Tag Archives: from

Boys with ‘narcissistic cult’ mindset removed from mother’s care

Three teenage brothers who developed a “narcissistic cult” mentality and came to believe there was no point leaving home, socialising or going to school should leave their mother’s care, a high court judge has concluded.

They formed a group identity and saw themselves as intellectually superior and separate to the rest of the world, psychotherapists told Mr Justice Hayden.

Two of the boys spoke to each other in a language they had devised, the judge heard.

Details of the case have emerged in a ruling by Hayden after a private hearing in the family division of the high court in central London. The judge said the family involved could not be identified.

He said social services bosses at Wandsworth council in south London had responsibility for the boys’ welfare and had asked him to make a decision about their future.

Social workers had raised a series of concerns and said the children had suffered neglect plus physical and emotional harm due to stress, inadequate food and a lack of medical provision.

They said the boys had not had appropriate exercise and outdoor activity. Their mother, who had mental health issues, had “failed” to allow them to attend school, socialise, play outside or take part in activities.

Social services bosses said the boys had come to believe there was no purpose to attending school, leaving the home or socialising with others.

The judge said he had been told of an achievement and award system operating at the boys’ home.

“There was an elaborate and quite rigid structure to their interactions predicated on an achievement and award system,” he said. “Achievement of particular tasks enabled time on the computer or an opportunity to pet and stroke the cat.”

Hayden indicated that the boys had been placed in residential care units temporarily pending a long-term decision on their future. He said they should remain where they were and not return to their mother’s care.

The judge made the decision after analysing legal argument from barristers Julien Foster, Rachel Gillman, and Lucy Sprinz.

I had psychosis and was sectioned. Nurses saved me from the brink

A few years ago, I was suffering with psychosis and was admitted to hospital under the Mental Health Act. I remained there for nearly two months. At the time I didn’t realise I was ill, despite hearing voices and experiencing major delusions. I have encountered many healthcare professionals since that time, but it has been the regular support from mental health nurses, especially out in the community, that has really kept me well, more than medication or appointments with psychiatrists or therapists.

A psychiatric ward can be a scary place for a patient; the nurses I came to know while living on the ward became beacons of stability. They encouraged us to get involved in activities; they chatted to us about mundane things; they didn’t press us on our delusions or misconceptions. They gently reinforced a day-to-day normality. One nurse brought in her manicure kit with over 30 polishes and painted our nails for us. Another organised meetings where patients could air their grievances and suggestions for improving the ward. At the time, my delusional mental state convinced me they were all actors and that I was in a fake secure unit. In contrast, I thought the psychiatrists were really military interrogators, based on my meetings with them.

When I left hospital, I was ushered into the care of a community mental health team with fortnightly and then monthly home visits from a community psychiatric nurse (CPN). At this time I was living with family, in another part of the country, as my marriage had broken down. I was still suffering from psychosis and refused to accept I was unwell, but a friendly CPN kept showing up every few weeks undeterred. While she offered kind words and suggestions about medication, follow-on services and general chat, I realised that the impending doom I was convinced of was a delusion, and that normal life as I had once known it could continue as before.

It took around four months after being discharged from hospital, for me to realise I had been suffering from psychosis. Prior to this my only experience with mental health problems had been a period of depression several years before. The monthly visits from my CPN became even more vital as I could now get the advice and support I needed to move forward with my life. Throughout this time, she was non-judgmental and didn’t press me to talk about my delusions. The home visits provided a dignified and supportive way to overcome my illness. I was encouraged by her to think about continuing with my studies and was given the confidence to start some voluntary work. Having one community nurse who I could develop a level of trust with undoubtedly helped me get well.

During this recovery time I was able to rekindle my relationship with my husband and me returned to the care of my original NHS trust. Unfortunately, the services that I had been accessing were restricted there by age and I was not eligible for the level of support or home visits I’d been receiving previously.

Due to the lack of support I could feel the improvements in my mental health slipping. I hadn’t realised, until that point, how much I’d been reliant on the stability of the monthly visits from a CPN or how NHS mental health care is a postcode lottery.

I was eventually offered family therapy, which proved to be really helpful. Two CPNs visited my husband and I at home over a period of several months and helped us identify triggers to prevent further psychosis in the future. Again, the nurses were kind, friendly and non-judgmental and helped us set joint and individual goals, such as joining a gym and finding voluntary work.

