Trump Administration Is In Court To Block Nation’s First Supervised Injection Site

Supporters of safe injection sites in Philadelphia rallied outside this week’s federal hearing. The judge’s ultimate ruling will determine if the proposed “Safehouse” facility to prevent deaths from opioid overdose would violate the federal Controlled Substances Act.
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Philadelphia could become the first U.S. city to offer opioid users a place to inject drugs under medical supervision. But lawyers for the Trump administration are trying to block the effort, citing a 1980s-era law known as “the crack house statute.”
Justice Department lawyers argued in federal court Thursday against Safehouse, the nonprofit organization that wants to open the site.
U.S. Attorney William McSwain, in a rare move, argued the case himself. He says Safehouse’s intended activities would clearly violate a portion of the federal Controlled Substances Act that makes it illegal to manage any place for the purpose of unlawfully using a controlled substance. The statute was added to the broader legislation in the mid-1980s at the height of the crack cocaine epidemic in American cities.
Safehouse argues the law does not apply because the nonprofit’s main purpose is saving lives, not providing illegal drugs. Its board members say that the “crack house statute” was not designed to be applied in the face of a public health emergency.
“Do you think that Congress would want to send volunteer nurses and doctors to prison?” asked former Philadelphia Mayor and Pennsylvania Governor Ed Rendell, who is on Safehouse’s board, after the hearing. “Do you think that’s a legitimate result of this statute? Of course not. No one could have ever contemplated that, ever!”
Safehouse earned the backing of Philadelphia’s mayor, health department, and district attorney, who announced they would support a supervised injection site in January 2018 as another tool to combat the city’s dire overdose crisis.
More than 1,100 people died of overdoses in Philadelphia in 2018 — an average of three people a day. That’s triple the city’s homicide rate.
In response, public health advocates and medical professionals teamed up with the operators of the city’s only syringe exchange to found Safehouse. They created a plan for its operations, and began scouting a location.
But the Trump Administration sued the nonprofit in February to block the supervised injection site from opening.
In June, the Justice Department filed a motion for judgment on the pleadings– essentially asking the judge to rule on the case based on the arguments that had already been submitted. Since then, a range of parties have filed amicus briefs in support of or in opposition to the site. Attorneys general, mayors, and governors from across the country filed briefs backing Safehouse, while several neighborhood associations in Kensington and the police union filed against it.
U.S. District Judge Gerald McHugh requested an evidentiary hearing to learn more about the nuts and bolts of how the facility would work, were it to open. At that hearing, in August, Safehouse’s legal team, led by Ilana H. Eisenstein, explained that Safehouse would not provide drugs, but that people could bring their own to inject while medical professionals stood by with naloxone, the overdose reversal drug. They said Safehouse would also be an opportunity for people to get access to treatment, if they were ready to commit to that.
Safehouse vice president Ronda Goldfein said the only difference between what Safehouse would do — and what’s already happening at federally sanctioned needle exchanges and the city’s emergency departments — is permit drug injection to happen in a safe, comfortable place.
“If the law allows for the provision of clean equipment, and the law allows for the provision of naloxone to save your life, does the law really not allow you to provide support in that thin sliver in between those federal[ly] permissible activities?” she said.
McSwain contends operating in that “sliver” is exactly what makes Safehouse illegal.
Much of the debate at Thursday’s hearing revolved around interpreting the word “purpose.” The statute in the Controlled Substances Act makes it illegal for anyone to “knowingly open … use or maintain any place … for the purpose of … using any controlled substance.”
The federal government says it’s simple: Safehouse’s purpose is for people to use drugs. McSwain conceded the facility will also provide access to treatment, but so does Prevention Point, the city’s only syringe exchange. Effectively, he argued, the only difference between Safehouse and what’s already going on elsewhere would be that people could inject drugs at Safehouse, which is prohibited by the statute.
“If this opens up, the whole point of it existing is for addicts to come and use drugs,” McSwain said.
Safehouse said its purpose is to keep people at risk of overdose from dying.
“I dispute the idea that we’re inviting people for drug use,” Eisenstein argued.
“We’re inviting people to stay to be proximal to medical support.”
McSwain conceded that if Safehouse were to offer the medical support without opening up a space specifically for people to use drugs, the statute would not apply.
Philadelphia Mayor Jim Kenney spoke Thursday in support of the Safehouse injection site to reduce the number of deadly overdoses in Philadelphia. More than 1,100 people died of overdoses in the city in 2018 — an average of three people a day.
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Kimberly Paynter/WHYY
“If Safehouse pulled an emergency truck up to the park where people are shooting up, I don’t think [the statute] would reach that. If they had people come into the unit, that would be different,” he said. Mobile units and tents in parks are supervised injection models that other cities like Montreal and Vancouver have implemented.
Safehouse has also said it hasn’t ruled out the idea that it might incorporate a supervised injection site into another medical facility or community center, which would indisputably have other purposes, as well.
McSwain ultimately argued that Safehouse had come to the “steps of the wrong institution,” and that if it wanted to change the law, it should appeal to Congress. He accused Safehouse’s board of hubris, pointing to Safehouse president Jose Benitez‘s testimony at the August hearing, where he acknowledged that they hadn’t tried to open a site until now because they feared the federal government would think it was illegal and might shut it down.
