The Opioid Epidemic: a multi-faceted crisis

Drug overdose is a pressing issue in the United States, being one of the leading causes of death. In 2019, more than 70,000 Americans died from drug overdose, including illicit drugs and prescription opioids(1). Overdose of opioids has adversely affected the entire country, but certain demographic groups have been affected more than others. Data has revealed that overdose is rising rapidly for minority groups in particular. In 2017, non-Hispanic Blacks had the highest percentages of opioid-related overdose deaths and total drugs deaths attributed to synthetic opioids compared to other race and ethnicities (2). These disparities are intimately linked to psychosocial determinants of health including racism, poverty, limited access to treatments and services, and socioeconomic status. Furthermore, there exist ethical problems related to prescription practices, naloxone availability, and clinician regulations. Prescription of opioids by clinicians, while used to ease the suffering of patients, is a source of potentially dangerous and addictive drugs.

In order to tackle the opioid crisis on a public health level, greater attention to the ethics of opioid prescription and regulation is necessary. Furthermore, the social determinants underlying this issue must be thoroughly analyzed and assessed. Factors such as economic conditions and social conditions create problems of accessing drugs in a proper manner for many minority populations (2). This then results in drugs being administered in an unsafe environment, which increases the likelihood of a negative outcome. Drug behavior can be heavily influenced by the drug use context, such as the setting or location under which it is administered. The stigma surrounding opioid use and addiction can also increase negative health outcomes. Stigma often prevents people from seeking help, due to fear of the social and legal repercussions. In order to address this issue, the discourse surrounding this topic needs to change. Those with opioid addiction need to have access to a safe, judgement-free space to share their experiences and spread awareness. Furthermore, the language used to describe opioid users needs to incorporate more person-centered language and acknowledgement of addiction as a disease requiring medical intervention. In order for the opioid crisis to be improved on a population level, there needs to be a social shift towards spreading awareness and destigmatizing addiction—factors not necessarily directly related to disease condition itself.

References

1. National Institute on Drug Abuse. Overdose Death Rates. [internet].; 2021 Jan 29 [cited 2021 Feb 20]. Available from: https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates

2. Centers for Disease Control and Prevention (CDC). 2019 Annual surveillance report of drug-related risks and outcomes —United States. [internet]. Atlanta, GA: CDC National Center for Injury Prevention and Control; 2019 Nov 1 [cited 2021 Feb 20]. Available from: https://www.cdc.gov/drugoverdose/pdf/ pubs/2019-cdc-drug-surveillance-report.pdf

The COVID-19 Publishing Paradox

Hundreds and thousands of scientific papers are published each day, communicating progress in medicine and up-to-date results to both scientists and the eager public eye. We turn to these articles and journals for reliable information on the latest advancements, with the assurance that the author is an expert in their field and that each work undergoes a rigorous editorial process often spanning months. Indeed, most of the publications we read are the result of months and years of work and a rigorous peer-review process. However, in recent years, light has been shed on the existence of a minority of flawed or even fraudulent publications that lack careful editing and review by publishers.

The discussion of the issue of publication ethics at this time is crucial, as the quantity and speed of publications have skyrocketed during the months of the COVID-19 pandemic. Researchers have suddenly found themselves faced with an overwhelming demand for medical research to be carried out and disseminated rapidly to the concerned public. As a result of these demand pressures, turnover rates of papers related to COVID-19 have increased extraordinarily. For example, journals available on PubMed are now averaging publication only 6 days after the time of submission, with an average of over 350 COVID-19 article publications per week including retractions of select publications.

Rapid publication provides us with new, much-needed evidence and knowledge during this fast-evolving pandemic, but how heavily should the pressure for speed be weighed against the need for extensive peer review and quality control? This paradox must be reconciled. The speed of this research has the ability to save lives, but we must ensure that the credibility of these publications is not put on the line for the sake of urgency alone. We must ensure that the sheer quantity and expedited nature of COVID-19 publishing does not plant doubts about scientific integrity or dilute the pool of evidence that is critical for experts and directly translates to public policy discourse and decisions. Ethical concerns of misinformation are being raised by scholars and they cannot be overlooked—trust is fragile, and at this time, to lose it is a dangerous thing.

