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AMA journal of ethics最新文献

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What Would Equitable Harm Reduction Look Like? 公平减低伤害会是什么样子？
AMA journal of ethics Pub Date : 2024-07-01 DOI: 10.1001/amajethics.2024.572
Oluwole Jegede, Julio C Nunes, Terence Tumenta, Carmen Black, Joao P DeAquino
{"title":"What Would Equitable Harm Reduction Look Like?","authors":"Oluwole Jegede, Julio C Nunes, Terence Tumenta, Carmen Black, Joao P DeAquino","doi":"10.1001/amajethics.2024.572","DOIUrl":"https://doi.org/10.1001/amajethics.2024.572","url":null,"abstract":"<p><p>Structural determinants of health frameworks must express antiracism to be effective, but racial and ethnic inequities are widely documented, even in harm reduction programs that focus on person-centered interventions. Harm reduction strategies should express social justice and health equity, resist stigma and discrimination, and mitigate marginalization experiences among people who use drugs (PWUD). To do so, government and organizational policies that promote harm reduction must acknowledge historical and ongoing patterns of racializing drug use. This article gives examples of such racialization and offers recommendations about how harm reduction programming can most easily and effectively motivate equitable, antiracist care for PWUD.</p>","PeriodicalId":38034,"journal":{"name":"AMA journal of ethics","volume":"26 7","pages":"E572-579"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
How Should Harm Reduction Strategies Differ for Adolescents and Adults? 针对青少年和成年人的减低伤害策略有何不同？
AMA journal of ethics Pub Date : 2024-07-01 DOI: 10.1001/amajethics.2024.534
Brady J Heward, Amy M Yule, Peter R Jackson
{"title":"How Should Harm Reduction Strategies Differ for Adolescents and Adults?","authors":"Brady J Heward, Amy M Yule, Peter R Jackson","doi":"10.1001/amajethics.2024.534","DOIUrl":"https://doi.org/10.1001/amajethics.2024.534","url":null,"abstract":"<p><p>Overall rates of opioid use are low in adolescents; however, recent increases in mortality from overdose in adolescents have outpaced increases in the general population. This article highlights the importance of expanding evidence-based treatment for adolescent opioid use, especially medication, while also addressing key ethical considerations of harm reduction practices and how application of such practices with adolescents may differ from adults. Concepts related to adolescent populations are discussed, including autonomy, confidentiality, and brain development. Application of harm reduction practices should be age appropriate, express respect for patients' autonomy, include social support, and be accompanied by broader aims to minimize adolescent initiation, escalation, and overall harm caused by opioid use.</p>","PeriodicalId":38034,"journal":{"name":"AMA journal of ethics","volume":"26 7","pages":"E534-545"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
How Should Harm Reduction Be Included in Care Continua for Patients With Opioid Use Disorder? 如何将减低伤害纳入阿片类药物使用障碍患者的连续护理？
AMA journal of ethics Pub Date : 2024-07-01 DOI: 10.1001/amajethics.2024.562
Elizabeth Salisbury-Afshar, Catherine J Livingston, Ricky N Bluthenthal
{"title":"How Should Harm Reduction Be Included in Care Continua for Patients With Opioid Use Disorder?","authors":"Elizabeth Salisbury-Afshar, Catherine J Livingston, Ricky N Bluthenthal","doi":"10.1001/amajethics.2024.562","DOIUrl":"https://doi.org/10.1001/amajethics.2024.562","url":null,"abstract":"<p><p>Practices and interventions that aim to slow progression or reduce negative consequences of substance use are harm reduction strategies. Often described as a form of tertiary prevention, harm reduction is key to caring well for people who use drugs. Evidence-based harm reduction interventions include naloxone and syringe service programs. Improving equitable outcomes for those with opioid use disorder (OUD) requires access to the continuum of evidence-based OUD care, including harm reduction interventions, as well as dismantling policies that undermine mental health and substance use disorder treatment continuity, housing stability, and education and employment opportunities.</p>","PeriodicalId":38034,"journal":{"name":"AMA journal of ethics","volume":"26 7","pages":"E562-571"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Why Harm Reduction and Equity Are Ethical Imperatives in Opioid Use Disorder Care. 为什么减少伤害和公平是阿片类药物使用障碍护理的伦理要务？
