Tag: iab-medical health

Biden administration declares fentanyl laced with xylazine ‘an emerging threat’ in the US | CNN

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CNN
 — 

The White House has declared that the powerful synthetic opioid fentanyl combined with xylazine – an animal tranquilizer that’s increasingly being used in illicit drugs – is an “emerging threat” facing the United States due to its role in the ongoing opioid crisis.

Administration officials call the threat FAAX, for fentanyl-adulterated or -associated xylazine.

The move, announced Wednesday, marks the first time in history that any administration has declared a substance to be an emerging threat to the country, said Dr. Rahul Gupta, director of the Office of National Drug Control Policy. The SUPPORT Act of 2018 established that the office has authority to declare such “emerging threats,” and no administration has used it until now. Last year, Congress declared methamphetamine an emerging drug threat but none have been declared by an administration previously. Under other agencies or in separate circumstances, concerns such as bioterrorism, infectious diseases or climate change may be identified as “emerging threats.”

“This drug, which is an animal sedative, is being mixed with fentanyl and is being found in almost all 50 states now,” Gupta said Tuesday. “It’s become an important part for us to make sure that we’re declaring it an emerging threat.”

Now that the administration has declared fentanyl combined with xylazine an emerging threat, it has 90 days to coordinate a national response. “We are working quickly to develop and implement a whole of government nationwide plan, with real deliverable action, that will save lives and will be published within 90 days of this designation,” Gupta said.

Xylazine, also known as tranq or tranq dope, has been linked to an increasing number of overdose deaths in the United States due to its rising illicit use. Between 2020 and 2021, overdose deaths involving xylazine increased more than 1,000% in the South, 750% in the West and about 500% in the Midwest, according to an intelligence report released last year by the US Drug Enforcement Administration.

And in some cases, people might not even know that xylazine was in the drug they used.

Just last month, authorities at the DEA issued a public safety alert about the “widespread threat” of fentanyl mixed with xylazine, reporting that in 2022 approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA contained xylazine.

Fentanyl, which has been driving the opioid crisis, is a fast-acting opioid, and people who use it illicitly say that adding xylazine can extend the duration of the high the drug provides.

Xylazine is not an opioid. It is approved by the US Food and Drug Administration for use as a tranquilizer in veterinary medicine, typically in horses, but it is not approved for use in humans. And xylazine can do major damage to the human body, including leaving drug users with severe skin ulcers, soft-tissue wounds and necrosis – sometimes described as rotting skin – that can lead to amputation.

“Xylazine is one of the contaminants in fentanyl, but there could be others,” Gupta said. “So, I think with the declaration of an emerging threat, we’re sending a clear message to producers and traffickers of illicit xylazine and illicit fentanyl that we’re going to respond quicker, we’re going to match the challenge of evolution of these drugs supply, and that we’re going to protect lives first and foremost.”

Now that xylazine has been declared an emerging threat, some of President Biden’s $46 billion drug budget request to Congress can be used to respond.

This year, the Biden administration announced that the President has called on Congress to invest $46.1 billion for agencies overseen by the Office of National Drug Control Policy to tackle the nation’s illicit drug crisis.

If the budget request is not approved, there could be the option to reallocate money within the Office of National Drug Control Policy, but “we don’t want to be in a position where moneys that are being utilized for some other important aspect of saving lives has to be moved away for this purpose,” Gupta said Tuesday. “That is the reason we are asking Congress to act.”

Such funds could be used to test drugs on the street for xylazine, collect data on FAAX, invest in care for people exposed to FAAX and develop potential treatments for a xylazine-related overdose.

The medication naloxone, also known as Narcan, is an antidote for an opioid overdose, but people who have overdosed on a combination of opioids and xylazine may not immediately wake up after taking naloxone, as it may not reverse the effects of xylazine in the same way it does opioids.

“We need to recognize, first of all, that there is a shift that is occurring from organic compounds and substances like heroin and cocaine to more synthetics,” Gupta said of the state of the nation’s illicit drug crisis.

“Both the types of drugs have changed – from predominantly organic to predominantly synthetics – but the way drugs are bought and sold have also changed,” he said. “Now, all you need is a phone in the palm of your hand and a social media app to order and buy some of the most dangerous substances on planet Earth.”

Xylazine is just one of the many adulterants – or substances that are typically added to others – found in the nation’s illicit drug supply.

“All of a sudden, you can synthesize hundreds of compounds and kind of mix them together and see what does the best in the market,” Joseph Friedman, a researcher at the University of California, Los Angeles, told CNN in March. “People are synthesizing new benzodiazepines, new stimulants, new cannabinoids constantly and adding them into the drug supply. So people have no idea what they’re buying and what they’re consuming.”

Some of these adulterants may be as simple as sugar or artificial sweeteners added for taste or additives or fillers that bulk up the drug. Sometimes, they may be contaminants left over from the manufacturing process.

Addicted? How to get help

  • If you’re addicted to prescription drugs, help is available. You can call the Substance Abuse Mental Health Services Administration 24/7 hotline at 1-800-662-HELP(4357) or visit their website.

    • But all of these things can carry real-life health harms, says Naburan Dasgupta, an epidemiologist and senior scientist at the Gillings School of Global Public Health at the University of North Carolina, Chapel Hill.

    Like an opioid, xylazine can depress the respiratory system, so the risk of overdose multiplies when it’s combined with heroin or fentanyl.

    Also, “in the veterinary literature, we know that it causes a really bad severe form of anemia. And so when people are injecting heroin that’s contaminated with xylazine, they can end up with a near-fatal form of blood iron deficiency,” Dasgupta said in March. “We had one person here who ended up going to the hospital needing multiple blood transfusions. And it was all because of the xylazine.”

    US lawmakers are moving to classify xylazine as a controlled substance.

    In March, bipartisan legislation – the Combating Illicit Xylazine Act – was introduced in the House and Senate. It describes illicit xylazine as an “urgent threat to public health and safety” and calls for it to be a Schedule III drug under the Controlled Substances Act, a category on the five-level system for substances with moderate to low potential for physical or psychological dependence. Xylazine would be one level below opioids like fentanyl.

    “Our bipartisan bill would take important steps to combat the abuse of xylazine by giving law enforcement more authority to crack down on the illicit distribution of this drug, including by putting stiffer penalties on criminals who are spreading this drug to our communities,” Sen. Maggie Hassan, D-N.H., said in a statement in March.

    The bill would also require manufacturers to send reports on production and distribution to the DEA so the agency can ensure that the product is not being diverted to the black market.

    “This bill recognizes the dangers posed by the increasing abuse of animal tranquilizers by drug traffickers, and provides new tools to combat this deadly trend,” Sen. Chuck Grassley, R-Iowa, said in the statement.

    “It also ensures that folks like veterinarians, ranchers and cattlemen can continue to access these drugs for bona fide animal treatment.”

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    What is autism? An expert explains | CNN

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    CNN
     — 

    Some individuals with autism have challenges processing senses. Others struggle to communicate. Still others might have a tough time socializing, thinking, physically moving or just going about daily living.

    People with autism have their own ways of interacting with the world, because autism is a developmental disability that affects everyone who has it a little differently, according to Dr. Daniel Geschwind, the Gordon and Virginia Macdonald distinguished professor of human genetics, neurology and psychiatry at UCLA.

    Geschwind has spent 25 years studying autism and what causes it. To mark Autism Awareness Month, CNN talked with him about what autism is and what causes it.

    This conversation has been lightly edited and condensed for clarity.

    CNN: What is autism?

