Pub Date : 2021-07-01DOI: 10.1080/01947648.2022.2147366
Cathleen London
The primary narrative directing opioid policy is that the overdose epidemic is driven by clinician overprescribing, creating patient addicts. This has led to draconian laws and the use of invasive prescription monitoring programs that have harmed patients with chronic pain throughout the country. 1 The black box algorithms mine data and have never been subjected to independent verification. 2 Patients and prescribers alike are flagged as sus-picious. 3 Although opioid prescribing has dropped dramatically since the introduction of prescription monitoring, overdose deaths have risen expo-nentially, driven by the illicit fentanyl market. Despite this, law enforcement continues to focus on the diversion of prescription medication. The drug prohibition policy set by the Department of Justice (DOJ) is a mis-guided attempt to address skyrocketing opioid overdoses. It is their way of trying to fix the issue of the unchecked distribution of opioids. The blame for that falls on the Drug Enforcement Agency (DEA), Congress, and lobbyists. 4 This focus on limiting the prescribing of legal opioids has led to an increasingly lethal illicit opiate supply. The DOJ continues to erroneously cite diversion of licit legitimate prescriptions of opioids as the problem. As a result, doctors have been imprisoned for terms ranging from 20 years to life without parole, all for practicing medicine. Others have had their careers and reputations irreparably harmed.
{"title":"DOJ Overreach: The Criminalization of Physicians.","authors":"Cathleen London","doi":"10.1080/01947648.2022.2147366","DOIUrl":"10.1080/01947648.2022.2147366","url":null,"abstract":"The primary narrative directing opioid policy is that the overdose epidemic is driven by clinician overprescribing, creating patient addicts. This has led to draconian laws and the use of invasive prescription monitoring programs that have harmed patients with chronic pain throughout the country. 1 The black box algorithms mine data and have never been subjected to independent verification. 2 Patients and prescribers alike are flagged as sus-picious. 3 Although opioid prescribing has dropped dramatically since the introduction of prescription monitoring, overdose deaths have risen expo-nentially, driven by the illicit fentanyl market. Despite this, law enforcement continues to focus on the diversion of prescription medication. The drug prohibition policy set by the Department of Justice (DOJ) is a mis-guided attempt to address skyrocketing opioid overdoses. It is their way of trying to fix the issue of the unchecked distribution of opioids. The blame for that falls on the Drug Enforcement Agency (DEA), Congress, and lobbyists. 4 This focus on limiting the prescribing of legal opioids has led to an increasingly lethal illicit opiate supply. The DOJ continues to erroneously cite diversion of licit legitimate prescriptions of opioids as the problem. As a result, doctors have been imprisoned for terms ranging from 20 years to life without parole, all for practicing medicine. Others have had their careers and reputations irreparably harmed.","PeriodicalId":44014,"journal":{"name":"Journal of Legal Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10528952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.1080/01947648.2022.2087406
Jacey DuBois, Lawson Hamilton
{"title":"In The Supreme Court of the United States: Docket No. 21-1967.","authors":"Jacey DuBois, Lawson Hamilton","doi":"10.1080/01947648.2022.2087406","DOIUrl":"https://doi.org/10.1080/01947648.2022.2087406","url":null,"abstract":"","PeriodicalId":44014,"journal":{"name":"Journal of Legal Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10527417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-21DOI: 10.1080/01947648.2021.1914488
S. Poole, Benjamin Selander, Joseph P. Hardy, W. Havins
Ethical Dilemma of Physicians Informing Patients of Foreign Organ Transplant Alternatives Sean Poole, OMS-II; spoole3@student.touro.edu Benjamin Selander, OMS-II; Touro bselande@student.touro.edu Joseph P. Hardy, MD, Associate Dean for Clinical Education Weldon Havins, MD, JD, LLM, FCLM, Emeritus Professor Touro University Nevada College of Osteopathic Medicine, NV Ever since the introduction of transplant surgery in the latter half of the 20th century, organ transplantation has improved the lives of thousands of people around the world. However, the demand for organs is steadily rising while the supply remains limited. This inevitably leads well-to-do individuals, placed on lengthy organ waiting lists, to seek organ transplants abroad in less ethical and less legal ways. Many procure these organs in China, where it is believed that non-consenting Falun Gong practitioners are persecuted, placed in detention centers or labor camps and illegally harvested for their organs. There are also issues of illegal brokers taking advantage of vulnerable individuals in developing nations, such as the Philippines and Moldova. However, regardless of how the organs are acquired, “organ tourists” are met with virtually no legal repercussions. The increasing need for organs has created a global