Optically Active Pharmaceutical Compounds Biology Essay

Optically Active Pharmaceutical Compounds Biology Essay The molecules which are non super imposable mirror images of one another are termed as chiral. These are a pair of enantiomers and are diasymmetric as well as optically active. Since they promote optical rotation, these enantiomers are also known as optical isomers. These chiral molecules consist of a tetrahedral carbon atom which is attached to four different groups. The carbon atom is the stereogenic or the asymmetric centre of the molecule. The enantiomers are similar in their physical and chemical properties in an achiral environment. Enantiomers have different biological properties. This influences the efficacy and the toxicity of the compounds. Usually, one of the enantiomers is bioactive and the others may be inactive or toxic. Example, Verapamil is a calcium channel blocker used for the treatment for blood pressure, angina. The (S) isomer treats the increase in BP more effectively than the racemate form. The (R) isoform inhibits resistance of cancer cells to anti cancer drugs (Crosby, 1991). The enantiomerically pure compounds are very useful and vital in the pharmaceutical and agrochemical industries. It has also been shown that the optically pure and chiral compounds should be used rather than mixture of enantiomers. The optically active pure compounds are used to produce antibodies, hormones, anti inflammatory, amino acids, vitamins, anti cancer drugs, cardiovascular drugs. Chiral chromatography or ligand exchange chromatography was an analytical technique used for separating enantiomers. High performance liquid chromatography whereby chiral stationary phase is used was efficient in separation of enantiomers. The optically active ligands like amino acids are bound covalently to a solid support, thereby forming a chiral stationary phase. Various amino acid derivatives like N -(3,5-dinitrobenzoyl) phenyl glycines are also used.(Pirkle and Pochapsky,1987). The major advantage of chromatography is that it results in high enantiomeric excess and is suitable on the analytical scale. However, its drawback is that the scale up is difficult. The production of enantiomers for optically active drugs may be produced by different methods. Pure compounds are recovered by various extraction techniques from chiral compounds (alkaloids, carbohydrates) exist as pure enantiomers naturally. Fermentation of cheap substrates which are available in abundance (like molasses and sucrose) was a widely used source of single chiral molecules lactic, tartaric and L- amino acids and also for complex substances which include vitamins, antibiotics and hormones.(Buchta,1983). Optically pure compounds may be prepared from inactive starting materials by asymmetric synthesis and resolution of racemates. In the process of asymmetric synthesis (Stinson,1993) an enantiomeric reagent or catalyst is used for carrying out a specific reaction on an achiral substrate (prochiral) to produce a single chiral product. Overall, it is a selective technique as it leads to product selectivity. Its disadvantages are that it may be expensive due to the numerous steps involved and also because of the use of costly enantiomeric reagents. It is cheaper to produce a racemic mixture and then separate the enantiomers by physical methods like kinetic resolution or diastereomeric crystallization. Covalent derivatives are formed using optically pure resolving agents in the diastereomic crystallization method. The drawback is that it is wasteful since the unwanted isomer may be discarded. On the other hand, kinetic resolution is based on the principle that two enantiomers react at vari able rates in the presence of a chiral catalyst like an enzyme. This method involves product selectivity. Biotransformation has also become a key technology used to produce chiral substances. It was used by many companies Eg. Celgene Corporation developed procedures to produce amines by using amino transferase (Celgene corporation,1990).The main advantage of this procedure is that it allows 100% theoretical conversion of the substrate into the final product. Membrane chirotechnology is also a widely used method for producing optically pure isomers. In this procedure, the membrane itself maybe intrinsically enantioselective. This means that the membrane represents a chiral system that separates the desired isomers on the basis of spatial conformation. On the other hand, a membrane separation process may be combined with kinetic resolution by making use of an enantiospecific biocatalyst.That is, the membrane helps in the separation of the product from the substrate on the basis of their chemical properties like solubility. Enantiospecific catalytic membrane reactors may also be used. These comprise of membrane processes which are advantageous as they have the ability to work in a continuous mode and enormous amounts of material could be processes at once. The competitive production of chiral