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Perrin S, Bertrand K, Langlois E. Avoiding the stigma. A qualitative study of socially included women's experiences of drug use and dealing, health services and the police in France. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 87:102850. [PMID: 32665146 DOI: 10.1016/j.drugpo.2020.102850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 10/23/2022]
Abstract
The figure of drug user and dealer is stigmatized, linked to violence and illness. This is due to a reductionist discourse which implements othering processes generating scapegoat figures in the drug world. All drug users and sellers are assimilated with these spoiled identities in the media or in drug policies, while the reality is much more diverse. This article draws on relational sociology to focus on figures who are the antithesis of stereotypes: socially integrated women who use or sell drugs (WUSD) and are invisible to the health and control enforcement agencies. By seeking to avoid the stigma of the drug user's and dealer's identities, how do socially included WUSD distance themselves from the control enforcement agencies and health institutions? This qualitative research is based on 26 semi-structured interviews conducted with socially included WUSD in France. Participants were recruited using a snowball sampling strategy. It appears that the participants normalized their drug use and integrated it into their professional and personal lives. Some were drug user-dealers and had social supply practices, selling the drugs they used to their friends in order to finance their consumption. None of the participants have ever been in contact with harm reduction and addiction services, both because they do not identify with the users of these services, and because these services are not designed to support this population. With the police, the participants play gender games and show their social inclusion to protect themselves from arrest. In both cases, the stigmatized figure of the drug user and drug seller alienate the participants from the health systems and control enforcement agencies. One of the consequences of the othering process is the invisibility of those who do not want to be identified as "others" by the health and law enforcement services. Rethinking drug policy is essential to reach populations that may need information and support.
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Affiliation(s)
- Sarah Perrin
- Centre Emile Durkheim, Sociology Department, Université de Bordeaux, 3ter Place de la Victoire, 33 000 Bordeaux, France.
| | - Karine Bertrand
- Addiction Research and Study Program, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC J4K 0A8
| | - Emmanuel Langlois
- Centre Emile Durkheim, Sociology Department, Université de Bordeaux, 3ter Place de la Victoire, 33 000 Bordeaux, France
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Morin KA, Eibl JK, Franklyn AM, Marsh DC. The opioid crisis: past, present and future policy climate in Ontario, Canada. Subst Abuse Treat Prev Policy 2017; 12:45. [PMID: 29096653 PMCID: PMC5667516 DOI: 10.1186/s13011-017-0130-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/18/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Addressing opioid use disorder has become a priority in Ontario, Canada, because of its high economic, social and health burden. There continues to be stigma and criticism relating to opioid use disorder and treatment options. The result has been unsystematic, partial, reactive policies and programs developed based on divergent points of view. The aim of this manuscript is to describe how past and present understandings, narratives, ideologies and discourse of opioid use, have impacted policies over the course of the growing opioid crisis. COMMENTARY Assessing the impact of policy is complex. It involves consideration of conceptual issues of what impacts policy change. In this manuscript we argue that the development of polices and initiatives regarding opioids, opioid use disorder and opioid agonist treatment in the last decade, have been more strongly associated with the evolution of ideas, narratives and discourses rather than research relating to opioids. We formulate our argument using a framework by Sumner, Crichton, Theobald, Zulu, and Parkhurs. We use examples from the Canadian context to outline our argument such as: the anti- drug legislation from the Canadian Federal Conservative government in 2007; the removal of OxyContin™ from the drug formulary in 2012; the rapid expansion of opioid agonist treatment beginning in the early 2000s, the unilateral decision made regarding fee cuts for physicians providing opioid agonist treatment in 2015; and the most recent implementation of a narcotics monitoring system, which are all closely linked with the shifts in public opinion and discourse at the time of which these policies and programs are implemented. CONCLUSION We conclude with recommendations to consider a multifactorial response using evidence and stakeholder engagement to address the opioid crisis, rather than a reactive policy approach. We suggest that researchers have an important role in shaping future policy by reframing ideas through knowledge translation, formation of values, creation of new knowledge and adding to the quality of public discourse and debate.
