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Face-saving strategies and the burden of opioid policy enactments: When physicians' compliance makes patients non-compliant

Description

The escalation of the opioid epidemic in the United States has sparked sweeping legislation meant to regulate physicians' opioid prescribing practices. The demands of such policies force physicians to initiate discussions that could jeopardize the collaborative doctor- patient relationships necessary for curbing inappropriate opioid prescriptions. Drawing on sociopragmatics, this discourse analysis study of primary care interactions examines the face- saving linguistic features employed by physicians in negotiating the line between policy demands and maintaining collaborative relationships. The findings reveal several face-saving acts‚"pseudo requests, downtowners, broadening, redirection, tag questions, impersonalization, listing, and (negative) imagery‚"used by physicians when enacting the three most prominent policies: (1) monitoring opioid use, (2) prescribing anti-overdose medication, and (3) transitioning patients from opioids to alternative treatment. Informed by Goffman's concept of "face-work," this study provides evidence of the communicative burden placed on physicians implementing disagreeable opioid policies, as well as opening up discussions on how policymakers and medical institutions can support physicians in implementing opioid policies. Keywords: opioids, face-work, face threats, medical discourse, doctor-patient interaction, discourse analysis, sociopragmatics

ContributorsTorres, Peter Joseph (Author)

Created2023-01-18

Coordinated like the criminals [electronic resource]: a policy analysis of the current and future U.S. responses to drug cartels

Description

The presence of drug cartels within Mexico impacts U.S. national security, foreign policy, U.S. crime rates, and public health policy. Due to the direct and indirect effects that the cartels have on the United States, this paper examines the Mérida Initiative, the current U.S. anti-cartel policy, and makes several recommendations for future policy directions. Using official documents as well as current academic research, this paper examines the outcomes of past comparable policies that the United States has implemented in Colombia and Afghanistan to address the issue of drug trafficking. The paper then builds on the present successes of the Mérida Initiative by recommending several policies in the areas of international cooperation, agricultural development, Mexican targeting and enforcement, and U.S. law enforcement. This paper recommends that information sharing between countries should be increased to reduce the likelihood that pressure place on cartels will cause displacement; crop eradication cease and alternative crop development be implemented to reduce illicit crop growth; the joint Mexican-U.S. enforcement focus should move from high-value targets to more highly connected members; the United States should increase vetting for gun purchases to help keep guns out of the hands of cartel members; and domestic drug policies should shift toward treatment and demand-focused policies. By implementing the recommended policies, this paper suggests that the influence of cartels within Mexico as well as the United States may be reduced.

ContributorsMulrooney, Megan (Author) / Rodriguez, Nancy (Thesis advisor) / Wang, Xia (Committee member) / Becerra, David (Committee member) / Arizona State University (Publisher)

Created2014