Using Medical Cannabis for Chronic Pain: A Social-Ecological Framework.

Early studies suggest medical cannabis (MC) has the potential to benefit people who suffer from chronic pain by offering a less addictive alternative to opioids; however, most investigators agree more research is indicated. Today, in 2023, cannabis remains a Schedule I drug and is an illegal substance in the United States under the Controlled Substances Act of 1970. Despite this designation, as of February 2022, 37 states, three territories, and the District of Columbia allowed using cannabis products to treat certain painful medical conditions. The contradictory status of federal and state legislation regarding cannabis use has resulted in delays and restrictions on relevant research. As a result, an inadequate foundation of knowledge exists needed to inform policy, program, and practice decisions concerning MC to treat pain. Implementing and controlling access to MC is influenced by overlapping individual, interpersonal, community, and organizational influences that all fall under the umbrella of federal and state policies. Increasingly, the legalization and expanded access to MC necessitates the integration of evidence, policy, and social-ecological reality. To adequately delineate these complex factors to anticipate and plan future interventions at multiple levels, we propose a social-ecological framework (SEF) for using MC to treat pain. This SEF assumes the transactional relationship between the individual and the environment and that no single factor can predict behavior or health outcomes. Our framework illustrates five dynamic levels of analysis that interact between dimensions. Key elements and intersections are discussed at the intrapersonal, interpersonal, institutional, community, and policy levels.

Pain Management During West Virginia's Opioid Crisis.

PURPOSE: Opioid use disorder has caused significant morbidity and mortality resulting in opioid prescribing limiting laws, such as State Bill 273 in West Virginia. The purpose of this study is to explore the impacts of a restrictive opioid prescription law on physicians in medical practice in West Virginia. METHODS: A qualitative study with open-ended semistructured interviews with a purposive sample of physicians in West Virginia. Interviews were recorded and transcribed verbatim. A preliminary code book was developed by 3 coinvestigators. Interview transcriptions were analyzed with a code-based text search query. Content analysis was utilized as the methodological orientation underpinning for the current work. RESULTS: Interviews were conducted with 20 physicians (10 primary care physicians and 10 specialty physicians) in practice in West Virginia. Physicians identified 5 theoretical domains related to SB273: changing opioid prescribing and documentation requirements; rural socioeconomic disparities; a continuum between chronic pain and substance use disorder; difficulty in balancing patient needs and the concern for diversion; lack of available alternatives to opioids for chronic. CONCLUSION: Prescribing opioids in rural West Virginia is complex due to identified challenges. Recommendations for opioids prescribing legislation include clear messaging of guidelines and recommendations, efforts to address socioeconomic disparities of health and pain, and improved accessibility for treatment of both pain and dependence in rural communities are important areas of growth in the rural health care environment.

"The DEA would come in and destroy you": a qualitative study of fear and unintended consequences among opioid prescribers in WV.

BACKGROUND: West Virginia has one of the highest rates of opioid overdose related deaths and is known as the epicenter of the opioid crisis in the United States. In an effort to reduce opioid-related harms, SB 273 was signed in 2018, and aimed to restrict opioid prescribing in West Virginia. SB 273 was enacted during a time when physician arrests and convictions had been increasing for years and were becoming more prevalent and more publicized. This study aims to better understand the impact of the legislation on patients and providers. METHODS: Twenty semi-structured interviews were conducted with opioid-prescribing primary care physicians and specialists practicing throughout West Virginia. RESULTS: Four themes emerged, 1. Fear of disciplinary action, 2. Exacerbation of opioid prescribing fear due to restrictive legislation, 3. Care shifts and treatment gaps, and 4. Conversion to illicit substances. The clinicians recognized the harms of inappropriate prescribing and how this could affect their patients. Decreases in opioid prescribing were already occurring prior to the law implementation. Disciplinary actions against opioid prescribers resulted in prescriber fear, which was then exacerbated by SB 273 and contributed to shifts in care that led to forced tapering and opioid under-prescribing. Providers felt that taking on patients who legitimately required opioids could jeopardize their career. CONCLUSION: A holistic and patient-centered approach should be taken by legislative and disciplinary bodies to ensure patients are not abandoned when disciplinary actions are taken against prescribers or new legislation is passed.

Sexual Assault in the Ivory Tower: Public Opinion on University Accountability and Mandatory Reporting.

Highly publicized college sex crimes have recently captured public and policy attention. In response, greater discussion has turned to institutional accountability and controversial reforms such as mandatory reporting (MR). No study to date has measured public perceptions of campus sex assault procedures, however. This omission is notable because public opinion can directly and indirectly shape crime policy and because the topic has become increasingly politicized. Drawing on a 2015 poll of Virginia residents, this study evaluates views about campus sexual assault policy. Results indicate that two thirds of the public feel universities can effectively respond to sex crime and a large majority favors MR. Some differences in public opinion are evident. Research and policy implications are discussed.

Drug Generations in the 2000s: An Analysis of Arrestee Data.

Much empirical evidence indicates that the popularity of various drugs tends to increase and wane over time producing episodic epidemics of particular drugs. These epidemics mostly affect persons reaching their late teens at the time of the epidemic resulting in distinct drug generations. This article examines the drug generations present in the 2000s among arrestees in the 10 locations served by the Arrestee Drug Abuse Monitoring-II program. At all 10 locations, our findings show that crack use is still common among older arrestees but not among arrestees born more recently. Marijuana is the drug most common among younger arrestees. The article also examines trends in heroin, methamphetamine, and powder cocaine use among arrestees at the few locations where their use was substantial.

The opiate pain reliever epidemic among U.S. arrestees 2000-2010: regional and demographic variations.

The increasing rate of opiate pain reliever (OPR) use is a pressing concern in the United States. This article uses a drug epidemics framework to examine OPR use among arrestees surveyed by the Arrestee Drug Abuse Monitoring program. Results demonstrate regional and demographic variation in use across nine focal cities. High rates of OPR use on the West Coast illustrate the expansion of use from its initial epicenter. By 2010, OPR use had plateaued in all focal cities. Findings suggest directions for ongoing research into pathways to use and vectors of diffusion and for regionally specific interventions sensitive to age and ethnic diversity.

Measuring the stability of illicit drug markets: why does it matter?

Contemporary drug policy in the United States favors a balanced approach including a supply side dimension. The supply side dimension is grounded in the assumption that the disruption of illicit drug markets will result in diminished capacity of the markets to provide for consumer demand and thereby a reduction in the use of illicit drugs and a related increase in demand for treatment. In this paper we consider the disruption of methamphetamine markets in 10 cities in terms of the relative stability of those markets. We use data from the Arrestee Drug Abuse Monitoring (ADAM) program for the years 2000-2003. We conduct a comparative analysis of those markets and look at patterns of methamphetamine use and participation in treatment in those cities. Our findings demonstrate how it is possible to construct measures of market stability, and how to use those measures to assess the stability of illicit drug markets in terms of both relative value and in fluctuation over time. We also demonstrate that markets with different patterns of stability will exhibit different patterns of drug using and treatment participation. We conclude that understanding patterns of market stability will help us to understand and respond to patterns of drug using and treatment participation.