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Using Telecare to Treat Opioid Use Disorder: An Ethnographic Study in New York During COVID-19 使用远程护理治疗阿片类药物使用障碍:新冠肺炎期间纽约的民族志研究
Q3 SUBSTANCE ABUSE Pub Date : 2021-09-16 DOI: 10.1177/00914509211046705
Christopher P. Caulfield
This paper presents an in-person and digital ethnography of people in New York State who use drugs and seek treatment for opioid use disorder (OUD) using phone or video connection to receive healthcare (telecare) including interviews prior to and during the COVID-19 pandemic. This article leverages a Feminist and Science and Technology Studies (STS) approach to elucidate how the framing of the opioid crisis shapes the interconnections that are discernable, providing a heuristic to understand the increased rates of deaths due to drug overdose during the pandemic. The narratives of people seeking treatment are analyzed through the theoretical lenses of Nelly Oudshoorn’s concept of the technogeography of care, Nancy Campbell’s concept of technologies of suspicion, and Nancy Fraser’s analysis of the US juridical-administrative-therapeutic in/justice system. This paper traces and problematizes how telecare contributes to redefining the experience of familiar places, such as home, into spaces of both care and surveillance, and how the technology of telecare presents both affordances and foreclosures to accessing care as people struggle to conform with its requirements in order to receive care. Key findings are, (1) the significance of hugs and tactile connection that is sorely missed by people using telecare for group therapy, (2) the critical importance of proximity to in-person services even while using telecare, (3) the resistance strategies of telecare users to surveillance mechanisms, and (4) the continued stigmatization of drug use and treatment acts as a key barrier to people who are striving to produce the identity of a patient who is clinically stable for take-home medication.
本文介绍了纽约州使用药物并通过电话或视频连接寻求阿片类药物使用障碍(OUD)治疗的人的住院和数字民族志,以接受医疗保健(电视护理),包括新冠肺炎大流行之前和期间的访谈。这篇文章利用女权主义和科学技术研究(STS)的方法来阐明阿片类药物危机的框架如何塑造可辨别的相互联系,为理解疫情期间因药物过量而增加的死亡率提供了一种启发。通过Nelly Oudshoorn的护理技术地理学概念、Nancy Campbell的怀疑技术概念和Nancy Fraser对美国司法行政治疗/司法系统的分析等理论视角,分析了人们寻求治疗的叙事。本文追踪并探讨了远程护理如何有助于将熟悉的地方(如家)的体验重新定义为护理和监督的空间,以及在人们努力满足其要求以获得护理时,远程护理技术如何为获得护理提供可负担性和止赎性。关键发现是,(1)使用远程护理进行集体治疗的人非常怀念拥抱和触觉连接的重要性,(2)即使在使用远程护理的同时,接近面对面服务的重要性,以及(4)对药物使用和治疗的持续污名化是人们努力创造一个临床上稳定的患者身份的一个关键障碍。
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引用次数: 4
Ephemeral Infrastructures of Drug Smuggling Mobilities 毒品走私流动的短暂基础设施
Q3 SUBSTANCE ABUSE Pub Date : 2021-09-16 DOI: 10.1177/00914509211045598
Javier Guerrero C., Craig Martin
The study of drug smuggling has often taken an organizational perspective whereby the structures of how smuggling is constituted predominate. Building on a growing body of scholarship addressing the networked complexities of drug smuggling this article considers the importance of distinct infrastructural arrangements. Its primary focus is on the materiality of drug smuggling infrastructures, and how the social, spatial and temporal qualities of these configurations overlap with licit mobility infrastructures, including intersections of visibility/invisibility, stability, and permanence. The core conceptual premise, drawn from Science and Technology Studies, is that drug smuggling mobilities are formed of ephemeral infrastructures that exhibit temporary, short-lived stability and permanence through the subversion of licit infrastructural configurations. Drawing on material from El Dorado Airport, Colombia, the paper examines the everyday artefacts which constitute these ephemeral infrastructures.
