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Deputy Chase has been tired for a long, long time. John Seed and the rest of his fucked-up family have been a pain in her ass for only a short amount of that time. She's not going to let little life-threatening situations and bodily harm get in the way of her task: saving everyone in this goddamn county whether they like it or not.
Screening for substance use should be part of comprehensive obstetric care and should be done at the first prenatal visit in partnership with the pregnant woman. Screening based only on factors, such as poor adherence to prenatal care or prior adverse pregnancy outcome, can lead to missed cases, and may add to stereotyping and stigma. Therefore, it is essential that screening be universal.
With the exception of buprenorphine, it is currently illegal for a physician to write a prescription for any other opioids, including methadone, for the treatment of opioid use disorder outside of a licensed opioid treatment program (where medications are dispensed) 45. Buprenorphine is the only opioid agonist currently approved for the treatment of opioid use disorder by prescription in an office-based setting 46. However, methadone and buprenorphine may be dispensed in a hospital setting by physicians without waivers. Prescribers should be familiar with federal regulations (available at www.gpo.gov/fdsys/pkg/CFR-2016-title21-vol9/xml/CFR-2016-title21-vol9-sec1306-07.xml and state regulations regarding prescribing of medications for the treatment of opioid use disorder.
The buprenorphine monoproduct has a higher potential for misuse, such as intravenous injection and diversion, and a higher street value when compared with the combination product. Thus, all patients should be monitored for the risk of diversion of their medication, especially if the monoproduct is prescribed. Unlike methadone, which may be administered only through tightly controlled programs, buprenorphine may be prescribed for the treatment of opioid use disorder by trained and U.S. Drug Enforcement Administration-approved health care providers in a medical office setting, which potentially increases the availability of treatment and decreases the stigma 47. The Substance Abuse and Mental Health Services Administration publishes a directory of health care providers registered to prescribe buprenorphine www.samhsa.gov/medication-assisted-treatment/physician-program-data/treatment-physician-locator. There are currently more than 37,000 health care providers from a variety of specialties who are trained and able to prescribe buprenorphine in the United States 53.
The Napa Valley arguably put America on the map as a respected wine producer but 100 years before the first grapevine was ever planted in California, the Hudson Valley and Northern New Jersey area was not only respected for its hard cider but it was considered among the finest in the world. The claim of producing the best cider is not as bold today as it was in early America where the average person consumed 35 gallons annually. Today a renaissance in hard cider-making and cultivating varieties that were once close to extinction is sweeping the region as people are learning the mass-marketed hard cider widely available today is a far cry from the drink of choice by early Americans.
Every October, hunters descend on our town. Some are novices and some are professionals, but everyone comes prepared with boots and a knife. Fortunately for everyone, this group is only hunting for mushrooms. Organized by the New York Mycological Society (NYMS), experts in the field of mycology lead a mushroom foray into Tallman Park to study, document, and catalogue the species found in our extremely fungi-fertile area.
Under human rights law, physical force may only be used against students where it is absolutely necessary to protect a child or others, and even then the principle of the minimum necessary amount of force for the shortest period of time must apply. Physical force with intent to punish is never acceptable, and is especially abusive when used to punish students for conduct related to their disabilities.
International instruments, including the UN Convention on the Rights of the Child, the UN Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, and the UN Convention on the Rights of Persons with Disabilities, prohibit the use of cruel, inhuman, or degrading treatment, regardless of circumstance. Corporal punishment also violates other human rights, including the right to security of person and the right to nondiscrimination. Corporal punishment infringes on the right to education. The UN Committee on Economic, Social and Cultural Rights, in General Comment 13 (on the right to education), not only describes corporal punishment as "inconsistent with the fundamental guiding principle of human rights law" but "welcomes initiatives taken by some States parties which actively encourage the schools to introduce 'positive,' non-violent approaches to school discipline."21
All children interviewed or discussed in this report are identified with pseudonyms to safeguard their privacy and ensure there is no retaliation against them. Because parents' names could be used to identify children, parents are referred to only by first name and first initial of the last name. In addition, all parents, teachers, administrators, school board members, or other adults who requested confidentiality are identified by pseudonyms, and this is indicated in the relevant citations. In some cases, certain other identifying information such as school, town, or grade level also has been withheld for the same reasons.
