The Challenge of CRISPR-Cas Toward Bioethics

Since determining the structure of the DNA double helix, the study of genes and genomes has revolutionized contemporary science; with the decoding of the human genome, new findings have been achieved, including the ability that humans have developed to modify genetic sequences in vitro. The discovery of gene modification mechanisms, such as the CRISPR-Cas system (Clustered Regularly Interspaced Short Palindromic Repeats) and Cas (CRISPR associated). Derived from the latest discoveries in genetics, the idea that science has no limits has exploded. However, improvements in genetic engineering allowed access to new possibilities to save lives or generate new treatment options for diseases that are not treatable by using genes and their modification in the genome. With this greater knowledge, the immediate question is who governs the limits of genetic science? The first answer would be the intervention of a legislative branch, with adequate scientific advice, from which the logical answer, bioethics, should result. This term was introduced for the first time by Van Rensselaer Potter, who in 1970 combined the Greek words bios and ethos, Bio-Ethik, which determined the study of the morality of human behavior in science. The approach to this term was introduced to avoid the natural tension that results from the scientific technical development and the ethics of limits. Therefore, associating the use of biotechnology through the CRISPR-Cas system and the regulation through bioethics, aims to monitor the use of techniques and technology, with benefits for humanity, without altering fundamental rights, acting with moral and ethical principles.

A Novel Approach to Pharmacy Practice Law Instruction

Pharmacy law instruction is often taught as a didactic course; however practical application of pharmacy law is a main component of pharmacy practice. Technology-based simulations are becoming more frequently used to enhance didactic pharmacy education. The goal of this study was to evaluate the utility of and student perceptions on the usefulness of MyDispense community pharmacy simulation for additional law instruction that if successful might prompt curricular revamping. This Institutional Review Board-approved, two-year, qualitative, prospective, survey study was conducted in a case study class where students completed MyDispense exercises focused on common legal issues that arise in practice, both individually before and within groups during class. Participating students completed a qualitative survey directed at use of MyDispense for pharmacy law review, which included a series of close-ended questions graded on a Likert scale and open-ended questions thematically grouped. Thirty-eight (41%) and twenty-eight (31%) students completed surveys in 2017 and 2018, respectively. The majority of respondents felt exercises improved their understanding of pharmacy laws, focused on challenging areas, and were more interesting than additional lectures. However, certain topics were reported as irrelevant based on practice experiences or not ideal for simulation, and students desired exercises on state laws versus pharmacy policies. Students reported the MyDispense simulation exercises helped them to recall pharmacy laws and focus on topics that were challenging. These study results prompted curricular revamping to incorporate MyDispense throughout the curriculum for practice in recognizing and solving legal scenarios, along with didactic course changes.

Adolescent Consent for Human Papillomavirus Vaccine: Ethical, Legal, and Practical Considerations

We address ethical, legal, and practical issues related to adolescent self-consent for human papillomavirus (HPV) vaccination. HPV vaccination coverage continues to lag well behind the national goal of 80% series completion. Structural and behavioral interventions have improved vaccination rates, but attitudinal, behavioral, and access barriers remain. A potential approach for increasing access and improving vaccination coverage would be to permit adolescents to consent to HPV vaccination for themselves. We argue that adolescent self-consent is ethical, but that there are legal hurdles to be overcome in many states. In jurisdictions where self-consent is legal, there can still be barriers due to lack of awareness of the policy among healthcare providers and adolescents. Other barriers to implementation of self-consent include resistance from antivaccine and parent rights activists, reluctance of providers to agree to vaccinate even when self-consent is legally supported, and threats to confidentiality. Confidentiality can be undermined when an adolescent's self-consented HPV vaccination appears in an explanation of benefits communication sent to a parent or if a parent accesses an adolescent's vaccination record via state immunization information systems. In the context of the COVID-19 pandemic, which has led to a substantial drop in HPV vaccination, there may be even more reason to consider self-consent. The atmosphere of uncertainty and distrust surrounding future COVID-19 vaccines underscores the need for any vaccine policy change to be pursued with clear communication and consistent with ethical principles.

Alcohol policy in Chile: a systematic review of policy developments and evaluations

AIMS

To comprehensively review enacted and proposed alcohol laws and existing impact evaluations of national alcohol policies in Chile.

