First Edition: March 5, 2019

Kaiser Health News: Patients Question How FDA Approves Medical Devices
There’s no doubt that surgically implanted medical devices can improve lives. Hip and knee replacements can help people regain their mobility. Drug pumps can deliver doses of pain-relieving medicine on demand. And metal rods can stabilize spines and broken bones. But implanted devices can also do serious damage, as happened to Mechel Keel, who lives in Owosso, Mich. (Farmer, 3/5)

Kaiser Health News: This Time When My Water Breaks, Take Me To A Hospital Without Surprise Bills
When it comes to having a baby, that bundle of joy may bring an unexpected price tag that can affect parents’ future health care choices. At least that was the finding of a study published Monday in Health Affairs. It examined how consumers respond to surprise medical bills in elective — or non-emergency — situations. Specifically, researchers used a large national sample of medical claims for obstetric patients who had two deliveries between 2007 and 2014 and who had employer-sponsored health insurance. (Bluth, 3/4)

The New York Times: John Hickenlooper Says He Is Running In 2020, Citing A ‘Crisis Of Division’
John Hickenlooper, the two-time Colorado governor and former brewpub owner who has overseen Colorado’s remarkable economic expansion, declared his candidacy for president on Monday. Mr. Hickenlooper, 67, a socially progressive, pro-business Democrat who has called himself an “extreme moderate,” had long said he was considering a run, and made early visits to Iowa and New Hampshire. (Turkewitz, 3/4)

The New York Times: John Hickenlooper On The Issues
Mr. Hickenlooper supports universal health care in principle but has refused to get behind specific proposals like “Medicare for all.” Speaking in New Hampshire last month, he said that there were “many different ways to cut the pie and work on the issue” and that intraparty arguments over the specifics were counterproductive. He did, however, explicitly reject the idea of eliminating private insurance companies, as promoted by Senators Bernie Sanders and Kamala Harris. During his governorship, Mr. Hickenlooper and Colorado’s divided Legislature expanded Medicaid under the Affordable Care Act, a fact he highlighted as speculation about a possible presidential run increased. (Astor, 3/4)

The New York Times: H.I.V. Is Reported Cured In A Second Patient, A Milestone In The Global AIDS Epidemic
For just the second time since the global epidemic began, a patient appears to have been cured of infection with H.I.V., the virus that causes AIDS. The news comes nearly 12 years to the day after the first patient known to be cured, a feat that researchers have long tried, and failed, to duplicate. The surprise success now confirms that a cure for H.I.V. infection is possible, if difficult, researchers said. The investigators are to publish their report on Tuesday in the journal Nature and to present some of the details at the Conference on Retroviruses and Opportunistic Infections in Seattle. (Mandavilli, 3/4)

The Associated Press: Second Man Seems To Be Free Of AIDS Virus After Transplant
The therapy had an early success with Timothy Ray Brown, a U.S. man treated in Germany who is 12 years post-transplant and still free of HIV. Until now, Brown is the only person thought to have been cured of infection with HIV, the virus that causes AIDS. Such transplants are dangerous and have failed in other patients. They're also impractical to try to cure the millions already infected. The latest case "shows the cure of Timothy Brown was not a fluke and can be recreated," said Dr. Keith Jerome of Fred Hutchinson Cancer Research Center in Seattle who had no role. He added that it could lead to a simpler approach that could be used more widely. (Johnson, 3/4)

The Washington Post: HIV Cure: A Second Patient Is In Long-Term Remission After Stem Cell Transplant, Researchers Say
“I think this is really quite significant. It shows the Berlin patient was not just a one-off, that this is a rational approach in limited circumstances,” said Daniel Kuritzkes, chief of infectious diseases at Brigham and Women’s Hospital, who was not involved in the study. “Nobody doubted the truth of the report with the Berlin patient, but it was one patient. And which of the many things that were done to him contributed to the apparent cure? It wasn’t clear this could be reproduced.” (Johnson, 3/4)

The Wall Street Journal: Second HIV Patient May Be Cured After Stem-Cell Transplant
A London man infected with HIV may be the second person to beat the virus that causes AIDS, researchers reported Monday, a finding advancing the costly and challenging search for a cure. Nearly three years after the man received a stem-cell transplant from a donor who was genetically resistant to HIV, extensive testing shows he has no detectable amounts of the virus, according to the research, published in the journal Nature. He has been off antiretroviral drugs for about 18 months. Those drugs keep HIV, the virus that causes AIDS, in check. (McKay, 3/4)

