Saturday Sports: Women’s Soccer Team, Jay-Z

This week talks between U.S. Soccer and 28 female players broke down. Also, Jay-Z signed a deal with the NFL to be the league’s “live music entertainment strategist.”



SCOTT SIMON, HOST:

Finally, time for sports.

(SOUNDBITE OF MUSIC)

SIMON: Talks broke down this week between U.S. soccer and the women’s team who demand equal pay. And you know who Jay-Z’s newest collaborator is? We’re going to be joined now by NPR’s Tom Goldman, who is not his newest collaborator so far as I know. Not yet. Not yet is what I should say. Thanks for being with us, Tom.

TOM GOLDMAN, BYLINE: Always a pleasure.

SIMON: So the women’s national team walked out of mediation with U.S. Soccer Wednesday I believe over equal pay. What happened?

GOLDMAN: If you ask the women’s team members, U.S. Soccer wasn’t interested in talking about equal pay, specifically, paying the women bonuses that match the men’s players. And if you ask U.S. Soccer, talks broke down because the women’s attorneys were, quote, “aggressive and unproductive after presenting misleading information to the public,” end quote. So, Scott, both sides are angry. No talks scheduled at this time. And the gender discrimination lawsuit the women filed against U.S. Soccer back in March may be heading to trial.

SIMON: In 2019, what kind of argument does U.S. Soccer – how shall I put this nicely? – pretend to make against equal pay?

GOLDMAN: (Laughter) Well, they’re arguing the women are compensated fairly although differently than the men. And they have a whole bunch of numbers that they say back that up. Politico first reported that U.S. Soccer even hired lobbyists to try to convince lawmakers in D.C. that the Federation is in the right. But, you know, engaging in this public battle appears to be self-defeating for the U.S. – for U.S. soccer. I mean, the women players, as you well know, are the best thing going for the sport in this country.

SIMON: Yeah.

GOLDMAN: They are wildly popular. They have the potential to help spread the game from the grassroots on up, and the Federation isn’t going to win the battle of public opinion. Critics say U.S. Soccer should pay women what they’re asking, fully get on their side, which appears to be the winning side, both on and off the pitch.

SIMON: I mean, many a problem in sports is solved by throwing money at it. And I wonder why they don’t do it now. Jay-Z. His newest collaborator’s the NFL. How? Why?

GOLDMAN: (Laughter) It’s a new deal between the league and Jay-Z’s entertainment and sports company Roc Nation. They’re going to work together on the Super Bowl halftime show. And Roc Nation reportedly will help promote NFL programs dedicated to social change. These are programs that grew out of the protests during national anthems by former player Colin Kaepernick and others. And as you might imagine, this alliance is creating a ton of controversy.

SIMON: Well – and Jay-Z has – I believe is a big buddy of Colin Kaepernick. But is it cheaper for the NFL to do business with Jay-Z than it is to actually get a job for Colin Kaepernick?

GOLDMAN: There’s the million – however-many-million-dollar question, you know? Jay-Z has been a big supporter of Kaepernick’s and a critic of the NFL for the way teams have apparently blackballed the former quarterback. Jay-Z says there’s a time for protests, but now is the time for action. He’s saying this collaboration can do a lot more good for the social issues that are at the heart of the player protests.

But, you know, he’s getting a lot of flak. Current NFL safety Eric Reid, who started kneeling in protest with Kaepernick back in 2016 – he has criticized Jay-Z for saying, essentially, we’ve moved past kneeling. And Reid called the collaboration a money move. The NFL’s being criticized, too, for making a cynical grab for more African American fans it lost because of the Kaepernick controversy, which, Scott, appears to be with us still as we head into a new NFL season in about three weeks. Reid plays for Carolina. He continues to kneel during the anthem. Kaepernick posted a video, recently, showing him working out and noting he’s still without a job after three years.

SIMON: Tom Goldman, thanks so much.

GOLDMAN: You’re welcome.

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.

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German Group Aims To Use Soccer To Empower Female Athletes

A German group gets women from around the world to play soccer — something that’s not so easy for those coming from Iran and other places where it’s considered a male pastime.



