Insurance claims for opioids, which are prescribed to help people manage pain, decreased almost 19% in a single year among the 1.5 million Californians served by the California Public Employees’ Retirement System. CalPERS manages health benefits for employees and retirees of state and local agencies and public schools, and their families.

Most notably, doctors reduced the daily dose and duration of opioid treatment: The number of new users who were prescribed large doses dropped 85% in the first half of 2018 compared with the same period in 2017, while new users prescribed more than a week’s supply dropped 73%, according to .

“These reductions are substantial,” said Beth McGinty, an associate professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. “They signal a reduction in the overprescribing practices that have driven the opioid epidemic in the U.S.”

What’s unclear, however, is how the reductions in prescriptions are affecting patients’ pain, she said.

Every day, from opioid overdoses, and about 40% of those deaths are caused by overdoses of prescription drugs. About one-quarter of the millions of patients who take the medications for chronic pain misuse them, the National Institutes of Health .

Prescription opioids — which are frequently prescribed for cancer patients and for orthopedic and dental pain — include hydrocodone, oxycodone, fentanyl, oxymorphone, morphine, codeine and others.

CalPERS has spent more than a decade trying to reduce prescription opioid use among its enrollees, working with health insurers and other state agencies to identify doctors who prescribe abnormally high amounts. In 2017, OptumRx, which manages CalPERS members’ pharmacy benefits, adopted a that includes limits on the quantity of opioids prescribed and requires prior authorization for some drugs.

CalPERS is the second-largest public purchaser of health benefits in the nation after the federal government, and medical trends among its members are often reflected nationally.

Indeed, the data showing a decline in opioid prescriptions among CalPERS members mirrors a nationwide drop that has been reported in all 50 states.

About 22% fewer opioid prescriptions were written in the United States from 2013 to 2017, dropping from 251.8 million to 196 million, according to the , the nation’s largest physician group.

A March study by researchers at the federal government’s Centers for Disease Control and Prevention a 13% decline in average opioids prescribed per person from 2016 to 2017. Maine, Massachusetts and North Dakota have experienced the biggest drops over the past decade.

One major factor is that many health insurers have imposed limits on prescriptions, by the CDC in 2016. The CDC advises doctors to prescribe new users no more than a seven-day supply and to keep daily doses under the equivalent of 50 morphine milligrams in an effort to prevent overdoses and new addictions.

In addition, the AMA created a task force in 2014 that has encouraged doctors to “start low and go slow” and use the drugs only if the benefits exceed the risks for a patient. The association also is offering doctors education programs on pain management.

Opioid medications act on receptors in the brain and spinal cord to reduce the intensity of pain perception, but they also activate regions of the brain that trigger euphoria, which underlies their potential for abuse.

Declines in prescriptions have not yet led to reductions in deaths, said Dr. Patrice Harris, president-elect of the AMA and chair of its Opioid Task Force. “Reducing opioid prescriptions is important but will not by itself reverse the epidemic,” she said. “We will reach a tipping point when opioid-related mortality begins to decrease.”

Medical experts also warned of unintended consequences of fewer opioid prescriptions: More people may suffer unmanaged chronic pain, and some may resort to illegal opioids, such as heroin or street versions of fentanyl. About Americans experience chronic pain.

“The focus on reducing opioid prescribing has likely left a large void in access to pain care,” Harris said.

Even as insurers set limits on opioids, they have not increased access to other pain care options, she said. “If policymakers solely focus on limiting access to prescription opioids for pain relief without increasing non-opioid options, the result will be increased patient suffering.”

The CalPERS data represents a cross section of patients throughout California who are enrolled in Blue Shield, Kaiser Permanente, Anthem Blue Cross and other health plans.

Reductions in their opioid use were across the board: The doctors cut back on numbers of people taking opioids for long periods of pain, but also how much people took daily. Prescriptions exceeding two weeks fell almost 32% from January to June 2017 and the same period in 2018. Daily average doses declined 14%.

“These are very positive numbers,” said Kathy Donneson, chief of CalPERS’ Health Plan Administration Division. “But we’re all going to keep working on it. Opioids are still a national crisis.”

CalPERS members are still being prescribed considerable volumes of the drugs. For instance, 34,321 patients were prescribed opioids in the first half of 2018, according to the data. Of those, 1,168 were prescribed doses that are considered large — over the equivalent of 50 morphine milligrams per day.

