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1 – 10 of 714Anne McDonnell and Marie Van Hout
Opiate use is no longer confined to the greater urban context in Ireland, with scant detoxification services present in rural areas (Carew et al, 2009; National Advisory Committee…
Abstract
Opiate use is no longer confined to the greater urban context in Ireland, with scant detoxification services present in rural areas (Carew et al, 2009; National Advisory Committee on Drugs, 2008). This exploratory research aimed to yield an illustrative account of opiate users' experiences of self‐detoxification by adopting a grounded theory approach (Glaser & Strauss, 1967). Data emerging from 21 in‐depth interviews (n=12 heroin users, n=9 drug service providers: statutory, community and voluntary) were analysed using the constant comparative method. The study generated a substantive theory of self‐detoxification as a subjective process of seeking heroin abstinence. Self‐detoxification emerged as a frequent and reactive or proactive process in collaboration with others (heroin users, family and drug service providers). The study has implications for drug service delivery in rural Ireland in terms of increasing information provision and access to opiate detoxification through the development of low threshold services and community‐based detoxification.
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The purpose of this paper is to estimate the demand and supply of opiates in the USA during the period 1870–1914 when the market was virtually unregulated.
Abstract
Purpose
The purpose of this paper is to estimate the demand and supply of opiates in the USA during the period 1870–1914 when the market was virtually unregulated.
Design/methodology/approach
The price and quantity of opiates is econometrically estimated using a data set constructed primarily from pharmaceutical trade journals.
Findings
Per capita opiate consumption varies in inverse proportion to its price, a price elasticity of demand of unity. The supply of opiates to the USA is perfectly elastic, a horizontal line, implying the USA was a “price-taker” in the world market for opium. The number of medical schools, a proxy for the state of medical science, significantly effects opiate consumption, as does the import tariff on opium.
Research limitations/implications
Opiate use, both medicinal and addictive, is highly responsive to purely the economic forces of price and income. The influential role of the medical profession in shaping the pattern of consumption is confirmed. Data limitations prevent making substantive statements about usage of the various sub-categories of opium, requiring all opium to be treated as equivalent units of morphine sulfate.
Practical implications
Decriminalized access to opiates and other addictive substances is likely to result in a significant increase in usage, which could be controlled by taxation.
Originality/value
Prior studies of unregulated opiate demand and supply have covered Indonesia and Taiwan under colonial government monopoly, not a major western country user like the USA. Also, this paper uses a newly created consistent set of inflation-adjusted opiate prices covering a long period (1870–1914).
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Ibogaine therapy offers a viable alternative to mainstream treatment for opiate addiction. The combination of the addiction‐arresting and fast‐acting properties of ibogaine, with…
Abstract
Ibogaine therapy offers a viable alternative to mainstream treatment for opiate addiction. The combination of the addiction‐arresting and fast‐acting properties of ibogaine, with the slow and thoughtful conversation of psychoanalytical psychotherapy is a novel approach to what still remains a difficult condition to overcome.Safer than methadone, ibogaine use is steadily increasing world‐wide, and is becoming a more accepted treatment for opiate addiction. This year it has become a prescription medication in New Zealand. Howard Lotsof, who discovered the anti‐addictive properties of ibogaine 47 years ago, and who died in January 2010, devoted his life to improving access to ibogaine treatment, and instigated the first ibogaine providers' conference in Mexico in 2009.This paper explores the use of ibogaine and psychoanalytic psychotherapy in the clinic for the treatment of opiate dependency, the relationships between the two approaches, and how they differ from other treatment modalities.
Jennifer Anderson, Kit Wa Chan, Cathy Walsh and Mervyn London
The purpose of this paper is to evaluate the clinical practice for management of opiate dependence in a general hospital in‐patient population based on agreed standards and…
Abstract
Purpose
The purpose of this paper is to evaluate the clinical practice for management of opiate dependence in a general hospital in‐patient population based on agreed standards and changes of clinical practice after the introduction of a guideline.
Design/methodology/approach
A complete cycle of audit was carried out based on the agreed guideline, which was introduced after the first cycle. Data were obtained, using a standardized audit form, over two one‐year periods, by cross‐sectional analysis of case notes for patients identified as having been dispensed methadone whilst an in‐patient.
Findings
There were significant increases in: referral to the specialist service whilst an in‐patient (p=0.01); referral to the addiction services on discharge (p<0.001) and providing information about the addiction diagnosis to GP (p<0.001). However, there was no improvement in the documented history and examination related to aspects of addiction, some of which were consistently low. Of most concern were significant decreases in the history documented for opiate withdrawal symptoms and alcohol consumption.
Research limitations/implications
The method used may not reflect actual clinical practice, only captures opiate‐dependent patients prescribed methadone and does not establish the extent of awareness of the new guideline.
Practical implications
The paper identifies a variation in clinical practice of management of patients with opiate dependence in the general hospital. Though there were some significant improvements, further improvement and continual evaluation are needed.
Originality/value
The paper identifies the need to study how co‐morbid opiate dependence is managed in the acute hospital setting.
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Emery R. Eaves, Ricky L. Camplain, Monica R. Lininger and Robert T. Trotter II
The purpose of this paper is to characterize the relationship between adverse childhood experiences (ACEs) and substance use among people incarcerated in a county jail.
