Latest news with #ASAM
Time Magazine
25-07-2025
- Health
- Time Magazine
The ‘Big Beautiful Bill' May Lead to More Fatal Overdoses
The sweeping tax and spending package that President Donald Trump signed into law earlier this month could cause thousands of people to lose access to treatment for opioid use disorder, leading to roughly 1,000 additional overdose deaths each year, researchers estimate. Fatal overdoses have been on the decline since they reached a record high in 2022. Drug policy and health experts have widely credited the drop to public health measures, such as investing in treatments, expanding therapies, and decreasing stigma. But now, they fear that Trump's 'Big Beautiful Bill' will undo that progress. The day before the bill passed the House, a group of researchers sent a memo to House Speaker Mike Johnson and Senate Majority Leader John Thune, estimating that the package would cause about 156,000 people to lose access to treatment for opioid use disorder. The next day, the bill cleared the House, and the day after, Trump signed it into law. 'I'm angry,' says Dr. Benjamin Linas, the lead researcher behind the memo and a professor of medicine and epidemiology at Boston University. 'I think it's a terrible policy. I think it's doing nothing but making America unhealthy and increasing misery.' The bill's provisions targeting Medicaid are expected to leave about 7.8 million people without health insurance in 2034 due to loss of coverage under the program, according to the Congressional Budget Office. Using that estimate, Linas and his colleagues projected, based on previous data about the proportion of people on Medicaid who receive medications for opioid use disorder, how many of those people will likely lose access to treatments. They then used simulation modeling to estimate how many additional fatal overdoses would occur in one year. Linas called the findings 'upsetting,' adding that the 1,000 additional deaths researchers projected was likely an underestimate because he and his colleagues only accounted for people not being able to access their medications for opioid use disorder—not for any other health complications that could worsen after losing access to health insurance, such as infections, heart attack, or cancer. Researchers also didn't account for the possibility that Medicaid cuts could cause some people to lose access to their preferred medication, forcing them to use a different option, which could cause 'misery and suffering and death,' Linas says. 'It's well-known and documented that when people can't get the treatment that's effective for them or that they would choose, the treatments are less effective and they fall out of care,' Linas says. American Society of Addiction Medicine (ASAM) President Dr. Stephen Taylor, who was not involved in writing the memo, says that while the impacts of the bill will vary from state to state, he found the researchers' findings to be reasonable. He notes that the bill has some provisions for people with substance use disorder, including exempting them from work requirements. 'Our focus at ASAM is just to try to mitigate some of the harms from the bill [and] make sure that these exemptions … will be implemented in as expansive and as generous a way as possible,' Taylor says. 'We want to prevent people from losing the coverage that they need; otherwise, those exemptions will be meaningless.' But Linas also points out that many people who are struggling with addiction are not diagnosed, which could make it difficult for them to access such exemptions. Overdose deaths declined by nearly 27% in the U.S. from 2023 to 2024, according to data released by the U.S. Centers for Disease Control and Prevention (CDC) in May. That comes out to about 81 lives saved each day, the CDC estimated. The number of overdose deaths specifically involving opioids plummeted from roughly 83,140 in 2023 to 54,743 in 2024, according to the CDC. In a statement, the CDC said the federal government has increased efforts to tackle the issue since Trump declared the opioid epidemic a public health emergency in October 2017, months into his first term. Since Trump returned to office in January, however, his second Administration has proposed sweeping cuts to programs dedicated to addiction treatment and research, while its efforts to address the crisis have focused on combatting drug trafficking from other countries. Many public health and addiction experts have criticized the aggressive strategy, saying that it doesn't effectively address the drug crisis. Linas says to attribute the decline in overdose deaths to cracking down on drug dealers and the border is 'completely false;' instead, he says, the credit should go to bolstering public health measures. The damage the tax and spending package is projected to wreak in opioid treatment, he says, exemplifies broader problems in how the Trump Administration is governing. 'After working so hard and seeing progress, to take such a step back is really depressing,' Linas says. 'It's also a microcosm of the total chaos that this Administration imposes on all of us. Because as recently as a year ago, we were investing a lot of federal dollars to reverse the course of this overdose epidemic and starting to see results, and now we're just going to pick up a 180 and reverse it—it's pretty miserable.'
