WST320 Arizona State University Messages for Substance Users Discussion DISCUSSION BOARD PROMPT: In this discussion board, you will note the differences yo

WST320 Arizona State University Messages for Substance Users Discussion DISCUSSION BOARD PROMPT: In this discussion board, you will note the differences you saw in the two medical statements about addiction treatment assigned for this module, from 1914 and 2014. While the style of writing is obviously different, I’d like you to focus on the substance of each of these pieces and answer the following questions in order to compare the two:What messages about substance users are implied or explicitly stated in these pieces? What factors are identified as influences on substance misuse, and what strategies are recommended for treating substance misuse? What ideas or assumptions about substance users are implied in these cultural and medical messages, and how do you think they have changed over time? ASSIGNMENT REQUIREMENTS: You must contribute twice to this discussion board, in the discussion board thread which matches your last name. First, you will post 350-450 word post responding to the assignment prompt. Am J Public Health. 2011 March; 101(3): 448–450.
PMCID: PMC3036695
PMID: 21307374
Drug Addictions, A Public Health Problem
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AS A POTENT SOCIAL AND economic cause leading to much of our public sickness and
inefficiency, I would present some facts relating to habit-forming drugs. In investigating this
community ailment I have endeavored to relate, as far as possible, the various causative factors
with the conditions found and their control.
In August 1912, the City Council passed, at my request, an ordinance regulating the sale of
certain drugs, those commonly employed by habitués, opium and its derivatives, cocaine,
eucaine, etc. This bill in general resembled those in operation elsewhere, requiring a written
prescription from a practicing physician, prohibiting refilling and demanding that a record of
sales be kept by druggists. Further it required that each prescription bear the name and address of
the individual for whom it was intended and that a true copy of any prescription containing more
than a specified amount of the drug named be sent, by the physician, to the office of the health
department. Granting that sales would be made only on prescription this provision was intended
to discover the number and location of users and also what class of physicians would, for the
most part, lend their services to the fostering of these habits.
Another section provided that habitual users could obtain, free of charge, prescriptions for the
drugs named from the health officer providing he might deem it advisable to issue them. It might
seem, at first sight, anomalous that a bill aimed to curtail the sale of certain drugs should provide
for the furnishing of gratuitous prescriptions by the health department. This provision, however,
was the keynote of the whole bill, its intent being, first, to remove any shadow of an excuse for
an illegal sale by a druggist, on the plea, frequently made, that the purchaser, an habitual user
requiring a supply, was unable to pay for a prescription, and second to bring the health officer
into personal contact with the unfortunates addicted to drug habits….
The bill further provides for the separate filing of all such prescriptions by the druggist and the
keeping of a book record of those filled, together with the names and addresses of the purchasers
and the physicians writing them, this record to be at all times open to inspection by the health
and police departments. The finding of these drugs in the possession of anyone other than a
druggist or physician was made a misdemeanor, except the possessor could show that he came
into such possession in accordance with the provisions of the ordinance.
Before this bill was submitted to the council, it was discussed and approved, section by section,
by the local medical society and before its passage a public hearing was held to which the
wholesale and retail druggist were invited to criticize it and make suggestions. After its passage,
a few druggists chose to consider its requirements not essential to their business; these were
promptly prosecuted and received the “limit” at the hands of the municipal judge. After these
occurrences it became extremely difficult to obtain, in Jacksonville, any of the habit-forming
drugs except through the authorized channels. Physicians and druggists were all notified and
furnished copies of the bill and, except for an occasional violation, the ordinance has been in
complete operation for a year at the present writing.
I have kept card records of all cases obtained through duplicate prescriptions sent in by
physicians and of those coming in person to the office. These cards are kept on file and each
prescription given by me or received in duplicate is entered with the date. A total of 646 users
have thus been recorded together with the drug or combination of drugs used, the amounts and
the physicians prescribing them.
This number represents, with considerable accuracy, the number of users in the city, about 1% of
our population. Some of those recorded were transients and are not now in the city, but these are
offset by a number who obtain their supply by mail from other places and a few who, I have
good grounds for believing, are furnished directly by physicians to avoid my records….
