Tag Archives: cdc

The GOP Health Bill Would Make Zika the Newest Preexisting Condition

Mother Jones

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The controversial GOP health care bill that narrowly passed the House of Representatives this month could have devastating consequences for mothers and children infected with Zika, experts say. The mosquito-borne virus is just one on a nearly endless list of preexisting medical conditions—cancer, asthma, pregnancy—for which insurers could potentially charge higher premiums if Republicans get their way.

One of the most popular features of Obamacare is a provision known as “community rating,” which bars insurance from charging more for people with preexisting conditions. This was a common practice before Obamacare was enacted in 2010; stories of sick people being unable to find affordable coverage were one of the main arguments used by the legislation’s supporters. Of course, the public health crisis surrounding Zika—and the birth defects it can cause—wasn’t an issue at the time; no one in the United States had yet contracted the virus. But if the House’s Obamacare repeal bill becomes law, people with Zika could end up paying far more for their health care—and could even end up priced out of insurance entirely.

Multiple health care experts told Mother Jones that the GOP bill would almost certainly mean a host of insurance problems for both pregnant women who have had Zika and infants born with microcephaly, a condition where a child has a smaller brain and other health defects. Zika can cause a host of other birth defects and in rare cases has been linked to Guillain-Barré syndrome, which can cause temporary paralysis in adults. What’s more, the GOP bill cuts funding to the Centers for Disease Control and Prevention, the agency on the front lines of the battle against the disease.

The Republican bill includes an amendment that allows states to opt out of the Obamacare community rating protection. Under the GOP plan, if a person’s health coverage were to lapse longer than 63 days in a state that opts out, that person could be charged a prohibitive cost on the private market. Short lapses in coverage are incredibly common. The Kaiser Family Foundation estimates that 27.4 million nonelderly adults had a several-month gap in coverage in 2015. For the 6.3 million of these adults who have preexisting conditions, the costs could be significant. The liberal Center for American Progress estimated that under the GOP bill, people with even mild preexisting conditions would pay thousands more per year—a 40-year-old, for example, would likely be charged an extra $4,340 in premiums if she had asthma, or $17,320 extra if she were pregnant.

Zika was first identified in 1947 in Uganda. It didn’t emerge in Brazil until 2015, when researchers began to notice the link to a spike in birth defects. Since then, mosquitoes carrying the Zika virus have been found in almost every country in the Western Hemisphere. Zika is particularly prevalent in Latin American, but it has also appeared in the United States. There have been more than 30,000 cases confirmed in Puerto Rico, including 3,300 pregnant woman, and more than 1,000 cases in Florida. The spread of Zika has varied wildly from year to year, with cases this year down sharply from 2016.

Yet our understanding of the Zika virus and its related health problems is still evolving. In most people, the virus shows no visible symptoms or just mild problems such as aches and a fever. But it does raise the risk of microcephaly, a rare brain defect in which a child develops with an abnormally small head and brain. Microcephaly is incredibly rare in a normal pregnancy, but a Zika infection in the first trimester raises the risk to 1 to 13 percent.

Zika is linked to various health problems in infants, but microcephaly itself is an expensive medical condition. The CDC estimates it would cost an additional $1 million to $10 million in medical care over the child’s lifetime. Zika-associated microcephaly would probably cost somewhere in the tens or hundreds of thousands of dollars per year in premium surcharges, according to the Center for American Progress health policy team.

Experts say that, under the Republican plan, insurers would almost certainly treat Zika as a reason to charge higher premiums.

“If it’s documented in your medical records that you had this infection and you have it now, they might well act on it,” Karen Pollitz, a senior fellow at the Kaiser Family Foundation, told Mother Jones. And if an infant was born with microcephaly, Pollitz added, “you’d have to be very careful as the parent of a child to never have a break in coverage.” Pollitz also added that the total number of Zika cases is small, but the issue could come up in medical records and be cause for insurers to “jump on that and possibly charge you a higher premium.”

In other words, insurers would be tempted to charge more based on the expensive medical costs sometimes associated with Zika, and there would be nothing preventing them from doing it. “There’s no rule about what can or cannot qualify” as a preexisting condition, New York University health care expert Sherry Glied said in an email, “and Zika will certainly raise later costs, so would count.”

