Ethical and legal issues in psychedelic harm reduction and integration therapy

Psychedelic-assisted therapy may represent an upcoming paradigm shift in the treatment of mental health problems as recent clinical trials have demonstrated strong evidence of their therapeutic benefits. While psychedelics are currently prohibited substances in most countries, the growing popularity of their therapeutic potential is leading many people to use psychedelics on their own rather than waiting for legal medical access. Therapists therefore have an ethical duty to meet this need by providing support for clients using psychedelics. However, incorporating psychedelics into traditional psychotherapy poses some risk given their prohibited status and many therapists are unsure of how they might practice in this area. This paper explicates such risks and describes ways in which therapists can mitigate them and strive to practice within legal and ethical boundaries. A harm reduction approach will be emphasized as a useful framework for conducting therapy around clients' use of psychedelics. It is argued that therapists can meet with clients before and after their own personal psychedelic experiences in order to help clients minimize risk and maximize benefit. Common clinical scenarios in this growing clinical area will also be discussed.

International cannabis market growth to drive reform

Significance Cannabis pharmaceuticals have experienced dramatic growth in recent years as regulatory approvals have increased. The sector’s expansion deepens contradictions within the international system of illicit narcotics control, and in national laws that limit medical access and criminalise ‘recreational’ cannabis use. Impacts Pressure on national governments and the international control system to address legal and regulatory contradictions will increase. Cannabis-cultivating states in the developing world, excluded from European and US supply and innovation chains, will agitate for reform. The pharmaceutical cannabis ‘green rush’ and mergers and acquisitions in the legal recreational sector will fuel ‘corporatisation’ fears.

Counseling Families and Children in Rural Poverty

This chapter discusses the unique needs and barriers that families and children living in rural poverty face regarding mental health counseling. It provides a literature review and specific statistics relevant to why this is a significant societal concern. Recommendations, resources, strategies, and techniques are provided for educators and counselors to implement in order to move forward to assist this marginalized population by using a holistic and multidisciplinary approach to assist the families who struggle with emotional, social, and cognitive needs. Once counselors and educators are aware of what defines poverty and the consequences of this global issue, we can move forward to progress towards a proactive and preventative approach to stop the cycle of poverty. Addressing how to decrease the number of families who are negatively affected by the lack of resources, decreased medical access, limited social support, and low self-efficacy may contribute to a better quality of life.

Multidisciplinary Telemedicine Care for Tourette Syndrome: Minireview

Tourette syndrome (TS) is a childhood-onset, chronic neuropsychiatric disorder characterized by multiple motor and vocal tics. TS poses a considerable burden on both patients and health care providers, leading to a major detriment of educational success, occupation, and interpersonal relationships. A multidisciplinary, specialist-driven management approach is required due to the complexity of TS. However, access to such specialty care is often dramatically limited by the patients' locations and the specialists' geographic clustering in large urban centers. Telemedicine uses electronic information and communication technology to provide and support health care when distance separates participants. Therefore, we conducted this mini-review to describe the latest information on telemedicine in the assessment and management of TS and discuss the potential contributions to care for TS patients with a multidisciplinary approach. We believe that telemedicine could be a revolutionary method in improving medical access to patients with TS.

Assessment of the reasonable number of physicians in Korea

The government argues that the expansion of the number of physicians is inevitable due to the absolute lack of practising physicians in Korea compared to members of the Organisation for Economic Co-operation and Development. Further, the government contends that poor medical access and adverse effects on the national health level require such an expansion. This study aimed to verify whether the government’s claims regarding the lack of physician manpower are reasonable by estimating the projected supply and demand of physicians by 2023 based on scenarios involving their productivity and number of working days. As a result, all scenarios indicated a projected oversupply, except for the scenario in which there are 255 working days and physicians’ productivity is the same as that of 2018. Even in scenario three, in which there are 255 working days and physicians’ productivity is the same as that of 2018, an oversupply was projected from 2027. Standards regarding the number of physicians vary from country to country, as they are affected by various factors including medical systems, demographic structures, national health levels, medical infrastructures, accessibility, medical finance and geographical conditions. This issue can be seen as resulting from the unbalanced regional distribution of physicians rather than from an absolute shortage of the number of physicians. The trickle-down effect of expanding the medical student enrollment cannot solve the problem of the unbalanced regional distribution of physicians.

