Narratives about illness and medication: a neglected theme/new methodology within pharmacy practice research. Part II: medication narratives in practice

AIM: Part 2 of this paper aims to provide a methodological framework for the study of medication narratives, including a semi-structured interview guide and suggested method of analysis, in an attempt to aid the development of narrative scholarship within pharmacy practice research. Examples of medication narratives are provided to illustrate their diversity and usefulness. METHODS: The framework is derived from the work of other researchers and adapted for our specific purpose. It comes from social psychology, narrative psychology, narrative anthropology, sociology and critical theory and fits within the social constructionist paradigm. The suggested methods of analysis could broadly be described as narrative analysis and discourse analysis. Examples of medication narratives are chosen from a variety of sources and brief interpretations are presented by way of illustration. CONCLUSION: Narrative analysis, a neglected area of research in pharmacy practice, has the potential to provide new understanding about how people relate to their medicines, how pharmacists are engaged in producing narratives and the importance of narrative in the education of students. IMPACT OF THE ARTICLE: This article aims to have the following impact on pharmacy practice research: Innovative approach to researching and conceptualising the use of medicines. Introduction of a new theoretical perspective and methodology. Incorporation of social science research methods into pharmacy practice research. Development of narrative scholarship within pharmacy.     

Chapter 5. Russian Media Narratives About Young Drug Users

Since the 1960s, the media in Western Europe and the United States has been one important actor in the public understanding of the drug phenomenon. In Russia, however, it is only since the 1980s that illegal drugs have been discussed in the media and this discussion remains on-going today. By using narrative analysis, this article focuses on how illegal drug use among young people is constructed in the Russian press. As a result of the narrative analysis, three main discourses were identified: a foreign problem discourse, a disease discourse, and a medical discourse.     

Donepezil in a chronic drug user—a potential treatment?

The objective of the current study was to explore the potential cognitive benefits of an anticholinesterase inhibitor, donepezil, in a former chronic drug user. A neuropsychological test battery composed of the vocabulary and matrix reasoning subtests of the Wechsler adult intelligence scale-III, measures of everyday executive functioning (behavioural assessment of the dysexecutive syndrome [BADS]), and verbal learning and memory tasks (California verbal learning test-II; Rivermead behavioural memory test) was completed at baseline, at 3 months after introducing donepezil, and at 3 months after donepezil was discontinued. After donepezil treatment, substantial improvements were found on tasks of nonverbal fluid reasoning (i.e. matrix reasoning) and other executive functioning tests (i.e. BADS). At entry into the study, poor academic performance and subjective problems with memory and concentration were reported, particularly after amphetamine use (i.e. MDMA and crystal methamphetamine); after donepezil treatment, dramatic increases in memory, concentration and academic achievement were observed. The finding of improvements in tests of executive functioning and in academic performance in this case study, together with the minimal adverse side effects of donepezil, warrants the investigation of controlled studies of cholinergic enhancement in chronic amphetamine and other drug users.     

Report of a human fatality due to amphetamine

A pathological report and toxicological examination of an uncommon case of fatal amphetamine poisoning are presented. Amphetamine was quantified in different tissues by thin-layer chromatography and spectrophotofluorometry after fluorigenic labeling of amphetamine with 4-chloro-7-nitrobenzo-2,1,3-oxadiazole (NBD-Cl).The distribution study of amphetamine showed an extremely high concentration of amphetamine in urine and blood; fairly small amounts were found in the contents of the stomach and small intestine. These figures could indicate that the subject had taken amphetamine over a long period and that his death was probably caused by intravenous injection of amphetamine.     

Sensitization elicited by directly and indirectly acting dopaminergic agonists: comparison using neural network analysis

 The major aim of this work was to compare sensitized responses to amphetamine with those of apomorphine. This was done using both a univariant analysis of locomotor activity and a multivariant neural network analysis of five different behaviors. The neural network analysis compares the pattern of behaviors from a treated group to a set of patterns from control conditions and estimates the dose of drug in control conditions that best matches the pattern of behaviors of the treated group. Both methods indicated that repeated administration of 2.0 mg/kg amphetamine but not 0.5 mg/kg amphetamine resulted in sensitization to the administration of a 0.5 mg/kg amphetamine challenge given 10 days following the end of the sensitizing regimen. Both analyses indicated sensitization following repeated administration of 5 mg/kg apomorphine. Studies of cross sensitization were done using a neural network analysis that could distinguish patterns of behavior elicited by amphetamine from those elicited by apomorphine. Such studies indicated that apomorphine elicits an apomorphine-like response in animals sensitized to either apomorphine or amphetamine. In contrast, amphetamine produces an amphetamine-like response in animals sensitized to amphetamine and an apomorphine-like response in animals sensitized to apomorphine. The results indicate that neural network analysis may be a useful tool for analyzing drug effects on patterns of behavior. Received: 20 February 1998 / Final version: 30 June 1998     