对毒品走私的研究往往从组织的角度出发,走私的构成结构占主导地位。在研究毒品走私网络复杂性的学术成果日益增多的基础上,本文考虑了不同基础设施安排的重要性。它的主要重点是毒品走私基础设施的物质性,以及这些结构的社会、空间和时间性质如何与合法的流动基础设施重叠,包括可见性/不可见性、稳定性和持久性的交叉点。从《科学与技术研究》中得出的核心概念前提是,毒品走私活动是由短暂的基础设施构成的,这些基础设施通过颠覆合法的基础设施结构,表现出暂时、短暂的稳定性和持久性。利用哥伦比亚埃尔多拉多机场的材料,本文研究了构成这些短暂基础设施的日常人工制品。
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引用次数: 0
Enacting Fentanyl Tests Strips for Overdose Prevention: The Socio-Material Transformation of “Suspect Technologies” into “Technologies of Solidarity” 制定芬太尼试纸条预防过量用药:从“可疑技术”到“团结技术”的社会物质转变
Q3 SUBSTANCE ABUSE Pub Date : 2021-09-06 DOI: 10.1177/00914509211038352
N. Campbell
Fentanyl Test Strips (FTS) make possible rapid visual determinations of whether or not fentanyl is present in a given drug supply. This article places FTS within the historical contexts of drug-checking for drug control, overdose prevention, and harm reduction in North America. Following Fentanyl Test Strips (FTS) as artifacts made to signify and enact possibilities other than those for which they were developed and licensed, this article contributes to socio-material theorization of drug control, overdose prevention, and harm reduction in relation to the agency, empowerment, and liveliness of drug users through enactment of the policy and practice of off-label use. The socio-materialities of FTS co-constitute their semiotics and their interpretive flexibility within prevailing forms of evidence-based reasoning that have transformed clinical practice over past decades. They offer new renderings of facticity and artifactuality, which I connect to Ludwik Fleck’s work on the Wasserman test in Genesis and Structure of a Scientific Fact. Reading both the materiality and the semiotics of FTS as artifacts provides a hybrid concept of socio-materiality attentive to the social and material relations embedded in and embodied by FTS, and those who use them in both intended and unintended ways. Such uses differ from individualized expertise and evaluation taken as contributory to the evidence base of the global North. The political work of articulating between different grounds of struggle is underway among those seeking to distribute FTS more widely. But it is their sociomaterial flexibility that makes these artifacts move into new relations that sustains the more affective and artisanal forms of political and cultural recognition characterized in this article as “artifactual” use for an alterbiopolitics.
芬太尼测试条(FTS)可以快速目视确定给定药物供应中是否存在芬太尼。本文将FTS置于北美药物管制、过量预防和减少危害的药物检查的历史背景下。芬太尼测试条(FTS)是一种人工制品,旨在表示和实施除其开发和许可外的其他可能性,本文通过制定标签外使用的政策和实践,为药物控制、过量预防和减少与吸毒者的代理、授权和活力相关的伤害的社会物质理论做出了贡献。FTS的社会物质性在过去几十年中改变了临床实践的循证推理的主流形式中共同构成了它们的符号学和解释灵活性。它们提供了真实性和人为性的新呈现,我将其与Ludwik Fleck在《科学事实的起源和结构》中关于Wasserman测试的工作联系起来。将FTS的物质性和符号学视为人工制品,提供了一个社会物质性的混合概念,关注FTS中嵌入和体现的社会和物质关系,以及那些以有意和无意的方式使用它们的人。这种用途不同于被视为有助于全球北方证据基础的个性化专业知识和评估。在那些寻求更广泛地分发FTS的人中,阐明不同斗争理由的政治工作正在进行中。但正是它们的社会物质灵活性使这些人工制品进入了新的关系,从而维持了更具情感和手工形式的政治和文化认可,本文将其描述为对另类生物政治的“人工”使用。
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引用次数: 1
Where, When and With Whom: Cannabis Use, Settings and Self-Regulation Rules 在哪里、何时以及与谁在一起:大麻的使用、设置和自律规则
Q3 SUBSTANCE ABUSE Pub Date : 2021-09-01 DOI: 10.1177/00914509211033921
Kostas Skliamis, A. Benschop, N. Liebregts, D. Korf