I was then offered five months of further home visits. I haven’t needed to take any medication for nearly 18 months and have had no further episodes of psychosis, so the future is looking very positive. The monthly check-ins with a CPN have really given me the support, knowledge and stability to stay well. Nurses provide the human side of healthcare and can explain problems in a way that doctors often fail to do. Where the doctors were clinical and cold and left me feeling like a strange case study, the nurses treated me like a human being and enabled me to accept my condition and move on from it. I can’t thank them or credit their skills enough.

If you would like to contribute to the Guardian Healthcare Professionals Network about experiences in healthcare, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

Selena Gomez received kidney transplant from TV actor Francia Raisa

Selena Gomez recently received a kidney transplant from television actor Francia Raisa due to her struggle with lupus, the actor and singer revealed on Thursday.

Gomez disclosed in an Instagram post confirmed by her publicist that she has been out of the spotlight this summer because she was recovering from the procedure. The 25-year-old calls the transplant “what I needed to do for my overall health”.

The post didn’t reveal Gomez’s current condition or say where or when the procedure took place. Gomez’s publicist declined to release more information. Gomez wrote “there aren’t words to describe” how she can thank Raisa, who she says gave “the ultimate gift and sacrifice by donating her kidney.”

“I am incredibly blessed,” she added.

Anna Wintour and Selena Gomez attend a show during New York Fashion Week on 12 September 2017.


Anna Wintour and Selena Gomez attend a show during New York Fashion Week on 12 September 2017. Photograph: Roy Rochlin/Getty Images for Coach

The Instagram post includes a picture of Gomez and Raisa holding hands while lying side-by-side in hospital beds and another photo of a scar on Gomez’s abdomen. The 29-year-old Raisa is best known for her role on the ABC Family series The Secret Life of the American Teenager. Raisa’s publicist didn’t immediately return a request for comment Thursday.

Gomez revealed her lupus diagnosis in 2015 and took a break from her career last year to deal with anxiety, panic attacks and depression stemming from her battle with the disease.

Lupus is an autoimmune disease, where the body mistakenly attacks its own tissues, sometimes including the kidneys. One healthy kidney is all the body needs, so a single kidney transplant can resolve the problem, said Dr David Klassen, chief medical officer for the United Network for Organ Sharing, which runs the nation’s transplant system.

“Lupus tends to be a disease of younger women, and younger people tend to do better with transplants than older patients, so the expectation is she would do quite well,” he said of Gomez.

Lupus also tends not to come back after the operation – “the drugs that prevent kidney rejection are also very good for treating lupus, the underlying disease,” Klassen said.

The causes of lupus are unknown. Symptoms can include bloody or foamy urine, unexplained weight gain, high blood pressure or swelling in the legs, ankles or around the eyes.

Only about 3% of kidney transplants are for lupus most are due to diabetes or chronic damage from high blood pressure.

There were about 19,000 kidney transplants in the US last year.

Gomez, whose hits include Good for You, Same Old Love and Come & Get It, has been in the spotlight since she was a child. She appeared on Barney and Friends before breaking through as a teen star on the Disney Channel’s Wizards of Waverly Place. She has a massive following on social media. Her 126 million followers on Instagram are the most on the platform.

She is due to star in a Woody Allen movie next year.

Gomez, who has been dating the singer The Weeknd for several months, also has had success behind the scenes as the executive producer of Netflix’s 13 Reasons Why, the controversial young adult series that became a summer sensation this year.

Britain flouting duty to protect citizens from toxic air pollution – UN

The UK government is “flouting” its duty to protect the lives and health of its citizens from illegal and dangerous levels of air pollution, according to the UN’s special rapporteur on human rights related to toxic waste.

Baskut Tuncak issued his warning after a fact-finding mission to the UK in January at the invitation of the government in a report that has been shared exclusively with the Guardian before it is presented to the UN human rights council this week.

“Air pollution continues to plague the UK,” he said. “I am alarmed that despite repeated judicial instruction, the UK government continues to flout its duty to ensure adequate air quality and protect the rights to life and health of its citizens. It has violated its obligations.”

Such harsh international criticism will be embarrassing for the government, whose air pollution plans have already been ruled illegally poor twice. The latest plan forced by the courts was released in July but condemned as “woefully inadequate” by city leaders and “inexcusable” by doctors.

Air pollution causes an estimated 40,000 early deaths every year in Britain and was declared a “public health emergency” by MPs in 2016. Air pollution is worst overall in London, but many other places have illegal levels of nitrogen dioxide emitted by diesel vehicles, such as Leeds, Birmingham, Bournemouth and Northampton. Ipswich has higher levels of particulate matter than London.