issue. This practice, called “organ tourism”, has been condemned, but not criminalized, by the greater international community in the Declaration of Istanbul, created in 2008 and supported by over 150 countries. Though internationally condemned, engagement in “organ tourism” has seen an increase in recent years. There are currently no U.S. laws prohibiting organ tourism, nor are there any mandates requiring physicians to report patients who have participated in organ tourism. Therefore, physicians are faced with an ethical dilemma; in what capacity, if any, to advise their patients regarding organ transplantation abroad. This review utilizes the Army’s 7 Steps in Problem Solving Model to provide a concise and conclusive framework to determine if there exists an ethical obligation for physicians to advise their patients of foreign transplant alternatives. By following the Army’s 7 Steps in Problem Solving Model, certain guiding criteria are established, such as: non-judgmental regard and fiduciary responsibility for patients who return with transplanted organs, deterring hopeful transplant patients from involving 2021 American College of Legal Medicine JOURNAL OF LEGAL MEDICINE 2021, VOL. 41, NO. S1, 36–37 https://doi.org/10.1080/01947648.2021.1914488 themselves in organ transplant systems engaged in crimes against humanity, and considering the greater societal impact of the benefits of organ tourism. This review concludes it is the physicians ethical duty to advise their patients of foreign options to obtain organ transplantation. However, there should be no obligation to inform patients of transplant organ systems which take part in highly unethical practices, such as thos
医师告知患者国外器官移植选择的伦理困境spoole3@student.touro.edu本杰明·塞兰德，OMS-II;Touro bselande@student.touro.edu Joseph P. Hardy，医学博士，临床教育副院长Weldon Havins，医学博士，法学硕士，FCLM，荣誉教授Touro University of Osteopathic Medicine, NV自从移植手术在20世纪下半叶引入以来，器官移植已经改善了全世界成千上万人的生活。然而，对器官的需求正在稳步上升，而供应仍然有限。这不可避免地导致那些排在漫长的器官等待名单上的富裕人士，以不那么道德和不那么合法的方式在国外寻求器官移植。许多人在中国获得这些器官，据信，在那里，未经同意的法轮功学员受到迫害，被关押在拘留中心或劳教所，并被非法摘取器官。在菲律宾和摩尔多瓦等发展中国家，也存在非法经纪人利用弱势群体牟利的问题。然而，不管器官是如何获得的，“器官游客”几乎没有受到任何法律制裁。对器官日益增长的需求已经成为一个全球性问题。这种被称为“器官旅游”的做法在2008年制定并得到150多个国家支持的《伊斯坦布尔宣言》中受到了更大的国际社会的谴责，但没有被定为犯罪。尽管受到国际社会的谴责，但近年来，“器官旅游”的活动有所增加。目前美国没有禁止器官旅游的法律，也没有任何强制要求医生报告参与器官旅游的病人。因此，医生面临着一个伦理困境;以何种身份(如果有的话)建议患者进行国外器官移植。本综述利用美国陆军的“问题解决的7个步骤”模型，提供了一个简明而结论性的框架，以确定医生是否有道德义务向患者建议国外移植的替代方案。通过遵循陆军解决问题的7个步骤模型，建立了一些指导标准，例如:对移植器官返回的患者的非判断性考虑和信托责任，阻止有希望的移植患者参与2021年美国法律医学学院法律医学杂志2021,VOL. 41, NO。S1, 36-37 https://doi.org/10.1080/01947648.2021.1914488他们自己在器官移植系统中从事反人类罪，并考虑到器官旅游带来的更大的社会影响。本综述的结论是，医生有道德责任向患者推荐国外的器官移植选择。然而，没有义务告知患者参与高度不道德做法的移植器官系统，例如那些被认为参与危害人类罪的移植器官系统。提供并鼓励未来的研究课题。可索取参考资料37
{"title":"Ethical Dilemma of Physicians Informing Patients of Foreign Organ Transplant Alternatives","authors":"S. Poole, Benjamin Selander, Joseph P. Hardy, W. Havins","doi":"10.1080/01947648.2021.1914488","DOIUrl":"https://doi.org/10.1080/01947648.2021.1914488","url":null,"abstract":"Ethical Dilemma of Physicians Informing Patients of Foreign Organ Transplant Alternatives Sean Poole, OMS-II; spoole3@student.touro.edu Benjamin Selander, OMS-II; Touro bselande@student.touro.edu Joseph P. Hardy, MD, Associate Dean for Clinical Education Weldon Havins, MD, JD, LLM, FCLM, Emeritus Professor Touro University Nevada College of Osteopathic Medicine, NV Ever since the introduction of transplant surgery in the latter half of the 20th century, organ transplantation has improved the lives of thousands of people around the world. However, the demand for organs is steadily rising while the supply remains limited. This inevitably leads well-to-do individuals, placed on lengthy organ waiting lists, to seek organ transplants abroad in less ethical and less legal ways. Many procure these organs in China, where it is believed that non-consenting Falun Gong practitioners are persecuted, placed in detention centers or labor camps and illegally harvested for their organs. There are also issues of illegal brokers taking advantage of vulnerable individuals in developing nations, such as the Philippines and Moldova. However, regardless of how the organs are acquired, “organ tourists” are met with virtually no legal repercussions. The increasing need for organs has created a global issue. This practice, called “organ tourism”, has been condemned, but not criminalized, by the greater international community in the Declaration of Istanbul, created in 2008 and supported by over 150 countries. Though internationally condemned, engagement in “organ tourism” has seen an increase in recent years. There are currently no U.S. laws prohibiting organ tourism, nor are there any mandates requiring physicians to report patients who have participated in organ tourism. Therefore, physicians are faced with an ethical dilemma; in what capacity, if any, to advise their patients regarding organ transplantation abroad. This review utilizes the Army’s 7 Steps in Problem Solving Model to provide a concise and conclusive framework to determine if there exists an ethical obligation for physicians to advise their patients of foreign transplant alternatives. By following the Army’s 7 Steps in Problem Solving