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Affiliation(s)
| | - Joseph K Eibl
- Northern Ontario School of Medicine, Sudbury, ON, P3E 2C6, Canada
| | | | - David C Marsh
- Northern Ontario School of Medicine, Sudbury, ON, P3E 2C6, Canada.
- Canadian Addiction Treatment Centres, Richmond Hill, ON, Canada.
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Roncero C, Daigre C, Barral C, Ros-Cucurull E, Grau-López L, Rodríguez-Cintas L, Tarifa N, Casas M, Valero S. Neuroticism associated with cocaine-induced psychosis in cocaine-dependent patients: a cross-sectional observational study. PLoS One 2014; 9:e106111. [PMID: 25254365 PMCID: PMC4177812 DOI: 10.1371/journal.pone.0106111] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 07/24/2014] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Cocaine consumption can induce transient psychotic symptoms, which has been correlated with more severe addiction and aggressive behavior. However, little is known about the nature of the relationship between personality traits and psychotic symptoms in cocaine-dependent patients. This study examined the relationship between neuroticism and cocaine-induced psychosis. METHODS A total of 231 cocaine-dependent patients seeking treatment were recruited to the study. Personality was evaluated by the Zuckerman-Kuhlman Personality Questionnaire. Cocaine-induced psychosis questionnaire, SCID-I, and SCID-II were used to evaluate comorbidity and clinical characteristics. Data analysis was performed in three steps: descriptive, bivariate, and multivariate analyses. RESULTS Cocaine-induced psychosis was reported in 65.4% of the patients and some personality disorder in 46.8%. Two personality dimensions (Neuroticism-Anxiety and Aggression-Hostility) presented a significant effect on the risk of experiencing psychotic symptoms (t(229) = 2.69, p = 0.008; t(229) = 2.06, p = 0.004), and patients with psychotic symptoms showed higher scores in both variables. On the multivariate analysis, only Neuroticism remained as a significant personality factor independently associated with psychotic symptoms (Wald = 7.44, p<0.05, OR = 1.08, CI 95% 1.02-1.16) after controlling for age, gender and number of consumption substances. CONCLUSIONS An association between high neuroticism scores and presence of psychotic symptoms induced by cocaine has been found, independently of other consumption variables. Personality dimensions should be evaluated in cocaine-dependent patients in order to detect high scores of neuroticism and warn patients about the risk of developing cocaine-induced psychotic symptoms.
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Affiliation(s)
- Carlos Roncero
- Outpatient Drug Clinic, Department of Psychiatry, Vall d’Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain
- Department of Psychiatry, Vall d’Hebron University Hospital, CIBERSAM, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Constanza Daigre
- Outpatient Drug Clinic, Department of Psychiatry, Vall d’Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carmen Barral
- Outpatient Drug Clinic, Department of Psychiatry, Vall d’Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain
- Department of Psychiatry, Vall d’Hebron University Hospital, CIBERSAM, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Ros-Cucurull
- Outpatient Drug Clinic, Department of Psychiatry, Vall d’Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain
- Department of Psychiatry, Vall d’Hebron University Hospital, CIBERSAM, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lara Grau-López
- Outpatient Drug Clinic, Department of Psychiatry, Vall d’Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain
- Department of Psychiatry, Vall d’Hebron University Hospital, CIBERSAM, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laia Rodríguez-Cintas
- Outpatient Drug Clinic, Department of Psychiatry, Vall d’Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nuria Tarifa
- Outpatient Drug Clinic, Department of Psychiatry, Vall d’Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain
| | - Miguel Casas
- Department of Psychiatry, Vall d’Hebron University Hospital, CIBERSAM, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sergi Valero
- Department of Psychiatry, Vall d’Hebron University Hospital, CIBERSAM, Barcelona, Spain