London breached its nominal annual air pollution limits five days into 2017 at Brixton Road in south London. Other known pollution hotspots in the capital include Putney High Street in west London, Oxford Street, Kings Road in Chelsea and the Strand.

In his report for the UN, Tuncak assessed how well the UK protects human rights that are infringed by pollution, such as the rights to life, health and safe housing.

Vulnerable groups were worst affected by air pollution, he said: “Children, older persons and people with pre-existing health conditions are at grave risk of mortality, morbidity and disability, with magnified risks among the poor and minorities.”

A government spokeswoman said Brexit represented an opportunity to improve the UK’s air quality standards. “EU policies, from the common agricultural policy to vehicle emissions tests, have damaged the environment. Our £3bn air quality plan will address the dirty air caused by the EU’s failed testing regime, and in ending the sale of new diesel and petrol cars by 2040, the UK is more ambitious than most EU member states including Germany.

“We now have an opportunity to deliver a green Brexit, ensuring the UK is a global leader in environmental protection,” she said.

Anna Heslop, at ClientEarth, the lawyers who have twice defeated the government on air quality standards, said: “This damning report with regard to air pollution is unsurprising but no less shocking for that. The UK has illegal levels of air pollution and successive governments have fought us in the courts rather than tackling it effectively.

“We are glad the report says the government must listen to the experts, including its own, and develop a national network of clean air zones to keep the worst polluting vehicles out of the most polluted areas of our towns and cities. This should happen as soon as possible.”

A new, wide-ranging ClientEarth report argues the government’s claim that all EU environmental laws will be retained after Brexit is misleading. It also criticises the government over other aspects of environmental policy “loopholes” in fracking regulation; the loss of environmental staff due to austerity which has resulted in “serious governance gaps”; and the risks to environmental safety posed by Brexit.

Tuncak also warned of the risk that fracking, soon to start in Lancashire, poses to safe water. “UK regulations on fracking are complex, split between several regulators and do not appear to be sufficiently stringent,” he said. “Fragmented policymaking allows for loopholes.”

All the UK’s environmental regulators have suffered due to budget cuts, he found: “The decreasing financial, technical and human resources due to austerity have created serious governance gaps.” The Department for Environment, Food and Rural Affairs (Defra) has lost a third of its staff compared with 2007.

Another consequence of austerity was Defra’s ending in March of capital grants to local councils for cleaning up contaminated land sites, which the UN report said posed “potentially serious health risks”.

Tuncak warned that unless the UK’s future green standards equalled those of the European Union, “the UK could risk becoming a haven for ‘dirty’ industries and a dumping ground for products failing to meet EU regulations”.

Labour MP Mary Creagh, who chairs the environmental audit committee, said: “It is vital the government passes a new environmental protection act as soon as possible to protect the lives and livelihoods of millions of people.” Tuncak backs that call in his report.

The committee warned in January that Brexit could result in key environmental protections being left as ineffective “zombie legislation”. Creagh said the UN report highlighted the “government’s lack of clarity about the future of environmental issues after Brexit and how they will stop the UK from becoming a dumping ground for dirty industries and a haven for bad practice”.

Tuncak’s report also asks the UK government to “reconsider national plans to increase reliance on nuclear energy, considering that long-term storage of nuclear waste is uncertain and poses significant risks to the population”. He criticised the UK’s cuts to legal aid and protection from legal costs which make it “extremely challenging” for victims of environmental harm to seek redress in the courts.

Britain flouting duty to protect citizens from toxic air pollution – UN

The UK government is “flouting” its duty to protect the lives and health of its citizens from illegal and dangerous levels of air pollution, according to the UN’s special rapporteur on human rights related to toxic waste.

Baskut Tuncak issued his warning after a fact-finding mission to the UK in January at the invitation of the government in a report that has been shared exclusively with the Guardian before it is presented to the UN human rights council this week.

“Air pollution continues to plague the UK,” he said. “I am alarmed that despite repeated judicial instruction, the UK government continues to flout its duty to ensure adequate air quality and protect the rights to life and health of its citizens. It has violated its obligations.”

Such harsh international criticism will be embarrassing for the government, whose air pollution plans have already been ruled illegally poor twice. The latest plan forced by the courts was released in July but condemned as “woefully inadequate” by city leaders and “inexcusable” by doctors.

