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.

Natural Gas Gathering and Transmission Pipelines and Social Vulnerability in the United States.

Midstream oil and gas infrastructure comprises vast networks of gathering and transmission pipelines that connect upstream extraction to downstream consumption. In the United States (US), public policies and corporate decisions have prompted a wave of proposals for new gathering and transmission pipelines in recent years, raising the question: Who bears the burdens associated with the existing pipeline infrastructure in the US? With this in mind, we examined the density of natural gas gathering and transmission pipelines in the US, together with county-level data on social vulnerability. For the 2,261 US counties containing natural gas pipelines, we found a positive correlation between county-level pipeline density and an index of social vulnerability. In general, counties with more socially vulnerable populations have significantly higher pipeline densities than counties with less socially vulnerable populations. In particular, counties in the top quartile of social vulnerability tend to have pipeline densities that are much higher than pipeline densities for counties in the bottom quartile of social vulnerability. The difference grows larger for counties at the upper extremes of pipeline density within each group. We discuss some of the implications for the indigenous communities and others affected by recent expansions of oil and gas infrastructure. We offer recommendations aimed at improving ways in which decision-makers identify and address the societal impacts and environmental justice implications of midstream pipeline infrastructure.