This work is a review of the most relevant historical events that have occurred in the United States in relation to the use of opioids in the treatment of pain. This analysis is relevant to identify the events that may have caused or contributed to the onset and development of the current ¿epidemic¿ of opioid use in the United States. We also provide an analysis and discussion of the measures that have been taken in the United States in relation to this epidemic. This article corresponds to the third and final part of our analysis. We continue with the study of federal legislation implemented by government administrations in the United States to conclude with events up to the end of 2019.

Objectives: To quantify the prevalence of opioid drug dependence and abuse in United States between 2017 and 2018 and identify which opioid molecules are associated with a higher level of dependence and abuse. Design: National Survey on Drug Use and Health (NSDUH) data for 2017 and 2018 have been extracted. The variables related to painkillers were studied, the most important ones were selected, and several variable crosses were made. After the data were extracted, they were analyzed using Microsoft Excel and PivotTables, calculating the relative prevalence and percentages of patients with abuse and dependence. Results: In total, 1.4 million people had dependence on pain relievers (PRs) in 2018. The last PR used was mostly hydrocodone (33 percent) and oxycodone (24 percent). The main reasons for using a PR without a doctor's prescription were relieving pain (48 percent), feeling good (16 percent), and relaxing or relieving tension (15 percent). Among patients who used a PR with a medical prescription, 1.5 million used it more frequently than prescribed, 1.2 million used it longer than prescribed, and 1.9 million used it in higher amounts than prescribed. Conclusions: Abuse and dependence to PRs is lower than expected with over 1.4 million people in the United States having dependence in 2018 (0.6 percent point prevalence). Most cases of dependence are associated with misuse or abuse of prescriptions without medical supervision or the use of medications without a prescription of their own. Oxycodone and hydrocodone are the molecules most associated with dependence, misuse, abuse, and use without prescription. The age of onset of oxycodone misuse is very early (14 years old). Fentanyl does not seem relevant in any of the variables studied.

This work is a review of the most relevant historical events that have occurred in the United States in relation to the use of opioids in the treatment of pain. This analysis is relevant to identify the events that may have caused or contributed to the onset and development of the current 'epidemic' of opioid use in the United States. We also provide an analysis and discussion of the measures that have been taken in the United States in relation to this epidemic. In this second part, we analyse developments and measures implemented in the United States between 2010 and 2018.

This work is a review of the most relevant historical events that have occurred in the United States in relation to the use of opioids in the treatment of pain. This analysis is relevant to identify the events that may have caused or contributed to the onset and development of the current 'epidemic' of opioid use in the United States. We also provide an analysis and discussion of the measures that have been taken in the United States in relation to this epidemic. In this second part, we analyse developments and measures implemented in the United States between 2010 and 2018.

This article looks at the case of Keira Bell, who sued Tavistock and Portman, the body that runs the gender identity change service for children in the UK, over the way it carried out her "gender transition" process.

This work is based on the recognition of the important role that community pharmacists play in the health care of people suffering from a terminal process and their families and/or carers. There is no doubt that the committee, treatment and accompaniment of healthcare professionals in any life-threatening pathology is fundamental. The community pharmacist, as a healthcare agent, must be involved in these processes. However, they are often forgotten by the healthcare system, which thus wastes one of its most qualified professionals. We are convinced that terminally ill patients and their relatives and/or carers would benefit greatly from greater involvement of pharmacists in their processes. For this reason, this article reflects on the benefits of including community pharmacists in the healthcare team caring for terminally ill patients.