Air pollution causes an estimated 40,000 early deaths every year in Britain and was declared a “public health emergency” by MPs in 2016. Air pollution is worst overall in London, but many other places have illegal levels of nitrogen dioxide emitted by diesel vehicles, such as Leeds, Birmingham, Bournemouth and Northampton. Ipswich has higher levels of particulate matter than London.

London breached its nominal annual air pollution limits five days into 2017 at Brixton Road in south London. Other known pollution hotspots in the capital include Putney High Street in west London, Oxford Street, Kings Road in Chelsea and the Strand.

In his report for the UN, Tuncak assessed how well the UK protects human rights that are infringed by pollution, such as the rights to life, health and safe housing.

Vulnerable groups were worst affected by air pollution, he said: “Children, older persons and people with pre-existing health conditions are at grave risk of mortality, morbidity and disability, with magnified risks among the poor and minorities.”

A government spokeswoman said Brexit represented an opportunity to improve the UK’s air quality standards. “EU policies, from the common agricultural policy to vehicle emissions tests, have damaged the environment. Our £3bn air quality plan will address the dirty air caused by the EU’s failed testing regime, and in ending the sale of new diesel and petrol cars by 2040, the UK is more ambitious than most EU member states including Germany.

“We now have an opportunity to deliver a green Brexit, ensuring the UK is a global leader in environmental protection,” she said.

Anna Heslop, at ClientEarth, the lawyers who have twice defeated the government on air quality standards, said: “This damning report with regard to air pollution is unsurprising but no less shocking for that. The UK has illegal levels of air pollution and successive governments have fought us in the courts rather than tackling it effectively.

“We are glad the report says the government must listen to the experts, including its own, and develop a national network of clean air zones to keep the worst polluting vehicles out of the most polluted areas of our towns and cities. This should happen as soon as possible.”

A new, wide-ranging ClientEarth report argues the government’s claim that all EU environmental laws will be retained after Brexit is misleading. It also criticises the government over other aspects of environmental policy “loopholes” in fracking regulation; the loss of environmental staff due to austerity which has resulted in “serious governance gaps”; and the risks to environmental safety posed by Brexit.

Tuncak also warned of the risk that fracking, soon to start in Lancashire, poses to safe water. “UK regulations on fracking are complex, split between several regulators and do not appear to be sufficiently stringent,” he said. “Fragmented policymaking allows for loopholes.”

All the UK’s environmental regulators have suffered due to budget cuts, he found: “The decreasing financial, technical and human resources due to austerity have created serious governance gaps.” The Department for Environment, Food and Rural Affairs (Defra) has lost a third of its staff compared with 2007.

Another consequence of austerity was Defra’s ending in March of capital grants to local councils for cleaning up contaminated land sites, which the UN report said posed “potentially serious health risks”.

Tuncak warned that unless the UK’s future green standards equalled those of the European Union, “the UK could risk becoming a haven for ‘dirty’ industries and a dumping ground for products failing to meet EU regulations”.

Labour MP Mary Creagh, who chairs the environmental audit committee, said: “It is vital the government passes a new environmental protection act as soon as possible to protect the lives and livelihoods of millions of people.” Tuncak backs that call in his report.

The committee warned in January that Brexit could result in key environmental protections being left as ineffective “zombie legislation”. Creagh said the UN report highlighted the “government’s lack of clarity about the future of environmental issues after Brexit and how they will stop the UK from becoming a dumping ground for dirty industries and a haven for bad practice”.

Tuncak’s report also asks the UK government to “reconsider national plans to increase reliance on nuclear energy, considering that long-term storage of nuclear waste is uncertain and poses significant risks to the population”. He criticised the UK’s cuts to legal aid and protection from legal costs which make it “extremely challenging” for victims of environmental harm to seek redress in the courts.

US overdose deaths from fentanyl and synthetic opioids doubled in 2016

The number of drug overdose deaths in the US increased by 21% last year, according to new statistics – with synthetic-opioid fatalities more than doubling in number.

The National Center for Health Statistics, a division of the Centers for Disease Control and Prevention, (CDC) estimates that drug overdoses killed 64,070 people in the US last year, a rise of 21% over the 52,898 drug overdose deaths recorded in 2015.

The epidemic of drug overdoses is killing people at almost double the rate of both firearm and motor vehicle-related death.

The statistics posted on the CDC website are the latest available on the gathering opioid crisis. The agency says they will be updated on a monthly basis.

