President Donald Trump’s budget proposal shows that his administration isn’t interested in spending much more to combat the opioid epidemic, even as drug overdoses were linked to more than 70,000 deaths — a record high — in 2017.
The budget plan does propose some new funding to fight the opioid crisis, including $245 million over 10 years to let states “extend Medicaid coverage for pregnant women with substance use disorder to one year postpartum.” But it also proposes cuts to some opioid-related programs, particularly at the Department of Justice. At best, the budget maybe adds some tens of millions a year to address the problem.
Tens of millions of dollars may sound like a lot of money, but it’s almost nothing in a budget valued at $4.7 trillion for 2020.
It’s also far short of the tens of billions of additional dollars that experts say is needed to address the opioid crisis. For reference, the White House’s own Council of Economic Advisers in 2017 linked the opioid epidemic to $500 billion in economic losses — so spending tens of billions would be only a fraction of what the White House says the crisis is costing the US.
Trump’s budget plan does implement spending and laws enacted by Congress in recent years to address the opioid crisis, including $3 billion a year approved by Congress early last year.
But Trump himself seemed to acknowledge that this wasn’t enough money. Last year, his budget plan called for an additional $7 billion for 2019. This year’s budget proposal drops that request — with no explanation as to why that money is no longer necessary.
Beyond the lack of money for the opioid epidemic, Trump also proposes steep cuts to domestic programs that could make the current crisis worse. Most notably, he calls for slashing hundreds of billions of dollars from Medicare and Medicaid — both of which, as health insurance programs, can help connect people to addiction treatment. Medicaid in particular pays for a quarter of drug addiction treatment in the US.
The budget proposal does call for $8.6 billion to build parts of a wall at the US-Mexico border, which Trump argues would help combat the flow of illicit drugs into the country and, as a result, mitigate the opioid crisis. But experts say this would be ineffective since most illegal drugs come through legal ports of entry, not through illegal border crossings that a wall would aim to stop.
The White House did not immediately respond to questions about the budget proposal.
The president’s budget blueprint is very unlikely to make it through Congress, especially now that Democrats control the House. But the budget plan offers a look at Trump’s priorities. The opioid epidemic is apparently not one of them, even as the statistics suggest that much more action is necessary.
Trump needs to go bigger
The opioid epidemic is a truly massive crisis. Since the 1990s, more than 700,000 people in the US have died of drug overdoses, mostly driven by the rise in opioid-related deaths. That’s comparable to the number of people who currently live in big cities like Denver and Washington, DC. Some estimates predict that hundreds of thousands more could die in the next decade of opioid overdoses alone.
When experts talk about the current epidemic, they compare it to previous public health crises like HIV/AIDS, which also killed tens of thousands of Americans each year.
“To actually stem the tide of overdose deaths, we need funding and innovation that is on par with our response to HIV/AIDS,” Sarah Wakeman, an addiction medicine doctor and medical director at the Massachusetts General Hospital Substance Use Disorder Initiative, previously told me. That, she explained, will require “a massive infusion of funding and a fundamental restructuring of how we treat addiction in this country.”
The New York Times last year asked 30 experts how they would spend $100 billion over five years to address the opioid epidemic — a number comparable to how much the US spends domestically on HIV/AIDS. That may sound like a lot, but some experts cautioned that even that amount of cash may not be enough.
That’s in large part because a lot of America’s addiction treatment infrastructure is in a very bad spot.
Federal data suggests that only one in 10 people with any substance use disorder and one in five people with an opioid use disorder seek specialty treatment. Even when an addiction treatment clinic is available, fewer than half of facilities offer any of the opioid addiction medications, such as methadone or buprenorphine, as an option, even though the medications are widely considered the gold standard for opioid addiction treatment. In other words, treatment is inaccessible enough that most people who need it don’t get it, and even when treatment is available, it doesn’t meet the best standards of care.
To change this, Congress needs to invest much more, and for the long term. In response to the HIV/AIDS crisis, for example, Congress set up the Ryan White program to provide long-term, sustained resources to deal with HIV/AIDS, particularly in the worst-hit communities. Unlike the limited-time grant money that lawmakers have allocated for the opioid crisis so far, the Ryan White funding is something that people on the ground know they can rely on for years to come.