David Anderson, a Duke University health policy researcher who has worked in the health insurance industry, added that another part of the GOP’s health bill—massive cuts to Medicaid spending—would add more strain to state budgets in the case of a Zika outbreak. The bill reduces Medicaid expenditures by $834 billion over the next decade, according to an analysis by the nonpartisan Congressional Budget Office. Trump’s 2018 budget released Tuesday proposes even deeper cuts than the GOP bill. If passed, the budget would reduce Medicaid spending by $1.4 trillion over 10 years.

Anything affecting babies is a big deal for Medicaid, which covers nearly half of all births in the United States. That would cause a significant problem if Zika leads to an unexpected spike in microcephaly. “If it’s not that common, states can handle one or two isolated events,” Anderson says. “If it’s very common and there are hundreds of babies born with microcephaly under high-cost conditions, then states can’t handle it.”

The House bill would have other impacts on Zika prevention efforts. It cuts nearly $1 billion from the CDC’s budget. The CDC funds testing and research and deploys emergency teams to provide extra medical assistance and to control the spread of Zika-infected mosquitoes. The CDC fights Zika by monitoring mosquitoes that transmit the virus, and it collects data about how Zika affects pregnancies. Trump’s budget doesn’t help the situation either. Although it sets up a CDC emergency response fund to deal with outbreaks like Zika, the budget weakens prevention efforts by seeking a 17 percent cut to the CDC and an 18 percent cut to the National Institutes of Health.

The confluence of Zika and the GOP health care bill could have political consequences in places like Florida, where the virus has already proved to be a potent electoral issue. Two South Florida congressmen—GOP Reps. Carlos Curbelo and Mario Diaz-Balart—championed a bill last year that sent $1.1 billion to the CDC and the NIH to combat Zika. Both also voted for the Obamacare repeal bill. Neither of their offices responded to requests for comment.

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The GOP Health Bill Would Make Zika the Newest Preexisting Condition

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Use Your Seat Belt!

Mother Jones

And now, from the Department of Random Stuff, we have seat belt use in the 50 states. Christopher Ingraham writes about this today over at Wonkblog, and his map showed shockingly low seat belt use. There were quite a few areas with seat belt use around 50 percent, and more than half the country was under 70 percent. Can that be true?

To find out, I headed over to the Owellian-named Behavioral Risk Factor Surveillance System at the CDC and created my own map. Here it is:

This doesn’t look so bad. The Dakotas are laggards at 70 percent, but most of the country is between 75-90 percent, with 11 states over 90 percent. The national average is 86.4 percent. I sort of assumed that after all these years, seat belt use was pretty much automatic for nearly everyone, but I guess not. Especially in the Dakotas.

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Use Your Seat Belt!

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Uninsured Population Holding Steady at About 10%

Mother Jones

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The latest CDC numbers on the uninsured population are out, and as of September 2016 the number of uninsured in the US had dropped from about 17 percent before Obamacare to 10.3 percent. That continues to be below the original CBO estimate of 11 percent for the full year.

For all of Obamacare’s faults, this is a tremendous achievement at a surprisingly modest cost. It’s beyond belief that Republicans want to destroy it instead of making it better.

NOTE: As always, I’m using the CDC’s figures for the nonelderly population. This is because (a) this is what CBO used for its estimates, so I need to use comparable numbers, and (b) it’s the number we actually care about. The overall figure for all ages is currently 8.8 percent.

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Uninsured Population Holding Steady at About 10%

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Raw Data: If Obamacare Is Repealed, 17-37 Million People Will Lose Health Coverage

Mother Jones

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As Republicans merrily head down their stated path of repealing Obamacare without bothering to replace it, here are the latest CDC numbers on the uninsured:

Let’s put that into raw numbers. There are currently 273 million people in America under the age of 65. If we abolished Obamacare and returned to the 2013 percentage of uninsured, 17 million people would lose health coverage.

And that’s optimistic. If Republican recklessness caused the insurance industry to abandon the individual market altogether, the number of people who would lose coverage is somewhere in the range of 32-37 million. That’s about 22 million people who are currently in the non-group insurance market and another 10-15 million who benefited from Obamacare’s Medicaid expansion.

Repealing Obamacare makes a great campaign slogan, but now Republicans have to actually govern. Do they really want to be responsible for 17-37 million people losing health coverage? Really?