Much of the increase in fatalities is blamed on the synthetic opioid fentanyl, which is typically used for pain management during surgery or in end-of-life settings and has a marked depressive effect on the respiratory system.

Along with other synthetic opioids, it is blamed for 20,145 deaths last year, significantly above the 15,446 attributed to heroin or the 14,427 attributed to opioid pills alone. The figure for synthetic opioids in 2015 was 9,945.

According to analysis published in the CDC’s 31 Auguse edition of Morbidity and Mortality Weekly, “approximately half of the increase in deaths involving heroin after 2013 is attributable to increases in deaths involving use of both heroin and fentanyl”.

The CDC journal concluded that the opioid overdose epidemic resulted in the deaths of approximately 300,000 people in the US during 1999–2015, including 33,000 in 2015.

“The first wave of deaths began in 1999 and included deaths involving prescription opioids. It was followed by a second wave, beginning in 2010, and characterized by deaths involving heroin. A third wave started in 2013, with deaths involving synthetic opioids, particularly illicitly manufactured fentanyl (IMF). IMF is now being used in combination with heroin, counterfeit pills, and cocaine.”

A Drug Enforcement Agency intelligence brief published in July called fentanyl a “global threat”.

Last week, White House drugs czar Michael Botticelli backed calls for a ban on the high-strength opioid painkillers widely blamed for creating a pain-management crisis that led to increased demand for heroin, now overwhelmingly smuggled from Mexico, and fentanyl, now largely imported from labs in China, according to DEA analysis.

The latest CDC figures show that the rate of increase in deaths from natural or semi-synthetic opioid pills was much less steep than that for synthetic opioids, rising from 12,726 in 2015 to 14,427 last year.

The national data also showed an increase in deaths attributed to stimulants such as cocaine – up from 6,986 to 10,619 – and psychostimulants such as methamphetamine, up from 5,922 to 7,663, year-on-year.

Underscoring the overall shift, Ohio last week reported that overdose deaths in 2016 rose 33% to 4,050 from 3,050 in 2015, or roughly 11 a day. It attributed the rise to fentanyl and carfentanil, an analgesic 5,000 times more powerful than heroin used to sedate elephants.

By contrast, the state said that heroin-related deaths were leveling off, and deaths from prescription painkillers fell for fifth straight year.

Other states, including hard-hit Massachusetts, report that opioid-related overdose deaths are declining, even as fatal fentanyl overdoses (termed T40.4 by CDC nosologists) continue to increase.

In May, Massachusetts reported that fentanyl had overtaken heroin as the cause of most overdose deaths. In the last three months of 2016, heroin was present in only a third of deaths that had a toxicology screen. A year earlier, heroin was the leading cause of overdose death. Of 1,899 recorded opioid related deaths last year, 69% tested positive for fentanyl.

The national figures showed striking regional differences in the rate of increase in overdose deaths. For deaths attributed to fentanyl, states and jurisdictions including Maryland, New York City and Virginia recorded significant increases.

Of the 22 reporting jurisdictions included in the release, some states, including Nebraska, Washington and Wyoming, recorded reductions in drug overdose deaths of up to 8%.

The statistical agency warns that the latest figures only reflect the percentage of death records available for analysis. Since drug overdose deaths are often initially reported with no specific toxicology, final numbers will be released at a later date.

US overdose deaths from fentanyl and synthetic opioids doubled in 2016

The number of drug overdose deaths in the US increased by 21% last year, according to new statistics – with synthetic-opioid fatalities more than doubling in number.

The National Center for Health Statistics, a division of the Centers for Disease Control and Prevention, (CDC) estimates that drug overdoses killed 64,070 people in the US last year, a rise of 21% over the 52,898 drug overdose deaths recorded in 2015.

The epidemic of drug overdoses is killing people at almost double the rate of both firearm and motor vehicle-related death.

The statistics posted on the CDC website are the latest available on the gathering opioid crisis. The agency says they will be updated on a monthly basis.

Much of the increase in fatalities is blamed on the synthetic opioid fentanyl, which is typically used for pain management during surgery or in end-of-life settings and has a marked depressive effect on the respiratory system.

Along with other synthetic opioids, it is blamed for 20,145 deaths last year, significantly above the 15,446 attributed to heroin or the 14,427 attributed to opioid pills alone. The figure for synthetic opioids in 2015 was 9,945.

