Group Title: History of Medicine lecture series
Title: Drug epidemics : historical inquiry and the challenge of the illicit
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 Material Information
Title: Drug epidemics : historical inquiry and the challenge of the illicit
Series Title: History of Medicine lecture series
Physical Description: Book
Language: English
Creator: Spillane, Joe
Publisher: College of Medicine, University of Florida
Place of Publication: Gainesville, Fla.
Copyright Date: 2005
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Bibliographic ID: UF00095032
Volume ID: VID00001
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.

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Drug Epidemics


Historical Inquiry and the
Challenge of the Illicit


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An "Epidemic" of Drug :
Epidemics

* The use of the term goes back to at least
1912
* Closely associated with increases in cocaine
use in Western Europe immediately before
and after World War I
* Came into widespread usage with the rise of
heroin use in post-World War II U.S. cities.




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Epidemics and Drug-Taking: ::0
Three Core Issues

* Disease
* Contagion
* Susceptibility




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Disease

* Epidemics--an increase over normal in the
number of cases, but what counts as a case?
* Disease related to drug-taking (AIDS,
hepatitis)
* Adverse health consequences
* Addiction
* Incidence--this is what most drug "epidemics"
are counting




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Contagion :

* "Social contagion" models
* Emphasized the importance of social
networks and the diffusion of drug-taking
practices
* Replaced the "psychopath" model of drug-
taking that had been dominant in the 1920s
and 1930s









The Spread of Marijuana Use :0





in the United States




Figure 1--From Ned Polsky, Hustlers, Beats, and Others (New York: Aldine
Publishing, 1967), p. 168.





wT SPr~fA OF MARIHUANA USAE IN AMERIMCA
teLNU Ca4 OaIentI Aa0r' cad WB sullal DMININ,

4"


05 Lo WES EMr UA NOT
NEW ORLEA -

S. taith by mid-l92'a:. r1 aprid spa ns out 1131)
NENRO JAZZ llNGl f & i NEGRO FAWS WHITIr CLOT C IN R EACALLY MIXED













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From Ned Polsky, Hustlers, Beats and Others (1967)




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THE SPREAD OF MARIHUANA USE IN AMERICA*
Culture Contact, Differential Association, and Subcultural Diffusion

MEXICO

SOUTHWESTERN U.S.
(Introduced about 1910 by Mexican laborers; becomes established among
Mexican-Americans; sporadic cowboy use, but doesn't become established
there) t
NEW ORLEANS
introduced d to Negroes, via Mexlcan-Amerlcans, by 1920)

URBAN NEGRO LOWER CLASS, SOUTH & NORTH
(weal established by mid-1920's; rapid spread begins about 1931)
v-v-\




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A Heroin Macroepidemic


Figure 2-1 rom Pa lrik H. Hughes. Behind the Wal ofRespet: Community
Erpeiments in Heroin Addiction Control (Chicago: University of Chicago Press
1977), p. 82.


YEAR OF FIRST HEROIN USE
I. C *. t I






.



S -1




0 --
-- -

----- -


From Patrick H. Hughes, Behind the Wall of Respect (1977).




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The Diffusion of Heroin


"Chasing"


in the Netherlands


Figure .-From Jean-Paul C. Ground, "From the Straw to the Needle?
Determinants of Heroin Administration Routes," in Heroin in the Age of Crack-
Cocaine, James A. Inciardi and Lana D. Harrison, eds. (Thousand Oaks: Sage
Publications, 1998), p. 227.



Process phases User groups Process stages
CHINESE DEALEFWUSERS
IW7 I a ran poord -
r Inrduction
'I, IEuRral


Figr 1. Te Docio f The Nehrl cs



S Fo t t o 1(1
i II Faao ls
In-group
consoidation
JUirj4MCE E P'. U N .
SCOMr UN II AT L flOAE T
sitmson

SecOway r roMup






Figur 9. 1. The Diffusiom of Chwag it. The Nerberlards
From Jean-Paul C. Grund, "From the Straw to the Needle?" (1998)



From Jean-Paul C. Grund, "From the Straw to the Needle?" (1998)


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S




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SURINAMESE DRUG USING
COMMUNITY AT LARGE


