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Heroin has been a street drug along the East African coast for 25 years (Beckerleg, 1995) but it has only recently been recognised and documented (Kilonzo et al, 2001; Jones & Needle, 2005). Heroin use is risky and HIV transmission an increasing problem (McCurdy et al, 2005). Susan Beckerleg and colleagues uncover high rates of unprotected sex, excessive needle sharing and continued re‐use of old and dirty needles often kept in old tins, pockets, or as most do, hidden under rocks.

In this chapter, I examine how racial disparities in punishment for nonviolent drug crimes align with significant differences in how the black and white drug problems are constructed in media, law enforcement, and academia.

By examining differences in how the black and white drug problems have been constructed over the past 70 years for the opioids (heroin, prescription painkillers), cocaine (both powder and crack), and marijuana, I illustrate how these distinct representations of the black and white drug problems accompany more punitive policies in response to black drug epidemics even as white drug epidemics are typically met with tolerance or indifference.

Historically, powerful interest groups like media and law enforcement have benefitted from circulating myths and exaggerations about the illegal drug problem that encourage punitive drug policies. By contrast, at least some academics have benefitted from taking the opposite tack and debunking many of these myths. Unfortunately, academics have been less willing to challenge myths about the black drug problem than the white drug problem. Indeed, some academics actually reinforce many of the myths about the black drug problem promoted by media and law enforcement.

This chapter builds upon a substantial academic literature that challenges myths about illegal drug use by whites. However, it goes beyond this literature to consider the paucity of similar academic research exposing media and law enforcement myths about the black drug problem.

Stigma reduction is an important public health challenge because of the large morbidity and mortality associated with some forms of substance use. Extreme stigma can lead to dehumanisation of target groups, who are ascribed with lesser humanity. The authors examined whether there was blatant and subtle dehumanisation of people who use heroin, and if these were associated with levels of support for non-discriminatory drug policy.

A cross-sectional online study using a UK convenience sample (n = 307 [75.2% female, mean age 28.6 ± 12.2 years]) was conducted. Participants completed assessments of blatant (Ascent of Humans [AoH] scale) and subtle (an emotion attribution task) dehumanisation and a bespoke measure assessing support for non-discriminatory drug policies. Other measures controlled for stigma towards people who use drugs (PWUD) and moral disgust.

There was greater blatant dehumanisation of people who used heroin compared to the general population and other potentially stigmatised reference groups, including people who use cannabis. The authors also found evidence of subtle dehumanisation, and people who used heroin were rated as being less likely to feel uniquely human emotions, less likely to feel positive emotions and more likely to feel negative emotions. Blatant dehumanisation was associated with significantly lower probability of support for non-discriminatory drug policy.

Dehumanisation may present significant challenges for stigma reduction initiatives and in fostering public support for drug policy and treatment. Denial of the humanity of this group could be used to justify discriminatory policies or relative deprioritisation of support services in funding decisions. Activities that seek to “rehumanise” PWUD, including social inclusion, and encouraging compassionate media representations that portray the lived experiences of substance use may be useful areas of future work.

This is the first study to investigate blatant and subtle dehumanisation of people who use heroin, and how this relates to public support for drug policy.

The Omari Project has been working with heroin users in the Kenyan towns of Watamu, Malindi and Mombasa for the past five years. The paper reports on the piloting, adaptation and evaluation of motivational interviewing carried out with 20 heroin users living in coastal Kenya, a cultural context in which participatory approaches and counselling in general, and motivational interviewing in particular, are not familiar. The findings indicate that motivational interviewing was nevertheless acceptable and useful to the study participants.

One hundred and seventy‐eight heroin addicts in reformatory school were sent to one of two rehabilitation treatments: reform through education and labour and therapeutic community (TC)‐based rehabilitation programme. After six months of being discharged, pre‐ and post‐treatment scores on the Addiction Severity Index were compared, and relapse related factors were investigated. Results indicated improvements in both treatments, with the TC‐based rehabilitation programme showing superior improvement overall. Results support the efficacy of the TC‐based rehabilitation programme proving it to be better than reform through labour and education. It is suggested that psychosocial intervention and relapse prevention should be emphasised in the treatment of drug dependence.

