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In an effort to curb what many consider the worst public health drug crisis in decades, the federal government on Tuesday published the first national standards for prescription painkillers, recommending that doctors try pain relievers like ibuprofen before prescribing the highly addictive pills, and that they give most patients only a few days’ supply. The release of the new guidelines by the Centers for Disease Control and Prevention ends months of arguments with pain doctors and drug industry groups, which had bitterly opposed the recommendations on the grounds that they would create unfair hurdles for patients who legitimately have long-term pain. (Tavernise, 3/15)

Prescription painkillers should not be a first choice for treating common ailments like back pain and arthritis, according to new federal guidelines designed to reshape how doctors prescribe drugs like OxyContin and Vicodin. Amid an epidemic of addiction and abuse tied to these powerful opioids drugs, the Centers for Disease Control and Prevention is urging primary care doctors to try physical therapy, exercise and over-the-counter pain medications before turning to painkillers for chronic pain. Opioid drugs include medications like morphine and oxycodone as well as illegal narcotics like heroin. (3/15)

Many state lawmakers have responded to the crisis by introducing bills to restrict prescribing. And the Food and Drug Administration is pushing drug makers to develop more tamper-resistant products. But the CDC guidelines, while voluntary, arguably represent the most sweeping effort to address the problem. (Silverman, 3/15)

This first national guidance on the subject is nonbinding, and doctors cannot be punished for failing to comply. But the head of the Centers for Disease Control and Prevention, which issued the guidelines, said the effort was critical to bringing about “a culture shift for patients and doctors.” “We are waking up as a society to the fact that these are dangerous drugs,” Director Tom Frieden said in an interview. “Starting a patient on opiates is a momentous decision, and it should only be done if the patient and the doctor have a full understanding of the substantial risks involved.” (Demirjian and Bernstein, 3/15)

The CDC also recommends limiting opioid prescriptions for patients suffering short-term, acute pain to three days or less in most conditions, and says that more than seven days’ worth of opioid drugs “will rarely be needed.” “If you’re prescribing an opiate to a patient for the first time, that’s a momentous decision,” CDC Director Tom Frieden said in an interview. “That may change that patient’s life for the worse forever. So you’ve really got to think carefully before doing it.” (McKay, 3/15)

"We know of no other medication routinely used for a nonfatal condition that kills so frequently," CDC Director Tom Frieden said. More than 40 Americans die each day from prescription opioid overdoses, he said. "We must act now," Frieden said. "Overprescribing opioid, largely for chronic pain, is a key driver of America's drug-overdose epidemic." (Fauber and Stephenson, 3/15)

Prescriptions and sales of opium-derived painkillers have quadrupled since 1999. In 2014, U.S. doctors wrote nearly 200 million prescriptions for opioid painkillers, while deaths linked to the drugs climbed to a record of roughly 19,000. (McCoppin, 3/15)

The 12 guidelines, which the CDC has worked on for two years, are voluntary and have been opposed by pharmaceutical companies and doctors who say they could interfere with the treatment of patients with chronic pain. (Radelat, 3/15)

In long-awaited final guidelines for prescribing opioid pain medications, federal health officials mostly kept in place recommendations that were criticized by some as restricting access to pain relieving drugs. And so the effort to change opioid prescribing practices among primary-care physicians, who prescribe nearly half of all opioid prescriptions, is likely to face challenges. (Ross Johnson, 3/15)

The action from the CDC comes after years of study within the organization, and in the middle of a presidential race where opioid abuse has become a major issue. (Sullivan, 3/15)

Members of a congressional oversight committee excoriated a former Environmental Protection Agency official on Tuesday for not responding more forcefully when she learned last year that Flint, Mich., was not adding a chemical to its new water supply that would have prevented the city’s pipes from corroding and leaching lead. The former official, Susan Hedman, testified that limited enforcement options had kept her from acting more aggressively to order corrosion control, saying, “I don’t think E.P.A. did anything wrong, but I do believe we could have done more.” But committee members from both parties reacted furiously to her explanation, casting Ms. Hedman, who resigned in January as director of the E.P.A. regional office in charge of Michigan, as one of the primary villains in Flint’s water crisis and heaping contempt on her for more than four hours. (Goodnough, 3/15)

