Hostname: page-component-7479d7b7d-wxhwt Total loading time: 0 Render date: 2024-07-12T04:38:58.413Z Has data issue: false hasContentIssue false
  • English
  • Français

The Epidemic as Stigma: The Bioethics of Opioids

Published online by Cambridge University Press:  01 January 2021

Daniel Z. Buchman ,
Pamela Leece  and
Aaron Orkin
Get access Rights & Permissions [Opens in a new window]

Abstract

In this paper, we claim that we can only seek to eradicate the stigma associated with the contemporary opioid overdose epidemic when we understand how opioid stigma and the epidemic have co-evolved. Rather than conceptualizing stigma as a parallel social process alongside the epidemiologically and physiologically defined harms of the epidemic, we argue that the stigmatized history of opioids and their use defines the epidemic. We conclude by offering recommendations for disrupting the burden of opioid stigma.

Type
Symposium Articles
Information
Journal of Law, Medicine & Ethics , Volume 45 , Issue 4: Stigma & Health , Winter 2017 , pp. 607 - 620
Copyright
Copyright © American Society of Law, Medicine and Ethics 2017

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

International Narcotics Control Board, 2016, “Narcotic Drugs Estimated World Requirements for 2016 Statistics for 2014,” United Nations.Google Scholar
Rudd, R.A, Seth, P., David, F, and Scholl, L., “Increases in Drug and Opioid-Involved Overdose Deaths - United States, 2010-2015,” Morbidity and Mortality Weekly Report 65, no. 50-51 (2016): 1445–1452.Google Scholar
Canadian Institute for Health Information and the Canadian Centre on Substance Abuse, 2016, “Hospitalizations and Emergency Department Visits Due to Opioid Poisoning in Canada” available at <https://secure.cihi.ca/free_products/Opioid%20Poisoning%20Report%20%20EN.pdf> (last visited 11/14/17).+(last+visited+11/14/17).>Google Scholar
Saha, T. D., Kerridge, B. T., Goldstein, R. B., Chou, S. P., Zhang, H., Jung, J., Pickering, R. P., et al., “Nonmedical Prescription Opioid Use and DSM-5 Nonmedical Prescription Opioid Use Disorder in the United States,” Journal of Clinical Psychiatry 77 (2016): 772–780.Google Scholar
See Rudd, supra note 2; Rudd, R.A, Aleshire, N., Zibbell, J. E., and Gladden, R. M., “Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014,” Morbidity and Mortality Weekly Report 64, no. 50-51(2016): 1378–1382; CDC, “Provisional Counts of Drug Overdose Deaths, as of 8/6/2017,” Vital Statistics Rapid Release, Surveillance Activites, available at <www.cdc.gov/nchs/health_policy/monthly-drug-overdose-death-estimates.pdf> (last visited December 1, 2017).CrossRefGoogle Scholar
Kolodny, A., Courtwright, D. T., Hwang, C. S., Kreiner, P., Eadie, J. L., Clark, T. W., Alexander, G. C., “The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction,” Annual Review of Public Health 36 (2016): 559–574.Google Scholar
Compton, W. M., Jones, C. M., and Baldwin, G. T., “Relationship Between Nonmedical Prescription-Opioid Use and Heroin Use,” N. Engl. J Med 374, no. 2 (2016): 154–163.Google Scholar
Government of Canada, “Joint Statement of Action to Address the Opioid Crisis” available at <http://www.healthy-canadians.gc.ca/healthy-living-vie-saine/substance-abuse-toxicomanie/opioids-opioides/conference-cadre/statement-declaration-eng.php> (last accessed 11/14/17).+(last+accessed+11/14/17).>Google Scholar
Room, R., Rehm, J., Trotter, R.T. II, Paglia, A., and Üstün, T.B., “Cross-Cultural Views on Stigma Valuation Parity and Societal Attitudes towards Disability,” in Üstün, T.B. and Chatterji, S., eds., Disability and Culture: Universalism and Diversity (Seattle: Hogrefe & Huber, 2001): 247–291.Google Scholar
