Heroin in brown, black and white: Structural factors and medical consequences in the US heroin market
Heroin in brown, black and white: Structural factors and medical consequences in the US heroin market
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DOI：
10.1016/j.drugpo.2008.08.003
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发表时间：
2009-05-01
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：
Ciccarone, Daniel
背景资料：历史上，进入美国的海洛因来自三个广泛分布的地理区域：西南亚，东南亚和墨西哥。美国海洛因的第四个来源来自哥伦比亚，起源于20世纪90年代初。四种海洛因来源产生不同形态和质量的海洛因，这一事实尚未得到严格审查。此外，还没有很好地确定当代相互竞争的阻截动态，或海洛因的限制如何跨越国际边界流动，以及新自由主义，例如，随着全球自由贸易的扩大，政策正在影响海洛因市场。本文将重点介绍美国海洛因市场的变化，包括来源趋势、目前占主导地位的来源的政治经济以及美国各地区对海洛因风险环境的影响。本文使用结构和历史框架，研究了二十年的二级数据源，包括政府和药物管制机构的文件，海洛因流量与发表的工作在拉丁美洲的政治和经济动态。结果：共同发生的新自由主义经济改革可能有助于美国/哥伦比亚的阻截努力的矛盾的影响。自从进入美国市场以来，来自哥伦比亚的海洛因以更高的质量和更低的零售价格销售。随着墨西哥和哥伦比亚的海洛因获得市场份额并取代亚洲的海洛因，形成了一个日益排外的市场。这些趋势对海洛因消费者的风险环境产生了巨大影响。一个有趣的因素是，全球不同的海洛因来源生产出截然不同的产品。海洛因来源/形式与吸毒行为和危害之间存在着合理的联系。例如，冷水可溶的粉末海洛因（来源：亚洲，哥伦比亚）可能与美国较高的艾滋病毒流行率有关，而低溶解度的“黑焦油”海洛因（BTH;来源：墨西哥）历史上用于艾滋病毒流行率降低的地区。结论：海洛因的来源和类型是海洛因使用者危险环境的结构性因素：来源决定分布，类型预测使用。具体类型的海洛因是如何使用的，因此在地理分布上有什么风险。海洛因市场的持续流动及其对吸毒者风险环境的影响值得进一步关注。(C)2008 Elsevier B. V.保留所有权利。
Background: Heroin coming into the United States historically comes from three widely dispersed geographical regions: Southwest Asia, Southeast Asia and Mexico. A fourth source of US-bound heroin, from Colombia, originated in the early 1990s. The fact that the four heroin sources produce differing morphologies and qualities of heroin has not been critically examined. in addition, it is not well established how the contemporary competing dynamics of interdiction, or restriction of heroin flows across international boundaries, and neoliberal, e.g., global expansion of free trade, policies are affecting heroin markets. This paper will highlight changes in the US heroin market, including source trends, the political economy of the now dominant Source and the resultant effects on the heroin risk environment by US region.Methods: Using a structural and historical framework this paper examines two decades of secondary data sources, including government and drug control agency documents, on heroin flows together with published work on the political and economic dynamics in Latin America.Results: Co-occurring neoliberal economic reforms may have contributed to paradoxical effects of US/Colombian interdiction efforts. Since entering the US market, heroin from Colombia ha's been distributed at a much higher quality and lower retail price. An increasingly exclusive market has developed with Mexican and Colombian heroin gaining market share and displacing Asian heroin. These trends have had dramatic effects on the risk environment for heroin consumers. An intriguing factor is that different global sources of heroin produce substantially different products. Plausible associations exist between heroin source/form and drug use behaviours and harms. For example, cold water-soluble powdered heroin (Sources: Asia, Colombia) may be associated with higher HIV prevalence in the US, while low-solubility "black tar" heroin (BTH; source: Mexico) is historically used in areas with reduced HIV prevalence. BTH is associated with soft tissue infections Caused by Clostridium bacteria.Conclusion: Source and type of heroin are structural factors in the risk environment of heroin users: source dictates distribution and type predicts practice. How specific types of heroin are used and with what risk is therefore distributed geographically. Continued flux in the heroin market and its effects on the risk environment for drug users deserves further attention. (C) 2008 Elsevier B.V. All rights reserved.