The Washington Post: ACA Premiums Rising Beyond Reach Of Older, Middle-Class Consumers
The sweeping health-care law created nearly a decade ago to put insurance within reach of more Americans has left significant holes in the ability of older, middle-class people to afford coverage, particularly in rural areas, according to a new analysis. Sixty-year-olds with a $50,000 income must pay at least one-fifth of what they earn for the least expensive premiums for health plans in Affordable Care Act marketplaces across a broad swath of the Midwest, the analysis shows. In much of the country, those premiums require at least one-sixth of such people’s income. (Goldstein, 3/5)

The New York Times: California Sues Trump Administration To Block Restrictions To Family Planning Program
Once again taking aim at President Trump, California on Monday filed its 47th lawsuit against the administration, this time to block a move that would effectively strip millions of federal dollars from reproductive health providers that perform abortions and abortion referrals. Attorney General Xavier Becerra, who has become one of Mr. Trump’s most aggressive critics, said Monday that the administration’s changes to Title X, the federal family planning program, would punish doctors and clinics for giving women a comprehensive portrait of their reproductive options. The administration announced those changes last month. (Del Real and Pear, 3/4)

The Associated Press: California Sues Over US Abortion Rule; 20 States To Follow
Twenty states and Washington, D.C., said they would sue separately Tuesday. The states are: Colorado, Connecticut, Delaware, Hawaii, Illinois, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia and Wisconsin. Washington's Democratic attorney general also previously said the state would challenge the rule. Trump administration officials have told abortion opponents that they expected a number of legal challenges to the new family planning rule, which also prohibits federally funded family planning clinics from being housed in the same place as abortion providers. (Elias, 3/4)

The Wall Street Journal: Democrats Aim To Block Trump Administration Move On Abortion Providers
The rule is designed primarily to target Planned Parenthood, the largest provider under the Title X family-planning program. The network of women’s health clinics receives about 10% of its funds from the program. The funding would instead largely shift to faith-based groups. The Title X program has become a battlefront in the U.S. fight over reproductive rights, with Democrats rallying to protect abortion rights against President Trump and Republicans who have made gains curtailing access to the procedure in this administration and in state legislatures in recent years. (Armour, 3/4)

The Washington Post: 21 States To File Suit To Block Trump Administration’s Abortion ‘Gag Rule’ In Family Planning Program
Becerra, in the California filing, called the rule an “extraordinary overreach.” “HHS has exceeded the scope its statutory authority and acted in a manner that is arbitrary, capricious, and not in accordance with law,” he wrote. In a statement, Becerra said the rule would deny “patients access to critical health care services and prevents doctors from providing comprehensive and accurate information about medical care.” (Cha, 3/4)

The New York Times: Eli Lilly Will Sell Half-Price Version Of Humalog, Its Popular Insulin
The drugmaker Eli Lilly will begin selling a cheaper version of its most popular insulin, Humalog, in an effort to head off criticism about the rising costs of prescription drugs, the company said Monday. Lilly will begin selling an “authorized generic” of Humalog 100 for $137.35 per vial, a 50 percent discount off the list price. An authorized generic means that, except for the label, it is identical to the brand-name drug and manufactured in the same facilities. The new product, which the company said would be made available as quickly as possible, will be called Insulin Lispro and will be sold through a Lilly subsidiary, ImClone Systems. (Thomas, 3/4)

The Hill: Drug Company Announces New Version Of Insulin At Half The Price
"While this change is a step in the right direction, all of us in the health care community must do more to fix the problem of high out-of-pocket costs for Americans living with chronic conditions," Eli Lilly CEO David Ricks said in a statement. "We hope our announcement is a catalyst for positive change across the U.S. health care system." The move received some measured praise from lawmakers in both parties on Monday, but they also stressed that much more needs to be done. (Sullivan, 3/4)