Goldberg, D. S., “Pain, Objectivity and History: Understanding Pain Stigma,” Journal of Medical Humanities 43, no. 4 (2017): 238-243.Google Scholar
Fraser, S., Pienaar, K., Dilkes-Frayne, E., Moore, D., Kokanovic, R., Treloar, C., and Dunlop, A., “Addiction Stigma and the Biopolitics of Liberal Modernity: A Qualitative Analysis,” The International Journal on Drug Policy, in Press (2017); Fraser, S., Moore, D., and Keane, H., Habits: Remaking Addiction (New York: Palgrave MacMillan, 2014): at 3.CrossRefGoogle Scholar
See Fraser supra note 11; Bourgois, P., In Search of Respect: Selling Crack in El Barrio (Cambridge: Cambridge University Press, 2003); Romo, L.K, Dinsmore, D. R., and Watterson, T. C.. “‘Coming Out’ as an Alcoholic: How Former Problem Drinkers Negotiate Disclosure of Their Nondrinking Identity,” Health Communication 31, no. 3 (2015): 336–345; Anstice, S., Strike, C. J., and Brands, B., “Supervised Methadone Consumption: Client Issues and Stigma,” Substance Use & Misuse 44, no. 6 (2009): 794–808; Buchman, D. Z., Ho, A., and Illes, J., “You Present Like a Drug Addict: Patient and Clinician Perspectives on Trust and Trustworthiness in Chronic Pain Management,” Pain Medicine 17, no. 8 (2016): 1394–1406.Google Scholar
Kelly, J. F., Wakeman, S. E., and Saitz, R., “Stop Talking ‘Dirty’: Clinicians, Language, and Quality of Care for the Leading Cause of Preventable Death in the United States,” The American Journal of Medicine 128, no. 1 (2015): 8–9.Google Scholar
Centers for Disease Control, “Lesson 1: Introduction to Epidemiology,” Principles of Epidemiology in Public Health Practice, Third Edition an Introduction to Applied Epidemiology and Biostatistics, May 18, 2012, availalbe at <https://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson1/section11.html> (last visited 11/14/17).+(last+visited+11/14/17).>Google Scholar
Room, R., “The Cultural Framing of Addiction,” Janus Head 6, no. 2 (2003): 221–234.Google Scholar
See Fraser, , supra note 11, at 26.Google Scholar
O’Brien, C., “Addiction and Dependence in DSM-V,” Addiction 106, no. 5 (2010): 866–867.Google Scholar
Goldberg, D. S., “On the Erroneous Conflation of Opiophobia and the Undertreatment of Pain,” The American Journal of Bioethics 10, no. 11 (2010): 20–22.CrossRefGoogle Scholar
Goffman, E., Stigma; Notes on the Management of Spoiled Identity (New York: Simon & Schuster, 1986); See Kelly supra note 13, at 8.Google Scholar
Link, B.G and Phelan, J. C., “Conceptualizing Stigma,” Annual Review of Sociology 27 (2001): 363–385, at 367.Google Scholar
Link, B.G and Phelan, J. C., “Stigma and its Public Health Implications,” The Lancet 367, no. 9509 (2006): 528-529.Google Scholar
See Goffman, , supra note 19.Google Scholar
Kelly, J.F, Dow, S. J., and Westerhoff, C., “Does Our Choice of Substance-Related Terms Influence Perceptions of Treatment Need? An Empirical Investigation with Two Commonly Used Terms,” Journal of Drug Issues 40, no. 4 (2010): 805–818.Google Scholar
Goldberg, D. S., “Social Justice, Health Inequalities and Methodological Individualismin US Health Promotion,” Public Health Ethics 5, no. 2 (2012): 104–115; Hatzenbuehler, M.L, Phelan, J. C., and Link, B. G., “Stigma as a Fundamental Cause of Population Health Inequalities,” American Journal of Public Health 103, no. 5(2013): 813–821.Google Scholar
See Hatzenbuehler, , supra note 24.Google Scholar
Powers, M. and Faden, R., Social Justice: The Moral Foundations of Public Health and Health Policy (Oxford: Oxford University Press, 2008): at 72.Google Scholar
