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HOW TO STOP DOMESTIC ABUSE?

HOW TO STOP DOMESTIC ABUSE?

by | Med-Legal Corner, Personal Injury, Protective Services

 

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Domestic abuse: October is a�Domestic Violence Awareness Month, so it�is time to get a closer look at this increasing form of violent behavior. By and large, the general public is unaware of the effects domestic abuse has on its victims, other family members and society as a whole. Therefore, attempts are being made to heighten society�s awareness of the many facets of this violent crime that plagues America today.

Organizations such as�National Center for Victims of Crime,�Love is Respect Website�and�National Domestic Violence Hotline�are educating the general public as well as potential victims of domestic abuse, about the elements of the crime of Domestic abuse, how to differentiate between this family crime and other crimes, and even how to tell whether any crime has actually been committed at all.

Because people should be aware of the types of abuse crimes that fall into the category of domestic abuse, and who the victims of domestic abuse are, the center is answering questions, such as �Does one have to be a spouse or other immediate family member to be considered a victim of domestic abuse?�

WHAT IS DOMESTIC ABUSE?

This is a crime that involves abuse of family members, romantic partners, and others. The crimes of domestic abuse are numerous, ranging from verbal abuse to murder. They include emotional abuse, such as intimidation and threats, assault, battery (with or without the use of a deadly weapon), sexual abuse (i.e. spousal rape), kidnapping, and detaining one against his or her will.

When considering crimes of domestic abuse, most states consider certain relationships to be �domestic relationships.� In these states, the relationships usually include spouses, former spouses, persons who share a common child together, persons currently residing together or those that have previously shared a domestic living arrangement together, in their criteria for domestic relationships.

DOMESTIC VIOLENCE TODAY

The problem of Domestic violence is on the rise and becoming ever more dangerous to its victims who live in fear. However, the average person in the United States today is unaware of just how serious and out of hand the crime of domestic violence is becoming. This could possibly be because many Americans do not live with conflict and violence in their homes.

Conversely, many victims of domestic violence do not even realize that they are victims of the crime of domestic violence. They�ve been misled by their abusers and believe that the abuse they are victimized by, really is not abuse at all, but just �a way of life.�

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Fear Has Silenced Undocumented Domestic Violence Victims

Fear Has Silenced Undocumented Domestic Violence Victims

by | Crime Victims, Med-Legal Corner, Protective Services

In February, an immigration enforcement case in El Paso earned the attention of domestic violence advocates across the country. As the El Paso Times reported, an undocumented woman was detained by immigration officers right after she went to the courthouse to get a restraining order against a violent and abusive partner. Domestic violence advocates were horrified, worried that it would potentially deter undocumented people from reporting abuse to law enforcement. “It sends a powerful message to victims and survivors that there is no safe place,” Ruth Glenn, executive director of the National Coalition Against Domestic Violence, told Bustle in February.

Now, a month later, the effect of fighting domestic violence is being felt. Sometime after the El Paso incident, Enrique Elizondo, a worker for a domestic violence hotline, received a call from an undocumented woman (I have not included any identifying details to protect her confidentiality), facing an abusive husband. According to Elizondo, she was at the point of fear that the abuse could become lethal. But, after selling all her belongings to come to the United States, she found herself feeling like she was out of options. According to Elizondo, her partner had specifically made threats about contacting Immigration and Customs Enforcement (ICE) and having her deported if she took action. The El Paso case made her fear he could. Elizondo tells Bustle he tried to help her contact legal help, but the woman asked him, Is this legal advocate going to deport me? Ultimately, Elizondo says he was able to get her legal help.

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According to domestic violence advocates interviewed for this article, these situations are becoming the norm for dealing with undocumented survivors of domestic violence. The 2013 re-authorization of the Violence Against Women Act (VAWA) protects survivors of abuse from deportation for reporting the crime, but, as fear in undocumented communities has grown due to more expansive calls for immigration enforcement under Donald Trump’s administration, it’s hard for the people helping survivors to convince them they’re safe.

 

The February El Paso case may very well have been a fluke according to the El Paso Times, the woman detained had further criminal complaints against her beyond her immigration status. But the publicity generated by a women detained while seeking help from a court has nevertheless led to worry among violence survivors. Already, four cases in Denver of domestic violence were dropped due to fears of the survivors about immigration status, according to Denver City Attorney Kristin Bronsonm who spoke to NPR about the situation.

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We believe a person’s safety shouldnt be contingent on their religion or immigration status.