substances requires a large scale, cheap process for the production and separation of the enantiomers. Eg. Pyridoxal phosphate dependant lyase and transferase were used as catalyst in the synthesis of L- amino acid via the carbon carbon bond formation. (Sheldon,1993) The widely used enantiospecific membrane reactors are ultrafiltration hollow fibre membrane reactor (Responsible for production of L phenylalanine by using dehydrogenase catalyst (Schimdt et al, 1987) ) immobilized enzyme membrane reactor, packed bed continuous bioreactor, biphasic membrane reactor etc. Ultra filtration, electrodialysis and membrane extraction are common separation processes that are combined with biotransformation. Matson and Quinn(1979) showed the optimization in production of amino acids enantiomers and studied the separation of L amino acids from the racemate solution by making use of an impregnated liquid membrane alone with an enzyme immobilised membrane. Production of L-phenylalanine from racemic mixture of D,L phenyl lactate was shown by 2 consecutive biotransformation in an enzyme membrane reactor whereby the enzyme and cofactor(NAD/H) had been compartmentalised behind an ultra filtration membrane.(Schmidt et al, 1987). Intrinsically enantioselective membranes are also widely used. Substances which are optically active can be separated on the basis of there physical stereo selectivity. Polymeric membranes having the enantioselective properties intrinsically may be prepared making use of chiral polymers or by chiral modifications of the achiral porous membrane in the presence of chiral recognition agent like cyclodextrins, cyclophane and oligopeptides. In order to prepare the enantioselective membranes, optically active polyacryl amides and cellulose derivatives may be used. Yoshikawa et al,1996, showed separation of tryptophan, phenylalanine and alanine by ultra filtration using the chiral selector which was molecularly imprinted polymeric membranes(DIDE derivatives). Enzymes have the ability to catalyse a broad spectrum of chemical reactions with great efficiency and selectivity under mild and environmentally friendly conditions. By exploiting the selectivity of enzymes for one form of the enantiomer of a racemic mixture, the enantiomerically enriched compound can be obtained by biocatalytic resolution.(Thomas et al,2002) Most commonly, the hydrolytic enzyme are used since they display a range of advantages like stability, specificity, no requirement of cofactors. Among hydrolases, lipase is most commonly used because of high enantioselectivity, commercial availability and good stability in various media.(Seung Hwan et al,2004) Recently a new technique was introduced to display the peptides and proteins on the surface of gram negative and gram positive bacteria, yeast or mammalian cells. This was done by fusing the peptides to surface anchoring motif; and the technique is known as cell surface display. The cell surface display lipase proved to be an excellent biocatalytic system for the kinetic chiral resolution of the racemic compound. Recent advances have shown the use of enzymes in the synthesis of optically pure drugs and biologically active compounds. Enzymes have the ability to distinguish between the enantiomers of racemic substrates. Various strategies have been developed to improve the stereoselectivity of resolutions catalysed by the enzyme. This includes modification of the substrate, recycling of the product and altering the reaction conditions. By making use of these strategies, enzymes with modest stereoselectivity can also be used but only one enantiomer is produced with high yield. Enzyme can catalyse transformations with high region selectivity and chemo selectivity under mild reactions. This is important in the modification of chiral drugs. Eg. Penicillin acylase causes the hydrolysis of benzyl penicillin without affecting the beta lactam ring and allows the industrial preparation of 6-aminopenicillanic acid which is a precursor for many semi synthetic penicillins. Enzymes (hydrolases) have success fully been used in the synthesis of chiral pharmaceuticals, however modern methods of protein engineering and industrial microbiology help in the production of enzymes which are more inexpensive, stable with broad substrate specificity and high stereoselectivity.