Berridge, V., “Opium and the Historical Perspective,” The Lancet 310, no. 8028 (1977): 78–80, at 78.Google Scholar
De Quincey, T., Confessions of an English Opium Eater (London: Walter Scott, 1886).Google Scholar
See Berridge, supra note 27, at 79; Berridge, V., Opium and the People: Opiate Use and Drug Control Policy in Nineteenth and Early Twentieth Century England (London: Free Association Books, 1999); Harding, G., Opiate Addiction, Morality and Medicine: From Moral Illness to Pathological Disease (New York: St. Martin’s Press, 1988).Google Scholar
Mills, J., “Morality, Society and the Science of Intoxication: A Response to David Courtwright’s ‘Mr. ATOD’s Wild Ride: What Do Alcohol, Tobacco, and Other Drugs Have in Common?” The Social History of Alcohol and Drugs 20, no. 1 (2005): 133–137.Google Scholar
Courtwright, D.T, Dark Paradise: A History of Opiate Addiction in America (Cambridge: Harvard University Press, 2009); Solomon, R. and Green, M., “The First Century: The History of Nonmedical Opiate Use and Control Policies in Canada, 1870-1970,” University of Western Ontario Law Review 20, no. 2 (1982): 307–336.Google Scholar
Courtwright, D. T., “Preventing and Treating Narcotic Addiction – a Century of Federal Drug Control,” N. Engl J Med 373, no. 22 (2015): 2093-2095.CrossRefGoogle Scholar
See Courtwright, supra note 31; See Solomon supra note 31.Google Scholar
See Courtwright, supra note 31.Google Scholar
See Solomon, supra note 31.Google Scholar
See Berridge, supra note 27, at 79.Google Scholar
See Courtwright, supra note 31; See Solomon supra note 31;Google Scholar
Id. at 308.Google Scholar
Id.Google Scholar
See Courtwright, supra note 31; see Solomon, supra note 31.Google Scholar
Ballantyne, J. C. and Mao, J., “Opioid Therapy for Chronic Pain,” N. Engl. J Med 349, no. 20 (2003): 1943-1953.Google Scholar
See Courtwright, supra note 31.Google Scholar
Controlled Drugs and Substances Act (1996).Google Scholar
Controlled Substances Act of 1970, 21 U.S.C § 811 (1970).Google Scholar
Courtwright, D. T., “The Controlled Substances Act: How a ‘Big Tent’ Reform Became a Punative Drug Law,” Drug and Alcohol Dependency 76, no. 1 (2004): 9–15Google Scholar
Dumont, D. M., Allen, S. A., Brockmann, B. W., Alexander, N. E., and Rich, J. D., “Incarcertation, Community Health, and Racial Disparities,” Journal of Health Care for the Poor and Underserved 24, no. 1(2013): 78-88.CrossRefGoogle Scholar
Portenoy, R. K., “Opioid Therapy for Chronic Nonmalignant Pain: A Review of the Critical Issues,” Journal of Pain and Symptom Management 11, no. 4 (1996): 203–217; Portenoy, R. K., “Opioid Therapy for Chronic Nonmalignant Pain: Clinicians’ Perspective,” The Journal of Law, Medicine & Ethics 24, no. 4 (1996): 296–309.CrossRefGoogle Scholar
Rich, B. A., “An Ethical Analysis of the Barriers to Effective Pain Management,” Cambridge Quarterly of Healthcare Ethics 9, no. 1 (2000): 54–70.CrossRefGoogle Scholar
Morgan, J. P., “American Opiophobia: Customary Underutilization of Opioid Analgesics,” Advances in Alcohol & Substance Abuse 5, no. 1-2 (1985): 163–173.CrossRefGoogle Scholar
See Portenoy, supra note 47; Portenoy, R. K. and Savage, S. R., “Clinical Realities and Economic Considerations: Special Therapeutic Issues in Intrathecal Therapy—Tolerance and Addiction,” Journal of Pain and Symptom Management 14, no. 3 supp (1997): S27–35.CrossRefGoogle Scholar
Porter, J. and Jick, H., “Addiction Rare in Patients Treated with Narcotics,” N. Engl. J Med 302, no. 2 (1980): 123.Google Scholar