Marc Edwards, the Virginia Tech scientist who exposed the tainted water when government agencies failed to do so, called Hedman’s remarks “completely unacceptable and criminal.” Edwards, appearing on the panel with Hedman and two others, said the EPA official was was guilty of “willful blindness,” was “unremorseful” and was “completely unrepentant and unable to learn from [her] mistakes.” “I guess being a government agency means you never have to say you’re sorry,” Edwards said. (Bernstein, 3/15)

[Hedman] took the brunt of complaints from lawmakers and local experts that the EPA did not do enough to prevent the water crisis in Flint despite the agency knowing of the risk. Records show the EPA knew in early 2015 that Flint’s water had dangerously high lead levels, but it did not take formal action, beyond pushing Michigan officials to address the matter, until January 2016. Hedman told lawmakers Tuesday that those allegations are “false.” She said the agency moved quickly to alert local officials about the corrosion problem before it developed into a crisis. Under state supervision, the city changed its water supply to the Flint River in 2014 as a cost-saving move. But the water wasn't properly treated to travel through lead pipes, and the toxic metal leached into the supply. (Henry, 3/15)

Hedman stepped down Feb. 1 over what she called "false allegations" that portrayed her as sitting on the sidelines during the crisis and that she "downplayed concerns raised by an EPA scientist about lead in the water." (Lardner and Daly, 3/16)

Flint children impacted by lead exposure will need help for years to come — help that may tax a school district struggling financially and academically. Already, nearly 15% of the 5,400 kids in Flint Community Schools have been identified with special education needs. Of that number, 22% have been identified with a cognitive impairment — a percentage that's far higher than the county and state averages. (Higgins, 3/15)

Across the country, it's hard to know whether there's lead in school water. [Researcher and activist Yanna Lambrinidou of Virginia Tech] says for the vast majority of schools, there is no requirement to test for lead. Even if a school finds lead, there's no mandate to fix it or tell parents. "What we see again and again is that the people who first discovered the contamination were parents whose children were diagnosed with elevated blood lead levels," Lambrinidou says. Three times over the past decade, she says, Congress has declined to pass legislation that would have required schools to test for lead and make the results public. (Ludden, 3/16)

The chairman of a powerful US Senate committee has asked 20 hospital systems, including the parent company of Massachusetts General Hospital, to provide detailed records about the controversial practice of allowing surgeons to operate on more than one patient at a time. (Saltzman and Abelson, 3/13)

The Cleveland Clinic is being queried about its use of concurrent surgeries – one surgeon operating on two patients simultaneously – as part of a U.S. Senate inquiry into the effectiveness and transparency of the practice nationally, a spokeswoman at the hospital confirmed. The U.S. Senate Finance Committee has asked the Clinic to provide detailed information on how many concurrent surgeries its physicians have performed during each of the last five years, as well as internal surveys on the safety and effectiveness of the practice. (Ross, 3/15)

The U.S. Health and Human Services Department is revamping its policies to help protect thousands of babies born dependent on drugs, a reform triggered by a Reuters investigative report, the agency’s leader told a congressional committee on Tuesday. (Shiffman and Wilson, 3/15)

Senate Democrats are denouncing Republicans on the Senate Judiciary Committee for holding a hearing on abortion legislation while refusing to consider a Supreme Court nominee. “While the Republicans on that committee say they won’t take up the time to do their most important actual job, they were happy to spend their time this morning on their favorite hobby: do everything they can to turn back the clock on women’s access to healthcare,” said Sen. Patty Murray (D-Wash.). (Sullivan, 3/15)

