About 100,000 nurses left the workforce due to pandemic-related burnout and stress, survey finds

About 100,000 registered nurses in the US left the workplace due to the stresses of the Covid-19 pandemic, according to the results of a survey published Thursday by the National Council of State Boards of Nursing.

Another 610,388 registered nurses, who had more than 10 years of experience and an average age of 57, said they planned to leave the workforce by 2027 because of stress, burnout or retirement. The same was true of 189,000 additional nurses with 10 or fewer years of experience and an average age of 36.

The survey found that there were over 5.2 million active registered nurses and 973,788 licensed practical nurses or vocational nurses in the US in 2022. The researchers analyzed data from 29,472 registered and advanced nurses and more than 24,000 licensed practical or vocational nurses across 45 states. More than a quarter of those surveyed said they plan to leave the industry or retire in the next five years, the study says.

About 62% of the nurses surveyed said their workload increased during the pandemic, and 50.8% said they felt emotionally drained at work.

Almost half of nurses said they felt fatigued or burnt-out: 49.7% and 45.1%, respectively. These concerns were seen most in nurses with less than 10 years of experience.

This exhausted tone was a driving factor behind a strike in New York in January, when over 7,000 nurses took to the streets to call attention to staffing shortages and burnout.

“We are sick and tired of the hospital only doing the bare minimum,” said Danny Fuentes, a union official who spoke to the crowd during the strike. “Time and time again, we are forced to take unsafe patient loads. We are humans, and we are burnt-out. And we are tired. And the hospital doesn’t seem to care. All they see are profits. We don’t want to be out here. We would much rather be with our patients. We need a fair contract to protect our patients.”

The strike ended when the New York State Nurses Association reached tentative deals with the two hospitals involved, Mount Sinai Health System and Montefiore Health System. The union said the deal would provide enforceable “safe staffing ratios” for all inpatient units at Mount Sinai and Montefiore.

Montefiore agreed to financial penalties for failing to comply with agreed-upon staffing levels in all units.

The researchers on the new survey say their findings pose a threat to the US workforce, especially among younger and less experienced nurses. The National Council of State Boards of Nursing says hospitals and policymakers should be quick to enact solutions and address these challenges.

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

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.”

‘There is a shift that is occurring’

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.”

Rise of synthetic drugs

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.

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.”

Move to make xylazine a controlled substance

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.”

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

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.”

Some ready-to-eat salads with chicken or ham may contain potentially deadly listeria

Certain brands of fresh ready-to-eat salads that include chicken or ham may also contain lettuce contaminated with listeria, a potentially deadly bacteria, according to the US Department of Agriculture’s Food Safety and Inspection Service (FSIS).

Revolution Farms of Caledonia, Michigan, voluntarily recalled lettuce produced and sold under the brand Revolution Farms on April 5, 2023, due to the potential for listeria contamination.

However, lettuce from that recall was used to create ready-to-eat salads under the brand names “Fruit Ridge Farms” and “Bell’s Bistro,” according to a FSIS public health alert issued Monday.

The salads were shipped to retail locations in Kentucky, Illinois, Indiana, Michigan, Ohio, Tennessee and Wisconsin.

As yet, no confirmed reports of adverse reactions have been reported, however the FSIS is “concerned some products may be in consumers’ refrigerators,” according to the alert.

“Consumers who have purchased these products are urged not to consume them. These products should be thrown away or returned to the place of purchase,” the alert advised.

The potentially contaminated products are “Fruit Ridge Farms White Chicken Caesar Salad”; “Fruit Ridge Farms Chef Salad with Ham”; “Bell’s Bistro White Chicken Caesar Salad”; and “Bell’s Bistro Chef Salad with Ham.”

Consumers can also identify the salads by looking for the numbers “EST. 17050” or “P-17050,” which should appear inside the USDA mark of inspection on the item, the alert said.

Listeria is a hardy germ, so determined to stick around that it can continue to grow while refrigerated, which even its fellow foodborne bacterial threats salmonella and E. coli cannot do.

Listeria contamination can cause listeriosis, a serious infection that primarily affects pregnant people and newborns, older adults and people with weakened immune systems.

In the United States, listeria is the third leading cause of death from foodborne illness, killing about 260 people a year, according to the Centers for Disease Control and Prevention.

“Even with adequate antibiotic treatment, the disease has a high mortality rate” of 20% to 30%, the US Food and Drug Administration said.

Pregnant people are about 10 times more likely to become sick from listeria, and the illness can be fatal to a fetus. Pregnant Hispanics are at highest risk, likely due to eating traditional soft cheeses such as queso fresco and other foods made with milk that is unpasteurized, the FDA said. Foods made with raw milk are 50 to 160 times more likely to contain listeria, the agency said.

Adults and healthy children with listeria infections may simply develop a mild or unpleasant illness that will not require hospitalization or antibiotics. However, anyone immunocompromised — including older adults, organ transplant patients, and those with cancer, kidney disease, diabetes or HIV/AIDS — can become seriously ill and die.