CNN: Eli Lilly Introduces Generic Insulin At Half The Price Of Brand-Name Drug
"We don't want anyone to ration or skip doses of insulin due to affordability. And no one should pay the full Humalog retail price," Ricks said, describing the generic drug as "a bridge that addresses gaps in the current system until we have a more sustainable model." In February, seven executives of top pharmaceutical companies were grilled before a congressional panel about the nation's skyrocketing drug prices. A week prior, Sens. Chuck Grassley and Ron Wyden began an investigation into insulin prices, sending letters to leading manufacturers Eli Lilly, Novo Nordisk and Sanofi about their recent price increases. (Nedelman, 3/4)

Stat: Lilly Will Sell A Half-Price Version Of Its Insulin. Will It Appease Critics? 
The move reflects growing anger at the pharmaceutical industry, although insulin has been a particular focal point among patients and, subsequently, lawmakers. The average list price for insulin nearly tripled between 2002 and 2013, according to the American Diabetes Association. More than 30 million Americans have some form of diabetes. Fifteen years ago, for instance, a patient with diabetes might have paid $175.57 for a 20-milliliter vial of the long-acting insulin Humulin R U-500, another Lilly treatment. Today, that medicine would cost $1,487. However, a recent study estimated the cost to produce a vial of human insulin is between $2.28 and $3.42, while the cost to produce a vial of most analog insulins is between $3.69 and $6.16. (Silverman, 3/4)

The Associated Press: FDA Chief Calls Out Walgreens Over Tobacco Sales To Minors
A top U.S. regulator wants to meet with Walgreens leaders to discuss whether the drugstore chain has a problem with illegal tobacco sales to minors. Scott Gottlieb of the Food and Drug Administration said Monday Walgreens is a top violator among drugstores that sell tobacco products including cigarettes, smokeless tobacco and e-cigarettes. He says inspectors have found nearly 1,800 instances since 2010 in which one of the company's stores violated the law. (3/4)

The New York Times: F.D.A. Criticizes Walgreens And Other Retailers For Selling Tobacco Products To Minors
The agency said its undercover inspection program had turned up high rates of tobacco violations at numerous retailers. Illegal sales of cigarettes and e-cigarettes to young people were even higher at other national gas station and convenience store chains, the agency found, but it singled out Walgreens for its harshest criticism. “The company’s stores have racked up almost 1,800 violations across the country,” said Dr. Scott Gottlieb, the agency’s commissioner, in a statement. “Both the rate of violations and sheer volume of violative inspections of Walgreens stores are disturbing, particularly since the company positions itself as a health-and-wellness-minded business.” (Kaplan, 3/4)

The Washington Post: Measles, Mumps And Rubella Vaccine Doesn't Cause Autism, Concludes European Study Of Half A Million People
The erroneous suggestion that vaccines could cause autism was refuted nine years ago, when a British medical panel concluded in 2010 that Andrew Wakefield, the doctor with undisclosed financial interests in making such claims, had acted with “callous disregard” in conducting his research. But in 2019, professional epidemiologists are still devoting time and resources to discrediting Wakefield’s work, which set off a steep decline in vaccinations, including in the United States, where Wakefield moved in 2004. (Stanley-Becker, 3/5)

CNN: MMR Vaccine Does Not Cause Autism, Another Study Confirms
Over 95% of the children received the MMR vaccine, and 6,517 were diagnosed with autism. The MMR vaccine did not increase the risk of autism in children who were not considered at risk for the disorder and did not trigger it in those who were, according to the study, published Monday in the journal Annals of Internal Medicine. "This idea that vaccines cause autism is still around and is still getting a lot of exposure in social media," noted Anders Hviid, lead study author and senior investigator at Statens Serum Institut in Denmark. (Bracho-Sanchez, 3/4)

Modern Healthcare: Vaccine Exemptions Call Doctors' Role In Outbreaks Into Question
California has one of the strictest requirements for childhood vaccinations in the U.S. after the state eliminated exemptions based on philosophical and religious grounds in 2015. Yet the state has seen a rise of unvaccinated children over the past couple years due to physicians granting medical exemptions from immunization. (Johnson, 3/4)

The Wall Street Journal: Amid Measles Outbreaks, States Seek To Force Parents To Vaccinate Children
Rebekah Otto plans to ask her son’s pediatrician to give him a measles vaccination early, before they travel to a wedding this summer in Washington state, where there is an outbreak of the deadly disease. “It gives me a lot of anxiety,” the 32-year-old mother of two from Oakland, Calif., said of the risk of exposing her son to the highly contagious respiratory disease. Washington, New York, Texas and Illinois have reported measles outbreaks, and more than 150 people have been infected nationwide this year, according to the Centers for Disease Control and Prevention. (King, 3/4)