Background: Opioid prescribing in recent years has been under scrutiny. To avoid a possible status epidemic in Spain it is necessary to study the prescribing dynamics in Spain. Our current analysis will focus on quantifying the level of prescribing by specialization program and indication. Methods: We analysed the prescribing data provided by IQVIA© for all molecules and products classified in ATC-N2A (narcotic analgesics) and ATC-N2B (non-narcotic analgesic) between 2019 and 2020. The information has been provided by IQVIA Information, S.A., extracted on 23 October 2020 and contains 21,724 records. We extracted issue of prescriptions by molecule and issue of prescriptions by diagnosis grouped by therapeutic areas. We cross-analysed: prescriptions by diagnosis and by molecule, and prescriptions by molecule and specialization program. All calculations and data analysis were performed using Microsoft Excel IOS 2019. Results: In 12 months, from June 2019 to June 2020, 3.2 million prescriptions for opioids from group N2A-ATC were prescribed in Spain. Most of the molecules prescribed were tapentadol (36 %), fentanyl (28 %) and oxycodone-naloxone (13 %). Eighty-one per cent of the fentanyl prescriptions were for the patch formulation. Primary care physicians were responsible for 73 % of prescriptions. Internal medicine specialists were relatively more relevant in prescribing fentanyl, while rheumatologists were relatively more important as prescribers of oxycodone-naloxone. The three most important indications were back pain (15 % of prescriptions), cancer (11 %) and osteoarthritis (10 %). By therapeutic area , 38 % of the prescriptions were for traumatological indications, 26 % for rheumatological diseases and 11 % for oncology. Conclusion: The issue of prescriptions for potent opioids grew by 9.6% in the last 12 months (moving annual rate to June 2020) compared to the same period in 2019. Seventy-three percent of these prescriptions were concentrated in three molecules: tapentadol, fentanyl patch and oxycodone-naloxone. Primary care is the most relevant prescriber, with 73% of prescriptions. Oncological indications account for only 11% of all prescriptions, with the remaining 89% for non-oncological indications.

Community pharmacists are in a privileged position to help people with their healthcare needs. In the case of minority or marginalised groups, who may have more problems in accessing efficient care, the proximity, immediacy, professionalism and affective atmosphere that these professionals manage to offer become very relevant. Specifically, one of the groups that may require particular attention from pharmacists is that of people with different sexual orientations or gender identities. In this framework, this book makes a research about the attendance health care that LGBT people currently receive, and should receive: care that must be based on correct professional practice and respect staff -understood as a requirement derived from the inherent dignity of any human being-. Subsequently, the book addresses in depth the needs related to pharmaceutical care for this sector of the population.

In applied pharmaceutical deontology, ethical reflection should not be seen as something abstract, ethereal or complicated to which one appeals from the academic world or when there is an irresolvable professional conflict. Ethical reasoning is part of the ordinary as ethical life begins when one asks oneself what is to become of it. It deals with important and topical issues such as the moral responsibility of pharmacists, patient autonomy, the rational use of medicines, pharmaceutical secrecy, unfair skill , miracle products and doping, cannabis, contraceptives, medicalisation and conscientious objection, and the role of the pharmacist as a pharmacist.

Biomedicine has advanced a lot in recent years, in plenary session of the Executive Council 21st century new technical situations require a study, a dialogue, a thinking about the life of man, in order to establish points of reference letter in a plural society. El sentido del vivir en el morir is the result of a scientific and interdisciplinary project carried out by academics from different European universities. The authors present, from different perspectives, anthropological, medical, social, psychological, legal, demographic, etc., human living in permanent fragility and dependence on each other. The main aim of the book, goal , is to provide, from a multidisciplinary perspective, the foundations that favour a more humane and equitable medicine internship . The bridges of speech between different areas must allow for the recognition and respect due to the dignity and freedom of every person and the observance of universal human rights that can be shared by all. Moreover, on the internship, they must truly protect every man in whatever status and whatever condition of life he may find himself in.

A work by reference letter to learn about the path taken and to be taken by community pharmacists in the National Health System, including specific proposals for greater integration of this professional in primary care teams.

This book is an action of the committee de Enfermería de la Comunidad Valenciana to promote, revitalise and promote the knowledge of ethical and deontological aspects in the nursing profession. The chapter "Nursing Responsibility" reflects on the responsibilities of nursing professionals, both individual and collective, derived from the moral dimension and the demands that their practice entails, mainly those caused by humanely excellent care.