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Jaramillo A, Hidalgo CG, Armijo I, Hayden V, Santis R, Lasagna A. Aspectos Clave en el Desempeño Exitoso de Agentes Comunitarios en Intervenciones de Outreach con Jóvenes Consumidores de Drogas. PSYKHE 2014. [DOI: 10.7764/psykhe.23.1.666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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van der Poel A, Barendregt C, van de Mheen D. Drug Users' Participation in Addiction Care: Different Groups Do Different Things. J Psychoactive Drugs 2006; 38:123-32. [PMID: 16903451 DOI: 10.1080/02791072.2006.10399836] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study allocated 201 (nearly) daily users of heroin and/or crack into four groups, depending on their addiction care participation. Earlier studies have compared treatment groups and nontreatment groups. In this study the treatment group is divided into three categories: (1) drug users in contact with only treatment agencies--i.e., methadone maintenance, clinical and ambulant drug treatment; (2) drugs users in contact with only care agencies--i.e., day and night shelters and drug consumption rooms, which have no explicit aims to change patterns of drug use; and (3) drug users in contact with both treatment and care agencies. This allocation intro three different groups fits the notion of harm reduction, one of the policy aims in The Netherlands. The fourth group consists of drug users in contact with neither treatment nor care agencies. The results show that it is useful to distinguish these four categories, instead of two. The four groups are different from each other with respect to some of their characteristics (e.g. debt situation, prostitution, homelessness) and their drug use (e.g. drug use in public, use of crack, and use of other drugs). A much clearer distinction can be made between the "care" group and the "treatment and care" group. Treatment and care agencies can thus better match their services to their clients or patients.
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Affiliation(s)
- Agnes van der Poel
- Addiction Research Institute Rotterdam (IVO), Heemraadssingel 194, 3021 DM Rotterdam, The Netherlands.
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Leri F, Stewart J, Fischer B, Jürgen R, Marsh DC, Brissette S, Bruneau J, El-Guebaly N, Noël L, Tyndall MW, Wild TC. Patterns of opioid and cocaine co-use: a descriptive study in a Canadian sample of untreated opioid-dependent individuals. Exp Clin Psychopharmacol 2005; 13:303-10. [PMID: 16366760 DOI: 10.1037/1064-1297.13.4.303] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined prevalence and patterns of co-use of opioids and cocaine in regular users of illicit opioids (N = 729) recruited from 5 Canadian cities. Fifty-seven percent (n = 417) reported having used both opioids and cocaine in the month and week preceding the interview; of these, 73% (n = 304) were able to identify a typical pattern of daily co-use. In a typical day, injectors of opioids and cocaine (n = 119) and injectors of opioids who inhaled cocaine (n = 111) showed stable opioid use but variable cocaine use, which peaked at 21 hr. Overall, 30% of the individuals used both drugs exclusively in a sequential fashion, 35% reported taking opioids and cocaine within the same hour, and 35% reported taking them together at the same time or mixing them. These findings indicate that different individuals display different patterns of opioids and cocaine co-use.
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Affiliation(s)
- Francesco Leri
- Department of Psychology, College of Social and Applied Human Sciences, University of Guelph, ON, Canada.
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Leri F, Tremblay A, Sorge RE, Stewart J. Methadone maintenance reduces heroin- and cocaine-induced relapse without affecting stress-induced relapse in a rodent model of poly-drug use. Neuropsychopharmacology 2004; 29:1312-20. [PMID: 15039768 DOI: 10.1038/sj.npp.1300435] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Although it is well established that methadone can be an effective treatment for opiate addiction, it is not clear how methadone maintenance affects cocaine use and cravings in individuals who self-administer both opiates and cocaine. In our attempt to explore the effect of methadone maintenance on the effects of cocaine, we first assessed the locomotor stimulatory effects of cocaine in rats maintained on methadone (0, 10, 20, or 30 mg/kg/day, via osmotic minipumps). Chronic methadone elevated baseline locomotion in a dose-dependent manner and did not reduce the direct stimulatory effects of cocaine (5 mg/kg). We then investigated the effects of the highest methadone maintenance dose (30 mg/kg/day) on heroin and cocaine seeking in extinction, and when it was precipitated by exposure to heroin, cocaine, or foot-shock stress in rats trained to self-administer both drugs in the same experimental context (heroin 0.05 mg/kg/inf; cocaine 0.5 mg/kg/inf, eight 3-h sessions each). In tests of reinstatement, rats responded selectively on the appropriate drug-associated lever after priming injections of heroin (0.25 mg/kg) or cocaine (20 mg/kg). Methadone maintenance blocked both cocaine- and heroin-induced reinstatement, but not stress-induced reinstatement, which was not lever selective. These results suggest that although methadone maintenance may not reduce the direct stimulatory effects of cocaine, it has the potential to reduce both spontaneous and cocaine-primed cocaine-seeking behavior.
