Does Nimbin have a drug problem? This tiny village in north-eastern NSW has an international reputation for its alternative community and its street drug market. Ever since the Aquarius Festival thirty years ago Nimbin has fascinated the media, and recurrent headlines about the village's (undefined) 'drug problem' suggested my research topic. My research aim was to investigate the meaning/s of Nimbin's 'drug problem' in the context of Nimbin's 'alternative' culture. Because the topic of illicit drugs is both ethically challenging and highly sensitive, my research design was strongly participant-focused, with an emphasis on confidentiality balanced by a mixed methodology to cross-validate results. My methods included an anonymous household (door-to-door) survey based on a national household survey; an anonymous mailed-back survey of Nimbin and Lismore drug injectors; taped interviews with health and legal professionals, cannabis activists and drug dealers; semi-structured interviews with 'professional' cannabis crop growers; and participant observation over several years. I found the multi-method research design to be particularly effective for investigating illegal drug marketing and use, and the design provided me with multiple perspectives on a complex issue. Superficially, there appeared to be two drug 'problems' in Nimbin — one was the (largely cannabis) street market, and the other revolved around heroin users, and included complaints about scruffy-looking people hanging around the main street, or overdosing in the public toilet. However, my research suggested that these issues, while immediately comprehensible as 'drug problems', obscured more complex issues. For example, the village's street drug market was intertwined with the local economy and with the alternative community's values and drug use, while close to half of the drug injectors lacked secure housing (which creates problems that are not related to heroin), and all heroin users were blamed for the actions of few. Many factors influence the creation and maintenance of what we might call 'problems', and drugs are frequently blamed for broader social problems. What is Nimbin’s drug problem? The answer depends, in part, on the drug of interest, but more importantly it depends on your definition of a ‘problem’. Some useful and meaningful perspectives on this important social issue include quantified indicators such as death, injury, arrest rates, the economics of black markets, the demographics of drug use, and estimates of ‘social costs’. Qualitative perspectives include people’s opinions about drugs, media-generated moral panics, the effects of social marginalisation, and the role of drug cultures. A number of ‘drug problems’ arise as a direct result of drug illegality. They include black markets, corruption, drug-related violence, theft, stronger forms of the drug, and more dangerous using practices (with the risk drug overdoses and HIV/AIDS), as well as public nuisance issues. Government policy, judicial sentencing and public opinion are moving towards the social reintegration of illicit drug users, but this is almost invariably counter-balanced by a toughening of legal sanctions against supply of the same drug. Most discussions about illicit drugs fail to consider the long-term implications of harsh penalties for, and elaborate and punitive police operations (such as occurred throughout my Nimbin research) against, small-scale independent growers and dealers. The only way to directly engage with drug markets and all the attendant problems, is to legitimise and regulate the supply of recreational drugs. I discuss several examples of the important role of the drug culture in mitigating problems caused by illegality. One example is the influence of Nimbin's alternative community on the style of the drug market. The village drug scene more closely resembles the many north coast village craft markets, than it does Kings Cross, Cabramatta or New York's Bronx. Buyers are north coast locals, along with national and international tourists (the small village is known to cannabis users world-wide, both through media attention and word-of-mouth). Nimbin offers a 'safe' village market ambience and competitive prices to a mainly cannabis using clientele. I suggest that there are two major underlying influences on the experience of a ‘drug problem’, regardless of the drug or the place. They are: 1. Political influences — specifically the effects of government policy on black markets, law enforcement practices, and access to services and resources; 2. Cultural influences — particularly the beneficial effects of norms and functional role models for the safe use of a drug, cultural effects on the drug market, and the role/s of the drug in the day-to-day life of the culture. These influences can operate with, or despite, each other, and can create or ameliorate many ‘drug problems’. In the case of Nimbin’s alternative culture, government policy has created a number of drug problems and the counter-culture has worked to minimise them. In my research into Nimbin’s ‘drug problem’ I have clarified some issues and raised a number of others. I have examined the notion of a ‘drug problem’ from several perspectives using a range of research tools, and discussed some key influences on the problem associated with drug use. Drawing from the Nimbin research and my reading, I suggest legalising the recreational drugs to bring them under the dual controls of supply legislation and social norms. In conclusion, I suggest that we need to be very clear about what ‘drug problem’ it is that we are talking about, and indeed, whether the problem is really about drugs at all.