METHODS

We searched enacted laws in the Chilean National Library of Congress, proposed laws in the websites of the House of Deputies and Senate and impact evaluations in PubMed, Web of Science, Scopus, Scielo, JSTOR, Epistemonikos and OpenGrey from inception to February 2019. Eligibility criteria included enacted laws and proposed laws on national alcohol policies and research studies evaluating the impact of national alcohol policies. One author screened enacted laws and proposed laws; two authors independently screened research records. We included any national alcohol policy intervention and classified policies according to 10 World Health Organization (WHO) alcohol policy domains. We used the Cochrane EPOC Review Group criteria to assess risk of bias of research records. We registered the review protocol in PROSPERO, registration record CRD42016050156.

RESULTS

We identified and screened 229 enacted laws, 138 proposed laws and 1538 research records. Of these, 72 enacted laws, 118 proposed laws and three research articles were eligible for synthesis. We found enacted policies in all WHO alcohol policy domains. Regarding the most cost-effective policies, Chile has made limited use of taxation, has not regulated alcohol marketing and has weakened alcohol availability regulation. We found a large number of proposed laws, 79% of which would strengthen alcohol control. The few impact evaluation studies examined drink-driving policies and found a short-term reduction of alcohol-related injuries and deaths.

CONCLUSIONS

Chile has enacted alcohol policies in all World Health Organization policy domains, but has not adopted policies with highest likely cost-effectiveness. Only the impact of drink-driving policies has been evaluated.

How to establish a medico-legal obstacle on the Medical Certificate of Death

Indicating a medico-legal obstacle to burial is not always evident for the pratician. In the absence of specific legal references and scientific Tunisian guidelines, we propose in this paper a practical guide to orientate the pratician on when and how to establish a medico-legal obstacle on the Medical Certificate of Death.

Guaranteeing the Health Rights of People with Disabilities in the COVID-19 Pandemic: Perspectives from China

The question of how to guarantee the health rights of people with disabilities, and their health equity in particular, is frequently neglected in infectious disease pandemics. The international response to the ongoing COVID-19 pandemic is no exception in this regard. This neglect is related to other forms of marginalization and exclusion, as people with disabilities are generally poorer and more vulnerable than their non-disabled counterparts. Sustainable Development Goal 3 lacks an appropriate human rights language that enshrines equality and inclusivity in pandemic prevention work and related policies and legislation; and, as a result, it does not sufficiently guarantee the health rights of people with disabilities. This paper draws on China's pandemic prevention work to extract relevant lessons, and seeks to explain how decision-making systems and resource allocation mechanisms impact on the health rights of people with disabilities. It discusses the unique roles of justice and legislation in helping to guarantee the health rights of people with disabilities in an infectious disease pandemic, and concludes that future research should more closely consider how Sustainable Development Goal 16 can support Sustainable Development Goal 3.

Preventing Occupational Tuberculosis in Health Workers: An Analysis of State Responsibilities and Worker Rights in Mozambique

Given the very high incidence of tuberculosis (TB) among health workers in Mozambique, a low-income country in Southern Africa, implementation of measures to protect health workers from occupational TB remains a major challenge. This study explores how Mozambique's legal framework and health system governance facilitate-or hinder-implementation of protective measures in its public (state-provided) healthcare sector. Using a mixed-methods approach, we examined international, constitutional, regulatory, and policy frameworks. We also recorded and analysed the content of a workshop and policy discussion group on the topic to elicit the perspectives of health workers and of officials responsible for implementing workplace TB policies. We found that despite a well-developed legal framework and national infection prevention and control policy, a number of implementation barrier persisted: lack of legal codification of TB as an occupational disease; absence of regulations assigning specific responsibilities to employers; failure to deal with privacy and stigma fears among health workers; and limited awareness among health workers of their legal rights, including that of collective action. While all these elements require attention to protect health workers from occupational TB, a stronger emphasis on their human and labour rights is needed alongside their perceived responsibilities as caregivers.

Classification of Benign and Malignant Breast Masses on Mammograms for Large Datasets using Core Vector Machines

BACKGROUND

Breast cancer is one of the most leading causes of cancer deaths among women. Early detection of cancer increases the survival rate of the affected women. Machine learning approaches that are used for classification of breast cancer usually takes a lot of processing time during the training process. This paper attempts to propose a Machine Learning approach for breast cancer detection in mammograms, which does not depend on the number of training samples.