    Dr. Daniel Geschwind: Autism refers to a broad range of conditions characterized by challenges with social skills and social and communication and repetitive behaviors, resistance to changes in routine, or restricted interests. I prefer to call it “the Autisms,” because it’s not one thing, and no two autistic children or adults are exactly alike even though they may share basic features. People with autism may also have some sensory-motor integration issues, especially sensory hypersensitivity.

    CNN: How prevalent is autism today?

    Geschwind: It isn’t rare. The most recent statistics (from the US Centers for Disease Control and Prevention) came out in March, pulled data from 11 sites (in the United States) and reported 1 out of every 36 kids is autistic. The study before that estimated around 1 in 40. About 10 years ago, the autism rate was 1 in 100, or even lower.

    It would be easy to look at this trend and say autism is increasing, but that’s not really what is happening. The most recent data reflects that our ability to recognize autism and diagnose it early has improved dramatically. We’re now able to diagnose people with autism who might have (previously) fallen through the cracks.

    Everybody is neurodivergent to some extent. For example, if you look at a simple IQ test, a substantial portion of people will perform really badly on one specific item. That doesn’t mean they have problems — it’s just that it means we all have strengths and weaknesses.

    If I were being tested on artistic ability, for example, or engineering ability, I would be far below what’s called typical. I think we have to accept that intelligence is not just one thing, that cognition isn’t one thing, that there’s not just one way to behave.

    CNN: What does it mean when people describe some as being “on the spectrum”?

    Geschwind: About a decade ago, the term “autism spectrum disorder” was adopted to encompass everything that we called autism into one rubric. The intent was simply to describe the variability in how people with autism act and behave biomedically. There are some autistic individuals who just need accommodations and don’t need treatment. There are other autistic individuals who need a lot of treatment. The spectrum was intended to include them all.

    Over time, non-autistic people began referring to the spectrum in a linear fashion: high to low. That means some autistic individuals were categorized as “high-functioning,” while others were categorized as “low-functioning.” For many, the notion of a spectrum is now a loaded term. Many believe that instead of talking about autism in a linear fashion, we should talk about it as a wheel or pie, where each slice represents a different trait and every individual has different strengths and weaknesses.

    CNN: Is there a cure for autism?

    Geschwind: There is no cure. At the same time, we’ve come very far in understanding what autism is, and we’re making progress on how to treat it. When I started researching autism 25 years ago, the autism rate was 1 in 1,000 or 1 in 2,000. To put it in deeper historical perspective, I think at that time there was only about $10 million a year or less in autism research being done that was funded (by the National Institutes of Health). And so, there was a huge disconnect between the research dollars, public awareness and the real needs of patients and families.

    The notion of the term “curing” autism can be controversial. From my perspective, our true goal is to establish a kind of personalized medicine, or precision health in autism and other neuropsychiatric disorders, so that each autistic person is seen as the individual they are. We envision a world where individuals who are severely impacted by autism have the opportunity to get therapy and drugs that can help them — and those for whom a therapy is not warranted or who don’t want it will have opportunities to live life the way they want to as well. Patient autonomy and societal accommodation are important aspects when considering these issues.

    CNN: What causes autism?

    Geschwind: Almost every medical condition has both genetic and environmental components. In autism, it seems that heritability is very high. The most recent large study suggested that heritable genetic factors — the things that you get from your parents that your parents have in their DNA — are probably somewhere around 80% or slightly higher.

    That leaves 20% that’s nonheritable, and of that we know that at least 10% of autism is caused by rare mutations that are not inherited. And that sounds like a paradox, but it’s not. If you think about Down syndrome, that’s a genetic mutation that the parents don’t have in their DNA. That’s called a new, or de novo, mutation.

    You can calculate a risk score for having autism based on genetics, (but) right now, the risk score for autism is not that predictive because we haven’t done enough research. For other conditions like cardiovascular or certain cancers, risk scores are very predictive because very large numbers of people have been studied.

    Even so, this autism risk score is strongly correlated with high educational attainment, or a high IQ, which again speaks to the strengths associated with being autistic and highlights that we need to be more aware of the strengths that autistic individuals may have as well to optimize their opportunities to achieve their goals or contribute to society.

    There also are several environmental factors that have been shown to increase the risk of autism. One of them is maternal exposure to valproate, which is an anti-epilepsy medication. There are several maternal viral infections that have been associated with autism. And two other things: the interbirth interval — how quickly after one birth a mother has another — and the age of the father. The thought on the last point is that as a man ages, their DNA repair mechanisms are maybe less active, and there are more frequent mutations in sperm.

    A key point is that all these known environmental factors act prenatally, so in most cases the tendency towards being on the spectrum is something that individuals are born with.

    CNN: To what extent has research debunked the controversial notion that vaccines can cause autism?

    Geschwind: The notion that vaccines cause autism has been entirely (disproved). There have been dozens of studies, using very different methodologies. There is absolutely no evidence that vaccines cause autism, and there’s been much more harm than good done by purveyors of that fiction.

    CNN: How do you treat autism?

    Geschwind: It is imperative to have an early diagnosis, because we know that early identification and early intervention with behavioral therapies can be effective in up to 50% of kids. Some kids will respond so well that it’s very hard to make a diagnosis of autism when they’re 9 years old if the therapy is started early enough.

    The problem is that for many autistic individuals, current therapies are not that effective. There’s a lot of work being done developing more effective cognitive behavioral therapies, figuring out which therapy is the best for which child. There’s also work being done to develop medications that can be helpful to treat certain symptoms such as injurious behavior, repetitive behavior or difficulty with changes in routines.

    My colleagues and I want to use treatment to augment and improve people’s symptoms, not change who they are fundamentally. We believe strongly in every individual’s autonomy. We also believe in personalized medicine so that it’s not one-size-fits-all. There will be some patients in whom we’re trying to correct a severe genetic mutation that has profound consequences, and there’ll be others that need only a handful of accommodations, just like we provide for folks who need wheelchairs.

    CNN: What will your research focus on next?

    Geschwind: There are two basic frontiers in my research. One recognizes that most of the work in neuropsychiatric disorders and autism has been done in primarily White European populations and focuses on a pressing need to be studying diverse populations. About seven or eight years ago, I started working with African American communities because certain aspects of genetics are population-specific, and we as researchers really need to understand that.

    The frontier that is crosscutting across all of this is we need to be able to move from genetics in a population to genetics in an individual, so that by looking at somebody’s genetic makeup, we can understand the mechanism of their autism. This is precision medicine.

    My work is trying to understand how specific genetic variants, how specific mutations, impact brain development to eventually lead to the symptoms of autism. If my colleagues and I can understand that mechanism, just like we can understand the genetic mechanism in cancer, we can find a drug to target that and improve those symptoms over time.

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    Why we have nightmares and how to stop them | CNN

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    Sign up for CNN’s Sleep, But Better newsletter series. Our seven-part guide has helpful hints to achieve better sleep.



    CNN
     — 

    We leave behind our fears of monsters under the bed as we say goodbye to our childhoods, but one can follow us into adulthood and loom over our heads.

    Nightmares are more common in childhood, but anywhere from 50% to 85% of adults report having occasional nightmares.

    Almost everyone can experience nightmares.

    “Dreams do usually incorporate things that happened during the day, leading some researchers to hypothesize that dreams and rapid eye movement sleep is essential for memory consolidation and cognitive rejuvenation,” said Joshua Tal, a sleep and health psychologist based in Manhattan.

