Fatal intravenous fentanyl abuse: four cases involving extraction of fentanyl from transdermal patches

The transdermal fentanyl system delivers a specific dose at a constant rate. Even after the prescribed application time has elapsed, enough fentanyl remains within a patch to provide a potentially lethal dose. Death due to the intravenous injection of fentanyl extracted from transdermal patches has not been previously reported. We present 4 cases in which the source of fentanyl was transdermal patches and was injected. In all of these cases, the victim was a white male who died at home. Case 1 was a 35-year-old with no known history of drug use, who was found by his wife on the floor of his workshop. Police recovered a fentanyl patch, needle, and syringe at the scene. Case 2 was a 38-year-old with a known history of drug use whose family claimed that he was in a treatment program that used fentanyl patches for unknown reasons. His brother found him dead in bed, and law enforcement officers found a hypodermic needle beside the body; a ligature around his left hand, and apparent needle marks between his first and second digits were also noted. Case 3 was a 42-year-old with a recent attempted suicide via overdose who was found dead at his home. An empty box of fentanyl patches, Valium, Ritalin, and 2 syringes were found at the scene. Case 4 was a 39-year-old found by his mother, who admitted to removing a needle with attached syringe from the decedent's arm. Medications at the scene included hydrocodone, alprazolam, zolpidem, and fentanyl patches. All reported deaths were attributed to fentanyl intoxication, with blood concentrations ranging from 5 to 27 microg/L.     

Evaluation of a national prison-based treatment program for sexual offenders in England and Wales

Treatment efficacy is described for a sample of sexual offenders who had undertaken treatment in United Kingdom prisons (N = 647) and for a retrospectively selected comparison group (N = 1,910). The outcomes under observation in this study were sexual, sexual and/or violent, and general reconviction. Treatment impact was also examined in relation to offenders' risk of reconviction. The treatment group had slightly lower 2-year sexual reconviction rates than the comparison group, but these differences were not statistically significant. Significant differences were found between the treatment and comparison group for sexual and/or violent reconviction. Further analysis suggested that treatment produced a reduction in the probability of sexual and/or violent reconviction (p <.05) when other relevant variables were controlled for. General reconviction rates were consistently lower in the treatment group, but these differences were not significant.     

Recent developments in privacy legislation

In this article, Ruth Carey takes a critical look at recent privacy-of-personal-information legislation drafted in three Canadian provinces--Ontario, Alberta, and British Columbia. The article begins with a historical overview of international legal instruments and other privacy guidelines, and the Canadian experience with privacy protection. It then critically analyzes the provincial initiatives in the context of the federal Personal Information Protection and and Electronic Documents Act and accepted privacy principles. The article goes on to highlight certain types of legislative provisions of particular interest to people with HIV/AIDS and those who advocate on their behalf. It concludes that the numerous legislative initiatives underway in Canada provide an opportunity to alter the public discourse around the virus, thereby improving the lives of people with HIV/AIDS.     

Ontario: people can now apply for forced HIV testing in certain situations

Ontario has finally issued a regulation to accompany its controversial "blood samples" legislation, passed in 2001. As a result, in certain circumstances, a person in Ontario can now seek an order to require another person to be tested for HIV, hepatitis B (HBV), and hepatitis C (HCV). However, the regulation contains a number of restrictions on the ability to apply for such an order.     

The Jewish Mother turned monster: Representations of motherhood by Hebrew women novelists 1881–1993

The paper discusses the changes in the representation of motherhood in Hebrew novels written by women within the span of a century. The outline of the changes is found to be similar to the general trend discernible in women's writing in the West, despite the anomalous history of Hebrew literature. In most general terms, the history of the mother in these novels might be outlined in terms of a move from absence to presence, from silence to voice, from passivity to activity, from asexuality to overt promiscuity, from submission to aggression. Given the culturally ingrained model of the Jewish Mother that the novelists have to cope with, this move is shattering. The mother, who was neglected or even suppressed in the earlier novels, returns, with a vengeance, in more recent ones. The vengeance, though, may prove excessive.     

Silences: Irish Women and Abortion

This article considers the forces which act to prevent women in Ireland from speaking about their experiences of abortion. It considers the various forms such silencing can take and the complexity of feelings and circumstance which women who have had abortions are subject to. In so doing it raises important questions about the way public debate about abortion between pro-choice and pro-life arguments - couched in terms of rights - acts to further silence women. Finally, the article calls for the creation of a new public and intellectual space in which the complexities of the issues can be realized. A new public space such as this could then facilitate the enactment of permissive legislation which in turn could enable women to decide the best pregnancy option available for them at any particular moment in their lives.