“What’s changed?” asked McSwain. “Safehouse just got to the point where they thought they knew better.”
“Either that, or it’s the death toll,” Judge McHugh replied.
Supervised injection sites are used widely in Canada and Europe, and studies have shown that they can reduce overdose deaths and instances of injection-related diseases like HIV and hepatitis C. San Francisco, Seattle, New York City, Ithaca, N.Y., and Pittsburgh, Pa., among other U.S. cities, have expressed interest in opening a similar site, and are watching the Philadelphia case closely. In 2016, a nonprofit in Boston opened a room where people can go after injecting drugs, to ride out their high. The room has nurses equipped with naloxone standing by.
The Justice Department’s motion for the judge to rule on the pleadings is still pending. McHugh could decide he now has enough information to issue a ruling, or he might request more hearings, arguments or a full fledged trial.
Safehouse’s legal team said this week that if the judge rules in its favor, it might request a preliminary injunction in the form of relief — to allow the facility to open early.
“We recognize there’s a crisis here,” said Safehouse’s Goldfien. “The goal would be to open as soon as possible.”
This story is part of NPR‘s reporting partnership with WHYY and Kaiser Health News.
This story is part of NPR’s reporting partnership with WHYY and Kaiser Health News.
Why Apple Is Entering The Crowded Credit Card Field
NPR’s Mary Louise Kelly speaks with Ted Rossman, industry analyst at CreditCards.com, about whether Apple’s new credit card is disrupting the industry.
MARY LOUISE KELLY, HOST:
The new titanium Apple credit card launched last month. It certainly looks different from the cards you’ve already got in your wallet – sleek, all white, no number on it and so delicate that the company warns you have to be careful how you store it so it doesn’t get stained. But there’s more to distinguish this card than just looks. And that’s what we’re going to consider on this week’s All Tech Considered.
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KELLY: We’re joined now by Ted Rossman. He’s an industry analyst at creditcards.com and he is on the record as being officially underwhelmed by this card.
Ted Rossman, welcome.
TED ROSSMAN: Thanks for having me.
KELLY: So how is the Apple Card different from any other credit card?
ROSSMAN: When it comes to the key aspects, like rewards, interest rates, fees, we’ve seen it all before. When I said I was underwhelmed, I was specifically referring to the rewards. That’s a huge thing for the 40% of cardholders who can pay their bills in full. We all love cash back, airline miles. This card lags most rewards cards. For the most part, this is something that’s appealing to Apple fanatics. It’s not a groundbreaking card.
KELLY: So you think people who may be attracted to this card are going to be people who liked Apple anyway and want to have an Apple Card in their wallet.
ROSSMAN: Yes. I think for the Apple fanatic, there is a definite desired market there. My thinking on this card has also evolved a little bit in that they’re approving a lot more people with subprime credit scores than I expected. And I think when you look at this card through that lens, the rewards start to look more attractive because, generally, you can’t get a good rewards credit card if you’re FICO score is below, let’s say, 670. But Apple is really dipping into the low 600s, even the 500s in some cases. So if you have spotty credit because of a blemish in the past or if you’re a young adult or an immigrant who’s new to credit, then this card starts to look more attractive.
KELLY: I’ll also put on the table what Apple says should be a selling point for this card. They say that it’s got way better privacy and security features than some other credit cards. Fact-check that for me. Does it?
ROSSMAN: That’s true. This card is more secure for a few reasons. One is that the card number and the expiration date and the card verification value, they’re not even printed on the physical card.
KELLY: Right.
ROSSMAN: That’s really unique. To get this card online, you need to also have the phone. That’s how you’re going to buy something from a website. You’re going to have to look in the Wallet app on your iPhone and find the number and the expiration date there. That’s secure. They’re also pushing privacy in another way, which is Apple and Goldman are not going to share or sell your purchase information, which is pretty unique in the credit card world.
KELLY: You mentioned Goldman. What’s their stake in this?
ROSSMAN: Goldman Sachs is the card issuer. They’re the bank, you know, behind the card. It’s their first consumer credit card, which is notable. I actually think it’s going to be even harder for them to make money with this because the card’s advertising no fees. They’re advertising lower interest rates. And they’re really encouraging you to pay as much as possible through these budgeting tools they have in their app. So I think for Goldman, it’s going to be a tough sell to make money. For Apple, I think they’re less in it for the revenue and more in it for the long game of getting more people loyal to their phones, getting more people using Apple Pay. I think they’re trying to play this long game to get deeper into our financial lives.
KELLY: That’s Ted Rossman, industry analyst at creditcards.com, talking about the new Apple credit card.
Ted Rossman, thanks.
ROSSMAN: Thank you.
Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.
NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.
The Thistle & Shamrock: The Lost Songs Of St. Kilda
Barrule
Phil Kneen/Courtesy of the artist
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Phil Kneen/Courtesy of the artist
Hear the haunting melodies from St. Kilda that offer a last link to the “island on the edge of the world,” with Julie Fowlis and Barrule.
NPR Names Veteran Media Executive John Lansing As Its New CEO

John Lansing, the chief executive officer and director of the U.S. Agency for Global Media, will become NPR’s CEO in mid-October.
