Surgeon General Urges Americans to Carry Drug that Stops Opioid Overdoses


Dr. Adams, who is scheduled to speak on Thursday at a conference in Atlanta, emphasized in the advisory that more opioid users, as well as their families and friends and anyone who regularly comes into contact with them, should carry naloxone.

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Surgeon General Jerome Adams in February. The advisory issued Thursday was the first from the office since 2005.

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Manuel Balce Ceneta/Associated Press

The last advisory from a surgeon general, in 2005, warned pregnant women against drinking any alcohol; a previous advisory in 1981 urged pregnant women to limit the amount of alcohol they drank.

The biggest factor in the increase in overdoses has been synthetic fentanyl and related highly toxic substances. Drug deaths involving fentanyl more than doubled from 2015 to 2016, accompanied by an upturn in deaths involving cocaine and methamphetamines. Together they add up to an epidemic of drug overdoses that is killing people at a faster rate than the H.I.V. epidemic at its peak.

Fentanyl is so powerful that emergency responders have often had to use multiple doses of naloxone to revive people who overdosed on it. Some critics have said it gives drug users a safety net, allowing them to overdose repeatedly with the assurance that they can be revived. But public health experts dismiss that notion as ridiculous, like saying seatbelts encourage riskier driving.

The price of naloxone has risen sharply as it has become more in demand, and though individuals can often get it at little or no cost through insurance or public programs, many local police, fire and health departments are struggling with the growing cost, which takes ever-larger chunks of their budgets.

Dr. Leana Wen, the health commissioner in Baltimore, said her city has to ration naloxone because it can’t afford to keep a stockpile on hand. She called on the Trump administration to negotiate directly with the manufacturers of naloxone to make it available at a steeply discounted rate.

“Every week, we count the doses we have left and make hard decisions about who will receive the medication and who will have to go without,” she said in a statement. “The federal government needs to follow their policy guidance with specific actions to actually ensure access.”

She added, “We should not be priced out of the ability to save lives.”

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Review: A Pulitzer Sequel for Orchestra, Packed With Drama in Microcosm


SEATTLE — Stress over sequels isn’t just for Hollywood moguls. Contemporary classical heavyweights can feel it, too.

In the music world, few recent works loom as large as John Luther Adams’s “Become Ocean,” from 2013. The follow-up to “Become River” (2010), for chamber orchestra, “Ocean” won the Pulitzer Prize, then a Grammy for the Seattle Symphony, which commissioned it.

It was a high bar to clear, then, on Thursday evening here, when the same orchestra gave the premiere of Mr. Adams’s “Become Desert,” completing a trilogy he never set out to write: three nature-immersed — and so inevitably, in this day and age, obliquely political — pieces. Mr. Adams has written about his concerns about our changing ecology, and has lately been pondering a line attributed to the French Romantic writer Chateaubriand: “Forests precede civilizations, and deserts follow.”

In an essay for The New York Times, he suggested that “Desert” would be an experience less obviously theatrical than the cresting waves of “Ocean”; he even imagined a listener thinking, “This music is never going to change.” In a program note Ludovic Morlot, who departs as the Seattle Symphony’s music director after next season, promised “a very different sonic landscape.”

Become Ocean Video by Seattle Symphony – Topic

Managing expectations made some sense. But it was also unnecessary. While “Become Desert” doesn’t have the easily graspable transitions of its predecessor, it is packed with moments of drama in microcosm. Over a nearly 40-minute span, those slight twists combine to create a new route toward a grand impact. Precisely because the two are so distinct in method, “Desert” came across as a thoroughly worthy successor to “Ocean.”

In the new work Mr. Adams divides a large orchestra and a 32-member chorus into five groups. Playing at different tempos — though none of them fast — these discrete ensembles are meant to surround the audience. In Benaroya Hall here, the singers were stationed high up, toward the rear of the space. Tubular chimes were visible two levels up from the orchestra seats, along both sides. Strings, winds and percussion instruments were congregated on the stage.

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“A vast expanse of heartbreak was surveyed in mere seconds, from the vantage of a vessel that barely had to hum to switch gears.”

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Brandon Patoc

This separation of sonic landscapes brought out Mr. Adams’s gift for orchestration. After an opening section coasted for a bit on a meditative air, courtesy of pinging bells and hissing high strings, the soft-grained entrance of trumpets signaled a change, without overhauling the moderate, peaceable dynamics. At the same time, the disparate tempos between the mini-ensembles kept this from feeling like an easy-listening exercise. Chiming sounds were omnipresent throughout. But they rarely struck in alignment.

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