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Raw Data: If Obamacare Is Repealed, 17-37 Million People Will Lose Health Coverage

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Spraying Pesticides May Not Kill Zika Mosquitos

Mother Jones

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In Miami Beach, daily crowds have been gathering outside city hall to protest a program to spray a potent pesticide called naled, in an effort to combat mosquitos carrying the Zika virus. After delays, officials began periodic naled sprayings Friday morning at 5 a.m.

People are concerned about the spraying because like other organophosphates, naled is a neurotoxin, or a poison that works by attacking the nervous system. Even at tiny doses, naled kills adult Aedes mosquitos—which, in parts of Miami, including Miami Beach, are known to carry the Zika virus. In South Carolina last week, aerial spraying of naled inadvertently killed millions of bees.

The EPA reports that naled is regularly sprayed on 16 million acres of land in the mainland United States “as part of routine mosquito control,” including in “highly populated major metropolitan areas.” That’s a lot of land—California, for comparison, occupies 100 million acres.

Here’s what we know about naled, its toxicity to people and ecosystems, and its potential as a tool to limit the spread of Zika.

• Is naled spraying toxic to humans? The European Union banned naled in 2012, citing “potential and unacceptable risk showed for human health.” But the US Centers for Disease Control and Prevention and the Environmental Protection Agency disagree. The chemical is used at such a low rate as a mosquito spray—about two tablespoons for each area the size of a football field—that it “does not pose a health risk to people or pets in the area that is sprayed,” the CDC says. Also, “Naled starts to degrade (break down) immediately on surfaces, in water, and in sunlight,” the CDC adds, meaning it doesn’t linger after spraying.

I asked Dana Barr, a research professor at Emory who has done extensive research on the ill effects of organophosphate exposure on kids’ neural development, whether people should worry about health effects from spraying. “Likely the small amount sprayed won’t pose significant risk,” she said. Barr added, though, that people who live in sprayed areas “need to consider their exposures from other sources as well,” like through garden insecticides and residues on food. A 2015 study by University of Washington, Harvard, and University of Texas researchers found that people who eat organic food have significantly lower levels of organophosphate traces in their urine than people who don’t.

Barr added that infants and pregnant women are the most vulnerable to harm from organophosphate exposure, and should “take precautions to stay inside during spraying”—which won’t be too hard, since the spraying are scheduled for early mornings (5 a.m.).

• Is spraying naled effective at slowing the spread of mosquito-borne illnesses like Zika? This one is surprisingly hard to answer. The CDC stresses it’s just one part of an “integrated mosquito control program” that includes “eliminating mosquito habitats, such as discarded containers and rain gutters” and other actions. But the agency insists that spraying is the “one method that can rapidly reduce the number of mosquitoes spreading Zika in a large area,” like Miami beach.

In a recent editorial in the medical journal JAMA, CDC Director Tom Frieden wrote that a spraying program in New Orleans, similar to the current one in Miami Beach, had reduced both indoor and outdoor adult mosquito populations by 90 percent.

However, the New Orleans figure cited by Friedan comes from an informal study that never underwent peer review, and some experts are skeptical of it. The Aedes mosquito, the variety that hosts Zika and other nasty pathogens, tends to live indoors, making it a tough target for spraying. “I know of no published reports that support Friedan’s figure,” Yale University professor emeritus of microbial diseases Durland Fish told Kaiser Health News. He added: “This is a domestic mosquito, meaning they live inside the house—in closets, under the bed, in the sink. Spraying outside won’t be very effective.”

A recent news report by the University of Minnesota’s Center for Disease Research and Policy also casts doubt of the efficacy of spraying, echoing concerns raised by Fish.

Will the spraying kill other bugs? While Aedes mosquitos live mainly indoors, protected from pesticide droplets falling from the sky, other critters aren’t so lucky. The South Carolina incident demonstrated how vulnerable honeybees are to an ill-timed naled spraying.

And a Florida International University team has published three papers since 2011—in the journals Environmental Toxicology and Chemistry, Science of the Total Environment, Chemosphere—finding that butterflies are even more susceptible to naled than bees. South Florida’s butterfly populations have declined dramatically in recent years. The Florida International University research, funded by the US Fish and Wildlife Service, prompted South Florida officials to scale back routine naled spraying last year. Butterflies are a key part of the food chain, serving as prey for birds and bats; they’re also important pollinators.