Drugs as an existential threat: An analysis of the international securitization of drugs

The stated intention behind the establishment of the global drug prohibition regime was to protect the world from the dangers of drugs. At different points in history, drug production, use and supply have all been presented as threats to security whether human, national or international security. The international relations theory of securitization can be used as a way of explaining how and why the 'drugs as an existential threat' discourse holds so much power, even today. Speech acts such as the UN Single Convention on Narcotic Drugs, the UN Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances and Russia's 'Rainbow-2 Plan' clearly illustrate the development of the 'drugs as an existential threat' discourse at a global level with particular reference to mankind, the State and global peace and security, respectively. Analysis of these speech acts also shows how the power of the security narrative means that the global drug prohibition regime continues to remain pre-eminent despite the wealth of unintended consequences that it causes.     

Analysis of amphetamine and methamphetamine contents in seized tablets from Jazan,Saudi Arabia by liquid chromatography-mass spectroscopy (LC-MS/MS) and chemometric techniques

A number of illegal amphetamine tablets were seized from three different cities of Jazan province of southern Saudi Arabia and were analyzed for amphetamine and methamphetamine contents using LC-MS/MS technique. Analyses were performed using a previously reported method taking 0.1 M ammonium formate buffer (85%) and 15% acetonitrile with 0.1% formic acid as mobile phase with a total runtime of 12 min. This method was successfully applied for the routine analysis of amphetamine and methamphetamine in the seized tablets using amphetamine-D5 and methamphetamine-D5 as internal standards. Hierarchical cluster analysis was performed to establish the similarity between samples. The retention times (RT) for internal standard, amphetamine and methamphetamine were observed to be within 6.0–7.1 min. Ten tablet samples from each city were subjected to analysis and the amount of amphetamine in all the samples were found to be in the range of 9.07–14.77 mg, whereas, the amount of methamphetamine ranged from 0.12 to 0.24 mg in each tablet. Hierarchical cluster analysis showed presence of five clusters of samples indicating different characteristics and possible sources of amphetamine tablets. The largest cluster consisted of 15 samples which are expected to be of the same origin. Both amphetamine and methamphetamine are considered to be illegal products and their illegal trade and use is banned in many countries including Saudi Arabia. Therefore, there is an urgent need of strict regulations worldwide to check the illicit trafficking of these psychoactive substances and should be considered on priority.     

Adolescent amphetamine users in treatment: client profiles and treatment outcomes

This study compares client profiles of adolescent amphetamine users to those of nonusers and examines the multivariate prediction of posttreatment drug use, criminal, and HIV risk behavior outcomes in the year following their separation from treatment. Data were collected as part of a larger longitudinal study on a sample of 938 adolescents who were admitted to residential therapeutic community drug treatment programs across the eastern United States and Canada from April of 1992 through April of 1994. A subsample of 485 adolescents were reinterviewed one year after their separation from treatment. Findings indicated that amphetamine users tended to be white, older, and have parents with higher education and occupational levels than nonusers. However, they also had more psychopathology, more extensive drug use and criminal histories, and engaged in more HIV-risk behaviors than nonusers. Additionally, amphetamine users tend to come from homes where one or both parents used illicit drugs, drank regularly, or had a mental illness, and they often reported histories of childhood maltreatment. Analyses of the one-year follow-up data indicated that being an amphetamine user was not related to treatment outcome after the client's demographic characteristics, overall drug use severity, and treatment completion were taken into account. Therefore, therapeutic community treatment appears to be an effective means of treating adolescent amphetamine users.     

Amphetamine-induced on- and off-wall rearing in adult laboratory rats

Recently, Bauer reported that amphetamine did not increase rearing behavior in adult rats. This result is at variance with many earlier reports demonstrating that amphetamine does increase rearing behavior. Because Bauer's automated measure only detected rearing when it occurred on the wall of the cage, it is possible that amphetamine only increased rearing behavior that occurred off the wall, which was not measured in his study. Bauer also included non-habituated animals in his study which might account for the discrepant results. The present experiment was performed to determine if, indeed, there was a difference between amphetamine induced on- and off-wall rearing and to determine to what extent habituation affected both types of rearing. The findings demonstrated that both types of rearing increased following d-amphetamine administration for both habituated and non-habituated animals. However, at the highest dose of d-amphetamine studied (4 mg/kg) rearing occurred mainly on the wall. Additionally, rearing behavior was found to increase following amphetamine when measured in the Digiscan Animal Activity Monitoring system which detects, but does not discriminate between, both on- and off-wall rearing.     

