Bill Sanders

In the Club: Ecstasy Use and Supply in a London Nightclub:

Every weekend in the UK millions of young people attend nightclubs and many of them will use ‘dance’ drugs such as ecstasy. Drawing from ethnographic data generated from working as a club security guard and in-depth interview material with other security guards and a club manager, this article describes and analyses the use and supply of ecstasy within a large London nightclub. The analyses are centred on the normalized character of ecstasy within this club, the efforts of several security guards to control the supply of ecstasy and how this setting was home to a lively drug culture complete with a prosperous and somewhat protected drug economy.

Prevalence and Patterns of Prescription Drug Misuse among Young Ketamine Injectors

In recent years, epidemiological monitoring data has indicated sharp increases in prescription drug misuse. Despite these increases, little is known about the context or patterns associated with prescription drug misuse, particularly among youth or young injection drug users (IDUs). A three-city study of 213 young IDUs found prescription drug misuse to be pervasive, specifically the use of opioids and benzodiazepines. Particular practices not commonly associated with prescription drugs were reported, such as sniffing, smoking, and injection. Associated health risks included initiation into injection drug use, polydrug use, drug overdose, and drug dependency. A greater awareness of the potential health risks associated with prescription drug misuse should be incorporated into services that target IDUs, including street outreach, syringe exchanges, and drug treatment.

Control over Drug Acquisition, Preparation, and Injection: Implications for HIV and HCV Risk among Young Female Injection Drug Users

Young female injection drug users (IDUs) are at risk for HIV/HCV, and initiating the use of a new drug may confer additional and unexpected risks. While gender differences in the social context of injection drug use have been identified, it is unknown whether those differences persist during the initiation of a new drug. This mixed-methods study examined the accounts of 30 young female IDUs in Los Angeles, CA, USA from 2004 to 2006, who described the social context of initiating injection drug use and initiating ketamine injection. The analysis aimed to understand how the social context of young womens injection events contributes to HIV/HCV risk. Womens initiation into ketamine injection occurred approximately 2 years after their first injection of any drug. Over that time, women experienced changes in some aspects of the social context of drug injection, including the size and composition of the using group. A significant proportion of women described injection events characterized by a lack of control over the acquisition, preparation, and injection of drugs, as well as reliance on friends and sexual partners. Findings suggest that lack of control over drug acquisition, preparation, and injection may elevate womens risk; these phenomena should be considered as a behavioral risk factor when designing interventions.

THE FIRST INJECTION EVENT: DIFFERENCES AMONG HEROIN, METHAMPHETAMINE, COCAINE, AND KETAMINE INITIATES.

This article describes how the drug type injected at the first injection event is related to characteristics of the initiate, risk behaviors at initiation, and future drug-using trajectories. A diverse sample (n=222) of young injection drug users (IDUs) were recruited from public settings in New York, New Orleans, and Los Angeles during 2004 and 2005. The sample was between 16 and 29 years old, and had injected ketamine at least once in the preceding two years. Interview data was analyzed both quantitatively and qualitatively. Young IDUs initiated with four primary drug types: heroin (48.6%), methamphetamine (20.3%), ketamine (17.1%), and cocaine (14%). Several variables evidenced statistically significant relationships with drug type: age at injection initiation, level of education, region of initiation, setting, mode of administration, patterns of self-injection, number of drugs ever injected, current housing status, and their hepatitis C virus (HCV) status. Qualitative analyses revealed that rationale for injection initiation and subjective experiences at first injection differed by drug type.

Gang youth as a vulnerable population for nursing intervention.

BACKGROUND Gang youth often come from socially and economically marginalized communities. Such youth report significantly higher rates of participation in violence, substance use, and risky sexual behaviors than their nongang peers. AIMS This manuscript argues that gang-identified youth constitute a vulnerable population. MATERIALS AND METHODS Data are drawn from the general research literature and a case example of how a nurse in Los Angeles partnered with law enforcement to provide preventive health care to gang youth and youth at-risk for joining gangs. CONCLUSION Gang youth are a vulnerable population amenable to nursing intervention. Gang youth may have particular health care needs and may need special access to health care.

