Doctoral Dissertation Research: An Ethnography of Opioid Addiction Treatment Trajectories and Experiences

该奖项支持的研究使人类学关注长期以来由公共卫生研究人员主导的问题：了解医疗保健和刑事司法系统如何影响低收入药物使用者的福祉。阿片类药物成瘾已成为一个全球性问题，在许多国家已达到流行病的程度。各国政府为此制定了无数政策和方案，以减少阿片类药物使用对社会和低收入人群生活的影响。不幸的是，有时结果是政策的信息不一致，效果矛盾。例如，低收入阿片类药物使用者可能继续面临严厉的刑法，即使他们获得免费和补贴的社会服务和治疗的机会增加了。因此，重要的是要了解低收入阿片类药物使用者如何体验和协商这些矛盾，以便进一步国家努力制定创新和有效的政策来解决这一日益严重的社会问题。这项研究将由布朗大学人类学博士生Parsa Bastani在Katherine A. Mason博士的监督下进行。这名研究人员将以伊朗为案例进行研究。伊朗是考察政策矛盾如何发生的合适地点，因为该国的法律规定，非法药物使用者既要受到国家强制的照顾，也要受到监视、控制和惩罚。这些法律包括对任何在公共场所似乎是非法吸毒者的人进行刑事起诉，即使在被捕时并未拥有毒品。最近，政府修改了法律，规定警察逮捕的药物使用者在被拘留在专门的拘留中心期间必须接受强制戒毒，然后在以重返社会为导向的减少伤害和康复设施中接受康复治疗。研究人员将进行12个月的人种学研究，以调查低收入阿片类药物使用者如何体验和应对同时被国家定罪和照顾的情况。他将通过半结构化访谈、参与者观察和文件分析来收集数据，以检验：1)定罪的经验：低收入物质使用者如何遇到并驾驭刑事司法系统？2)护理体验：护理基础设施对低收入物质使用者的社会边缘化体验有何影响？3)成瘾经历：低收入物质使用者对其药物使用的道德倾向是什么？他们是如何看待关于成瘾的竞争性道德话语的？这项研究的结果将有助于了解有关非法阿片类药物使用的法律的实际影响，以及能够和阻碍高度污名化人群重新融入社会的因素。该研究还将有助于建立更强大的社会科学理解边缘化的社会行动者如何协商冲突的社会制度和道德话语。该奖项反映了美国国家科学基金会的法定使命，并通过使用基金会的知识价值和更广泛的影响审查标准进行评估，被认为值得支持。

The research supported by this award brings anthropological attention to an issue that has long been dominated by public health researchers: understanding how healthcare and criminal justice systems shape the well-being of low-income substance users. Opioid addiction has become a global problem, having reached epidemic proportions in many countries. Governments have responded with myriad policies and programs to reduce the impact of opioid use, on society and on the lives of low-income populations. Unfortunately, sometimes the result is policies that are inconsistent in their messaging and contradictory in their effects. For example, low-income opioid users may continue to face harsh criminal laws even as their access to free and subsidized social services and treatment increases. Therefore, it is important to understand how low-income opioid users experience and negotiate these contradictions in order to further national efforts to craft innovative and effective policies to address this growing social issue. The research will be conducted by Brown University anthropology doctoral student, Parsa Bastani, with the oversight of Dr. Katherine A. Mason. The researcher will use Iran as a case study. Iran is an appropriate site to examine how contradictory policies are experienced because the country has laws that subject illicit substance users to both state-mandated care and surveillance, control, and punishment. This laws have included subjecting anyone who even appears to be an illicit drug user in public spaces to criminal prosecution, even if not in possession of drugs at the time of arrest. Recently, the government amended the laws to mandate that police-apprehended substance users undergo mandatory detoxification while detained in specialized carceral centers followed by aftercare in reintegration-oriented harm reduction and rehabilitation facilities. The researcher will undertake twelve months of ethnographic research to investigate how low-income opioid users experience and respond to being simultaneously criminalized and cared for by the state. He will collect data through semi-structured interviews, participant-observation, and document analysis, to examine: 1) Experiences of criminalization: how do low-income substance users encounter and navigate the criminal justice system? 2) Experiences of care: what impact does care infrastructure have on low-income substance users' experiences with social marginalization? 3) Experiences of addiction: What are low income substance users' moral dispositions toward their drug usage? What do they make of competing moral discourses about addiction? Findings from this research will contribute to understanding the actual effects of laws about illegal opioid use and the factors that enable and hinder the reintegration of highly stigmatized populations into society. The research also will contribute to building more robust social scientific understanding of how marginalized social actors negotiate conflicting social institutions and moral discourses.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.