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- Genre: Doctoral Dissertation
Description
The US is unique in dispensing methadone for opioid dependent people only via opioid treatment programs (OTP), or “methadone clinics”. These OTP are governed by federal regulations which outline rules, such as mandatory counseling. Mandatory counseling in this context is a tool to determine which individuals may gain access to a sanctuary for safer drug use and who may not.This dissertation is an analysis of data previously collected from a larger parent study, but which had remained unexamined until now. Utilizing a qualitative thematic approach to data analysis, this study seeks to answer two central research objectives. Firstly, what does the mandatory counseling consist of and what is the professional background of the counselors. When participant responses were analyzed, it was found that clients at OTP were provided scarce details regarding the professional background of their counselors and which, if any, therapeutic modality is offered. Clients have very little control over their treatment plans or counseling, and the role of the counselor is focused more directly on surveillance than therapeutic goals.
Secondly, this analysis explores client beliefs about mandatory counseling. While most participants generally held positive views about counseling independent of the mandate, responses bifurcated into two distinct groups. Participants were very supportive of the mandatory counseling, or they expressed a desire for more autonomy and freedom of choice regarding counseling. The findings of this dissertation indicate the need for comprehensive reform of methadone dispensation in the United States.
ContributorsRussell, Danielle Marie (Author) / Quan, Helen L (Thesis advisor) / Meyerson, Beth E (Committee member) / Gomez, Alan E (Committee member) / Daniulaityte, Raminta (Committee member) / Arizona State University (Publisher)
Created2023
Description
Hepatitis C is an infectious disease that affects 71 million people worldwide and causes liver failure and death if untreated. In 2013, a direct acting antiviral drug, sofosbuvir, revolutionized treatment of the disease. Sofosbuvir showed immense promise, but the high price point at which it was launched created access barriers that prevented it from reaching its full public health potential. By 2016, fewer than 1% of Hepatitis C patients worldwide had received treatment. In the United States (US), concerns about the cost of the drug led public and private payers to implement rationing and treatment restrictions that prevented some of the most vulnerable populations from accessing Hepatitis C treatment at all. Through interviews with researchers, patients and providers, and a literature review of grants, patents, papers, court documents, and news articles, I examine the history of sofosbuvir with attention to the ways in which federal funding practices and intellectual property law encouraged the high initial pricing of the drug. I then examine the impact of this drug on healthcare systems in the United States and abroad, and discuss how the fragmented nature of the United States healthcare system has exacerbated price-based barriers to access. Finally, I discuss intellectual property laws as potential mechanisms to increase access. My study underscores how the political reluctance to use well-established federal funding and intellectual property laws has resulted in a drug development system that delivers medications that are so highly priced that the fragmented US healthcare system cannot compensate for the expense. This leads to low access and poor public health outcomes, and a continued failure to contain or control diseases for which effective therapies exist.
ContributorsTiffney, Theora (Author) / Cook-Deegan, Robert M. (Thesis advisor) / Collins, James P. (Thesis advisor) / Ross, Heather M (Committee member) / Chew, Matthew K (Committee member) / Arizona State University (Publisher)
Created2020