SCOTT SIMON, HOST:

Despite the celebrated successes at the U.S. women’s team, soccer – or football, as they call it in most of the world – is seen as a man’s sport. In Berlin, an organization called Discover Football wants to embolden women athletes. As NPR’s Deborah Amos reports, eight teams gathered to lace up and speak out.

UNIDENTIFIED PERSON #1: (Cheering)

SIMON: For a decade now, Discover Football has connected women who have a passion to compete. More than a hundred women – coaches, referees, players – come from countries where apathy and downright hostility make it hard for women to come together to kick around a ball.

UNIDENTIFIED PERSON #1: Welcome to the opening ceremony of the 8th Discover Football Festival here in Berlin.

(APPLAUSE)

DEBORAH AMOS, BYLINE: They gather in Berlin to tackle problems on and off the field. For Sonia Slepcev and her team from Serbia, the challenge is to build talent early. But that means convincing young girls that soccer is for them.

SONIA SLEPCEV: We have a lot of stereotypes that women should not play football because it is all-male sports.

AMOS: She got her start playing neighborhood ball with boys. She joined a semi-professional women’s league before college. But she says the biggest barrier to women playing soccer is often women.

SLEPCEV: My friends from school – they were like, why do you play football? Are you a boy? Or – it’s hurtful, I think.

AMOS: The Iranian team came late. Their visas were delayed. But Iran now has a dozen national women’s soccer teams. And that’s progress, says Mahnaz Zokaee, an Iranian soccer referee. But still, the women’s matches aren’t allowed on Iranian TV.

MAHNAZ ZOKAEE: In Iran, we can just watch the men’s matches, not women match, you know? – but just follows in the Internet and, you know, in the Web.

AMOS: So you’re a crazy sports fan.

ZOKAEE: Yeah (laughter).

AMOS: She’s a big fan of the American women’s soccer team that won this year’s World Cup but no fan of American politics and the punishing economic sanctions imposed on her homeland by President Trump, which even touched her sport, she says, when she wasn’t allowed to wear her Nike gear as a professional referee in the 2018 Asian Games.

ZOKAEE: All of the Iranian referees are forbidden to wear the – Nike’s clothes in their international matches.

AMOS: What do you think about that?

ZOKAEE: I think it’s not fair. I think the sanction influenced it.

UNIDENTIFIED PERSON #2: Talk to each other, guys – communication.

AMOS: The theme of this festival is fair play, as the Iranian referee points out, a feature in sports but rarely in international politics. There are other links here to the political playing fields.

UNIDENTIFIED PERSON #3: (Chanting) Hello.

UNIDENTIFIED PLAYERS: (Chanting) Hi.

UNIDENTIFIED PERSON #3: (Chanting) Hello.

UNIDENTIFIED PLAYERS: (Chanting) Hi.

AMOS: This energetic team is called Players Without Borders. All of them are refugees in Berlin. Many are playing soccer for the very first time. It’s a milestone, says Dana Rosiger (ph). It’s why she’s worked for this organization for a decade. But she says women still have to speak out, like the American World Cup winners.

DANA ROSIGER: It was really good that America won this year because they have strong voices. And we need the strong voices. We still need to fight.

AMOS: It wasn’t until 1970 that the German Football Association lifted a ban on women’s soccer. And it took decades for the German team to catch up. The women’s team finally won the World Cup twice in 2003 and 2007. But despite the success, the German team still doesn’t get proper support, says Rosiger.

ROSIGER: Start with fair payments. Start with access to trainings. Most of the teams – they have a job besides to the – their football training.

AMOS: Restrictions that every player here has faced, which is why the bonds are so strong after a week on the field.

ROSIGER: Some are playing behind the doors or not visible at all until they get here – until they get here – and not to worry about what the consequences are.

AMOS: And here in Berlin, everybody plays to cheering fans, no matter the rules back home. Deborah Amos, NPR News, Berlin.

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.

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Creative Recruiting Helps Rural Hospitals Overcome Doctor Shortages

The wide-open spaces of Arco, Idaho, appeal to some doctors with a love of the outdoors.