(Alexey L.Margolin,1993) Catalytic asymmetric synthesis is the asymmetric synthesis that is catalysed by chiral (transition) metal complex. The reactions that are involved are Redox transformations or carbon carbon bond forming processes that complement enzymatic hydrolytic process. The three types of chemo catalysts that exist are heterogenous metal catalyst, homogenous complex and soluble chiral acid or bases. Emil Fishers work on asymmetric induction which was based on cyanohydrin synthesis was the first reaction subjected to asymmetric catalysis. Enantiomerically pure amino acids, amino alcohols, amines, alcohols and epoxides play an important role as intermediates in the agrochemical and pharmaceutical industry whereby high level of purity and a large quantity is required. The enantiomerically pure active compounds help in improving the economics of the process, thereby leading to reduced quantities applied and less amount of an environmental impact. Chemical process for the manufacturing of amino acids: Even though asymmetric syntheses of amino acids are known (Michael Breuer et al,2004), no economical process has been developed. Bucherer Bergs sub type which is Strecker synthesis was employed for the industrial manufacturing of the racemic amino acids. The alpha amino nitrile is produced from hydrocyanic acid, ammonia and an aldehyde and may be hydrolysed to the amino acid directly or in the presence of carbon dioxide it gets converted into hydantoin. The hydantoin is then subjected to hydrolysis in a basic media to give the racemic amino acid. Another route to the racemic amino acid is amido carbonylation in the presence of a transition metal. Although, there is no commercially viable chemical process for the synthesis of enantiomerically pure amino acid, the production of racemic amino acid is still of great importance because the racemates may be converted to enantiomerically pure compounds by various biocatalytic methods. The catalysts used in the biotransformation are metabolically inactive cells or isolated enzymes. It is the method of choice for the production of enantiomerically pure D- amino acids and various other non natural amino acids. Lyases may be used as biocatalysts in the production of L- Aspartic acid from fumaric acid (Beller et al,2000). Amino acid dehydrogenase (deaminating amino acid oxido reductase) allows enantioselective biotransformation on an industrial scale. These enzymes have low substrate specificity due to which non natural compounds may also be transformed. In addition, they also require co substrates which help in supplying the hydride ions for the reduction of Schiff base. There is also a chemo enzymatic method for amino acid synthesis. In this, L- amino acid gets oxidised by L- amino acid oxidase. Imine (intermediate) gets reduced by Pd-C in ammonium formate buffer. In the resulting racemic mixture, only L enantiomer is utilised by oxidase where as the D- enantiomer accumulates. Therefore, the enantiomeric form of the amino acid which is produced depends entirely on the specificity of the oxidase. The enantiomerically pure amino acid can also be prepared by the racemate resolution. Eg: L and D amino acid can be prepared with the Hydantoinase-carbamoylase system. Production of carboxylic acids: Carboxylic acid can be isolated from natural sources(chiral pool).Naturally occurring chiral compounds obtained from the chiral pool are an alternative to the synthesis of enantiomerically pure products. An examples of a chiral carboxylic acid that is isolated from the natural sources is L (+) tartaric acid (Mitsugi et al,1978). During the fermentation of grape, the isomeric form of tartaric acid separates out as tartarate (potassium hydrogen tartarate).On reacting with calcium chloride or calcium hydroxide and sulphuric acid, isomeric tartaric acid is released; gypsum and yeast residues occur as the by products. Natural carbohydrate building blocks were used for several decades for the preparation of sugar acids which were enantiomerically pure. Another method is the classical chemical synthesis which involves crystallization with enantiomerically pure amines. The enantiomers of the racemic carboxylic acids are known to separate by fractional crystal lization of the diastereomeric salts which are formed with the enantiomerically pure amines. Eg: Thiazolidine carboxylic acid (enantiomerically pure), an intermediate in the synthesis of CP-060- S is isolated by the resolution of racemate with N- benzyl-1-phenylethylamine. (Pompejus et al, 2001) Production of amines: The chemical process involved is the crystallization with chiral carboxylic acids. Isolation of enantiomerically pure amines can be carried out by the crystallization of diastereomeric salts of chiral carboxylic acids with chiral amines (Jacques et al,1980). Thus (R) or (S) 1- phenylethlyamine may be produced on an industrial scale by the crystallization with either (R)- mandelic acid or (S)- malic acid. Mandelic acid was shown to be an important resolving agent for numerous numbers of amines. Dutch resolution is a variant of the classical racemate resolution. In order to reduce the search for an appropriate resolving agent for an amine through combinatorial approach, a mixture of many optically active acids were used. The salt that was precipitated contained several acid anions. Production of optically active amino alcohols: (S)-2-Aminobutanol is an important amino alcohol intermediate which is used for the synthesis of ethambutol (tuberculostatic)and it must be administered in its enantiomerically pure form as it may lead to blindness. The enantiomerically pure form can be obtained from the racemate by carrying out the crystallization with L-Tartaric acid.