Micro-
diffusion


Socio-Ecological
Factors 2


jary
ion


General Socio-
Econ. Factors 2


Socio-Cultural
Factors 3


Drug Market
Factors 3


Network/
peer group
diffusion



Macro-
diffusion


OTHER ETHNIC GROUPS AND
OTHER CITIES,TOWNS AND RURAL AREAS


Differentiation
of patterns


~




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Susceptibility :

* Explained why drug "epidemics" were self-
limited
* Social learning could "innoculate" potential
users
* Emphasis on personal and social correlates
of drug use; high-risk, addiction prone people
and pathological environments




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Why Historians Worry :

* Discomfort with underlying notions of disease
and pathology
* Little room in most models for individual
agency
* Most models generalize from historically-
specific phenomenon






A "Model" Amphetamine


Epidemic


ESTABLISHMENT OF
AMPHETAMINE MARKET AND
SUBCULTURE, BEGINNING/
OF EPIDEMIC PHASE"/


CURBS ON
"LEGAL"
SUPPLIES
I


SUBCULTURE
BECOMES INC ASINGLY
CRIMINALIZED D VIOLENT:
MANY USERS BURN OUT, MANY
DISENCHANTED RECRUITS STOP
BEFORE BECOMING HEA LY IN-
VOLVED. SOCIETY BEGI S TO
EXERT COUNTER-MEASURES


BASE LINE



INCEPTION OF EARLY ENDEMIC PHASE
INCREASING INOCULATION OF MANY INDIVIDUALS
WITH AMPHETAMINE EXPERIENCE*
OFTEN OVERSUPPLY OF LEGAL DRUGS
SOCIETAL AND ENVIRONMENTAL FACTORS SET THE STAGE


I
DEVELOPMENT OF ILLEGAL AMPHETAMINE
LABORATORIES AND INCREASING
"CONTAGIOUS" RECRUITMENT OF NEW
USERS. OFTEN DURING A FAD OR
POPULATION PHASE AMONG *THE ALIEN-
ATED AND DELINQUENT". FREQUENTLY
INTO THE HIGH-DOSE INTRAVENOUS PATTERN


From Everett Ellinwood, "The Epidemiology of Stimulant Abuse," 1974.


**.
**
*


ENDEMIC




An Alternative Model of S:.
Historical Inquiry

* Consumption
* Distribution
* Regulation




0S0
Tracking Chicago's Post-War :0
Heroin Epidemic, 1947-1951

* Consumption changes
Heroin replaces opium and morphine
IV drug use increases
Age of initiation drops
Larger proportion of African-American users





Chicago Narcotic Offenders,

By Year of Birth




.4M
3N ".
300







100 TO T469* 06

N^ ^cm of t N
..*--- ;LIll ^ ^<



From Dr. Walter A. Adams, testimony to U.S. Senate (1955)


*OO
S





SOO.
Addict Admissions Under 21, 0

U.S. Narcotic Hospital, 1935-51


Addict Admissions in Lexington Hospital under Age of 21

1935-1951
Ida ----------- ------- -- -- - -

------------- ---- -----
- ---------- ----- _- _



250
------------------------------------------------------j__

~-------------- ------------------------------
1---------- -----------.



--------------- ---------------- --- ------
35 6 1937 1 3a8 19 W 19 9l 1912 193 9AU 19165 1946 19? 19158 19i 19O 1951
Ebt.lutl buead a fire 5 mestau of 1951




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Distribution :

* Critical changes
Wartime supply disruptions end
Retail heroin purity increases (from 2% during the
war to a high of 55% in November of 1948)
More addicts are participating in the distribution
system
From "vice" to "street-corner" markets




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Regulation :

* Critical changes
Shift from a stable, penetrated market to a
growing market invisible to regulators
1947--CPD had few anti-narcotics resources
No organized prevention programs
No publicly-funded treatment in Chicago
Surveillance of young heroin users does not begin
until early 1949; City of Chicago's first response
comes in 1950




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Conclusion

* Historical patterns of drug-taking are poorly
understood
* Few studies integrate consumption,
distribution, and regulation issues
* Drug "epidemics" are useful objects of
historical inquiry, but are historically-specific
events
* Our ability to predict epidemics will remain
limited




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