In this paper, we claim that we can only seek to eradicate the stigma associated with the contemporary opioid overdose epidemic when we understand how opioid stigma and the epidemic have co-evolved. Rather than conceptualizing stigma as a parallel social process alongside the epidemiologically and physiologically defined harms of the epidemic, we argue that the stigmatized history of opioids and their use defines the epidemic. We conclude by offering recommendations for disrupting the burden of opioid stigma.
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References
1.
International Narcotics Control Board, 2016, “Narcotic Drugs Estimated World Requirements for 2016 Statistics for 2014,”United Nations.
2.
R.ARudd, P.Seth, F, David, and L.Scholl, “Increases in Drug and Opioid-Involved Overdose Deaths - United States, 2010-2015,”Morbidity and Mortality Weekly Report65, no. 50-51 (2016): 1445–1452.
T.D.Saha, B.T.Kerridge, R.B.Goldstein, S.P.Chou, H.Zhang, J.Jung, R.P.Pickering, et al., “Nonmedical Prescription Opioid Use and DSM-5 Nonmedical Prescription Opioid Use Disorder in the United States,”Journal of Clinical Psychiatry77 (2016): 772–780.
5.
See Rudd, supra note 2; R.ARudd, N.Aleshire, J.E.Zibbell, and R.M.Gladden, “Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014,”Morbidity and Mortality Weekly Report64, no. 50-51(2016): 1378–1382; CDC, “Provisional Counts of Drug Overdose Deaths, as of 8/6/2017,” Vital Statistics Rapid Release, Surveillance Activites, available at <www.cdc.gov/nchs/health_policy/monthly-drug-overdose-death-estimates.pdf> (last visited December 1, 2017).
6.
A.Kolodny, D.T.Courtwright, C.S.Hwang, P.Kreiner, J.L.Eadie, T.W.Clark, G.C.Alexander, “The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction,”Annual Review of Public Health36 (2016): 559–574.
7.
W.M.Compton, C.M.Jones, and G.T.Baldwin, “Relationship Between Nonmedical Prescription-Opioid Use and Heroin Use,”N. Engl. J Med374, no. 2 (2016): 154–163.
R.Room, J.Rehm, R.T.TrotterII, A.Paglia, and T.B.Üstün, “Cross-Cultural Views on Stigma Valuation Parity and Societal Attitudes towards Disability,” in T.B.Üstün and S.Chatterji, eds., Disability and Culture: Universalism and Diversity (Seattle: Hogrefe & Huber, 2001): 247–291.
10.
D.S.Goldberg, “Pain, Objectivity and History: Understanding Pain Stigma,”Journal of Medical Humanities43, no. 4 (2017): 238-243.
11.
S.Fraser, K.Pienaar, E.Dilkes-Frayne, D.Moore, R.Kokanovic, C.Treloar, and A.Dunlop, “Addiction Stigma and the Biopolitics of Liberal Modernity: A Qualitative Analysis,”The International Journal on Drug Policy, in Press (2017); S.Fraser, D.Moore, and H.Keane, Habits: Remaking Addiction (New York: Palgrave MacMillan, 2014): at 3.
12.
See Fraser supra note 11; P.Bourgois, In Search of Respect: Selling Crack in El Barrio (Cambridge: Cambridge University Press, 2003); L.KRomo, D.R.Dinsmore, and T.C.Watterson. “‘Coming Out’ as an Alcoholic: How Former Problem Drinkers Negotiate Disclosure of Their Nondrinking Identity,”Health Communication31, no. 3 (2015): 336–345; S.Anstice, C.J.Strike, and B.Brands, “Supervised Methadone Consumption: Client Issues and Stigma,”Substance Use & Misuse44, no. 6 (2009): 794–808; D.Z.Buchman, A.Ho, and J.Illes, “You Present Like a Drug Addict: Patient and Clinician Perspectives on Trust and Trustworthiness in Chronic Pain Management,”Pain Medicine17, no. 8 (2016): 1394-1406.
13.
J.F.Kelly, S.E.Wakeman, and R.Saitz, “Stop Talking ‘Dirty’: Clinicians, Language, and Quality of Care for the Leading Cause of Preventable Death in the United States,”The American Journal of Medicine128, no. 1 (2015): 8–9.
14.