U.S. Agency for Global Media
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U.S. Agency for Global Media
NPR has a new CEO. John Lansing, a veteran government broadcast and cable television executive, has been selected by NPR’s corporate board to succeed its current chief, Jarl Mohn.
Lansing, who is 62, is currently the chief executive of the government agency that oversees Voice of America, Radio and Television Martí and Radio Free Europe/Radio Liberty, among others. He made his mark in his current job with stirring defenses of journalism, free from government interference.
Lansing will start in his new position in mid-October. He will be the 11th permanent president or chief executive in the radio network’s nearly 50-year history.
In an interview, Lansing said he wants to build on NPR’s successes in broadcast news and entertainment to become even more dominant in podcasting and more prevalent in streaming.
“When I think of NPR and I think of the member stations collectively, I think really of journalism as a public service, not tied to a profit motive,” Lansing told NPR News. He defined NPR’s mission as “serving the public with information and an excellence and quality about it that makes it ‘must see’ on a variety of platforms.”
A number of executives will report directly to Lansing, including Nancy Barnes, senior vice president for news and editorial director, who joined NPR last November and oversees the network’s newsroom.
Four years ago, Lansing was named by President Barack Obama to be the first chief executive of the broadcasting outfit that was renamed the U.S. Agency for Global Media. Lansing has won plaudits from journalists for his rousing defense of a free press even while serving in the Trump administration, which has been notably hostile to traditional notions of the role of journalism in civic life.
He took over a troubled organization beset by infighting and bureaucratic inefficiency. He is credited with restoring morale, in part by naming a noted journalist as head of the Voice of America: Amanda Bennett is a former top news executive at the Philadelphia Inquirer who previously held senior newsroom jobs at Bloomberg News and The Wall Street Journal.
Lansing said he took pride in maintaining conventional broadcasts while appealing to new audiences, reaching about 25% more people each week.
“What you really want to do is be connected to people that are consuming content on something they’re holding in their hand, and aren’t necessarily tied to a TV set on a wall or a radio in a living room,” Lansing said. “Your mobility becomes extremely important to be involved and connected to audiences that are mobile and that tend to be, frankly, younger and, as we think of it at USAGM, future leaders, who can influence the rise of free and open societies.”
Lansing’s tenure at the agency has not been without controversy.
He held off a push by House Republicans to spin off Voice of America into a nongovernmental broadcaster. Lansing also elevated to chief strategy officer a former U.S. State Department staffer who recently pleaded guilty to having defrauded the U.S. Agency for Global Media out of more than $40,000 in government money in 2018, according to federal prosecutors.
Lansing says the agency referred Haroon Ullah’s expenditures to auditors and investigators after travel assistants flagged them; according to the Justice Department statement, Ullah admitted submitting fraudulent receipts for hotel room reimbursements and fake medical claims to get government payments of upgrades in airline seat assignments, among other offenses.
Lansing previously held positions overseeing the Scripps Co.’s local television stations and then its national cable channels, which include the Food Network and HGTV, among others. For two years, he served as the president and CEO of a cable trade group called the Cable and Telecommunications Association for Marketing.
He will now lead the nation’s top audio producer and broadcaster.
“In terms of mission, understanding of media, the depth of experience, his strategic leadership, his commitment to people and culture, I would say those were really the key things that we were looking for,” said Goli Sheikholeslami, vice chairwoman of the NPR board of directors and CEO of Chicago Public Media.
“The challenges he will face at NPR are not dissimilar to challenges across the media landscape as a whole,” said Sheikholeslami, who will soon take up the CEO job at New York Public Radio.
NPR stands stronger than it did at the outset of Mohn’s five-year term in 2014. The network had run deficits in six of the seven previous years; under Mohn, it has achieved a slight surplus for each year during his tenure, even as the annual budget grew by more than 40%.
NPR draws more than 28 million listeners each week and 40 million unique monthly visitors to its website — both represent a rise of several million over those five years. NPR has also been the nation’s leading producer of podcasts since Podtrac started measuring audiences. NPR maintains 17 national bureaus and 17 bureaus abroad. The network has won acclaim for its coverage of wars and disasters, yet suffered its own crisis and tragedy in 2016 when its David Gilkey and Zabihullah Tamanna were killed while on assignment in southern Afghanistan. Mohn placed an emphasis on fostering a more collaborative dynamic with the public radio stations that NPR serves and was given credit for making progress on that score.
Yet Lansing also takes over an institution riven by a scandal that hit its top reaches, with a chief news executive toppled over #MeToo complaints of inappropriate conduct toward female subordinates and colleagues. Mohn fired head of news Michael Oreskes on Halloween 2017. A later report commissioned by the NPR board found that questions had been raised about Oreskes’ behavior even before his hiring and that concerns were raised throughout his tenure; the repeated and formal warnings by top executives (including Mohn) to Oreskes to stop the unwanted attention he paid to female colleagues proved ineffective.
NPR’s president of operations, Loren Mayor, was the leading internal candidate for the chief executive position. While serving as chief operating officer, she took on a greater role during two of Mohn’s medical leaves and in the aftermath of the sexual harassment scandal. She also has led initiatives to reform hiring practices and to sweep far more temporary positions into permanent slots, often working closely with the network’s chief unions to do so.