Weight loss may mean a risk of death for older adults, study shows

As much as people may celebrate their own weight loss, it is not always healthy.

A new study shows that weight loss in older adults is associated with early death and life-limiting conditions.

Weight gain, on the other hand, was not associated with mortality, according to the study published Monday in JAMA Network Open.

Medical professionals have known to be concerned when older people with health conditions lose weight but researchers have not fully understood the impact of weight change on healthy older adults, according to lead study author Dr. Monira Hussain, a clinical epidemiologist and senior research fellow in public health and preventative medicine at Monash University in Melbourne, Australia.

The study looked at nearly 17,000 adults at least 70 years old in Australia and more than 2,000 adults in the United States who were at least 65 years old. Everyone who participated in the study was weighed at their annual checkup between 2010 and 2014, according to the study.

“Our study found that even a 5% weight loss increases mortality risk, particularly in older men,” Hussain said.

Weight gain in healthy older people, on the other hand, showed no association, she added.

The association was found across starting weights, meaning people who are medically classified as obese also were at an increased risk when losing weight, said Perri Halperin, the clinical nutrition director for the Mount Sinai Health System. Halperin was not involved in the study.

Other health issues

The study was able to account for health issues at the start. It excluded people who had conditions like cardiovascular disease, dementia, physical disabilities or chronic illness, Hussain said.

“It also excluded those with recent hospitalizations, which is important because hospitalization is often followed by weight loss due to acute conditions,” Halperin said in an email.

But the study wasn’t able to distinguish if people involved lost weight intentionally or unintentionally, Hussain added.

“No questions were asked about changes in activity level and diet quality between the baseline study visit and subsequent study visits, so we do not have any information on how those factors may have impacted the results,” Haperin said.

Why weight loss can be a risk

Weight loss may be a risk factor for mortality because it can signal underlying issues.

Weight loss may be a warning sign for conditions like cancer and dementia, and it is “often linked to reduced appetite influenced by inflammation and hormones,” Hussain said.

Underlying chronic health conditions can also trigger weight loss in older adults by impacting appetite, metabolism and eating habits, Halperin said. Mobility issues and medication side effects can also affect weight.

Changes in weight can also signal concerns in lifestyle, Halperin said.

“A major contributing factor to weight loss in older adults is social isolation. Other concerns include financial constraints and pain and discomfort,” she added.

In studies like these, remembering that correlation is not causation is important, Halperin said. Weight loss was associated with mortality, which means it’s correlated – but that doesn’t mean the weight loss caused a person’s death.

“It’s also important to say that the opposite cannot be extrapolated nor recommended – ie gaining weight would not necessarily decrease your mortality risk,” she said in an email. “As always, discuss your weight changes with your doctor or other medical professional.”

The takeaway is for older adults to monitor their weight change, Halperin said.

“If they notice a decrease in the number on the scale (weight loss) or perhaps pants that were once snug fitting looser (decreased waist circumference),” she added, “bring it up with their doctor for possible further screening or testing.”

But the advice also goes for the medical community, she said. Doctors and health care providers need to know that changes in weight require further investigation.

Drugmakers sign letter supporting FDA and calling for reversal of Texas judge’s mifepristone ruling

Pfizer CEO Albert Bourla and dozens of other biotech and pharmaceutical company leaders have signed an open letter in support of the US Food and Drug Administration’s authority “to approve and regulate safe, effective medicines for every American” after Friday’s decision by a Texas district court judge to halt the agency’s approval of mifepristone, one of the medications used in abortion procedures.

US District Judge Matthew Kacsmaryk said Friday that he will suspend the FDA’s approval of mifepristone, the first of two drugs used in a medication abortion, after a weeklong stay to allow for appeals. On Monday, the US Department of Justice asked a federal appeals court to put a hold on the ruling.

The letter called for a reversal of Kacsmaryk’s decision, saying it “set a precedent for diminishing FDA’s authority over drug approvals, and in so doing, creates uncertainty for the entire biopharma industry.”

“As an industry we count on the FDA’s autonomy and authority to bring new medicines to patients under a reliable regulatory process for drug evaluation and approval. Adding regulatory uncertainty to the already inherently risky work of discovering and developing new medicines will likely have the effect of reducing incentives for investment, endangering the innovation that characterizes our industry,” the letter says.

The letter also warns that if the judicial system “can overturn drug approvals without regard for science or evidence, or for the complexity required to fully vet the safety and efficacy of new drugs, any medicine is at risk for the same outcome as mifepristone.”

In a separate statement, the biotech industry group BIO’s interim president and CEO, Rachel King, emphasized the “dangerous precedent” the Texas judge’s decision sets.

“The preliminary ruling by a federal judge in Texas is an assault on science and the FDA’s long-standing role as the authority to make decisions on the safety and efficacy of medicines. For a court to invalidate the approval of a drug that was reviewed and approved more than two decades ago is without precedent. As legal scholars have noted, the courts do not have the medical expertise to make these types of scientific determinations,” King said.