Health experts said it’s important to wean people off the drugs properly, prevent relapses and ensure they don’t switch to heroin.

The surest sign of success, Donneson said, will be when patients with many types of chronic pain, such as knee or back pain, are “kept pain-free in other ways” and when opioids are reserved for patients who need them the most, such as those with cancer or in hospice or post-surgery care.

“We’re not there yet,” she said.

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Hace pocos días, un jurado federal ordenó a Monsanto, el fabricante de Roundup, a que lo había usado durante tres décadas en sus 56 acres, en el condado de Sonoma, California. El jurado determinó que Roundup fue un “factor sustancial” en su enfermedad.

Bayer AG, que compró Monsanto el año pasado, dijo que apelará la decisión.

El año pasado, un jurado de un tribunal superior de California, en San Francisco, llegó a un veredicto similar contra Monsanto a favor de con la misma enfermedad: linfoma no Hodgkin, un cáncer potencialmente mortal del sistema inmunológico. Monsanto también apeló esa decisión.

El glifosato es, por lejos, en los Estados Unidos, y probablemente en todo el mundo. Se usa en casi cultivados en el país. Es posible que lo hayas utilizado para rociar tu césped o tu jardín.

Pero muchas jurisdicciones, en , han prohibido o restringido su uso. Entre las últimas: el condado de Los Ángeles anunció en marzo que en las propiedades del condado hasta que se sepa más sobre sus efectos en la salud.

Bayer dice que el herbicida ha sido probado exhaustivamente y que “un extenso corpus de investigación” muestra que los productos que lo contienen “se pueden usar de manera segura y que el glifosato no es cancerígeno”.

Cynthia Curl, científica de salud ambiental en la Universidad de Boise State en Idaho, quien estudia esta sustancia química, dijo: “hubo muchas suposiciones sobre la seguridad del glifosato que ahora se están cuestionando activamente. Veremos una explosión de información sobre el glifosato, y ya es hora. Estamos realmente poniéndonos al día con este producto”.

Las siguientes son algunas respuestas sobre el glifosato:

-¿Qué es el glifosato y para qué se utiliza?

Comercializado por Monsanto en 1974 bajo el nombre de Roundup, el glifosato mata las malezas al bloquear las enzimas que regulan el crecimiento de las plantas.

Durante las cuatro décadas posteriores a su lanzamiento, el uso de Roundup se multiplicó por cien. En 1996, Monsanto modificó genéticamente cultivos para tolerar el glifosato, y estas semillas allanaron el camino para que el herbicida se usara en campos agrícolas de todo el mundo.

-Roundup no es el único herbicida con glifosato, ¿verdad?

Si. En los Estados Unidos, s que contienen glifosato, ya sea en forma sólida o líquida. Además del Roundup, los más comunes incluyen Ortho GroundClear, Rodeo de DowDuPont, un concentrado de nivelación de hierba llamado Compare-N-Save, Weed Killer, RM43 Total Vegetation Control y Ranger Pro Herbicide, también fabricado por Monsanto. Si no sabes si un herbicida contiene glifosato, lee la etiqueta. Está en la lista de ingredientes activos.

-¿Qué tan extensa es la exposición humana al glifosato?

Por su uso generalizado, el glifosato se encuentra en el agua, los alimentos y el polvo, por lo que es probable que casi todos hayamos estado expuestos. Y la exposición humana a través de los alimentos y el agua probablemente aumentará a medida que aumenta el uso del herbicida, según publicado en la revista Environmental Sciences Europe.

Pero poco se sabe sobre la magnitud de esta exposición, porque los alimentos y el agua no se analizan regularmente para detectar residuos de glifosato. Sin embargo, hace unos años, investigadores de un pequeño grupo de personas en los Estados Unidos y encontraron residuos de glifosato en el 93%.

Curl dijo que está lanzando un proyecto que comparará la exposición de mujeres embarazadas que viven en áreas agrícolas y no agrícolas, y luego introducirá dietas orgánicas para tratar de determinar qué parte del glifosato proviene de los alimentos.

-¿Qué sabemos realmente sobre los riesgos para la salud humana del glifosato?

Durante décadas, se pensó que el glifosato representaba un riesgo solo para las plantas, no para las personas. Eso es porque inhibe una enzima que los humanos ni siquiera tienen.

