Ready for Retirement: The Gateway Drug Hypothesis.

The psycho-social observation that the use of some psychoactive substances ("drugs") is often followed by the use of other and more problematic drugs has given rise to a cluster of so-called "gateway drug hypotheses," and such hypotheses have often played an important role in developing drug use policy. The current essay suggests that drug use policies that have drawn on versions of the hypothesis have involved an unjustified oversimplification of the dynamics of drug use, reflecting the interests of certain stakeholders rather than wise social policy. The hypothesis should be retired.

Confronting death from drug self-intoxication (DDSI): prevention through a better definition.

Suicide and other self-directed violence deaths are likely grossly underestimated, reflecting inappropriate classification of many drug intoxication deaths as accidents or unintentional and heterogeneous ascertainment and coding practices across states. As the tide of prescription and illicit drug-poisoning deaths is rising, public health and research needs would be better satisfied by considering most of these deaths a result of self-intoxication. Epidemiologists and prevention scientists could design better intervention strategies by focusing on premorbid behavior. We propose incorporating deaths from drug self-intoxication and investigations of all poisoning deaths into the National Violent Death Reporting System, which contains misclassified homicides and undetermined intent deaths, to facilitate efforts to comprehend and reverse the surging rate of drug intoxication fatalities.

Framing failure.

This essay offers a conceptual framework for thinking about failure--a type of falling short with respect to some normatively characterized activity, task or expectation. It brings this discussion to bear on the complexities of therapeutic failure, noting how attributions of such failure may make controversial assumptions about the normative status of ends and the match between means and ends, as well as the more common location of responsibility in the therapeutic subject. In many cases, failure should be seen as a learning prelude to success, rather than as its exclusion.

Leading causes of unintentional and intentional injury mortality: United States, 2000-2009.

OBJECTIVES: We have described national trends for the 5 leading external causes of injury mortality. METHODS: We used negative binomial regression and annual underlying cause-of-death data for US residents for 2000 through 2009. RESULTS: Mortality rates for unintentional poisoning, unintentional falls, and suicide increased by 128%, 71%, and 15%, respectively. The unintentional motor vehicle traffic crash mortality rate declined 25%. Suicide ranked first as a cause of injury mortality, followed by motor vehicle traffic crashes, poisoning, falls, and homicide. Females had a lower injury mortality rate than did males. The adjusted fall mortality rate displayed a positive age gradient. Blacks and Hispanics had lower adjusted motor vehicle traffic crash and suicide mortality rates and higher adjusted homicide rates than did Whites, and a lower unadjusted total injury mortality rate. CONCLUSIONS: Mortality rates for suicide, poisoning, and falls rose substantially over the past decade. Suicide has surpassed motor vehicle traffic crashes as the leading cause of injury mortality. Comprehensive traffic safety measures have successfully reduced the national motor vehicle traffic crash mortality rate. Similar efforts will be required to diminish the burden of other injury.

Recovery as an ethical ideal.

The paper explores the varied implications of cure, healing, and recovery and considers why recovery is often the preferred characterization in relation to a medicalized drug dependency. The positive as well as the negative dimensions of recovery are noted; the ethical challenges of the primarily processual associations of recovery are investigated; and some policy implications are indicated.

The ethics of harm reduction.

The article attempts to set harm minimization within drug settings into a larger framework of harm minimization practices. It seeks to provide a plausible account of harm reduction and then explores four ethical challenges for harm reduction strategies.

Thinking ethically about needle and syringe programs.

Accepting-for the sake of argument-our current legal policies concerning heroin use and its users, what ethical questions are raised for needle and syringe program (NSPs)? Do they weaken drug laws, send the wrong message or obscure the right message, do little to eliminate the harm of drugs, detract from alternatives, and/or constitute a counsel of despair? I suggest that in the absence of established better alternatives, NSPs constitute a morally acceptable and in some cases even desirable option despite the continued criminalization of injecting drug use. Yet they must be conceived and administered in ways that do not reinforce prevailing social prejudices.

Ethical issues in substance use intervention.

This essay offers an overview of some of the ethical questions raised by governmental and medical interventions into drug use. With respect to the former, it begins with the liberal assumption that constraints on free action are to be justified by reference to its deleterious impact on others, but then qualifies that assumption by noting the social requisites of free action. With respect to medical interventions, it focuses on the codes that have been developed for treatment providers and their clients, and explores the ethical underpinnings of several of their central provisions--informed consent, privacy, confidentiality, nondiscrimination, professionalism, and accountability.