This article examines to what extent and how cannabis users in different countries, with different cannabis legislation and policies practice normalization and self-regulation of cannabis use in everyday life. Data were collected in a survey among a convenience sample of 1,225 last-year cannabis users aged 18–40 from seven European countries, with cannabis policies ranging from relatively liberal to more punitive. Participants were recruited in or in the vicinity of Dutch coffeeshops. We assessed whether cannabis users experience and interpret formal control and informal social norms differently across countries with different cannabis policies. The findings suggest that many cannabis users set boundaries to control their use. Irrespective of national cannabis policy, using cannabis in private settings and setting risk avoidance rules were equally predominant in all countries. This illustrates that many cannabis users are concerned with responsible use, demonstrating the importance that they attach to discretion. Overall, self-regulation was highest in the most liberal country (the Netherlands). This indicates that liberalization does not automatically lead to chaotic or otherwise problematic use as critics of the policy have predicted, as the diminishing of formal control (law enforcement) is accompanied by increased importance of informal norms and stronger self-regulation. In understanding risk-management, societal tolerance of cannabis use seems more important than cross-national differences in cannabis policy. The setting of cannabis use and self-regulation rules were strongly associated with frequency of use. Daily users were less selective in choosing settings of use and less strict in self-regulation rules. Further differences in age, gender, and household status underline the relevance of a differentiated, more nuanced understanding of cannabis normalization.
本文探讨了不同国家的大麻使用者在多大程度上以及如何在不同的大麻立法和政策下对日常生活中的大麻使用进行规范化和自我监管。去年,一项调查对来自七个欧洲国家的1225名18-40岁的大麻使用者进行了便利抽样,收集了数据,大麻政策从相对自由到更严厉不等。参与者是在荷兰咖啡店内或附近招募的。我们评估了不同大麻政策国家的大麻使用者对正式控制和非正式社会规范的体验和解释是否不同。研究结果表明,许多大麻使用者设定了控制其使用的界限。无论国家大麻政策如何,在私人环境中使用大麻和制定规避风险规则在所有国家都同样占主导地位。这表明,许多大麻使用者关心负责任的使用,表明他们重视自由裁量权。总体而言,在最自由的国家(荷兰),自我监管最高。这表明,自由化并不会像政策批评者所预测的那样自动导致混乱或其他有问题的使用,因为正式控制(执法)的减少伴随着非正式规范和更强有力的自我监管的重要性增加。在理解风险管理方面,社会对大麻使用的容忍似乎比大麻政策的跨国家差异更重要。大麻使用和自律规则的制定与使用频率密切相关。日常用户在选择使用环境方面没有那么挑剔,在自律规则方面也没有那么严格。年龄、性别和家庭状况的进一步差异突显了对大麻正常化有区别、更细致理解的相关性。
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引用次数: 2
Possessing Drugs, Possessing Rights: Harm Reduction and Drug Policy Reform in Argentina 拥有毒品,拥有权利:阿根廷减少危害和毒品政策改革
Q3 SUBSTANCE ABUSE Pub Date : 2021-09-01 DOI: 10.1177/00914509211034006
Shana Harris
Argentina’s national drug law, Law 23.737, has been in effect since 1989. Based on prohibitionist drug policy, this law was intended to severely punish drug traffickers and protect the public from drug use-related health concerns. However, it has failed to achieve these goals, and instead targets people who use drugs (PWUD) and brands them “criminals.” In response, the Argentine government announced its intent to reform Law 23.737 in 2008, sparking widespread debate among health, legal, and social service professionals. This article discusses this debate from the perspective of harm reductionists, those who work to reduce the negative effects of drug use rather than eliminate drug use or ensure abstinence. Drawing on archival research and 16 months of ethnographic fieldwork in Argentina, this article examines the positionality of harm reductionists in this drug policy reform, particularly the controversial proposal to decriminalize drug possession for personal use. Demonstrating their contention that Argentina’s legal apparatus is a major contributor to PWUD’s discrimination, stigmatization, and isolation from health and social services, I argue that challenging these problems through policy engagement allows Argentine harm reductionists to draw attention to the broader question of PWUD’s rights and to ultimately recast PWUD as rights-bearing citizens.