Centers for Disease Control, “Lesson 1: Introduction to Epidemiology,”Principles of Epidemiology in Public Health Practice, Third Edition an Introduction to Applied Epidemiology and Biostatistics, May18, 2012, availalbe at <https://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson1/section11.html> (last visited 11/14/17).
15.
R.Room, “The Cultural Framing of Addiction,”Janus Head6, no. 2 (2003): 221–234.
16.
See Fraser, supra note 11, at 26.
17.
C.O’Brien, “Addiction and Dependence in DSM-V,”Addiction106, no. 5 (2010): 866–867.
18.
D.S.Goldberg, “On the Erroneous Conflation of Opiophobia and the Undertreatment of Pain,”The American Journal of Bioethics10, no. 11 (2010): 20–22.
19.
E.Goffman, Stigma; Notes on the Management of Spoiled Identity (New York: Simon & Schuster, 1986); See Kelly supra note 13, at 8.
20.
B.GLink and J.C.Phelan, “Conceptualizing Stigma,”Annual Review of Sociology27 (2001): 363–385, at 367.
21.
B.GLink and J.C.Phelan, “Stigma and its Public Health Implications,”The Lancet367, no. 9509 (2006): 528-529.
22.
See Goffman, supra note 19.
23.
J.FKelly, S.J.Dow, and C.Westerhoff, “Does Our Choice of Substance-Related Terms Influence Perceptions of Treatment Need? An Empirical Investigation with Two Commonly Used Terms,”Journal of Drug Issues40, no. 4 (2010): 805–818.
24.
D.S.Goldberg, “Social Justice, Health Inequalities and Methodological Individualismin US Health Promotion,”Public Health Ethics5, no. 2 (2012): 104–115; M.LHatzenbuehler, J.C.Phelan, and B.G.Link, “Stigma as a Fundamental Cause of Population Health Inequalities,”American Journal of Public Health103, no. 5(2013): 813–821.
25.
See Hatzenbuehler, supra note 24.
26.
M.Powers and R.Faden, Social Justice: The Moral Foundations of Public Health and Health Policy (Oxford: Oxford University Press, 2008): at 72.
27.
V.Berridge, “Opium and the Historical Perspective,”The Lancet310, no. 8028 (1977): 78–80, at 78.
28.
T.De Quincey, Confessions of an English Opium Eater (London: Walter Scott, 1886).
29.
See Berridge, supra note 27, at 79; V.Berridge, Opium and the People: Opiate Use and Drug Control Policy in Nineteenth and Early Twentieth Century England (London: Free Association Books, 1999); G.Harding, Opiate Addiction, Morality and Medicine: From Moral Illness to Pathological Disease (New York: St. Martin’s Press, 1988).
30.
J.Mills, “Morality, Society and the Science of Intoxication: A Response to David Courtwright’s ‘Mr. ATOD’s Wild Ride: What Do Alcohol, Tobacco, and Other Drugs Have in Common?”The Social History of Alcohol and Drugs20, no. 1 (2005): 133–137.
31.
D.TCourtwright, Dark Paradise: A History of Opiate Addiction in America (Cambridge: Harvard University Press, 2009); R.Solomon and M.Green, “The First Century: The History of Nonmedical Opiate Use and Control Policies in Canada, 1870-1970,”University of Western Ontario Law Review20, no. 2 (1982): 307–336.
32.
D.T.Courtwright, “Preventing and Treating Narcotic Addiction – a Century of Federal Drug Control,”N. Engl J Med373, no. 22 (2015): 2093-2095.
33.
See Courtwright, supra note 31; See Solomon supra note 31.
34.
See Courtwright, supra note 31.
35.
See Solomon, supra note 31.
36.
See Berridge, supra note 27, at 79.
37.
See Courtwright, supra note 31; See Solomon supra note 31;
38.
Id. at 308.
39.
Id.
40.
See Courtwright, supra note 31; see Solomon, supra note 31.
41.
J.C.Ballantyne and J.Mao, “Opioid Therapy for Chronic Pain,”N. Engl. J Med349, no. 20 (2003): 1943-1953.
42.
See Courtwright, supra note 31.
43.
Controlled Drugs and Substances Act (1996).
44.
Controlled Substances Act of 1970, 21 U.S.C § 811 (1970).
45.
D.T.Courtwright, “The Controlled Substances Act: How a ‘Big Tent’ Reform Became a Punative Drug Law,”Drug and Alcohol Dependency76, no. 1 (2004): 9–15
46.