According to analysis published in the CDC’s 31 Auguse edition of Morbidity and Mortality Weekly, “approximately half of the increase in deaths involving heroin after 2013 is attributable to increases in deaths involving use of both heroin and fentanyl”.

The CDC journal concluded that the opioid overdose epidemic resulted in the deaths of approximately 300,000 people in the US during 1999–2015, including 33,000 in 2015.

“The first wave of deaths began in 1999 and included deaths involving prescription opioids. It was followed by a second wave, beginning in 2010, and characterized by deaths involving heroin. A third wave started in 2013, with deaths involving synthetic opioids, particularly illicitly manufactured fentanyl (IMF). IMF is now being used in combination with heroin, counterfeit pills, and cocaine.”

A Drug Enforcement Agency intelligence brief published in July called fentanyl a “global threat”.

Last week, White House drugs czar Michael Botticelli backed calls for a ban on the high-strength opioid painkillers widely blamed for creating a pain-management crisis that led to increased demand for heroin, now overwhelmingly smuggled from Mexico, and fentanyl, now largely imported from labs in China, according to DEA analysis.

The latest CDC figures show that the rate of increase in deaths from natural or semi-synthetic opioid pills was much less steep than that for synthetic opioids, rising from 12,726 in 2015 to 14,427 last year.

The national data also showed an increase in deaths attributed to stimulants such as cocaine – up from 6,986 to 10,619 – and psychostimulants such as methamphetamine, up from 5,922 to 7,663, year-on-year.

Underscoring the overall shift, Ohio last week reported that overdose deaths in 2016 rose 33% to 4,050 from 3,050 in 2015, or roughly 11 a day. It attributed the rise to fentanyl and carfentanil, an analgesic 5,000 times more powerful than heroin used to sedate elephants.

By contrast, the state said that heroin-related deaths were leveling off, and deaths from prescription painkillers fell for fifth straight year.

Other states, including hard-hit Massachusetts, report that opioid-related overdose deaths are declining, even as fatal fentanyl overdoses (termed T40.4 by CDC nosologists) continue to increase.

In May, Massachusetts reported that fentanyl had overtaken heroin as the cause of most overdose deaths. In the last three months of 2016, heroin was present in only a third of deaths that had a toxicology screen. A year earlier, heroin was the leading cause of overdose death. Of 1,899 recorded opioid related deaths last year, 69% tested positive for fentanyl.

The national figures showed striking regional differences in the rate of increase in overdose deaths. For deaths attributed to fentanyl, states and jurisdictions including Maryland, New York City and Virginia recorded significant increases.

Of the 22 reporting jurisdictions included in the release, some states, including Nebraska, Washington and Wyoming, recorded reductions in drug overdose deaths of up to 8%.

The statistical agency warns that the latest figures only reflect the percentage of death records available for analysis. Since drug overdose deaths are often initially reported with no specific toxicology, final numbers will be released at a later date.

US overdose deaths from fentanyl and synthetic opioids doubled in 2016

The number of drug overdose deaths in the US increased by 21% last year, according to new statistics – with synthetic-opioid fatalities more than doubling in number.

The National Center for Health Statistics, a division of the Centers for Disease Control and Prevention, (CDC) estimates that drug overdoses killed 64,070 people in the US last year, a rise of 21% over the 52,898 drug overdose deaths recorded in 2015.

The epidemic of drug overdoses is killing people at almost double the rate of both firearm and motor vehicle-related death.

The statistics posted on the CDC website are the latest available on the gathering opioid crisis. The agency says they will be updated on a monthly basis.

Much of the increase in fatalities is blamed on the synthetic opioid fentanyl, which is typically used for pain management during surgery or in end-of-life settings and has a marked depressive effect on the respiratory system.

Along with other synthetic opioids, it is blamed for 20,145 deaths last year, significantly above the 15,446 attributed to heroin or the 14,427 attributed to opioid pills alone. The figure for synthetic opioids in 2015 was 9,945.

According to analysis published in the CDC’s 31 Auguse edition of Morbidity and Mortality Weekly, “approximately half of the increase in deaths involving heroin after 2013 is attributable to increases in deaths involving use of both heroin and fentanyl”.

The CDC journal concluded that the opioid overdose epidemic resulted in the deaths of approximately 300,000 people in the US during 1999–2015, including 33,000 in 2015.