Some lawmakers have called for similar actions in response to the opioid crisis, like the CARE Act proposed by Rep. Elijah Cummings (D-MD) and Sen. Elizabeth Warren (D-MA). But these proposals have not moved forward in Congress, largely due to Republican concerns about the extra spending.
Instead, Congress has passed limited measures like the Support for Patients and Communities Act, which Trump signed into law last year. As Stanford drug policy expert Keith Humphreys told me when the law passed, it takes some good steps, but it just isn’t enough: “This reflects a fundamental disagreement between the parties over whether the government should appropriate the large sums a massive response would require. Lacking that, Congress did the next best thing — which is to find agreement on as many second-tier issues as they could.”
Experts have long told me there is no silver bullet that will solve the opioid epidemic overnight, but there’s a mix of policies that would help: more treatment (particularly medications like methadone and buprenorphine), more harm reduction (such as better access to naloxone), fewer painkiller prescriptions (while ensuring the drugs are available to those who really need them), and policies that can help address the root cause of addiction (like mental health issues and socioeconomic despair).
A recent study by Stanford researchers found that a mix of these options could save at least tens of thousands of lives in the next decade.
But Trump hasn’t embraced a full approach. He hasn’t called for putting tens of billions of dollars toward treatment infrastructure. His administration declared a public health emergency over the opioid epidemic, but nothing significant came out of it. When he has spoken about the crisis, he’s done so to advocate for ineffective policies such as the wall and expanded use of the death penalty.
That shows in Trump’s budget, in which the opioid epidemic is relegated to practically a non-issue.
What happens when a gothic lit expert moves into a haunted house
Welcome to Vox’s weekly book link roundup, a curated selection of the internet’s best writing on books and related subjects. Here’s the best the web has to offer for the week of May 19, 2019.
Another thing about that first workshop was that I heard something about myself that I had never heard before: that my story was protective and civilized and carefully managed. These to me seemed the primary virtues of fiction that I loved and that I wanted to write. There’s nothing I want more than peace and order. I had a difficult life. A strange life. And so in turning to fiction, I wanted to create for my characters a space where the urgent material of their lives would not contain the question of whether or not they would live or die. I wanted to write about people moving through the world who could count on more time, who didn’t have to confront the ugliness of violence and harm and malevolence. I wanted only to make for my characters a space where they could be. I left the workshop that night feeling like I had been struck by lightning. I was angry and ashamed.
Become a literary citizen of the world. Spend time in a foreign literary community by hatching an insane plot to launch a new Holy War against the infidels of Egypt, a plot so deeply deranged that when you finally manage to present your plan to Louis XIV, a king who enthusiastically led France into four major wars, he’s so appalled by the idea of a new crusade that he literally responds, “I have nothing to say.” Do all of this just to live in Paris for a bit.
“I don’t think the Times has ever seen this number of requests,” a veteran editor concurred, adding, “For department heads, it’s become almost impossible to manage.” The glut of big newsy projects that require essential beat reporters to take book leave is especially tricky. For one thing, there’s always concern among editors about balancing reporting that’s exclusive to books with reporting that can be published in the Times. More practically, as another Times journalist put it, “It’s kind of made the editors stand up and realize, holy shit, we have all these people writing books, and that’s an awful lot of man- and woman-power off the daily report in a pretty significant way.”
Books can be aesthetic signifiers, colorful set pieces of sorts, their spines telegraphing a certain gravitas — or a certain playfulness, depending on how they’re arranged. “I like to compare physical books to candles,” Mr. Blackwell said. “Light bulbs do the job, but there’s a strong aesthetic of a candle that puts soul into a room. Books do that, too. They create theater and drama.”
It is lined with red, marbled paper. On the inside cover, two skeletons hold a banner reading: “Statutum est hominibus semel mori,” or “All people are destined to die once.” It’s Hebrews 9:27, and it wouldn’t be nearly as ominous if it wasn’t next to 10 little drawers labeled with names of poisonous plants, and a mirrored shelf holding several little glass bottles.