D.M.Dumont, S.A.Allen, B.W.Brockmann, N.E.Alexander, and J.D.Rich, “Incarcertation, Community Health, and Racial Disparities,”Journal of Health Care for the Poor and Underserved24, no. 1(2013): 78-88.
47.
R.K.Portenoy, “Opioid Therapy for Chronic Nonmalignant Pain: A Review of the Critical Issues,”Journal of Pain and Symptom Management11, no. 4 (1996): 203–217; R.K.Portenoy, “Opioid Therapy for Chronic Nonmalignant Pain: Clinicians’ Perspective,”The Journal of Law, Medicine & Ethics24, no. 4 (1996): 296–309.
48.
B.A.Rich, “An Ethical Analysis of the Barriers to Effective Pain Management,”Cambridge Quarterly of Healthcare Ethics9, no. 1 (2000): 54–70.
49.
J.P.Morgan, “American Opiophobia: Customary Underutilization of Opioid Analgesics,”Advances in Alcohol & Substance Abuse5, no. 1-2 (1985): 163–173.
50.
See Portenoy, supra note 47; R.K.Portenoy and S.R.Savage, “Clinical Realities and Economic Considerations: Special Therapeutic Issues in Intrathecal Therapy—Tolerance and Addiction,”Journal of Pain and Symptom Management14, no. 3 supp (1997): S27–35.
51.
J.Porter and H.Jick, “Addiction Rare in Patients Treated with Narcotics,”N. Engl. J Med302, no. 2 (1980): 123.
52.
Purdue Pharma L.P, “I Got My Life Back: Pain Patients Tell Their Story,” OxyContin promotional video, from Opiods for Chronic Pain: Addiction is NOT Rare, available at <http://www.youtube.com/watch?v=DgyuBWN9D4w> (last visited 11/17/17).
53.
P.T.M.Leung, E.M.Macdonald, M.B.Stanbrook, I.A.Dhalla, and D.N.Juurlink, “A 1980 Letter on the Risk of Opioid Addiction,”N. Engl. J Med376, no. 22 (2017): 2194-2195.
54.
R.K.Portenoy and K.M.Foley, “Chronic use of Opioid Anal-gesics in Non-Malignant Pain: Report of 38 Cases,”Pain25, no. 2 (1986): 171-186.
55.
H.AHeit, “The Truth About Pain Management: The Difference Between a Pain Patient and an Addicted Patient,”European Journal of Pain5, Supp A (2001): 27–29, at 27.
56.
R.D.Jovey, J.Ennis, J.Gardner-Nix, B.Goldman, H.Hays, M.Lynch, and D.Moulin, “Use of Opioid Analgesics for the Treatment of Chronic Noncancer Pain — A Consensus Statement and Guidelines from the Canadian Pain Society, 2002,”Pain Research & Management8, Supp A (2003): 3A–14A; American Academy of Pain Medicine and the American Pain Society, “The Use of Opioids for the Treatment of Chronic Pain. A Consensus Statement from the American Academy of Pain Medicine and the American Pain Society,”The Clinical Journal of Pain13, no. 1 (1997): 6–8.
57.
National Advisory Committee on Prescription Drug Misuse, “First Do No Harm: Responding to Canada’s Prescription Drug Crisis,”Canadian Centre on Substance Abuse (2013).
58.
D.Dowell, T.M.Haegerich, and R.Chou, “CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016,”MMWR Recomm Reports65, no. 1 (2016):1–49.
59.
J.Derrida, “The Rhetoric of Drugs: An Interview,”Differences: A Journal of Feminist Cultural Studies5, no.1 (1993): 1-25.
60.
M.L.Meldrum, “The Prescription as Stigma: Opioid Pain Relievers and the Long Walk to the Pharmacy Counter,” in J.Greene and E.S.Watkins, eds. Prescribed: Writing, Filling, Using, and Abusing the Prescription in Modern America (Baltimore: Johns Hopkins University Press, 2011): 184-206.
61.
H.Keane, What’s Wrong with Addiction? (Melbourne: Melbourne University Press, 2002); H.Keane, “Pleasure and Discipline in the Uses of Ritalin,”The International Journal of Drug Policy19, no. 5 (2008): 401–409.
62.