Medscape
17-07-2025
- Health
- Medscape
Rapid Rx Quiz: Opioid Overdose
Recent efforts in prevention, treatment, and harm reduction have led to encouraging signs of progress in the opioid epidemic. Increased public awareness, expanded access to naloxone, and evolving prescribing practices have all contributed to a decline in overdose deaths. However, due to the widespread availability of synthetic opioids (particularly fentanyl), clinicians must remain vigilant because overdose presentations are becoming increasingly complex and resistant to standard interventions. Effective management requires rapid clinical decision-making and a thorough understanding of opioid pharmacology and toxicity. How much do you know about managing opioid overdose? Test yourself with this quick quiz. Activation of cardiac opioid receptors during overdose leads to membrane hyperpolarization and increased vagal tone. These effects promote bradycardia and peripheral vasodilation, both of which can lead to hypotension. In addition, systemic histamine release can further intensify vasodilation and might result in profound hypotension. Learn more about the pathophysiology of opioid toxicity. According to ASAM guidelines, naloxone should be administered to all pregnant women experiencing an opioid overdose to prioritize maternal survival. Delaying or withholding naloxone during overdose due to concerns about fetal effects is not recommended. Although naloxone might precipitate opioid withdrawal, this risk is outweighed by the need to reverse potentially fatal respiratory depression. Learn more about the presentation of opioid toxicity. Buprenorphine has an exceptionally high affinity for the mu opioid receptor, making it difficult to displace with naloxone. A bolus dose of naloxone is recommended to achieve a high enough serum concentration to begin competitively binding at these receptor sites. Continuous infusion alone might be insufficient to rapidly reverse respiratory depression without an initial bolus. Hemodialysis is not an effective treatment for buprenorphine overdose, and avoiding dialysis is not a relevant consideration. Although benzodiazepines are commonly co-ingested with buprenorphine and might contribute to respiratory depression, this does not explain the need for a naloxone bolus, because naloxone does not reverse benzodiazepine effects. Buprenorphine has a long half-life compared to many other opioid drugs, but this affects the duration of monitoring and the potential need for prolonged naloxone infusion, not the decision to administer a bolus dose. Learn more about buprenorphine/naloxone toxicity. Recommended criteria for emergency department discharge following 6-12 hours of observation after naloxone reversal of opioid overdose include an oxygen saturation ≥ 92% on room air. Other criteria include a Glasgow Coma Scale score of 15, a respiratory rate ≥ 10 breaths/min, and blood pressure between 110/90 mm Hg and 140/90 mm Hg. These parameters help confirm sustained clinical stability following naloxone reversal. Learn more about emergency department care of opioid toxicity. Fentanyl exhibits a biphasic plasma concentration profile, with an initial peak followed by a decline. However, in overdose, secondary plasma peaks might occur 45-60 minutes or even hours later, a phenomenon referred to as 'fentanyl rebound.' These delayed increases in fentanyl concentration have been linked to new or recurrent respiratory depression, sometimes requiring additional naloxone. Nalmefene injection or nalmefene intranasal are other options for treating fentanyl overdose. Nalmefene has a longer half-life than naloxone. Despite rapid hepatic metabolism, fentanyl has a prolonged and variable duration of effect due to redistribution into peripheral tissues. Because fentanyl is highly lipophilic, it readily accumulates in tissues like muscle and fat, especially with repeated use. Fentanyl-induced skeletal muscle rigidity, including the chest wall rigidity known as wooden chest syndrome, typically occurs within minutes of exposure. This complication can make airway management more difficult in overdose scenarios. Learn more about fentanyl.
The Star
20-05-2025
- Business
- The Star
Penang to welcome direct flights from Phnom Penh from June 26
GEORGE TOWN: Penang is set to welcome new direct flights from Phnom Penh starting June 26 via Cambodia Airways, marking another significant milestone in enhancing regional connectivity and underscoring Malaysia's role as Asean chair. Penang tourism and creative economy committee chairman Wong Hon Wai said Cambodia Airways has officially confirmed the new route and this latest development follows the successful launch of the Chengdu-Penang direct flight on April 30. "This marks the first direct air link between Phnom Penh and Penang, signalling a new era in the exchange between the two cities. "The launch of the direct flight service between Phnom Penh and Penang will open up more opportunities for tourism, trade and bilateral collaboration between Malaysia and Cambodia, offering more convenient travel options for both business and leisure travellers," he said in a statement today. Wong said the flight will operate twice weekly on Thursdays and Sundays. Flight KR785 will depart from the Phnom Penh International Airport (PNH) at 8.05am and arrive at Penang International Airport (PIA) at 10.55am while the return flight KR786 will depart Penang at 11.55am and land in Phnom Penh at 12.40pm. He emphasised that this direct connection highlights Penang's unique appeal and growth potential on the regional aviation map, further solidifying its position as an international hub for business events and tourism. With the inclusion of Cambodia, he said Penang now has direct air links with six Asean member states, namely Thailand, Indonesia, Singapore, Vietnam, Myanmar and Cambodia. "This achievement not only enhances Penang's position as a key international air hub in Southeast Asia but also strengthens regional air connectivity, further solidifying Penang's strategic role in the regional aviation landscape," he said. With the inclusion of Phnom Penh, PIA now has direct flights to 22 international cities, further boosting Penang's global reach. Wong also highlighted Malaysia's Asean chairmanship, which began on Jan 1 this year, focusing on promoting regional integration and connectivity and the Master Plan on Asean Connectivity 2025, which identifies air transport as a key pillar for fostering integration. He noted that the launch of the direct flight from Phnom Penh to Penang is a concrete reflection of a regional vision, advancing seamless air connectivity between Penang and Asean countries while further strengthening the foundation for the goal of an Asean Single Aviation Market (ASAM). "It will contribute to further enhancing Penang's position as a strategic hub within the regional aviation and trade networks, expanding its role as a key connectivity node in Asean and attracting more business, tourism and investment opportunities," Wong said. - Bernama