OBJECTIVES

The paper aims to develop a core vector machine-based diagnosis system for breast cancer detection using the date from MIAS. The main motivation behind using this system is to reduce the computational and memory requirement for large training data and to improve the classification accuracy.

METHODS

The proposed method has four stages: 1) Pre-processing is done to extract the breast region using global thresholding and enhancement using histogram equalization; 2) identification of potential mass using Otsu thresholding; 3) feature extraction using Laws Texture energy measures; and 4) mass detection is done using Core vector machine (CVM) classifier.

RESULTS

Comparative analysis was done with different existing algorithms: Artificial Neural Network (ANN), Support Vector Machine (SVM), and Fuzzy Support Vector Machines (FSVM). The results illustrate that the proposed Core Vector Machine (CVM) classifier produced a promising result in terms of sensitivity (96.9%), misclassification rate (0.0443) and accuracy (95.89%). The time taken for training process is 0.0443, which is less when compared with other machine learning algorithms.

CONCLUSION

Performance analysis shows that CVM classifier is superior to other classifiers like ANN, SVM and FSVM. The computational time of the CVM classifier during the training process was also analysed and found to be better than other discussed algorithms. The results achieved show that CVM classifier is the best algorithm for breast mass detection in mammograms.

Child abuse and the role of a dentist in its identification, prevention and protection: A literature review

Child abuse, a reprehensible act, pervades all strata of society. Dentists are more likely to encounter such cases in their daily practice. However, such cases usually go unreported due to lack of adequate knowledge. Practitioners flinch from reporting these due to various reasons, and this sets up a vicious cycle which traps the victim leading to grave long-term consequences. This review aims to collect all literature available on PubMed, PubMed Central, MEDLINE, Google Scholar, and Google search engines on the role of dentists in child abuse identification and information and summarize these details. The review will shed light on the identification of abuse in dental settings, the various legal recourses and organizations related to it, and how dentists can better equip themselves to tackle such cases if they come across one. The review also makes certain recommendations by which dentists and healthcare providers in general can better prepare themselves for such contingencies.

State policies in the United States impacting drug-related convictions and their consequences in 2015

Background

Criminal justice system involvement has been associated with health issues, including sexually transmitted disease. Both incarceration and sexually transmitted disease share associations with various social conditions, including poverty, stigma, and drug use.

Methods

United States state laws (including Washington, D.C.) regarding drug possession and consequences of drug-related criminal convictions were collected and coded. Drug possession policies focused on mandatory sentences for possession of marijuana, crack cocaine and methamphetamines. Consequences of drug-related convictions included ineligibility for public programmes, ineligibility for occupational licences and whether employers may ask prospective employees about criminal history. We analysed correlations between state sexually transmitted disease rates and percentage of a state's population convicted of a felony.

Results

First-time possession of marijuana results in mandatory incarceration in one state; first-time possession of crack cocaine or methamphetamines results in mandatory incarceration in 12 (23.5%) states. Many states provide enhanced punishment upon a third possession conviction. A felony drug conviction results in mandatory ineligibility for the Supplemental Nutrition Assistance Program and/or Temporary Assistance for Needy Families in 17 (33.3%) states. Nine (17.6%) states prohibit criminal history questions on job applications. Criminal convictions limit eligibility for various professional licences in all states. State chlamydia, gonorrhoea and syphilis rates were positively associated with the percentage of the state population convicted of a felony (p < 0.05).

Conclusion

While associations between crime, poverty, stigma and health have been investigated, our findings could be used to investigate the relationship between the likelihood of criminal justice system interactions, their consequences and public health outcomes including sexually transmitted disease risk.

Abortion practices among women in Buea: a socio-legal investigation

Introduction

there are controversies surrounding the practice of abortion especially in developing countries of Africa. Cameroon is not an exception to this and hence this study aims at assessing knowledge on the awareness of abortion laws, the factors that determine abortion and people's perceptions on the legality of abortion in Cameroon.

Methods

the study is cross-sectional in its design. A total of 224 women were randomly sampled. Data for the study were collected through the use of questionnaires from the sampled women of child bearing age. These were used to assess knowledge on the awareness of abortion laws and the determinants of abortion. The data were analysed using STATA 15.