Purdue Pharma L.P, “I Got My Life Back: Pain Patients Tell Their Story,” OxyContin promotional video, from Opiods for Chronic Pain: Addiction is NOT Rare, available at <http://www.youtube.com/watch?v=DgyuBWN9D4w> (last visited 11/17/17).+(last+visited+11/17/17).>Google Scholar
Leung, P.T.M., Macdonald, E. M., Stanbrook, M. B., Dhalla, I. A., and Juurlink, D. N., “A 1980 Letter on the Risk of Opioid Addiction,” N. Engl. J Med 376, no. 22 (2017): 2194-2195.Google Scholar
Portenoy, R. K. and Foley, K. M., “Chronic use of Opioid Anal-gesics in Non-Malignant Pain: Report of 38 Cases,” Pain 25, no. 2 (1986): 171-186.CrossRefGoogle Scholar
Heit, H.A, “The Truth About Pain Management: The Difference Between a Pain Patient and an Addicted Patient,” European Journal of Pain 5, Supp A (2001): 27–29, at 27.Google Scholar
Jovey, R. D., Ennis, J., Gardner-Nix, J., Goldman, B., Hays, H., Lynch, M., and Moulin, D., “Use of Opioid Analgesics for the Treatment of Chronic Noncancer Pain — A Consensus Statement and Guidelines from the Canadian Pain Society, 2002,” Pain Research & Management 8, Supp A (2003): 3A–14A; American Academy of Pain Medicine and the American Pain Society, “The Use of Opioids for the Treatment of Chronic Pain. A Consensus Statement from the American Academy of Pain Medicine and the American Pain Society,” The Clinical Journal of Pain 13, no. 1 (1997): 6–8.Google Scholar
National Advisory Committee on Prescription Drug Misuse, “First Do No Harm: Responding to Canada’s Prescription Drug Crisis,” Canadian Centre on Substance Abuse (2013).Google Scholar
Dowell, D., Haegerich, T. M., and Chou, R., “CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016,” MMWR Recomm Reports 65, no. 1 (2016):1–49.CrossRefGoogle Scholar
Derrida, J., “The Rhetoric of Drugs: An Interview,” Differences: A Journal of Feminist Cultural Studies 5, no.1 (1993): 1-25.Google Scholar
Meldrum, M. L., “The Prescription as Stigma: Opioid Pain Relievers and the Long Walk to the Pharmacy Counter,” in Greene, J. and Watkins, E. S., eds. Prescribed: Writing, Filling, Using, and Abusing the Prescription in Modern America (Baltimore: Johns Hopkins University Press, 2011): 184-206.Google Scholar
Keane, H., What’s Wrong with Addiction? (Melbourne: Melbourne University Press, 2002); Keane, H., “Pleasure and Discipline in the Uses of Ritalin,” The International Journal of Drug Policy 19, no. 5 (2008): 401–409.CrossRefGoogle Scholar
Tupper, K. W., “Psychoactive Substances and the English Language: ‘Drugs,’ Discourses, and Public Policy,” Contemporary Drug Problems 39, no. 3 (2012): 461–492, at 475.CrossRefGoogle Scholar
Id. at 476.Google Scholar
Id. at 477.Google Scholar
Hansen, H. and Netherland, J., “Is the Prescription Opioid Epidemic a White Problem?” American Journal of Public Health 106, no. 12 (2016): 2127–2129.Google Scholar
Treloar, C., Rance, J., Yates, K., and Mao, L., “Trust and People Who Inject Drugs: The Perspectives of Clients and Staff of Needle Syringe Programs,” The International Journal on Drug Policy 27 (2016): 138–145; Harris, J. and McElrath, K., “Methadone as Social Control: Institutionalized Stigma and the Prospect of Recovery,” Qualitative Health Research 22, no. 6 (2012): 810–824; see Kelly supra note 13.Google Scholar
Foddy, B. and Savulescu, J., “A Liberal Account of Addiction,” Philosophy, Psychiatry, and Psychology 17, no. 1(2010): 1-22.CrossRefGoogle Scholar
Sedgwick, E. K., “Epidemics of the Will,” in Tendencies (Durham, Duke University Press, 1993): at 130.CrossRefGoogle Scholar