“That case [in El Paso] alone, I am actually sure had a chilling effect,” Ruth Glenn tells Bustle a month after we initially spoke. Her organization, the National Coalition Against Violence, is working “to ensure that advocates know how to support those victims by making sure that they know what the laws and the rules are,” she says. Specifically, it has been focusing on helping shelters figure out how to deal with these issues such as knowing that they are expected to maintain the confidentiality of their residents even if ICE officers shows up at the door.

Unfortunately, some are prioritizing continuing to live with abuse.

Under the Obama administration, a 2011 legal memorandum required ICE to exercise prosecutorial discretion when dealing with victims or witnesses to crimes like domestic violence.

According to a statement from Letitia Zamarippa, spokeswoman for ICE, that memo is still in effect. U.S. Immigration and Customs Enforcement (ICE) officers will take into consideration if an individual is the immediate victim or witness to a crime, in determining whether to take enforcement action. Particular attention is paid to victims of domestic violence, human trafficking or other serious crimes.”

But even with the law officially in place, the uncertainty caused by Trump administration actions stepping up deportations and limiting restrictions on ICE causes fear among survivors.

The Trump administration’s recent actions taking aim at sanctuary cities, hoping to push local police agencies to enforce immigration laws, worries advocates, as well.

If you think about victims of domestic violence who are already being controlled by a perpetrator, that is compounded and exacerbated when you rely on that person to interpret the laws for you, who is filtering all that information to control you.”

“When you have your local sheriff, whose job is to come to domestic violence scenes and to be in the community if they’re also enforcing immigration law the question is whether victims are going to come call when they’re being abused or sexually assaulted,” says Huang. “Entire communities are afraid of reaching out for help. ICE officers are not always the best at finding out if there’s victims.”

 

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Overall, the growing sense of uncertainty, the anti-immigration rhetoric, and the threats to sanctuary city are leaving a strong impact on domestic violence victims who live in a legal gray area and may not be well versed in their legal rights. “If you think about victims of domestic violence who are already being controlled by a perpetrator, that is compounded and exacerbated when you rely on that person to interpret the laws for you, who is filtering all that information to control you,” Monica McLaughlin, Deputy Director of Public Policy at the National Network to End Domestic Violence, tells Bustle.

The underlying problem is that even if undocumented immigrants can technically get help, McLaughlin explains, “if what’s been communicated indicates that they can’t because they’re not safe, then survivors really aren’t going to reach out to law enforcement for help.”

 

Chiropractic Wellness Care Lessens Need for Opioid Prescriptions

Chiropractic Wellness Care Lessens Need for Opioid Prescriptions

by | Chiropractic, Chronic Back Pain, Wellness

If you want to reduce the number of opioid prescriptions and pills being used, and potentially misused, you need alternative pain management. And chiropractors say that�s what they�ve been providing for decades.

�It gives people options, and that�s probably the most important thing right now is to give people options for treatment,� Dr. Mark Stagnone, president of the New Hampshire Chiropractic Association said.

At its annual meeting, the association is pointing to a trio of recent studies showing that chiropractic care cuts down on the use of opiate pain medicines.

 

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In one of the studies, a former Dartmouth doctor analyzed 33,000 cases of lower back pain in a New Hampshire database.

�His preliminary research is indicating that there�s about a 56-57 percent reduction in opioid use when chiropractic care has been utilized in a patients treatment,� Stagnone said.

James Vara, the governor�s adviser on addiction and behavorial health, said the state needs more alternative pain management.

�It becomes a question of what insurance covers it and how long they cover it for, and that�s certainly something I�ve looked at and will continue to,� said Vara.

The Current Insurance Model Puts Patients On A Path To Prescription Drugs

 

�The problem that it produces is that the average individual who�s trying to treat a condition is faced with paying a high co-pay to visit a chiropractor or paying a considerably lower one to see a primary care physician,� Stagnone said.

Changing that dynamic will require legislation that has failed in the past. But chiropractors said in this ongoing addiction crisis, it�s time for adjustment.

Chiropractic care is covered under the New Hampshire Health Protection program, or expanded Medicaid. And if the program lapses, so does that coverage.

 

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Painkillers Sometimes Increase Chronic Pain

We’re facing an opioid addiction crisis in America. Opioid (narcotic) pain medications killed an estimated 14,000 people in the U.S. in 2014 through overdose. A further 14,000 people overdosed on heroin, another opioid that many people turn to when they can’t access prescription painkillers.