What can be done to protect and reinforce the ethics of publication amid the surge in scientific literature? Measures such as the transparent labelling of non-peer-reviewed publications as preprints may help prevent news outlets and the general public from misusing these works or being misled. Given the volume of articles, we must also question the general public’s ability to identify the substance of these articles and their limitations. Requiring a simple summary for a nonprofessional audience on findings, applications, and their limits may help prevent public confusion. Select journals have begun to raise the conventional bar for publications to ensure the vigor of the review process and to refine the growing sea of articles that the general audience is drowning in.

The ethics of publication is central to integrity in research, and now more than ever it must be safeguarded.

References

Q. Chen, A. Allot, et al. “Publishing Volumes in Major Databases Related to Covid-19.” Scientometrics, Springer International Publishing, 28 August 2020, link.springer.com/article/10.1007/s11192-020-03675-3.

Palayew, Adam, et al. “Pandemic Publishing Poses a New COVID-19 Challenge.” Nature News, Nature Publishing Group, 23 June 2020, www.nature.com/articles/s41562-020-0911-0.

The Promise to Do Better: A Reflection on the Fight for Intersex Rights in Medicine

As children, we learn, albeit on a smaller scale, many of the fundamental skills we need to navigate the world. We are taught how to share, to treat others with kindness and respect, and crucially, we are taught how to apologize. Choruses of “I’m sorry. I won’t do it again” fill the soundtrack of our days, and we undoubtedly sound like broken records. Yes, we make a lot of mistakes, but we do our best not to make the same ones twice. As adults, we continue to call on much of what was taught to us at a young age, often times without conscious effort. Unfortunately, this is not always true when it comes to making meaningful apologies.

This idea has weighed on my mind with the recent passing of Intersex Awareness Day and the focus on several notable apologies from the medical field addressing past wrongdoings that have harmed the intersex community. Intersex Awareness Day is recognized on the 26th of October and marks the anniversary of the first public demonstration by intersex individuals in the US (1996). They protested the accepted practice of performing unnecessary genital surgeries on infants and children in order to better match them into binary sex categories. The prevailing argument is that these children could not and cannot provide meaningful consent, and the only procedures that should be performed in this case are those that are medically necessary.[1] In the decades since this demonstration, many individuals and several larger bodies have spoken out against the harm inflicted upon the intersex community by the healthcare system. However, it wasn’t until this year (nearly a quarter of a century after the first public demonstration) that Lurie Children’s Hospital and Boston Children’s Hospital announced actual changes to their policies on performing genital surgeries on intersex children.[2]

These decisions could be a catalyst in the fight for intersex rights, prompting other hospitals and policymakers to follow suit. That said, it is important for us to realize that advocates aren’t just protesting for an admission of guilt. An apology isn’t simply a statement of regret or a request for forgiveness. A true apology is a promise to do better, and the only way to do better is to know better. Knowing better means taking responsibility for past actions and learning from them. Although we are slowly making progress in the realm of recognizing past mistakes, we are nowhere close to where we need to be when it comes to learning from these mistakes and taking action to rectify them, evidenced by the fact that the first study on intersex adults in the United States wasn’t published until October of 2020.[3]

At this very moment, we are on the cusp of truly meaningful change for the intersex community. This is a pivotal moment in which the decisions of the medical community have the potential to propel us down a path of righting past wrongs and ensuring that they do not happen again. While these monumental announcements are reason to celebrate, they are not the end of the road. In terms of forgiving and forgetting, we may see a day when the medical community has enacted significant change that warrants forgiveness, but we ought never to forget these, or any other, injustices committed. A forgotten history is a soon repeated one.

The scope of wrongdoing in our healthcare system is vast, and I would be naïve to believe that the collection is finite. There will always be growth to be had and progress to be made. In that journey, we will make mistakes, but it is our responsibility to acknowledge those mistakes and learn from them. We must know better, and we must promise to do better.

[1] Intersex Awareness Day History. (2020, October 24). Retrieved October 25, 2020, from https://interactadvocates.org/intersex-awareness-day/ [2] Luthra, S. (2020, October 22). Boston Children's Hospital will no longer perform two types of intersex surgery on children. Retrieved October 25, 2020, from https://www.usatoday.com/story/news/health/2020/10/22/intersex-surgery-boston-childrens-hospitals-decision-watershed-moment-rights/3721096001/ [3] Rosenwohl-Mack, A., Tamar-Mattis, S., Baratz, A. B., Dalke, K. B., Ittelson, A., Zieselman, K., & Flatt, J. D. (2020, October 9). A national study on the physical and mental health of intersex adults in the U.S. Retrieved October 25, 2020, from https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0240088