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In the central Idaho community of Arco, where Lost Rivers Medical Center is located, the elk and bear outnumber the human population of a thousand. The view from the hospital is flat grassland surrounded by mountain ranges that make for formidable driving in wintertime.

“We’re actually considered a frontier area, which I didn’t even know was a census designation until I moved there,” says Brad Huerta, CEO of the hospital. “I didn’t think there’s anything more rural than rural.”

There are no stoplights in the area. Nor is there a Costco, a Starbucks or — more critically — a surgeon. With 63 full-time employees, the hospital is the county’s largest employer, serving an area larger than Rhode Island.

Six years ago, the hospital declared bankruptcy and was on the cusp of closing. Like many other rural hospitals, it was beset by challenges, including chronic difficulties recruiting medical staff willing to live and work in remote, sparsely populated communities. A hot job market made that even harder.

But against the odds, Huerta has turned Lost Rivers around. He trimmed budgets, but also invested in new technologies and services. And he focused on recruitment.

Kearny County Hospital CEO Benjamin Anderson, left, and Bradley Huerta, CEO of Lost Rivers Medical Center.

Courtesy of Becky Chappel and Bradley Huerta


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Courtesy of Becky Chappel and Bradley Huerta

He targeted older physicians — semiretired empty nesters willing to work part time. He also lured recruits using the area’s best asset: the great outdoors.

“You like mountain climbing, we’re gonna go mountain climbing,” says Huerta, who also uses his local connections to take recruits and their families on ATV tours or flights on small planes, if they’re interested. “The big joke in health care is you don’t recruit the person you recruit their spouse.”

Huerta’s approach has paid off; Lost Rivers is now fully staffed.

Recruitment is a life or death issue, not just for patients in those areas, but for the hospitals themselves, says Alan Morgan, CEO of the National Rural Health Association. Over the last decade, more than 100 rural hospitals have closed, he says, and over the next decade, another 700 more are at risk.

“Keeping access to health care in rural America is simply a challenge no matter how you look at it, but this shortage of rural health care professionals just is an unfortunate driving issue towards more closures,” Morgan says.

And that’s affecting the health of rural communities. “Most certainly the workforce shortages in rural America are contributing towards the decreased life expectancy that we’re seeing in rural America,” he says.

For some rural hospitals, that dire need is the basis of their recruiting pitch: Come here. Make a difference.

That is the crux of Benjamin Anderson’s approach at Kearny County Hospital in the southwestern Kansas town of Lakin.

With a population of about 2,000, last year The Washington Post ranked Lakin one of the country’s most “middle of nowhere” places.

Anderson says he’s found success targeting people motivated by mission over money: “A person that is driven toward the relief of human suffering and the pursuit of justice and equity.”

It’s not that the hospital ignores practical concerns. Hospital staff often house-hunt for recruits, or manage home renovations for incoming workers. Anderson, who isn’t a doctor, also personally babysits the children of his staff, because Lakin lacks nanny services.

“I mean as a CEO I do a lot of different things, but that’s among the most important, because it communicates we love you,” Anderson says. “We’re gonna live in a remote area but we’re gonna live here and support each other.”

But the cornerstone of the hospital’s recruitment pitch is 10 weeks of paid sabbatical a year, which allows time for doctors to serve on medical missions overseas.

Anderson says he came to appreciate the draw of that after a mentor told him, “Go with them and see what motivates them; see why they would want to go there.” Anderson did. It not only changed his life, he says, “I realized that in rural Kansas we have more in common with rural Zimbabwe than we do with Boston, Mass.”

It’s a compelling enough draw that every couple of weeks, Anderson gets a call from physicians saying they want to work in Lakin, despite its remoteness.

One of those callers was Dr. Daniel Linville. He’d read about Kearny County Hospital and its sabbaticals in a magazine article during medical school. Last fall, Linville joined the hospital, having done mission work since childhood in Ecuador, Kenya and Belize.

He says he and his physician wife were also drawn to the surprisingly diverse population Kearny County Hospital serves, including immigrants from Somalia, Vietnam, Laos and Guatemala. In that sense, says Linville, every day feels like an international medical mission, requiring everything from delivering babies to treating dementia.