See Narcotic Pain Medications

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Opioid painkillers like hydrocodone can trigger dependency and increased sensitivity to pain.
See�Pain Killer Addiction Treatment

 

This epidemic is why physicians and pharmacists are increasingly raising the bar on who can receive opioid medications, how much, and for how long. It’s not just the addiction risk that calls for caution when using opioids to treat chronic pain though�long-term use of opioids can actually make pain worse.

See Opioid Medication Potential Risks and Complications

Physical Impact Of Painkillers

Becoming addicted to pain medication is a disease. This is because these painkillers (oxycodone, hydrocodone, methadone, fentanyl) cause a change in your brain chemistry that is not under your control.

Most people who take opioids for more than 2 to 4 weeks will develop a tolerance to the medication. Tolerance means your body may need an increased dosage to feel the same effect. Opioid tolerance can cause withdrawal symptoms when the medication is stopped. This is a natural process, and it is not to be confused with addiction.

See Rapid Opiate Detoxification Treatment

In his recent blog on the subject, Dr. Ullrich explains: “Pain medication addiction is a more complicated process. It involves manipulative behavior to obtain narcotic medications and a refusal to discontinue a medication even though it is no longer being used for a medical purpose. Some, including those at significant risk of overdosing, will go to multiple doctors to get medications.”

For those who are addicted to opioid medications, a detoxification program is often needed. Painkiller addiction is a chemical, physical disease, one that requires expert medical treatment in a safe, humane environment.

See Pain Killer Addiction Treatment

Painkillers May Increase Pain

Most people know that painkillers can be addictive, but they don’t know that taking opioids over a long period of time may in fact increase a patient’s sensitivity to pain (hyperalgesia). This happens because long-term use of opiate painkillers causes a decrease in your ability to tolerate pain and an increase in sensitivity to pain. In fact, people taking opioids long term may keep having pain, or may see their pain increase, long after the original cause of pain has healed.

See Chronic Pain As a Disease: Why Does It Still Hurt?

Stopping opioid use can solve this problem�but it may not seem as if the pain is gone at first, because the discomfort of withdrawal can mimic the original pain. Dependency is not easy to deal with, but it shouldn’t be an excuse to stay on the opioid medication and raise the risk for addiction. This is why physicians are encouraged to only prescribe opioids for short durations and be cautious when using them to treat chronic pain.

Since long-term use of opioid painkillers is a risky option for controlling chronic pain, patients are often advised to focus on other safe, proven methods for managing chronic pain, such as:

Learn more:

Modern Theories of Chronic Pain

Medications for Back Pain and Neck Pain

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Six Things Every Chiropractor Should Know About Opioids

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An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.

1. What Are Opioids?

Opioid medications are prescribed to reduce pain; however, they are addictive and can be dangerous. Although some suggest there is �no safe dose� for opioids, these drugs may be helpful for people with severe pain, such as those experiencing pain from cancer. However, over the past several decades, more patients have been prescribed opioids for musculoskeletal pain, such as back or neck pain, instead of being provided with nondrug therapies.

As with any drug, opioids have side effects and may �adversely affect respiratory, gastrointestinal, musculoskeletal, cardiovascular, immune, endocrine, and central nervous systems.�1 �As the dose increases, the risks for overdose and health concerns also increase, including �fractures, addiction, intestinal blockages, and sedation.�1 If too high a dose is consumed or if opioids are taken with certain other drugs or alcohol, death may result.

 

2. Why Is Opioid Use / Overuse Problematic?

Since 1999, prescription opioid sales have increased fourfold, along with a surge in the use of opioids as a first line for pain management, rather than only for severe cancer-related pain. This trend has led to burgeoning opioid prescribing in the U.S.:2

? One in five people with non-cancer pain have been prescribed opioids.

? More than 165,000 prescription opioid-related deaths occurred between 1999 and 2014.

? An estimated 2 million people were addicted to opioids as of 2014.

 

3. Who Is Addressing This Health Crisis?

Currently, many professions are seeking ways to address this national epidemic. The medical profession has launched various initiatives to help medical doctors (MDs) reduce prescriptions. These include an initiative to remove pain as the 5th�vital sign, and promoting guidelines for when to prescribe and how to better manage patients in pain without the use of opioids.

The Centers for Disease Control and Prevention (CDC) has�released guidelines�to curb opioid prescriptions, with the following categories of recommendations to those who prescribe opioids: 1) determine when to initiate or continue opioids for chronic pain; 2) opioid selection, dosage, duration, follow-up, discontinuation, and assessing risk; and 3) addressing harms of opioid use.

