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The Trump administration’s revival of the failed war on drugs did not spring from a place of reason. But increasingly, it looks like Attorney General Jeff Sessions’ veiled threats toward states with legal marijuana laws might actually hinder America’s ability to solve the nation’s real drug problem: The opioid crisis. Two new studies suggest that when medical marijuana is legally and easily available, patients may be more likely to turn to pot instead of highly addictive opioids to treat their pain. (4/11)

Public health efforts inevitably involve trade-offs, but interventions that are broadly disseminated must have minimal harms. For example, while vaccine reactions can be serious and even lethal, they are exceedingly rare. Not so for harms associated with marijuana use. There is ample evidence that individuals — especially adolescents — who use marijuana have much higher rates of mood, anxiety, and psychotic disorders than their peers. The loss of motivation that we see in so many of our patients who use marijuana, its negative impact on functioning at school or at work, and its likely connection with cognitive decline are other serious and common harms. Adolescents who use marijuana are also more likely to misuse prescription opioid medications. In our experience, nearly all of our patients with opioid addiction first used marijuana heavily. (Nicholas Chadi and Sharon Levy, 4/12)

We have been here before — a raging epidemic of addiction that destroys lives, families and communities. Who was on the front line in the 1990s, when the drug was crack and the addicts were mostly black? Drug czar William Bennett. His weapon was prosecution and prison. Today, when the drugs are opioids and the addicts are mostly white? U.S. Surgeon General Jerome Adams, a doctor, is out there, telling the country, “We need to see addiction as a chronic disease and not a moral failing.” (Petula Dvorak, 4/12)

As a physician and Chair of the American Medical Association’s (AMA) Opioid Task Force, I view naloxone as a medication that works to restore normal breathing to an individual suffering from an opioid overdose. A life saved is not a moral hazard. (Patrice Harris, 4/12)

Even more than the tax reform that Congress passed this year, the definitive Paul Ryan achievement was the American Health Care Act, the attempt to repeal the Affordable Care Act that the House voted for and the Senate nixed. The AHCA was a reflection of Ryan's worldview so pure it almost reached the level of self-parody. It cut healthcare savagely; the CBO estimated 23 million people would lose their health insurance. The money saved was transferred to, you guessed it, the well-to-do. The AHCA bill reflected Ryan's leadership in other ways too. It was rushed through an undemocratic process, with only three hours of debate and voted on before a public version of the bill was even made available. This is Ryan's legacy: a single-minded campaign of rich-on-poor class warfare. Worse, he aggressively covered up Trump's unprecedented corruption and unfitness for office just to further that agenda. (Scott Lemieux, 4/12)

Speaker Paul Ryan’s announcement Wednesday that he will not seek re-election is bad news for Republicans, Congress and America’s political culture. Mr. Ryan says he’s confident Republicans will keep their House majority in the midterms, but his decision reflects a recognition that one of two outcomes is likely—neither of which is promising for GOP leadership. One is that Democrats take the House. After being his party’s vice presidential nominee and third in line to the presidency, a demotion to minority leader is unappealing, especially if the Democrats are more interested in resistance than constructive action. The other possibility is that Republicans end up with a diminished majority that makes governing more difficult. (Karl Rove, 4/11)

Spinoza said that free will is like a stone that doesn’t know why it’s falling but wants to keep going. On Wednesday, Paul Ryan announced that he would not seek re-election. A midterm defeat, should Mr. Ryan have chosen to run, wasn’t exactly inevitable. But when no less an authority than the speaker of House of Representatives expressed the desire to rejoin his children, with all the freedom of plummeting rock longing to eat dirt, it confirmed what practically everyone suspects: The Republican Party is in free fall, and its House majority is racing toward annihilation. ... Politics isn’t physics, but a governing Republican philosophy that sees it as a moral imperative to slash the budgets of social programs that benefit mainly older and working-class white people is bound, sooner or later, to drive a party of mainly older and working-class white people off a cliff. The slow-motion disaster now unfolding in Washington results in no small measure from Mr. Ryan’s puzzling success in persuading Republican elites that they could flourish as the party of free-market, anti-redistributive convictions. (Will Wilkinson, 4/13)

Proposed work requirements for public benefits, such as those in Pennsylvania House Bills 1659, 2024, and 2183, are a bad idea. Work requirements for public benefits sound reasonable in theory, but are actually harmful and costly to Pennsylvania — and undermine highly effective programs, such as SNAP (food stamps) and Medicaid. (Debby Freedman, 4/12)

It’s time for California to get serious about pharmacy safety. SB 1442 is new legislation that would protect the public by ensuring pharmacists aren’t working alone. At the same time, it delivers safety to pharmacists who have become targets because they work alone. (Jim Araby, 4/12)

Antibiotics are the most important drug class in human history. Without them, minor infections like strep throat or urinary tract infections could turn deadly. Heart surgery, cancer treatment, and virtually everything else that happens in a hospital would be far more dangerous than it is today. But if we keep taking them for granted, and fail to provide innovative approaches to funding the development of new antibiotics, drug-resistant microbes will get the upper hand.Although we’ve made great strides in the development of antibiotics since the discovery of penicillin in the early 20th century, we aren’t keeping up with the rise of superbugs — common bacteria that have acquired genes that make them resistant to most or all of our antibiotics. “[T]he end of the road isn’t very far away for antibiotics,” Dr. Tom Frieden, the former head of the Centers for Disease Control and Prevention, once said. (Kevin Outterson, 4/11)

In January, the U.S. Department of Health and Human Services (HHS) announced the creation of its Conscience and Religious Freedom Division, explaining that it will allow HHS’s Office of Civil Rights to “more vigorously and effectively enforce existing laws protecting the rights of conscience and religious freedom” and will ensure that “no one is coerced into participating in activities that would violate their consciences, such as abortion, sterilization or assisted suicide.” Responses were as expected: religious conservatives hailed the new division as a needed intervention; public health and clinical leaders and advocates decried it, worrying about its impact on access to care and harm to patients. HHS leaders’ comments to date suggest that they are uninterested in discrimination against health care providers whose consciences compel them to provide care, and uninterested in injuries to patients caused by care refusals. This framing makes conscience yet another issue dividing Americans, largely along partisan lines. (Lisa Harris, 4/11)

In December, the U.S. Department of Justice halted efforts on a national level to make medical diagnostic equipment accessible to people with disability, many of whom face considerable difficulty getting care because of inaccessible equipment in health care settings. (Lisa I. Lezzoni and Elizabeth Pendo, 4/12)