published_or_final_version / Social Work / Master / Master of Social Work

This thesis applies lessons drawn from a historical-cultural analysis of rural power structures in Afghanistan to understand the nature of the threat posed by that country's opiate economy and to assess the counter-narcotics policies of the United Kingdom, the Government(s) of Afghanistan, and the United States. It argues that that the opiate economy should be considered an Afghan-specific problem involving narcotics, not a "drug war" problem involving Afghanistan. Specific lessons are taken from a chapter dedicated to Afghan culture, history, and rural power structures, and applied in chapters analyzing the opiate economy and current counter-narcotics policies. Several insights that are critical to sound policy, and that are not found in existing literature, are developed. Overall, the current policy emphasis on aggressive eradication of opium poppy is incongruent with local cultural and political realities and undermines central government stability. Counter-narcotics policy makers should adopt a roll-back strategy, eliminating cultivation from minor-cultivation provinces first for democraticgovernance, cultural, and counter-narcotics reasons. Counter-trafficking should be prioritized over eradication efforts and should particularly target anti-government forces, many of which are legacy groups of the anti-Soviet jihad and are not accountable to or culturally integral to rural society.

The aim of the research is to identify and apprehend all the factors in terms of administration, economy, culture, and ideas within and without Taiwan that influenced drugs control there in the early twentieth century. The means is to explore narcotics control on the island with special consideration to international conferences on opium. The period covers the late Qing dynasty (1850-1895), early Japanese period (1895-1920), and late Japanese period (1920-1940). The conclusion will discuss the relationship between narcotics control and the conferences, compare practical measures and cultures of drugs, and compare abstract ideas that defined the practical side. The research is original because it studies previously unexplored cultural and intellectual history. It is also a synthesis of a rarely researched topic: namely: the international conferences angle on drugs control on the island during Japanese rule (hence its emphasis in the thesis title). The main findings regarding the Qing dynasty is that the administration was weak and opium culture was acceptable, fashionable and useful. The administration was weak because officials were undermined by informal administrators who were gentry. The gentry occupied a privileged socio-legal position and were relied upon by officials for implementing policy. It was also weak because it could not enforce the law: edicts stipulating prohibition of opium smoking and emigration to Taiwan were ignored. Opium culture was rendered fashionable and acceptable by the literati who smoked it. Opium also served as a treatment for many illnesses. It was popular especially among professional men in Taiwan. Opium was largely available since the treaty ports were opened in 1858. A favourable balance of trade meant the Chinese could afford opium. The early Japanese period had a strong administration and definitive new ideas. The administration was strong because of its army, Law 63, and the hokō and police systems. It successfully established the opium monopoly system. It was a licensing and rationing system that was on the whole effective, but it was flawed because of its recording and commission on sales system. Biological principles and economic warfare defined the opium policy. The former meant that the Taiwanese would be made fitter over time by gradually suppressing opium. The latter referred to selling opium as a means to enhance national survival in the newly perceived protracted war where resources were crucial for victory. Fear of national destruction through Japanese adopting the smoking habit triggered the formulation of an opium policy. Occasional and habitual smokers were homogenised through media. Opium smokers were presented negatively. Iwai Tatsumi had opium revenue become Government-General revenue. It was important until 1930. A black market of opium for secret smokers flourished possibly with the approval of the administration for profit or social stability. The late Japanese period was marked by introduction of powerful foreign ideas and cultural change. The ideas were self-determination and humanitarianism. The former incited anti-colonialism. That forced the administration to adopt a concessionary attitude towards the Chinese in order to maintain peaceful rule. It promoted accelerated assimilation that undermined the discriminatory biological principles that was the bedrock of the gradual suppression policy. Humanitarianism put opium on the international public and national government agendas. It stimulated reform such as the 1928 Taiwan Opium Ordinance, 1929 Addict Registration Campaign and expedited the 1930 Rehabilitation Programme. Du Congming established the first rehabilitation centre after administration funded research into opium. Cultural change is expressed in the ambiguous attitude towards opium crystallizing into a fiercely anti-opium one held by Chinese. Opium was rendered unacceptable and traitorous. The Japanese viewed opium addiction as a disease; hence addicts were medicalised. Allegedly Japanese officials and businessmen respectively approved of and engaged in the export of crude morphine and cocaine from Taiwan. The opium monopoly system allegedly provided cover for the import of excessive quantities of opium. Weak regulations in Japan meant exporting cocaine was not problematic. Increasingly opium businesses became unprofitable or were closed excepting wholesalers. Revenue from opium was minute but still useful. The main points of the international conferences concern their aims, origins, results, the League of Nations and Japanese policy. The aims were to eliminate opium smoking and suppress narcotics. They originated from American President Theodore Roosevelt who was prompted by American missionary Charles Brent. British diplomat Sir Malcolm Delevingne was instrumental in calling for the 1924-25 Geneva conferences. The results are vast and complex. The sound ideas were: a) licensing; b) rationing; c) recording; d) government monopoly; e) standardised import and export certificates; f) independent body to handle estimates from consumer countries and orders to supplier countries; g) education. The main problems were: a) the agreements were only obligatory; b) diplomatic language afforded the ability to neglect reforms; c) there was not a timetable for limiting supply. The League of Nations was established in order to avert war. It was revolutionary because it provided a platform for open and multilateral diplomacy, and redefined acceptable behaviour of nations. It added a new dimension to traditional closed and bilateral diplomacy where states had freedom of action. The League was a phenomenal propaganda machine because it was admirable, authoritative and hence held global media attention. The Japanese view was originally typified by indifference and strategic interest. The latter is regarding the Anglo-Japanese alliance. It developed to become morally concerned and concerned as per foreign pressure over the illicit traffic of narcotics from Japan. Indifference was due to the fact that in Japan drugs were not an electoral issue. Moreover, the government was dominated by businesses which had an economic interest in the trade. Lastly it was offensive to undermine business in Japanese culture. Moral concern arose in terms of humanitarianism under the League of Nations. Additionally social hygiene viewing opium as a treatable threat to survival was applied to the eradication of opium. The conclusion reveals the relationship between conferences and narcotics control on the island to be mutual, direct, indirect and significant. The Chinese and Foreign Powers created and surmounted the opium crisis in Taiwan. Japanese rule provided for suitable conditions for the Chinese to resist opium. Administration and culture are the most influential factors in narcotics control. Foreign ideas of self-determination and humanitarianism defeated Japanese ideas and compelled reform of the opium system. Mobilisation of public opinion is vital for cultural change. The opium monopoly system was on the whole efficacious. Lastly, the statistics on opium are dubious as they are provided by Kaku Sagatarō who may have been involved in the illicit traffic of narcotics.