In addition to these efforts, even more focus is needed to assist people who seek help for pain and to provide them with nonpharmacological alternatives.

 

4. What Can Doctors of Chiropractic Do?

Chiropractic care can be part of the solution. DCs can work with other health care providers and support policy to offer alternatives to opioids for addressing patients in pain, especially chronic non-cancer pain.

Although there are no large trials comparing outcomes of chiropractic care to opioids, we do know opioid use is associated with worse functioning in back pain patients at six-month follow-up3 �and greater disability;4 �and that injured workers whose first health care visit is to a DC have better outcomes.5 �We also know that the per-capita supply of DCs and higher use of manipulative therapy is associated with lower rates of opioid prescriptions among Medicare recipients.6

All this suggests chiropractic care may help reduce the use of and need for opioid prescriptions for back pain sufferers; and may play an important role in reducing the opioid epidemic by helping to prevent patients from ever getting an opioid prescription in the first place.

Important resources DCs should be aware of include:

? Never�Only�Opioids:�www.painsproject.org/ policy-brief-never-opioids/

? Chiropractic: A Safer Strategy Than Opioids:�www.f4cp. com/f4cp_opioid_white_paper.pdf

? Centers for Disease Control and Prevention (CDC): Opioid Overdose:�www.cdc.gov/drugoverdose/ Six Things Every Chiropractor Should Know About Opioids By Claire Johnson, DC, MSEd, PhD, Bart N. Green, DC, MSEd, PhD and Michael Haneline, DC, MPH Reprinted with permission from Dynamic Chiropractic, Sept. 1, 2016, Vol. 34, Issue 15 (www.dynamicchiropractic.com/digital/index.php?i=1220&r=t#19)

 

5. What Can We Do If a Patient Is Already Taking Opioids?

Most chiropractors take a history and ask patients what medications they are taking. The first step is to recognize that the following are opioid-class drugs: hydrocodone (Vicodin), ultram (Tramadol), oxycodone (OxyContin, Percocet), morphine (Kadian, Avinza) and codeine.7

Once we know a patient is taking opioids, we must first seek to understand the situation before we provide education.

Questions we can ask include:

  • ? For what condition is the patient taking the medication?
  • ? How long has the patient been taking opioids and at what daily dose?
  • ? Who is the provider watching over their prescription? Is more than one provider prescribing opioids?
  • ? When was the last time the patient saw the prescribing physician and when is the next appointment?
  • ? Does the patient have any safety issues? For example, does the patient operate machinery? Is the patient experiencing side effects such as �sedation, dizziness, nausea, vomiting, constipation, physical dependence, tolerance, or respiratory depression�?8
  • ? What is the patient�s level of function? Are there any psychological flags or addictive behaviors?
  • ? Is the patient taking any other substances or drugs that may have deadly interactions, such as alcohol, benzodiazepines and/or other opioids?

As chiropractors, we can discuss treatment goals, such as reasonable functional activity; and pain goals with and without medication. We also can discuss potential adverse events, including the risks for side effects, addiction and death.

We can inform patients of other dangers they may not be aware of, such as the deadly combination of opioids when combined with other drugs that depress CNS activity (e.g., alcohol or drugs for anxiety such as benzodiazepines). We can encourage patients to contact the prescribing provider to discuss reducing and stopping opioid use, and to ask for safer alternatives for pain control, such as chiropractic care, physical therapy, acupuncture and mind-body methods. If a patient is already addicted, we can encourage the patient to seek a specialist provider and addiction care program. (Note that some patients may need to remain on opioids, such as for cancer pain or end-of-life care.)

Most importantly, we can work with the patient and their prescribing provider to offer them nonpharmacological care to help reduce their pain and help them reach their functional goals.

 

6. How Can We Collaborate More on Solutions?

As DCs, we can work more closely with local MDs and discuss better ways to collaborate concerning patients with pain. Remember that MDs are not the enemy, but are an essential component of the solution to this epidemic. Most MDs are also extremely concerned about the opioid epidemic, and are looking for efficient and cost-effective ways of helping their patients. We should remain professional when speaking about MDs with our patients, as our patients likely have good relations with them.

We can be part of the safety net to help reduce the number of people who become addicted or die from overdose. As we work with other health care professionals and our patients, we can remind them that the first recommendation per the CDC�s�Guideline for Prescribing Opioids for Chronic Pain�is �Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain.�9 �Thus, through collaboration, the chiropractic profession can be a part of the solution.

 

Pain Killers & What They�Cost!

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