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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 iunusually elevated occurrence, i 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.

We present findings from a qualitative study of 80 women and men who sold Ecstasy in private settings. In this paper we explore Ecstasy sellers' identity processes and pathways to dealing. Interviewees believed 'real dealers' sold in public settings to people they did not know and relied on drug sales as their main source of income. We found that 76% of the sample resisted the dealer identity due to the stigma associated with dealing, Ecstasy's benign reputation, selling in private settings, and customer bases that comprised mainly friends. The majority of the sample 'drifted' into dealing and did not consciously decide to sell. Additionally, most interviewees did not implement precautionary sales strategies that characterize drug dealing operations described in our own and other investigators' research on drug markets. Ecstasy sellers created new, more positive identity constructions for themselves, which is also an important focus of this paper.

We present analyses based on selected findings from a NIDA-funded project entitled, 'An Exploratory Study of Ecstasy Distribution' (2003-2006). We conducted in-depth interviews with 120 men and women in the San Francisco Bay area who had sold five or more doses five or more times in the six months prior to the interview. The research focused on the motivations and circumstances surrounding the decision to initiate sales, sales settings, the characteristics of both sellers and buyers and their relationships. It also focused on negotiated order and social identities. We describe the ways in which a sample of educated, housed, and employed Ecstasy dealers' attitudes and practices compared with more marginalized groups from other drug market studies. These findings suggest attention to social class, that is, the social characteristics of sellers and the availability of types of sales settings (public vs. private) is critical to developing a sociological understanding of drug markets.

From a process evaluation, participants in San Francisco's syringe exchange program (SEP) are described. Three groups, primary, secondary, and nonexchangers, were interviewed for a total of 244 study participants recruited from eight needle exchange sessions. Fifty percent of all primary exchangers exchanged for one or more injecting drug user(s) (IDUs). Three general routes of syringe distribution were identified between primary and secondary exchangers: between close friends and lovers; for people who lived in close proximity to them; and with customers who bought drugs from them. Focusing on why some go to SEPs and why some rely on others to go for them, findings are summarized primarily as the barriers for not attending SEPs, including exposure, legal status, illness, drug lifestyle, and conflicts with service provision. The secondary exchangers had similar risk reduction profiles to the SEP users that overall were better than the nonexchangers. For example, they shared syringes and cookers significantly fewer times than nonexchangers. The results demonstrate that these client-provided exchanges enable the SEP to overcome injection drug users' obstacles to program attendance, thereby reaching even hard to access members of IDU populations. We found the effects of these client-provided services to be positive for the larger IDU population.

This is a report of a qualitative study of the perceived risks and criminal justice pressures experienced by middle class cocaine suppliers. In-depth interviews with eighty ex-sellers indicate that most feel that they can avoid arrest by controlling the networks of buyers they sell to and do not believe that the police, police investigations, RICO laws and the activities of the IRS are any real threat. In general, they were much more concerned about informants, disgruntled customers and robberies than the police. Very often the sellers own drug abuse was a regular unanticipated risk that caused them to give up drug sales more than criminal justice pressures.

Mothers who use crack cocaine are commonly believed to be selfish, uncaring, and neglectful of their children. For this paper, the grounded theory method was used to analyze 68 semi-structured depth interviews with cocaine-using mothers. These women's views of motherhood, the strategies they used to manage mothering on cocaine, and the contextual influences on mothering outcomes were explored. Contrary to popular assumptions, the women highly valued motherhood and held firm standards for childrearing. Mothers were concerned about the possible risks to their children and used a process of defensive compensation to protect both their children and their maternal identities from the negative influences of crack cocaine. When unable to fulfill their maternal responsibilities by other means, some mothers placed their children with family members, and others lost custody involuntarily. When children were forcibly removed, mothers often increased their drug use to cope with the loss. Social and economic conditions influenced the outcomes of mothering on crack.

In this exploratory study of pregnant drug users who have experienced one or more violent events (physical/sexual or emotional) while pregnant, the authors detail how drug use is both a survival strategy and a source of vulnerability to violence. Using a qualitative methodology, 126 women were interviewed who were or had recently been pregnant (within six months postpartum) and had used marijuana, crack, cocaine, or heroin singly or in combination (including alcohol with one or more of the above). Data concerning demographics, family, relationships, reproductive, drug use and violence histories were collected with a structured questionnaire. Of the 126 interviewees, 79% (100) were selected on the basis of their violent experiences during pregnancy for an in-depth interview that focused on their drug use and violence histories. The authors detail the ways in which women's drug use was a form of recreation, as well as a coping and survival strategy. Drug use also caused them serious problems. Women were demonized for using drugs while pregnant but not given feasible or reasonable alternatives.

Purpose: Notwithstanding a paucity of data, prescription of the opioid antagonist naloxone to patients prescribed opioids is increasingly recommended in opioid stewardship guidelines. The aim of this study was to evaluate chronic pain patients' attitudes toward being offered a naloxone prescription and their experience with naloxone.Methods: We interviewed 60 patients who received naloxone prescriptions across 6 safety-net primary care clinics (10 patients per clinic) from October 2013 to October 2015. We used a standardized questionnaire to collect information on substance use, perception of personal overdose risk, history of overdose, and experiences with naloxone prescription, including initial reaction, barriers to filling the prescription, storage and use of naloxone, associated behavioral changes, and opinions about future prescribing.Results: Respondents were demographically similar to all clinic patients receiving opioid prescriptions. Ninety percent had never previously received a naloxone prescription, 82% successfully filled a prescription for naloxone, and 97% believed that patients prescribed opioids for pain should be offered naloxone. Most patients had a positive (57%) or neutral (22%) response to being offered naloxone, and 37% reported beneficial behavior changes after receiving the prescription; there were no harmful behavior changes reported. Although 37% had personally experienced an opioid-poisoning event (17% of which were described as bad reactions but consistent with an overdose) and 5% reported that the prescribed naloxone had been used on them, 77% estimated their risk of overdose as low.Conclusions: Primary care patients on opioids reported that receiving a prescription for naloxone was acceptable, the prescription reached patients who had not had access to naloxone, and having naloxone may be associated with beneficial changes in opioid use behaviors. Patients prescribed opioids may not interpret the terminology describing overdose to imply unintentional opioid poisoning. [ABSTRACT FROM AUTHOR]