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Six Michigan doctors have been charged with insurance fraud and unnecessarily prescribing opioids to patients in a $464 million scheme, according to court documents...The 56-count indictment...named Dr. Rajendra Bothra...who owned and operated the Pain Center USA in Warren and Eastpointe, Mich., and the Interventional Pain Center in Warren. The other five doctors were employed by the clinics, which catered to patients with joint and spinal injuries...The doctors have been charged with submitting false claims...and diverting the proceeds to themselves...Prosecutors said the doctors submitted claims of $182.5 million to Medicare, $272.6 million to Medicaid and $9.2 million to Blue Cross Blue Shield of Michigan...

The landmark legislation would disburse nearly $8 billion to HHS, CMS, CDC and state governments, with big goals for population health, care coordination and patient safety...The Opioid Crisis Response Act of 2018...It's a massive bill comprising a wide array of proposals drawn from five Senate committees, and has many implications for the use and funding of health IT...It contains funding for stopping the flow of illegal opioids from other countries, and for supporting local programs for prevention, treatment and recovery...spur research and development of new non-addictive painkillers and stem "doctor shopping" by boosting prescription drug monitoring programs...has funds to give behavioral and mental health providers the tools they need to offer treatment and recovery – including potential electronic health record incentives – and for hospitals to better care for infants with neonatal abstinence syndrome.

The Department of Health and Human Services has recommended a ban on the chemicals in kratom that would make the popular herbal supplement as illegal as heroin or LSD…HHS asserted in a letter to the Drug Enforcement Administration that two chemicals in kratom should be classified as Schedule I substances... FDA...has said that kratom is “an opioid” and has been “associated” with dozens of deaths...Kratom should not be used to treat medical conditions, nor should it be used as an alternative to prescription opioids...Some states have already banned kratom, but it’s currently legal at the federal level. It’s sold in different forms, including dry powder and capsules. According to the American Kratom Association, millions of Americans use the substance.

Fentanyl is a big culprit, but there are also encouraging signs from states that have prioritized public health campaigns and addiction treatment...Drug overdoses killed about 72,000 Americans last year, a record number that reflects a rise of around 10 percent, according to new preliminary estimates from the Centers for Disease Control...Analysts pointed to two major reasons for the increase: A growing number of Americans are using opioids, and drugs are becoming more deadly. It is the second factor that most likely explains the bulk of the increased number of overdoses last year...During 2017, the president declared the opioid crisis a national public health emergency, and states began tapping a $1 billion grant program to help fight the problem...Because it’s a drug epidemic as opposed to an infectious disease epidemic...the response is slower...Because of the forces of stigma, the population is reluctant to seek care... The dominant factor is the changing drug supply...Strong synthetic opioids like fentanyl and its analogues have become mixed into black-market supplies of heroin, cocaine, methamphetamine and...benzodiazepines. Unlike heroin, which is derived from poppy plants, fentanyl can be manufactured in a laboratory, and it is often easier to transport because it is more concentrated...Unexpected combinations of those drugs can overwhelm even experienced drug users...

A day after President Trump signed a massive piece of legislation responding to the opioid crisis into law, the Department of Justice announced it's pouring even more resources into its crackdown on prescribers...Attorney General Jeff Sessions said his agency was creating a new Appalachian Regional Prescription Opioid Strike Force to focus on communities "hit especially hard by addiction and opioid fraud."...a dozen prosecutors and data analysts will operate out of hubs in Cincinnati/Northern Kentucky and Nashville, Tennessee, monitoring the Appalachian region for fraudulent opioid prescriptions by physicians...

For many public health experts, Massachusetts’ near-universal health insurance coverage makes it the gold standard for access to care…the industrial cities of Lowell and Lawrence...have both seen a surge in new HIV cases among people who use intravenous drugs...Between 2015 and 2018, there were 129 new HIV cases linked to drug use in the two cities...By comparison, from 2012 to 2014, an average of just 41 cases of HIV linked to injection drug use were diagnosed per year in the entire state of Massachusetts...local stakeholders told investigators that Lawrence had a local illegal fentanyl manufacturing operation, which made the synthetic opioid ― an efficient vector for HIV because its short high leads to more frequent injections ― both pervasive and cheap. Meanwhile, rampant homelessness disrupted treatment for those most at risk. And even though community leaders in Lawrence and Lowell pushed for clean needle exchanges, a known method for stopping infectious disease spread, they only did so after the outbreak began...As fentanyl spreads across the U.S. and drug use patterns evolve, other areas of the country with this same constellation of risk factors should take note.