阿根廷的国家禁毒法第23.737号法律自1989年起生效。这项法律以禁毒政策为基础,旨在严惩毒贩,保护公众免受与吸毒有关的健康问题的影响。然而,它未能实现这些目标,而是以吸毒者为目标,并将他们称为“罪犯”。作为回应,阿根廷政府于2008年宣布打算改革第23.737号法律,这在卫生、法律和社会服务专业人士中引发了广泛的争论。本文从减少伤害论者的角度讨论了这场辩论,他们致力于减少药物使用的负面影响,而不是消除药物使用或确保禁欲。根据档案研究和阿根廷16个月的民族志实地调查,本文考察了减少伤害论者在这场毒品政策改革中的地位,特别是将个人使用毒品合法化的有争议的提议。证明他们的论点,即阿根廷的法律机构是PWUD歧视、污名化和与卫生和社会服务隔绝的主要原因,我认为,通过政策参与来挑战这些问题,可以让阿根廷减少伤害论者引起人们对PWUD权利这一更广泛问题的关注,并最终将PWUD重塑为有权利的公民。
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引用次数: 0
Women Who Inject Drugs (WWID): Stigma, Gender and Barriers to Needle Exchange Programmes (NEPs) 注射毒品妇女:耻辱感、性别和针头交换规划的障碍
Q3 SUBSTANCE ABUSE Pub Date : 2021-09-01 DOI: 10.1177/00914509211035242
Kirsten Gibson, F. Hutton
Global evidence suggests that experiences of access to Needle Exchange services are gendered and that women who inject drugs (WWID) access needle exchange services differently to men. Despite being a significant proportion of injecting drug users, women’s voices and experiences have often been silenced in studies around harm reduction service provision, hampering the development of harm reduction services for WWID. This article highlights the experiences of four women and one trans man who have previously injected drugs, in accessing needle exchange programmes (NEPs) in a New Zealand context. Semi-structured qualitative interviews were carried out with five participants and thematic analysis of the interviews produced three core themes: how stigma permeates WWIDs’ lives; barriers in accessing needle exchange services; and how experiences within a drugs context are gendered. Stigma was an overwhelming issue affecting WWID which also acted as a barrier to their access of NEPs. The WWID in our study in terms of Goffman’s original theorizing were “doubly discredited” as well as “precariously discreditable” due to their gender and injection drug using status. The participants keenly felt their stigmatized status through interactions with pharmacy-based needle exchange staff, perceiving that pharmacy staff viewed them as more contaminated than their male counterparts. Gendered relationships were also noted in injection practices, although initiation for this group of WWID was done by intimate partners as well as friends, dispelling the stereotype of WWID as passive victims. Some participants also learnt to self-inject which gave them a sense of empowerment and freedom as they did not have to rely on others to help them. The social structures that support stigmatizing tropes about WWID need to be addressed as well as more local interventions to prevent stigma in NEPs, alongside women focused services.