Magister Social Work -MSW / Heroin usage is on the increase in the Western Cape province of South Africa owing to globalization and to increased access to the drug in this province. The goal of this study is to explore the experiences of coloured heroin users in the Metro South area of Cape Town, which stretches from Simons Town and Muizenberg to Retreat, Lavender Hill, Grassy Park, Parkwood and Wynberg. These individuals have been found to congregate in the Wynberg CBD. The overarching theoretical framework for the purpose of this research is social constructionism and symbolic interactionism, using a qualitative means of inquiry. Snowball sampling was used to recruit prospective participants and data was collected by means of in-depth interviews, with a semi structures interviewing schedule. The questions informed the subsequent themes and categories that arise from the data collection process. Snowball sampling was employed in this case, a non-probability sample, in which participants were recruited via key informants. The sample distribution included 13 participants, 10 of which were heroin users (5 female, 5 male) and the remaining 3 were key informants which contributed to triangulation of the data.

Magister Social Work -MSW / Heroin usage is on the increase in the Western Cape province of South Africa owing to globalization and to increased access to the drug in this province. The goal of this study is to explore the experiences of coloured heroin users in the Metro South area of Cape Town, which stretches from Simons Town and Muizenberg to Retreat, Lavender Hill, Grassy Park, Parkwood and Wynberg. These individuals have been found to congregate in the Wynberg CBD. The overarching theoretical framework for the purpose of this research is social constructionism and symbolic interactionism, using a qualitative means of inquiry. Snowball sampling was used to recruit prospective participants and data was collected by means of in-depth interviews, with a semi structures interviewing schedule. The questions informed the subsequent themes and categories that arise from the data collection process.

Utilizing a social construction perspective, this study uses a mixed method approach to examine the opioid epidemic. The study begins by identifying the numerous claims-making groups along with conducting a content analysis of the rhetoric and symbols used to legitimize the claims about the opioid epidemic. The data for the content analysis was obtained through a search of the websites, newsrooms, and pressrooms of claims-making groups. Additionally, the study examines and assesses the volume of money that is generated and allocated towards opioid research and prevention in an effort to determine who has more power to influence the policy initiatives. Findings show that the frequency of rhetoric and the number of claims-making groups releasing information about the opioid epidemic increased from 2010-2016. Most of the rhetoric consists of groups proposing resolution strategies and formulating new policies. Only a few claims-makers are making financial contributions towards opioid prevention initiatives and in most cases, it is a very small amount of money.

Opioids are scheduled by the propensity for misuse and abuse with a high rate of dependency and risk of fatal overdose. Opioids can be divided into different classes, including, natural, synthetic, and semi-synthetic. Opiates are naturally occurring and come directly from the opium poppy plant; whereas the semi synthetics opioids are chemical modifications of the poppy plant. Synthetic opioids attach to the opioid receptor but contain no part of the poppy plant. The increased variety and frequency in opioid prescriptions contributed to an opioid epidemic in the United States which is still on going. According to the CDC, the opioid epidemic has occurred in three waves. The first wave of the epidemic began in the 1990’s with the increase in opioid prescription pain medication overdoses. The second wave began around 2010 when heroin overdoses became more prevalent. This was followed by a sharp uptick in fentanyl deaths beginning around the year 2013, indicating the start of the third wave. The opioid epidemic has had a huge cost to society, not just due to deaths but also because of lost productivity, medical expenses and judicial system costs (Florence, Zhou, Luo, & Xu, 2016). To best design and implement strategies to combat this issue, an understanding of the population effected is needed. Since many public health policies are implemented at the regional level, knowing the characteristics and demographics of the epidemic at the local level is important. This study evaluates trends in drug related death cases in the Florida District 6 Medical Examiner Office (MEO) from the calendar years 2011 through 2016. Specifically, it focuses on opioids and the role of fentanyl in overdose related mortality. Additional attention is given to fentanyl and fentanyl analog related deaths. Fentanyl analogs present challenges from an analytical toxicology perspective. Fentanyl analogs can be difficult to detect. Two sets of data from each calendar year were obtained from the MEO. This data was collated, standardized and then statistically analyzed. It was determined that there was not a significant difference in month of the year or the day of the week that drug related fatalities occurred. The time of day was statistically significant with more drug related mortalities occurring during the hours of 8:00am and 4:00pm. When assessing mortality rates, Pinellas and Pasco county demonstrated differences. Pasco county has higher overall mortality for opioid related deaths. Pinellas county has almost twice the number of the opioid, fentanyl, related overdose fatalities. Racial demographics, divided into White, Black, and Asian populations, demonstrated that the White population is disproportionally affected by fentanyl drug related mortality. Binary logistic regression showed that fentanyl and heroin tend to co-occur, and that ethanol, hydrocodone, methadone, morphine, and oxycodone do not usually co-occur with fentanyl in drug related fatalities. These data help elucidate trends in the opioid epidemic at a regional level. There are differences between Pinellas and Pasco county; with the former having more fentanyl related drug deaths and the latter having more opioid related drug deaths over the six years analyzed. An interesting result is derived from the binary logistic regression. It is shown here that fentanyl and heroin tend to co-occur together. It is also shown that ethanol, hydrocodone, morphine, oxycodone, and methadone do not co-occur with fentanyl related overdose cases. Notably, methadone has the strongest negative association with fentanyl related overdoses.