When naled degrades, it turns into another potent organophosphate called dichlorvos, which in turn can linger in water, a 2014 study by University of California at Davis researchers found. Once there, it’s highly toxic to aquatic species at the “low end of the food chain,” including insects and frog larvae, one of the study’s authors, Bryn Phillips, recently told CNN.

So while people probably don’t have much to fear from naled spraying, bees and butterflies do. As for Zika-carrying mosquitos, the jury is still out.

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Spraying Pesticides May Not Kill Zika Mosquitos

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The Devastation of the Opioid Epidemic, in One Chart

Mother Jones

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The opioid epidemic in America is taking its toll on a class of victims who have received relatively little attention in the crisis: babies. The rate of babies born in drug withdrawal has quadrupled over a 15-year stretch, according to data released Thursday by the Centers for Disease Control and Prevention.

The report looked at the prevalence of babies born between 1999 and 2013 with neonatal abstinence syndrome (NAS), an illness caused by exposure in the womb to addictive drugs, primarily opioids—including heroin, methadone, and prescription painkillers such as oxycodone and hydrocodone (known by brand names OxyContin and Vicodin, respectively).

NAS isn’t known to have long-lasting effects, but babies going through it can suffer from tremors, seizures, gastrointestinal problems, and fevers. The increasing rates mirror the skyrocketing use of opioids across the country. In 2014, more than 47,000 Americans died from drug overdoses—a similar number to the fatalities during the HIV epidemic at its peak in the late 1980s and early 1990s. (According to the CDC, NAS can also be caused by non-opioid drugs such as cocaine, amphetamines, and barbiturates, but opioids are detected in the vast majority of cases.)

Only 28 states currently collect data on NAS, and some of those states have kept figures on the condition only for the past few years. But as the chart below shows, the number of babies born dependent on drugs varies drastically by state, with West Virginia, Vermont, and Maine showing the highest rates. That’s due in part to different use rates of opioids. West Virginia and Maine have some of the highest prescription opioid rates in the country, while Vermont is struggling with a spiraling heroin problem.

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In an attempt to curb the opioid crisis, the CDC released the first national standards for prescribing painkillers this spring. The recommendations, which are not binding, call for doctors to first try ibuprofen or aspirin to treat pain, limit short-term opioid treatment to three days, monitor patients’ drug use with regular urine tests and prescription tracking systems, and advise patients—particularly those who are pregnant—about the addictive effects.

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The Devastation of the Opioid Epidemic, in One Chart

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We Have Terrible News For Anyone Who Eats Chicken

Mother Jones

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One of the US Department of Agriculture’s main tasks is to ensure that the nation’s meat supply is safe. But according to a new peer-reviewed study from the department’s own researchers, the USDA’s process for monitoring salmonella contamination on chicken—by far the most-consumed US meat—may be flawed.

The process works like this: After birds are slaughtered, plucked, and eviscerated, the carcasses are sprayed with a variety of antimicrobial chemicals designed to kill pathogens like salmonella and campylobacter, and then plunged into a cold bath (which also includes antimicrobial chemicals) to lower their temperature. At that point, a few of the birds are randomly selected, rinsed, removed from the line, and put into plastic bags filled with a liquid that collects any remaining pathogens. The liquid is then sent to a lab for testing within 24 hours. (The test birds go back into the production line.) If a large number of them test positive for salmonella, the USDA knows there’s a problem and takes steps to address it.

According to the USDA’s Food Safety and Inspection Service (FSIS), which oversees safety protocols in the nation’s slaughterhouses, the salmonella system works great. The agency’s latest numbers show a steadily falling incidence of positive tests for salmonella on chicken carcasses: just 3.9 percent in 2013, down from 7.2 percent in 2009.

But a new study by scientists at the USDA’s Agricultural Research Service (ARS) paints a less rosy picture. The researchers simulated the FSIS’s method for testing collecting pathogens from chicken carcasses, and found it can turn up negative results even when salmonella is present.