全球证据表明,获得针头交换服务的经历是性别化的,注射毒品(WWID)的女性获得针头交换的服务与男性不同。尽管女性在注射毒品使用者中占很大比例,但在有关减少伤害服务提供的研究中,女性的声音和经历往往被压制,阻碍了二战减少伤害服务的发展。本文重点介绍了四名曾注射过药物的女性和一名跨性别男性在新西兰参与针头交换计划(NEP)的经历。对五名参与者进行了半结构化的定性访谈,访谈的主题分析产生了三个核心主题:污名如何渗透到二战受害者的生活中;获得针头交换服务的障碍;以及毒品背景下的经历是如何被性别化的。污名是影响第二次世界大战的一个压倒性问题,这也成为他们获得《国家环境政策》的障碍。根据戈夫曼最初的理论,我们研究中的二战由于其性别和注射毒品使用状况而“双重不可信”和“不稳定不可信”。参与者通过与药房针头交换工作人员的互动,敏锐地感受到了自己被污名化的地位,他们认为药房工作人员认为他们比男性同行更受污染。在注射实践中也注意到了性别关系,尽管这组二战的发起人是亲密伴侣和朋友,消除了二战被动受害者的刻板印象。一些参与者还学会了自我注入,这给了他们一种赋权和自由的感觉,因为他们不必依赖他人来帮助他们。需要解决支持二战污名化比喻的社会结构,以及更多的地方干预措施,以防止非符合国家政策者的污名化,同时提供以妇女为重点的服务。
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引用次数: 13
Geoffrey Hunt, Contemporary Drug Problems Board Member, Wins Major International Award 杰弗里·亨特,当代毒品问题委员会成员,荣获重大国际奖
Q3 SUBSTANCE ABUSE Pub Date : 2021-09-01 DOI: 10.1177/00914509211034653
G. Hunt
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引用次数: 0
Narratives of Change: Identity and Recognition Dynamics in the Process of Moving Away From a Life Dominated by Drug Use 变化的叙事:摆脱吸毒主导生活过程中的身份和认知动态
Q3 SUBSTANCE ABUSE Pub Date : 2021-09-01 DOI: 10.1177/00914509211027075
In Robertson, Hildegunn Sagvaag, L. B. Selseng, Sverre Nesvaag
The concepts of identity and recovery capital are recognized as being an embedded part of moving away from a life dominated by drug use. However, the link between these two concepts and the effect of broader social structures, and the normative assumptions underpinning the condition of recovery, is less explored. This article focuses on the social practices of everyday life in the foreground of identity formation, meaning that “who I am” is an inseparable part of “what I do.” A narrative approach was employed to analyze qualitative follow-up data extracted from 48 in-depth interviews with 17 males and females with drug-using experience that were conducted posttreatment on three separate occasions over a period of 2.5 years. Theories of identity formation were employed to analyze the interdependent dynamic between social structure, persona and social resources, and way of life and identity. The analyses identified four narratives related to how people present themselves through the process of changing practices. Following the work of Honneth, we argue that the positive identity formation revealed in these narratives is best understood as a struggle for recognition via the principle of achievement. However, the participants’ self-narratives reflected cultural stories—specified as formula stories—of “normality,” “addiction,” and the “addict,” which work into the concepts of self and confine options of storying experiences during the recovery process. This study demonstrate that the process of recovery is culturally embedded and constitutes a process of adaption to conventional social positions and roles. We suggest challenging dominant discourses related to “addiction as a disease” and “normality” in order to prevent stigma related to drug use and recovery. In so doing, it may contribute to broaden conditions for identity (trans)formation for people in recovery.
身份和恢复资本的概念被认为是摆脱吸毒主导的生活的重要组成部分。然而,这两个概念与更广泛的社会结构的影响之间的联系,以及支撑复苏条件的规范假设,却很少被探索。本文关注的是身份形成前景中日常生活中的社会实践,意思是“我是谁”是“我做什么”不可分割的一部分。本文采用叙事法对17名有吸毒经历的男性和女性进行48次深度访谈,随访时间为2.5年,访谈时间为3次。运用身份形成理论分析社会结构、人格与社会资源、生活方式与身份之间的相互依存动态关系。分析确定了四种叙述,这些叙述与人们在改变实践的过程中如何表现自己有关。根据Honneth的研究,我们认为这些叙事中揭示的积极身份形成最好理解为通过成就原则获得认可的斗争。然而,参与者的自我叙述反映了“正常”、“成瘾”和“成瘾”的文化故事,这些故事被指定为公式故事,这些故事融入了自我的概念,并限制了在康复过程中故事经历的选择。本研究表明,恢复过程是文化嵌入的,构成了对传统社会地位和角色的适应过程。我们建议挑战与“成瘾作为一种疾病”和“正常”有关的主流话语,以防止与吸毒和康复有关的耻辱。这样做,它可能有助于扩大恢复中的人的身份(转变)形成的条件。
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引用次数: 6
The Sober Professor: Reflections on the Sober Paradox, Sober Phobia, and Disclosing an Alcohol Recovery Identity in Academia 清醒的教授:对清醒悖论、清醒恐惧症的反思,以及在学术界揭露酒精恢复身份
Q3 SUBSTANCE ABUSE Pub Date : 2021-09-01 DOI: 10.1177/00914509211031092
Victoria F. Burns
Fueled by stigma, individuals in, or seeking recovery from addiction struggle with disclosure across personal and professional life domains. Guided by the concepts of stigma and alcogenic environments, this paper explores the risks, benefits, and paradoxes of disclosing an alcohol addiction recovery identity from the perspective of an assistant professor in a Canadian university context. It argues that disclosure can be a promising way to strengthen personal recovery, combat self and public stigma, help build community, model authenticity and transparency in teaching and research roles, shift university drinking culture, and provide a safer environment for others to disclose and/or seek help for addiction. Policy and practice recommendations are provided.