Model, certain guiding criteria are established, such as: non-judgmental regard and fiduciary responsibility for patients who return with transplanted organs, deterring hopeful transplant patients from involving 2021 American College of Legal Medicine JOURNAL OF LEGAL MEDICINE 2021, VOL. 41, NO. S1, 36–37 https://doi.org/10.1080/01947648.2021.1914488 themselves in organ transplant systems engaged in crimes against humanity, and considering the greater societal impact of the benefits of organ tourism. This review concludes it is the physicians ethical duty to advise their patients of foreign options to obtain organ transplantation. However, there should be no obligation to inform patients of transplant organ systems which take part in highly unethical practices, such as thos","PeriodicalId":44014,"journal":{"name":"Journal of Legal Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80801645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-21DOI: 10.1080/01947648.2021.1914483
Nilsha Khurana, A. Bedi, W. Havins
Mortality of COVID-19 and Seasonal Influenza in Southern Nevada and the United States Nilsha Khurana, OMS-II; nkhurana@student.touro.edu Avneet Bedi, OMS-II; abedi2@student.touro.edu Weldon E Havins, MD, JD, LLM, FCLM, Professor Emeritus Touro University Nevada College of Osteopathic Medicine In early March 2020, Coronavirus disease 2019 (COVID-19) was declared a national pandemic by the World Health Organization. Many have claimed that COVID-19 is no more serious than the influenza. Although influenza and COVID-19 have some symptoms in common, COVID-19 is a more destructive virus. Because the virus that causes COVID-19 is newly introduced in human populations, there is an urgent need to know more about how the disease impacts human populations. The purpose of this study was to estimate and compare mortality rates between COVID-19 and influenza in Southern Nevada and in the United States. Data for Southern Nevada was collected from Southern Nevada Health District (SNHD) and covered COVID-19 and influenza deaths from 2016-2020. Nationwide data was obtained from the Centers for Disease Control and Prevention (CDC) and covered 2016-2020 for both COVID-19 and influenza. Deaths per 100,000 people, which were attributable to influenza and Coronavirus, were calculated for the Southern Nevada population and for the United States population. After analyzing the data, it was found that there has been an average of 113.19/100,000 COVID deaths in Nevada since the discovery of the virus. On the other hand, for influenza, there has been an average of 1.8/100,000 deaths in Nevada for the past four flu seasons, which typically peaks between December and February. A similar trend is observed nationally. According to the CDC data, it was calculated that nationwide, there are about 111.55/100,000 COVID deaths. Contrarily, there are about 12.46/100,000 influenza-related deaths nationwide. According to the calculations, COVID-19 has a mortality rate higher than reported for influenza, both in Nevada and in the nation. The differences in mortality rates are linked to other important ways that COVID-19 differs from influenza. Because COVID-19 is novel, every individual is therefore susceptible to the virus. Awareness that COVID-19 is not just the flu needs to be made more vigorously. COVID-19 will be a more lethal virus than the influenza strains that seasonally affect world populations. References upon request 2021 American College of Legal Medicine JOURNAL OF LEGAL MEDICINE 2021, VOL. 41, NO. S1, 31 https://doi.org/10.1080/01947648.2021.1914483
{"title":"Mortality of COVID-19 and Seasonal Influenza in Southern Nevada and the United States","authors":"Nilsha Khurana, A. Bedi, W. Havins","doi":"10.1080/01947648.2021.1914483","DOIUrl":"https://doi.org/10.1080/01947648.2021.1914483","url":null,"abstract":"Mortality of COVID-19 and Seasonal Influenza in Southern Nevada and the United States Nilsha Khurana, OMS-II; nkhurana@student.touro.edu Avneet Bedi, OMS-II; abedi2@student.touro.edu Weldon E Havins, MD, JD, LLM, FCLM, Professor Emeritus Touro University Nevada College of Osteopathic Medicine In early March 2020, Coronavirus disease 2019 (COVID-19) was declared a national pandemic by the World Health Organization. Many have claimed that COVID-19 is no more serious than the influenza. Although influenza and COVID-19 have some symptoms in common, COVID-19 is a more destructive virus. Because the virus that causes COVID-19 is newly introduced in human populations, there is an urgent need to know more about how the disease impacts human populations. The purpose of this study was to estimate and compare mortality rates between COVID-19 and influenza in Southern Nevada and in the United States. Data for Southern Nevada was collected from Southern Nevada Health District (SNHD) and covered COVID-19 and influenza deaths from 2016-2020. Nationwide data was obtained from the Centers for Disease Control and Prevention (CDC) and covered 2016-2020 for both COVID-19 and influenza. Deaths per 100,000 people, which were attributable to influenza and Coronavirus, were calculated for the Southern Nevada population and for the United States population. After