With 213 drug habitués, or roughly one third of those recorded, I have come in personal contact
and have obtained from them more or less complete histories as to age, duration of habit,
occupation, income, social state and factors leading to the formation of their habits….
A further study of these histories brings to light information of real value as relating to the
causes, both direct and indirect, which appear responsible for the creation of the user. In this
connection I will state that these histories are seldom obtained during the first visit or two of the
user to my office but rather after repeated visits and kindly treatment has served to establish
more or less confidential relations. It may be said that mendacity is a common attribute of the
drug fiend and that information so obtained is not reliable. I can only state that from the
beginning I have tried to encourage their trust in every way; that much of what I have recorded
has come unasked and little by little at different visits; that my contact with individuals has been
almost daily, and that the quite evident frankness of many who admit dissipation and evil ways,
as entirely responsible for their condition, leaves no good reason for doubting those who, with
equal frankness and for the most part without rancor, place this responsibility on others.
As direct causes of drug-habit formation, I have divided these 213 histories as follows in the
order of their frequency:
•
Through physicians’ prescriptions or treatment personally administered 54.8%
•
Through the advice of acquaintances (for the most part themselves users) 21.6%
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Through dissipation and evil companions 21.2%
•
Through chronic and incurable disease 2.4%
With the … largest class of all, the 54.8% who owe their unfortunate condition to the offices of
the medical man, are we most concerned as public health officials. It may seem a strong
statement to make that over 50% of drug users owe their habit to the medical profession, and yet
I am convinced that my figures are not far wrong….
Here were 112 men and women become confirmed drug habitués through the judgment of as
many physicians who elected to submit their patients to this risk, to relieve varying degrees of
pain caused by conditions which, for the most part, were in no way permanently benefited by the
administration of an opiate … and where, in some instances, opiates, by every rule of intelligent
practice, were distinctly contra indicated! Surely here were assumed, in view of subsequent
events, responsibilities too heavy to be lightly borne.
In many instances these first doses were not given at the bedside to allay severe pain, but handed
out to office patients with apparently as little concern as a dose of calomel. Codeine, morphine,
heroin and laudanum are all thus passed over to the temporary sufferer; the neurotic woman with
obscure symptoms, the young mechanic with a broken arm, the over-tired business man; to
young and old, it matters not, who chance to stray into the wrong office and who pay the price of
their evil choice years after their faces are forgotten and their fees spent by the “expert” who so
readily relieved their symptoms. Not only are these drugs carelessly prescribed but we find many
repeated orders to “refill the prescription and then let me hear from you,” the patient in entire
ignorance, not infrequently learning for the first time from another physician or a conscientious
druggist the nature of the “remedy” in which they have been placing their hope of cure.
Not infrequently is the refilling done without the knowledge or advice of the physician, who,
were the opportunity given him might seek to cover his mistake, and equally responsible is the
druggist who, in full knowledge of their danger, refills such prescriptions as often as requested.
In some instances this is done through a mistaken conception of professional ethics, through an
ill-advised hesitancy to call upon the physician for advice; in others through indifference equal to
his and in all too many, to avoid losing the trade of one who, experience has shown, will be a
constant and remunerative customer. For the past year morphine has been selling by the jobber at
an average price of about sixty-five cents a drachm and cocaine at about fifty cents. The usual
price paid by habitual users is $1.25 for original drachm bottles, a profit of one hundred per
cent….
Much more might be told of the sordid details of this drug sickness that is to be found in every
community, instances of malpractice of a peculiarly aggravated nature; of physicians who, for a
fee of twenty-five or fifty cents, will write a prescription for any amount of any drug without
making an effort to discover if the purchaser be really an habitual user. I could name all too
many such in my own city and can prove such statements by most carefully obtained and
recorded evidence; of druggists whose chief income is derived from the usurious profits of dope
sales.
The points, however, which I wish especially to make are, first, the necessity of securing
accurate data in each community as to the prevalence of drug habits. I am convinced that, in spite
of all that has been said and written of this evil that few public officials are aware of the actual
facts. The only persons who really know them are the druggists who cater to this trade and the
users themselves. Obviously neither party will supply the information unbidden….