AMA journal of ethics Pub Date : 2024-07-01 DOI: 10.1001/amajethics.2024.509
Jeremy Weleff
{"title":"Why Harm Reduction and Equity Are Ethical Imperatives in Opioid Use Disorder Care.","authors":"Jeremy Weleff","doi":"10.1001/amajethics.2024.509","DOIUrl":"10.1001/amajethics.2024.509","url":null,"abstract":"","PeriodicalId":38034,"journal":{"name":"AMA journal of ethics","volume":"26 7","pages":"E509-511"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
How Should the Use of Opioids Be Regulated to Motivate Better Clinical Practice? 应如何规范阿片类药物的使用以促进更好的临床实践？
AMA journal of ethics Pub Date : 2024-07-01 DOI: 10.1001/amajethics.2024.551
Ellen L Edens, Gabriela Garcia Vassallo, Robert Heimer
{"title":"How Should the Use of Opioids Be Regulated to Motivate Better Clinical Practice?","authors":"Ellen L Edens, Gabriela Garcia Vassallo, Robert Heimer","doi":"10.1001/amajethics.2024.551","DOIUrl":"https://doi.org/10.1001/amajethics.2024.551","url":null,"abstract":"<p><p>This article describes historical and political reasons for-and devastating consequences of-US opioid prescribing policy since the 1990s, which has restricted opioid prescribing for pain less than for treating opioid use disorder (OUD) treatment. This article considers merits and drawbacks of a new diagnostic category and proposes a regulatory and clinical framework for prescribing long-term opioid therapy for pain and for prescribing opioids to treat OUD.</p>","PeriodicalId":38034,"journal":{"name":"AMA journal of ethics","volume":"26 7","pages":"E551-561"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
When Are "Paraphernalia" Critical Medical Supplies? 什么情况下 "辅助用具 "属于关键医疗用品？
AMA journal of ethics Pub Date : 2024-07-01 DOI: 10.1001/amajethics.2024.527
Adriane M Dela Cruz, Donald Egan, Sarah E Baker, John Z Sadler
{"title":"When Are \"Paraphernalia\" Critical Medical Supplies?","authors":"Adriane M Dela Cruz, Donald Egan, Sarah E Baker, John Z Sadler","doi":"10.1001/amajethics.2024.527","DOIUrl":"https://doi.org/10.1001/amajethics.2024.527","url":null,"abstract":"<p><p>Evidence of harm reduction interventions' morbidity and mortality benefits is abundant and of high quality, so there are good reasons for regional and national groups to advocate for more widespread distribution of legally regulated \"drug paraphernalia,\" including needles, syringes, and fentanyl test strips. But lack of consistency among states' laws means that patients' interstate travel can subject them to being charged with possession of illegal items. This commentary on a case offers guidance to clinicians looking to help patients understand legal risks of interstate travel with supplies that are prescribed or recommended to reduce harms of their drug use and explores the ethical responsibilities of physicians in jurisdictions that legally prohibit these harm reduction interventions.</p>","PeriodicalId":38034,"journal":{"name":"AMA journal of ethics","volume":"26 7","pages":"E527-533"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
When Medication Treatment for Opioid Use Disorder Gets Disrupted by Extra-Clinical Variables, How Should Clinicians Respond? 当阿片类药物使用障碍的药物治疗受到临床外变量的干扰时，临床医生应如何应对？
AMA journal of ethics Pub Date : 2024-07-01 DOI: 10.1001/amajethics.2024.520
Taleed El-Sabawi, Kelly Gillespie