Purpose of review: Overdose deaths have increased significantly over the last 5 years. This review analyzes the severity and nature of the epidemic, its impact on society, factors driving the increase in mortality, special populations disproportionately affected, and solutions to decrease overdose deaths. A thorough understanding of opioid overdose rates and deaths position the reader to respond most effectively in their sphere of influence. Recent findings: Final statistics for 2017 show a continued worsening of the epidemic. Recent studies focus on the evolving role of synthetic fentanyl, risk factors for fatal overdose, variation of mortality across demographic and socioeconomic regions, and the effectiveness of harm reduction strategies such as naloxone. Summary: The national overdose death rate continues to rise unabated with a 9.6% increase during 2017, with an estimated cost over $550 billion in 2019. There are, however, effective strategies to identify and treat individuals at risk for a fatal overdose. The root cause of addiction is the brain’s response to despair, social stressors, and societal structural inequities. It is unlikely we will see a significant decrease in addiction and its consequences until these root causes are addressed. Additional research is needed on the role of social determinants in addiction, strategies to treat incarcerated individuals, the role of suicidal ideation in fatal overdose, and risk factors, and frequency of non-fatal overdose.

The costs in terms of both monetary and human lives lost due to substance abuse in the United States is well documented and it is publicized that it is increasing. There has been a large amount of research completed that has examined methamphetamine users, heroin users, and the drug-crime nexus; however, there is a paucity of research that provides insight into these users’ arrest experiences. Using a phenomenological approach, this research examined methamphetamine and heroin users’ incidents of being arrested to gain a greater understanding of their lived experiences. The analysis was based on interviews that were conducted with five adults that had been regular users of methamphetamine and/or heroin and had been arrested for an offense that was either directly or indirectly a result of their drug use. The results revealed four general themes that indicated: (1) the users felt they were living self-destructive lifestyles at the time of their arrest; (2) they experienced shock and confusion at the time of the arrest and afterwards; (3) interactions with the police were commonplace and they each had mixed experiences dealing with the police; (4) each of the participants expressed directly or indirectly that they needed to be arrested, complete long term confinement, or the possibility of long-term confinement, after a charge to successfully achieve sobriety and positive changes in their lives. These findings were discussed, reviewing evaluations of drug court diversion, incarceration, or the concept of an individual hitting rock-bottom as a prerequisite for lasting positive change and rehabilitation. Future research comparing the success of these post-arrest outcomes is suggested.

Indiana University-Purdue University Indianapolis (IUPUI) / Deaths due to prescription painkillers and heroin have quickly become national, state, and local public health concerns. Studies using data from Medical Examiners or Coroner Offices throughout the United States have been conducted and are contributing to the understanding of this epidemic. However, the analysis of these fatalities are specific to the communities where the study was conducted and cannot be assumed that the decedents in one community are similar to decedents in another community. Many local governments and agencies throughout the U.S. are aware that this problem exists in their communities, but are not prepared to adequately respond to and intervene in these fatalities as an analysis of those who have died has rarely been conducted. This dissertation is a replication study of longitudinal epidemiological analyses of opiate related fatalities that was implemented in a location where an analysis of opiate-related fatalities had not been conducted, Marion County, Indiana. The purpose of the dissertation was twofold: (1) to describe the demographic characteristics of the decedents using publicly available data from the Marion County Coroner’s Office to be used in informing future preventative efforts to decrease opiate-related fatalities in Marion County and (2) to inform other communities on how to conduct a similar analysis in their own community. This dissertation describes the methods of the replication study, provides descriptive results of the people who died from opiate-related overdoses, and: (a) Report the types of opiates identified in blood toxicology reports and (b) Present the histories of opiate-related decedents as reported in the Deputy Coroner Field Officer’s Reports (DCFOR). Additionally, analysis was conducted to determine if decedent characteristics deferred depending on the type of opiate fatality based on the toxicology in 1) heroin alone, 2) painkillers alone, and 3) heroin and painkillers combined.

Underhållsbehandling. En redogörelse för de olika faktorer som haften avgörande rollför behandlingsformen. / Drug-substitution treatment. A report of the various factors which have had asignificant role for this form of treatment.

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