Abstract
Purpose
The purpose of this paper is to characterize the relationship between adverse childhood experiences (ACEs) and substance use among people incarcerated in a county jail.
Design/methodology/approach
A questionnaire was administered to 199 individuals incarcerated in a Southwest county jail as part of a social-epidemiological exploration of converging comorbidities in incarcerated populations. Among 96 participants with complete ACEs data, the authors determined associations between individual ACEs items and a summative score with methamphetamine (meth), heroin, other opiates and cocaine use and binge drinking in the 30 days prior to incarceration using logistic regression.
Findings
People who self-reported use of methamphetamine, heroin, other opiates or cocaine in the 30 days prior to incarceration had higher average ACEs scores. Methamphetamine use was significantly associated with living with anyone who served time in a correctional facility and with someone trying to make them touch sexually. Opiate use was significantly associated with living with anyone who was depressed, mentally ill or suicidal; living with anyone who used illegal street drugs or misused prescription medications; and if an adult touched them sexually. Binge drinking was significantly associated with having lived with someone who was a problem drinker or alcoholic.
Social implications
The findings point to a need for research to understand differences between methamphetamine use and opiate use in relation to particular adverse experiences during childhood and a need for tailored intervention for people incarcerated in jail.
Originality/value
Significant associations between methamphetamine use and opiate use and specific ACEs suggest important entry points for improving jail and community programming.
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C. N. E. Tompkins, N. M. J. Wright, M. G. Waterman and L. Sheard
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…
Abstract
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.
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Abstract
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This study explores how the provision of opiate substitution therapy to pregnant women could achieve a reduction in heroin use. It further explores whether such a reduction is…
Abstract
This study explores how the provision of opiate substitution therapy to pregnant women could achieve a reduction in heroin use. It further explores whether such a reduction is accompanied by an increase in alcohol consumption, and concludes that women do not substitute decreased opiate use with increased alcohol consumption during pregnancy. Thirty women who had been pregnant and in drug treatment at a community drug team in Dudley West Midlands agreed to participate in this study. For many, this was an opportunity to express their fears and anxieties about being drug‐using mothers and being in drug treatment. Data was collected by semi‐structured interviews and collection of urine samples.
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There is limited research documenting recovery experiences of residential service users. The purpose of this paper is to explore the perceptions service users on methadone have…
Abstract
Purpose
There is limited research documenting recovery experiences of residential service users. The purpose of this paper is to explore the perceptions service users on methadone have about recovery. In depth, semi structured 1-1 interviews with seven poly drug using homeless males between the ages of 37 and 46 and analysed using NVivo software. Results are presented thematically. Participants conform to “recovery” norms allowing stigma and shame of illicit drug use to be attributed to former addict identities. Participants on methadone maintenance report inner conflict arising from changing societal and cultural norms that equate recovery with abstinence. Tensions were revealed in true motivations for active rather than passive participation in adopting group work norms.
Design/methodology/approach
A qualitative design utilises small numbers of participants to gather rich data. In depth, semi structured 1-1 interviews conducted with seven poly drug using homeless males who have completed between ten and 15 weeks of a minimum 26-week residential treatment programme. Participants were aged 37-46. Results were analysed thematically using NVivo software.
Findings
Participants conform to “recovery” norms allowing stigma and shame of illicit drug use to be attributed to a former stigmatised addict identity. Participants on methadone maintenance report inner conflict arising from changing societal and cultural norms regards recovery and abstinence. A significant process of recovery involved adopting the norms of 12-step groups and TC therapy to gain enough trust to leave the therapeutic community (TC) unsupervised. This created tension regards motivation, were these individuals in recovery, or merely “faking it”?
Research limitations/implications
A female perspective may have provided a more balanced discussion and yielded greater depth in results. Only one service was studied and the findings may be specific to that cohort. The duration of stay at the service of ten to 15 weeks is a relatively short time and excluded participants resident for six months or more. Longer term residents may have been more reflective and informative.
Practical implications
Encourage active options and increased debate on the variety of treatment options available to long term homeless opiate users who have failed to comply with previous treatments. While this is a small modest study, the rich data yields practical advice for policy makers and service providers.
Social implications
This research study adds to an informed perspective by encouraging debate on methadone as a challenge to definitions of recovery that infer abstinence as a key definition of success.
Originality/value
There is a paucity of research documenting a Scottish TC service user perspective using qualitative methods on experiences of addiction, treatment and recovery.
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In this chapter, the author examines the way in which the purchase and delivery infrastructure of darknet cryptomarkets shapes the experience of opiate drug use and dependence. It…
Abstract
In this chapter, the author examines the way in which the purchase and delivery infrastructure of darknet cryptomarkets shapes the experience of opiate drug use and dependence. It uses the concept of social time and posits that the illicit drug distribution system reshapes two temporal dimensions shaping the experience of drug users. There is the experience of time located in the pharmacology of the drug and in the body of the drug user, which evokes experiences of withdrawal and dependence. Then there is the socio-technical embedding of the delivery system and governance structures which support or impinge on the autonomy of the user. This ‘drug time’ is both a benefit and a cost of engaging in cryptomarket use. The market infrastructure can give users the opportunities to more carefully manage their drug time, while also creating new risks of non-delivery that can sharpen experiences of dope sickness. The author concludes that the growing professionalisation, digitisation, and commercialisation of the drug market increasingly embed drug time in material infrastructures mediated through technical systems.
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