    “Nightmares are the mind’s attempts at making sense of these events, by replaying them in images during sleep.”

    Nightmares are what the American Academy of Sleep Medicine call “vivid, realistic and disturbing dreams typically involving threats to survival or security, which often evoke emotions of anxiety, fear or terror.”

    If someone has frequent nightmares — more than once or twice weekly — that cause distress or impairment at work or among people, he or she might have nightmare disorder. Treatments include medications and behavioral therapies.

    Addressing frequent nightmares is important since they have also been linked to insomnia, depression and suicidal behavior. Since nightmares can also cause sleep deprivation, they are linked to heart disease and obesity as well.

    Trying out these 10 steps could help you ease your nightmares and improve your sleep and quality of life.

    Nightmares occur during rapid eye movement sleep, the phase during which our muscles relax and we dream. Waking up during REM sleep enables recollection of the dream and resulting distress, said Jennifer Martin, a professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles, and member of the American Academy of Sleep Medicine’s board of directors.

    “One of the most effective ways to treat nightmare problems in adults is actually to get them sleeping more soundly (so) they wake up less often,” Martin said.

    A healthy sleep routine begets sound sleep. Develop one by exercising, setting regular sleep and waking times, ensuring your room is dark and cool, avoiding stimulating beverages after midafternoon and engaging in relaxing activities.

    Alcoholic beverages can induce restlessness and awakenings throughout the night — potentially helping you remember nightmares, Martin said.

    “A lot of people use alcohol as a way to wind down and feel sleepy at the end of the day, but it’s really not the right solution,” she added. Instead, try herbal teas and other beverages conducive to sleep. If drinking was the only part of your relaxation routine, chat with your partner or read instead.

    One drink more than three hours before bedtime is OK, Martin said. Just pay attention to whether it causes a post-dinner nap and alertness at bedtime, and eliminate that drink if it does.

    Avoid snacking before bed to prevent spiking your metabolism and activating your brain.

    Snacking can boost metabolism, which causes your brain to be more active and could lead to nightmares, according to the National Sleep Foundation.

    While some people sleep better after eating a light snack, you should stop eating two to three hours before bedtime. If you notice that you have nightmares afterward, try avoiding nighttime snacking or heavier meals before bed.

    Some medications can prompt nightmares by interrupting REM sleep.

    “If people can identify that their nightmares either started or increased when they had a change in their medication, that’s definitely a reason to talk to their doctor” about their medication schedule or alternatives, Martin said.

    Melatonin, while a popular sleep aid, influences our circadian rhythm that regulates REM sleep, and can lead to more or fewer nightmares. If you want to take melatonin for better sleep, work with a sleep specialist to ensure you’re taking it at the right time and not compounding the problem, Martin said.

    Calming activities can deactivate your fight-or-flight response and trigger your relaxation system.

    Progressive muscle relaxation — tensing muscle groups as you inhale and relaxing them as you exhale — has been effective for reducing nightmares.

    “Nightmares activate the sympathetic nervous system, the ‘fight or flight system,’ the body’s natural response to imminent danger,” said Tal via email.

    “The body also has an innate relaxation system: the parasympathetic nervous system, aka the ‘rest and digest’ system.” Progressive muscle relaxation and other relaxation activities can help activate that system.

    Journaling can help you release your anxieties.

    Write down your worries to get them all out ahead of time, lest they rear their disquieting heads at night. Journaling can be helpful for alleviating nightmares and stress in general, Tal said.

    Images from any exciting or disturbing content you watched before bed can appear in your dreams.

    Since our nighttime observations can appear during sleep, “spend some energy engaging with things that are more emotionally neutral or even positive” before bedtime, Martin suggested.

    During the pandemic, our everyday lives are looking pretty scary, too. “Reading the news media and then hopping into bed is more likely to trigger disturbing and upsetting dreams than looking through pictures from your last vacation with your family,” she added.

    Imagery rehearsal therapy is effective “when the chronic nightmares are showing similar themes and patterns,” Tal said.

    Since nightmares can be learned behavior for the brain, this practice involves writing down in detail the narrative elements of the dream. Then rewrite the dream so that it ends positively. Just before falling asleep, set the intention to re-dream by saying aloud, “If or when I have the beginnings of the same bad dream, I will be able to instead have this much better dream with a positive outcome.”

    “By practicing a rewrite during the daytime, you increase your chances of having them at night while you’re sleeping instead of your nightmare,” Tal said.

    Silence is key in a sleep routine, but “for people who either don’t like it to be completely quiet or who are awakened by noises they can’t control during the night,” background noise “is a good strategy,” Martin said.

    Try a fan or a white noise machine or app for several consecutive nights to help your brain adapt, she added.

    If nothing works and you’re still having nightmares, talk with a therapist or sleep specialist.

    “Nightmares might be a sign of a larger issue, such as PTSD or a mood disorder,” Tal said. “It is possible to treat the nightmares without treating the underlying disorder, but it may also be helpful to treat both the symptom and the disorder.

    “There has been great progress on psychological treatments for nightmares, insomnia, anxiety and mood disorders,” Tal added. “Do not be afraid to ask for help; psychotherapy works and it is often short term and accessible.”

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    Clinics and doctors brace for more restrictions on women’s health care after court ruling on abortion drug | CNN

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    CNN
     — 

    Less than a year after the US Supreme Court ended legal protection for abortions nationwide, clinics that provide reproductive health care across the United States are bracing for more restrictions on the care they provide to women.

    If a judge’s ruling takes effect Friday, it may soon be illegal for doctors to prescribe mifepristone, the first in a two-drug regimen that can help women terminate a pregnancy at home – and that has other uses.

    At Northeast Ohio Women’s Center, staffers are calling patients who expected to get medication abortions next week, telling them to change their plans.

    “They’re scrambling to change their schedules to get in to see us earlier,” said Dr. David Burkons, the physician who runs the clinics.

    About half of abortions in the US use mifepristone, which is sold under the brand name Mifeprex.

    Mifeprex blocks the hormone progesterone, which effectively stops a pregnancy from continuing. For an abortion, women take mifepristone first, followed one or two days later by misoprostol, a drug that causes the uterus to contract, cramp and bleed, similar to a heavy period. It empties out the uterus, ending the pregnancy. It can be used up to 10 weeks of pregnancy.

    But the uses of mifepristone go beyond abortion.

    The drug helps soften and open the cervix, the neck of the uterus, and doctors depend on it to help when women are having a miscarriage and when a pregnancy needs to be terminated quickly if the life of the mother is at stake.

    In certain situations, when a pregnancy has become too risky, time is of the essence, says Dr. Alison Edelman, who directs the division of Complex Family Planning at Oregon Health and Sciences University.

    “The more expediently that we can have somebody not be pregnant, the better, and mifepristone helps us speed that process up and make it safer for patients,” she said.

    Doctors also use mifepristone before procedures in which they need to go into the uterus, such as to remove bleeding polyps. Studies have shown that the drug helps reduce the amount of force needed to open the cervix and reduces the amount of blood loss associated with the procedure.

    Studies also show that mifepristone has moderate to strong benefits for inducing labor and treating uterine fibroids and endometriosis, sometimes helping avoid surgery, according to the American Society of Health Systems Pharmacists.

    It can be used to prevent bleeding between periods and to control hyperstimulation of the ovaries during in-vitro fertilization, the society said in a statement.

    Doctors say they still have other ways to treat those problems, but when considering the needs of individual patients, they will be missing a valuable tool.

    “We have our gold standard of what we provide – the safest, most effective regimen – and then if it’s not available, we use the next best one. And that’s what we would be left with,” Edelman said.