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Affiliation(s)
- Francesco Leri
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada.
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Abstract
We investigated whether chronic exposure to heroin alters responses to cocaine in ways that might explain the use of cocaine by opioid addicts. To this end, the effects of cocaine (5 and 20 mg/kg) were assessed on locomotor activity of rats chronically exposed to heroin (0.0, 3.5, 7.0, and 14.0 mg/kg/day, over 14 days, via osmotic mini-pumps), or withdrawn from heroin (1 day, acute withdrawal, and 14 days, protracted withdrawal). Chronic heroin exposure, in itself, dose dependently increased locomotion and acute cocaine administration further elevated locomotor activity in a dose-dependent and additive manner. During acute withdrawal, there was a dose-dependent decrease in locomotion that was reversed by cocaine in a dose-dependent manner. During protracted withdrawal, spontaneous locomotion normalized, but rats previously exposed to heroin displayed cross-sensitization to cocaine as indicated by small, but significant, enhanced locomotor response to 5 mg/kg of cocaine, and enhanced intravenous self-administration of low doses of cocaine (0.13 mg/kg/infusion). In a separate study, we measured extracellular dopamine (DA) in the nucleus accumbens (Acb) using in vivo microdialysis before and after acute withdrawal from heroin. During chronic exposure to heroin, basal extracellular DA was elevated dose dependently, whereas in acute withdrawal, levels were not different from those in vehicle-treated rats. In response to cocaine, however, DA activity in the Acb was significantly lower in rats withdrawn from the highest dose of heroin.
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Abstract
The use of cocaine by heroin-dependent individuals, or by patients in methadone or buprenorphine maintenance treatment, is substantial and has negative consequences on health, social adjustment and outcome of opioid-addiction treatment. The pharmacological reasons for cocaine use in opioid-dependent individuals, however, are poorly understood and little is known about the patterns of heroin and cocaine co-use. We reviewed anecdotal evidence suggesting that cocaine is co-used with opioid drugs in a variety of different patterns, to achieve different goals. Clinical and preclinical experimental evidence indicates that the simultaneous administration of cocaine and heroin (i.e. 'speedball') does not induce a novel set of subjective effects, nor is it more reinforcing than either drug alone, especially when the doses of heroin and cocaine are high. There is mixed evidence that the subjective effects of cocaine are enhanced in individuals dependent on opioids, although it is clear that cocaine can alleviate the severity of symptoms of withdrawal from opioids. We also reviewed preclinical studies investigating possible neurobiological interactions between opioids and cocaine, but the results of these studies have been difficult to interpret mainly because the neurochemical mechanisms mediating the motivational effects of cocaine are modified by dependence on, and withdrawal from, opioid drugs. Our analysis encourages further systematic investigation of cocaine use patterns among opioid-dependent individuals and in laboratory animals. Once clearly identified, pharmacological and neuroanatomical methods can be employed in self-administering laboratory animals to uncover the neurobiological correlates of specific patterns of co-use.
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Affiliation(s)
- Francesco Leri
- Center for Studies in Behavioural Neurobiology, Concordia University, Montréal, Montréal, Canada.
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Drogenkonsumenten als benachteiligte Gruppe: die Entwicklung ihrer sozialen und gesundheitlichen Situation in der Schweiz. J Public Health (Oxf) 2000. [DOI: 10.1007/bf02962614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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