NPR: Arizona Considers Expanding Exemptions For School Vaccines
The measles outbreak in Washington state and elsewhere is prompting some states to look at tightening vaccine requirements for schoolchildren. But not in Arizona. Lawmakers there have been considering bills to make it even easier for parents to get exemptions for their kids from the usual childhood vaccinations. Supporters of the controversial bills being considered in the Arizona capitol say they are not "anti-vaccine." (Stone, 3/5)

The Associated Press: OxyContin Maker: Lawsuit Distorts Facts, Scapegoats Company
OxyContin maker Purdue Pharma is asking a court to throw out a lawsuit filed by Massachusetts' attorney general that accuses the company, its owners and top executives of deceiving patients and doctors about the risks of opioids. In its most expansive response to date, Connecticut-based Purdue argued in a motion filed late Friday that the state makes "sensational and inflammatory allegations" in its bid to hold the company accountable for America's deadly opioid addiction crisis, and called for the lawsuit to be dismissed "as oversimplified scapegoating based on a distorted account of the facts." (Salsberg, 3/4)

The Washington Post: Purdue Pharma Says Opioid Lawsuit By Mass. Attorney General Amounts To ‘Oversimplified Scapegoating’
In a recent motion to dismiss the case, Purdue says Massachusetts Attorney General Maura Healey (D) has created a “sensationalist and distorted narrative that ignores facts” in the lawsuit she filed last year. It alleges the company disregarded safety and addiction and deceived patients and doctors to get them to prescribe and take high doses of OxyContin and looked the other way as overdose deaths linked to prescription opioids soared. Purdue alleges that some claims made by Healey are contradicted by the Massachusetts Department of Health and the Food and Drug Administration, which approved the medication and its labeling. Purdue argues that Healey is putting forward a “misleading narrative” about OxyContin. (Zezima, 3/4)

Stat: Purdue Pharma Seeks To Have Massachusetts Lawsuit Thrown Out
The judge, Purdue’s motion says, should “dismiss the Commonwealth’s [lawsuit] as oversimplified scapegoating based on a distorted account of the facts unsupported by applicable law. “To be sure, there is an opioid crisis in the Commonwealth,” the motion continues, “but the responsibility for this crisis cannot, as a matter of law, be tied to one company that manufactures a tiny fraction of the prescription opioids in the Commonwealth.” (Joseph, 3/4)

CNN: Purdue Pharma Seeks Dismissal Of Lawsuit In Massachusetts
The court did not initially rule on the first motion because the Attorney General's office amended the complaint. The commonwealth released the heavily redacted complaint that accuses the company of contributing to the opioid crisis. Suffolk County Superior Court Judge Janet Sanders ruled that the unredacted amended suit be released in January. The redactions revealed internal company documents and email correspondence between top executives, some of whom are named as defendants. (del Valle, 3/4)

Reuters: OxyContin Maker Purdue Pharma Exploring Bankruptcy: Sources
OxyContin maker Purdue Pharma LP is exploring filing for bankruptcy to address potentially significant liabilities from roughly 2,000 lawsuits alleging the drugmaker contributed to the deadly opioid crisis sweeping the United States, people familiar with the matter said on Monday. The potential move shows how Purdue and its wealthy owners, the Sackler family, are under pressure to respond to mounting litigation accusing the company of misleading doctors and patients about risks associated with prolonged use of its prescription opioids. (3/4)

The Wall Street Journal: Purdue Pharma Preparing Possible Bankruptcy Filing
Its restructuring advisers now include AlixPartners LLP, a New York-based consulting firm known for its restructuring work, according to a person familiar with the hiring. The company last year hired law firm Davis Polk & Wardwell LLP as restructuring counsel and added longtime restructuring specialist Steve Miller to chair its board. Purdue has been targeted in lawsuits by some 1,600 cities, counties and states seeking to recoup costs incurred by widespread opioid abuse. The municipalities claim Purdue and other drugmakers’ aggressive marketing of prescription painkillers helped hook the nation on opioids, leading to a proliferation of overdoses from both legal and illegal opioids. (Randazzo and Hopkins, 3/4)