    Mifepristone has been approved by the US Food and Drug Administration for 23 years, and it has been used by over 5 million women in the United States. FDA data shows that less than 1% of women who take it have significant adverse events. A CNN analysis of FDA data found that mifepristone was even less risky than some other common medications, including Viagra and penicillin.

    Medication abortions have become an increasingly important option for women in states that restricted abortion access after the Supreme Court’s ruling last year that ended legal protections for abortions in every state. They are also sometimes the only kind of abortion many women can get in rural areas that have lost abortion providers.

    This ease of access has also made the medication regimen a target for abortion opponents.

    “They want to see a national ban, and this is in fact what they are going for in this case,” said Kristen Moore, director of the EMAA Project, a nonprofit that is seeking to make it easier to get abortion medications in the US.

    What will happen next is far from settled. Appeals have been filed to stop the ruling in Texas from taking hold, and higher courts will have to weigh in.

    Even if the court does take mifepristone off the market in the US, doctors say, they will still be able to provide medication abortions using misoprostol alone.

    In fact, some abortion providers have been planning on using misoprostol by itself in case mifepristone is isn’t available.

    Carafem, which provides telehealth abortion care, has been offering a misoprostol-only regimen since the Covid-19 pandemic began, Chief Operating Officer Melissa Grant says.

    “In 2020, we started to use misoprostol alone as an option,” she said. Workers have since been tweaking the regimen and gathering data.

    “We now feel confident that, even though we would much prefer to use both, that we can use misoprostol alone effectively and are ready to switch gears to have a higher percentage of our clients or even 100% of our colleagues use that option if necessary,” Grant said.

    Still, some providers said it’s not ideal.

    The misoprostol-only regimen is slightly less effective than the one that uses both drugs, and it causes more cramping and bleeding, which can mean more complications.

    “We’re more likely to see failures and therefore more likely to need surgical intervention after misoprostol alone,” said Dr. Erika Werner, chair of the Department of Obstetrics and Gynecology at Tufts Medical Center.

    Still, doctors want women to know that medication abortions and miscarriage care will still be available even if mifepristone isn’t. And they hope that higher courts will intervene to keep this medication on pharmacy shelves.

    “The clinicians would have to use these other options instead of choosing based on their own expertise, knowledge and judgment when rendering such care,” Dr. Iffath Hoskins, president of the American Congress of Obstetricians and Gynecologists, said Monday. “Frankly, as a clinician, I do not want to be in that position.”

    Correction: This story has been updated to include the correct name of Tufts Medical Center.

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    Concerned about the courts, some states and universities are stockpiling abortion drugs | CNN

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    CNN
     — 

    With an eye on the courts, a growing number of Democratic-led states are stockpiling the pills that can be used for a medication abortion, the most common form of the procedure in the US.

    The officials want to be prepared, in case US District Judge Matthew Kacsmaryk’s decision to suspend the US Food and Drug Administration’s approval of mifepristone goes through, so medication abortions would still be available in their states for some period of time. But they’re taking different approaches to the idea.

    New York Gov. Kathy Hochul announced Tuesday that her state’s Department of Health would buy 150,000 doses of misoprostol, the other of the two drugs typically used in a medication abortion.

    Misoprostol can be used off-label for an abortion, without mifepristone, but patients often have to use more of it. It would not be covered by the court case, and if Kacsmaryk’s decision stands, the New York City’s Health Department tweeted, it will change to using this medication only.

    “Medication abortion continues to be available at our Sexual Health Clinics and NYC Health + Hospitals locations. Should mifepristone become unavailable, we will continue to make medication abortion accessible to all in NYC by shifting to a misoprostol-only treatment regimen,” the tweet said.

    The state says the 150,000 doses should represent a five-year supply of pills.

    “Anti-choice extremists have shown that they are not stopping at overturning Roe, and they are working to entirely dismantle our country’s reproductive health care system, including medication abortion and contraception,” Hochul said. “New York will always be a safe harbor for abortion care, and I am taking action to protect abortion access in our State and continue to lead the nation in defending the right to reproductive autonomy.”

    California is also stocking up on misoprostol.

    “While California still believes Mifepristone is central to the preferred regimen for medication abortion, the State negotiated and purchased an emergency stockpile of Misoprostol in anticipation of Friday’s ruling by far-right federal judge Matthew Kacsmaryk to ensure that California remains a safe haven for safe, affordable, and accessible reproductive care,” Gov. Gavin Newsom’s office said in a release Monday.

    California plans to purchase up to 2 million pills through CalRx, a state initiative set up to make drugs more affordable.

    The governor’s office said the state now has more than 250,000 pills on hand, which it purchased for about $100,000.

    California said it shared the terms of its purchase agreement with other members of the Reproductive Freedom Alliance, a nonpartisan coalition of 21 governors who are committed to protecting reproductive rights, and who might also be interested in taking such action.

    Another member of that alliance, Washington Gov. Jay Inslee, announced last week that his state bought a three year-supply of mifepristone, the drug at the center of Kacsmaryk’s ruling.

    Inslee directed the state Department of Corrections – which has a pharmacy license and is legally able to buy medications – to buy the drug last month, he said, and the shipment was delivered March 31. The University of Washington also purchased 10,000 doses.

    Lawmakers are introducing a bill to authorize officials to distribute or sell the medication to licensed providers throughout the state.

    “This Texas lawsuit is a clear and present danger to patients and providers all across the country. Washington will not sit by idly and risk the devastating consequences of inaction,” Inslee said. “Washington is a pro-choice state, and no Texas judge will order us otherwise.”

    In the meantime, its attorney general, Bob Ferguson, is helping lead a multistate lawsuit to protect access to mifepristone.

    On Friday, the same day Kacsmaryk’s ruling came down, a federal judge in Washington ordered the US not to make any changes that would restrict access to mifepristone in the territories that brought the lawsuit: 17 states and the District of Columbia.

    On Monday, Massachusetts Gov. Maura T. Healey announced that at her request, the University of Massachusetts and health care providers have also taken action to stockpile doses of mifepristone.

    The governor’s office said last week that the university bought about 15,000 doses of mifepristone, enough to cover the commonwealth for about a year, and the pills are expected to arrive this week. Local health care providers have agreed to buy more, and the government agreed to set aside $1 million to pay for those doses.

    The Massachusetts governor also signed an executive order confirming protections for medication abortion under existing law.

    “Here in Massachusetts, we are not going to let one extremist judge in Texas turn back the clock on this proven medication and restrict access to care in our state,” Healey said. “The action we are taking today protects access to mifepristone in Massachusetts and protects patients and providers from liability. In Massachusetts, we stand for civil rights and freedom. We will always protect access to reproductive health care, including medication abortion.”

    Danco Laboratories, the manufacturer of the brand-name version of mifepristone, says that orders for the drug have increased substantially in recent months and are significantly higher than they were at this time last year.

    Demand for mifepristone is up across all types of customers, including clinics, pharmacies and individual providers, said Abby Long, Danco’s director of public affairs. But Massachusetts is the only state that has requested an especially large number of pills from the company.

    Maine Gov. Janet Mills, who called the Texas decision “reckless” and a “fundamental assault on women’s rights,” said Monday that her administration is evaluating its options, “including procuring mifepristone if needed, to protect access to medication abortion for Maine women.”

    The Connecticut governor’s office said Wednesday that it is also monitoring the situation.