"My Sister Sarah" is a 25-minute long documentary film about my sister, Sarah Chatelain, a recovering methamphetamine addict from Fargo, North Dakota. Utilizing a combination of family home videos, Super 8 film and verité footage of Sarah's contemporary life, "My Sister Sarah" relates Sarah's journey with drug addiction from childhood through recovery. This report contains the process of creating the film: its inception, production and completion. / text

Thesis (M.Soc.Sc.)--University of Hong Kong, 1988. / Also available in print.

Boston University. University Professors Program Senior theses. / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / This paper will show that the trade in psychoactive substances has in fact been a major facilitator of the process now known as globalization. Not only has the drug trade fed off of globalization, globalization feeds off of and is driven by it. The perspective I will take here is a historical one. My thesis, that the drug trade has been an influential force on what is known as "globalization," is a reevaluation of the relationship between three historical processes: 1} The development over several centuries of a global system for the production, trade, and distribution of drugs 2} The "cold war" for economic and geopolitical hegemony between capitalist and communist power structures 3} The development and expansion of a global economic system, known in its current liberal phase as "globalization" / 2031-01-02

There has been a growing interest in addiction research on what role identity has to play in terms of recovery from drug addiction. One field of study that has gained traction in this area is the social identity approach, which argues that those in recovery tend to go from an ‘addict identity’ towards a ‘recovery identity’ when enrolled in treatment. This has been criticized by critical addiction studies, who argue that this notion is fueling an already established set of binary oppositions such as normality/abnormality, health/sickness etc., said to permeate addiction discourse. They argue that identity works to restrain the lives of those in recovery, and that these binary oppositions are problematic and both stigmatizes and pathologizes former drug users to mere products of recovery. The present thesis therefore interrogates these notions further by exploring the experiences of individuals enrolled in twelve step recovery, to see how identity formation and binary assumptions are experienced by former addicts themselves. The thesis employs a qualitative approach, and data were collected through 10 semi-structured interviews with active members of Narcotics Anonymous during March and April 2021. By applying actor network theory (ANT), the analysis of the study suggests that former addicts tend to present various identity-claims besides those only tied to recovery practices. Also, enrolling in twelve step recovery and identifying as a recovering addict seemed to enrich, rather than restrain their lives. Although binary assumptions and a struggle for normality seemed a burden in active substance abuse, it is suggested to be a necessary feature of recovery in terms of providing a framework for life. Thus, the analysis suggests that recovery might be a more fluid process than these respective fields tend to assume, and that binary assumptions are perhaps a necessity in terms of staying abstinent. / Det finns ett växande intresse inom beroendeforskning gällande identitetens roll i tillfrisknande från drogmissbruk. Ett forskningsfält som belyser detta är det gällande social identitet, som hävdar att de i tillfrisknande tenderar att gå från en ’beroendeidentitet’ till en ’tillfrisknandeidentitet’ i behandling. Samtidigt kritiseras detta av teoretiker från kritiska beroendestudier, som argumenterar för att denna föreställning ger stöd åt en redan etablerad uppfattning om binära motsättningar gällande normalitet/abnormitet, hälsa/sjukdom osv., som fått fäste inom beroendediskursen. De hävdar att identitet verkar genom att begränsa livet för individer i behandling, och att dessa binära motsättningar är problematiska då de bidrar till att stigmatisera och patologisera missbrukare till att bli produkter av sin behandling. Syftet med detta arbete är därför att undersöka dessa föreställningar genom att granska erfarenheter av individer som är aktiva inom tolvstegsbehandling, för att se hur identitetsformering och binära föreställningar upplevs av före detta missbrukare själva. Detta arbete använder sig av en kvalitativ ansats, och insamlandet av data skedde genom 10 semi-strukturerade