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Fluctuations in the use of many drugs at one time or another have been characterized as drug epidemics. The depiction of drug use as an epidemic, as in the recent cases of methamphetamine and crack use, is a proven mechanism for communicating that a problem exists, but such depictions are not without risk. When the public characterization of drug use as an epidemic represents more than its epidemiological meaning of “unusually elevated occurrence,” panic is often substituted for reasoned action. Such declarations are likely to truncate objective investigation, generate fear rather than understanding, and stimulate reactive measures that exacerbate drug misuse. This article discusses the epidemiological origin and meaning of epidemic, documents how media headlines have sensationally depicted methamphetamine use, and recommends that alternative strategies for describing an increase in the incidence and prevalence of use may be more successful in directing researchers and policy makers toward effective strategies for reducing misuse.

AbstractMDMA (3,4-methylenedioxymethamphetamine) was first used as a legal adjunct to psychotherapy in the 1970s. By the early 1980s, “Ecstasy” had become a tiny part of the recreational American drug scene, and was ultimately criminalized in 1986. For a decade use continued, but remained quiet. By the end of the 1990s, increased supply, demand, seizures of pills, arrests of distributors associated with organized crime, adverse reactions, and government repons of problematic brain changes created an Ecstasy media frenzy. The government's reaction led to a public education campaign and proposals for exponential penalties for production, distribution and use of MDMA. This article looks at the history, epidemiology, and politics of Ecstasy, the media's response, and the ways in which media and government reaction will compromise harm reduction and safety.

Despite increasing expenditures on prevention, government survey after survey indicates that marijuana use-which comprises 90% of illicit drug use-has not been eradicated among teenagers. Today's adolescents have been exposed to the largest dose of prevention in our history. After three decades of such efforts, one must ask why young people continue to use marijuana, and why drug education has failed to bring about a marijuana-free teenage America. Drug education falls short because it is based on a “no-use” premise, scare tactics and top-down teaching. Such programs do not educate, and may even be counterproductive for those who choose to say “maybe” or “sometimes,” or “yes.” Moreover, drug education, as has been the case since its advent, is based on politics rather than science-an enormous taxpayer drain with few demonstrative results. A new strategy for drug education requires a pragmatic view that accepts the ability of teenagers, if educated honestly and in ways they trust, to make wise decisions leading, if not to abstinence, to moderate, controlled, and safe use.

AbstractDespite increasing expenditures on prevention, government survey after survey indicates that marijuana use—which comprises 90% of illicit drug use—has not been eradicated among teenagers. Today's adolescents have been exposed to the largest dose of prevention in our history. After three decades of such efforts, one must ask why young people continue to use marijuana, and why drug education has failed to bring about a marijuana-free teenage America. Drug education falls short because it is based on a “no-use” premise, scare tactics and top-down teaching. Such programs do not educate, and may even be counterproductive for those who choose to say “maybe” or “sometimes.” or “yes.” Moreover, drug education, as has been the case since its advent, is based on politics rather than science—an enormous taxpayer drain with few demonstrative results. A new strategy for drug education requires a pragmatic view that accepts the ability of teenagers, if educated honestly and in ways they trust, to make wise decisions leading, if not to abstinence, to moderate, controlled, and safe use.

AbstractMethadone maintenance is again receiving attention as an intervention for needle use/sharing among intravenous drug users. A major criticism is that methadone has its ownaddictive properties; consequently, the client is unable to detoxify and stay off opioids permanently. Study respondents had been off methadone for several years and offered their strategies for success. Motivating forces included the freedom and rewards, such as pride and respect. The following helped individuals to get off and stay off methadone: avoidance of opioids; treatment affiliation to supply ideology and to structure and fill free time; employment; social supports, specifically family and role models; modest plans to avoid disappointment; effective coping skills to avoid depression; and aging and burning out, In addition, those individuals who had immersed themselves in the conventional world, especially those having a higher social class status, had a less difficult time staying off methadone.

Getting off maintenance is problematic for methadone clients. This paper, based on data from qualitative/ethnographic data from 100 depth interviews with women on methadone, attempts to document and analyze this problem. We begin with a discussion of women's conceptions of readiness to detoxify from methadone, the components of this state and the illusions which are operative. Next is a discussion of obstacles to detachment from methadone: models of failure so visible in the clinic setting; being a success in the eyes of clinic staff and clients; and ever-present and intensive fears of clients about this process. We examine the actual detoxification process: the clinic's role, methadone withdrawal, and aids and accessories in this endeavor. Finally we look at the failure to complete a detoxification or remain abstinent upon getting off methadone, the meaning this has for the addict, and its implications.

AbstractDrug treatment on demand, appropriate and affordable drug treatment for injection drug users who are “ready” to enter a program, is a humane approach to drug treatment services and an important mechanism to halt the spread of HIV. However, drug treatment on demand is not a reality in the United States. In fact, due to funding cuts at federal, state, and local levels, entry into drug treatment programs has become increasingly more difficult over the past decade. In a NIDA-funded ethnographic study of methadone maintenance, IV drug use and AIDS, 70 heroin addicts who were out of treatment and actively seeking methadone maintenance were interviewed. In life-history interviews, the drug users described barriers to treatment, waiting-list experiences, and the impact of these experiences on their drug use, drug-using behavior, and emotional well-being. Respondents used many mechanisms to cope with the lack of availability of drug treatment slots, some of which have increased their risk of exposure to and spread of HIV. These findings indicate the need for an increase in the availability of subsidized methadone maintenance treatment slots “on demand” if individuals are to decrease their drug use and their high-risk behaviors, Drug treatment on demand is more than politically correct rhetoric, It is a necessary ingredient in reducing the harm caused by the use of illegal drugs.

