Update: opioid epidemic. In October 2017, President Trump declared the opioid epidemic to be a national emergency and directed executive agencies to fight the crisis. The latest data from the National Center for Health Statistics underscore the need for this call to action. Deaths from opioid overdose, prescription or illicit, have continued to rise, from more than 42,000 in 2016 to more than 49,000 in 2017-a fourfold increase since 2002. The U.S. Senate weighed in last September, voting to support the Opioid Crisis Response Act (OCRA) of 2018. OCRA directs federal agencies to work with state and local governments to reduce supplies of legal and illicit opioids and enhance prevention and recovery efforts. But the legislation provides little additional funding for such interventions. The opioid epidemic, moreover, isn't solely a problem of excessive drug supply and inadequate treatment options. Research shows opioid use and addiction to be closely intertwined with economic hardship, lack of opportunity, social isolation, and traumatic life events. Also influential is obesity that leads to disability and chronic pain. These underlying factors argue strongly for interventions that address the structural issues driving the epidemic.

Drug shortages. In 2018, hospital pharmacists saw shortages of as many as 238 drugs on a given day, including a wide variety of everyday medical products such as iv solutions, pain killers, anesthetics, antibiotics, and chemotherapies. Although a continuing problem, drug shortages are down from their peak in 2012, partly due to legislation requiring manufacturers to give advance warning to the Food and Drug Administration of any production issues likely to result in reduced supply. A variety of factors contribute to drug shortages, including manufacturing problems, regulatory issues, business incentives, difficulties in acquiring raw materials, and other supply-chain disturbances. Current shortages, for example, are partly due to damage to production facilities in Puerto Rico caused by hurricanes Irma and Maria in 2017. A recent survey of hospital pharmacy directors and pharmacists revealed that most were affected by at least one drug shortage daily. Of nearly 300 respondents, a majority said the shortages compromised patient outcomes or delayed treatment.

Immigrant access to health care. While newly arrived immigrants are sometimes faulted for the nation's spiraling health care costs, a study in the August 8 International Journal of Health Services shows that immigrants utilize fewer health care services and pay more out of pocket than U.S.-born residents. Immigrant access to health care is limited by exclusion from government programs, language barriers, difficulty navigating the U.S. health care system, and employment in low-level jobs that don't provide insurance.

Undocumented immigrants face the greatest barriers: data suggest that some avoid public health services out of fear of deportation, encounters with Immigration and Customs Enforcement agents, and negative attitudes toward immigrants. Discouraging care to this population can have negative effects on community disease control as well as overuse of costly emergency care.-Joan Zolot, PA