(Sheldon et al,1993) Production of alcohols: The main process involved was the asymmetric hydrogenation of ketones. Noyori et al showed the development of asymmetric hydrogenation of keto esters and ketones. The catalysts used were ruthenium complexes of binap and derivatives like tol-binap (Akutagawa,1995)and segphos. The biotechnological process is mainly the enzyme catalysed resolution. For the resolution of racemate alcohols, enzymatic acylations were developed in early 1980s.The racemic alcohols are made to react with an acylating agent under enzyme catalysis whereby one enantiomer is unconverted whereas the other enantiomer is esterified. The biocatalysts used are bacterial and fungal lipases. Production of epoxides: This includes sharpless asymmetric dihydroxylation. The route to the formation of chiral epoxides is based on the optically active diols which may be converted to their respective oxiranes. Another method is the Jacobsen asymmetric epoxidation which is based on (salen) manganese III precatalyst and the hypochlorite is used as the stoichiometric oxidizing agent. The chemical processes may be compared with the biotransformation with respect to the environmental impact and economic efficiency. The drawbacks of the chemical routes are solvent emission or toxicity of certain compounds. On the other hand, chiral technologies are developing rapidly. Highly versatile technologies and procedures are introduced. Most chiral intermediates are produced in minute quantities. Therefore, the criteria that should be considered for the methods introduced are that they should have a broad substrate spectrum, not require specialised equipment and have a cost effective access to a range of products. It is not possible to make general conclusions about the superiority of one type of technology in comparison with the others. The most economic technique will depend on their component which is why each case should be investigated individually. However, in the overall process, the chiral step should be introduced as early as possible but this may be hindered by other factors like racemisation of the unwanted isomer. Membrane chirotechnology is also an emerging technique having several advantages with respect to the purity of simple isomers, productivity and ease of scale up. These techniques have mainly been used at the laboratory scale. Application on a large scale needs more investment especially in developing the experimental set up rather than investigations which have been carried out on chirality that have been developed in the chromatographic field.

HCS/466 Facility Planning I Essay

Strategic Planning is an essential first step in the development of a result-base accountability system,† (Schilder, 2013, p. 1). In strategic planning an organization must know their goals, missions, and how to reach them. Health care facilities are in huge demand for the elderly and for people who lives in low-income communities. A person who receives good quality health care services can prevent the spread of contagious diseases. This paper will describe the need of the community, population it is serving, and a brief description of the facility. Franklin C. Fetter Family Health Center (FCFFHC) is an outpatient clinic and has served the communities, and the surrounded rural areas since 1975. This health center is greatly needed in the rural and low-income communities because the people could not get to their local hospital. Therefore, the people in those communities were not getting the necessary medical health care needed. Dr. Franklin C. Fetter, the Dean of Medicine at the Medical University of South Carolina, and founder, provided culturally sensitive comprehensive primary health and home care services to children, and adults as part of a demonstration grant under the Medical University in 1968, (FCFFHC, 2013). The center offers support to the community by sponsoring health awareness campaigns, health fairs, and through their media. The most important need that the elderly community needed was a Home Health Department (FCFFHC, 2013). This department provides services to home bound people who cannot travel to see the doctor. Home Health have a staff of one medical doctor, physician assistant, and a nurse practitioner. According to Roberta Porterfield RN, and Home Health Manger, â€Å"The object of home health staff is to assist patients in need of intermittent skilled nursing care to arrive at a stable level of health through treatment, while teaching and involving the patients’ family,† (Porterfield, FCFFHC, 2013, p.1). The medical facility operates eight primary health sites for the residents of Berkeley, Charleston, Colleton, and Dorchester counties. The centers hours are Monday – Friday, 8 a.m. – 8 p.m. â€Å"Franklin C. Fetter mission is to provide quality, affordable, culturally sensitive comprehensive primary health and home care services to families throughout their community