在污名化的推动下,处于成瘾状态或寻求从成瘾中恢复的个人在个人和职业生活领域的披露方面举步维艰。本文以污名和酒精环境的概念为指导,从加拿大大学助理教授的角度探讨了披露酒精成瘾康复身份的风险、好处和悖论。它认为,披露可能是一种很有前途的方式,可以加强个人康复,打击自我和公众的污名,帮助建立社区,树立教学和研究角色的真实性和透明度,改变大学饮酒文化,并为他人披露和/或寻求成瘾帮助提供一个更安全的环境。提供了政策和实践建议。
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引用次数: 6
Auras of Detection: Power and Knowledge in Drug Prohibition 侦测的光环:禁毒的力量与知识
Q3 SUBSTANCE ABUSE Pub Date : 2021-08-04 DOI: 10.1177/00914509211035487
J. Carroll
Drug checking is an evidence-based strategy for overdose prevention that continues to operate (where it operates) in a legal “gray zone” due to the legal classification of some drug checking tools as drug paraphernalia—the purview of law enforcement, not public health. This article takes the emergence of fentanyl in the U.S. drug supply as a starting point for examining two closely related questions about drug checking and drug market expertise. First, how is the epistemic authority of law enforcement over the material realities of the drug market produced? Second, in the context of that authority, what are the socio-political implications of technologically advanced drug checking instruments in the hands of people who use drugs? The expertise that people who use drugs maintain about the nature of illicit drug market and how to navigate the illicit drug supply has long been discounted as untrustworthy, irrational, or otherwise invalid. Yet, increased access to drug checking tools has the potential to afford the knowledge produced by people who use drugs a technological validity it has never before enjoyed. In this article, I engage with theories of knowledge production and ontological standpoint from the field of science, technology, and society studies to examine how law enforcement produces and maintains epistemic authority over the illicit drug market and to explore how drug checking technologies enable new forms of knowledge production. I argue that drug checking be viewed as a form of social resistance against law enforcement’s epistemological authority and as a refuge against the harms produced by drug criminalization.
毒品检查是一种以证据为基础的预防过量使用的策略,由于一些毒品检查工具在法律上被归类为毒品用具,属于执法部门的职权范围,而不是公共卫生部门的职权范围,因此它继续在法律的“灰色地带”运作(在它运作的地方)。本文以芬太尼在美国药物供应中的出现为起点,研究两个密切相关的问题,即药物检查和药物市场专业知识。首先,执法部门对毒品市场物质现实的认知权威是如何产生的?第二,在这种权威的背景下,技术先进的药物检查仪器在吸毒者手中的社会政治影响是什么?长期以来,吸毒者所掌握的关于非法毒品市场的性质以及如何驾驭非法毒品供应的专业知识一直被认为是不可信的、不合理的或无效的。然而,增加获得药物检查工具的机会有可能使吸毒者所产生的知识具有前所未有的技术有效性。在这篇文章中,我从科学、技术和社会研究领域的知识生产理论和本体论观点出发,研究执法部门如何产生和维持对非法毒品市场的认识权威,并探索毒品检查技术如何使知识生产的新形式成为可能。我认为,毒品检查应被视为一种对执法认识论权威的社会抵抗形式,也是一种对毒品定罪所产生的危害的避难所。
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引用次数: 9
期刊
Contemporary Drug Problems
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