The compartments bear the German names for hemlock, wolfsbane, foxglove, and more—all lethal, properly administered—and the suggestion seems to be that the little vials are there for a would-be poisoner to mix up their own deadly cocktails.
Stories give shape to experience, sometimes by accommodating traditional literary forms, sometimes by turning them upside down, sometimes by reorganizing them. Stories draw readers into their web, and engage them by putting them to work, body and soul, so that they can transform the black thread of writing into people, ideas, feelings, actions, cities, worlds, humanity, life. Storytelling, in other words, gives us the power to bring order to the chaos of the real under our own sign, and in this it isn’t very far from political power.
Of course, bookstores sell books, but these shops often serve other purposes as well. Leftist bookstores in particular commonly act as multipurpose spaces for local activists as well as stops for progressive and leftist authors’ book tours. In some smaller towns, these bookshops can be neighborhood or even city strongholds for locals who may not have many other places to safely and comfortably organize, or even just hang out. Bookshops that are not expressly political in their mission still frequently host authors whose work is political, and thus when these authors are targeted, often bookshops are as well.
This is the problem with white people, as Eddie Murphy assesses it in his 1983 standup comedy special Delirious: we stay in haunted houses, like idiots. We don’t heed the warnings; we don’t read the signs. In pursuit of the American dream of homeownership—the middle-class domestic ideal, the manicured lawn, the 30-year mortgage and its promise of equity and upward mobility—we colonize spaces, nominally vacant and hauntingly occupied, as if we belong there. As if it is our right.
Here’s a rundown of the past week in books at Vox:
As always, you can keep up with Vox’s book coverage by visiting vox.com/books. Happy reading!
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Whales dying from plastic bags: The alarming trend, explained
Another dead whale has washed ashore with a belly full of plastic.
This week, the carcass of the young sperm whale, estimated to have been 7 years old, was found on a beach in Cefalù, Italy. Investigators aren’t certain whether the plastic killed the whale. But it’s part of a gruesome pattern that’s become impossible to ignore.
In April, a pregnant sperm whale washed up on a beach in Sardinia with nearly 50 pounds’ worth of plastic bags, containers, and tubing in her stomach. Biologists in Florida last month euthanized a baby rough-toothed dolphin with two plastic bags and a shredded balloon in its stomach.
“The dolphin was very young and emaciated,” said Michelle Kerr, a spokesperson for the Florida Fish and Wildlife Conservation Commission, in an email. “Due to a poor prognosis, the decision was made to humanely euthanize the animal on scene.”
In March, a 1,100-pound Cuvier’s beaked whale was recovered in the Philippines filled with 88 pounds of plastic bags, fishing line, and rice sacks. A beached sperm whale was found in Indonesia last year with more than 1,000 pieces of plastic inside.
As the quantity of plastic humans dump in the ocean has reached obscene proportions, we’re seeing more and more sea life — including birds, otters, sea turtles, and fish — choking on it.
But the impact on whales is particularly alarming. After centuries of whaling and overfishing, the survival of many whale species is already precarious. Now, just as their numbers are starting to recover, whales are consuming our toxic waste. And their deaths aren’t just about biodiversity loss: Whales play a critical role in marine ecosystems, which provide 3 billion people with their primary sources of protein.
To find out more about why whales are so vulnerable to plastic waste, I talked to Lars Bejder, director of the Marine Mammal Research Program at the University of Hawaii Manoa. He said there are multiple mechanisms at work here and that dying isn’t the only plastic hazard for whales, and explained why the problem will only get worse.
There’s a gargantuan amount of plastic in the ocean
The root cause of these stranded, plastic-filled whales is that plastic is cheap and easy to produce but almost impossible for nature to destroy. Chunks of plastic linger for decades, breaking down into smaller and smaller pieces. This waste then churns in the ocean in massive gyres.
Roughly 8 million metric tons of plastic — a mass greater than that of the Great Pyramid of Giza — enters the ocean each year.
