Matching Items (4)
Description
Arizona’s struggle with the opioid crisis reflects a failure of drug policy. This failure stems from decades of mimicking federal narcotic criminalization legislation. Arizona’s deference on narcotic policy was driven by a fear of addicts that was intentionally inflated by federal agents. Further, the federal prioritization of state uniformity of narcotic policy spread and entrenched the consequences of creating an illegal narcotics market. Arizona adopted these uniform policies enthusiastically. The state’s continued adoption of federal policy— exemplified by five pieces of legislation spanning between 1931 and 1979— show a continued theme of fear of addicts and prioritization of criminalization for the sake of uniformity. Criminalization and demonization of addicts are the main drivers of the modern opioid crisis. In this way, Arizona is culpable and is thus obligated to adopt an alternate narcotic policy approach that prioritizes evidence, compassion, and individual rights.
ContributorsRamsey, Grace Michele (Author) / Provine, Doris Marie (Thesis director) / Spohn, Cassia (Committee member) / School of Criminology and Criminal Justice (Contributor) / School of Public Affairs (Contributor) / Sanford School of Social and Family Dynamics (Contributor) / Barrett, The Honors College (Contributor)
Created2019-12
Description
Purdue Pharma was started by Arthur, Mortimer, and Raymond Sackler in the 1950s. Its most successful product was OxyContin. Purdue failed to perform the required trials and used misleading marketing practices to promote the drug. The Sackler family encouraged these false advertising campaigns in an attempt to drive up sales. These deceitful tactics caught up with the company and Purdue Pharma’s affiliate pled guilty to deliberately misbranding the drug in 2006. Purdue Pharma currently faces thousands of lawsuits, with Sackler family members personally named, for misleading marketing practices. States uncovering evidence of the Sackers attempting to hide their fortune via wire transfers and offshore accounts and institutions removing the family name from their doors threaten both the Purdue Pharma and the Sackler family’s money and influence.
The opioid crisis was inflamed by multiple sources, from which Purdue Pharma and other pharmaceutical companies benefited. The first is the Revolving Door, where government workers go to work for the companies they were once in charge of regulating. Existing loopholes allow former officials to immediately become lobbyists and perform consulting work. The Food and Drug Administration has close ties with lobbyists and pharmaceutical companies, which casts doubt and suspicion on its policies. Tightening and expanding current Revolving Door regulations would begin to stem this problem. Extending the cooling-off period to a minimum of five years would prevent former government workers from immediately influencing government policies. Furthermore, the laws need to be modified to include more specific language to eliminate loopholes. Banning former government employees from any counseling services or lobbying any government branch, agency, or office will make it much more difficult to circumvent the rules.
The second are “pill mills,” whereby physicians, clinics, or pharmacies prescribe prescription drugs inappropriately. There exists a web of regulation and reporting laws from federal and state governments, but pill mills still established themselves. Florida enacted laws that created stricter requirements for dispensing drugs, medical examinations, and follow-ups before and after prescribing opioids for chronic pain. These laws had positive results in stopping pill mills. Similar laws should be enacted nationally. Existing laws focusing on the pharmaceutical manufacturers, distributors, and pharmacies should be expanded to improve reporting between those agencies and the DEA and the DEA and other government agencies.
The last one is the American drug addiction rehab system. It is fraught with stigma, lax insurance information, inconsistent treatments, and poorly utilized information. The system often fails to provide care for those who need it. Increasing the scope of treatments would boost its effectiveness. States need to require insurance companies to cover mental health treatment to the same extent and degree as physical health issues and use a uniform, standardized tool to decide the necessary level of care addiction patients need. Public report cards for treatment centers would improve their long-term level of care and ease patients in finding a treatment center that fits them.
Addressing these problems has already begun at the both federal and state level. As these causes are identified and attacked, it will become easier to pass the laws needed to repair the system that allowed the opioid crisis to occur.
The opioid crisis was inflamed by multiple sources, from which Purdue Pharma and other pharmaceutical companies benefited. The first is the Revolving Door, where government workers go to work for the companies they were once in charge of regulating. Existing loopholes allow former officials to immediately become lobbyists and perform consulting work. The Food and Drug Administration has close ties with lobbyists and pharmaceutical companies, which casts doubt and suspicion on its policies. Tightening and expanding current Revolving Door regulations would begin to stem this problem. Extending the cooling-off period to a minimum of five years would prevent former government workers from immediately influencing government policies. Furthermore, the laws need to be modified to include more specific language to eliminate loopholes. Banning former government employees from any counseling services or lobbying any government branch, agency, or office will make it much more difficult to circumvent the rules.
The second are “pill mills,” whereby physicians, clinics, or pharmacies prescribe prescription drugs inappropriately. There exists a web of regulation and reporting laws from federal and state governments, but pill mills still established themselves. Florida enacted laws that created stricter requirements for dispensing drugs, medical examinations, and follow-ups before and after prescribing opioids for chronic pain. These laws had positive results in stopping pill mills. Similar laws should be enacted nationally. Existing laws focusing on the pharmaceutical manufacturers, distributors, and pharmacies should be expanded to improve reporting between those agencies and the DEA and the DEA and other government agencies.
The last one is the American drug addiction rehab system. It is fraught with stigma, lax insurance information, inconsistent treatments, and poorly utilized information. The system often fails to provide care for those who need it. Increasing the scope of treatments would boost its effectiveness. States need to require insurance companies to cover mental health treatment to the same extent and degree as physical health issues and use a uniform, standardized tool to decide the necessary level of care addiction patients need. Public report cards for treatment centers would improve their long-term level of care and ease patients in finding a treatment center that fits them.
Addressing these problems has already begun at the both federal and state level. As these causes are identified and attacked, it will become easier to pass the laws needed to repair the system that allowed the opioid crisis to occur.