Dackis, C. and O’Brien, C., “Neurobiology of Addiction: Treatment and Public Policy Ramifications,” Nature Neuroscience 8, no. 11 (2005): 1431–1436.CrossRefGoogle Scholar
Volkow, N. D., Baler, R. D., and Goldstein, R. Z., “Addiction: Pulling at the Neural Threads of Social Behaviors,” Neuron 69, no. 4 (2011): 599–602, at 600.CrossRefGoogle Scholar
Leshner, A. I., “Addiction Is a Brain Disease, and It Matters,” Science 278, no. 5335 (1997): 45–47.Google Scholar
Rush, B., An Inquiry into the Effects of Ardent Spirits Upon the Human Body and Mind: With an Account of the Means of Preventing, and of the Remedies for Curing Them (Boston: James Loring, 1823).Google Scholar
Jellinek, E. M., The Disease Concept of Alcoholism (New Haven: Hillhouse Press, 1960); Levine, H. G., “The Discovery of Addiction: Changing Conceptions of Habitual Drunkenness in America,” Journal of Studies on Alcohol 39, no. 1 (1978): 143-174.Google Scholar
Volkow, N. D. and Li, T-K, “Drug Addiction: The Neurobiology of Behaviour Gone Awry,” Nature Reviews Neuroscience 5, no. 12 (2004): 963–970.Google Scholar
Hall, W., Carter, A., and Forlini, C., “The Brain Disease Model of Addiction: Is It Supported by the Evidence and Has It Delivered on Its Promises?” The Lancet Psychiatry 2, no. 1 (2015): 105–110.Google Scholar
Buchman, D. Z., Illes, J., and Reiner, P. B., “The Paradox of Addiction Neuroscience,” Neuroethics 4, no. 2 (2011): 65–77.Google Scholar
Pescosolido, B. A., Martin, J. K., Long, J.S, Medina, T. R., Phelan, J. C., and Link, B. G., “‘A Disease Like Any Other’? A Decade of Change in Public Reactions to Schizophrenia, Depression, and Alcohol Dependence,” The American Journal of Psychiatry 167, no. 11 (2010): 1321–1330.CrossRefGoogle Scholar
Kvaale, E.P, Gottdiener, W. H., and Haslam, N., “Biogenetic Explanations and Stigma: A Meta-Analytic Review of Associations among Laypeople,” Social Science & Medicine 96 (2013): 95–103.CrossRefGoogle Scholar
Keane, H. and Hamill, K., “Variations in Addiction: The Molecular and the Molar in Neuroscience and Pain Medicine,” BioSocieties 5, no. 1 (2010): 52–69, at 54.CrossRefGoogle Scholar
Id.Google Scholar
Katikireddi, S. V. and Valles, S. A., “Coupled Ethical-Epistemic Analysis of Public Health Research and Practice: Categorizing Variables to Improve Population Health and Equity,” American Journal of Public Health 105, no. 1 (2015): e36–42.Google Scholar
Hacking, I., “Kinds of People: Moving Targets,” in Proceedings of the British Academy, Volume 151, 2006 Lectures, 285–317, at 285.Google Scholar
Keane, H., Moore, D., and Fraser, S., “Addiction and Dependence: Making Realities in the DSM,” Addiction 106, no. 5 (2011): 875-877.CrossRefGoogle Scholar
Dwyer, R. and Fraser, S., “Making Addictions in Standardised Screening and Diagnostic Tools,” Health Sociology Review 25 no. 3 (2016): 223–239.CrossRefGoogle Scholar
Dwyer, R. and Fraser, S., “Addiction Screening and Diagnostic Tools: ‘Refuting’ and ‘Unmasking’ Claims to Legitimacy,” The International Journal of Drug Policy 26, no. 12 (2015): 1189–1197; Midanik, L. T., Greenfield, T. K., and Bond, J., “Addiction Sciences and Its Psychometrics: The Measurement of Alcohol-Related Problems,” Addiction 102, no. 11 (2007): 1701–1710; see Dwyer supra note 84.CrossRefGoogle Scholar
American Psychiatric Association, “Section 3,” in Diagnostic and Statistical Manual of Mental Disorders: DSM-5, 5th ed. (Arlington, VA: American Psychiatric Association, 2013).Google Scholar
Katz, J., Rosenbloom, B. N., and Fashler, S., “Chronic Pain, Psychopathology, and DSM-5 Somatic Symptom Disorder,” Canadian Journal of Psychiatry 60, no. 4 (2015): 160–167.Google Scholar
