a Qualitative Project Director, Heroin in Transition, Department of Family and Community Medicine , University of California , San Francisco , CA , USA.
b Ethnographer, Heroin in Transition, Department of Family and Community Medicine , University of California , San Francisco , CA , USA.
J Psychoactive Drugs. 2018 Apr-Jun;50(2):167-176. doi: 10.1080/02791072.2017.1394508. Epub 2017 Dec 6.
Since 2001, heroin-related overdose deaths in the United States have risen six-fold, a rise unaccounted for by the expanding user population. Has heroin become a more dangerous drug? Reports of fentanyl and its analogs, often concealed in or sold as heroin, have also increased sharply. This article investigates heroin injectors' perceptions and experiences of changes in the heroin supply in the East Coast city of Baltimore, Maryland, currently facing an epidemic in heroin- and fentanyl-related overdose deaths. Unusually, Baltimore's heroin market is divided between two types: "Raw," believed to be Colombian in origin and relatively pure, and the more adulterated "Scramble" (raw heroin traditionally blended with quinine and lactose). Users reported that Scramble heroin, while gaining market share, has become a highly unstable product, varying dramatically in appearance, intensity of onset, duration of action, and effect. Some considered that Scramble was no longer "heroin," but was heavily adulterated or even replaced, mentioning fentanyl, benzodiazepines, and crushed opioid pills as additives. There was intense awareness of overdose as a present danger in users' lives, which they linked to the recent adulteration of the heroin supply. Responses to this perceived adulteration varied, including information gathering, attraction, avoidance, taking precautions, and acceptance.
自 2001 年以来，美国与海洛因相关的过量死亡人数增加了六倍，而这一增长无法用用户人数的扩大来解释。海洛因是否变得更危险了？有关芬太尼及其类似物的报告也急剧增加，这些物质通常隐藏在海洛因中或作为海洛因出售。本文调查了马里兰州巴尔的摩市东海岸海洛因注射者对海洛因供应变化的看法和经验，该市目前正面临海洛因和芬太尼相关过量死亡的流行。不同寻常的是，巴尔的摩的海洛因市场分为两种类型：“Raw”，据信来自哥伦比亚，相对纯净，以及更掺假的“Scramble”（传统上与奎宁和乳糖混合的生海洛因）。用户报告说，Scramble 海洛因虽然占据了市场份额，但已成为一种极不稳定的产品，在外观、发作强度、作用持续时间和效果上差异很大。一些人认为 Scramble 不再是“海洛因”，而是被大量掺假，甚至被替代，提到了芬太尼、苯二氮䓬类药物和压碎的阿片类药物作为添加剂。用户强烈意识到过量是他们生活中的一个当前危险，这与最近海洛因供应的掺假有关。他们对这种感知到的掺假的反应各不相同，包括信息收集、吸引力、回避、预防措施和接受。
