New Treatments for Addiction Behavioral, Ethical, Legal, and Social Questions (2004) / Chapter Skim
Currently Skimming:
4 Behavioral Responses and Consent
4 Behavioral Responses and Consent
Pages 37-53
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 37... ...
This section reviews some of the considerations associated with each of these scenarios. Users' Trying to Swamp or Override Treatment It would be a major boon to treatment if an intervention such as immunotherapy or depot medication made a user completely uninterested in using a drug.
|
From page 38... ...
Individuals might continue to ingest some of the drug, but less than they otherwise would have and, hence, they and society generally would benefit. Another possibility, however, is that these individuals will try to swamp or override the partial blockade of the drug by ingesting larger doses than they would have in the absence of the immunotherapy or depot medication, resulting in greater total use than before treatment.
|
From page 39... ...
(In contrast, commodities that are price elastic show proportionally equal or larger reductions in consumption as prices rise.) In the context of immunotherapies, although there is little reason to think that attempts to swamp or override treatment will lead to increases in the amount of the drug reaching the brain -- since it is only the effective price of getting drugs into the brain not the actual price paid by a user to the drug seller that increases -- increased spending implies increased purchasing from the seller.
|
From page 40... ...
For illicit drugs, adverse consequences of swamping could extend beyond the drug user to other people. If immunotherapies reduced the amount of an illicit drug reaching users' brains but increased demand from drug dealers, it could affect the black markets for those drugs (MacCoun and Reuter, 2001)
|
From page 41... ...
. The question arises as to whether the availability of efficacious immunotherapies and depot medications might make the risk of addiction seem to be less dangerous and possibly invite increased use of drugs (and tobacco products)
|
From page 42... ...
Thus, to the extent that individual patients on these medications increase their total drug purchases and use in order to override the medication, there is likely to be a net negative benefit to society from that individual's taking the medication. Sellers Illicit drug markets are not well understood, so it is difficult to predict how drug dealers would respond to demand changes induced by immunotherapies or sustained-release formulations.
|
From page 43... ...
The potential market for use of immunotherapies to treat overdoses can be crudely gauged from data on emergency room visits involving various illicit drugs (Substance Abuse and Mental Health Services Administration, 2003)
|
From page 44... ...
Recommendation 8 The National Institute on Drug Abuse should support studies of the potential effect of immunotherapy medica tions on illicit drug markets and market-related behaviors. CONSENT AND VULNERABLE POPULATIONS As noted early in this report, the committee has particular concerns around behavioral, ethical, legal and social issues for vulnerable populations.
|
From page 45... ...
The right to make medical decisions is maintained through the doctrine of informed consent, which prohibits a physician from performing any medical procedure without first explaining all relevant information and obtaining the individual's knowing and voluntary agreement (see Kaimowitz v. Department of Mental Health for the State of Michigan, 1973)
|
From page 46... ...
does not affect his or her right to consent, unless an independent determination of incompetence has been made. The voluntariness of the consent must be evaluated in the particular context in which it is rendered and the establishment of due process protections tailored to the particular context.
|
From page 47... ...
Justice requires a fair and equal distribution of benefits and burdens of research involving human subjects. In terms of consent issues, the NACDA guidelines require that researchers: assure that an informed consent process is in place that gives individuals all the information needed to make decisions; give adequate consideration to the mental and physical condition of participants to ensure that they fully understand the "context of consent;" conduct an independent evaluation if there is a question about a person's ability to comprehend the consent process; and update the informed consent process when new data about safety and efficacy are available.
|
From page 48... ...
Adherence to the ethical principles discussed above and use of guidelines has served to help researchers and clinicians appropriately include individuals with substance use diagnoses in their research, woth their giving consent to treatment, barring any indication of diminished autonomy or capacity. The Belmont principles and NACDA guidelines support the considerations noted above, in terms of the ability of drug-dependent individuals to make their own decisions about receiving immunotherapies or depot medications, with the full knowledge of the expected risks and benefits of treatment, as well as an understanding of alternative treatments that may be available.
|
From page 49... ...
158, 1944) , "It is cardinal with us that the custody, care and nurture of the child reside first in the parents, whose primary function and freedom include preparations for obligations the state can neither supply nor hinder." The law recognizes, however, that there are situations in which legal intervention may take place to overturn parental decisions; ".
|
From page 50... ...
Coerced Treatment for Adults The human and societal costs of drug dependence have compelled virtually all sectors -- medical, criminal justice, education, child welfare, social services, and religious -- to search for effective solutions to prevent and treat drug dependence. If, and when, the safety and efficacy of immunotherapies or sustained-release formulations is demonstrated, the severity of the drug problem together with the promise of these therapies may result in a push in some state agencies to mandate the use of these therapies for drug-dependent individuals in the civil or criminal systems.
|
From page 51... ...
. Looking again to the mental illness context for guidance on whether an incarcerated individual can refuse to undergo a particular type of treatment, the Supreme Court has enunciated a qualified right of mentally ill individuals to refuse psychotropic medication.
|
From page 52... ...
The imposition of a particular type of treatment on pregnant women has been less of an issue than the therapeutic value, need, and clinical capacity to impose any type of treatment given the severe shortage of services that are appropriate for and available to pregnant and parenting women. The mandatory use of immunotherapies for pregnant women who do not voluntarily consent raises the particular issue of whether safety data will be available to make the necessary determination of safety and efficacy of these therapies for pregnant women and fetuses, which would be required before being imposed.
|
From page 53... ...
Recommendation 9 The National Institute on Drug Abuse should support studies to determine the standards to be applied when immunotherapy medications are considered for use in the criminal justice and child welfare systems, including due process protections when there is a government-imposed treatment requirement. Recommendation 10 The National Institute on Drug Abuse should support studies to carefully articulate the behavioral, ethical, and social risks associated with treatment of pregnant women and their fetuses and protective therapy in minors and to develop clinical practice guidelines for such use or discouragement of such use.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.