    Oregon Gov. Tina Kotek’s office said in an email Wednesday that she has directed the Oregon Health Authority to “explore all available avenues for ensuring Oregon is prepared should Mifepristone become less available. That includes evaluating the supply of Mifepristone and Misoprostol and consulting with providers to better understand the potential impact on the provision of abortion and reproductive health care and what additional support might be necessary.”



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    ‘It just didn’t enter my mind to initiate sex;’ Low sex drive in men linked to chemical imbalance | CNN

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    CNN
     — 

    While hanging out with his college roommates, Peter (not his real name) realized he felt differently about sex than other heterosexual men.

    “I’ve never been somebody who was interested in pornography, but I’d laugh along with their jokes,” said Peter, now 44, who is British. “Of course I never mentioned that … as a man, you’d be kicked out of the herd.”

    As he developed “proper, serious relationships” with women, Peter discovered he didn’t have the sexual drive many of his partners did.

    “I would make excuses around getting tired or feeling stressed, that kind of thing,” he said. “It wasn’t an issue with attraction to my partner. It just didn’t enter my mind to initiate sex.”

    In 2021, Peter saw an ad recruiting male volunteers for a new study on hypoactive sexual desire disorder, or HSDD. Researchers planned to inject the study’s participants with kisspeptin —a naturally occurring sexual hormone — to see if it increased their sex drive. Kisspeptin plays a key role in reproduction; without adequate levels of the hormone children do not go through puberty, for example.

    In a long-term, committed relationship with a woman he says has a higher sexual appetite, Peter signed up, intrigued by the thought that a biological imbalance might help explain his behavior.

    In the week after the final session, Peter said, something amazing occurred.

    “All of a sudden, I wanted to initiate intimacy. I can only presume it was driven not by my mind remembering something, but my body wanting something,” he said. “I did initiate sex more and it improved things with my partner incredibly.”

    Experts believe HSDD affects at least 10% of women and up to 8% of men, although those numbers may be low, said Stanley Althof, a professor emeritus of psychology at Case Western Reserve University School of Medicine in Cleveland, Ohio and executive director of the Center for Marital and Sexual Health of South Florida.

    “Men are embarrassed to go to the doctor to begin with, and you’re supposed to be a macho guy,” said Althof, who was not involved in the kisspeptin study.

    “So it’s difficult for men to say, ‘Hey, I’ve got a problem with my sex drive.’ That’s why the majority of male patients I see with HSDD are sent in by their partners.”

    To be diagnosed with the disorder, a person must have no other issues that might cause a change in libido, such as erectile dysfunction or premature ejaculation.

    “Losing interest due to performance issues is common, but HSDD is its own thing,” Althof said. “It’s an absence of erotic thoughts and a lack of desire for sex that has to be present for six months. It also cannot be better explained by another disorder or other stressors: It can’t be due to depression. It can’t be due to a bad relationship. It can’t be due to taking an antidepressant.”

    One more key point: A man or woman must have clinically significant distress to have HSDD, said clinical psychologist Dr. Sheryl Kingsberg, a professor in reproductive biology and psychiatry at Case Western Reserve University, who was also not involved in the kisspeptin study.

    “Some people aren’t bothered by their lack of interest in sex, so we wouldn’t treat them for HSDD,” said Kingsberg, who is also chief of behavioral medicine at MacDonald Women’s Hospital and University Hospitals Cleveland Medical Center.

    “The women coming into my office are deeply distressed,” she said. “They tell me ‘I used to have desire but it’s gone. I could be on a desert island with no pressures, but I just don’t have the appetite. I want it back.’ Those women have HSDD.”

    Dr. Waljit Dhillo, a professor in endocrinology and metabolism at Imperial College London, has been studying the relationship between low sexual desire and the hormone kisspeptin for years, first in animals, then in people.

    Prior studies by Dhillo of healthy men with no libido problems found giving them kisspeptin boosted levels of testosterone and luteinizing hormone, which is important for gonad function.

    His newest study, published in the journal JAMA Network Open in February, enrolled 32 men with verified HSDD. Peter was one of them.

    “So many people say to themselves, ‘It’s just me. I’ve got a problem.’ But actually, HSDD may be how your brain is wired,” said Dhillo, who is a dean at the United Kingdom’s National Institute for Health and Care Research Academy in Newcastle upon Tyne.

    “The biology is telling us there’s increased activation of inhibitory areas in the brain — the same areas that tell us it’s not OK to walk around in public naked — and those areas are switching off sexual desire. How can we tackle that? We give a hormone that would naturally give you increased sexual desire, essentially hijacking the normal system.”

    The men participating in the new study visited Dhillo’s lab twice. On each occasion, they were fitted with a device to objectively measure arousal, given an injection and asked to watch pornography while their brains were scanned via functional magnetic resonance imaging (fMRI).

    Neither the subjects or the researchers knew if that day’s injection was kisspeptin or a placebo.

    “It was extraordinarily surreal, lying there with something resembling a hangman’s noose around your bits and watching a mixture of ’70s to modern-day pornographic images and videos,” Peter said. “You’d get about five or six seconds of one type of image or video, rate your arousal for the researchers, and then move on to the next.”

    Brain scans showed a significant dual effect after the kisspeptin injection, Dhillo said. Activity in the areas of the brain that inhibit behavior slowed, while areas of the brain connected to sexual interest lit up.

    “As a group, the men had a 56% higher sexual response to sexual images after the kisspeptin than the placebo,” Dhillo said. “And we found no side effects at the very, very small dose that we are using.”

    Peter noticed a difference immediately after finishing the treatments. His sex life was so robust, in fact, that it wasn’t long before his partner was pregnant with their first child.

    As published, the study did not follow the men long-term to see if the effects of kisspeptin lasted. For Peter, however, its impact has been life-changing.

    “I have found there’s been a lasting effect for me,” he said. “I do find I have a much better sexual appetite even now some years after the treatment.”

    Even the arrival of a baby boy didn’t deter his new interest in sex.

    “The cliche is when you have kids, your sex life takes a bit of a hit,” he told CNN. “But that hasn’t been the case for us. In fact, we’re pregnant with our second child, due in July.”

    While Peter had a positive long-term result, it’s too soon to say kisspeptin injections were the reason, Althof said.

    “When you hear dramatic results like Peter’s, I would be cautious in saying that is the typical outcome. While it’s wonderful that it happened for him, these fMRI studies are difficult to interpret and not conclusive,” he said.

    “Sexual desire is very complicated — I say it’s a combination of brain function, hormones and love, wine and roses,” Althof added. “This study is promising, but it needs replication in larger groups.”

    And even if future research does confirm kisspeptin’s benefits, medical treatment is not a substitution for healthy communication about sex between partners and with health care providers, Dhillo said.

    “These are society’s taboos, but actually, the more we talk about real (sexual) issues that affect real people, the more we find it’s actually quite common,” he said.”If you’re not troubled by low libido, it’s not an issue at all, but if you are troubled by it, this can lead to marital breakdown, unhappiness and reduced quality of life.”

    Study: Climate change is killing our sex drive

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    EPA proposes new regulations on toxic gas used to sterilize spices and medical equipment | CNN

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    CNN
     — 

    The US Environmental Protection Agency on Tuesday proposed a set of new restrictions on facilities that use the cancer-causing chemical ethylene oxide, a colorless, odorless gas that is used to sterilize medical devices and spices.

    The agency said the new rules, which have not been finalized, would help to reduce ethylene oxide gas that these facilities release by 80%, bringing emissions below a Clean Air Act standard for elevated cancer risk.