analyzing the data, it was found that there has been an average of 113.19/100,000 COVID deaths in Nevada since the discovery of the virus. On the other hand, for influenza, there has been an average of 1.8/100,000 deaths in Nevada for the past four flu seasons, which typically peaks between December and February. A similar trend is observed nationally. According to the CDC data, it was calculated that nationwide, there are about 111.55/100,000 COVID deaths. Contrarily, there are about 12.46/100,000 influenza-related deaths nationwide. According to the calculations, COVID-19 has a mortality rate higher than reported for influenza, both in Nevada and in the nation. The differences in mortality rates are linked to other important ways that COVID-19 differs from influenza. Because COVID-19 is novel, every individual is therefore susceptible to the virus. Awareness that COVID-19 is not just the flu needs to be made more vigorously. COVID-19 will be a more lethal virus than the influenza strains that seasonally affect world populations. References upon request 2021 American College of Legal Medicine JOURNAL OF LEGAL MEDICINE 2021, VOL. 41, NO. S1, 31 https://doi.org/10.1080/01947648.2021.1914483","PeriodicalId":44014,"journal":{"name":"Journal of Legal Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90452431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-21DOI: 10.1080/01947648.2021.1914476
Sarah J. Diekman
Objectives: To inform hospital infection control, risk management, hospital administrators, and healthcare workers about a new and surprising threat to infection control: air-powered costumes Background: Air-powered costumes use a small motor to create positive pressure within the costume This mechanism is similar to Powered Air Purifying Respirator (PAPR) 1 However, unlike a PAPR the air-powered costume does not filter the incoming air through a HEPA filter Nor does it capture the air inside a contained space and filter it before it is released into the environment The affect is that droplets from the person in the costume or from air that is drawn into the costume, which would normally be too heavy to travel farther than 6 feet, are aerosolized by traveling through the turbulent blower These small particles can easily penetrate the thin fabric that makes the costume This creates an infection control problem by aerosolizing the particles and then propelling them with the force of positive pressure " Case Description: In January of 2021, a Covid-19 outbreak in San Jose, CA, was contact traced back to a surprising source On Christmas day, a worker wishing to lift spirits, unknowingly spread Covid-19 via an air-powered Christmas tree costume The worker did not have symptoms of SARS-COV-2 and did not know they were infected The result is tragic In San Jose, at least 60 people were infected, and one person died " Conclusion: This case manifests a tragic outcome to what was meant to be a benevolent action All evidence points to lack of information guiding this well-intentioned action What was meant to decrease the stress and burden of the pandemic, became a greater stress and burden Tragically with a loss of life and unknown morbidity Further, there is the potential for a psychologic toll on the person who thought they were helping others, only to learn that they had harmed them Given that these costumes in hospitals are rare, further tragedies such as this one should be preventable Covid-19 is not the only pathogen that could theoretically be spread by this mechanism Hospital should have a policy that restricts the use of these costumes Education about the danger of these costumes should be provided to staff Given that personal may act by finding replacement, risk management and infection control should create an adequate policy to address the mental health needs of staff and patients, while maintain appropriate infection control Now that there is documentation of this methods of pathogenic spread, hospitals may face liability if they fail to establish a reasonable policy and education regarding turbulent flow air-powered costumes
{"title":"Turbulent Airflow Costume Compromises Occupational Safety and Infection Control: A Hospital Risk Management Case Report","authors":"Sarah J. Diekman","doi":"10.1080/01947648.2021.1914476","DOIUrl":"https://doi.org/10.1080/01947648.2021.1914476","url":null,"abstract":"Objectives: To inform hospital infection control, risk management, hospital administrators, and healthcare workers about a new and surprising threat to infection control: air-powered costumes Background: Air-powered costumes use a small motor to create positive pressure within the costume This mechanism is similar to Powered Air Purifying Respirator (PAPR) 1 However, unlike a PAPR the air-powered costume does not filter the incoming air through a HEPA filter Nor does it capture the air inside a contained space and filter it before it is released into the environment The affect is that droplets from the person in the costume or from air that is drawn into the costume, which would normally be too heavy to travel farther than 6 feet, are aerosolized by traveling through the turbulent blower These small