Meanwhile, we’re still trying to figure out how much plastic waste has already accumulated in the ocean. A study published this week in the journal Scientific Reports estimated that 414 million bits of garbage weighing 238 tons have been deposited on the Cocos (Keeling) Islands 1,300 miles off the coast of Australia. It’s a sign that even the most remote regions of the world are now contaminated with the detritus of civilization.
“Sadly, the situation on the Cocos (Keeling) Islands is not unique, with significant quantities of debris documented on islands and coastal areas from the Arctic to the Antarctic,” researchers wrote. “[G]lobal debris surveys, the majority of which are focused solely on surface debris, have drastically underestimated the scale of debris accumulation.”
And the amount of plastic waste in the ocean is surging. Our current trajectory puts us on track to have more plastic in the ocean than fish by weight by 2050, according to the World Economic Forum.
So for the largest, hungriest animals in the ocean, plastic is becoming an unwelcome part of their diets.
Different whales face different risks from plastic
Whales are among the more intelligent creatures in the ocean, so why aren’t they smart enough to avoid eating plastic?
Well, one reason is that often plastic is in their food.
Small crustaceans like krill and tiny fish like anchovies often end up inadvertently consuming microplastics. Whales, the largest animals ever known to have existed, have a voracious appetite for these critters. A blue whale eats between 2 and 4 tons of krill per day.
Whales like the blue whale have baleen plates in their mouths that act as filters, trapping their small prey as well as small bits of plastic. This means they are less likely to ingest larger plastic waste items like bottles and containers, but the small plastic bits they consume quickly pile up.
“These baleen whales filter hundreds of thousands of cubic meters of water per day,” Bejder said. “You can imagine all these microplastics they encounter through this filtration process that then become bioaccumulated.”
Microplastics are unlikely to obstruct the digestive tract of a baleen whale, but as they build up inside an animal’s tissues, they can leach toxic chemicals like endocrine disruptors that make the creature sick. This problem can affect all ocean filter feeders, including manta rays and whale sharks.
That means there could be large whales dying of plastic poisoning without obvious culprits like flip-flops and food containers in their stomachs, according to Bejder.
A study published this week in Royal Society Open Science also reported that plastic pollution is more dangerous to baleen whales than oil spills. “Particle capture studies suggest potentially greater danger to [baleen whales] from plastic pollution than oil,” the authors wrote.
Toothed whales like sperm whales and dolphins normally catch bigger prey, like squid. But since they can swallow larger animals, they are vulnerable to larger chunks of plastic, like bags and nets.
“They might be seeking those out because they’re thinking they might be prey,” Bejder said. A plastic container in murky waters could resemble a fish to a toothed whale, or a sperm whale may inadvertently swallow plastic garbage as it hunts for a meal.
Once ingested, the plastic piles up in the whale’s stomach. It can then obstruct bowels, preventing whales from digesting food and leading them to starve to death. It can also give a whale a false sense of being full, leading the whale to eat less and get weaker. That leaves it vulnerable to predators and disease.
We’re only seeing a tiny fraction of the whales being harmed by plastic
Part of the reason we pay so much attention to whales killed by plastic is because the whales themselves are very big and the plastic culprits are startlingly obvious. Large animals decay slowly, giving people plenty of time to figure out the cause of death, whereas smaller fish and crustaceans dying from plastic decompose quickly and are rarely investigated. Even for casual observers, a dead whale blocking a beach vacation photo is pretty hard to ignore.
Still, we’re missing a big part of the picture.
“The ones that land on the beach that are killed through ingestion, they’re just the tip of the iceberg. They’re just the ones that we see,” Bejder said. “I’m sure that many, many marine mammals have some levels of plastic bags and plastic items in their stomachs.”
Many more whales could be dying from plastic poisoning without our knowledge. Around the Gulf of Mexico for example, 2 to 6 percent of whale carcasses end up on a shoreline. That means the vast majority sink to the ocean floor. This is likely the case for most of the world’s waters.
And the fact that whales are suffering shows that our marine ecosystems in general are in peril. “Whales, baleen whales, these larger dolphins species are pretty much at the top of the food chain,” Bejder said. “They are sentinels of ocean health for sure.”
But with more plastic waste pouring into the ocean, the prognosis for the most mega of megafauna is grim.
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