Biomedical subjects

Michael Agar

Publications and source records attributed to Michael Agar.

5 recordsLinked to original sources

PubMed2006

Getting clean and harm reduction: adversarial or complementary issues for injection drug users.

Many contemporary HIV prevention interventions targeting injection drug users (IDUs) have been implemented using Harm Reduction as a theoretical framework. Among drug-using individuals, however, the abstinence-based "getting clean" models espoused by Narcotics Anonymous and other widely adopted approaches to drug treatment are often more readily accepted. This paper describes an ethnographic examination of the ideological dichotomy between Harm Reduction and abstinence-based "getting clean" treatment model which emerged during the piloting phase of an HIV prevention intervention in Baltimore City, Maryland, USA. This paper describes how the conflict was identified and what changes were made to the intervention to help resolve the participants' dichotomous thinking concerning their substance abuse issues.

Anthropology, Cultural↗

PubMed2004

Ecstasy: commodity or disease?

This article evaluates past work on heroin and crack cocaine epidemics by comparing it with the increase in Ecstasy use in the late 1990s. First of all, the authors make the case that there was, in fact, a dramatic increase in Ecstasy use in the late 1990s. Following that is a review of the rise and fall of several different Ecstasy scenes beginning in the 1960s. The most recent rise, in the late 1990s, requires a broadening of the theory of epidemics to include longer historical waves of change, so we do that by reviewing work on post World War II trends in social disconnection and consumerism. We then shift to a marketing rather than a public health framework and look at the nature of the Ecstasy "product," both its good and bad characteristics. Finally, we describe the narrative mechanism, developed in our earlier work, that plausibly explains why use rose when it did, given the needs of the market. The article concludes by discussing the changes this case motivates for our theory, particularly in light of globalized and normalized drug use that at the moment appears to be the current context for illicit drug use.

Humans↗

PubMed2003

Toward a qualitative epidemiology.

This article is based on an invited keynote lecture to the Qualitative Health Research meetings in Banff, Alberta, in April 2002 and so is written in an informal style. The author begins with problems in traditional epidemiology, with its focus on the case record and the epidemiological triad of host, agent, and environment. The idea of a person-in-context "movie" is offered as an alternative kind of case record, and broader issues of identity and context are added to enrich the explanations of those records. In the original presentation, an agent-based model in the style of complexity theory was demonstrated. That model is beyond the scope of this article and is now under review by a complexity journal; a draft manuscript is available on request.

Anthropology, Cultural↗

PubMed2002

A tale of two policies: the French connection, methadone, and heroin epidemics.

The law enforcement and treatment policies of the Nixon administration are often credited with ending the epidemic of heroin addiction that rose in America's cities in the 1960s. In this article it is argued that although the interventions did in fact cause a major change in heroin distribution and use, the epidemic did not end in any simple way. The decline in heroin and increase in methadone that resulted from the Nixon policies lead to a shift for many addicts in both clinical and street settings from one narcotic to another. The temporary shortage of heroin that resulted from law enforcement was quickly compensated for with methadone, as well as with new distribution systems from Southeast Asia and Mexico. In the end, the interventions caused a change in an enduring "heroin system," a change that left that system in a stronger form in terms of supply and in a situation of continuing growth in terms of the number of addicts.

Drug and Narcotic Control↗

PubMedDate not supplied

A heroin epidemic at the intersection of histories: the 1960s epidemic among African Americans in Baltimore.

In the drug field the fundamental epidemiological question-why illicit drug use, here, now, among these people-has still not been adequately answered. Drawing on the work of colleagues in medical anthropology, we attempt to move closer to an answer by developing a "trend theory." In this article we analyze a single case: the increase in heroin use and addiction among African Americans in the City of Baltimore in the 1960s. We found that the two most important historical processes behind the epidemic were (1) a changing distribution/supply system and (2) the mix of hope and despair that was part of the early civil rights movement.

Black or African American↗