K.W.Tupper, “Psychoactive Substances and the English Language: ‘Drugs,’ Discourses, and Public Policy,”Contemporary Drug Problems39, no. 3 (2012): 461–492, at 475.
63.
Id. at 476.
64.
Id. at 477.
65.
H.Hansen and J.Netherland, “Is the Prescription Opioid Epidemic a White Problem?”American Journal of Public Health106, no. 12 (2016): 2127–2129.
66.
C.Treloar, J.Rance, K.Yates, and L.Mao, “Trust and People Who Inject Drugs: The Perspectives of Clients and Staff of Needle Syringe Programs,”The International Journal on Drug Policy27 (2016): 138–145; J.Harris and K.McElrath, “Methadone as Social Control: Institutionalized Stigma and the Prospect of Recovery,”Qualitative Health Research22, no. 6 (2012): 810–824; see Kelly supra note 13.
67.
B.Foddy and J.Savulescu, “A Liberal Account of Addiction,”Philosophy, Psychiatry, and Psychology17, no. 1(2010): 1-22.
68.
E.K.Sedgwick, “Epidemics of the Will,” in Tendencies (Durham, Duke University Press, 1993): at 130.
69.
C.Dackis and C.O’Brien, “Neurobiology of Addiction: Treatment and Public Policy Ramifications,”Nature Neuroscience8, no. 11 (2005): 1431–1436.
70.
N.D.Volkow, R.D.Baler, and R.Z.Goldstein, “Addiction: Pulling at the Neural Threads of Social Behaviors,”Neuron69, no. 4 (2011): 599–602, at 600.
71.
A.I.Leshner, “Addiction Is a Brain Disease, and It Matters,”Science278, no. 5335 (1997): 45–47.
72.
B.Rush, An Inquiry into the Effects of Ardent Spirits Upon the Human Body and Mind: With an Account of the Means of Preventing, and of the Remedies for Curing Them (Boston: James Loring, 1823).
73.
E.M.Jellinek, The Disease Concept of Alcoholism (New Haven: Hillhouse Press, 1960); H.G.Levine, “The Discovery of Addiction: Changing Conceptions of Habitual Drunkenness in America,”Journal of Studies on Alcohol39, no. 1 (1978): 143-174.
74.
N.D.Volkow and T-KLi, “Drug Addiction: The Neurobiology of Behaviour Gone Awry,”Nature Reviews Neuroscience5, no. 12 (2004): 963–970.
75.
W.Hall, A. Carter, and C.Forlini, “The Brain Disease Model of Addiction: Is It Supported by the Evidence and Has It Delivered on Its Promises?”The Lancet Psychiatry2, no. 1 (2015): 105–110.
76.
D.Z.Buchman, J.Illes, and P.B.Reiner, “The Paradox of Addiction Neuroscience,”Neuroethics4, no. 2 (2011): 65–77.
77.
B.A.Pescosolido, J.K.Martin, J.SLong, T.R.Medina, J.C.Phelan, and B.G.Link, “‘A Disease Like Any Other’? A Decade of Change in Public Reactions to Schizophrenia, Depression, and Alcohol Dependence,”The American Journal of Psychiatry167, no. 11 (2010): 1321–1330.
78.
E.PKvaale, W.H.Gottdiener, and N.Haslam, “Biogenetic Explanations and Stigma: A Meta-Analytic Review of Associations among Laypeople,”Social Science & Medicine96 (2013): 95–103.
79.
H.Keane and K.Hamill, “Variations in Addiction: The Molecular and the Molar in Neuroscience and Pain Medicine,”BioSocieties5, no. 1 (2010): 52–69, at 54.
80.
Id.
81.
S.V.Katikireddi and S.A.Valles, “Coupled Ethical-Epistemic Analysis of Public Health Research and Practice: Categorizing Variables to Improve Population Health and Equity,”American Journal of Public Health105, no. 1 (2015): e36–42.
82.
I.Hacking, “Kinds of People: Moving Targets,” in Proceedings of the British Academy, Volume 151, 2006 Lectures, 285–317, at 285.
83.
H.Keane, D.Moore, and S.Fraser, “Addiction and Dependence: Making Realities in the DSM,”Addiction106, no. 5 (2011): 875-877.
84.
R.Dwyer and S.Fraser, “Making Addictions in Standardised Screening and Diagnostic Tools,”Health Sociology Review25 no. 3 (2016): 223–239.