Stat: If Purdue Pharma Declares Bankruptcy, What Happens To The Opioid Cases?
The legal battle over who’s at fault for the opioid crisis, which involves more than 1,600 lawsuits in federal and state courts, could get even more complicated soon, with OxyContin manufacturer Purdue Pharma reportedly considering filing for bankruptcy. As first reported Monday by Reuters and confirmed by the Wall Street Journal, Purdue is weighing a bankruptcy filing in the face of the lawsuits, which allege the company misled doctors and the public about safety concerns as it promoted its opioid painkillers. (Joseph, 3/4)

The New York Times: Open Wounds, Head Injuries, Fever: Ailing Migrants Suffer At The Border
It was nearly 9 p.m., hours after the makeshift clinic for newly arrived migrants near the Mexican border in Texas was supposed to close, but the patients would not stop coming: A feverish teenager with a vile-smelling wound on his foot. A man with a head injury and bright red eyes. Children with fevers, coughs and colds. Earlier in the day, a little girl named Nancy had been brought into the clinic with a cough and shaking chills. She had been vomiting, she said, and her spine hurt. An assistant took her temperature. “She’s got 104, almost 105,” she said. (Fink and Dickerson, 3/5)

Reuters: U.S. Seeks To Cut Dialysis Costs With More Home Care Versus Clinics
The Trump administration is working on a new payment approach for treating kidney disease that favors lower cost care at home and transplants, a change that would upend a dialysis industry that provides care in thousands of clinics nationwide. The goal is to reduce the $114 billion paid by the U.S. government each year to treat chronic kidney disease and end-stage renal disease, a top area of spending. (3/4)

Reuters: Will $14.5 Billion Plug GE's Long-Term Care Insurance Hole? Some Experts Say 'No'
General Electric Co is setting aside one of the largest amounts ever to cover potential losses on policies that provide long-term care in nursing facilities and patients' homes. But insurance experts are concerned that may not be enough. GE shocked investors last year when it took a $6.2 billion after-tax charge and said it planned to set aside $15 billion over seven years to cover claims on some 300,000 long-term care policies written more than a decade ago, when actuaries did not yet know how costly the claims would become. (Scott, 3/4)

Reuters: To Save Time And Money, Companies Roll Out Caregiving Benefits
When Laura Hirsch of Keller Texas had to find a rehabilitation center to help her father recover from a difficult surgery in September, the caregiving service Cariloop saved her a whole day. A case manager at Cariloop, based in Richardson, Texas, sorted through more than a dozen rehab facility options, then armed Hirsch with the right questions to ask when choosing among the final contenders. (3/4)

The New York Times: Reducing Maternal Mortality
Women in the United States face a far greater risk of dying from childbirth complications than in many other wealthy countries. Now the federal government has taken a step toward addressing the problem with the Preventing Maternal Deaths Act, signed in December, which will provide federal grants to states to investigate the deaths of women who die within a year of being pregnant. (Kaplan, 3/5)

The New York Times: Hospital And Time Of Delivery May Affect Mother’s Health
A mother’s health during a hospital birth may depend in part on the time of day and the kind of hospital. For a study published in Risk Analysis, researchers recorded maternal complications in more than two million births, tracking complications that can reasonably be controlled by hospital staff: severe perineal laceration, ruptured uterus, unplanned hysterectomy, admission to an intensive care unit, or unplanned operating procedure following delivery. More than 21,000 women had one or more of these complications. (Bakalar, 3/4)

The New York Times: She Helped Deliver Hundreds Of Babies. Then She Was Arrested.
For a generation of Mennonite women, Elizabeth Catlin was integral to the most joyous occasions of their lives: the births of their children. Ms. Catlin was a second mother, they said, a birthing attendant who helped them with prenatal care and then caught their babies during hundreds of natural childbirth deliveries at their homes. So it was incomprehensible to them that on a recent winter day they were in a courtroom to support Ms. Catlin, who in December had been arrested and charged with four felonies for practicing midwifery in a county about an hour southeast of Rochester. (Pager, 3/5)

The Associated Press: Activists Campaign For Treaty To End Violence Against Women
Women's rights activists from 128 nations are launching a public campaign Tuesday for an international treaty to end violence against women and girls, a global scourge estimated by the United Nations to affect 35 percent of females worldwide. The campaign led by the Seattle-based nonprofit organization Every Woman Treaty aims to have the U.N. World Health Organization adopt the treaty with the goal of getting all 193 U.N. member states to ratify it. (3/4)