particles can easily penetrate the thin fabric that makes the costume This creates an infection control problem by aerosolizing the particles and then propelling them with the force of positive pressure \" Case Description: In January of 2021, a Covid-19 outbreak in San Jose, CA, was contact traced back to a surprising source On Christmas day, a worker wishing to lift spirits, unknowingly spread Covid-19 via an air-powered Christmas tree costume The worker did not have symptoms of SARS-COV-2 and did not know they were infected The result is tragic In San Jose, at least 60 people were infected, and one person died \" Conclusion: This case manifests a tragic outcome to what was meant to be a benevolent action All evidence points to lack of information guiding this well-intentioned action What was meant to decrease the stress and burden of the pandemic, became a greater stress and burden Tragically with a loss of life and unknown morbidity Further, there is the potential for a psychologic toll on the person who thought they were helping others, only to learn that they had harmed them Given that these costumes in hospitals are rare, further tragedies such as this one should be preventable Covid-19 is not the only pathogen that could theoretically be spread by this mechanism Hospital should have a policy that restricts the use of these costumes Education about the danger of these costumes should be provided to staff Given that personal may act by finding replacement, risk management and infection control should create an adequate policy to address the mental health needs of staff and patients, while maintain appropriate infection control Now that there is documentation of this methods of pathogenic spread, hospitals may face liability if they fail to establish a reasonable policy and education regarding turbulent flow air-powered costumes","PeriodicalId":44014,"journal":{"name":"Journal of Legal Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87881583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-21DOI: 10.1080/01947648.2021.1914473
Eric H. Chai, D. Chan, W. Havins
{"title":"In-State Retention of Physicians in Nevada Residency Programs","authors":"Eric H. Chai, D. Chan, W. Havins","doi":"10.1080/01947648.2021.1914473","DOIUrl":"https://doi.org/10.1080/01947648.2021.1914473","url":null,"abstract":"","PeriodicalId":44014,"journal":{"name":"Journal of Legal Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89290088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-21DOI: 10.1080/01947648.2021.1914481
Samia Mouaki-Benani, A. Sheikh, Joseph P. Hardy, W. Havins
Prescribing Patterns of XR-Naltrexone for Treating OUD by Nevada Addiction Specialists Samia Mouaki-Benani, OMS-II; smouaki@student.touro.edu Ansab Sheikh, OMS-II; asheikh5@student.touro.edu Joseph P. Hardy, MD, Associate Dean for Clinical Education Weldon Havins, MD, JD, LLM, FCLM Touro University Nevada College of Osteopathic Medicine Background: The Opioid crisis is a nationwide epidemic with devastating consequences to American communities and public health. In 2018, 46,802 (70%) of all overdose deaths in the United States, and 372 drug overdose deaths in Nevada, were opioid-related. Medication-assisted treatment (MAT) is an effective “whole-patient” approach to the treatment of opioid use disorder (OUD), combining medications with behavioral therapy and counseling. There are three FDAapproved medications indicated for opioid dependency: naltrexone, methadone, and buprenorphine. Treatment centers rarely offer naltrexone (XR-NTX, or Vivitrol available in injectable extended release form) compared with opioid agonist treatments. The goal of this study is to quantify prescribing patterns of MAT to treat OUD in Nevada and to understand the reasons addiction specialists do or do not prescribe it. Methods: A survey was created with questions designed and sent to practicing Nevada addiction specialists, including physicians (MD and DO), physician assistants, and nurse practitioners in the state of Nevada (Nevada Addiction Specialists hereafter), by mail. Results: Of 309 Nevada Addiction Specialists surveyed, 34 (11%) responded. Almost half (47%) of responding addiction specialists in Nevada prescribed XR-NTX, yet only 9% of OUD patients were treated with XR-NTX. The leading reasons addiction specialists prescribed XRNTX were the frequency of injections and the non-addictive nature of the drug. The leading reasons for not prescribing XR-NTX were its detoxification requirement (35% of respondents), accessibility (29%), and price (24%). Of the Nevada addiction specialists who did not prescribe XR-NTX, 28% were unfamiliar with the drug. Conclusion: The survey results suggest that XR-NTX is appropriate for only a small subset of patients with OUD, as indicated by the CDC and other studies. XR-NTX has potential in highly motivated patients that are 2021 American College of Legal Medicine JOURNAL OF LEGAL MEDICINE 2021, VOL. 41, NO. S1, 27–28 https://doi.org/10.1080/01947648.2021.1914481 willing to abstain from opioid use during the detox period, those willing to pay the higher cost, and patients in the criminal justice system. There may be a need for increasing awareness and education of MAT options earlier in medical training to bridge the gap in knowledge related to the treatments available for patients with OUD. The generalizability of this study is limited by the small number of respondents. References available upon request 28 ABSTRACT