En los últimos años, su posible vínculo con el cáncer ha provocado una avalancha de reclamos y contra reclamos, y las principales agencias de salud pública no se ponen de acuerdo. La Agencia Internacional para la Investigación sobre el Cáncer de la Organización Mundial de la Salud (OMS) ha calificado al glifosato como un “probable carcinógeno humano”, y en 2017, California lo agregó a su lista de .

Sin embargo, la Agencia de Protección Ambiental (EPA), decidió a finales de 2017 que que el glifosato causara cáncer en seres humanos.

Pero hay cada vez más pruebas de que las personas que están muy expuestas a esta sustancia (trabajadores agrícolas y paisajistas, por ejemplo) tienen un mayor riesgo de linfoma no Hodgkin.

Una revisión de científicos de la Universidad de Washington publicada en febrero encontró que los trabajadores agrícolas que usaban mucho glifosato tenían un riesgo 41% más alto de contraer linfoma no Hodgkin durante su vida que las personas que lo usaban con poca frecuencia o que no lo utilizaban.

En promedio, aproximadamente 2 de cada 100 estadounidenses desarrollan linfoma no Hodgkin. Para las personas que están altamente expuestas al glifosato, la tasa de enfermedad aumenta a 2.8 por cada 100. Eso significa que todavía tienen una probabilidad relativamente pequeña de padecer la enfermedad, pero su riesgo es sustancialmente mayor debido al uso de este químico.

Monsanto ha presentado más de 800 estudios a la EPA y a las agencias reguladoras europeas que sugieren que el glifosato es seguro, según Bayer.

-¿Qué ocurre con los riesgos para el resto de nosotros, que solo usamos glifosato ocasionalmente y en pequeña escala?

Nadie sabe.

“Los datos realmente están comenzando a sugerir que existe una correlación entre la alta exposición al glifosato y el linfoma no Hodgkin”, dijo Curl. “Pero tenemos muchas preguntas sin respuesta sobre el resto. “No sabemos qué significa eso para las personas que no tienen exposiciones altas, y no sabemos qué significa con un químico que se usa tanto”.

-¿Las personas deben seguir utilizando glifosato en el hogar o hay sustitutos más seguros?

Todos los pesticidas químicos son tóxicos. Algunos jardineros tienen un éxito limitado usando .

La mejor solución no tóxica para matar las malas hierbas es usar el brazo: busque una pala y sáquela a mano.

“Desde una perspectiva personal, prefiero tener cuidado y evitar los pesticidas en mi propio jardín”, dijo Rachel Shaffer, estudiante de la Escuela de Salud Pública de la Universidad de Washington y coautora del estudio de la universidad sobre el glifosato y el linfoma no Hodgkin.

“Nuestra comprensión de los efectos del glifosato sobre la salud continuará evolucionando a medida que avanza la ciencia”, dijo Shaffer, quien sobre sus hallazgos. “En el interín, las personas que están particularmente preocupadas pueden querer tomar medidas para reducir el uso en sus jardines”.

-Si uso productos con glifosato, ¿qué precauciones debo tomar?

Sigue cuidadosamente las instrucciones y advertencias de la etiqueta. Usa guantes y no permitas que el químico entre en contacto con tu piel, ropa u ojos. Úsalo solo en días tranquilos y sin lluvia para evitar salpicarte. No dejes que se escurra hacia vías de agua o canaletas. Las mascotas y las personas deben esperar hasta que las áreas tratadas estén secas antes de entrar en ellas.

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

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Last week, a federal jury ordered Monsanto, the maker of Roundup, to to a with cancer who had used it for three decades on his 56 acres in Sonoma County, Calif. The jury found that Roundup was a “substantial factor” in his illness.

Bayer AG, which bought Monsanto last year, said it would appeal the decision.

Last year, a California superior court jury in San Francisco reached a similar verdict against Monsanto in favor of a with the same disease — non-Hodgkin lymphoma, a potentially fatal cancer of the immune system. Monsanto also appealed that decision.

Glyphosate is by far the in the United States, and probably worldwide. It is used on of corn, cotton and soybeans grown in the U.S. You may have sprayed it on your lawn or garden.

But many jurisdictions, in more than , have banned or restricted its use. Among the latest: Los Angeles County announced last month that it on county property until more is known about its health effects.

Bayer says on its that the weed killer has been thoroughly tested, and “an extensive body of research” shows that products containing it “can be used safely and that glyphosate is not carcinogenic.”

Cynthia Curl, an environmental health scientist at Boise State University in Idaho who studies the chemical, said, “many assumptions have been made about the safety of glyphosate that are now being actively questioned. We will see an explosion of information about glyphosate, and it’s about time. We’re really playing catch-up on this one.”