    Communities exposed to ethylene oxide gas have been pushing the EPA to put tighter controls on plants that use ethylene oxide gas.

    In 2018, an EPA report found that dozens of communities across the nation faced elevated cancer risks because of trace of amounts of ethylene oxide released into air as part of the sterilization process.

    The EPA issued the report on the new risks without issuing a news release, as it had done for the same report in years past. Some affected communities learned of the risk through a health assessment conducted by the Agency for Toxic Substances and Disease Registry, a division of the US Centers for Disease Control and Prevention, and media reports. A report from the EPA’s Office of the Inspector General found that some communities weren’t alerted to their risk by EPA at all.

    The elevated risk became apparent after a two-decade long review of the toxicity of ethylene oxide by scientists in EPA’s Integrated Risk Information System (IRIS) program.

    While the EPA acknowledged that ethylene oxide was more dangerous that had been previously understood, it continued to use an older set of rules to regulate facilities that released ethylene oxide as well as companies that manufacture it.

    The proposed rules aim to better align regulations on the producers and users of ethylene oxide with the cancer risk posed by the chemical. They follow a set of proposed rules issued by EPA last week that would put new controls on facilities that manufacture ethylene oxide.

    Taken together, the two sets of rules would remove 77 tons of ethylene oxide emissions a year, an 84% reduction compared with 2020 levels, EPA Deputy Administrator Janet McCabe said in a call with reporters on Tuesday.

    Environmental watchdog groups applauded the proposed restrictions, but noted that they don’t go far enough to protect vulnerable communities, where residents are often low-income and disproportionately people of color.

    “These regulations are long overdue, by almost a decade. I’m relieved and pleased that the EPA has finally issued proposed standards that are based on their own scientists’ recommendations on an updated, higher cancer risk value. If enacted, these updated regulations would reduce emissions in fenceline communities,” said Darya Minovi, a senior researcher scientist at the Union of Concerned Scientists.

    “When the EPA issues the final rule, they should throw the net wider. The standard should cover a larger range of facilities to include off-site warehouses that often store recently sterilized equipment that continue to release ethylene oxide, but aren’t regulated for their air emissions.”

    Minovi also said the EPA should require fenceline monitors – devices that constantly read the air outside of facilities to make sure that toxic gas isn’t drifting into neighborhoods.

    Jaime Rukstales, a member of the Illinois grassroots advocacy group Stop EtO in Lake County – one of the communities impacted by ethylene oxide pollution – says the EPA needs to impose tougher restrictions on “all types of facilities that impact the health of our communities … including sterilizers, manufacturers and warehouses near our homes, schools and businesses.”

    Some off-site warehouses used to store newly sterilized products have registered high levels of ethylene oxide due to off-gassing of the products.

    Meanwhile, chemical manufacturers sued the EPA in February over its updated hazard assessment for ethylene oxide. The industry wants the agency to use a less protective standard developed by the Texas Commission on Environmental Quality.

    AdvaMed, a group that lobbies for the interests of medical device manufacturers, warned that more regulations could pose problems for patients.

    “If new EPA regulations force sterilization facilities to close, patients could face treatment delays as sterile technology supplies, such as pacemakers and surgical equipment, fall short,” Scott Whitaker, president and CEO of AdvaMed, said in a comment posted on the group’s website.

    The EPA said some commercial sterilizers have already made the planned changes.

    “Many sterilization and health care facilities are already taking the steps outlined in the proposal and have seen emissions drop significantly,” McCabe said.

    Most facilities have taken action to control ethylene oxide blown out of sterilization chambers through exhaust vents known as “back vents” but only 25% to 33% of sterilizers are controlling so-called fugitive emissions, ethylene oxide that escapes or leaks into room air, said Jonathan Witt, an environmental engineer and technical lead on EPA’s review of the National Emissions Standards for Hazardous Air Pollutants.

    “So we think it’s a good sizable chunk of the industry, but still a little ways to go,” Witt said on a call with reporters.

    If the rules go into effect, sterilizers would have 18 months to make the changes, which the EPA said is an accelerated time frame under the Clean Air Act.

    AdvaMed’s Whitaker says that’s not enough time.

    “It could take many months for abatement equipment to arrive. Supply chains and manufacturing are still recovering from the pandemic,” he noted in the statement.

    In issuing the proposed rules, the EPA said it aimed to strike a balance between lowing cancer risks for impacted communities and workers who use ethylene oxide while preserving “critical sterilization capabilities.”

    The proposed rules would apply to 86 commercial sterilization facilities in the United States that use ethylene oxide gas to fumigate spices and medical devices.

    The EPA says 20 billion medical devices – mostly single-use, disposable items used in health care such as catheters, gloves and surgical gowns – are sterilized using ethylene oxide.

    The US Food and Drug Administration is actively exploring alternatives to the use of the gas, the EPA said on Tuesday, but some devices still can’t be sterilized any other way.

    In proposing the new rules, EPA said its new analysis found that exposure to ethylene oxide, or EtO, on the job significantly increased cancer risks for workers in sterilization facilities and those who apply ethylene oxide in health care facilities.

    “Now, a new EPA analysis shows that there may also be significant risks to workers who handle [ethylene oxide] and people who live, work or go to school near places where EtO is used in sterilization. And failing to take action to address these risks is simply unacceptable,” EPA Administrator Janet McCabe said on a call with reporters.

    The additional lifetime cancer risk for a worker exposed to ethylene oxide for eight hours a day, 240 days a year for 35 years was between 1 in 10 and 1 in 36 for workers in sterilization facilities; and between 1 in 12 and 1 in 25 for workers exposed to ethylene oxide in health care facilities.

    To help lower those risks, the proposed rules require greater use of personal protective equipment for workers and new controls to decrease the amount of ethylene oxide in indoor air.

    Whitaker from AdvaMed, the medical device industry group, said the cancer risk for employees exposed to ethylene oxide on the job is overstated and disregards “the strong employee protections already in practice.”

    Companies will also be required to use new real-time monitoring methods to confirm that these pollution controls are working inside facilities. These controls can measure ethylene oxide in indoor air down to 10 parts per billion. If ethylene oxide levels climb above this threshold, everyone in the workplace would be required to wear protective equipment.

    They will also lower the amount of ethylene oxide that can be used for each sterilization cycle. The EPA is proposing to limit the application rate for ethylene oxide to no more than 500 milligrams per liter of air.

    The rules would eliminate some niche uses of ethylene oxide where alternatives exist, including its use in museums, archival settings, beekeeping, some cosmetics, and in musical instruments.

    The EPA will take public comment on the new rules for 60 days. The agency will also host a virtual public webinar on May 1 to discuss its proposed rules and new risk assessment.

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    Whether you’re a ‘shark,’ ‘teddy bear’ or ‘fox,’ here’s how to ease conflict with family and friends | CNN

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    Editor’s Note: The views expressed in this commentary are solely those of the writers. CNN is showcasing the work of The Conversation, a collaboration between journalists and academics to provide news analysis and commentary. The content is produced solely by The Conversation.



    The Conversation
     — 

    For all the joy they bring, families and close friendships often involve conflict, betrayal, regret and resentment. Prince Harry’s recent memoir, “Spare,” is a reminder of the fact that the people closest to us often have the greatest power to hurt us. He describes power struggles, conflict, challenging family dynamics and decades of guilt, jealousy and resentment.

    This sort of conflict can feel impossible to resolve. It’s not easy to move past, and sometimes it simply isn’t going to happen — at least in the short term. But psychology has helped us understand more about the breakdown of close relationships and what factors make resolution more likely.