内华达成瘾专家Samia Mouaki-Benani研究xr -纳曲酮治疗OUD的处方模式smouaki@student.touro.edu Ansab Sheikh, OMS-II;asheikh5@student.touro.edu Joseph P. Hardy，医学博士，临床教育副院长Weldon Havins，医学博士，法学硕士，FCLM Touro University of Nevada College of Osteopathic Medicine背景:阿片类药物危机是一种全国性的流行病，对美国社区和公共卫生造成了毁灭性的后果。2018年，美国46,802例(70%)药物过量死亡和内华达州372例药物过量死亡与阿片类药物有关。药物辅助治疗(MAT)是一种有效的“全患者”治疗阿片类药物使用障碍(OUD)的方法，将药物与行为治疗和咨询相结合。有三种fda批准的药物用于治疗阿片类药物依赖:纳曲酮、美沙酮和丁丙诺啡。与阿片类激动剂治疗相比，治疗中心很少提供纳曲酮(XR-NTX，或注射缓释形式的维维特罗)。本研究的目的是量化内华达州MAT治疗OUD的处方模式，并了解成瘾专家开或不开MAT的原因。方法:设计了一份调查问卷，并通过邮件发送给内华达州的执业成瘾专家，包括医生(MD和DO)、医师助理和执业护士(以下简称内华达州成瘾专家)。结果:在接受调查的309名内华达州成瘾专家中，34名(11%)做出了回应。内华达州几乎一半(47%)的成瘾专家开了XR-NTX，但只有9%的OUD患者接受了XR-NTX治疗。成瘾专家开出XRNTX的主要原因是注射的频率和药物的非成瘾性。不开XR-NTX的主要原因是其解毒要求(35%的受访者)、可及性(29%)和价格(24%)。在没有开XR-NTX处方的内华达州成瘾专家中，28%的人不熟悉这种药物。结论:调查结果表明，正如CDC和其他研究表明的那样，XR-NTX仅适用于一小部分OUD患者。XR-NTX在高度积极的患者中具有潜力，2021年美国法律医学学院法律医学杂志2021年，第41卷，NO。S1, 27-28 https://doi.org/10.1080/01947648.2021.1914481在戒毒期间愿意放弃阿片类药物使用的人，愿意支付较高费用的人，以及刑事司法系统中的患者。可能需要在医疗培训中尽早提高对MAT选择的认识和教育，以弥补与OUD患者可用治疗方法相关的知识差距。本研究的普遍性受到调查对象较少的限制。参考文献可根据要求提供
{"title":"Prescribing Patterns of XR-Naltrexone for Treating OUD by Nevada Addiction Specialists","authors":"Samia Mouaki-Benani, A. Sheikh, Joseph P. Hardy, W. Havins","doi":"10.1080/01947648.2021.1914481","DOIUrl":"https://doi.org/10.1080/01947648.2021.1914481","url":null,"abstract":"Prescribing Patterns of XR-Naltrexone for Treating OUD by Nevada Addiction Specialists Samia Mouaki-Benani, OMS-II; smouaki@student.touro.edu Ansab Sheikh, OMS-II; asheikh5@student.touro.edu Joseph P. Hardy, MD, Associate Dean for Clinical Education Weldon Havins, MD, JD, LLM, FCLM Touro University Nevada College of Osteopathic Medicine Background: The Opioid crisis is a nationwide epidemic with devastating consequences to American communities and public health. In 2018, 46,802 (70%) of all overdose deaths in the United States, and 372 drug overdose deaths in Nevada, were opioid-related. Medication-assisted treatment (MAT) is an effective “whole-patient” approach to the treatment of opioid use disorder (OUD), combining medications with behavioral therapy and counseling. There are three FDAapproved medications indicated for opioid dependency: naltrexone, methadone, and buprenorphine. Treatment centers rarely offer naltrexone (XR-NTX, or Vivitrol available in injectable extended release form) compared with opioid agonist treatments. The goal of this study is to quantify prescribing patterns of MAT to treat OUD in Nevada and to understand the reasons addiction specialists do or do not prescribe it. Methods: A survey was created with questions designed and sent to practicing Nevada addiction specialists, including physicians (MD and DO), physician assistants, and nurse practitioners in the state of Nevada (Nevada Addiction Specialists hereafter), by mail. Results: Of 309 Nevada Addiction Specialists surveyed, 34 (11%) responded. Almost half (47%) of responding addiction specialists in Nevada prescribed XR-NTX, yet only 9% of OUD patients were treated with XR-NTX. The leading reasons addiction specialists prescribed XRNTX were the frequency of injections and the non-addictive nature of the drug. The leading reasons for not prescribing XR-NTX were its detoxification requirement (35% of respondents), accessibility (29%), and price (24%). Of the Nevada addiction specialists who did not prescribe XR-NTX, 28% were unfamiliar with the drug. Conclusion: The survey results suggest that XR-NTX is appropriate for only a small subset of patients with OUD, as indicated by the CDC and other studies. XR-NTX has potential in highly motivated patients that are 2021 American College of Legal Medicine JOURNAL OF LEGAL MEDICINE 2021, VOL. 41, NO. S1, 27–28 https://doi.org/10.1080/01947648.2021.1914481 willing to abstain from opioid use during the detox period, those willing to pay the higher cost, and patients in the criminal justice system. There may be a need for increasing awareness and education of MAT options earlier in medical training to bridge the gap in knowledge related to the treatments available for patients with OUD. The generalizability of this study is limited by the small number of respondents. References available upon request 28 ABSTRACT","PeriodicalId":44014,"journal":{"name":"Journal of Legal Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78952833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-21DOI: 10.1080/01947648.2021.1914492
S. Tun, H. Luong, W. Havins