Assessing Norway’s Gender Recognition Act of 2016: Analysing personal experiences of legal gender change

<p><br />In July 2016, a Gender Recognition Act (GRA) was implemented in Norway which allows one to change legal gender (male/female) without the previously required sterilisation. Though this move by the Norwegian state has been widely celebrated by trans rights advocates for its progressive approach to gender recognition, the Act’s limitation to the male/female binary and the lack of concurrent improvement in trans-specific medical access raise concerns about how far-reaching and transformative it actually is. Given the diversity of trans experiences and identities, this article seeks to address the following question: in what ways is the Act on gender recognition capable of empowering those who change legal gender, and in what ways can it prove limiting or detrimental? To answer this, I conducted interviews with twelve individuals who changed their legal gender soon after the Act’s implementation. Applying Thematic Analysis to the interviews, I uncover and analyse moments of empowerment and disempowerment in order to explore the potential of legal gender recognition to shape one’s personhood and citizenship in the Norwegian context.</p>

P028 URGENT MEDICAL ACCESS FOR PATIENTS WITH INFLAMMATORY BOWEL DISEASE AT A PRIVATE COMMUNITY GASTROENTEROLOGY PRACTICE

Background Patients with inflammatory bowel disease (IBD) have chronic, life-long diseases with relapsing-remitting pattern that often require frequent utilization of healthcare services.[1] Urgent access to specialty care can help identify patients with acute medical needs so they can receive appropriate care in a timely manner. This can avoid unnecessary high-cost medical interventions, such as visits to the emergency department (ED), which often lead to excess use of steroids, narcotics, and radiographic imaging, all important measures of quality of IBD care.[2] We sought to introduce an access/quality improvement program at a private gastroenterology practice with the goal of triaging and returning urgent calls from IBD patients in a timely manner and mitigate avoidable visits to the ED. Methods Gastroenterologists, nurses, and support staff at our private practice developed four criteria for “urgent” IBD calls: new, severe abdominal pain; new, severe anal pain; fever greater than 101 Fahrenheit; and refractory emesis. Patient calls that met any of these criteria were highlighted with a red flag and labelled as “IBD URGENT” by support staff in the electronic medical system. The primary gastroenterologist (or covering provider) then responded to these calls as soon as possible with a goal of responding within 4 hours. Subsequently, patients were advised to go to the ED for further emergent evaluation, given same/next day clinic visits, and/or given advice, such as medication changes, by the gastroenterologists. Results Over a 15-month period from June 2018 to August 2019, we received a total of 167 “IBD URGENT” calls (average 11 calls per month); of these, 92% (153 calls) received a response from a gastroenterologist within 4 hours. Abdominal pain, diarrhea, blood in the stools, and vomiting were the most common reasons for urgent calls. Only 10% (16 calls) of calls were patients with worrisome symptoms in which they were advised to go to the ED, 37% of calls led to same/next day clinic visits (62 calls), and 58% resulted in advice/orders from the gastroenterologist such as laboratory testing, medication continuation/changes (97 calls); 12% (20 calls) resulted in both urgent clinic visits and advice (e.g., obtain laboratory testing and then present for office visit). Conclusion We piloted an urgent care hotline for IBD patients to receive rapid medical access at a private community gastroenterology practice. The majority of patients were successfully managed with outpatient medical care, including same/next-day office visits and advice for laboratory testing/medication changes. Only a minority (10%) of calls resulted in ED visits. We plan to continue this project with the aim to return more than 90% of the urgent calls within 4 hours. References