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Zhang C. Negotiating SHI-FEI and shifei: Pursuing a Moralist Self in China's Community-Based Addiction Treatment Programs. Cult Med Psychiatry 2022; 46:435-455. [PMID: 34169449 DOI: 10.1007/s11013-021-09724-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
Based on 16 months of fieldwork conducted at drug addiction treatment facilities in Yunnan, Southwest China, this article examines how Chinese drug users invent moralist selves during the frequent occurrences of shifei incidents. Shìfēi, meaning literally right/wrong, is a crucial concept in Chinese society with two contradictory meanings: (1) moral norms/judgment that ought to be discerned and followed (SHI-FEI); (2) "troubles" or "quarrels" that are often morally undesirable (shifei). By delving into a typical incident of shifei, this article analyzes the logic, motivation, and interpretations of the drug users and addiction treatment facility staff who are involved in the local moral world. It argues that for drug users, the relationship between SHI-FEI and shifei is not oppositional, as often assumed. Instead, both are valuable moral experiences and useful cultural means in response to users' moral demands and tensions. Negotiating SHI-FEI and shifei enables an ambiguous space in which drug users seek, claim, and practice their moralist selves. This article also argues that under various sociopolitical and moral constraints, drug users' moral selves are characterized by an inward focus on claims of morality and legitimacy. This inward focus reflects a process of moral involution. This study contributes to understandings of moral self-making in stigmatized situations.
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Affiliation(s)
- Chaoxiong Zhang
- Institute of advanced Studies in Humanities and Social Sciences, Beijing Normal University at Zhuhai, Zhuhai, 519087, China. .,China Academy of Social Management/School of Sociology, Beijing Normal University, Beijing, China.
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Sud A, Salamanca-Buentello F, Buchman DZ, Sabioni P, Majid U. Beyond harm-producing versus harm-reducing: A qualitative meta-synthesis of people who use drugs' perspectives of and experiences with the extramedical use and diversion of buprenorphine. J Subst Abuse Treat 2021; 135:108651. [PMID: 34728134 DOI: 10.1016/j.jsat.2021.108651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/27/2021] [Accepted: 10/26/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION This review synthesizes the literature on the perspectives and experiences of people who use drugs to better understand motivations and behaviors related to the extramedical use and diversion of buprenorphine. Given the particular social construction of buprenorphine against methadone, and the centrality of concerns around extramedical use in delivering opioid agonist therapies, a focus on extramedical buprenorphine use can provide an important lens through which to analyze treatment for opioid use disorder. This review is framed within persistent tensions between potential harm-producing versus harm-reducing effects of extramedical use that have long been described for opioid agonist therapies. METHODS The research team conducted a qualitative meta-synthesis based on a systematic search of eight databases as well as hand searching. The review includes all primary qualitative and mixed-methods studies related to the perspectives and experiences of people who use drugs on extramedical buprenorphine use. The study team carried out three rounds of qualitative coding using NVivo 12, and constructivist grounded theory and the constant comparative method informed the synthesis. RESULTS The review includes twenty-one studies. Findings are organized into the following three themes: 1) the experiences of people who use drugs (PWUD) with extramedical use of buprenorphine and their motivations to engage in it (including the desire to self-medicate and achieve "stability", to manage ongoing use of other opioids, and to "get high"); 2) the relationship between extramedical use and formal medical opioid agonist therapy programs; and 3) the established drug economy of extramedical buprenorphine. CONCLUSIONS The review identified varied and often divergent perspectives and experiences with extramedical buprenorphine use. An examination of the reported "normalizing" effects of extramedical buprenorphine suggests this practice as extending medicalized discipline beyond the clinical environment. Taken together, these findings identify a need to move beyond the tension of harm-reducing versus harm-producing effects toward forms of health care and promotion that focus on the needs, perspectives, and priorities of people who use drugs.
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Affiliation(s)
- Abhimanyu Sud
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada; Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6, Canada.
| | - Fabio Salamanca-Buentello
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada
| | - Daniel Z Buchman
- Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario M6J 1H1, Canada; Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, Ontario M5T 3M6, Canada; University of Toronto Joint Centre for Bioethics, Health Sciences Building, 155 College Street, Suite 754, Toronto, ON M5T 3M6, Canada
| | - Pamela Sabioni
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada
| | - Umair Majid
- Institute for Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6, Canada
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Attending to Aliveness: Self-Harm, Body and World in Contexts of Urban Homelessness. Cult Med Psychiatry 2021; 45:282-311. [PMID: 33030644 DOI: 10.1007/s11013-020-09687-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The DSM-5 proposes that self-harm be recognized as a diagnostic category of mental disease, compared to its previous definition as a behavioral symptom. Based on fieldwork in London, I challenge this proposal by exploring the life-history of a homeless sex-worker and substance-user who practices self-cutting. By bringing phenomenological anthropology into conversation with psychoanalytic theory, this article provisionally re-conceptualizes self-harm as an ethics of self-reparation and existential affirmation in the face of extreme precarity. Approached as an agentive practice through which human beings reclaim "somethingness" by altering their bodily conditions, we can conceive self-harm in a way that is attentive to the situational conditions that shape existential pain, instead of reaching straight for the diagnostic toolkit. In taking self-harm as simultaneously a reaction to and a reflection on existential crisis-rather than a sui generis disorder-this paper situates such practices as a pluralized condition-of-world rather than a bounded pathology-of-mind.
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Bartoszko A. Polluting pharmaceutical atmospheres: Compulsion, resistance, and symbolism of buprenorphine in Norway. NORDIC STUDIES ON ALCOHOL AND DRUGS 2019; 36:267-285. [PMID: 32934564 PMCID: PMC7434164 DOI: 10.1177/1455072518814313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/17/2018] [Indexed: 11/17/2022] Open
Abstract
This article offers a counter narrative to the current ethnographic
studies on treatment with buprenorphine, in which notions of promised
and experienced normality dominate. In some countries, introduction of
buprenorphine led to a perceived “normalisation” of opioid
substitution treatment, and this new modality was well received.
However, in Norway the response has been almost the opposite: patients
have reacted with feelings of disenfranchisement, failure, and
mistrust. Based on ethnographic fieldwork in Norway, this article
offers comparative insight into local experiences and subjectivities
in the context of the globalisation of buprenorphine. By outlining the
ethnographic description of the pharmaceutical atmosphere of forced
transfers to buprenorphine-naloxone, I show that the social history of
the medication is as significant as its pharmacological qualities for
various treatment effects. An analysis of the reactions to this
treatment modality highlights the reciprocal shaping of lived
experiences and institutional forces surrounding pharmaceutical use in
general and opioids in particular.
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