See American Psychiatric Association, supra note 86.Google Scholar
See Katz, supra note 87; Kelly, J. F., Saitz, R., and Wakeman, S., ”Language, Substance Use Disorders, and Policy: The Need to Reach Consensus on an ‘Addiction-Ary,’” Alcoholism Treatment Quarterly 34, no. 1 (2016): 116–123.CrossRefGoogle Scholar
Webster, L. R. and Webster, R. M., “Predicting Aberrant Behaviors in Opioid-Treated Patients: Preliminary Validation of the Opioid Risk Tool,” Pain Medicine 6, no. 86 (2005): 432–442.Google Scholar
See Dwyer, , supra note 84, at 13.Google Scholar
Juurlink, D. N. and Dhalla, I. A., “Dependence and Addiction During Chronic Opioid Therapy,” Journal of Medical Toxicology 8, no. 4 (2012): 393–399.CrossRefGoogle Scholar
See Dwyer, supra note 84, at 2.Google Scholar
Von Korff, M., Kolodny, A, Deyo, R. A., and Chou, R., “Long-Term Opioid Therapy Reconsidered,” Annals of Internal Medicine 155, no. 5 (2011): 325–328.CrossRefGoogle Scholar
Witkin, L. R., Diskina, D., Fernandes, S., Farrar, J. T., and Ashburn, M. A., “Usefulness of the Opioid Risk Tool to Predict Aberrant Drug-Related Behavior in Patients Receiving Opioids for the Treatment of Chronic Pain,” Journal of Opioid Management 9, no. 3 (2013): 177–187.Google Scholar
Meltzer, E. C., Hall, W. D., and Fins, J. J., “Error and Bias in the Evaluation of Prescription Opioid Misuse: Should the FDA Regulate Clinical Assessment Tools?” Pain Medicine 14, no. 7 (2013): 982–987.Google Scholar
See Tupper, , supra note 62.Google Scholar
Bell, K. and Salmon, A., “Pain, Physical Dependence and Pseudoaddiction: Redefining Addiction for ‘Nice’ People?” The International Journal on Drug Policy 20, no. 2 (2009): 170–178.CrossRefGoogle Scholar
Rosenfeld, A., The Truth about Chronic Pain: Patients and Professionals on How to Face it, Understand it, Overcome it (New York: Basic Books, 2003): at 100.Google Scholar
Wasan, A.D, Wootton, J., and Jamison, R. N., “Dealing with Difficult Patients in Your Pain Practice,” Regional Anesthesia and Pain Medicine 30, no. 2 (2005): 184–192.Google Scholar
See Fraser, , supra note 11 at 6.Google Scholar
DEA Museum and Visitors Center, “Good Medicine, Bad Behavior: Drug Diversion in America,” (2012) available at <http://www.goodmedicinebadbehavior.org/> (last visited 11/21/17).+(last+visited+11/21/17).>Google Scholar
Adriaensen, H., Vissers, K., Noorduin, H., and Meert, T., “Opioid Tolerance and Dependence: An Inevitable Consequence of Chronic Treatment?” Acta Anaesthesia Belgium 54, no. 1 (2003): 37-47, at 44. Emphasis added.Google Scholar
Fraser, S. and Valentine, K., Substance and Substitution: Methadone Subjects in Liberal Societies (New York: Palgrave Mac-Millan, 2008).CrossRefGoogle Scholar
Fricker, M., Epistemic Injustice: Power and the Ethics of Knowing (Oxford: Oxford University Press, 2007).Google Scholar
Larance, B., Degenhardt, L., Lintzeris, N., Winstock, A., and Mattick, R., “Definitions Related to the Use of Pharmaceutical Opioids: Extramedical Use, Diversion, Non-Adherence and Aberrant Medication-Related Behaviours,” Drug and Alcohol Review 30, no. 3 (2011): 236–245, at 240.Google Scholar
Id.Google Scholar
Livingston, J. D., Milne, T., Fang, M. L., and Amari, E., “The Effectiveness of Interventions for Reducing Stigma Related to Substance Use Disorders: A Systematic Review,” Addiction 107, no. 1 (2012): 39–50.Google Scholar
Csete, J., Kamarulzaman, A., Kazatchkine, M., Altice, F., Balicki, M., Buxton, J., Cepeda, J., et al., “Public Health and International Drug Policy,” The Lancet 387, no. 10026 (2016): 1427–1480.CrossRefGoogle Scholar