“The first wave of deaths began in 1999 and included deaths involving prescription opioids. It was followed by a second wave, beginning in 2010, and characterized by deaths involving heroin. A third wave started in 2013, with deaths involving synthetic opioids, particularly illicitly manufactured fentanyl (IMF). IMF is now being used in combination with heroin, counterfeit pills, and cocaine.”

A Drug Enforcement Agency intelligence brief published in July called fentanyl a “global threat”.

Last week, White House drugs czar Michael Botticelli backed calls for a ban on the high-strength opioid painkillers widely blamed for creating a pain-management crisis that led to increased demand for heroin, now overwhelmingly smuggled from Mexico, and fentanyl, now largely imported from labs in China, according to DEA analysis.

The latest CDC figures show that the rate of increase in deaths from natural or semi-synthetic opioid pills was much less steep than that for synthetic opioids, rising from 12,726 in 2015 to 14,427 last year.

The national data also showed an increase in deaths attributed to stimulants such as cocaine – up from 6,986 to 10,619 – and psychostimulants such as methamphetamine, up from 5,922 to 7,663, year-on-year.

Underscoring the overall shift, Ohio last week reported that overdose deaths in 2016 rose 33% to 4,050 from 3,050 in 2015, or roughly 11 a day. It attributed the rise to fentanyl and carfentanil, an analgesic 5,000 times more powerful than heroin used to sedate elephants.

By contrast, the state said that heroin-related deaths were leveling off, and deaths from prescription painkillers fell for fifth straight year.

Other states, including hard-hit Massachusetts, report that opioid-related overdose deaths are declining, even as fatal fentanyl overdoses (termed T40.4 by CDC nosologists) continue to increase.

In May, Massachusetts reported that fentanyl had overtaken heroin as the cause of most overdose deaths. In the last three months of 2016, heroin was present in only a third of deaths that had a toxicology screen. A year earlier, heroin was the leading cause of overdose death. Of 1,899 recorded opioid related deaths last year, 69% tested positive for fentanyl.

The national figures showed striking regional differences in the rate of increase in overdose deaths. For deaths attributed to fentanyl, states and jurisdictions including Maryland, New York City and Virginia recorded significant increases.

Of the 22 reporting jurisdictions included in the release, some states, including Nebraska, Washington and Wyoming, recorded reductions in drug overdose deaths of up to 8%.

The statistical agency warns that the latest figures only reflect the percentage of death records available for analysis. Since drug overdose deaths are often initially reported with no specific toxicology, final numbers will be released at a later date.

Private firms poised to make another £1bn from building NHS hospitals

Companies that have built NHS hospitals under the private finance initiative have made pre-tax profits of £831m over the past six years and are poised to make almost £1bn more over the next five years.

Large sums that could have been used for patient care have instead gone into the pockets of a handful of PFI companies at a time when the health service is starved of funding, according to the Centre for Health and the Public Interest.

Its analysis, published on Wednesday, found that if the NHS had not been paying pre-tax profits on PFI schemes between 2010 and 2015 inclusive, the deficits in its hospitals would have been reduced by a quarter.

Expected payments to PFI companies in the form of pre-tax profits over the next five years constitute 22% of the extra cash the government has promised the NHS between 2016-17 and 2020-21, it says.

The centre’s co-chair, Colin Leys, said: “This money was designated by parliament to pay for patient care, not to pay dividends to a small number of investors. Given the extreme austerity in the NHS where patients are being denied treatment and waiting times for operations are rising, the government needs to take action to stop this leakage of taxpayer funds out of the NHS.”

PFI contracts have proved controversial because they are much more expensive than the traditional method of public borrowing. A private company called a special purpose vehicle is set up and borrows money from the private sector to build a facility, such as a hospital, which it leases back to the public body in exchange for annual payments, known as unitary charges.

In the case of the current 125 health PFI projects, the average payment term is 31 years. The CHPI says the capital value of the assets that have been built under the contracts is £12.4bn but the NHS will pay about £80bn for their use.

It found that about 8% of the cash the NHS has paid to PFI companies over the past six years has left the health service in the form of pre-tax profit, but in 13 contracts the figure was more than 20%. For example, the PFI company for University College Hospital London made 31% (£139.7m) in pre-tax profit on the money paid to it by the trust between 2010 and 2015.

The returns are high even though the risks are low once construction is completed, as the government guarantees the payments, save in exceptional circumstances.

The figures were derived from a study of the Treasury database and the accounts of PFI companies held by Companies House. They do not include information on the borrowing costs the NHS has to pay to the companies on top of these profits so, according to Leys, they form “only part of the full picture”.