But life in Lakin also been an adjustment.

“Now that we’ve been out here practicing for a little bit, we realize exactly how rural we are,” Linville says. It’s not just that same-day shipping takes four days; transferring a patient to the next biggest hospital in Wichita means the ambulance and staff are gone for an 8-hour round-trip ride.

And, in an incredibly tight-knit community where he is a newcomer, he’s often reminded that patients see him as another doctor just passing through.

“We’re seen a little bit as outsiders,” Linville says. “We get asked frequently: ‘How long are you here for?’ “

I don’t know, he tells them. But for now, I’m happy.

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‘Cadillac Tax’ On Generous Health Plans May Be Headed To Congressional Junkyard

The ‘Cadillac tax,’ an enacted but not yet implemented part of the Affordable Care Act, is a 40% tax on the most generous employer-provided health insurance plans — those that cost more than $11,200 per year for an individual policy or $30,150 for family coverage.

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Andrew Harrer/Bloomberg Creative/Getty Images

The politics of health care are changing. And one of the most controversial parts of the Affordable Care Act — the so-called “Cadillac tax” — may be about to change with it.

The Cadillac tax is a 40% tax on the most generous employer-provided health insurance plans — those that cost more than $11,200 per year for an individual policy or $30,150 for family coverage. It was a tax on employers, and was supposed to take effect in 2018 — but Congress has delayed implementation twice.

And the House, now controlled by Democrats, recently voted overwhelmingly — 419 to 6 — to repeal that part of the ACA entirely. A Senate companion bill is bipartisan and now has a total of 61 cosponsors — more than enough to ensure passage.

The tax was always an unpopular and controversial part of the 2010 health law, because the expectation was that employers would cut benefits to avoid the tax. Still, ACA backers initially said the tax was necessary to help pay for the law’s nearly $1 trillion cost and help stem the use of what was seen as potentially unnecessary care.

In the ensuing years, however, public opinion has shifted decisively, as premiums and out-of-pocket costs for patients have soared. Now the biggest health issue is not how much the nation is spending on health care, but how much individuals are.

“Voters deeply care about health care, still,” says Heather Meade, a spokeswoman for the Alliance to Fight the 40, a coalition of business, labor and patient advocacy groups urging repeal of the Cadillac tax. “But it is about their own personal cost and their ability to afford health care.”

Stan Dorn, a senior fellow at Families USA, recently wrote in the journal Health Affairs that the backers of the ACA thought the tax was necessary to sell the law to people concerned about its price tag, and to cut back on overly generous benefits that could drive up health costs. But transitions in health care, such the increasing use of high-deductible plans in the workplace, make that argument less compelling, he said.

“Nowadays, few observers would argue that [employer-sponsored insurance] gives most workers and their families excessive coverage,” he wrote.

The possibility that the tax might be implemented has been “casting a statutory shadow over 180 million Americans’ health plans, which we know, from HR administrators and employee reps in real life, has added pressure to shift coverage into higher-deductible plans,” says Rep. Joe Courtney, D-Conn. And that, he adds, “falls on the backs of working Americans.

Support or opposition to the Cadillac tax has never broken down cleanly along party lines. For example, economists from across the ideological spectrum supported its inclusion in the ACA, and many continue to endorse it.

“If people have insurance that pays for too much, they don’t have enough skin in the game. They may be too quick to seek professional medical care. They may too easily accede when physicians recommend superfluous tests and treatments,” wrote N. Gregory Mankiw, an economics adviser in the George W. Bush administration, and Lawrence Summers, an economic aide to President Barack Obama, in a 2015 column in the New York Times. “Such behavior can drive national health spending beyond what is necessary and desirable.”

At the same time, however, the tax has been bitterly opposed by organized labor, a key constituency for Democrats. “Many unions have been unable to bargain for higher wages, but they have been taking more generous health benefits, instead, for years,” says Robert Blendon, a professor at the Harvard School of Public Health who studies health and public opinion.