ContributorsNowicki, Elizabeth Anne (Author) / Koretz, Lora (Thesis director) / Moore, James (Committee member) / Department of Management and Entrepreneurship (Contributor) / School of Politics and Global Studies (Contributor) / Barrett, The Honors College (Contributor)
Created2020-05
Description
Background: Natural Language Processing models have been trained to locate questions and answers in forum settings before but on topics such as cancer and diabetes. Also, studies have used filtering methods to understand themes in forum settings regarding opioid use. However, studies have not been conducted regarding training an NLP model to locate the questions people addicted to opioids are asking their peers and the answers they are receiving in forums. There are a variety of annotation tools available to help aid the data collection to train NLP models. For academic purposes, brat is the best tool for this purpose. This study will inform clinical practice by indicating what the inner thoughts of their patients who are addicted to opioids are so that they will be able to have more meaningful conversations during appointments that the patient may be too afraid to start.
Methods: The standard NLP process was used for this study in which a gold standard was reached through matched paired annotations of the forum text in brat and a neural network was trained on the content. Following the annotation process, adjudication occurred to increase the inter-annotator agreement. Categories were developed by local physicians to describe the questions and three pilots were run to test the best way to categorize the questions.
Results: The inter-annotator agreement, calculated via F-score, before adjudication for a 0.7 threshold was 0.378 for the annotation activity. After adjudication at a threshold of 0.7, the inter-annotator agreement increased to 0.560. Pilots 1, 2, and 3 of the categorization activity had an inter-annotator agreement of 0.375, 0.5, and 0.966 respectively.
Discussion: The inter-annotator agreement of the annotation activity may have been low initially since the annotators were students who may have not been as invested in the project as necessary to accurately annotate the text. Also, as everyone interprets the text slightly differently, it is possible that that contributed to the differences in the matched pairs’ annotations. The F-score variation for the categorization activity partially had to do with different delivery systems of the instructions and partially with the area of study of the participants. The first pilot did not mandate the use of the original context located in brat and the instructions were provided in the form of a downloadable document. The participants were computer science graduate students. The second pilot also had the instructions delivered via a document, but it was strongly suggested that the context be used to gain an understanding of the questions’ meanings. The participants were also computer science graduate students who upon a discussion of their results after the pilot expressed that they did not have a good understanding of the medical jargon in the posts. The final pilot used a combination of students with and without medical background, required to use the context, and included verbal instructions in combination with the written ones. The combination of these factors increased the F-score significantly. For a full-scale experiment, students with a medical background should be used to categorize the questions.
Methods: The standard NLP process was used for this study in which a gold standard was reached through matched paired annotations of the forum text in brat and a neural network was trained on the content. Following the annotation process, adjudication occurred to increase the inter-annotator agreement. Categories were developed by local physicians to describe the questions and three pilots were run to test the best way to categorize the questions.
Results: The inter-annotator agreement, calculated via F-score, before adjudication for a 0.7 threshold was 0.378 for the annotation activity. After adjudication at a threshold of 0.7, the inter-annotator agreement increased to 0.560. Pilots 1, 2, and 3 of the categorization activity had an inter-annotator agreement of 0.375, 0.5, and 0.966 respectively.
Discussion: The inter-annotator agreement of the annotation activity may have been low initially since the annotators were students who may have not been as invested in the project as necessary to accurately annotate the text. Also, as everyone interprets the text slightly differently, it is possible that that contributed to the differences in the matched pairs’ annotations. The F-score variation for the categorization activity partially had to do with different delivery systems of the instructions and partially with the area of study of the participants. The first pilot did not mandate the use of the original context located in brat and the instructions were provided in the form of a downloadable document. The participants were computer science graduate students. The second pilot also had the instructions delivered via a document, but it was strongly suggested that the context be used to gain an understanding of the questions’ meanings. The participants were also computer science graduate students who upon a discussion of their results after the pilot expressed that they did not have a good understanding of the medical jargon in the posts. The final pilot used a combination of students with and without medical background, required to use the context, and included verbal instructions in combination with the written ones. The combination of these factors increased the F-score significantly. For a full-scale experiment, students with a medical background should be used to categorize the questions.
ContributorsPawlik, Katie (Author) / Devarakonda, Murthy (Thesis director) / Murcko, Anita (Committee member) / Green, Ellen (Committee member) / College of Health Solutions (Contributor) / Barrett, The Honors College (Contributor)
Created2019-12
Description
In this paper, I analyze the pharmaceutical supply chain to identify the main causes of drug surplus. The main example I use throughout the paper is the current opioid epidemic, which has resulted in thousands of fatalities, caused by overdoses. After researching the industry players and their relationships in the supply chain, I have identified four main causes of drug surplus: the consolidation of pharmaceutical corporations with third-party manufacturers, along with consolidation within the wholesaler industry; the inappropriate pricing of opioid-based prescriptions negotiated by pharmacy benefit managers (PBMs); the significant influence of pharmaceutical corporations on physicians, leading to potentially unethical practices; and lastly patients openly distributing leftover prescriptions to the market, and looking for prescriptions elsewhere. To alleviate the drug surplus issue, I provide three solutions: implement both blockchain and reverse logistics into the pharmaceutical supply chain, improving transparency, and allowing patients to return incomplete prescriptions; and research the consolidation of PBMs with providers (hospital systems, clinics, etc.) to increase buyer power and appropriately price opioid-based prescriptions.
ContributorsRutkowski, Sarah (Author) / Helm, Jonathan (Thesis director) / Wiedmer, Robert (Committee member) / Department of Information Systems (Contributor) / W.P. Carey School of Business (Contributor) / Department of Supply Chain Management (Contributor) / Barrett, The Honors College (Contributor)
Created2018-05