Bennett, A. S., Bell, A., Tomedi, L., Hulsey, E. G., and Kral, A. H., “Characteristics of an Overdose Prevention, Response, and Naloxone Distribution Program in Pittsburgh and Allegheny County, Pennsylvania,” Journal of Urban Health 88, no. 6 (2011): 1020–1030.CrossRefGoogle Scholar
European Monitoring Centre for Drugs and Drug Addiction, “European Drug Report: Trends and Development” (Luxembourg, 2015).Google Scholar
Hawkes, N., “Highs and Lows of Drug Decriminalisation,” British Medical Journal 343 (2011): d6881-d6882, at d6881.CrossRefGoogle Scholar
Evans, T.I, Hadland, S. E., Clark, M. A., Green, T. C., and Marshall, B.D.L., “Factors Associated with Knowledge of a Good Samaritan Law among Young Adults Who Use Prescription Opioids Non-Medically,” Harm Reduction Journal 13, no. 24 (2016): 1-6.CrossRefGoogle Scholar
See Kelly, , supra note 13.Google Scholar
See Fraser, , supra note 11.Google Scholar
Kelly, J. F. and Westerhoff, C. M., “Does It Matter How We Refer to Individuals with Substance-Related Conditions? A Randomized Study of Two Commonly Used Terms,” The International Journal of Drug Policy 21, no. 3 (2010): 202–207.Google Scholar
Broyles, L. M., Binswanger, I. A., Jenkins, J. A., Finnell, D. S., Faseru, B., Cavaiola, A., Pugatch, M., and Gordon, A. J., “Confronting Inadvertent Stigma and Pejorative Language in Addiction Scholarship: A Recognition and Response,” Substance Abuse 35, no. 3 (2014): 217–221.CrossRefGoogle Scholar
Baron-Cohen, S., “Neuroethics of Neurodiversity” in Clausen, J. and Levy, N., eds., Handbook of Neuroethics (Dordrecht: Springer, 2015): 1757–1763.Google Scholar
Wittgenstein, L., Philosophical Investigations (London: Blackwell, 1953), at §43.Google Scholar
Banjo, O., Tzemis, D., Al-Qutub, D., Amlani, A., Kesselring, S., and Buxton, J. A., “A Quantitative and Qualitative Evaluation of the British Columbia Take Home Naloxone Program,” Canadian Medical Association Journal Open 2, no. 3 (2014): E153–E161;Maxwell, S., Bigg, D., Stanczykiewicz, K, and Carlberg-Racich, S., “Prescribing Naloxone to Actively Injecting Heroin Users: A Program to Reduce Heroin Overdose Deaths,” Journal of Addictive Diseases 25, no. 3(2006): 89–96.Google Scholar
World Health Organization, “Task Shifting: Rational Redistribution of Tasks among Health Workforce Teams: Global Recommendations and Guidelines,” (Geneva: World Health Organization, 2007).Google Scholar
Chen, L., Evans, T., Anand, S., Boufford, J. I., Brown, H., Chowdhury, M., Cueto, M., et al., “Human Resources for Health: Overcoming the Crisis,” The Lancet 364, no. 9449 (2004): 1984–1990; Heller, R., “Officiers de Santé: The Second-Class Doctors of Nineteenth-Century France,” Medical History 22, no. 1 (1978): 25–43.Google Scholar
Health Canada, “Notice: Prescription Drug List (PDL): Naloxone,” Drugs and Health Products, March 22, 2016, available at <http://www.hc-sc.gc.ca/dhp-mps/prodpharma/pdlord/pdl-ldo-noa-ad-naloxone-eng.php> (last visited 11/21/17).+(last+visited+11/21/17).>Google Scholar
Roe, G., “Harm Reduction as Paradigm: Is Better than Bad Good Enough? The Origins of Harm Reduction,” Critical Public Health 15, no. 3 (2005): 243–250.CrossRefGoogle Scholar
Walley, A. Y., Xuan, Z., Hackman, H. H., Quinn, E., Doe-Simkins, M., Sorensen-Alawad, A., et al., “Opioid Overdose Rates and Implementation of Overdose Education and Nasal Naloxone Distribution in Massachusetts: Interrupted Time Series Analysis,” British Medical Journal 346 (2013): f174.Google Scholar
See Livingston, , supra note 108.Google Scholar