As discussed later in this report, educators may use force under limited circumstances to ensure a safe environment for their students, including through physical restraint. Yet this must be strictly limited: international human rights standards state that the use of force against students is only permissible in exceptional circumstances, and even then only to a minimal degree.28 Educators must be trained to respond to dangerous behavior, "both to minimize the necessity to use restraint and to ensure that any methods used are safe and proportionate to the situation and do not involve the deliberate infliction of pain."29 Any force with intent to punish is prohibited,30 meaning that the vast majority of the violent techniques used in US public schools amount to corporal punishment and violate human rights law.
Paddling (also commonly called "swats," "pops," or "licks") usually means hitting a student three or more times on the buttocks and upper thighs with a wooden paddle.31 Charles B., the father of an 11-year-old Texas boy with attention deficit hyperactivity disorder and dyslexia, described a paddling his son received in early 2009:
I was picking her up under her armpits, that's when she started crying. You could see the bruising. Her whole arm was swollen by the time she got to the emergency room. Her right arm. The doctor said it looked like she'd been hit by a baseball bat or had been in a motorcycle accident. That's the only time he'd seen injuries like that ... To this day, I have no idea what they hit her with ... The human hand doesn't have that kind of strength.44
Karen W.'s son, who has autism, was only able to describe prone restraint years later: "Later, now, he's been able to tell me about face down restraints. He showed me on the floor. One person on his back, one person on his feet. If he would raise his head, they'd force it back down. I think they were trying to break his spirit."69
Many families we interviewed described other forms of restraint used against their children, including "holds" or vertical restraints, which can amount to corporal punishment when used with intent to discipline and cause pain and discomfort. Families reported that their students were bruised or even more severely injured in the course of restraints. Again, international standards mandate that force can only be used to protect a child or others, and then the force used must be to the minimum degree possible for the shortest period of time. The restraints reported to us far exceed human rights standards.
Students with disabilities are corporally punished at disproportionately high rates in almost every state that uses paddling heavily. In Tennessee, for example, students with disabilities are 2.1 times as likely to be paddled as all students.86 Likewise, in Georgia, students with disabilities are 1.7 times as likely to be paddled as all students.87 Of these states that use corporal punishment heavily, only Oklahoma paddles students with and without disabilities at roughly the same rate.88 While some students with disabilities may have particular behavioral problems, this does not justify the disproportionate use of violence against these students. As discussed below, there are more effective methods of discipline that provide safe environments in which all students can learn.89
Second, school districts in states without legal corporal punishment may nonetheless use violent techniques against students with disabilities;94 such instances are not reported to OCR.95 For instance, in the course of restraint in states throughout the US, students are subjected to violent discipline that can amount to corporal punishment.96 Furthermore, there is no federal reporting requirement for the use of restraint, and only two states (California and Connecticut) require annual reporting on the use of restraints.97
According to our interviews, students with autism, especially very young students, were physically punished for exhibiting behaviors commonly manifested by children on the autism spectrum. Students with autism often have difficulty with "normal" school behavior or socialization, as "[t]he regression, or failure to progress, affects language, play, and social interaction and occasionally other skills."133 Common behaviors stemming from the condition may include physical and verbal aggression, repetitive talking on a favorite theme, stubborn resistance, and the constant asking of the same questions.134 The Committee on Educational Interventions for Children With Autism of the National Research Council notes that "[s]ocial dysfunction is perhaps the most central defining feature of autism and related conditions, so it is critical that the effects of a child's social disability on behavior be considered."135 2b1af7f3a8