Results

the prevalence of induced abortion was 21%. The major determinants of abortion among these women were; desire to stay in school (28%), fear of parents (24%) and shame of being pregnant out of wedlock (26%). Furthermore, many women are not aware of the situations where abortion is allowed and hence some still undertake illegal abortions even when they find themselves in situations deserving a legal abortion.

Conclusion

induced abortion is still common in Buea, Cameroon despite the fact that it is illegal. Cameroon's legal and health system needs to work in harmony in order to lessen the legal processes of having a legal abortion.

'Of Mice and Dementia': A filmed conversation on the use of animals in dementia research

Preclinical science research focuses on the study of physiological systems regulating body functions, and how they are dysregulated in disease, in a non-human setting. For example, cells in a dish, computer simulations or animals. Scientific procedures traditionally involve a specialist scientist developing a hypothesis and subsequently testing it using an experimental set-up. The results are then disseminated to the wider scientific community, following peer review and only at the last stage the news will reach the general, lay public. In the last few years, some research funding institutions have promoted a different model, with the direct involvement of members of the public in the research co-creation, from the hypothesis development, to the grant revision, project monitoring and results communication. We personally experienced this model and brought it to a further level by producing a movie. Animal research is a very controversial topic as, while still being necessary for the investigation of body functions, it brings about issues related to the ethics, the regulation and the practical execution of experimental procedures on animals. Here we discuss the different stages of the ideation, production and outcomes of the movie 'Of Mice and Dementia', a filmed conversation on animal experimentation in dementia research. The conversation was between scientists and lay people with a direct experience of dementia.

Tail Docking of Canine Puppies: Reassessment of the Tail's Role in Communication, the Acute Pain Caused by Docking and Interpretation of Behavioural Responses

Simple Summary

Bans or restrictions on non-therapeutic tail docking of canine puppies are becoming more widespread. Justifications for constraining this practice have usually referred to hindrances to the tail contributing to unambiguous communication between different dogs, the marked acute pain presumed to be experienced during the docking procedure itself, the subsequent occurrence of chronic pain and heightened pain sensitivity, and other harmful complications. The present re-examination of these matters led to the following conclusions: first, the contribution the tail makes to canine communication has been seriously underestimated; second, the capacity of puppies to consciously experience any pain at the early ages docking is usually conducted has been markedly overestimated; third, the probability that docking causes significant chronic pain and an ongoing heightened pain sensitivity is reaffirmed as high; and fourth, other harmful effects are apparent, but their prevalence is not well documented. Nevertheless, it is concluded that, overall, the life-long negative welfare impacts of tail docking in puppies, especially impacts associated with impaired communication, as also the occurrence of chronic pain and heightened pain sensitivity, still strongly justify banning or restricting docking unless it is undertaken for therapeutic purposes.

Abstract

Laws, regulations and professional standards increasingly aim to ban or restrict non-therapeutic tail docking in canine puppies. These constraints have usually been justified by reference to loss of tail participation in communication between dogs, the acute pain presumed to be caused during docking itself, subsequent experiences of chronic pain and heightened pain sensitivity, and the occurrence of other complications. These areas are reconsidered here. First, a scientifically robust examination of the dynamic functional foundations, sensory components and key features of body language that are integral to canine communication shows that the role of the tail has been greatly underestimated. More specifically, it shows that tail behaviour is so embedded in canine communication that docking can markedly impede unambiguous interactions between different dogs and between dogs and people. These interactions include the expression of wide ranges of both negative and positive emotions, moods and intentions that are of daily significance for dog welfare. Moreover, all docked dogs may experience these impediments throughout their lives, which challenges assertions by opponents to such bans or restrictions that the tail is a dispensable appendage. Second, and in contrast, a re-examination of the sensory capacities of canine puppies reveals that they cannot consciously experience acute or chronic pain during at least the first week after birth, which is when they are usually docked. The contrary view is based on questionable between-species extrapolation of information about pain from neurologically mature newborns such as calves, lambs, piglets and human infants, which certainly can consciously experience pain in response to injury, to neurologically immature puppies which remain unconscious and therefore unable to experience pain until about two weeks after birth. Third, underpinned by the incorrect conclusion that puppies are conscious at the usual docking age, it is argued here that the well-validated human emotional drive or desire to care for and protect vulnerable young, leads observers to misread striking docking-induced behaviour as indicating that the puppies consciously experience significant acute pain and distress. Fourth, updated information reaffirms the conclusion that a significant proportion of dogs docked as puppies will subsequently experience persistent and significant chronic pain and heightened pain sensitivity. And fifth, other reported negative consequences of docking should also be considered because, although their prevalence is unclear, when they do occur they would have significant negative welfare impacts. It is argued that the present analysis strengthens the rationale for such bans or restrictions on docking of puppies by clarifying which of several justifications previously used are and are not scientifically supportable. In particular, it highlights the major roles the tail plays in canine communication, as well as the lifetime handicaps to communication caused by docking. Thus, it is concluded that non-therapeutic tail docking of puppies represents an unnecessary removal of a necessary appendage and should therefore be banned or restricted.