Mayor is said to be staying on at the network as a top executive and deputy to Lansing, retaining the enhanced portfolio she took on after Mohn’s health crises. Both Lansing and Sheikholeslami say he is adamant about pressing forward with reforms to the workplace culture at NPR that Mayor has already started to put in place.
NPR faces financial pressures from two fronts.
The network’s fight for listeners’ time has become more feverish. Others have waded into the podcast fray with a vengeance. The streaming platform Spotify paid nearly a quarter-billion dollars to buy the podcast producer Gimlet, founded by former staffers of NPR and other public radio outlets. And The New York Times has won praise and new fans through its weekday podcast The Daily, with in-depth interviews of reporters and newsmakers.
The other is the fight for donors. Mohn had promised to attract major contributions to NPR before the end of his tenure; to date he has not landed the major eight- and nine-figure donations his stated aspirations suggested.
“Jarl would be the first to say that it is the area where he feels that his work was not complete,” Sheikholeslami said. “The combination of his health issues plus the situation with Mike Oreskes did derail his plans.”
That said, Mohn set higher annual expectations for the network in fundraising and agreed to be co-chairman of its 50th-anniversary capital campaign. He has previously announced he would be staying on as president emeritus to help the network raise major gifts, and along with his wife, Pamela Mohn, he personally committed $10 million to the network.
Unlike some predecessors, Lansing doesn’t face a particularly fraught political landscape. Government support for the public radio system isn’t in any immediate jeopardy. NPR takes only a few million dollars a year from federal sources for its programs. While member stations on average receive about 10% of their funding from the federal government, fees from the stations make up a significant part of the NPR budget.
Lansing has earned an advanced degree in political agility. At the U.S. Agency for Global Media, Lansing championed a free press even as leaders of many nations move against it.
“Governments around the world are increasingly cracking down on the free flow of information; silencing dialogue and dissent; and distorting reality,” Lansing said in a speech he delivered in May to the Media for Democracy Forum. “The result, I believe, is a war on truth.”
He continued: “Citizens in countries from Russia to China, from Iran to North Korea, have been victimized for decades. But now we’re seeing authoritarian regimes expanding around the globe, with media repression in places like Turkey and Venezuela, Cambodia and Vietnam.”
Trump has notably praised authoritarian figures, including the leaders of North Korea, the Philippines, Russia and Turkey and has waged his own fight against journalists.
While they do not broadcast within the U.S., the Voice of America and the other media outfits Lansing has overseen typically adhere to traditional concepts of factual, nonideological journalism, with the frequent exception of Radio Martí — historically an anti-Castro and anti-Cuban communist outlet. The roots of the VOA involved providing truthful reports to people under Nazi and Axis power rule during World War II. The varied broadcasters also offered jazz and other music to appeal to people under communist regimes using a soft form of diplomacy. Their editorial independence is enshrined in federal law, though it sometimes came under attack.
Now Lansing says he wants to draw on the intellectual and creative impulses of his new staffers as he leads a domestic journalistic powerhouse with an international reputation and reach.
“I want to hear the ideas that are bubbling underneath right now and what people are excited about, what they’re looking forward to developing,” Lansing said Thursday. “And I want to look for areas that I can provide leadership to bring resources together as needed strategically to find the right priorities that make the most sense for growing NPR this year and then into the future.“
Disclosure: This story was reported by NPR media correspondent David Folkenflik under guidance from NPR chief business editor Pallavi Gogoi. Under standard procedures for reporting on NPR matters, NPR’s corporate and news executives were not allowed to review the report until it was posted.
Women’s Soccer Stars Concerned About Trauma From Repetitive Head Impact
As research into head injuries expands to include women’s soccer, some of the sport’s former stars are calling attention to the health fallout from heading the ball multiple times.
MARY LOUISE KELLY, HOST:
With a new NFL season starting tonight, concerns about head injuries in football are expected to ramp up again, and now the discussion is expanding to women’s soccer. After the Women’s World Cup, researchers are preparing to study how a lifetime of head impacts could affect women, including heading the ball. NPR’s Tom Goldman reports.
TOM GOLDMAN, BYLINE: Using the head to redirect a soccer ball or to score a goal – that’s an integral part of the game, especially as players become more skilled. But in an era of increased concussion awareness, heading is fraught with potential risk, and the science exploring that risk hasn’t been inclusive.
ROBERT STERN: We really have needed to expand this research to include women.
GOLDMAN: Dr. Robert Stern studies chronic traumatic encephalopathy – that’s the degenerative brain disease known as CTE. He and others at Boston University have focused a lot of their attention on CTEs linked to head trauma in men who play tackle football. But next month he’ll start working with former female soccer players, some well-known, on a study called SHINE – it stands for soccer head impacts and neurological effects.
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UNIDENTIFIED ANNOUNCER: The shot saved, rebound – score. Michelle Akers’ first goal. And the U.S. goes on top, 1-0.
GOLDMAN: Former national team star Michelle Akers, now 53, was the catalyst for Stern’s study. She’s concerned about her peers and wonders whether certain mental lapses are early signs of soccer-induced brain problems, including CTE. Akers and former U.S. teammate Brandi Chastain spoke on CBS about their involvement in the study. Akers said she now regrets what she estimates to be at least 50 headers per game during her career.