A House panel is pressing ahead with a 10-year balanced budget plan that cuts federal health care programs and agency budgets even though tea partyers are rebelling in a setback for Speaker Paul Ryan. The Budget Committee vote on Wednesday would send the GOP fiscal plan to the full House, but it's looking increasingly likely that the blueprint may not pass. The fiscal blueprint released by Budget Committee Chairman Tom Price relies on eliminating health care subsidies and other coverage provided by Obama's health care law, makes sharp cuts to Medicaid, and reprises a plan devised by Ryan years ago that would transform Medicare into a voucher-like program for future retirees. (3/16)

A crowd quickly gathers here on one of West Baltimore’s many drug-infested street corners. But it isn’t heroin they’re seeking. It’s a heroin antidote known as naloxone, or Narcan. Two city health department workers are holding up slim salmon-colored boxes and explaining that the medication inside can be used to stop someone from dying of a heroin overdose. Most onlookers nod solemnly in recognition. They’ve heard about the drug. They want to know more. Nationwide, more than 150,000 people received naloxone kits from community outreach programs like Baltimore’s between 1996 and 2014, and more than 26,000 overdoses were reversed using those kits, according to a recent survey funded by the U.S. Centers for Disease Control and Prevention. (Vestal, 3/16)

Along with their firearms, badges and other more traditional tools of the trade, bicycle police in Seattle will add a pharmaceutical to their armory to combat heroin overdoses. The newest addition will help officers rescue people in dire distress, Seattle Police Chief Kathleen O’Toole said. (Clarridge, 3/15)

Measles and whooping cough, two infectious diseases US public health officials had gotten pretty good at preventing, have made a disturbing comeback in recent years. Why? Many believe the recent outbreaks were closely tied to people who refuse vaccinations for all kinds of reasons. And a new paper in JAMA confirms they're right. (Belluz, 3/15)

Parents who delay or skip childhood vaccinations even when kids have no medical reason to avoid their shots are contributing to U.S. outbreaks of measles and pertussis, a research review suggests. More than half of 1,416 measles cases reported in the U.S. since the disease was declared eliminated in 2000 were for people with no history of measles vaccination, the analysis found. (Rapaport, 3/15)

Nicola Lindson-Hawley remembers how hard it was for her mom to stop smoking. "One of the reasons I find this topic very interesting and why I went into it was because my mom was a smoker when I was younger," says Lindson-Hawley, who studies tobacco and health at the Nuffield Department of Primary Care Health Sciences at the University of Oxford. She remembers helping her mom keep track of the number of days she'd stayed away from cigarettes by putting stickers in a journal. By studying about 700 adult smokers, she found out that her mom quit the right way — by going cold turkey. The results are out in the current issue of Annals of Internal Medicine. (Bichell, 3/15)

People who quit smoking all at once are more likely to be successful than those who cut down on cigarettes gradually, according to a new study. “For many people, the obvious way to quit smoking is to cut down gradually until they stop,” said lead author Nicola Lindson-Hawley, a post-doctoral researcher at the University of Oxford in the U.K. (Doyle, 3/15)

The NFL is standing by the acknowledgement on Capitol Hill by its top player safety official of a link between football and degenerative brain disease. “The comments made by Jeff Miller yesterday accurately reflect the view of the NFL,” league spokesman Brian McCarthy said in a written statement provided Tuesday to The Washington Post. Miller, the NFL’s senior vice president for health and safety policy, was asked during a round-table discussion Monday by Rep. Jan Schakowsky (D-Ill.) whether there is a link between football and degenerative brain disorders such as chronic traumatic encephalopathy, or CTE. Miller said that “the answer to that is certainly, yes.”