Legalised non-consensual sterilisation - eugenics put into practice before 1945, and the aftermath. Part 2: Europe

This article deals with the nine European nations which legalised non-consensual sterilisation during the interwar years, thus completing the review, the first part of which was published in an earlier issue of this Journal. Like we did for North America, Japan and Mexico, countries concerned are addressed in chronological order, as practices in one of these influenced policies in others, involved later. For each, we assess the continuum of events up to the present time. The Swiss canton of Vaud was the first political entity in Europe to introduce a law on compulsory sterilisation of people with intellectual disability, in 1928. Vaud's sterilisation Act aimed at safeguarding against the abusive performance of these procedures. The purpose of the laws enforced later in eight other European countries (all five Nordic countries; Germany and, after its annexation by the latter, Austria; Estonia) was, on the contrary, to effect the sterilisation of large numbers of people considered a burden to society. Between 1933 and 1939, from 360,000 [corrected] to 400,000 residents (two-thirds of whom were women) were compulsorily sterilised in Nazi Germany. In Sweden, some 32,000 sterilisations carried out between 1935 and 1975 were involuntary. It might have been expected that after the Second World War ended and Nazi legislation was suspended in Germany and Austria, including that regulating coerced sterilisation, these inhuman practices would have been discontinued in all nations concerned; but this happened only decades later. More time still went by before the authorities in certain countries officially acknowledged the human rights violations committed, issued apologies and developed reparation schemes for the victims' benefit.

Laws and regulations of laser operation in the United States

The laws and regulations governing laser operation in the United States are vague, complex, and vary state-to-state. The objective of this study is to present an overview of the laws and regulations of laser operation in each of the 50 states. We performed an extensive online search of the law in each of the 50 states by examining multiple state cosmetology boards, state legislative boards, state nursing boards, and state medical boards. Laser regulations are best divided into three categories: delegation, supervision, and operation. Our findings demonstrate the complicated nature of the regulations covering this issue and identify a lack of regulation in numerous states. Lasers Surg. Med. 50:272-279, 2018. © 2018 Wiley Periodicals, Inc.

The trajectories of cannabis and tobacco policies in the United States, Uruguay, Canada and Portugal: is more cross-substance learning possible outside the United States?

Commentary to: The diverging trajectories of cannabis and tobacco policies in the United States: reasons and possible implications

A review of mental health policies from Commonwealth countries

BACKGROUND

The burden of disease related to mental disorders across the world is substantial. However, there remains inequality between funding for clinical and research activities between physical illness and mental illness in almost all countries.

AIMS

One way of reducing this inequality is to ensure that mental health policies reflect this. We were interested in looking at the policies of members of Commonwealth.

METHOD

We decided to survey 52 member countries of the Commonwealth to explore whether mental health policies existed and whether there was equity between physical and mental health services funding. Using World Health Organization (WHO) data sets and other sources when indicated, we looked at the existence and contents of mental health policies.

RESULTS

We found that less than half of the countries had a mental health policy. Deinstitutionalization was not seen as a priority in many countries and there was no equity between physical and mental health funding. Although integration between physical and mental health care was recommended in many countries, there was a clear gap.

CONCLUSION

It is apparent that there is still a long way to go in terms of equity between physical and mental health in terms of funding in member states of the Commonwealth. These findings confirm earlier observations of discrimination against people with mental illness. We suggest that there must be mechanisms in place to facilitate and support change wherever required.