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MICHELLE AKERS: I would not be heading a million balls like that. There is no way on earth I would do that again.
GOLDMAN: Robert Stern says prior research shows a relationship between the amount of heading and cognitive and even chemical changes in the brain, enough so that, in 2015, the U.S. Soccer Federation banned heading for kids 10 and younger.
DAN PINGREY: So how do we head the ball? We look with what?
UNIDENTIFIED CHILDREN: Our eyes.
PINGREY: OK?
GOLDMAN: Youth coach Dan Pingrey has led his Seattle United club team through its first year of heading. By the time they start playing games this fall, most of the girls will be 11, meaning no more ban. At a practice on the University of Washington campus, Pingree runs a refresher drill.
PINGREY: Upper body straight. Don’t bend your head. Nice and easy. Right to the forehead. Good. Don’t bend over, Ella. Don’t bend over, Ella.
GOLDMAN: What Pingrey doesn’t want to see is heads wobbling. Neurologists say girls can be more prone to concussion because they sometimes have weaker neck muscles that cause the head to flop and the brain to shake. Pingrey also trains his kids to keep their elbows out, creating a protective buffer to help prevent smacking skulls when someone else is flying in to head the same ball.
UNIDENTIFIED CHILD #1: Up.
UNIDENTIFIED CHILD #2: Ella.
UNIDENTIFIED CHILD #3: I got this.
GOLDMAN: Shahram Salemy daughter Hannah plays on the Seattle United team. He says the new study isn’t creating extra concern among parents. He hasn’t sensed the kind of concussion hysteria that’s gripped some parents of young boys playing football.
SHAHRAM SALEMY: I will say that I know parents who have kids that are older – they’re teenagers – and what I hear from them is more of a concern about ACL injuries and knee injuries more than head injuries. We just don’t see a whole lot of that at – maybe it’s just the age of the kids.
GOLDMAN: In 2017, research by the American Academy of Orthopedic Surgeons found high school soccer-playing girls did have a significantly higher rate of concussions, even more than boys who play football. The study points to headers as part of the problem. That’s where Dr. Stern now is turning his attention, with an open mind.
STERN: I’m one of the people who does the bulk of this research, and I’m not really sure exactly what leads to CTE and how it’s manifest and what the risk factors are.
GOLDMAN: But, Stern stresses, repetitive head impacts of any kind, even ones that don’t cause concussions, are not good. And he hopes the 20 women signed up for his soccer study will help science inch closer to understanding the risks of playing the games we love.
Tom Goldman, NPR News.
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Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.
NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.
Treatment Limitations For Physicians With Opioid Addictions
Opioid addiction can happen to anyone, and that includes doctors and nurses. But unlike the general population, they are often barred from medications like methadone, the gold standard of treatment.
MARY LOUISE KELLY, HOST:
When doctors and nurses become addicted to opioids and they get caught, they have to follow strict treatment guidelines to get their licenses back. Often that means they’re not allowed to use the so-called gold standard of treatment – medications such as methadone and Suboxone. NPR’s Selena Simmons-Duffin has more.
SELENA SIMMONS-DUFFIN, BYLINE: Here’s how this played out for Dr. Peter Grinspoon. He got addicted to Vicodin in med school and still had an opiate addiction five years into practice as a primary care physician. Then, back in February 2005, he got in trouble.
PETER GRINSPOON: In my addicted mind frame, I was writing prescriptions for a nanny who had since returned back to another country. And it didn’t take the pharmacist long to figure out that I was not a 19-year-old nanny from New Zealand.
SIMMONS-DUFFIN: One day during lunch, he says the state police and the DEA showed up at his medical office.
GRINSPOON: I start going, oh, I’m glad you’re here. You know, how can I help you? And they’re like, Doc, cut the crap. We know you’re writing bad scripts.
SIMMONS-DUFFIN: He was fingerprinted the next day, charged with three felony counts of fraudulently obtaining a controlled substance. And he got referred to his state’s physician health program or PHP. They work with state licensing boards. If you follow the treatment and monitoring plan they set up for you, they’ll recommend to the board that you get your medical license back.
GRINSPOON: The PHPs basically say, do whatever we say, or we won’t give you a letter that will help you get back to work. So they put a gun to your head.
SIMMONS-DUFFIN: And, Grinspoon says, they gave him very little choice. To avoid a criminal record, he needed to spend 90 days at an inpatient center in Virginia.
GRINSPOON: Why would you send this Jewish atheist to a Christian rehab place in Virginia? Didn’t make any sense. I was just sitting there listening to people recite the Lord’s Prayer and hold hands. They took me cold turkey off all my medications. It was completely insane.
SIMMONS-DUFFIN: He says medication-assisted treatment with Suboxone or methadone was off the table for him. Those medications are similar to opioids and work by suppressing cravings to the abused drug. Physician health programs, he says, effectively banned the use of these medications in the treatment plans they set up for physicians like him.
GRINSPOON: Why on earth would you deny physicians who are under so much stress and who have a higher access – they have free refills – and they have a higher addiction rate, why would you deny them the one life-saving treatment for this deadly disease that’s killing more people in this country every year than died in the entire Vietnam War?
