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Background: the administration of puberty blockers to adolescents with gender dysphoria has ignited significant bioethical controversy, especially in light of recent legislative changes in the United States, Australia and several European states, especially the UK, which in March 2024 permanently banned the administration of puberty blockers to children. Italy and Spain, with their distinct legal, cultural, and medical approaches to treating gender dysphoria in minors, serve as focal points for examining these complex issues. Aims: this article aims to explore the bioethical and medico-legal implications of using puberty blockers in adolescents with gender dysphoria, focusing on the regulatory frameworks in Italy and Spain. It seeks to contribute to the international dialogue on best practices for supporting adolescents with gender dysphoria by comparing these two countries' approaches. Discussion: in recent years in many European states there has been an important evolution in the position on hormone blockade therapy for minors with gender dysphoria, having gone from open policies on puberty blockade treatment to decidedly more restrictive positions. In Italy, the debate on the legitimacy of authorising treatment has been lively for several years, and in the last year has become even more intense due to the decisions taken by countries such as Finland, Sweden, Norway and the United Kingdom. In Spain, a landmark law on trans rights was passed in 2023, but it did not directly regulate hormone-blocking treatment in adolescents with gender dysphoria, which only made an already intense debate even more heated. Conclusion: it is essential to recognise the complexity of gender identity in adolescents and adopt an inclusive approach that considers medical, legal, ethical and social implications. The dynamic nature of the debate on the use of puberty blockers requires ongoing international dialogue. Policy analysis from Italy and Spain can inform best practice globally, promoting inclusive guidelines that prioritise adolescent welfare by addressing the complex bioethical, medico-legal and scientific issues related to the use of puberty blockers. [ABSTRACT FROM AUTHOR]

Conscientious objection refers to the non-performance by an individual of a given obligation of legal nature on moral grounds, because the performance of that obligation would seriously hurt the own conscience. From the very origins of Democracy, respect for the freedom of conscience has been considered as one of most fundamental rights, since it is assumed that human liberty and dignity must prevail, even over and above the State itself. The right to conscientious objection can be understood as the external dimension of ideological freedom and the freedom of conscience. This right, as an essential pillar of any Democracy, bears special relevance in the bioethical debate by being a very proper way to solve, in a democratic system, the unavoidable conflicts that the tension between legality and justice generates. In the past few decades, the right to conscientious objection has developed all its implicitness in those countries where abortion legalization laws have been passed. Sanitary professions have a clear horizon and a precise meaning: care and respect for the life, health and integrity of all human beings. Consequently, when a legal rule wounds, violates or contradicts this principle, sound reasons arise to support the sanitary actors' right to conscientious objection. [ABSTRACT FROM AUTHOR]

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), feel good (16 percent), and relax or relieve 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.