Mixing politics and crime – The prevalence and decline of political discourse on the cryptomarket

BackgroundDread Pirate Roberts, founder of the first cryptomarket for illicit drugs named Silk Road, articulated libertarian political motives for his ventures. Previous research argues that there is a significant political component present or involved in cryptomarket drug dealing which is specifically libertarian. The aim of the paper is to investigate the prevalence of political discourses within discussions of cryptomarket drug dealing, and further to research the potential changes of these over the timespan of the study.MethodsWe develop a novel operationalization of discourse analytic concepts which we combine with topic modelling enabling us to study how politics are articulated on cryptomarket forums. We apply the Structural Topic Model on a corpus extracted from crawls of cryptomarket forums encompassing posts dating from 2011 to 2015.ResultsThe topics discussed on cryptomarket forums are primarily centered around the distribution of drugs including discussions of shipping and receiving, product advertisements, and reviews as well as aspects of drug consumption such as testing and consumption. However, on forums whose primary function is aiding operations on a black market, we still observe political matter. We identified one topic which expresses a libertarian discourse that emphasizes the individual's right to non-interference. Over time we observe an increasing prevalence of the libertarian discourse from 2011 to the end of 2013. In the end of 2013 – when Silk Road was seized – we observe an abrupt change in the prevalence of the libertarian discourse.ConclusionsThe libertarian political discourse has historically been prevalent on cryptomarket forums. The closure of Silk Road has affected the prevalence of libertarian discourse suggesting that while the closure did not succeed in curtailing the cryptomarket economy, it dampened political sentiments.     

Comparing primary heroin and primary amphetamine users' knowledge of withdrawal and treatment options in inner metropolitan Brisbane, Australia

The present study compared knowledge of withdrawal and treatment services among twelve primary heroin injectors (PHIs) and fourteen primary amphetamine injectors (PAIs). Assessment of knowledge about withdrawal and treatment was made using the Withdrawal Knowledge Questionnaire (WKQ). Results showed that, on average, knowledge about withdrawal differed depending on the drug used. Specifically, regular amphetamine users knew less about withdrawal from amphetamine, than regular heroin users knew about withdrawal from heroin. In addition, amphetamine users appeared to underestimate the likely length of amphetamine withdrawal. There was no difference between regular amphetamine and regular heroin users' knowledge of available treatment services, such that both groups knew where to seek assistance for detoxification and rehabilitation. However, both user groups shared some important misconceptions about withdrawal. This suggests a clear need for improved dissemination of educational resources, emphasizing the length and severity of amphetamine withdrawal and the risks associated with excessive self-medication of withdrawal symptoms.     

Antipsychotic effect of propranolol on chronic schizophrenics: Study of a gradual treatment regimen

Experiments are reported which show that 1 mg/kg of d-methylamphetamine HCl induced hyperactivity in pigmented strains (C57BR, C57BL/6, and SEC) and hypoactivity or no change in albino strains (BALB/c, A, and AKR) of mice. In F1 hybrids, the B6 genotype was partially dominant over BR and C, and BR over C. In animals back-crossed to C parents widespread distributions with two peaks were obtained in control experiments, and amphetamine induced hyperactivity in 38% of the albino population, and hypoactivity or no significant change in 45% of the pigmented one. This genetic study indicates that genes influencing locomotor activity are independent from those influencing amphetamine sensitivity. From results obtained in back-crosses and C57BL/6-c^2J mice, the albino gene does not seem to be involved in the hypoactive effect of amphetamine.     