intervjuer med aktiva medlemmar i Anonyma Narkomaner i Mars och April 2021. På arbetets resultat applicerades actor network theory (ANT), och analysen indikerar att före detta missbrukare tenderar att identifiera sig med diverse andra praktiker än de endast kopplade till behandling. Analysen visar även att identifikation med tolvstegsbehandling tenderade att öppna upp och berika livet för de i tillfrisknande, snarare än att begränsa det. Även om binära uppfattningar och en kamp för normalitet tenderade att vara en börda för individer i aktivt missbruk, så verkar det vara en nödvändig egenskap av tillfrisknandet genom att förse dessa med ett ramverk för hur de kan leva sina liv. Sammanfattningsvis visar studien att identitet i tillfrisknande verkar vara en mer rörlig och icke-fixerad process än vad dessa fält hävdar, och att binära uppfattningar är en nödvändighet för att bibehålla en fortsatt nykterhet.

This study investigated the influence of tobacco use on postoperative narcotic requirements of female patients following pelvic surgery. The history of tobacco use was taken by telephone survey, and the amount of postoperative narcotic used was obtained from a retrospective review of the patients’ hospital charts. Postoperative narcotic use for patients who never smoked was 10.9 mg/12 hr (n = 83, S.E. = 0.5), for former smokers was 13.0 mg/12 hr (n = 33, S.E. = 0.8) and for current smokers was 13.1 mg/12 hr (n = 53, S.E. = 0.7). Patients who never smoked used significantly less narcotic than former smokers (p =.02) or current smokers (p =.007). There was no difference between current and former smokers. Patients who have smoked required more narcotic for postoperative pain control. This effect was equally strong for former as for current smokers.

Background: Capsule endoscopy (CE) is a non-invasive imaging modality designed to evaluate various small bowel pathologies. Failure to reach the cecum within the battery lifespan, termed incomplete examination, may result in inadequate testing and possibly delayed therapy. Several studies have attempted to evaluate the association between CE completion and opioid use. However, their results are conflicting. The aim of this meta-analysis is to evaluate the previously published literature on the association between opioid use and CE completion. Methods: We performed a comprehensive literature search in PubMed, PubMed Central, Embase, and ScienceDirect databases from inception through June 1, 2018, to identify all studies that evaluated the association between CE completion and opioid use. We included studies that presented an odds ratio (OR) with a 95% confidence interval (CI) or presented the data sufficient to calculate the OR with a 95% CI. Statistical analysis was performed using the comprehensive meta-analysis (CMA), version 3 software. Results: Five studies with a total of 1,614 patients undergoing CE in the inpatient (IP) and outpatient (OP) setting were included in this study, 349 of which had an incomplete CE (21.6%). The pooled OR for CE completion is 0.50 (95% CI: 0.38-0.66, I2=36.9%) in opioid users compared to non-users. No publication bias was found using Egger's regression test. Conclusions: Our results indicate that patients on opioids are significantly less likely to have a complete CE examination compared to non-users. To our knowledge, this study represents the first meta-analysis to assess this association.

Controlled substance use, particularly among the rising elderly population, places these patients at a much higher risk of falls, injuries, and hospitalization. This study examines the association between preinjury controlled substance prescription and clinical outcomes of older adults after a ground-level fall. A total of 5,930 patients were included. Their home medication list was analyzed to record active opioids, benzodiazepines, narcotics, or other substances defined as controlled according to the Drug Enforcement Agency. Almost half (45%) of the patients were taking controlled substances. Sixty-seven percent of those were females. Total hospital days, Injury Severity Score (ISS), and mortality outcomes were not significantly different between groups. However, intensive care unit (ICU) days, days on mechanical ventilation (MV), and discharge destination were significantly different for patients taking controlled substances versus those not taking controlled substances. Patients taking controlled substances were more likely to be discharged to short- and long-term care facilities versus patients not taking controlled substances (P≤0.001).