… Any effective prohibitive legislation must provide for the free treatment of existing users. To
deprive them of their supply alone would be inhuman; private institutional treatment is beyond
the reach of all but comparatively few, a circumstance probably more fortunate than otherwise,
in view of the methods of most such places, and they should be considered a public charge for at
least one rational course of treatment….
In conclusion, it seems to me that the whole subject is one which may best be handled by health
authorities, municipal, state and Federal. For the most part its control has been left to the police
departments and violators of existing drug laws are spasmodically prosecuted, whenever chance
or some too flagrant act brings the matter to their attention. In most communities the time of the
police department is fully occupied with other matters nor should they be expected to possess
such a realization of the profound importance of this subject as must precede and accompany any
successful effort at control….
I believe that few of those confronting us affect more seriously the public health than this of drug
addictions. It directly and indirectly increases the death rate and lowers the birth rate of every
civilized community. It closely resembles, in its dissemination, contact infection of disease; in
one neighborhood nearly all the users will be addicted to one drug while in another section some
other drug will be the favorite. Knowing the address of the applicant, I could prescribe correctly
for over fifty per cent of the users in my city.
We concern ourselves, quite rightly, with other preventable conditions, quarantine our scarlet
fever and diphtheria, trace with zeal our typhoid cooks, and tabulate with regret each death from
these causes, feeling even some measure of responsibility in their occurrence; yet contributory to
how many such records, to our deaths from pneumonia, tuberculosis, our still-births and suicides
might be stated, were the truth known, “drug addiction.” The social misery, the inefficiency and
communal depletion resulting from this civic malady, may not be properly realized by one who
has not seen for himself this pitiful array of wrecks waiting, as in a breadline, for the free dope
prescription, wives fearful lest their husbands discover their condition; fathers and mothers
hiding by every artifice, a stimulated cunning may devise, their habit from their own children;
young men and women asking in a whisper for a fifty-cent prescription for “coke,” a vicious
circle of carelessness, ignorance and cupidity involving a responsibility that has been shifted
from shoulder to shoulder until no one seems willing to admit it, yet intimately associated with
the public welfare, and health conservation and deserving of most careful investigation and
expert treatment.
OPIOIDS
Prescription drug misuse, overdose, &
death
See the AMA’s efforts to help physicians prevent and reduce abuse,
misuse, overdose and death from prescription drugs and addiction.
The best approach
A comprehensive public health approach is needed to address prescription
opioid-related harm and the growing heroin epidemic.
Steps in finding a solution
Here are a number of actions physicians can take to help end the epidemic:
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Register for and use their state prescription drug monitoring program
Enhance their education about safe and effective prescribing practices and other approaches
to treating pain
Increase access to comprehensive treatment for opioid use disorders, including medicationassisted treatment (MAT), for example, by becoming trained to provide it or by referring
their patients for this treatment
Ensure that patients in pain receive the care they need and avoid the stigma of pain
Reduce the stigma of having a substance use disorder (SUD) through recognizing that they
are treatable medical conditions
Increase access to naloxone through co-prescribing and other overdose prevention measures,
and expanding Good Samaritan laws
AMA Opioid Task Force
Background
The AMA supports:
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Full funding for up-to-date, interoperable, at the point-of-care prescription drug monitoring
programs that are integrated into a physician’s workflow
Tools and resources that support identification and assessment of SUD treatment gaps and
appropriate targeting of funding and resources to expand access to treatment
Support for a national framework to support accessible community-level take-back locations
to remove unneeded prescription drugs including controlled substances from the household
Voluntary physician education programs on safe prescribing practices that are tailored to
meet a physician’s practice/patient population needs
Enforcement actions to halt “pill mill” activities and rogue online pharmacies
Coordinated public health efforts to expand access to legitimate pain management providers
as well as SUD treatment and recovery
A public health approach that places a premium on overdose prevention, education and
treatment
The AMA has long held that preventing and reducing prescription drug
misuse, and diversion while ensuring access to necessary pain medication
should guide policymakers as they craft solutions to address these complex
problems. From the outset of this epidemic, the AMA has advocated for
solutions that provide physicians with patient-specific up-to-date information at
the point-of-care in order to support appropriate prescribing.