{"title":"When Medication Treatment for Opioid Use Disorder Gets Disrupted by Extra-Clinical Variables, How Should Clinicians Respond?","authors":"Taleed El-Sabawi, Kelly Gillespie","doi":"10.1001/amajethics.2024.520","DOIUrl":"10.1001/amajethics.2024.520","url":null,"abstract":"<p><p>Structural and systemic discrimination against people with substance use disorder is pervasive. Clinicians caring for patients receiving medications for opioid use disorders (MOUDs) should plan for possible disruptions of treatment caused by arrests and pretrial confinement in jails. This case commentary suggests that harms caused by such treatment disruption can be mitigated by clinicians who take some of the practical approaches outlined in this commentary to better preserve continuity of care for people receiving MOUD.</p>","PeriodicalId":38034,"journal":{"name":"AMA journal of ethics","volume":"26 7","pages":"E520-526"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11293620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
What Should the US Learn From New York's and Portugal's Approaches to the Opioid Crisis? 美国应从纽约和葡萄牙应对阿片类药物危机的方法中学到什么？
AMA journal of ethics Pub Date : 2024-07-01 DOI: 10.1001/amajethics.2024.546
Maura McGinnity
{"title":"What Should the US Learn From New York's and Portugal's Approaches to the Opioid Crisis?","authors":"Maura McGinnity","doi":"10.1001/amajethics.2024.546","DOIUrl":"https://doi.org/10.1001/amajethics.2024.546","url":null,"abstract":"<p><p>Between 1999 and 2020, more than 564 000 people in the United States died from opioid overdose. Domestically, the opioid epidemic tends to be approached not as a public health problem but as a law enforcement or judicial problem. Some US localities, however, are trying interventions modeled after international approaches that decriminalize opioid dependence. This article describes Portuguese approaches to persons with opioid use disorder.</p>","PeriodicalId":38034,"journal":{"name":"AMA journal of ethics","volume":"26 7","pages":"E546-550"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Drawing on Black and Queer Communities' Harm Reduction Histories to Improve Overdose Prevention Strategies and Policies. 借鉴黑人和同性恋社区的减低伤害历史，改进用药过量预防战略和政策。
AMA journal of ethics Pub Date : 2024-07-01 DOI: 10.1001/amajethics.2024.580
Sterling Johnson, Kimberly L Sue
{"title":"Drawing on Black and Queer Communities' Harm Reduction Histories to Improve Overdose Prevention Strategies and Policies.","authors":"Sterling Johnson, Kimberly L Sue","doi":"10.1001/amajethics.2024.580","DOIUrl":"10.1001/amajethics.2024.580","url":null,"abstract":"<p><p>Harm reduction emerged as a set of strategies developed by and for people who use opioids and other substances and strive to do so in ways that are as safe as possible. This article reviews histories of Black and queer community-based harm reduction practices and suggests how these histories can inform harm reduction policy and guide development and implementation of anti-overdose interventions.</p>","PeriodicalId":38034,"journal":{"name":"AMA journal of ethics","volume":"26 7","pages":"E580-586"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Opioid Epidemic Grief and Characterological Harm Reduction. 阿片类药物流行的悲伤与特色减害。
AMA journal of ethics Pub Date : 2024-07-01 DOI: 10.1001/amajethics.2024.587
Christy A Rentmeester
{"title":"Opioid Epidemic Grief and Characterological Harm Reduction.","authors":"Christy A Rentmeester","doi":"10.1001/amajethics.2024.587","DOIUrl":"https://doi.org/10.1001/amajethics.2024.587","url":null,"abstract":"<p><p>This article considers what it might mean to do the moral work of grieving during an opioid epidemic. Becoming callous, bitter, or resentful are harms we can suffer to our characters when grieving losses, especially at epidemic scale. This article suggests how appreciating beauty can play roles in grieving that could help mitigate these harms.</p>","PeriodicalId":38034,"journal":{"name":"AMA journal of ethics","volume":"26 7","pages":"E587-590"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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