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In the United States, taper and discontinuation of opioids prescribed for long-term pain have emerged as statistical correlates of suicidal events. Suicide is a complex and multidetermined event reflecting a combination of risks occurring over time in a particular narrative context. Prevention of suicides should be informed by a detailed understanding of life events, pain-related and other risk factors contributing to these tragedies. To date, there have been no efforts to qualitatively profile these suicides through interview of bereaved survivors or review of medical records. This method is usually termed \"psychological autopsy.\". This paper summarizes the protocol for the Clinical Context of Suicide Following Opioid Transitions (CSI:OPIOIDs) study. The study seeks to qualitatively characterize patient and clinical context factors associated with suicide among persons who died by suicide in the context of opioid stoppage or reduction, and to compare findings between Veteran and non-Veteran decedents. In the United States, there is no master list for suicide deaths linked to an antemortem health care event. For this reason, recruitment requires public advertising followed by screening of bereaved individuals who wish to participate. Data collection and interpretation are guided by the Social-Ecological Model for suicide. The study involves a collaboration of persons with lived experience and disciplinary experts in suicide, primary care, pain, health services, and medical anthropology. This study aims to deliver the first in-depth analysis of suicide events occurring in persons with chronic pain who died by suicide in the context of a prescription opioid reduction or stoppage. The results should provide insights that can guide alterations to care by health systems and by individual practitioners.

[This corrects the article DOI: 10.1371/journal.pone.0329874.].

Communicating health research through local and national print, television, and radio news can amplify the impact of research findings. However, relatively few health researchers work with the media to communicate their findings to a broader audience. In April 2024, we convened a group of specialists with expertise in traditional media, health news, and health advocacy for a webinar sponsored by the Helping to End Addiction Long-term (HEAL) Initiative. We present an overview of the discussion, including opportunities within the context of traditional media, guidance for health researchers on partnering with the media, and themes on translating health research to a general audience. Health researchers can use this article as a guide to working with the media to expand the influence of their research findings.

In their article in this supplement issue of AJPH, Sud et al. (p. S56) begin by acknowledging that clinical interventions focused on opioid analgesic prescribing have failed to deliver significant public health benefits, while arguably doing harm. Recognizing that policymakers must act on knowledge that is provisional, the authors use Weber and Khademian's three-fold strategy of knowledge translation-as syntactic, semantic, and pragmatic-to posit a framework capable of navigating complexity, adapting to new information, and minimizing negative consequences.1Among the topics the authors consider is the conundrum that, while risks of opioid analgesic prescribing generally rise with higher doses, interventions targeting dosage have resulted in unintended harms. Notably, opioid tapering may actually increase patients' risk of death, in addition to destabilizing their health, mental health, and lives. Applying a \"syntactic\" lens to this problem, the authors conclude that interventions involving knowledge translation across systems, such as continuing medical education and prescription drug monitoring programs, have often lacked entirely in metrics to trace patient outcomes. Using the \"semantic\" lens of how knowledge is formulated and received, they identify flaws in evidence characterization and suggest that policymakers ought to have focused on distribution of risk, and not just on those at higher doses, because far more overdose deaths correlate with low-dose prescribing. The relative risks that rise with higher doses also ought to have been weighed against absolute risks, in my view. One study of the impact of highdose analgesics on overdose mortality, for example, places the absolute risk of overdose death in patients prescribed opioids at 0.022%.2 In applying Weber and Khademian's framework to opioid tapering, the authors thus deftly expose gaps in knowledge translation that may explain emergent harms.

We, the undersigned, stand as a unified community of stakeholders and key opinion leaders deeply concerned about forced opioid tapering in patients receiving longterm prescription opioid therapy for chronic pain. This is a large-scale humanitarian issue. Our specific concerns involve: • rapid, forced opioid tapering among outpatients; • mandated opioid tapers that require aggressive opioid dose reductions over a defined period, even when that period is an extended one. Opioid tapering guidelines were created, in part, to decrease harm to patients resulting from high-dose opioid therapy for chronic pain. However, countless “legacy patients” with chronic pain who were progressively escalated to high opioid doses, often over many years, now face additional and very serious risks resulting from rapid tapering or related policies that mandate extreme dose reductions that are aggressive and unrealistic.

Doctors have two ethical duties: to cure disease or ease suffering and, also, to do no harm. The ethical duty to “Do No Harm” has been used to justify two sides of a pendulum swing in the philosophy of opioid prescribing for pain. In the 1990s, it was invoked to expand prescribing, and more recently to justify dramatic reductions in prescription opioid use. In this Article, we explore whether prescribing opioids for pain presents challenges that differ from the ordinary mandate physicians face as they balance the call for action with the imperative to do no harm [DNH]. We argue that the treatment of pain differs in three important ways. First, the fact that pain is present and occurrent reduces uncertainty about the need for action, and thus strengthens the reasons to act. Second, while DNH applies to both physicians and policymakers, each has distinct duties: physicians have a duty to the individual patient; policymakers have a duty to society. As a result, harm from drug diversion should weigh little when clinicians decide how to treat individual patients. Public health officials, by contrast, rightly consider societal effects. However, in doing so, they must adopt policies that mitigate the ethical burdens placed on physicians, respect the testimony of patients in pain, and pay particular attention to how policy guidance is likely to be implemented by others. Finally, we address what duties are owed to patients who are currently taking opioid medication, given evidence that they are experiencing significant barriers in receiving healthcare. We argue that once treatment has been initiated, there are special duties to these patients.

The COVID-19 pandemic and the unprecedented natural disasters of 2020 remind us of the importance of emergency preparedness. This Article contributes to our legal and ethical readiness by examining state \"Crisis Standards of Care,\" which are the standards that determine how medical resources are allocated in times of scarcity. The Article identifies a flaw in the policy choice at the heart of the standards: the standards focus on saving as many lives as possible but, in so doing, will predictably disadvantage the ability of people with disabilities and racial minorities to access life-saving care. To date, scholarly attention has focused on explicit exclusions of people with particular medical conditions or the standards' failure to be sufficiently individualized. Amending the protocols to address these concerns, while important, will simply tinker at the margins. The more consequential and harder question is how states should balance the demand to save as many lives as possible while also ensuring that people with disabilities and other vulnerable groups are treated fairly. To answer that question, this Article distills and analyzes four rationing principles that animate the state standards and contends that none ultimately balances these two important aims in a manner consistent with the Americans with Disabilities Act (ADA) and the moral commitments on which it rests. It thus provides a moral and legal framework to guide the ongoing revision of the standards. The Article concludes by proposing a novel, alternative rationing system that reserves resources to accommodate both efficiency and equity, thereby better instantiating the balance that undergirds the ADA.