A rapid method of determining amphetamine in plasma samples using pentafluorobenzenesulfonyl chloride and electron-capture gas chromatography

INTRODUCTION: Acute administration of (+)-amphetamine has been used as a model for mania in humans since it mimics the physiological, biochemical, and cognitive effects seen in mania. A rapid and sensitive method for the determination of amphetamine in human plasma samples using gas chromatography with electron-capture detection was developed in our laboratory to follow the time course of amphetamine levels in patients receiving this drug as part of a study using amphetamine as a model for mania. METHODS: Blood samples were taken from healthy male volunteers at 30, 60, 90, 150, 210, 240, and 480 min after administration of 25 mg of (+)-amphetamine. Plasma was isolated by centrifugation and used for the analysis. This method is a modification of the procedure described by Paetsch et al. [J. Chromatogr. 573 (1992) 313] for the determination of amphetamine in rat brain tissue. Amphetamine was derivatized under basic conditions using pentafluorobenzenesulfonyl chloride (PFBSC) prior to analysis on a gas chromatograph equipped with a capillary column and an electron-capture detector. The internal standard used was benzylamine. The structure of the amphetamine derivative was confirmed using combined gas chromatography-mass spectrometry (GC-MS). RESULTS: The limit of detection was <1 ng/ml, and the method was linear in the 1- to 100-ng range used. Mean amphetamine levels peaked at 3.5 h after drug administration, and were 40.8 +/- 1.5 ng/ml at that time. DISCUSSION: This procedure produces a stable derivative with excellent chromatographic properties and is both simple and reproducible.     

The trouble with morality: the effects of 12-step discourse on addicts' decision-making

Since its development in the 1960s, researchers have extensively scrutinized methadone maintenance treatment (MMT) as a medical response to heroin addiction. Studies consistently find that MMT is more successful than other treatment models in the reduction of opiate/opioid misuse, the transmission of diseases like HIV/AIDS and hepatitis C, and criminal arrest and conviction rates. Nonetheless, a significant portion of active and former heroin addicts view MMT negatively and-perhaps as a result-MMT is vastly underused. This study examines the effects of 12-Step discourses on the opinions and treatment decisions of active heroin addicts, addicts in MMT, and addicts in 12-Step treatment programs. The study finds the abstinence/morality based discourse of drug addiction and treatment is pervasive among addicts and their non-drug using relations and peers alike; moreover, addicts have internalized this narrative, oftentimes despite their own knowledge of MMT's success and positive personal experiences. The findings suggest that the dominance of abstinence/morality narratives contributes to MMT's poor reputation among, and low use rate by current and former heroin addicts and that the power of the dominant discourse is such that it produces a desire to buy into its values and tenets even when it is against the individual's interests to do so.     

Narratives about illness and medication: a neglected theme/new methodology within pharmacy practice research. Part II: medication narratives in practice

Aim

Part 2 of this paper aims to provide a methodological framework for the study of medication narratives, including a semi-structured interview guide and suggested method of analysis, in an attempt to aid the development of narrative scholarship within pharmacy practice research. Examples of medication narratives are provided to illustrate their diversity and usefulness.

Methods

The framework is derived from the work of other researchers and adapted for our specific purpose. It comes from social psychology, narrative psychology, narrative anthropology, sociology and critical theory and fits within the social constructionist paradigm. The suggested methods of analysis could broadly be described as narrative analysis and discourse analysis. Examples of medication narratives are chosen from a variety of sources and brief interpretations are presented by way of illustration.

Conclusion

Narrative analysis, a neglected area of research in pharmacy practice, has the potential to provide new understanding about how people relate to their medicines, how pharmacists are engaged in producing narratives and the importance of narrative in the education of students.

Impact of the article

This article aims to have the following impact on pharmacy practice research:

• Innovative approach to researching and conceptualising the use of medicines
• Introduction of a new theoretical perspective and methodology
• Incorporation of social science research methods into pharmacy practice research
• Development of narrative scholarship within pharmacy

     

To be one who continues to smoke: Construction of legitimacy and meaning in young adults’ accounts of smoking

This study analyses young smokers’ accounts of continuing to smoke in a context of increasing structural and symbolic pressure to quit. It explores the accounts in relation to issues of legitimacy, meaning and identity. A qualitative study was conducted with interviews with 21 male and female smokers aged 18–23 years. The interviewees described themselves in various ways as ‘in control’ of their smoking, discursively rejecting addiction. They also spoke about control in accounts of calculation of risk of ill health, and of compensating for smoking by other health promoting lifestyles. At the same time the interviewees talked about smoking in a way that opposed this rational discourse, highlighting pleasure and an emotional and metaphysical side of smoking. The material was interpreted using a discourse analytic framework, inspired by a Foucauldian understanding of discourse as impacting on the construction of subjectivity, selfhood and identity.     