A discussion on Capitol Hill about concussion research brought a startling moment Monday, as an NFL executive acknowledged for the first time that football has been linked to a degenerative brain disease. Jeff Miller, the NFL's executive vice president for health and safety, admitted the connection when he was asked about research by Boston University neuropathologist Dr. Ann McKee, who has reported finding signs of chronic traumatic encephalopathy in the brains of 90 out of 94 former pro football players — and 45 out of 55 former college players. (Chappell, 3/15)

NPR's Robert Siegel interviews Rep. Jan Schakowsky about the NFL acknowledging the links between football and CTE, a degenerative brain disease found in people who have suffered severe blows to the head. (3/15)

Gov. Nikki Haley said Tuesday that she will almost certainly sign a bill banning abortion past 19 weeks in South Carolina. "I can't imagine any scenario in which I wouldn't sign it," said the Republican governor. She said she will look at the details once the bill reaches her desk. That could be soon. The GOP-controlled House is expected to vote Wednesday on a compromise the Senate passed last week. (3/15)

Two Sacramento pregnancy service centers that oppose abortion are not complying with a state law requiring they put up signs informing patients about California’s free and low-cost public programs for family planning, prenatal care and abortion services, according to an investigation carried out by a San Francisco-based abortion rights advocacy group. (Caiola, 3/15)

As has been widely reported in recent months, rural hospitals throughout the country face some daunting challenges. Now a new report helps put the extent of this issue into perspective. According to the study, iVantage Health Analytics’ “2006 Rural Relevance: Vulnerability to Value” report, released last month, 673 of 2,078 rural hospitals are “vulnerable or at risk for closure.” Of those 673 hospitals, 210 were found to be most vulnerable, with 463 more deemed to be less so but still very much at risk. (Sisk, 3/16)

An initial state examination of Franciscan St. James Health's controversial plans to restructure hospital operations in the south suburbs delivered mixed results for the Catholic health system. Franciscan St. James proposes to close a hospital in Chicago Heights and relocate services to its Olympia Fields hospital, which is about 5 miles away. To accommodate patients who have been served in Chicago Heights, Franciscan St. James would like to renovate and add 56 beds to the Olympia Fields facility at a cost of $114.6 million. (Sachdev, 3/15)

As hospital officials describe it, state policy is pushing them in two opposing directions. The state has, in the past five years, increased the net taxes hospitals pay by close to $400 million while reducing Medicaid reimbursement rates for certain services. Hospital leaders say that financial strain adds to the factors pushing independent community hospitals to join larger health systems. (Levin Becker, 3/16)

Three more executives are being fired from the troubled Phoenix veterans hospital where a national scandal erupted two years ago over secret waiting lists and unnecessary deaths, the Department of Veterans Affairs said. Dr. Darren Deering, the hospital's chief of staff; Lance Robinson, the hospital's associate director; and Brad Curry, chief of health administration services, were all formally proposed for removal from the VA on Tuesday. The officials will be able to challenge their dismissals under VA rules. (3/15)

The next step in North Carolina’s Medicaid reform process requires state health officials to prepare an application that will go to federal regulators at the Centers for Medicare and Medicaid Services. Since CMS pays for two-thirds of North Carolina’s Medicaid program, federal regulators have the power to greenlight any plans for changes. North Carolina is asking for a so-called 1115 waiver to the federal Social Security Act. 1115 waivers are supposed to not just save money, but also demonstrate that the state is engaging in some innovative ways to deliver care to Medicaid recipients, who are children, some of their parents, pregnant women, people with disabilities and low income elderly. (Hoban, 3/16)

Non-profit groups told legislators Tuesday that rolling back a business tax exemption in order to lower the food sales tax would allow low-income Kansans to eat healthier. Kansans pay 6.5 percent state sales tax on groceries — the second highest percentage in the nation. Karen Siebert, advocacy advisor for Harvesters, told the House Taxation Committee that the high tax drives low-income consumers to “cheaper, calorie-dense,” foods that are not healthy. (Marso, 3/15)

If he had a magic wand, Bill Persinger would turn back time to May 2009. Failing that, however, he would increase resources for crisis care and substance abuse treatment, said Persinger, who is CEO of Valeo Behavioral Health Care. Rep. Will Carpenter, chair of the House Social Services Budget committee, asked Persinger and two other people who testified before the committee on Tuesday afternoon what they would do to fix the state’s mental health system if given a magic wand as a way of narrowing down priorities. The Adult Continuum of Care Committee had produced a report with dozens of recommendations, but confronting them all at once would be impossible given limited resources, Carpenter said. (Hart, 3/15)