85.
R.Dwyer and S.Fraser, “Addiction Screening and Diagnostic Tools: ‘Refuting’ and ‘Unmasking’ Claims to Legitimacy,”The International Journal of Drug Policy26, no. 12 (2015): 1189–1197; L.T.Midanik, T.K.Greenfield, and J.Bond, “Addiction Sciences and Its Psychometrics: The Measurement of Alcohol-Related Problems,”Addiction102, no. 11 (2007): 1701–1710; see Dwyer supra note 84.
86.
American Psychiatric Association, “Section 3,” in Diagnostic and Statistical Manual of Mental Disorders: DSM-5, 5th ed. (Arlington, VA: American Psychiatric Association, 2013).
87.
J.Katz, B.N.Rosenbloom, and S.Fashler, “Chronic Pain, Psychopathology, and DSM-5 Somatic Symptom Disorder,”Canadian Journal of Psychiatry60, no. 4 (2015): 160–167.
88.
See American Psychiatric Association, supra note 86.
89.
See Katz, supra note 87; J.F.Kelly, R.Saitz, and S.Wakeman, ”Language, Substance Use Disorders, and Policy: The Need to Reach Consensus on an ‘Addiction-Ary,’”Alcoholism Treatment Quarterly34, no. 1 (2016): 116–123.
90.
L.R.Webster and R.M.Webster, “Predicting Aberrant Behaviors in Opioid-Treated Patients: Preliminary Validation of the Opioid Risk Tool,”Pain Medicine6, no. 86 (2005): 432–442.
91.
See Dwyer, supra note 84, at 13.
92.
D.N.Juurlink and I.A.Dhalla, “Dependence and Addiction During Chronic Opioid Therapy,”Journal of Medical Toxicology8, no. 4 (2012): 393–399.
93.
See Dwyer supra note 84, at 2.
94.
M.Von Korff, A, Kolodny, R.A.Deyo, and R.Chou, “Long-Term Opioid Therapy Reconsidered,”Annals of Internal Medicine155, no. 5 (2011): 325–328.
95.
L.R.Witkin, D.Diskina, S.Fernandes, J.T.Farrar, and M.A.Ashburn, “Usefulness of the Opioid Risk Tool to Predict Aberrant Drug-Related Behavior in Patients Receiving Opioids for the Treatment of Chronic Pain,”Journal of Opioid Management9, no. 3 (2013): 177–187.
96.
E.C.Meltzer, W.D.Hall, and J.J.Fins, “Error and Bias in the Evaluation of Prescription Opioid Misuse: Should the FDA Regulate Clinical Assessment Tools?”Pain Medicine14, no. 7 (2013): 982–987.
97.
See Tupper, supra note 62.
98.
K.Bell and A.Salmon, “Pain, Physical Dependence and Pseudoaddiction: Redefining Addiction for ‘Nice’ People?”The International Journal on Drug Policy20, no. 2 (2009): 170–178.
99.
A.Rosenfeld, The Truth about Chronic Pain: Patients and Professionals on How to Face it, Understand it, Overcome it (New York: Basic Books, 2003): at 100.
100.
A.DWasan, J.Wootton, and R.N.Jamison, “Dealing with Difficult Patients in Your Pain Practice,”Regional Anesthesia and Pain Medicine30, no. 2 (2005): 184–192.
101.
See Fraser, supra note 11 at 6.
102.
DEA Museum and Visitors Center, “Good Medicine, Bad Behavior: Drug Diversion in America,” (2012) available at <http://www.goodmedicinebadbehavior.org/> (last visited 11/21/17).
103.
H.Adriaensen, K.Vissers, H.Noorduin, and T.Meert, “Opioid Tolerance and Dependence: An Inevitable Consequence of Chronic Treatment?”Acta Anaesthesia Belgium54, no. 1 (2003): 37-47, at 44. Emphasis added.
104.
S.Fraser and K.Valentine, Substance and Substitution: Methadone Subjects in Liberal Societies (New York: Palgrave Mac-Millan, 2008).
105.
M.Fricker, Epistemic Injustice: Power and the Ethics of Knowing (Oxford: Oxford University Press, 2007).
106.
B.Larance, L.Degenhardt, N.Lintzeris, A.Winstock, and R.Mattick, “Definitions Related to the Use of Pharmaceutical Opioids: Extramedical Use, Diversion, Non-Adherence and Aberrant Medication-Related Behaviours,”Drug and Alcohol Review30, no. 3 (2011): 236–245, at 240.