and surrounding areas,† (FCFFHC, 2013, p. 1). , ‘ Franklin C. Fetter Center’s services includes: (FCFFHC, 2013) Prenatal Care Infant and Adolescent Care Adult and Geriatric Care Behavioral Health Breast Examinations Cervical Cancer Screening Skilled Home Health Service Prenatal Care (OB/GYN) EPSDT/ Immunizations Family Planning The health center offers many more services to the local community (FCFFHC, 2013). The population that FCFFHC provide medical care services to is 19,325 of rural and low-income people. The Health Center serve people of all ages from newborns to adults. Patients with insurance are require to present their insurance card before he or she receive services. Patients are expect to pay the co-payment or co-insurance. Patients without insurance at 100% of poverty level are require to pay a minimum of $30. Patients who pay for his or her services are require to pay, according to the sliding fee of $40, $50, or $60. The Health Centers’ sources of revenue are generated from: Fees-for-Service, Medicare, Medicaid, Private Insurance, and Grant Funds (FCFFHC, 2013). The newest facility was built in the spring, 2013. The center is in Yonges Island, South Carolina. This is a rural and remote area with mostly elderly people with little or no income. A health care facility existed where the new site is but had to be torn down because it needed severe repair. It is a one story brick building. The clinic has a patient registration that is adjacent to the Medical Records department. The Admitting front desk consisted of two receptions who check in the patient to see his or her provider. The appointment clerk is next to the Front desk. The appointment receptionists are the people who schedules everyone appointment and cancel a no show appointment. The Pharmacy is behind the Front desk personnel. The pharmacy provides the patients with low cost medicine based on a sliding fee. The nursing department and the physician’s office are behind the â€Å"DO NOT ENTER† sign. The health clinic have a total of seven adult examination room, and four pediatric rooms. The lab is behind the nursing station in the back of the facility. The medical center have a staff of 35 people. Building new health care centers in low income and rural areas will have a huge influence on families in the community. Getting good quality health care services are essential to the everyday living. It would make the people in the community feel as if someone cares about him or her. When a community is left with nowhere to get any medical services, they tend to deal with whatever health issues he or she may have. Not possessing access to medical care can sometimes lead to terminal illness and maybe death. Families would be able get the medical services that he or she needed for his or her family. References Franklin C. Fetter Family Health Care Center, Inc.: Home Retrieved from http://www.fcfetter.com Schilder, D. (2013). Strategic Planning Process; Steps in Developing Strategic Planning. Retrieved from http://www.hfrp.org/publications-resources/browse-our-publications/strategic-planning-proc..

Definition and Examples of Cleft Sentences

In English grammar, a cleft is a construction in which some element in a sentence is moved from its normal position into a separate clause to give it greater emphasis. A cleft is also known as a  cleft sentence, a  cleft construction, and a  cleft clause. A  cleft sentence  is a sentence that is cleft (split) so as to put the focus on one part of it. The cleft sentence is introduced by  it, which is followed by a  verb phrase  whose main verb is generally  be. The focused part comes next, and then the rest of the sentence is introduced by a  relative pronoun, relative  determiner, or  relative adverb. If we take the sentence  Tom felt a sharp pain after lunch, two possible cleft sentences formed from it are  It was Tom who felt a sharp pain after lunch  and  It was after lunch that Tom felt a sharp pain. Take, for example, the simple declarative sentence, Jerry went to the movie yesterday. If you would want to emphasize one element or another, the sentence could be rewritten in several different ways: It was  Jerry  who went to the movie  yesterday.It was to the  movie  that Jerry went  yesterday.It was  yesterday  that Jerry went to the movie.   English has many different varieties of cleft constructions, but the two major types are it-clefts and wh-clefts.  Wh- clefts use  wh words, which is most often what in the construction. However, why, where, how, etc. are also possibilities. Examples and Observations It-Clefts It was only last month that  I decided to go back to school.It was my father who  sent Dyer out to proselyte.  