Greenwood Village-based Envision Healthcare is continuing its buying spree and snapping up a Michigan physicians group for at least $120 million. Envision on Tuesday announced plans to acquire Emergency Physicians Medical Group, an Ann Arbor, Mich.-based operator of 37 clinics in six states. Envision plans to pay $120 million plus an undisclosed amount contingent upon EPMG's post-acquisition performance. (Wallace, 3/14)

The health scare caused by the recent drug-theft indictment of a surgical tech has prompted a push to require Colorado to conduct criminal background checks on those seeking to become surgical technologists and surgical assistants. Key legislators also want any pre-employment tests conducted by hospitals that detect drug use in those fields of work to be reported to state regulators. (Osher, 3/15)

A Charlotte man was sentenced to three years in federal prison on Tuesday for bilking Medicaid out of more than $2 million by using personal information from former disabled customers. Eric Bernard Mitchell, 44, pleaded guilty in October to health care fraud and money laundering. Prosecutors say Mitchell used the client list from his defunct company to file five years of phony reimbursements. The disabled clients, who had qualified for Medicaid coverage under Mitchell’s former company, never received the treatments for which Mitchell was reimbursed. (Gordon, 3/15)

Severe medical marijuana restrictions that would force the closure of large dispensaries should go into effect no more than 49 days after the Montana Supreme Court upheld a disputed 2011 state law, an attorney for the Department of Justice said Tuesday. State health officials are backing medical marijuana advocates who are seeking a longer delay, saying it would take months for the agency to carry out the regulatory changes in the court s ruling. (3/15)

When firefighter Stephen Babcock found out he had non-Hodgkin's lymphoma in October, his costs to fight the illness should have been covered. State lawmakers had passed a bill that was supposed to protect firefighters who fell ill with 10 types of cancer that likely stem from on-the-job exposure to carcinogens. Those firefighters were supposed to have their lost wages covered as well. But it turned out that lawmakers never actually set aside any money. (Bethencourt, 3/15)

The two principal expenditures of the Affordable Care Act so far include $850 billion for insurance subsidies and a similar outlay for a massive Medicaid expansion. The truth is that Medicaid—a program costing $500 billion a year that rises to $890 billion in 2024—funnels low-income families into substandard coverage. Instead of providing a pathway to excellent health care for poor Americans, ObamaCare’s Medicaid expansion doubles down on their second-class health-care status. (Scott W. Atlas, 3/15)

In this latest case known as Whole Woman’s Health v. Hellerstedt, Justice Anthony Kennedy is the likely swing vote. If the court ends up with a 4-4 ruling due to conservative Justice Antonin Scalia’s death, the Texas law would stand and possibly set a dangerous precedent. (3/14)

Gov. Matt Bevin has a deep-seated need to end Kynect. Everyone gets that by now. In the spirit of acceptance, may we suggest: Rather than the Rube Goldberg-style shell game outlined recently by Health and Family Services Secretary Vickie Yates Brown Glisson, just rename it. (3/15)

[Ohio Gov. John] Kasich, for all of his conservative positions on issues like abortion and taxes, committed the ultimate act of Republican heresy: He had his state participate in the Affordable Care Act’s expansion of Medicaid. Of course, Kasich wasn’t the only Republican to do so -- Arizona’s Jan Brewer and Michigan’s Rick Snyder, among others, did the same thing. (Jonathan Cohn, 3/15)

Nebraska legislators are currently considering another plan to bring Obamacare’s Medicaid expansion to the Cornhusker state. The proposal would create a new welfare program, dubbed the “Transitional Health Insurance Program,” for more than 130,000 able-bodied adults, costing taxpayers nearly $15 billion over the next ten years. (Josh Archambault, 3/15)