SIMMONS-DUFFIN: Grinspoon recovered despite what he called several awful rehabs. Today, he’s a licensed primary care doctor and teaches at Harvard Medical School. He also wrote a book about his experience with addiction called “Free Refills.” Now, this was over a decade ago, but Dr. Sarah Wakeman – also at Harvard – says most physician health programs still don’t promote medication and treatment for addiction.
SARAH WAKEMAN: The sort of general standard of care is to send people to abstinence-based residential treatment programs that don’t offer medication treatment.
SIMMONS-DUFFIN: She just co-authored a piece in The New England Journal of Medicine which called this, quote, “bad medicine, bad policy and discriminatory.”
WAKEMAN: I think the underlying issue is stigma and the sort of misunderstanding of the role of medication and this idea that a non-medication-based approach is somehow better than someone taking the medication to control their illness.
SIMMONS-DUFFIN: So what do the institutions getting blamed here – physician health programs – have to say about all this? Dr. Christopher Bundy runs Washington state’s PHP and the federation of all the state PHPs. He says it’s true that these medications aren’t often used, but that’s not because of stigma or ideology.
CHRISTOPHER BUNDY: Proceeding with caution is understandable and warranted.
SIMMONS-DUFFIN: He says medication may be the gold standard of treatment in the general population, but there should be an asterisk when it comes to so-called safety sensitive workers, not just health care providers, also pilots, for instance. He says the concern is that these medications can affect cognition. So the idea of people caring for patients while taking something like buprenorphine makes some people nervous.
BUNDY: We only need one bad outcome involving a physician with substance use disorder who’s back to work, then immediately the PHP is under the microscope.
SIMMONS-DUFFIN: He says then the criticism would be, how could you let that doctor work on a medication that could have played a role in that bad outcome? He doesn’t know of a case where that’s happened. Wakeman and her co-authors also argue there isn’t clear evidence that these medications do impair cognition. Still, that fear could be what’s driving the reluctance here. Bill Kinkel is currently navigating all of this. He lives outside Philadelphia.
BILL KINKLE: I’m a nurse, and I’m also a person in sustained recovery from opioid use disorder.
SIMMONS-DUFFIN: He’ll be eligible to practice nursing again next fall after three years of documented sobriety. And he’s public about being in recovery. He even has a podcast. When he was addicted, he said he was under a strong impression he wouldn’t be able to go back to nursing if he was in a medication-assisted treatment program. So he went to abstinence-based rehabs over and over again. And over and over again, as soon as the rehab ended, he relapsed.
KINKLE: A lot of those I overdosed. And had my wife not found me on the floor and been able to take care of me, I very well may have died. And all that possibly could have been mitigated had I gotten either buprenorphine or methadone.
SIMMONS-DUFFIN: He doesn’t fault the PHPs or the licensing boards for these policies even though he thinks they put his life at risk. He thinks stigma against those with addiction is so ingrained in our culture, there’s no one institution to blame. What’s important is that this changes, he says, and health professionals have access to all possible tools in recovery.
Selena Simmons-Duffin, NPR News.
Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.
NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.
U.S. Authorities Reconsider Some Requests To Stay From Immigrants Seeking Medical Aid
Immigration authorities are reconsidering some requests from migrants to be allowed to stay in the U.S. to get medical treatment. But others hoping to get care here could be facing deportation.
MARY LOUISE KELLY, HOST:
Immigration authorities are now reconsidering some requests from immigrants to stay in the U.S. for medical treatment. This is giving hope to those who were recently denied. But as WBUR’s Shannon Dooling reports, other immigrants hoping to get lifesaving care here could still be facing deportation.
SHANNON DOOLING, BYLINE: On the 10th floor of a Boston hospital, a software engineer from Morocco describes his quest to get treatment for a rare vascular tumor. He says he consulted doctors in Belgium, Germany and South Korea, but they didn’t want to risk the surgery.
MK: I do tests, and then they said, like, we’re sorry. We can’t do that surgery because we’ll kill you. And then I’ve been looking in research papers, and then I found two doctors here in Boston.
DOOLING: The 33-year-old struggles to lift himself in bed. He asked to use his initials, M.K., because he’s afraid speaking out will hurt his case. M.K. entered the country in 2017 on a tourist and medical visa. After extending his visa as many times as he could, he applied for what’s known as medical deferred action, knowing it was likely his last option to be able to stay in the country legally. Last week, he read WBUR’s report that U.S. Customs and Immigration Services was sending letters to patients, denying requests to stay in the U.S.
MK: I called a family member. I was like, check out the mail. And surprise, surprise, there’s the letter.
DOOLING: The agency told him he had 33 days to leave the country. He says he got the news on the same day his doctor suggested yet another surgery. Earlier this week, Customs and Immigration Services ended the medical deferrals with no public announcement, just denial letters. In the future, officials say, any immigrants facing deportation can ask Immigration and Customs Enforcement for a delay. In a partial reversal, USCIS then said it would consider cases that were pending as of August 7. M.K. says he hopes the federal government does the right thing.
MK: It’s impossible for me to go back. It will be like a death sentence.
DOOLING: Sixteen-year-old Jonathan Sanchez has cystic fibrosis. His family received the same denial letter sent to M.K. and others around the country.