Encouraging Online Voter Registration of Nevada Physicians A Challenge in Apathy? Sein Tun, MS, OMS-II; stun@student.touro.edu Hao Luong, MS, OMS-II; hluong2@student.touro.edu Weldon E Havins, MD, JD, LLM, FCLM, Emeritus Professor Touro University Nevada College of Osteopathic Medicine, Henderson, Nevada Voting is the most basic way a citizen can have his or her voice heard. It is also one of the easiest ways for an individual to participate in changing or maintaining the legislation. Voting registration and participation can allow citizens to have a direct impact on the healthcare system, which is an essential aspect of policy making within the United States’ political system. Physicians are the most equipped with knowledge about the healthcare system, therefore, there is a need to increase voting amongst physician populations. Physicians’ votes and influence on health policy impact not only the medical community but their patients as well. To improve the healthcare system for both physicians and their patients, the candidates chosen to become legislators must align with the views held by their constituents. As registered voters and constituents of an Assemblyperson and a Senator, physicians can actively voice their concerns and ideas that could potentially contribute to new and improved legislation. However, the first and most important step in getting involved is to register to vote. When compared to other higher education professionals such as lawyers, physicians are less active in politics. This needs to be improved because healthcare policy contributes to a large portion of political discussion. In order to promote physician engagement in politics, there must be promotion of registration to vote. One benefit is that it is especially easy to register now because it can be done conveniently online. This study aims to improve physician voter registration outcomes by identifying physicians in Clark County who are not registered voters and contacting them to discuss the importance of voting and how to register online. However, because of limited information available from the National Board of Medical Examiners (NBME) and the National Board of Osteopathic Medical Examiners (NBOME) databases, the only feasible method of contact to physicians is through mailing physical letters to their work offices. The method utilized in this study is not effective because it lacked sufficient time to allow the letters to be received by physicians before the data was 2021 American College of Legal Medicine JOURNAL OF LEGAL MEDICINE 2021, VOL. 41, NO. S1, 47–48 https://doi.org/10.1080/01947648.2021.1914492 analyzed. Although this study could not prove that mailing letters to the physicians’ office of practice is an adequate method, it did show that approximately 74% of physicians in Clark County are registered voters, which is of higher percentage than the general population of Nevada. Nonetheless, this number does not account for other variables that may influen
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Pub Date : 2021-05-21DOI: 10.1080/01947648.2021.1914493
C. Wyant, Taylor Cornwell-Hinrichs, Joseph P. Hardy, W. Havins
Investigating the Relationship Between Opioid Prescription Frequency and Deaths From Illicit Opioids Cara Wyant, OMS-II Taylor Cornwell-Hinrichs, MPH, MLIS, OMS-II Joseph P. Hardy, MD, Associate Dean of Clinical Education Weldon Havins, MD, JD, LLM, MA, Emeritus Professor Touro University Nevada College of Osteopathic Medicine In accordance with the global opioid epidemic, the CDC issued guidelines for practitioners prescribing opioids for chronic pain. In response to these guidelines and to the opioid epidemic itself, Nevada issued restrictive legislation on practitioners prescribing opioids: SB 459, AB 474, and AB 239. To investigate the relationships between opioid legislature and opioidrelated death rates, data was obtained from the Nevada Board of Pharmacy and the Clark and Washoe County medical examiner offices. The data demonstrate that there was a significant decrease in prescriptions following the legislation; however, there was no correlation between the legislation and overall rate of opioid-related deaths because there was a subsequent and dramatic rise in deaths from illicit opioids. This suggests that more patients switched to the use of heroin and/or fentanyl as a result in limiting legal opioid prescribing power. A Spearman correlation was calculated (-0.04) and a two-way analysis of variance (ANOVA) was used to compare the time periods of the legislation implementation and the county. There were no interactions between the two counties and law; so, both counties experienced the same trends following these laws. To compare opioid-related deaths to opioid prescription rate for each time period, a t-test with law as the only factor was conducted with combined data from both counties (SB 459 p1⁄4 0.744; AB 474 p1⁄4 0.640; AB 239 p1⁄4 0.704). No significance was found. The COVID-19 Stay at Home order has statistically increased opioid-related deaths (p1⁄4 0.010), albeit it is unknown if this increase is due to Nevadans selfmedicating in response to work stoppages and financial stress, inability to see a practitioner in person, or restrictions involving addiction clinics during the pandemic. The goal of Nevada’s three opioid prescription bills was to reduce the rate of Nevadans dying from opioid overdoses, yet more Nevadans are dying from opioids now than before the bills passed. We recommend three provisions that will allow providers to confidently prescribe appropriate 2021 American College of Legal Medicine JOURNAL OF LEGAL MEDICINE 2021, VOL. 41, NO. S1, 49–50 https://doi.org/10.1080/01947648.2021.1914493 pain management for their patients without fear of sanction from another licensing board’s misunderstandings, allow providers to humanely manage their patients’ legitimate pain, and limit unintended consequences where patients are forced to seek out illicit opioids to control their pain and inadvertently die in the process. These are our recommendations: (1) Base law requirements on guidelines provided by professional or governmen