Missouri lawmakers are just as likely to fail as Indiana and Arizona legislators did in efforts to block Medicaid funding for Planned Parenthood. Knowing that has not stopped them from persisting in a battle that is going to cost taxpayers dearly when the issue winds up in court. That is what happened in Arizona and Indiana, which lost court fights over this same issue. Court battles are in progress in other states, too. A federal judge in Louisiana temporarily blocked efforts there, and lawsuits are pending to prevent cutoffs in Alabama, Arkansas, Utah and New Hampshire. Defunding efforts are underway in Florida, Texas and Ohio. (3/15)

The hypocrisy of this one almost leaves me speechless. Recently, I wrote about an Iowa state senator’s failed effort to have abortion classified as a hate crime. It was one in a slew of abortion restrictions that Sen. Jake Chapman of Dallas County has sought, with a few of his Senate Republican colleagues, to get passed into law. (Rekha Basu, 3/15)

Anyone who's ever experienced an ambulance ride — myself included — probably has a horror story to tell about the crazy fee, even when only basic medical care was provided ... Like anyone in such a situation, I wasn't thinking about money. I was just grateful, albeit barely coherent, to be receiving prompt and efficient treatment. Happily my ticker was fine; it was just a weird virus. Then the bill came for nearly $1,000 and I remember thinking, "For what?" (David Lazarus, 3/15)

Providing health care at home is on the minds of many doctors and health system CEOs who are coming to realize that the traditional model of hospital- and clinic-centric care may not be financially viable ... Just as online retailers have threatened the dominance of Walmart, new entrants into the health care market threaten the dominance of clinic- and hospital-based doctors. (Ravi Parikh, 3/15)

A little over a year ago, on January 1, 2015, Medicare implemented a chronic care management (CCM) billing code. This code, which pays an average of $42, can be billed once a month when a practitioner provides at least 20 minutes of CCM services to a patient with 2 or more chronic conditions. The CCM services include the monitoring of a beneficiary’s care plan, the provision of access 24 hours a day, 7 days a week, to clinical staff who can retrieve information from the beneficiary’s electronic health record even when the office is closed; management of a beneficiary’s care transitions; and coordination with other clinicians, hospitals, and others who provide clinical services. (Andrew B. Bindman and Donald F. Cox, 3/14)

Healthcare has made great gains in patient safety in recent years. According to a federal Department of Health and Human Services report issued in December, the rate of hospital-acquired conditions dropped 17 percent from 2010 to 2014. (Tim Jahn and Steve Hanson, 3/15)

"Mr. Johnson, we need to talk. As you know, your cancer has spread in spite of the surgery. The drugs that we tried did not reduce the tumor size. And neither has the radiation therapy. I do not know exactly how much time you have left, but it may be only six months. It's hard to predict; you are a very hardy man. You have essentially two options left. I can refer you to the palliative care team; those folks are really good to help you with pain and suffering; but of course there are no guarantees. (Dr. Jos V.M. Welie, 3/16)

Look no further than Flint to understand why this matters. State and federal investigations are now underway to determine whether any criminal acts were involved in the concealing and distorting of data and decisions that resulted in dangerously polluted water flowing into 60,000 homes, a problem that will take millions of public dollars to fix and years of study to determine how badly people, especially children, have been hurt. Look no further back than the closing hours of the legislative session in 2015, when the Republican majority engineered without public hearings or notice the wholesale substitution of an election reform bill with a far more complex one that muzzled local officials from explaining ballot proposals and further concealed campaign money from public view. (Ron Dzwonkowski, 3/14)

So here's some good news out of Valeant. Remember a couple of weeks ago, when Valeant was doing one-on-one calls with selected research analysts, and those analysts were then telling clients what they had learned? That struck people, including me, as a bit odd. A lot was going on at Valeant! Chief Executive Officer Michael Pearson was just back from medical leave, it had just withdrawn its guidance, it had discovered accounting problems that would delay the filing of its financial statements, and now the CEO was going around chatting up analysts privately? Sure, Valeant said that "in engaging in such dialogue, Valeant’s officers are cognizant of obligations under Regulation FD, and it is the company’s policy not to selectively disclose material non-public information," but it was a little difficult to believe that Valeant hadn't told those analysts anything useful. (Matt Levine, 3/15)