JONATHAN SANCHEZ: Every night, I start woken up, like, at 2:55, 3 a.m., thinking, I will wake up tomorrow. I won’t. I’ll be alive. I’ll be dead. What will happen to me?
DOOLING: Jonathan and his family came to the U.S. on tourist visas in 2016. They left their home country of Honduras, seeking treatment at Boston Children’s Hospital. Their medical deferred action request, like M.K.’s, should now be reopened. Gary Sanchez, Jonathan’s father, breaks down when he talks about his son’s future, saying he wants to see him grow up.
GARY SANCHEZ: I have a dream that one day I can see to my son, like, a man with a wife, children.
DOOLING: He says his daughter died in Honduras of cystic fibrosis. He says doctors there had no idea how to treat her condition. On her death certificate, he says, the cause was left blank.
G SANCHEZ: I don’t want that my son die because he is all my life.
DOOLING: There’s no guarantee the Sanchez family and M.K. will be approved to stay. But for now, they have something to hope for.
For NPR News, I’m Shannon Dooling in Boston.
Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.
NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.
‘It’s The Stone Age Of Fossil Fuels’: Coal Bankruptcy Tests Wyoming Town

In Gillette, Wyo., miner Bill Fortner stands by stalled trains that normally would be transporting coal. Local production has declined by one-third in the past decade.
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Two months ago, coal company Blackjewel declared bankruptcy, putting hundreds of miners in Wyoming and across Appalachia out of work. Miners affected by the bankruptcy in Kentucky have been camping out on a train track for six weeks in protest.
Blackjewel is the third coal company in Wyoming to declare bankruptcy this year, but this one is more dramatic: paychecks went unpaid, a CEO was pushed out and, most importantly, the gates of the mines in Gillette, Wyo., which calls itself the energy capital of the U.S., were locked, stopping coal production. Miners say that just doesn’t happen.
The move left about 600 people out of work in Gillette. In two months, only 25% of workers have found jobs, according to local management.
Until two months ago, Darlene Rea worked in Blackjewel’s warehouse. She received freight, wrote invoices and found parts. Since the coal company’s abrupt bankruptcy, she’s been stuck looking for work.
“Every day, every day, every day, you keep waiting and wondering if somebody is going to call you up. And then there’s nothing,” Rea says, slapping down a sheet of paper listing all the places she’s applied for jobs.
“Peabody Energy, Cloud Peak, Campbell County Hospital, Walmart, Pegasus,” she says.
Next to many is the word “rejection.”
Rea has a medically retired husband and a mortgage. Worst comes to worst, they might have to sell the house and move — a tough option with grandkids nearby. Rea says her positivity is fading with each passing day of a particularly prolonged bankruptcy.
“I didn’t think it was going to be this long. Seriously.”
Ty Cordingly is one of the few who managed to land a new job.
“I got some co-workers that had to go to Nevada, Montana, South Carolina, you know, Arizona,” he said. “When there’s not very many jobs — our entire community is based around the energy industry.”
Gillette isn’t just losing people — it’s losing money, too. Blackjewel owes the county $37 million — funds that support not only local services but state education. It’s left local vendors unpaid. The company even owes the federal government more than $60 million. Cordingly thinks Wyoming relies too much on energy.
“This isn’t a story about one individual or one generation. The state has always just counted on us being the cash cow for the state of Wyoming and they didn’t have to do any planning because the oil kept flowing and the trains kept rolling out with coal on it,” he says.
Ty Cordingly and his dad at a local Gillette diner. He’s seen coworkers leave the state for jobs and thinks Wyoming relies too much on the energy industry.
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Cooper McKim/Wyoming Public Media
Over the past year, Campbell County produced the most tax revenue for the state: 15% of it. Oil and gas are certainly still flowing, but coal isn’t having as much luck.
Driving to his regular diner, retired coal miner Bill Fortner says, “It’s the Stone Age of fossil fuels, coal is. It’s done.”
His ancestors homesteaded here four generations ago. Fortner is a staunch Republican who has mined coal for much of his life. He says President Trump has been the best shot coal has had, but it hasn’t been enough. Production in the Powder River Basin has declined by one-third in the past decade. Fortner says the area needs to adapt, and quickly.
“Otherwise, we’re going to be sitting here looking at another ghost town,” he said.
Local leaders say Gillette is already taking steps to diversify its economy. While that’s underway, Wyoming Gov. Mark Gordon says there may be some tight financial years ahead.
The future is still uncertain for Blackjewel’s two mines. The former owner says it plans to buy them back but would only keep them open for the short term.
Sports Commentary: Does The NFL Pay For Pain?
The National Football League’s regular season kicks off Thursday. Sports commentator Mike Pesca offers his take on NFL monetary incentives.
STEVE INSKEEP, HOST:
The NFL season begins tomorrow without some of the top players in the game. Some players are contract holdouts; one made a high-profile retirement. Commentator Mike Pesca says, many players face a question. How much money makes it worth the injuries and pain?