调查阿片类药物处方频率与非法阿片类药物死亡之间的关系Cara Wyant, OMS-II Taylor Cornwell-Hinrichs, MPH, MLIS, OMS-II Joseph P. Hardy, MD，临床教育副院长Weldon Havins, MD, JD, LLM, MA, Touro University Nevada College of Osteopathic Medicine名誉教授根据全球阿片类药物流行，CDC发布了从业人员处方阿片类药物治疗慢性疼痛的指南。为了响应这些指导方针和阿片类药物的流行，内华达州颁布了关于开具阿片类药物处方的从业人员的限制性立法:SB 459、AB 474和AB 239。为了调查阿片类药物立法与阿片类药物相关死亡率之间的关系，从内华达州药房委员会以及克拉克和瓦肖县法医办公室获得了数据。数据表明，立法后处方显着减少;然而，立法与阿片类药物相关死亡率之间没有相关性，因为非法阿片类药物导致的死亡人数随后急剧上升。这表明，由于限制了阿片类药物的合法处方权，更多的患者转而使用海洛因和/或芬太尼。计算Spearman相关(-0.04)，并采用双向方差分析(ANOVA)比较立法实施与县的时间段。这两个国家和法律之间没有互动;因此，这两个国家都经历了遵循这些法律的相同趋势。为了比较每个时间段阿片类药物相关死亡与阿片类药物处方率，对两县的合并数据进行了t检验，法律是唯一的因素(SB 459 p1⁄4 0.744;AB 474 p1 / 4 0.640;AB 239 p1 / 4 0.704)。没有发现显著性。2019冠状病毒病居家令在统计上增加了与阿片类药物相关的死亡人数(p1 / 4 0.010)，尽管尚不清楚这一增加是由于内华达州人为应对停工和经济压力而自我用药、无法亲自去看医生，还是疫情期间涉及成瘾诊所的限制。内华达州三项阿片类药物处方法案的目标是降低内华达人因过量服用阿片类药物而死亡的比例，然而，与法案通过之前相比，现在死于阿片类药物的内华达人更多了。我们建议三条规定，使提供者能够自信地开出适当的2021年美国法律医学学院法律医学杂志2021年，第41卷，NO。S1, 49-50 https://doi.org/10.1080/01947648.2021.1914493对患者的疼痛管理，而不必担心另一个许可委员会的误解，允许提供者人道地管理患者的合法疼痛，并限制患者被迫寻求非法阿片类药物来控制疼痛并在此过程中无意中死亡的意外后果。以下是我们的建议:(1)以医学为导向的专业或政府机构提供的指导方针为基础的法律要求;(2)首先以教育为纪律，然后以制裁为纪律;(3)通过非常熟悉提供者执业范围的实体来执行要求，例如内华达州医学检验委员会和内华达州骨科医学委员会。应要求提供参考资料。50文摘
{"title":"Investigating the Relationship Between Opioid Prescription Frequency and Deaths From Illicit Opioids","authors":"C. Wyant, Taylor Cornwell-Hinrichs, Joseph P. Hardy, W. Havins","doi":"10.1080/01947648.2021.1914493","DOIUrl":"https://doi.org/10.1080/01947648.2021.1914493","url":null,"abstract":"Investigating the Relationship Between Opioid Prescription Frequency and Deaths From Illicit Opioids Cara Wyant, OMS-II Taylor Cornwell-Hinrichs, MPH, MLIS, OMS-II Joseph P. Hardy, MD, Associate Dean of Clinical Education Weldon Havins, MD, JD, LLM, MA, Emeritus Professor Touro University Nevada College of Osteopathic Medicine In accordance with the global opioid epidemic, the CDC issued guidelines for practitioners prescribing opioids for chronic pain. In response to these guidelines and to the opioid epidemic itself, Nevada issued restrictive legislation on practitioners prescribing opioids: SB 459, AB 474, and AB 239. To investigate the relationships between opioid legislature and opioidrelated death rates, data was obtained from the Nevada Board of Pharmacy and the Clark and Washoe County medical examiner offices. The data demonstrate that there was a significant decrease in prescriptions following the legislation; however, there was no correlation between the legislation and overall rate of opioid-related deaths because there was a subsequent and dramatic rise in deaths from illicit opioids. This suggests that more patients switched to the use of heroin and/or fentanyl as a result in limiting legal opioid prescribing power. A Spearman correlation was calculated (-0.04) and a two-way analysis of variance (ANOVA) was used to compare the time periods of the legislation implementation and the county. There were no interactions between the two counties and law; so, both counties experienced the same trends following these laws. To compare opioid-related deaths to opioid prescription rate for each time period, a t-test with law as the only factor was conducted with combined data from both counties (SB 459 p1⁄4 0.744; AB 474 p1⁄4 0.640; AB 239 p1⁄4 0.704). No significance was found. The COVID-19 Stay at Home order has statistically increased opioid-related deaths (p1⁄4 0.010), albeit it is unknown if this increase is due to Nevadans selfmedicating in response to work stoppages and financial stress, inability to see a practitioner in person, or restrictions involving addiction clinics during the pandemic. The goal of Nevada’s three opioid prescription bills was to reduce the rate of Nevadans dying from opioid overdoses, yet more Nevadans are dying from opioids now than before the bills passed. We recommend three provisions that will allow providers to confidently prescribe appropriate 2021 American College of Legal Medicine JOURNAL OF LEGAL MEDICINE 2021, VOL. 41, NO. S1, 49–50 https://doi.org/10.1080/01947648.2021.1914493 pain management for their patients without fear of sanction from another licensing board’s misunderstandings, allow providers to humanely manage their patients’ legitimate pain, and limit unintended consequences where patients are forced to seek out illicit opioids to control their pain and inadvertently die in the process. These are our recommendations: (1) Base law requirements on guidelines provided by professional or governmen","PeriodicalId":44014,"journal":{"name":"Journal of Legal Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88853928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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