Here’s why: When those birds are plucked off the line for testing, they’ve just been bombarded with antimicrobial chemicals, and traces of those chemicals can collect in the testing bags along with remaining microbes. In order for tests to be accurate, the germ-killing chemicals have to be quickly neutralized by the testing liquid. If they’re not, they can keep killing bacteria and, as the study puts it, “lead to false-negative results due to sanitizer carryover into the carcass.” And that’s exactly what happened in the simulation the researchers conducted. The authors concluded that their study “suggests that current procedures for the isolation and identification of Salmonella on poultry carcasses may need modification.”

But the FSIS disagrees with this conclusion. “FSIS is confident that our testing results yield accurate outcomes,” an agency spokesman wrote in an email. He emphasized that the ARS study was a simulation, and “did not evaluate the same practices as our in-plant personnel utilize.”

Salmonella poisoning remains a huge problem. Starting in March 2013, a salmonella outbreak traced back to chicken sickened more than 600 people in 29 states, 38 percent of whom had to be hospitalized. And—unlike the FSIS’s tests for salmonella on chicken carcasses—salmonella poisoning rates have not shown any steady decline pattern over the past 15 years. Here’s a chart from the Centers for Disease Control and Prevention:

Chart: Centers for Disease Control

Not all of those infections come from contaminated chicken, of course. The CDC doesn’t break down salmonella poisoning by food source, and doing so is tricky, said Mansour Samadpour, a food safety expert and chief executive of IEH Laboratories and Consulting Group. Most chicken-related salmonella infections come from not from eating undercooked meat, but rather from cross-contamination, he said—like cutting vegetables for a salad with the same knife used to slice raw chicken. As a result, the source of a given salmonella-triggered food poisoning is hard to trace. But chicken is the “item in the supermarket most likely to be contaminated with salmonella,” he said.

And also, while the FSIS’s numbers show impressively low rates of salmonella on chicken carcasses from its carcass testing—3.9 percent in 2013, 4.3 percent in 2012—other numbers from the agency suggest the problem may be worse. In another report, based on tests conducted in 2012, the FSIS gathered chicken samples from the very end of production lines, after they’d been cut into parts, the way consumers typically buy them. They found a positive rate for salmonella of 26.2 percent—about six times the rate found the same year on the FSIS’s testing of carcasses.

For Samadpour, that huge discrepancy suggests that the carcass testing may indeed be generating lots of false negatives. That means consumers could be being exposed to salmonella-contaminated chicken at much higher rates than the FSIS’s carcass numbers suggest.

The solution is pretty clear, Samadpour told me. Instead of testing whole carcasses just after they’ve been bathed in antimicrobials, while they’re still in the middle of the processing line, the tests should happen at the end of the processing line, when the carcasses have been cut up and are ready for packaging. He said Big Chicken could learn something from the beef industry, which began testing its finished products in that manner for a virulent E. coli strain called O157:H7 in the 1990s: Rates of poisoning from that often-deadly bacteria have plunged since.

In the meantime, I’m taking extra care when prepping chicken. Here‘s how the CDC says consumers should handle it.

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We Have Terrible News For Anyone Who Eats Chicken

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Childhood Obesity Is Still Going Up, Up, Up

Mother Jones

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Hey, do you remember that breathless CDC study from a couple of years ago showing a dramatic drop in obesity among 2-5-year-olds? I was pretty skeptical about it, and today I learn that I was right to be. I basically figured that it was a noisy sample that didn’t make sense, but according to a new look at the data it’s worse than that: the data is noisy, and that allowed the CDC researchers to cherry pick a starting point that made it look like there was a huge drop.

Roberto Ferdman provides a new chart based on the new study. Take a look. If you start in 2003, as the CDC study did, it looks like there’s a big drop. The prevalence of obesity among girls goes down 2.1 percentage points, and among boys it goes down a whopping 6.1 percentage points.

But if you include data going back to 1999, which is the true beginning of this data series, the improvement is distinctly more modest: a drop of 1.1 percentage points for girls and 1.7 percentage points for boys. And those drops aren’t even statistically significant.

The original study was always suspect because the alleged drop for 2-5-year-olds wasn’t matched in any other age group. And sure enough, a fresh look at the rest of the data continues to show rising obesity for every other age group. Suddenly the results for 2-5-year-olds look perfectly in sync.

It’s one thing if this newer study shows different results because it includes 2013-14 data. But deliberately excluding the starting point of the data series is the real culprit, and that’s inexcusable. The authors of the original study have some explaining to do.