Now, unions say, those benefits are disappearing, with premiums, deductibles and other cost-sharing moves are rising as employers scramble to stay under the threshold for the impending tax.

“Employers are using the tax as justification to shift more costs to employees, raising costs for workers and their families,” said a letter to members of Congress from the Service Employees International Union in July.

Deductibles in health insurance plans have been rising for a number of reasons, the possibility of the tax among them. According to a 2018 survey by the federal government’s National Center for Health Statistics, nearly half of Americans under age 65 (47%) had high-deductible health plans. Those are plans that have deductibles of at least $1,350 for individual coverage or $2,700 for family coverage.

It’s not yet clear if the Senate will take up the House-passed bill, or one like it.

The senators leading the charge in that chamber — Mike Rounds, R-S.D., and Martin Heinrich, D-N.M., — have already written to Senate Majority Leader Mitch McConnell to urge him to bring the bill to the floor following the House’s overwhelming vote.

“At a time when health care expenses continue to go up, and Congress remains divided on many issues, the repeal of the Cadillac Tax is something that has true bipartisan support,” their letter said.

Still, there is opposition to repealing the tax. A letter to the Senate July 29 from health care economists and others argued that implementing it, instead, would “help curtail the growth of private health insurance premiums by encouraging employers to limit the costs of plans to the tax-free amount.” That letter also pointed out that repealing the tax “would add directly to the federal budget deficit, an estimated $197 billion over the next decade, according to the Joint Committee on Taxation.”

If McConnell does bring the bill up, there is little doubt it will pass, despite support for the tax from economists and budget watchdogs.

“When employers and employees agree in lockstep that they hate it, there are not enough economists out there to outvote them,” says former Senate GOP aide Rodney Whitlock, now a health care consultant.

Harvard professor Blendon agrees. “Voters are saying, ‘We want you to lower our health costs,'” he says. The Cadillac tax, at least for those affected by it, would do the opposite.

Kaiser Health News is a nonprofit, editorially independent program of the Kaiser Family Foundation, and is not affiliated with Kaiser Permanente.

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Newark’s Drinking Water Problem: Lead And Unreliable Filters

A Newark, N.J., resident carries a case of bottled water distributed Monday at a recreation center. The Environmental Protection Agency said residents shouldn’t rely on water filters the city gave out to address lead contamination.

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Kathy Willens/AP

Lead contamination in the drinking water in Newark, N.J., is not a new problem, but the city’s fleeting solution has become newly problematic.

Officials in Newark, the state’s largest city, which supplies water to some 280,000 people, began to hand out bottled water Monday.

That’s because the U.S. Environmental Protection Agency has concerns about water filters that the city distributed to residents.

Last fall, Newark gave out more than 40,000 water filters, even going door to door to reach families with lead service lines. The toxin is believed to have leached into drinking water through the old pipes between water treatment plants and people’s homes. Free filters and cartridges would remove 99% of lead, the city of Newark said.

But recent test results introduced an element of doubt about that claim. A regional administrator at the EPA sent a letter Friday to city officials, saying tests on two homes suggested the filters “may not be reliably effective.” Samples showed the filtered drinking water had lead levels exceeding 15 parts per billion, which is the federal and state standard, EPA regional administrator Peter Lopez said.

City leaders acknowledged the problem in the days that followed.

Gov. Phil Murphy and Mayor Ras Baraka, both Democrats, said in a joint statement that they were prepared to do “everything the City needs,” including doling out free water bottles.

They added that the city and state will need assistance from the federal government to provide and distribute the bottles.

In January, Baraka urged President Trump to help protect Newark’s fraught water infrastructure systems instead of funding a wall at the U.S. Southern border to deter migrants. “It will cost an estimated $70 million to replace the lead service lines in Newark,” Baraka said in a letter.

A spokesperson for Sen. Cory Booker, a former mayor of Newark and presidential candidate, told NPR that the senator had made efforts to address New Jersey’s water problem. “We’ll be sending a letter to the [EPA]” later on Tuesday with other federal lawmakers in New Jersey, “urging the EPA to help the city and state with distributing bottled water to its residents,” spokesperson Kristin Lynch said.

