Department of Anthropology, University of Maryland, 1111Woods Hall, 4302 Chapel Lane, College Park, MD 20742, USA.
Department of Anthropology, University of Maryland, 1111Woods Hall, 4302 Chapel Lane, College Park, MD 20742, USA.
Int J Drug Policy. 2021 May;91:103098. doi: 10.1016/j.drugpo.2020.103098. Epub 2021 Jan 19.
Rates of methamphetamine use and methamphetamine-related deaths have increased steadily in the United States in recent years. Methamphetamine is increasingly present in opioid-related deaths. An initial study of de-identified urine specimens (n = 102) collected at a drug treatment program between 2017 and 2018 indicated that 61% of specimens contained methamphetamine; of the specimens containing methamphetamine, people were, on average, five years younger than those who tested negative for methamphetamine; and non-fentanyl opioids were more than three times as common in methamphetamine positive specimens. The National Drug Early Warning System (NDEWS) Coordinating Center initiated a HotSpot Study to assess whether there was an emerging dynamic in the area, or if enhanced data collection could give insights into the co-use of methamphetamine and opioids.
A qualitative study, grounded in principles of rapid ethnographic assessment and a social science/anthropological framework was conducted and used methodological complementarity to contextualize results from the initial urinalysis study. Targeted sampling was conducted at two treatment sites. Program staff and patients were recruited to participate in focus groups and semi-structured interviews to assess structural, community, and individual-level factors impacting methamphetamine and opioid co-use.
Within our broader framework of structural, community, and individual-level factors intersecting co-use, our data yielded three sub-themes: 1) the circulation of stigma regarding methamphetamine use was consistently described by both patients and staff and this intersected structural changes in treatment policy and suggested compounded stigma; 2) community-level factors and temporality were important for understanding patterns of methamphetamine use and for further interpreting the initial urinalysis; 3) patient rationales regarding the co-use of methamphetamine and opioids included strategies to mitigate the harms of heroin, as well as to detox or titrate the effects of heroin.
Using an ethnographically-oriented and social science/anthropological approach and methodological complementarity to contextualize the prior urinalysis study demonstrates how behavioral variables cannot be abstracted from larger socio-structural and community contexts which impact people's decision-making process regarding co-use of methamphetamine and opioids. Further, by grounding our analysis in the meaning-centered and experiential narratives of people who use drugs, our research demonstrates the importance of considering the expertise of people who co-use opioids and methamphetamine as central for informing future sustainable program planning to address co-use that also accounts for the interrelationship between structural, community, and individual-level factors.
近年来，美国的甲基苯丙胺使用和与甲基苯丙胺相关的死亡人数稳步上升。甲基苯丙胺在阿片类药物相关死亡中越来越常见。一项对 2017 年至 2018 年期间在一个戒毒治疗项目中收集的 102 份未经身份识别的尿液样本的初步研究表明，61%的样本含有甲基苯丙胺；在含有甲基苯丙胺的样本中，人的平均年龄比甲基苯丙胺检测呈阴性的人年轻五岁；在含有甲基苯丙胺的样本中，非芬太尼类阿片类药物的出现频率是检测呈阳性样本的三倍多。国家毒品预警系统（NDEWS）协调中心启动了一个热点研究，以评估该地区是否存在新的动态，或者加强数据收集是否可以深入了解甲基苯丙胺和阿片类药物的共同使用。
一项基于快速人种学评估和社会科学/人类学框架的定性研究，并使用方法互补性来使初始尿液分析研究的结果背景化。在两个治疗地点进行了有针对性的抽样。招募项目工作人员和患者参加焦点小组和半结构化访谈，以评估影响甲基苯丙胺和阿片类药物共同使用的结构、社区和个人层面的因素。
在我们结构、社区和个人层面因素相互交叉共同使用的更广泛框架内，我们的数据产生了三个子主题：1）患者和工作人员一致描述了关于甲基苯丙胺使用的污名循环，这与治疗政策的结构性变化相交织，并暗示了复合污名；2）社区层面的因素和时间因素对于理解甲基苯丙胺使用模式以及进一步解释初始尿液分析非常重要；3）患者关于甲基苯丙胺和阿片类药物共同使用的理由包括减轻海洛因危害的策略，以及戒除或调节海洛因的影响。
使用人种学为导向的和社会科学/人类学的方法以及方法互补性来使先前的尿液分析研究背景化，表明行为变量不能从影响人们关于甲基苯丙胺和阿片类药物共同使用决策过程的更大社会结构和社区背景中抽象出来。此外，通过将我们的分析建立在吸毒者的以意义为中心和经验性叙述的基础上，我们的研究表明，考虑到共同使用阿片类药物和甲基苯丙胺的人的专业知识的重要性，这是为解决共同使用问题提供信息的关键，同时也要考虑到结构、社区和个人层面因素之间的相互关系。