Qualitative data from women defunded from a subsidized methadone maintenance treatment (MMT) program were analyzed to determine the impact of defunding on the women and their dependents. Women attested to the efficacy of MMT in creating a stable environment in which their illicit drug use was eliminated or controlled; they were able to decrease their participation in illicit activities and pursue further employment and educational goals. When defunding occurred women employed a variety of strategies including family borrowing, welfare funds, and illicit activities to remain on private MMT programs. The result of these payment strategies was often a premature detoxification from MMT due to unpaid clinic bills. Many women returned to heroin use to alleviate withdrawal symptoms from methadone detoxification. This return to heroin use was also accompanied by increased illicit activities. Defunded women reported severe emotional and financial destabilization as a result of lost access to subsidized methadone maintenance treatment.

AbstractDespite numerous research studies demonstrating the efficacy of methadone maintenance treatment (MMT) in general and the value of retention in particular, the increasing defunding of this modality has compromised its potential. From 1990 to 1995 the lead author conducted a longitudinal research project to determine the impact of the cost of treatment on 233 San Francisco Bay Area study participants seeking, enrolled in, or defunded from MMT. This paper reports on selected findings from that study. Using variables of drug use, crime, gender and HIV risk, qualitative and quantitative results comparing those seeking treatment with those enrolled in treatment indicated that MMT functioned as a harm-reduction tool. When clients were defunded, however, drug use, crime and HIV risk increased and harm was maximized.

The inundation which characterizes the heroin world focuses one's attention almost exclusively on drugs. Heroin often provides an addicted couple with commonality and a necessary focus in their relationship. However, lacking sexuality and other nondrug activities, heroin begins to undermine the relationship. The addict couple often begins to argue over money and drugs. There is bitterness, resentment, and often violence as a result of perceived inequalities on the part of one partner or the other. Finally, most addict-couples' relationships end on a sad and bitter note. The woman addict gradually becomes generally embittered with men, especially male addicts. With this embitterment, she occasionally gives up men completely and, in so doing, relinquishes one of the few roles open to her-that of home-maker.

AbstractThe institution of methad one maintenance as a treatment modality for heroin addiction in the mid-1960s was part of the growing medicalization of social problems in the United States. The definition of deviance as “sickness” rather than “badness” set the stage for America's first harm-reduction strategy. By the 1970s methadone maintenance was seen as a way to reduce drug-related crime, and federally funded programs prolife rated. Accompanying methadone's phenomenal expansion was increased regulation, bureaucratization, and criticism. The early 1980s brought the Reagan era, fiscal austerity, the new “just say no” abstinence morality, and demediculization of methadone maintenance. By the time needle-sharing was recognized as a major contributing factor ill the spread of HIV, methadone had been transformed into a largely fee-for-service, short-term, begrudgingly tolerated treatment modality. Ironically, while other countries were able to use methadone to curh the spread of AIDS, the United States refused to facilitate its expansion, and in fact impeded it. To the frustration of proponents and consumers, this original harm-reduction tool, with the potenual to impact the epidemic, was demedicalized and remains marginalized.

This paper is devoted to a discussion of women addicts as mothers. Women who are addicted while pregnant begin their careers as mothers with extreme guilt and a sense of initial failure. Heroin becomes a mechanism for coping with the routine difficulties of childraising. Children can also act as a controlling force on their mother's addiction if she has the option to perform her mothering duties in an otherwise "normal" fashion. If the woman is being supported adequately and can be available for her children, it is possible to combine addiction and mothering. Often, however, the woman has to work outside the home (usually in criminal pursuits) and the general chaos of her life greatly impinges on her ability to fulfill her mothering duties. Children are occasionally mistreated, sometimes neglected physically, and often neglected psychologically by a mother who is frequently absent. Addicted mothers feel extreme guilt and remorse over this neglect, and often take stock of their situation when their role as a mother is threatened; the children are being taken away physically or growing up and she is losing them to time. The woman addict most often wants "out" of the heroin life when her children and her role as mother-her last remaining option-are in jeopardy.

The authors report on a subset of data from a three-year qualitative and quantitative study of 233 injection drug users (IDUs) in and out of methadone maintenance treatment (MMT) programs in the San Francisco Bay Area. We analyzed data from ten study participants detoxified from their MMT programs voluntarily and thirty involuntarily detoxified due to the defunding of their subsidized MMT slots. All of the study participants reported benefits from MMT program participation including decreased drug use or abstinence; decreased illicit activity; increased ability to maintain or initiate conventional employment; and increased ability to respond to parenting and family obligations. Those who were involuntarily detoxified from MMT programs experienced severe destabilization. Many were financially unstable and dependent on subsidized drug treatment prior to defunding. Several defunded participants were detoxified because they could not afford private fees ($225-300/month); others reverted to illicit activities to pay clinic fees. The majority increased heroin use, illicit activity, and experienced economic and personal harm as a result of involuntary detoxification from MMT. Those who chose to detoxify from MMT programs reported longer treatment histories and greater financial stability. Most described methadone as a prescription-like drug; ancillary clinic services, such as counseling, were unnecessary and undesired by many who voluntarily detoxified. Those who remained opi-oid-free reported that slow detoxifications from MMT, with client input and control, were necessary to prevent relapse. Study participants in this group who returned to the intermittent use of heroin had the financial resources to re-enroll in MMT. None of the voluntarily detoxified study participants returned to daily heroin use or illicit activity when leaving MMT programs.

Provides information on the conference organized in San Francisco, California to address the problem of student cynicism about drug education.