Booker also introduced the Water Infrastructure Funding Transfer Bill in May. He said the measure would give states flexibility to fund infrastructure projects. That bill’s passage was blocked in Congress, Lynch said.

Newark resident Emmett Coleman told USA Today that he spent an hour on Monday waiting for two cases of bottled water. “In the senior building, it’s bad,” he said. “All of us are sick or have problems, and we can’t drink the water. And the filters aren’t working.”

The distribution scene would have looked familiar to residents in Flint, Mich., who suffered from years of contaminated drinking water and subsisted on bottled water. And like Flint, Newark has a high poverty rate — about 28%, compared with the national rate of 12.3% in 2017, according to the Census Bureau.

About 15,000 homes in Newark had lead service lines that brought contaminated water to their residences, the city said in a statement. It advised residents to take precautions, including getting children’s blood tested for lead exposure.

The city will continue to test both the filters and filtered water.

The Natural Resources Defense Council and Newark Education Workers Caucus sued Newark and New Jersey state officials last year, accusing them of violating the federal Safe Drinking Water Act. “If it takes filing a lawsuit to end violations of federal drinking water law, we’ll do it,” Claire Woods, an attorney with NRDC, said at the time. That lawsuit is pending.

Authorities say there is no safe level of lead exposure. Pregnant women and children are the most vulnerable groups, with dangers that include fertility problems, damage to organs and cognitive dysfunction.

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It’s The Go-To Drug To Treat Opioid Addiction. Why Won’t More Pharmacies Stock It?

A bus run by the organization Prevention Point parks at Kensington and Allegheny avenues in Philadelphia to offer harm-reduction services to drug users in the area. Louis Morano (center), who was visiting the Prevention Point bus for the second time, sits outside and waits to be seen by Dr. Ben Cocchiaro.

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Brad Larrison for WHYY

Louis Morano knows what he needs, and he knows where to get it.

Morano, 29, has done seven stints in rehab for opioid addiction in the past 15 years. So, he has come to a mobile medical clinic parked on a corner of Philadelphia’s Kensington neighborhood, in the geographical heart of the city’s overdose crisis. People call the mobile clinic the “bupe bus.”

Buprenorphine is a drug, also known by its brand name, Suboxone, that curbs cravings and treats the symptoms of withdrawal from opioid addiction. Combined with cognitive behavioral therapy, it is one of the three FDA-approved medicines considered the gold standard for opioid-addiction treatment.

Morano has tried Suboxone before — he used to buy it from a street dealer to help him get through his workday when he couldn’t use heroin. It kept the sick feelings of withdrawal at bay. So he has a sense of how it will make him feel, though he has never been prescribed it. He used to think of it as a crutch. But now, he is committed to his recovery, and buprenorphine is key.

“I can’t do this anymore,” Morano says. He wants the medical support.

The bupe bus is a project of Prevention Point, Philadelphia’s only syringe-exchange program, and is part of the city’s efforts to expand access to this particular form of medication-assisted treatment for opioid addiction.

Morano is first in line. After a short time, the heavy doors of the bus heave open and Dr. Ben Cocchiaro waves Morano inside, where they squeeze into a tiny exam room. Together, Cocchiaro and Morano discuss how buprenorphine might help Morano’s recovery be more successful this time, as well as if he’s open to seeing a therapist. Cocchiaro gives Morano instructions on how to take the medication and then calls a pharmacy to authorize a prescription.

To date, much of the research on barriers to buprenorphine access has focused on the fact that there are too few medical providers available to write the prescriptions.

According to federal law, doctors must apply for a special waiver from the federal Substance Abuse and Mental Health Services Administration to prescribe buprenorphine. To get the waiver, a doctor must undergo eight hours of training — and, initially, can prescribe the drug to only a maximum of 30 patients at any one time. Given these constraints, many doctors don’t bother.

Inside the exam room on the “bupe bus,” as the mobile medical clinic is called, Dr. Ben Cocchiaro and Louis Morano talk over Morano’s options. Morano says he’s committed to his recovery this time and wants the support of buprenorphine to help him quit heroin.