The Sun
20-05-2025
- Business
- The Sun
Penang to welcome new direct flights from Phnom Penh starting June 26
GEORGE TOWN: Penang is set to welcome new direct flights from Phnom Penh starting June 26 via Cambodia Airways, marking another significant milestone in enhancing regional connectivity and underscoring Malaysia's role as ASEAN Chair. Penang Tourism and Creative Economy Committee chairman Wong Hon Wai said Cambodia Airways has officially confirmed the new route and this latest development follows the successful launch of the Chengdu-Penang direct flight on April 30. 'This marks the first direct air link between Phnom Penh and Penang, signalling a new era in the exchange between the two cities. 'The launch of the direct flight service between Phnom Penh and Penang will open up more opportunities for tourism, trade and bilateral collaboration between Malaysia and Cambodia, offering more convenient travel options for both business and leisure travellers,' he said in a statement today. Wong said the flight will operate twice weekly on Thursdays and Sundays. Flight KR785 will depart from the Phnom Penh International Airport (PNH) at 8.05 am and arrive at Penang International Airport (PIA) at 10.55 am while the return flight KR786 will depart Penang at 11.55 am and land in Phnom Penh at 12.40 pm. He emphasised that this direct connection highlights Penang's unique appeal and growth potential on the regional aviation map, further solidifying its position as an international hub for business events and tourism. With the inclusion of Cambodia, he said Penang now has direct air links with six ASEAN member states, namely Thailand, Indonesia, Singapore, Vietnam, Myanmar and Cambodia. 'This achievement not only enhances Penang's position as a key international air hub in Southeast Asia but also strengthens regional air connectivity, further solidifying Penang's strategic role in the regional aviation landscape,' he said. With the inclusion of Phnom Penh, PIA now has direct flights to 22 international cities, further boosting Penang's global reach. Wong also highlighted Malaysia's ASEAN Chairmanship, which began on Jan 1 this year, focusing on promoting regional integration and connectivity and the Master Plan on ASEAN Connectivity 2025, which identifies air transport as a key pillar for fostering integration. He noted that the launch of the direct flight from Phnom Penh to Penang is a concrete reflection of a regional vision, advancing seamless air connectivity between Penang and ASEAN countries while further strengthening the foundation for the goal of an ASEAN Single Aviation Market (ASAM). 'It will contribute to further enhancing Penang's position as a strategic hub within the regional aviation and trade networks, expanding its role as a key connectivity node in ASEAN and attracting more business, tourism and investment opportunities,' Wong said.
The Sun
20-05-2025
- Business
- The Sun
Penang gets direct Phnom Penh flights from June 26
GEORGE TOWN: Penang is set to welcome new direct flights from Phnom Penh starting June 26 via Cambodia Airways, marking another significant milestone in enhancing regional connectivity and underscoring Malaysia's role as ASEAN Chair. Penang Tourism and Creative Economy Committee chairman Wong Hon Wai said Cambodia Airways has officially confirmed the new route and this latest development follows the successful launch of the Chengdu-Penang direct flight on April 30. 'This marks the first direct air link between Phnom Penh and Penang, signalling a new era in the exchange between the two cities. 'The launch of the direct flight service between Phnom Penh and Penang will open up more opportunities for tourism, trade and bilateral collaboration between Malaysia and Cambodia, offering more convenient travel options for both business and leisure travellers,' he said in a statement today. Wong said the flight will operate twice weekly on Thursdays and Sundays. Flight KR785 will depart from the Phnom Penh International Airport (PNH) at 8.05 am and arrive at Penang International Airport (PIA) at 10.55 am while the return flight KR786 will depart Penang at 11.55 am and land in Phnom Penh at 12.40 pm. He emphasised that this direct connection highlights Penang's unique appeal and growth potential on the regional aviation map, further solidifying its position as an international hub for business events and tourism. With the inclusion of Cambodia, he said Penang now has direct air links with six ASEAN member states, namely Thailand, Indonesia, Singapore, Vietnam, Myanmar and Cambodia. 'This achievement not only enhances Penang's position as a key international air hub in Southeast Asia but also strengthens regional air connectivity, further solidifying Penang's strategic role in the regional aviation landscape,' he said. With the inclusion of Phnom Penh, PIA now has direct flights to 22 international cities, further boosting Penang's global reach. Wong also highlighted Malaysia's ASEAN Chairmanship, which began on Jan 1 this year, focusing on promoting regional integration and connectivity and the Master Plan on ASEAN Connectivity 2025, which identifies air transport as a key pillar for fostering integration. He noted that the launch of the direct flight from Phnom Penh to Penang is a concrete reflection of a regional vision, advancing seamless air connectivity between Penang and ASEAN countries while further strengthening the foundation for the goal of an ASEAN Single Aviation Market (ASAM). 'It will contribute to further enhancing Penang's position as a strategic hub within the regional aviation and trade networks, expanding its role as a key connectivity node in ASEAN and attracting more business, tourism and investment opportunities,' Wong said.