    In the course of a lifetime, it is difficult to avoid hurting, upsetting or being in conflict with people we love. It is an inevitable part of most lives, and learning how to negotiate it is a more useful and realistic goal than avoiding it. The first step is understanding what makes relationship conflict so difficult and the different approaches people have to it.

    Canadian psychologists Judy Makinen and Susan Johnson have used the term attachment injuries to describe the sorts of wounds inflicted when we perceive that we have been abandoned, betrayed or mistreated by those closest to us.

    These wounds sting so sharply because they lead us to question the safety, dependability or allegiance of these people. They trigger a myriad of emotional and behavioral responses, including aggression, resentment, fear, avoidance and reluctance to forgive. These responses have evolved as self-protection and are rooted to our personal histories and personality.

    But the pain can linger indefinitely, continuing to influence us from the shadows. So what have psychologists learned about how people heal, move through the hurt and even learn and grow from it?

    READ MORE: ‘Love languages’ might help you understand your partner — but it’s not exactly science

    Much research has been carried out studying conflict resolution. Social psychologist David W. Johnson studied conflict management “styles” in humans and modeled the typical ways we respond to conflict.

    He argued that our responses and strategies in conflict resolution tend to involve an attempt to balance our own concerns (our goals) with the concerns of the other people involved (their goals and preservation of the relationship).

    Johnson outlined five main styles or approaches to this balancing act.

    • “Turtles” withdraw, abandoning both their own goals and the relationship. The result tends to be frozen, unresolved conflict.
    • “Sharks” have an aggressive, forceful take and protect their own goals at all costs. They tend to attack, intimidate and overwhelm during conflict.
    • “Teddy bears” seek to keep the peace and smooth things over. They drop their own goals completely. They sacrifice for the sake of the relationship.
    • “Foxes” adopt a compromising style. They are concerned with sacrifices being made on both sides and see concession as the solution, even when it results in less-than-ideal outcomes for both sides.
    • “Owls” adopt a style that views conflict as a problem to be resolved. They are open to solving it through whichever solutions offer both parties a pathway to achieve their goals and maintain the relationship. This can involve considerable time and effort. But owls are willing to endure the struggle.

    READ MORE: Moving in with your partner? Talking about these 3 things first can smooth the way, according to a couples therapist

    Research has suggested that our conflict resolution styles are related to our personalities and attachment histories. For example, people whose early attachment experiences taught them that their feelings are unimportant or invisible may be more likely to develop conflict management styles that instinctively minimize their needs (for example, the teddy bear).

    Some psychologists have also suggested that our conflict management styles can be modified in long-term relationships but do not tend to change dramatically. In other words, while a teddy bear may have the potential to develop conflict management characteristics that reflect other styles, they are highly unlikely to turn into a shark.

    Psychologists Richard Mackey, Matthew Diemer and Bernard O’Brien argued conflict is inevitable in all relationships. Their research found the duration of a relationship heavily depends upon how conflict is dealt with, and the longest-lasting, most fulfilling relationships are those in which conflict is accepted and constructively approached by both parties.

    So, while a relationship between two sharks might be enduring, the likelihood that it will be harmonious is significantly less compared with a relationship between two owls.

    READ MORE: Should I stay or should I go? Here are the factors people ponder when deciding to break up

    Forgiveness is often hailed as the ultimate goal in relationship conflict. Jungian analysts Lisa Marchiano, Joseph Lee and Deborah Stewart describe forgiveness as reaching a place where we are able to “hold in our hearts at the same time, the magnitude of the injury that has been done to us and the humanity of the injurer.” That’s not an easy place to reach because it can feel as though we are minimizing our suffering by forgiving someone.

    Psychologists Masi Noor and Marina Cantacuzino founded the Forgiveness Project, which provides resources to help people overcome unresolved grievances. They include a set of essential skills or tools that they argue can help us reach forgiveness.

    These include understanding that all humans are fallible (including ourselves), giving up competing over who has suffered more, finding empathy for how others see the world and acknowledging that other perspectives exist, and accepting responsibility for how we might have contributed to our own suffering, even if it’s a bitter pill to swallow.

    As Mark Twain put it: “Forgiveness is the fragrance that the violet sheds on the heel that has crushed it.”

    READ MORE: Sex, love and companionship … with AI? Why human-machine relationships could go mainstream

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    How safe is the abortion pill compared with other common drugs | CNN

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    CNN
     — 

    A federal judge in Texas ruled on Friday to suspend the Food and Drug Administration’s approval of mifepristone, the first drug in the medication abortion process, nationwide by the end of this week.

    The judge sided with the coalition of anti-abortion national medical associations that filed the lawsuit. He argued that the FDA failed to adequately consider risks associated with the drug, including “the intense psychological trauma and post-traumatic stress women often experience from chemical abortion.”

    However, data analyzed by CNN shows mifepristone is even safer than some common, low-risk prescription drugs, including penicillin and Viagra. There were five deaths associated with mifepristone use for every 1 million people in the US who have used the drug since its approval in 2000, according to the US Food and Drug Administration as of last summer. That’s a death rate of 0.0005%.

    Comparatively, the risk of death by penicillin — a common antibiotic used to treat bacterial infections like pneumonia — is four times greater than it is for mifepristone, according to a study on life-threatening allergic reactions. Risk of death by taking Viagra — used to treat erectile dysfunction — is nearly 10 times greater, according to a study cited in the amicus brief filed by the FDA.

    “[Mifepristone] has been used for over 20 years by over five million people with the capacity to become pregnant,” said Ushma Upadhyay, an associate professor in the department of obstetrics, gynecology and reproductive science at the University of California, San Francisco. “Its safety is very well established.”

    The Justice Department, the FDA, and Danco — a manufacturer of mifepristone that intervened in the case — have already appealed the ruling.

    Within hours of the decision in Texas, a federal judge in Washington state issued a conflicting ruling that the federal government must keep mifepristone available in the 17 Democrat-led states and the District of Columbia that had sued in a separate lawsuit.

    If the Texas ruling is allowed to take effect this week, 40 million more women of reproductive age would lose access to medication abortion care around the country, according to data from abortion rights advocacy group NARAL Pro-Choice America. That’s in addition to the 24.5 million women of reproductive age living in states with abortion bans.

    “The court’s disregard for well-established scientific facts in favor of speculative allegations and ideological assertions will cause harm to our patients and undermines the health of the nation,” said Dr. Jack Resneck, Jr., president of the American Medical Association, in a statement. “By rejecting medical facts, the court has intruded into the exam room and has intervened in decisions that belong to patients and physicians.”

    Medication abortion has become the most common method for abortion, accounting for more than half of all US abortions in 2020, according to the Guttmacher Institute.

    The growing popularity of medication abortion is largely because of its accessibility, said Abigail Aiken, associate professor at the University of Texas at Austin who leads a research group on medication abortion.

    “It reduces the cost, it reduces barriers where people may not want to go to a clinic,” she said.

    It is also a safer option than both procedural abortion or childbirth. The rate of major complications — like hemorrhages or infections — for medication abortions is about one-third of a percent, according to a 2015 study conducted by Upadhyay. That means out of more than 11,000 cases, 35 experienced any major complications.

    The likelihood of serious complications via procedural abortion — performed second-trimester or later — is slightly higher than medication abortion at 0.41%, according to the same study. And childbirth by far comes with the highest risk, at 1.3%.