Use of amphetamine by recreational users of ecstasy (MDMA) is associated with reduced striatal dopamine transporter densities: a [123I]β-CIT SPECT study – preliminary report

RATIONALE: Tablets sold as ecstasy often contain not only 3,4-methylenedioxymethamphetamine (MDMA) but other compounds well known to cause dopaminergic neurotoxicity, such as (meth)amphetamine. Furthermore, the use of ecstasy in the Netherlands is often combined with the use of amphetamine. However, little is known about the effects of ecstasy use or the combination of ecstasy and amphetamine use on dopamine (DA) neurones in the human brain. OBJECTIVES: This study was designed to investigate the effects of ecstasy as well as the combined use of ecstasy and amphetamine on the density of nigrostriatal DA neurones. METHODS: [123I]beta-CIT SPECT was used to quantify striatal DA transporters. Striatal [123I]beta-CIT binding ratios of control subjects ( n=15) were compared with binding ratios of ecstasy users ( n=29) and individuals with a history of combined ecstasy and amphetamine use ( n=9) after adjustment for age. RESULTS: Striatal [123I]beta-CIT binding ratios were significantly lower in combined ecstasy and amphetamine users compared to sole ecstasy users (6.75 versus 8.46, respectively: -20.2%, P=0.007). Binding ratios were significantly higher in ecstasy users when compared to controls (8.46 versus 7.47, respectively: +13.2%, P=0.045). CONCLUSIONS: These initial observations suggest that the sole use of ecstasy is not related to dopaminergic neurotoxicity in humans. In contrast, the reported use of amphetamine by regular users of ecstasy seems to be associated with a reduction in nigrostriatal DA neurones.     

Turn on, tune in, but don’t drop out: The impact of neo-liberalism on magic mushroom users’ (in)ability to imagine collectivist social worlds

BackgroundBetween 2002 and 2005 fresh or unprepared psilocin-based ‘magic’ mushrooms were legal to possess and traffic in the UK, and commercial sales demonstrated a significant market for this hallucinogenic drug. During and after this time there has been relatively little analysis concerning how magic mushroom users accounted for their drug use, nor on the wider political and cultural discourses that might have shaped this sense making.MethodIn this paper we present a critical analysis of contemporary discourses around magic mushroom use in the UK through a multi-level discourse analysis of focus group data from 20 magic mushroom users (13 male and 7 female, mean age 25 years), taken at a time when magic mushrooms were being legally sold in the UK.ResultsLocating participants’ use of magic mushrooms within the context of a culture of intoxication, neo-liberalism and the legacy of 1960s psychedelic philosophy, we identify six interpretative repertoires in their talk, which were subsumed within two overarching discourses. The first discourse drew on neo-liberal rhetoric, constructing participants as rational risk managing subjects engaged in a form of calculated hedonism that was legitimated as an act of personal freedom and consumer choice. The second discourse, identified as ‘post-psychedelic’, both celebrated and problematised a collective, connected ‘hippy’ form of spirituality.ConclusionThe paper analyses the relationships between identity, consumption and citizenship by arguing that people's ability to imagine collectivist, spiritual or interconnected social worlds has been contained within neo-liberalism rhetoric.     

Enacting multiple methamphetamines: The ontological politics of public discourse and consumer accounts of a drug and its effects

Over the last decade in Australia, methamphetamine has come to be seen as a significant issue for drug research, policy and practice. Concerns have been expressed over its potency, the increasing prevalence of its use and its potential for producing greater levels, and more severe forms, of harm compared to amphetamine or other drugs. In this article, we critically examine some of the ways in which methamphetamine and its effects are produced and reproduced within and through Australian public discourse, focusing in particular on the associations made between methamphetamine and psychosis. We show how public discourse enacts methamphetamine as an anterior, stable, singular and definite object routinely linked to the severe psychological ‘harm’ of psychosis. We contrast the enactment of methamphetamine within public discourse with how methamphetamine is enacted by consumers of the drug. In their accounts, consumers perform different methamphetamine objects and offer different interpretations of the relationships of these objects to psychological problems and of the ontological nature (i.e. relating to what is real, what is, what exists) of these problems. In examining public discourse and consumer accounts, we challenge conventional ontological understandings of methamphetamine as anterior, singular, stable and definite, and of its psychological effects as indicative of pathology. In line with recent critical social research on drugs, we draw on social studies of science and technology that focus on the performativity of scientific knowledge and material practices. We suggest that recognising the ontological contingency, and therefore the multiplicity, of methamphetamine offers a critical counterpoint to conventional research, policy and practice accounts of methamphetamine and its psychological effects.