While NASPER, a grant program to fund the creation of state prescription
drug monitoring programs (PDMPs), passed in 2005, it was not until 2009 that
funds were approved to support the program. While the majority of states now
have a PDMP, most became operational only in the past couple years.
Unfortunately, only a handful of PDMPs are real-time and few are readily
available at the point of care as part of a prescriber’s workflow. The AMA
strongly supports NASPER Reauthorization and its full funding, which offer an
opportunity to make a strong commitment to combating prescription drug
misuse and diversion, as well as developing best practices for using PDMPs.
Physician education
The AMA Task Force to Reduce Opioid Abuse has compiled several state,
federal, academic and medical specialty society educational resources to
promote appropriate prescribing for pain management, reduce prescription
opioid-related harm and combat drug diversion. The AMA encourages the
development of a wide range of educational materials and urges physicians to
seek out educational opportunities appropriate for their particular practice and
patient population.
Educational resources
The AMA developed several webinars on topics related to the intersection of
pain, substance use disorders and opioids, also as part of the PCSS-O
collaborative. Webinars developed by the AMA are archived.
The AMA supported the launch of NIDAMED, which is devoted to educating
physicians on issues surrounding substance misuse. As part of NIDAMED,
AMA partnered with Prescriber Clinical Support System for Opioid
Therapies NIDA Centers of Excellence via AMA’s ISTEP program. These
Centers of Excellence for Physician Information are charged with the task of
developing innovative drug misuse and addiction curriculum resources with
the goal of helping to fill the gaps in current medical students/resident
physician curricula.
Past PCSS-O webinars
Educational resources on reducing opioid abuse
Federal legislative activities
Passage of H.R. 1725/S. 480, the National All Schedules Prescription
Electronic Reporting Reauthorization Act of 2015 (NASPER 2015) and full
appropriations is urgently needed to ensure that physicians across the country
have a critical tool at the point-of-care to combat prescription drug misuse
while ensuring patients with legitimate need of pain management continue to
have access. Unfortunately, the appropriations to fully fund, modernize and
optimize NASPER PDMPs have not kept pace with the rapid escalation in the
opioid misuse epidemic. Fully funded PDMPs would provide more physicians
with access to reliable, real-time information about prescriptions patients have
obtained (and filled) from other prescribers, particularly controlled substances.
AMA comments on federal legislative efforts to reduce prescription drug
misuse
Federal agency and administration activities
AMA Jan. 12, 2016 comments on CDC Proposed Guideline for Prescribing
Opioids for Chronic Pain
AMA Oct. 21, 2015 statement about AMA Partnering with the Administration
to Halt Nation’s Opioid Crisis
AMA Oct. 1, 2015 comments on CDC Draft Guidelines for the Use of Opioids
in Chronic Pain
AMA May 20, 2015 comments to NIH on Draft National Pain Strategy
AMA April 28, 2014 comments to DEA regarding Rescheduling of
Hydrocodone Combination Products from Schedule III to Schedule II
April 28, 2014 coalition letter to DEA Administrator urging delay in finalizing
proposal to reschedule hydrocodone from Schedule III to Schedule II until
long-term care exception or special procedure is developed
The AMA has expressed concerns with rescheduling combination medication
that will worsen access to needed pain treatment in long-term care
The AMA has communicated its support for most elements of the Obama
administration’s plan to combat prescription drug misuse and diversion
In order to strengthen and improve state PDMPs, we have urged the Obama
administration to direct the Veterans Administration to share information with
state PDMPs. The AMA has also supported the Department of
Defense’s proposed revisions to the TRICARE regulation to reduce
administrative barriers to access to mental health benefit coverage and to
improve access to substance use disorder (SUD) treatment. We have
also recommended that the Centers for Medicare & Medicaid Services direct
Medicare Prescription Drug plan sponsors to also share information with state
PDMPs and urged the Substance Misuse and Mental Health Services
Administration to require reporting of methadone treatment to PDMPs.
Leadership from the AMA’s Board of Trustees met with other key stakeholders
as part of a roun…
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