Pain and Policy Studies Group: Two Decades of Working to Address Regulatory Barriers to Improve Opioid Availability and Accessibility Around the World

For two decades, the Pain & Policy Studies Group (PPSG), a global research program at the University of Wisconsin Carbone Cancer Center, has worked passionately to fulfill its mission of improving pain relief by achieving balanced access to opioids worldwide. PPSG's early work highlighted the conceptual framework of balance leading to the development of the seminal guidelines and criteria for evaluating opioid policy. It has collaborated at the global level with United Nations agencies to promote access to opioids and has developed a unique model of technical assistance to help national governments assess regulatory barriers to essential medicines for pain relief and amend existing or develop new legislation that facilitates appropriate and adequate opioid prescribing according to international standards. This model was initially applied in regional workshops and individual country projects and then adapted for PPSG's International Pain Policy Fellowship, which provides long-term mentoring and support for several countries simultaneously. The PPSG disseminates its work online in several ways, including an extensive Web site, news alerts, and through several social media outlets. PPSG has become the focal point for expertise on policy governing drug control and medicine and pharmacy practice related to opioid availability and pain relief.

Decline in opioid prescribing after federal rescheduling of hydrocodone products

PURPOSE

To examine differences in opioid prescribing by patient characteristics and variation in hydrocodone combination product (HCP) prescribing attributed to states, before and after the 2014 Drug Enforcement Administration's reclassification of HCP from schedule III to the more restrictive schedule II.

METHODS

We used 2013 to 2015 data for 9 202 958 patients aged 18 to 64 from a large nationally representative commercial health insurance program to assess the temporal trends in the monthly rate of opioid prescribing.

RESULTS

HCP prescribing decreased by 26% from June 2013 to June 2015; the rate of prescriptions for any opioid decreased by 11%. Prescribing of non-hydrocodone schedule III opioids increased slightly while prescribing of non-hydrocodone schedule II opioids and tramadol was stable. Absolute decreases in HCP prescribing rates were larger in patients being treated for cancer (-2.26% vs -0.7% for non-cancer patients, P < 0.0001) and in those with high comorbidities (-2.13% vs -0.55% for those with no comorbidity, P < 0.0001). Differences in the absolute and relative changes in HCP prescribing rates among states were large; for example, a relative decrease of 46.7% in Texas and a 12.7% increase in South Dakota. The variation in HCP prescribing attributable to the state of residence increased from 6.6% in 2013 to 8.7% in 2015.

CONCLUSIONS

The 2014 federal policy was associated with a decrease in rates of HCP and total opioid prescribing. The large decrease in the rates of HCP prescribing for patients with actively treated cancer may represent an unintended consequence.

The Contribution of the International Pain Policy Fellowship in Improving Opioid Availability in Georgia

In the Republic of Georgia, the incidence and prevalence of cancer are increasing, signifying a growing need for palliative care and pain relief, including with controlled opioid medicines. As a signatory to the Single Convention, the Georgian government has a responsibility to ensure the adequate availability of controlled medicines for medical purposes; however, the consumption of morphine is very low, suggesting a high occurrence of unrelieved pain. In Georgia, palliative care development began in the 2000s including the adoption of a policy document in 2005, the creation of the National Palliative Care Coordinator in 2006, and important changes in Georgian legislation in 2007 and 2008, which served to lay a foundation for improving opioid availability. In 2008, a neurologist from the Sarajishvili Institute of Neurology and Neurosurgery in Tbilisi, and member of the Georgia National Association for Palliative Care, was selected to be an International Pain Policy Fellow to focus on improving opioid availability. Working with colleagues, government officials, and international experts, the Fellow contributed to several improvements to opioid availability, such as 1) positive changes to opioid prescribing legislation, 2) clarification of legislative terminology regarding dependence syndrome, 3) initiating the importation of both sustained-release and immediate-release oral morphine, and 4) improvements in the availability of sustained-release morphine. Despite these varied achievements, morphine consumption remains low in Georgia relative to the estimated amounts needed. The Fellow is continuing to study and understand the barriers that are impeding physician's prescription of opioids and patient's acceptance of them.