Politico: Cardiologists Say Apple Is Overselling Its Health Rollout While FDA Applauds
Apple is touting its new health software with an aggressive public relations strategy that worries many cardiologists, who feel the company is exaggerating the significance of the Apple Watch readings of a heart condition called atrial fibrillation. Critics are also concerned that the FDA’s unusual celebration of Apple’s new tech — which is central to the company’s move into health care — represents boosterism that distorts the agency’s role of assuring the safety and efficacy of medical devices. (Tahir, 3/4)

CNN: Every Senior Needs Cognitive Screening, Alzheimer's Association Says
At first, she just forgot a name or two. Then, a few meetings on her schedule. A few months later, LuPita Gutierrez-Parker found herself struggling at work to use computer software she knew intimately. "In the beginning, when I wasn't sure what was happening to me, I just figured it must be stress because I was doing a lot of work and had too much on my mind," Gutierrez-Parker said. (LaMotte, 3/5)

Stat: To Treat Alzheimer’s, An Ambitious Biotech Sees Promise In ‘Young Blood’
The executives at Alkahest have heard plenty of vampire jokes. They are, after all, turning to blood from young donors in search of an elixir for diseases associated with aging. And yes, they’re in Silicon Valley. But this five-year-old biotech company led by Genentech alums is doing serious science. It just happens to be working in a field that the Food and Drug Administration rebuked last month with a stern warning, noting that plasma infusions from young people provide “no proven clinical benefit” against diseases including Alzheimer’s and Parkinson’s. (Robbins, 3/4)

NPR: FDA Expected To Approve Esketamine Nasal Spray For Depression
The Food and Drug Administration is expected to approve a new type of drug for depression. It is esketamine, a chemical cousin of the anesthetic and party drug ketamine. (Hamilton, 3/4)

NPR: 'The Orchid And The Dandelion' Highlights Science Of Sensitive Kids
Dr. Thomas Boyce, an emeritus professor of pediatrics and psychiatry at the University of California, San Francisco, has treated children who seem to be completely unflappable and unfazed by their surroundings — as well as those who are extremely sensitive to their environments. Over the years, he began to liken these two types of children to two very different flowers: dandelions and orchids. (Davies, 3/4)

The Associated Press: High Heat Warnings Go Out Too Late In Some Of US, Study Says
A new study finds even moderate heat sends Northerners to the hospital, suggesting that government warnings of dangerously high temperatures are coming too late in some parts of the U.S. The research shows an uptick in hospital admissions for heat problems long before alerts go out in northern, generally cooler states. And that's happening at lower temperatures than in the toastier South, where people are more accustomed to the heat. (3/4)

The Associated Press: New Mexico Moves To Expand Background Checks On Gun Sales
Legislators sent a bill to expand background checks on private gun sales in New Mexico to the governor's desk Monday for certain approval after a bruising series of debates and objections from county sheriffs across much of the state. Democratic Gov. Michelle Lujan Grisham has vowed to sign the legislation and immediately issued a statement that applauded final legislative approval by the House on a 42-27 vote, after legislators exhausted a three-hour limit on floor debate. (3/5)

The New York Times: Man Charged In Arson At Planned Parenthood Clinic In Missouri
A 42-year-old man was charged on Monday in connection with a fire that was set at a Planned Parenthood clinic in Columbia, Mo., last month. The man, Wesley Brian Kaster, was arrested Saturday, about three weeks after the authorities began investigating what they called a suspicious fire at the clinic on Feb. 10. Don Ledford, a spokesman for the United States Attorney’s office, declined to elaborate on a possible motive. “It’s early in the case,” he said. “It’s still an ongoing investigation.” (Zaveri, 3/4)

The Associated Press: Cocaine, Meth On Rise In Pennsylvania's Early Warning Areas
Methamphetamine and cocaine use are on the rise in Pennsylvania while prescription drug and heroin deaths are leveling off in some areas, data that appears to reflect nationwide trends. Jennifer Smith, secretary for Pennsylvania's Department of Drug and Alcohol Programs, told a state Senate committee Monday that the state is seeing "quite an uptick" in cocaine and methamphetamine use in three early warning areas. (3/4)