107.
Id.
108.
J.D.Livingston, T.Milne, M.L.Fang, and E.Amari, “The Effectiveness of Interventions for Reducing Stigma Related to Substance Use Disorders: A Systematic Review,”Addiction107, no. 1 (2012): 39–50.
109.
J.Csete, A.Kamarulzaman, M.Kazatchkine, F.Altice, M.Balicki, J.Buxton, J.Cepeda, et al., “Public Health and International Drug Policy,”The Lancet387, no. 10026 (2016): 1427–1480.
110.
A.S.Bennett, A.Bell, L.Tomedi, E.G.Hulsey, and A.H.Kral, “Characteristics of an Overdose Prevention, Response, and Naloxone Distribution Program in Pittsburgh and Allegheny County, Pennsylvania,”Journal of Urban Health88, no. 6 (2011): 1020–1030.
111.
European Monitoring Centre for Drugs and Drug Addiction, “European Drug Report: Trends and Development” (Luxembourg, 2015).
112.
N.Hawkes, “Highs and Lows of Drug Decriminalisation,”British Medical Journal343 (2011): d6881-d6882, at d6881.
113.
T.IEvans, S.E.Hadland, M.A.Clark, T.C.Green, and B.D.L.Marshall, “Factors Associated with Knowledge of a Good Samaritan Law among Young Adults Who Use Prescription Opioids Non-Medically,”Harm Reduction Journal13, no. 24 (2016): 1-6.
114.
See Kelly, supra note 13.
115.
See Fraser, supra note 11.
116.
J.F.Kelly and C.M.Westerhoff, “Does It Matter How We Refer to Individuals with Substance-Related Conditions? A Randomized Study of Two Commonly Used Terms,”The International Journal of Drug Policy21, no. 3 (2010): 202–207.
117.
L.M.Broyles, I.A.Binswanger, J.A.Jenkins, D.S.Finnell, B.Faseru, A.Cavaiola, M.Pugatch, and A.J.Gordon, “Confronting Inadvertent Stigma and Pejorative Language in Addiction Scholarship: A Recognition and Response,”Substance Abuse35, no. 3 (2014): 217–221.
118.
S.Baron-Cohen, “Neuroethics of Neurodiversity” in J.Clausen and N.Levy, eds., Handbook of Neuroethics (Dordrecht: Springer, 2015): 1757–1763.
119.
L.Wittgenstein, Philosophical Investigations (London: Blackwell, 1953), at §43.
120.
O.Banjo, D.Tzemis, D.Al-Qutub, A.Amlani, S.Kesselring, and J.A.Buxton, “A Quantitative and Qualitative Evaluation of the British Columbia Take Home Naloxone Program,”Canadian Medical Association Journal Open2, no. 3 (2014): E153–E161;S.Maxwell, D.Bigg, K, Stanczykiewicz, and S.Carlberg-Racich, “Prescribing Naloxone to Actively Injecting Heroin Users: A Program to Reduce Heroin Overdose Deaths,”Journal of Addictive Diseases25, no. 3(2006): 89–96.
121.
World Health Organization, “Task Shifting: Rational Redistribution of Tasks among Health Workforce Teams: Global Recommendations and Guidelines,” (Geneva: World Health Organization, 2007).
122.
L.Chen, T.Evans, S.Anand, J.I.Boufford, H.Brown, M.Chowdhury, M.Cueto, et al., “Human Resources for Health: Overcoming the Crisis,”The Lancet364, no. 9449 (2004): 1984–1990; R.Heller, “Officiers de Santé: The Second-Class Doctors of Nineteenth-Century France,”Medical History22, no. 1 (1978): 25–43.
G.Roe, “Harm Reduction as Paradigm: Is Better than Bad Good Enough? The Origins of Harm Reduction,”Critical Public Health15, no. 3 (2005): 243–250.
125.
A.Y.Walley, Z.Xuan, H.H.Hackman, E.Quinn, M.Doe-Simkins, A.Sorensen-Alawad, et al., “Opioid Overdose Rates and Implementation of Overdose Education and Nasal Naloxone Distribution in Massachusetts: Interrupted Time Series Analysis,”British Medical Journal346 (2013): f174.