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Brad Larrison for WHYY

But, according to people active in addressing the opioid crisis, some pharmacists also prevent many opioid users who need buprenorphine from getting it.

“We can write a bunch of prescriptions for people,” says Dan Ventricelli of the Philadelphia College of Pharmacy. “But if they don’t have a pharmacy and a pharmacist that’s willing to fill that medication for them, fill it consistently and have an open conversation with that patient throughout that treatment process, then we may end up with a bottleneck at the community pharmacy.”

Pharmacists frustrated by remedy’s street use

There are a number of reasons some pharmacists say they are hesitant.

Just a few blocks away from the bupe bus in Kensington, for example, Richard Ost owns an independent pharmacy. He says his store was one of the first in the neighborhood to stock buprenorphine. But after a while, Ost started noticing that people were not using the medication as directed — they were selling it instead.

Richard Ost owns Philadelphia Pharmacy, in the city’s Kensington neighborhood. He says he has stopped carrying Suboxone, for the most part, because the illegal market for the drug brought unwanted traffic to his store.

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Nina Feldman/WHYY

Buprenorphine acts as a partial opioid agonist, which means it’s a low-grade opioid, in a sense. When taken in pill or tablet form, bupe is unlikely to cause the same feelings of euphoria as heroin would, but it might if it were dissolved and injected. Many people buy it on the street for the same reason Morano did: to keep from going into withdrawal between injecting heroin or fentanyl. Others buy it to try to quit using opioids on their own.

“We started seeing people [sell the drug] in our store in front of us,” says Ost. He says it’s unethical to dispense a prescription if a patient turns around and sells the drug illegally, rather than uses it. “Once we saw that with a patient, we terminated them as a patient.”

Ost explains that the illegal market for Suboxone also means that customers trying to stay sober are continually targeted and tempted.

“So if we were having a lot of people in recovery coming out of our stores,” Ost says, “the people who were dealing illicit drugs knew that, and they would be there to talk to them. And they would say, ‘Well, I’ll give you this’ or ‘I’ll give you that’ or ‘I’ll buy your Suboxone’ or ‘I’ll trade you for this.’ “

Eventually, Ost’s staff didn’t feel safe, he says, and neither did the customers. He understands the value of bupe but says it just wasn’t worth it. He has mostly stopped carrying it.

Even pharmacies that aim to stock buprenorphine can have trouble doing so. Limits set by wholesalers require pharmacies to order the drug in small, frequent batches. Though pharmacies can apply for exemptions to order more at a time or have a higher percentage of their total stock be controlled substances, doing so invites a higher level of scrutiny from the wholesaler and, in turn, from the federal Drug Enforcement Administration.

Buprenorphine saves lives

Doctors and pharmacists also receive different education about how long buprenorphine should be prescribed before tapering a patient off the drug. Medical providers sometimes prescribe it for long-term treatment, based on recent SAMHSA guidelines, while pharmacists may view longer courses of treatment as intensifying the risk of long-term dependency.

“It’s not even that they’re on different pages,” says Ventricelli. “It’s that they’re reading completely different books.”

If a patient going through withdrawal can’t quickly get buprenorphine, the stakes are high, says Silvana Mazzella, associate executive director at Prevention Point — patients may be more likely to turn back to heroin or fentanyl.

“We’re in a situation where if you are in withdrawal, you’re sick — you need to get well,” she says. “You want help today, and you can’t get it through medication-assisted treatment. Unfortunately, you will find it a block away — very quickly and very cheaply.”

Doctors with Prevention Point have found a pharmacy near the bupe bus — the Pharmacy of America — that will reliably dispense buprenorphine to their Philadelphia patients.

The head pharmacist there, Anthony Shirley, says he’s comfortable filling the scripts because he trusts that the doctors at Prevention Point will write prescriptions only to patients who need the medication. He has heard firsthand from patients who say buprenorphine saved their lives.

“That’s something you can’t really put a price tag on,” Shirley says. For him, the calculation is simple: His store is in an area where lots of people need buprenorphine. That means it’s his job to get it to them.

This story is part of a reporting partnership with NPR, WHYY and Kaiser Health News.

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