"Every 'Never' I Ever Said Came True": Transitions from opioid pills to heroin injecting
"Every 'Never' I Ever Said Came True": Transitions from opioid pills to heroin injecting
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DOI：
10.1016/j.drugpo.2013.10.004
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发表时间：
2014-03-01
影响因子：
4.4
通讯作者：
Ciccarone, Daniel
中科院分区：
文献类型：
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作者：
Mars, Sarah G.;Bourgois, Philippe;Ciccarone, Daniel
这项定性研究记录了费城和旧金山的使用者在阿片类药物药丸流行之前和期间注射海洛因的途径。数据是通过深入、半结构化访谈（2010年至2012年期间进行）收集的，这些访谈是在对费城（2007-12年）和旧金山（1994-2007年、2012年）街头吸毒者和毒贩进行长期参与者观察、人种学研究的背景下进行的。费城和旧金山因其截然不同的政治经济、移民模式和海洛因来源类型而被选中。在费城，人种学家发现了海洛因注射者，通常是白人使用者，他们开始使用处方阿片类药物而不是从其他药物过渡到阿片类药物。在费城和旧金山，接受采访的大多数年轻海洛因注射者的吸毒轨迹都是从阿片类药物开始——通常是Percocet（羟考酮和对乙酰氨基酚）、非专利短效羟考酮或奥施康定（长效羟考酮）——然后转向海洛因，通常首先通过鼻吸入（嗅吸）或吸烟，然后进行注射。虽然大多数费城吸毒者出生在该市或其郊区，并开始在那里使用阿片类药物和海洛因，但许多旧金山吸毒者是在其他地方开始使用阿片类药物，有时还吸食海洛因，并从全国各地迁移到该市。尽管如此，两个城市年轻注射者的转变模式相似，表明全国模式正在演变。相比之下，费城和旧金山的老年吸毒者更有可能从大麻、甲基苯丙胺和可卡因等非阿片类药物转向注射海洛因。阿片类药物使用者通常报告称，在身体和情感上依赖阿片类药物后，出于成本和易于获得供应的原因转而使用海洛因。许多人对他们吸食海洛因并随后注射海洛因表示惊讶和沮丧。从历史和结构上看，这些吸毒者发现自己陷入了阿片供应的两个主要发展的交叉点：(1) 从 1997 年到 2005 年，阿片药物处方增加了 500% 以上，导致人们很容易获得比海洛因更轻的阿片供应；(2) 在 20 世纪 90 年代初哥伦比亚产海洛因进入美国后，海洛因供应过剩，降低了成本并提高了纯度。零售层面。由于处方阿片类药物的广泛使用，全国范围内的年轻内城、郊区和农村青年可能会出现海洛因使用的上升周期。 (C) 2013 Elsevier B.V. 保留所有权利。
This qualitative study documents the pathways to injecting heroin by users in Philadelphia and San Francisco before and during a pharmaceutical opioid pill epidemic. Data was collected through in-depth, semi-structured interviews (conducted between 2010 and 2012) that were, conducted against a background of longer-term participant-observation, ethnographic studies of street-based drug users and dealers in Philadelphia (2007-12) and San Francisco (1994-2007,2012). Philadelphia and San Francisco were selected for their contrasting political economies, immigration patterns and source type of heroin. In Philadelphia the ethnographers found heroin injectors, usually white users, who had started their opiate using careers with prescription opioids rather than transitioning from other drugs. In both Philadelphia and San Francisco, most of the young heroin injectors interviewed began, their drug-use trajectories with opioid pills - usually Percocet (oxycodone and acetaminophen), generic short acting oxycodone or, OxyContin (long-acting oxycodone) - before transitioning to heroin, usually by nasal inhalation (sniffing) or smoking at first, followed by injecting. While most of the Philadelphia users were born in the city or its suburbs and had started using both opioid pills and heroin there, many of the San Francisco users had initiated their pill and sometimes heroin use elsewhere and had migrated to the city from around the country. Nevertheless, patterns of transition of younger injectors were similar in both cities suggesting an evolving national pattern. In contrast, older users in both Philadelphia and San Francisco were more likely to have graduated to heroin injection from non-opiate drugs such as cannabis, methamphetamine and cocaine. Pharmaceutical opioid initiates typically reported switching to heroin for reasons of cost and ease-of-access to supply after becoming physically and emotionally dependent on opioid pills. Many expressed surprise and dismay at their progression to sniffing and subsequently to injecting heroin. Historically and structurally these users found themselves caught at the intersection of two major developments in the opiate supply: (1) an over 500% increase in opiate pill prescription from 1997 to 2005 resulting in easy access to diverted supplies of less stigmatized opiates than heroin and (2) a heroin supply glut, following the US entry of Colombian-sourced, heroin in the early 1990s, that decreased cost and increased purity at the retail level. A nationwide up-cycle of heroin use may be occurring among young inner city, suburban and rural youth fueled by widespread prescription opioid pill use. (C) 2013 Elsevier B.V. All rights reserved.