The CHPI found that just eight companies, which each employ a handful of people, have equity stakes in 92% of the NHS PFI schemes.

It calculates that if the PFI companies continue to accrue the same percentage profit – 9.4% – as in 2015, they will earn about £973m in real terms pre-tax profit over the next five years.

Its report, PFI Profiting from Infirmaries, includes recommendations to renegotiate contracts or use public sector loans to buy them out, tax PFI companies to recoup some of the excess profits and cap the amount they can make.

The Labour MP Stella Creasy, who has been campaigning for an urgent competition enquiry into the market for public borrowing, said: “PFI companies are squeezing our public services at a great cost to the taxpayer and a great profit to their shareholders. Governments may keep using these loans but with Britain struggling with so much public debt we can’t afford to keep paying for this mistake.”

A Department of Health spokesperson said: “The NHS is recognised by the independent Commonwealth Fund as the most efficient healthcare system in the world and currently spends less than 3% of its annual budget on PFI.

“The first PFI contracts for NHS hospitals, which were signed in 1997, range between 25-30 years – this report analyses just six years of contracts and as a result does not represent the full picture.”

Private firms poised to make another £1bn from building NHS hospitals

Companies that have built NHS hospitals under the private finance initiative have made pre-tax profits of £831m over the past six years and are poised to make almost £1bn more over the next five years.

Large sums that could have been used for patient care have instead gone into the pockets of a handful of PFI companies at a time when the health service is starved of funding, according to the Centre for Health and the Public Interest.

Its analysis, published on Wednesday, found that if the NHS had not been paying pre-tax profits on PFI schemes between 2010 and 2015 inclusive, the deficits in its hospitals would have been reduced by a quarter.

Expected payments to PFI companies in the form of pre-tax profits over the next five years constitute 22% of the extra cash the government has promised the NHS between 2016-17 and 2020-21, it says.

The centre’s co-chair, Colin Leys, said: “This money was designated by parliament to pay for patient care, not to pay dividends to a small number of investors. Given the extreme austerity in the NHS where patients are being denied treatment and waiting times for operations are rising, the government needs to take action to stop this leakage of taxpayer funds out of the NHS.”

PFI contracts have proved controversial because they are much more expensive than the traditional method of public borrowing. A private company called a special purpose vehicle is set up and borrows money from the private sector to build a facility, such as a hospital, which it leases back to the public body in exchange for annual payments, known as unitary charges.

In the case of the current 125 health PFI projects, the average payment term is 31 years. The CHPI says the capital value of the assets that have been built under the contracts is £12.4bn but the NHS will pay about £80bn for their use.

It found that about 8% of the cash the NHS has paid to PFI companies over the past six years has left the health service in the form of pre-tax profit, but in 13 contracts the figure was more than 20%. For example, the PFI company for University College Hospital London made 31% (£139.7m) in pre-tax profit on the money paid to it by the trust between 2010 and 2015.

The returns are high even though the risks are low once construction is completed, as the government guarantees the payments, save in exceptional circumstances.

The figures were derived from a study of the Treasury database and the accounts of PFI companies held by Companies House. They do not include information on the borrowing costs the NHS has to pay to the companies on top of these profits so, according to Leys, they form “only part of the full picture”.

The CHPI found that just eight companies, which each employ a handful of people, have equity stakes in 92% of the NHS PFI schemes.

It calculates that if the PFI companies continue to accrue the same percentage profit – 9.4% – as in 2015, they will earn about £973m in real terms pre-tax profit over the next five years.

Its report, PFI Profiting from Infirmaries, includes recommendations to renegotiate contracts or use public sector loans to buy them out, tax PFI companies to recoup some of the excess profits and cap the amount they can make.

The Labour MP Stella Creasy, who has been campaigning for an urgent competition enquiry into the market for public borrowing, said: “PFI companies are squeezing our public services at a great cost to the taxpayer and a great profit to their shareholders. Governments may keep using these loans but with Britain struggling with so much public debt we can’t afford to keep paying for this mistake.”

A Department of Health spokesperson said: “The NHS is recognised by the independent Commonwealth Fund as the most efficient healthcare system in the world and currently spends less than 3% of its annual budget on PFI.

“The first PFI contracts for NHS hospitals, which were signed in 1997, range between 25-30 years – this report analyses just six years of contracts and as a result does not represent the full picture.”