It was my father who  had the blue-ice eye and the beard of gold.It was Roosevelt who impetuously blurted out the unconditional surrender ultimatum at a press conference in Casablanca, to the surprise of Winston Churchill, who was sitting at his side and who had no alternative but to nod approval. Wh-Clefts What I needed was a weapon. Other people, hitchhikers, told me they always carried a little something, a knife or a can of Mace, and Id laughed, thinking there was no greater weapon than the human mind. You idiot.Strange, but  what I really wanted was  a dad who would come down to the police station, ​yell his head off, and then take me home to talk about what happened, to come up with a new plan for how Id act in the future, etc. All the other guys had that. But not me. My dad left me alone in jail for the night. Sources Douglas Biber et al.,  Longman Student Grammar. Pearson, 2002George N. Crocker,  Roosevelts Road to Russia. Regnery, 1959David Crystal,  Making Sense of Grammar. Longman, 2004Zane Gray,  Riders of the Purple Sage, 1912Sidney Greenbaum,  Oxford English Grammar. Oxford University Press, 1996David Sedaris,  Naked. Little, Brown Company, 1997Michael Simmons,  Finding Lubchenko. Razorbill, 2005

Harm Of Substance Abuse During Pregnancy - Free Essay Example

Sample details Pages: 4 Words: 1312 Downloads: 7 Date added: 2019/08/16 Category Health Essay Level High school Tags: Substance Abuse Essay Did you like this example? Substance abuse during pregnancy The controversy of substance abuse during pregnancy has initiated speculation regarding matters of consequences specifically, treatment vs. punishment. There has been incredible speculation as well as various questions asked regarding this matter. Don’t waste time! Our writers will create an original "Harm Of Substance Abuse During Pregnancy" essay for you Create order Should the mother be held accountable for her actions and face the consequences or should she be given the right to appropriate treatment? In the United States there are a wide range of different stances on this issue such as a severely illicit viewpoint to where the mother should be faced with harsh punishments because of the effects dealt to the fetus to one that really emphasizes the concern of the mothers mental health and the importance of getting treatment that copes with this issue. It is hoped that by raising awareness on these issues, policy enforcers throughout the United States will consider the approach that views both the mother and fetus as humanely as possible.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The complexities of dealing with this issue are not easily overcome. There are essentially pros and cons that stem from both perspectives however, mothers facing substance abuse during pregnancy especially those who are addicted should be obligated to get professional treatment to help herself as well as her fetus as opposed to being looked down upon as a criminal who disregards human life because that just may not be the case.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Statistically, about 12% of the adult population in the United States suffers from some form of substance abuse. This number boosts to 28% if we include substance or mental health disorders which often times than not are inseparable from one another. Whats being done to punish women for facing this crisis of substance abuse during pregnancy far surpasses whats being done to combat punishment and focus on the treatment regarding the mother and the fetus. As NCBI states The cost of society of drug use including crime, health care and reduced work productivity was estimated at over 300 billion dollars annually (NCBI 1). This is far more that was spent on the treatment of substance abuse which the total expenditure was only 13 billion dollars annually in 2005. This disparity between both consequences shows that there could be far more spending for treatment programs for women facing this problem.   In addition, maternal prenatal substance abuse has always been around. Although some people may believe that the fetus must be protected and is severely invulnerable we must also engage in the mothers wellbeing and health as well. Getting treatment and help from this substance abuse crisis can result in a tremendous increase in the amount of women not facing substance abuse. By punishing them, they are not being exposed to a positive environment in which they can grow from and will result in only negative consequences. Firstly, if women are punished they are not being put in a position to cope with their problem and try and disengage in substance abuse. The punishment will only want them to continue using illicit and licit drugs. Secondly, women who are punished often face cruel stress which can lead to problematic outcomes for the fetus which can be irreversible. This starts with policymakers within and throughout the United States. One way to combat this epidemic of substance abuse during pregnancy would be behavioral interventions. In Hendree E Jones article Drug Addiction during Pregnancy: Advances in Maternal Treatment and Understanding Child Outcomes, she makes note that Drug use occurs in the absence of other positive reinforces. Thus, drug use can be eliminated by increasing the density of non-drug positive