Putting in work: qualitative research on substance use and other risk behaviors among gang youth in Los Angeles.

Gang youth are notoriously difficult to access for research purposes. Despite this difficulty, qualitative research about substance use among gang youth is important because research indicates that such youth use more substances than their nongang peers. This manuscript discusses how a small sample of gang youth (n = 60) in Los Angeles was accessed and interviewed during a National Institute of Drug Abuse-funded pilot study on substance use and other risk behaviors. Topics discussed include the rationale and operationalization of the research methodology, working with community-based organizations, and the recruitment of different gang youth with varying levels of substance use.

Gang youth, substance use, and drug normalization.

Gang membership is an indicator of chronic illicit substance use and such patterns of use may have a normalized character. Using epidemiological and qualitative data collected between 2006 and 2007, this manuscript examines the drug normalization thesis among a small sample (n=60) of gang youth aged 16–25 years from Los Angeles. Overall, while evidence does suggest that illicit drug use was pervasive among the sample, data do not support the idea that all drugs were normalized. However, findings do indicate that marijuana use was normalized. This was due to the samples high frequency of marijuana use, wide access to marijuana, intent to use marijuana, positive attitudes about marijuana use, critical attitudes of the use of certain ‘hard’ illicit drugs, and cultural references supportive of marijuana use. Illicit substance use among gang youth could seemingly be divided into two categories: marijuana and everything else. In this respect, the values of gang members in relation to illicit substance use appear very similar to those of youth from the general population who also use illicit substances. This question the applicability of theories couched in pathology to understand the differential patterns of substance use among serious young offenders.

Recruiting and retaining mobile young injection drug users in a longitudinal study.

Longitudinal studies that research homeless persons or transient drug users face particular challenges in retaining subjects. Between 2005 and 2006, 101 mobile young injection drug users were recruited in Los Angeles into a 2-year longitudinal study. Several features of ethnographic methodology, including fieldwork and qualitative interviews, and modifications to the original design, such as toll-free calls routed directly to ethnographer cell phones and wiring incentive payments, resulted in retention of 78% of subjects for the first follow-up interview. Longitudinal studies that are flexible and based upon qualitative methodologies are more likely to retain mobile subjects while also uncovering emergent research findings.

Towards an Explanation of Subjective Ketamine Experiences among Young Injection Drug Users.

Ketamine is a dissociative anesthetic with powerful sedative and hallucinogenic properties. Despite the wide variability in reported subjective experiences, no study has attempted to describe the particular factors that shape these experiences. This manuscript is based upon a sample of 213 young injection drug users recruited in New York, New Orleans, and Los Angeles with histories of ketamine use. Qualitative interviews focused on specific ketamine events, such as first injection of ketamine, most recent injection of ketamine, and most recent experience sniffing ketamine. Findings indicate that six factors impacted both positive and negative ketamine experiences: polydrug use, drug using history, mode of administration, quantity and quality of ketamine, user group, and setting. Most subjective experiences during any given ketamine event were shaped by a combination of these factors. Additionally, subjective ketamine experiences were particularly influenced by a lifestyle characterized by homelessness and traveling.

Gang Youth, Risk Behaviors, and Negative Health Outcomes

Gang youth have been a perennial issue with criminologists for nearly a century. Much evidence suggests that something about participation within a gang leads youth to commit more crime when compared to non-gang youth. Gang youth are at an increased risk of arrest and incarceration for serious offences in comparison to other delinquent youth. Gang youth also are more likely to report participation in what are described as ‘health risk behaviors’, which include substance use, violence, and unsafe sexual practices. Consequently, gang youth are at an elevated risk of exposure to the negative health outcomes related to such behaviors, including addiction, overdose, infection, injury, disability, and death. This chapter offers data gathered in three cities over a 20-year period to provide a descriptive epidemiology of substance use, violence and unsafe sexual practices among gang-identified youth. We conclude with a discussion on how public health approaches towards other high-risk categories of youth could compliment current criminal justice efforts aimed at curbing the influence or impact of youth gangs.