Let’s try to provide a few answers:

Q: What is glyphosate, and what is it used for?Ìý

First sold commercially by Monsanto in 1974 under the name Roundup, glyphosate kills weeds by blocking enzymes that regulate plant growth.

Over the four decades after its launch, use of Roundup increased a hundredfold. Monsanto genetically engineered crops to tolerate glyphosate in 1996, and these seeds paved the way for the weed killer to be used on farm fields around the world.

Q: Roundup isn’t the only weed killer with glyphosate, right?

Right. glyphosate-containing products are sold in the United States, either in solid or liquid form. In addition to Roundup, common ones include Ortho GroundClear, DowDuPont’s Rodeo, Compare-N-Save Concentrate Grass and Weed Killer, RM43 Total Vegetation Control and Ranger Pro Herbicide, also made by Monsanto. If you don’t know whether a weed killer contains glyphosate, read the label. It would be listed under active ingredients.

Q: How extensive is human exposure to glyphosate?

Because of its widespread use, glyphosate is in water, food and dust, so it’s likely almost everyone has been exposed. And human exposure, through food and water, will probably increase in tandem with growing use of the weed killer, according to a published in the journal Environmental Sciences Europe.

But little is known about the magnitude of human exposure, because food and water are not regularly tested for glyphosate residue. However, a few years ago, researchers the urine of a small group of people across the United States and found glyphosate residue in 93% of them.

Curl said she is launching a project that will compare the exposure of pregnant women who live in farm areas and non-farm areas, then introduce organic diets to try to tease out how much of the glyphosate comes from food.

Q: What do we really know about the human health risks of glyphosate?Ìý

For decades, it was thought that glyphosate posed a risk only to plants, not people. That’s because it inhibits an enzyme that humans don’t even have.

Its possible link to cancer has prompted a blizzard of claims and counterclaims over the past several years, and major public health agencies disagree about it. The World Health Organization’s International Agency for Research on Cancer has called glyphosate a “probable human carcinogen,” and in 2017, the state of California added it to its .

The Environmental Protection Agency, however, decided in late 2017 that glyphosate was to cause cancer in humans.

But evidence is mounting that people who are heavily exposed to it — farmworkers and landscapers, for example — have an increased risk of non-Hodgkin lymphoma.

A led by University of Washington scientists published in February found that agricultural workers who used a lot of glyphosate had a 41% higher risk of contracting non-Hodgkin lymphoma over their lifetimes than people who used it infrequently or not at all.

On average, about 2 out of every 100 Americans develop non-Hodgkin lymphoma. For people who are highly exposed to glyphosate, the disease rate jumps to 2.8 per 100. That means they still have a relatively small chance of contracting the disease, but their risk is substantially higher because of glyphosate use.

Monsanto has submitted more than 800 studies to the EPA and European regulatory agencies suggesting that glyphosate is safe, according to Bayer.

Q: What about the risks to the rest of us, who only occasionally use glyphosate — and only on a small scale?

No one knows.

“The data is really starting to suggest that there is a correlation between high glyphosate exposure and non-Hodgkin lymphoma,” said Curl. “But we have a lot of unanswered questions about the rest of us. We don’t know what that means for people who don’t have high exposures, and we don’t know what it means with a chemical that is so widely used.”

Q: Should people still use glyphosate at home, or are there safer substitutes?

All chemical pesticides are toxic. Some gardeners have limited success using .

The best non-toxic solution for killing weeds is good old elbow grease: Get a trowel and dig them out.

“From a personal perspective, I prefer to use caution and avoid pesticides in my own garden,” said Rachel Shaffer, a Ph.D. student at the University of Washington’s School of Public Health and co-author of the university’s study on glyphosate and non-Hodgkin lymphoma.

“Our understanding of the health effects of glyphosate will continue to evolve as the science advances,” said Shaffer, who . “Individuals who are particularly concerned in the interim may want to take steps to reduce use in their home gardens.”

Q: If I use glyphosate products, what precautions should I take?

Carefully follow label instructions and warnings. Wear gloves and don’t let the chemical come in contact with your skin, clothing or eyes. Use it only on calm, rain-free days to prevent drift. Do not let it run off into waterways or gutters. Pets and people should wait until treated areas are dry before entering them.

This story was produced byÌý, which publishesÌý, an editorially independent service of theÌý.

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).