Evaluations of Antigay Hate Crimes and Hate Crime Legislation: Independent and Differentially Predicted

Minimal studies have investigated individuals' evaluations of antigay hate crimes and hate crime legislation simultaneously, with most research focusing on one or the other. In a sample of 246 heterosexual undergraduates, the present study found that evaluations of antigay hate crimes and hate crime legislation were unrelated. Higher social dominance orientation (SDO) and crime control orientation scores were associated with more positive evaluations of antigay hate crimes. Positive evaluations of hate crime legislation were associated with more positive attitudes toward gay men and lesbians. We also found that the relationship between SDO and evaluations were mediated by crime control beliefs (for hate crimes evaluations) and antigay attitudes (for hate crime legislation evaluations). The present findings have possible implications for the manner in which organizations advocate for the extension of hate crime legislation to include sexual orientation.

Impact of Laws Regulating Pain Clinics on Opioid Prescribing and Opioid-Related Toxicity Among Texas Medicare Part D Beneficiaries

BACKGROUND

Pain management clinics are major sources of prescription opioids. Texas government passed several laws regulating pain clinics between 2009 and 2011 to reduce opioid-related toxicity. Understanding the impact of these laws can inform policy geared toward making the laws more effective in curbing the growing epidemic of opioid overdose, especially among the elderly population.

OBJECTIVES

To examine the longitudinal association of laws regulating pain clinics on opioid-prescribing and opioid-related toxicity among Texas Medicare recipients.

METHODS

The 2007 to 2012 claims data for Texas Medicare Part D recipients were used to assess temporal trends in the percentage of patients filling any schedule II or schedule III opioid prescription, hospitalization for opioid toxicity, and their relationships to the 2009 to 2011 Texas laws regulating pain clinics. We excluded those with a cancer diagnosis. Join-point trend analysis with Bayesian Information Criterion selection methods were used to evaluate the change in monthly percentages of patients filling opioid prescriptions and hospitalization over time.

RESULTS

There was a short-lived decline in the monthly percentages of patients who filled a schedule II or schedule III opioid prescription after the 2009 laws regulating pain clinics. The decline lasted about 3 months. Subsequent new laws had no effect on the percentages of patients who filled any opioid prescription or were hospitalized for potential opioid toxicity. Hospitalizations for opioid toxicity were highest in the winter and lowest in the summer.

CONCLUSIONS

Changes in the percentages of opioid-prescribing or opioid-related hospitalizations over time were not associated with laws regulating pain clinics.

How does state marijuana policy affect US youth? Medical marijuana laws, marijuana use and perceived harmfulness: 1991-2014

AIMS

To test, among US students: (1) whether perceived harmfulness of marijuana has changed over time, (2) whether perceived harmfulness of marijuana changed post-passage of state medical marijuana laws (MML) compared with pre-passage; and (3) whether perceived harmfulness of marijuana statistically mediates and/or modifies the relation between MML and marijuana use as a function of grade level.

DESIGN

Cross-sectional nationally representative surveys of US students, conducted annually, 1991-2014, in the Monitoring the Future study.

SETTING

Surveys conducted in schools in all coterminous states; 21 states passed MML between 1996 and 2014.

PARTICIPANTS

The sample included 1 134 734 adolescents in 8th, 10th and 12th grades.

MEASUREMENTS

State passage of MML; perceived harmfulness of marijuana use (perceiving great or moderate risk to health from smoking marijuana occasionally versus slight or no risk); and marijuana use (prior 30 days). Data were analyzed using time-varying multi-level regression modeling.

FINDINGS

The perceived harmfulness of marijuana has decreased significantly since 1991 (from an estimated 84.0% in 1991 to 53.8% in 2014, P < 0.01) and, across time, perceived harmfulness was lower in states that passed MML [odds ratio (OR) = 0.86, 95% confidence interval (CI) = 0.75-0.97]. In states with MML, perceived harmfulness of marijuana increased among 8th graders after MML passage (OR = 1.21, 95% CI = 1.08-1.36), while marijuana use decreased (OR = 0.81, 95% CI = 0.72-0.92). Results were null for other grades, and for all grades combined. Increases in perceived harmfulness among 8th graders after MML passage was associated with ~33% of the decrease in use. When adolescents were stratified by perceived harmfulness, use in 8th graders decreased to a greater extent among those who perceived marijuana as harmful.

CONCLUSIONS

While perceived harmfulness of marijuana use appears to be decreasing nationally among adolescents in the United States, the passage of medical marijuana laws (MML) is associated with increases in perceived harmfulness among young adolescents and marijuana use has decreased among those who perceive marijuana to be harmful after passage of MML.