MIKE PESCA, BYLINE: When Andrew Luck, the NFL’s most accomplished quarterback under age 30, decided to become an ex-NFL quarterback 10 days ago, he explained that his frustration and pain were adding up to true despair, essentially asking us to consider his humanity. And we should. But we should weigh the humanity against the monetary because that’s the calculation that NFL players have to constantly perform. Andrew Luck’s contracts have paid him close to $100 million up to this point. There’s no way to know how much he kept. But after taxes, expenses and agents fees, it’s safe to say that Luck has tens of millions of dollars to his name.
Now, I ask you, if I put $20 million to $40 million in your bank account and told you you could earn an extra hundred million dollars over the next few years, but you’d have to break a bone a year or maybe lacerate a kidney or spleen every third year, would you do it? The money matters, of course it does, but it also incentivizes decisions in ways fans might not appreciate. The NFL is a pay-for-pain enterprise.
Let’s take the case of Melvin Gordon, running back for the Los Angeles Chargers. Like Dallas Cowboys running back Ezekiel Elliott, Gordon is a great talent who refuses to play for the amount his contract calls for. You should know that their contracts call for these running backs to be paid in the mid-seven figures this year, which seems like a lot of money – and it is except when you realize that other running backs, who might not even be as good as them, are being paid in the low eight figures. All sports have rookie contracts before a period of free agency that players have to suffer through. But in football, the suffering isn’t figurative.
Last year, Elliott ran or received the ball 381 times. A few of those possessions ended with him touching a foot out of bounds or, perhaps, scampering into the end zone untouched. But in the vast majority of occasions – literally hundreds of times – Elliott’s labor ended as he was knocked to the ground by a 200-to-300-pound man – not fun. I’d try to get every dollar I could in exchange for that inconvenience. If someone told me, 250 times this year, I’d be tackled by a 300-pound professional athlete and that, in exchange, I would get $3 million to $5 million, I would probably take it. But if you also told me that if I refused to participate in 50 to 100 more pre-season tackles by the 300-pound man and that by doing so I might be able to get $13 million, I would be really interested in the part where I didn’t have to get tackled for free.
We’re not talking about practice basketball drills or batting practice. We’re talking about pay for pain. Fans want their players to play. In fact, if every Chargers fan and owner of Melvin Gordon in fantasy football were allowed to contribute a dollar to a hypothetical GoFundMe, we could solve his contract holdout tomorrow. And fans generally know intellectually about the costs of the game and accept it. But knowing the costs and feeling them – really feeling them – is what makes football an entertainment to its viewers but, too often, an affliction to its practitioners.
INSKEEP: Commentator Mike Pesca is the author of “Upon Further Review: The Greatest What-Ifs In Sports History.” And it looks like the Dallas Cowboys had been listening to Mike Pesca because – this just in – the team has announced it has agreed to terms with running back Ezekiel Elliott.
(SOUNDBITE OF RAPPER BIG POOH’S “TOO REAL [INSTRUMENTAL]”)
Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.
NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.
The Sisters Of A-WA ‘Want To Bring Something New’ To Yemen’s Musical Traditions

A-WA’s latest album, Bayti Fi Rasi, is out now.
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A-WA is made up of three Israeli sisters, Tair, Liron and Tagel Haim. This melodic trio of Jewish women of Yemeni descent women emphasize mixing their culture’s traditions with forward-thinking modifications to sound, visuals and ethos. The sisters are known for eye-popping music videos that challenge gender stereotypes. Picture women in traditional robes that are neon pink while off-roading across a barren desert. The trio’s sound is just as distinctive. The sisters’ latest album, Bayti Fi Rasi (My Home Is In My Head), reworks traditional music from their ancestors’ home country of Yemen with hip-hop and electronic elements.
While A-WA was at NPR’s headquarters in Washington D.C. to perform a Tiny Desk concert, the members spoke with NPR’s Ari Shapiro about the messaging of the band’s music.
“The songs on this album are inspired by our great grandma,” Tahir, the eldest sister, says. “She was traveling from Yemen to Israel as a single mom and [“Hana Mash Hu Al Yaman”] talks about her arrival in Israel. They put all the Yemenite Jews back then in transition camps or a tent camp. … We talk about all the mixed emotions she felt.”
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With Bayti Fi Rasi being sung from the point of view of the sisters’ great grandmother, Rachel, in 1949, Tahir explains that this music upholds her legacy.
“She was a feminist before she even knew what a feminist is,” Tahir says. “She was so strong. Her journey was so courageous and she didn’t have any help from anyone. But thanks to her, we are a generation born in Israel and our future and our present are better. We have a better life.”
The ladies take what they have inherited from older generations — the harmonies, melodies and Yemenite traditions — and deliberately yank them into the 21st century by adding beats and production effects that their great grandmother would never have heard of.
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“For us, it’s not interesting to put the tradition as it is because we want to bring something new. We want to bring ourselves,” Tahir says. “We also have three voices as young women, so in the album, for instance, we sort of blended her voice — things that she couldn’t say back then — with our voices.”
With the current global refugee crisis, the Haim sisters hope that the story of their great grandmother will speak to people, especially women, who find themselves in these similar situations today.
“We felt that this issue is so relevant,” Tahir says.
“It’s a story about one woman, but it’s actually a story of so many other refugees around the world. So, for us, it’s a story that we wanted to tell for years,” Liron adds.
Audio editor Emily Kopp and web editor Sidney Madden contributed to this story.