    If access to mifepristone is cut off, abortion clinics and telehealth organizations could pivot to misoprostol-only abortions, Aiken told CNN. Although misoprostol-only abortions are used around the world, they are less effective, associated with a higher risk of serious complications and often more painful than the mifepristone and misoprostol combination, she said.

    In the latest study of self-managed misoprostol-only medication abortions in the US, Johnson found misoprostol-only abortions to be a safe alternative, though less safe than using both pills. The study, published in February, analyzed data from online telehealth medication abortion provider Aid Access from 2020. Nearly 90% of 568 users reported completed abortions and 2% experienced serious complications using only misoprostol.

    Mifepristone and misoprostol together is still considered the gold standard, Aiken told CNN. People who used the two-pill combination were less likely to experience serious complications than those who went with the misoprostol-only regimen.

    “It’s clear people can use these medications, mifepristone and misoprostol, at home even without the help of a medical professional very safely,” said Aiken.

    Because misoprostol is used to treat multiple ailments including stomach ulcers, it’s readily stocked in pharmacies and unlikely to be taken off the market anytime soon, Johnson told CNN.

    However, a lesser-effective method means more people will likely have unsuccessful abortions.

    “It’s possible that it might not work for some people, and it will prolong their abortions,” said Upadhyay. “Then by the time they get back to the clinic, they’re seeking abortion later in pregnancy.”

    Before the ruling, 19 states already restricted telehealth abortion care, limiting access to medication abortion. Nearly half of US adults were unsure whether medication abortion was currently legal in their state as of late-January, according to a survey conducted by the Kaiser Family Foundation. Experts say that confusion will only be exacerbated.

    “People are not going to be sure mifepristone or misoprostol in fact, is available. I think it’s going to be confusing,” said Aiken. “As people look around for options or feel unsure about their options, they may end up delaying [care].”

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    Why you keep having the same dream | CNN

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    Sign up for CNN’s Sleep, But Better newsletter series. Our seven-part guide has helpful hints to achieve better sleep.



    CNN
     — 

    For years, dreams of my teeth cracking, loosening or falling out plagued my sleep. Loved ones of mine have repeatedly dreamed of flying, rolling away in a self-operating car, or running late for school or work. These aren’t typical nightmares, which usually happen once. They’re some of the most common recurring dreams, which tend to lean negative and can take some work to overcome.

    “Recurring dreams are likelier to be about very profound life experiences or just very character logic issues that are kind of guaranteed to recur in waking life because they’re part of you rather than a one-time event,” said dream researcher Deirdre Barrett, a lecturer of psychology in the department of psychiatry at Harvard Medical School.

    Since our dreams typically don’t repeat themselves, all it takes is dreaming the same dream twice or more for it to be considered recurring, Barrett said. They’re more common in childhood, Barrett said, but can last into adulthood. And recurring dreams don’t always happen in close proximity to each other — they can pop up multiple times per month or years apart, Barrett said.

    Recurring dreams might be the same every time, or they might just recycle the same types of scenarios or worries, experts said.

    “It is difficult to assess the prevalence of recurrent dreams because it is not something that happens on a regular basis for most people,” said clinical psychologist Dr. Nirit Soffer-Dudek, a senior lecturer in the department of psychology at Ben-Gurion University of the Negev in Israel, via email. “And when people are asked about past dreams in their life, they may be influenced by memory distortions, interest in dreams (or lack thereof), or other factors.”

    Regardless, anything that comes up repeatedly is worth investigating, said sleep medicine specialist Dr. Alex Dimitriu, founder of Silicon Psych, a psychiatry and sleep medicine practice in Menlo Park, California.

    “People have this kind of touch-and-go approach with things that are uncomfortable or fear-inducing, and I think dreams are, in some way, the same way,” Dimitriu said. “As a psychiatrist, I’m inclined to say that there is some message that might be trying to be conveyed to you. And the answer, then, might be to figure out what that is. And I think when you do, you might be able to put the thing to rest.”

    Here’s how to figure out what’s triggering your recurring dreams.

    For some recurring dreams, the message is straightforward — if you repeatedly dream about running late for school or work, you’re probably just often nervous about being unprepared for those things. But others, despite their commonness, might not have a universal meaning, requiring you do some soul-searching to learn more.

    “In interpretation, we really don’t believe there are universal symbols, but that (it’s) what an individual’s own sort of personal symbol system is and their associations to something are,” Barrett said.

    In addition to unpreparedness, other common themes of recurring dreams include social embarrassment, feeling inadequate compared with others, and danger in the form of car crashes or natural disasters, Barrett and Dimitriu said.

    Some people have dreams revolving around test anxiety even if they haven’t been in school in years, Barrett said. This can reflect a general fear of failure or a sense of being judged by authority figures. Dreams of tooth loss or damage might have to do with loss of something else in your life, feelings of hopelessness or defenselessness, or health concerns.

    When faced with a recurring dream, ask yourself what the message could be, Dimitriu said. What is your relationship to the things or people in the dream? What are your fears and belief systems about those things? What are the top five things in your life that might be triggering it or related to it? What are you really worried about?

    “I definitely think it’s fine to do informal dream interpretation, either on your own or with a close, trusted person who may just sort of see things to question in it that you don’t,” Barrett said.

    People with post-traumatic stress disorder or anxiety are more likely to have recurring dreams, especially ones with anxious natures, Dimitriu said. A PTSD dream stems from a trauma so severe it keeps returning as a nightmare.

    “The brain is trying to resolve something and lay it to rest,” he added. But “in people with PTSD, their dreams are so vivid that they wake them up from sleep. And that becomes the problem because the dream never gets processed. … And that’s why it recurs — it’s unfinished work.”

    Sometimes recurring dreams can point to biological sources, too. “People with sleep apnea will report dreams of, like, drowning, suffocating, giant waves, gasping for air, being underwater or being choked,” Dimitriu said, when they’re actually experiencing breathing interruptions because of their condition.

    There can be environmental triggers as well, such as a car alarm down the street or a dripping faucet, he added, which can set off dreams with imagery of those things.

    Once you have a better sense of what your worries are, writing about them before bed can be helpful for alleviating negative recurring dreams and stress in general.

    “For my patients and myself, journaling is such a powerful tool,” Dimitriu said. Meditating could also help.

    When you know what fear is behind your dream, Dimitriu recommended processing it via a three-column method used in cognitive behavioral therapy: What is your automatic thought? What’s your automatic feeling? Lastly, what’s the more reality-based alternative thought?

    Dream rehearsal therapy, also known as imagery rehearsal therapy, can be effective for both recurring dreams and nightmares. This approach involves writing down in detail the narrative elements of the dream, then rewriting it so it ends positively. Right before falling asleep, you’d set the intention to re-dream by saying aloud, “If or when I have the beginnings of the same bad dream, I will be able to instead have this much better dream with a positive outcome.”

    If your recurring dreams are making you stressed or unhappy, causing other symptoms, or starting to impair your ability to function on a regular basis, it’s time to seek professional help, experts said.

    Recurring dreams could also stem from poor sleep hygiene, Soffer-Dudek said.

    “A lot of awkward things happen in the night when people are sleep deprived, drink caffeine too late, drink alcohol too late, worked too late or slept four hours last night because they stayed up too late,” he said. “The fundamental core and foundation of healthy dream life starts with healthy sleep.”

    Dimitriu also recommended limiting distractions that interfere with your time to reflect and process, such as spending unnecessary time on your phone or always filling the silence.

    When your mind is always occupied, “what happens is all that processing has to happen somewhere,” he said. “So now there’s more pressure for that to happen in your dream life.”

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