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Childhood Obesity Is Still Going Up, Up, Up

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The Uninsured Rate Just Keeps Going Down, Down, Down

Mother Jones

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I’m back. I’ve now done my civic duty yet again, so I’m safe until the next time the Orange County justice system wants me to sit around all day and curse at unreliable Wi-Fi coverage. Oddly, their Wi-Fi is worse than it was the last time I was there, three or four years ago. I think they’ve outsourced it since then. On the bright side, this time around I could provide my own internet connection, so I don’t care that much. Plus, since I never get actually called for a jury these days, I’ve once again preserved my record of being foreman on 100 percent of the juries I’ve ever sat on.

As your reward for waiting around all day for me, here’s the latest CDC data on the uninsured rate. Being the big government agency they are, they’re just getting around to crunching the numbers for the second quarter, and they report that Obamacare has driven the uninsured rate down yet again, to 10.3 percent.1 Not bad for a program that, I’m told, is in a death spiral and will implode any second now.

1Gallup says the uninsured rate in the second quarter was 11.4 percent. The difference comes from who they count. Gallup counts everyone over 18. CDC counts everyone under age 65.

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The Uninsured Rate Just Keeps Going Down, Down, Down

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Heroin’s Death Toll Reaches Another Gruesome Landmark

Mother Jones

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For the first time in Virginia’s history, more people died last year from overdoses on heroin and prescription opioids than from automobile accidents. The state joins 35 others that have seen heroin and opioid deaths eclipse traffic deaths, in an alarming trend that has begun to draw attention on the presidential campaign trail.

In 2014, 728 people succumbed to heroin or opioid-related overdoses, compared to 700 people who died in car crashes. A year earlier, the statistical comparison was flipped, with the highway death toll in Virginia at 741, compared to 661 deaths from drug overdoses. The year before that, in 2012, the numbers were even more skewed toward automobile accidents, as 750 traffic deaths trumped the 504 drug overdoses in the state.

As the rate of traffic deaths drops—those 700 deaths are the fewest in a decade—the heroin overdose rate continues to climb. According to the office of Virginia Attorney General Mark Herring, fatal heroin and prescription drug overdoses have increased by 57% in the last five years alone.

“This heroin and prescription drug epidemic is a public health issue, a public safety and law enforcement issue, and most importantly, it’s a family issue,” Herring’s office stated in a press release last week. “The rising and tragic death toll adds a dose of reality and a sense of urgency to our efforts and those of our local, state and federal partners.”

The rise in fatal overdoses is not limited to Virginia. In 36 states and Washington, DC, more people are dying from drug overdoses than from traffic incidents. According to the nonprofit Trust for America’s Health, more than 2 million Americans abuse prescription drugs, and the number of new heroin users has doubled in the past seven years. As opiates prescribed by physicians have become more expensive, people have turned to heroin, a cheaper option with similar effects. The Center for Disease Control reports that heroin deaths quadrupled between 2000 and 2013.

“They are addicted to prescription opiates because they are essentially the same chemical with the same effect on the brain as heroin,” CDC director Frieden said at a press conference in July. “Heroin costs roughly 5 times less than prescription opiates on the street.”

Although heroin and opioid deaths are climbing at an alarming rate, less than one percent of the US population abuses heroin, according to the CDC. That figure, however, does not include people in the military, homeless people, or prison inmates, so the true number may be higher.

Presidential candidates have had to field questions about the growing trend while on the campaign trail. At an August public forum in New Hampshire, Democratic front-runner Hillary Clinton expressed surprise at the prevalence of the problem.

“I have to confess—I was surprised,” Clinton said. “I did not expect that I would hear about drug abuse and substance abuse and other such challenges everywhere I went.”

In May, New Jersey Gov. Chris Christie signed a bill designed to stymie substance abuse, and a week later expressed his frustration at what he considered a correctable issue. “This is a treatable problem,” Christie said. “And we need to be talking about it and treating it like an illness, and not like some moral failure.”

Former Hewlett-Packard CEO Carly Fiorina, whose daughter died in 2009 after years of drug and alcohol abuse, argued against imprisoning people for their drug problems. “Drug addition shouldn’t be criminalized,” Fiorina told a group of reporters during a conference call in May. “We need to treat it appropriately.”

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Heroin’s Death Toll Reaches Another Gruesome Landmark

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