reinforces and decreasing the positive reinforces attained from substance use (Jones 127). One example of behavioral intervention would be contingency management which essentially is a system that conveys reinforcing rewards that are rectifiable for goods and services or punishing consequences that are contingent on behavior such as providing a negative drug test. Jones also states This intervention has been subsequently used in a variety of addicted populations including nicotine, heroin, and poly-drug users. In 85% of reports publ ished, this type of intervention produced significant changes in target behaviors (Jones 127-128). Another use of contingency management to help treat women who face substance abuse during pregnancy is the therapeutic workplace. Women who show results of an absence of drugs earn rewards for work related performance. In the article Evidence-Based Drug Treatment Practice and the Child Welfare System: The Example of Methadone   it makes note of the outcomes of this management program and states Over 3 years, therapeutic-work-place participants significantly increased cocaine abstinence relative to controls (54% and 28%) and opioid abstinence relative to controls (60% vs. 37%) (Lundgren 77). This demonstrates that contingency management can be an alternative to resulting to punishment for these women. This type of treatment is an incentive based program that can develop women to become substance free by eliminating those negative variables and incorporating positive variables in which women has some incentive to actually do well and try and help themselves.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Instead of punishing women for using substances while pregnant, taking into considerations of what was previously mentioned could be a viable alternative. Some counterarguments to be made about this epidemic include the crime of fetal abuse and the delivery of drugs through the umbilical cord. Women are often being committed of crime or jailed, as well as losing custody of their children. Although this may be true, most women are far more capable of being great parents to their children if the appropriate treatment and care for these women are incorporated in their daily lives and this starts with the help of our policy makers and social workers who. As Arlene Bowers Andrews states in her novel Searching for Solutions to Alcohol and Other Drug Abuse during Pregnancy: Ethics, Values, and Constitutional Principles, she makes note that Women have long been disadvantaged in the provision of health care, particularly addictions treatment and obstetrical care (Andrews 57). The novel also mentions a statement provided by the NASW (National Association of Social Workers) Code of Ethics in which they state The social worker should act to ensure that all persons have access to the resources, services, and opportunities which they require.[and should act to expand choice and opportunity for all persons, with special regard for disadvantaged or oppressed groups and persons (NASW 10). Social workers play a critical role in the advancement of care for women facing substance abuse during pregnancy. And the best way to advocate for this is by organizing all-inclusive care for their clients. With the epidemic of substance abuse during pregnancy, many would think the mother should be held accountable for her actions of fetal abuse and delivering irregular substances to the fetus. This opportunity should be taken as a way to encompass social values and while doing so implementing treatment programs such as contingency management that would result in a desired professional and safe environment for mothers who are willingly open to acknowledge their problem. By increasing the amount of non-drug reinforces that are positive and decreasing the reinforces that are positive stemming from substance abuse we can observe women to be less dependent upon substance abuse as a positive reinforcement and instead rely more upon things that are much less detriment to the health of the mother and the fetus such as prescribed medication and therapy and getting augmented treatment with professionals. Works Cited Andrews, Arlene Bowers, and Elizabeth G. Patterson. Searching for Solutions to Alcohol and Other Drug Abuse during Pregnancy: Ethics, Values, and Constitutional Principles. Social Work, vol. 40, no. 1, 1995, pp. 55–64. JSTOR, JSTOR, www.jstor.org/stable/23718350. Jones, Hendree E. Drug Addiction during Pregnancy: Advances in Maternal Treatment and Understanding Child Outcomes. Current Directions in Psychological Science, vol. 15, no. 3, 2006, pp. 126–130. JSTOR, JSTOR, www.jstor.org/stable/20183094 Lundgren, Lena M., et al. Evidence-Based Drug Treatment Practice and the Child Welfare System: The Example of Methadone. Social Work, vol. 50, no. 1, 2005, pp. 53–63. JSTOR, JSTOR, www.jstor.org/stable/23721299. National Institute on Drug Abuse. Trends Statistics. NIDA, 24 Apr. 2017, www.drugabuse.gov/related-topics/trends-statistics.