients with chronic diseases. But even Mom's Meals isn't reaching everyone who qualifies, because doctors and patients don't always know it's an option, said Catherine Macpherson, the company's chief nutrition officer.
“Utilization is not as high as it should be yet,” she said. “But we were well positioned, because we already had departments to do billing and contracting with health care.”
Middleman companies also have their eye on the billions of CalAIM dollars and are popping up to assist small organizations to go up against established ones like Mom's Meals. For instance, the New York-based Nonprofit Finance Fund is advising homeless service providers how to get more contracts and expand benefits.
Full Circle Health Network, with 70 member organizations, is helping smaller nonprofit groups develop and deliver services primarily for families and foster children. Full Circle has signed a deal with Kaiser Permanente, allowing the health care giant to access its network of community groups.
“We're allowing organizations to launch these benefits much faster than they've been able to do and to reach more vulnerable people,” said Camille Schraeder, chief executive of Full Circle. “Many of these are grassroots organizations that have the trust and expertise on the ground, but they're new to health care.”
One of the biggest challenges community groups face is hiring workers, who are key to finding eligible patients and persuading them to participate.
Kathryn Phillips, a workforce expert at the California Health Care Foundation, said there isn't enough seed money for community groups to hire workers and pay for new technology platforms. “They bring the trust that is needed, the cultural competency, the diversity of languages,” she said. “But there needs to be more funding and reimbursement to build this workforce.”
Health insurers say they are trying to increase the workforce. For instance, L.A. Care Health Plan, the largest Medi-Cal insurer in California, has given $66 million to community organizations for hiring and other CalAIM needs, said Sameer Amin, the group's chief medical officer.
“They don't have the staffing to do all this stuff, so we're helping with that all while teaching them how to build up their health care infrastructure,” he said. “Everyone wants a win, but this isn't going to be successful overnight.”
In the Central Valley, Jorge Sanchez is one of the lucky early beneficiaries of CalAIM.
His mother credits the trust she established with community health workers, who spent many hours over multiple visits to teach her how to control her son's asthma.
“I used to love cleaning with bleach” but learned it can trigger breathing problems, Sandoval said.
Since she implemented the health workers' recommendations, Sandoval has been able to let Jorge sleep alone at night for the first time in four years.
“Having this program and all the things available is amazing,” said Sandoval, as she pointed to the dirty dust cup in her new vacuum cleaner. “Now my son doesn't have as many asthma attacks and he can run around and be a normal kid.”
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
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By: Angela Hart
Title: California's $12 Billion Medicaid Makeover Banks on Nonprofits' Buy-In
Sourced From: kffhealthnews.org/news/article/newsom-medicaid-12-billion-dollar-makeover-nonprofits-bureacracy-calaim/
Published Date: Thu, 16 May 2024 09:00:00 +0000
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