This article reports findings from qualitative research conducted in a rural county. Crack cocaine is often used in combination with heroin with the latter drug acting as a ‘downer’ after the intense experience of crack. Users see their heroin use as a problem but not their crack use. Services are geared to opiate misuse and there is a need to consider provision for crack misuse.

The United Kingdom Ministry of Justice recently highlighted the extent of buprenorphine (Subutex) misuse in English andWelsh prisons, naming it the third most misused drug overall. Yet little is known regarding how illicit buprenorphine is obtained in prison and what influences prisoners to use it. Qualitative research was used to explore prison drug using practices. Thirty men who were former prisoners with a history of injecting drug use were interviewed in depth about their illicit prison drug use, including buprenorphine. Interviews were conducted over 18 months, from August 2006 to January 2008 and were analysed using Framework. The misuse of Subutex by snorting emerged as a significant theme. Accounts suggested that the diversion of prison prescribed Subutex was widespread and prisoners used various tactics to obtain the medication. Various complex and interlinked reasons were given to explain why Subutex was snorted in prison. The main motivation for snorting was to experience a prolonged euphoric opiate effect, believed to help to combat the boredom of being in prison. The price of illicit Subutex in prison was linked to its availability, but it was generally cheaper than heroin, thus contributing to its use. Participants’narratives identified the belief that snorting Subutex in prison was not risk free, but risks were lower than continuing to use other drugs, particularly injecting illicit opiates. The implications of prison Subutex misuse for prisoners, prison medical services, commissioners, and prescribing policy and practice are discussed.

This paper examines the believability of strong warnings about the negative consequences of drug use among young adults in Australia who have never tried, currently use, or have tried and rejected cannabis. It finds that the strong warnings about cannabis are generally believed by never‐triers. The same warnings are perceived by current users as only slightly believable. Surprisingly, but also consistent with cognitive dissonance, trier‐rejecters of cannabis are the most likely, more so even than never‐triers, to believe the warnings about cannabis. The paper also examines warnings about cocaine and heroin by cannabis usage status. Current users of cannabis, compared with non‐users, perceive the warnings about the harmful effects of cocaine as less believable, suggesting possible “gateway” susceptibility to trial of this drug. But for heroin, all groups perceive the warnings very believable. The beliefs about particular negative consequences that are most likely to lead to discontinuation of use of cannabis, and those that should discourage uptake of cocaine and heroin, are identified.

The purpose of this paper is to review the literature on the connections between illegal drugs and the informal economy and consider this in the light of the increasing levels of global interconnectedness in recent decades.

This is a review of the empirical drugs literature with a primary focus on British‐based research and analysis of the impact of different aspects of globalization.

Patterns of heroin and crack‐cocaine use need to be understood in their social, economic and cultural context, particularly in relation to their location in the informal economy. Globalizing processes have profoundly shaped local drug problems over the last 30 years.

The governance of the drug problem needs to be reframed to take account of its social economic nature and global character. New ways of thinking are required to advance future research and policy.

The focus on the impact of globalizing processes is original and leads to some important new insights for future research and policy.

The purpose of this paper is to explore the persistent negative reputation of two particular types of drug users, the so-called heroin junkie and the meth head. The visual portrayal of both kinds of users in the media has been consistent in the last decades. Inspired by films and anti-drug campaigns, stereotypical ideas about heroin and meth users dominate the visual portrayals. Existing research has already shown that this standardised picture is not applicable uniformly. Nevertheless, the important role of the visual element for constituting beliefs about drug use and users is lacking in the current drug research. Therefore, this work focusses on the visual element of the drug discourse.

On the basis of the British movie Trainspotting, and the two American campaigns Faces of Meth and Montana Meth Project the visual representation of heroin and meth users is discussed. With the help of a visual discourse analysis this research discloses the particularities of every image.

The current visual portrayal of heroin and meth users stigmatises them as deviant and unhealthy. This single-sided perspective labels all users, without acknowledging different patterns of use. Counterexamples obtained through existing research do not support this uniformly applied stereotypical representation. The persistent negative reputation mediates inaccurate knowledge about drug use, with harmful consequences for the users, and harm-reduction work.

Drug research has not been focussing enough on the visual element of the drug discourse. This research intends to close the existing gap and emphasise the possible harmful consequences produced by such visuality.