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"Cocaine abuse California San Francisco."
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Innovation and adaptation: The rise of a fentanyl smoking culture in San Francisco
Illicitly manufactured fentanyls and stimulants are implicated in the escalating US mortality from drug overdose. San Francisco, California (SF) has seen declining fentanyl injection while smoking has increased. Beliefs and behaviors surrounding this development are not well understood.
The study used rapid ethnography to explore fentanyl and methamphetamine use in SF. The team conducted semi-structured interviews (n = 34) with participants recruited from syringe service programs. Video-recorded smoking sequences (n = 12), photography and daily field notes supplemented interview data.
Difficulty injecting and fear of overdose motivated transitions from injecting to smoking. Fentanyl was extremely cheap-$10/gram-with variability in quality. Foil was the most commonly used smoking material but glass bubbles, bongs and dabbing devices were also popular. No reliable visible methods for determining fentanyl quality existed, however, participants could gauge potency upon inhalation, and developed techniques to regulate dosage. Several participants reported at least hourly use, some reporting one or more grams of daily fentanyl consumption. Smoking was also very social, with people sharing equipment, drugs and information. Participants raised concerns about hygiene and overdose risk to others arising from shared equipment. Reportedly potent fentanyl 'residue' accumulated on smoking materials and was commonly shared/traded/stolen or consumed accidentally with diverse preferences for its use.
Our data highlight fentanyl residue as a new overdose risk with potential mismatch between the potency of the residual drug and the recipient's tolerance. Further, large doses of fentanyl are being consumed (estimated at approximately 50 mg of pure fentanyl/day). Smoking fentanyl has potential health benefits over injecting and may be protective against overdose, but substantial uncertainty exists. However, SF overdose mortality hit a record high in 2023. Recommendations to reduce fentanyl smoking overdose risks through pacing, greater awareness of dosages consumed and checking tolerance of residue recipients are potentially viable interventions deserving further exploration.
Journal Article
Intersecting Epidemics -- Crack Cocaine Use and HIV Infection among Inner-City Young Adults
“Crack” cocaine, an addictive, smokable form of cocaine, gained widespread use in many urban neighborhoods in the United States in the mid-1980s, particularly among poor young adults who were members of minority groups
1
–
6
. A recent national household survey of drug use found that approximately 1 million Americans, including 1.0 percent of those between 18 and 25 years of age, had used crack during the previous year
7
. Unlike injection-drug use, which is practiced predominantly by men, the use of crack cocaine is widespread among both men and women
7
–
9
.
When inhaled, vaporized cocaine base gains rapid access . . .
Journal Article
Predictors of Current Housing Status Among HIV-Seropositive Injection Drug Users (IDUs): Results from a 1-Year Study
Using longitudinal data collected from 821 HIV-seropositive injection drug users (IDUs) who participated in a multi-site behavioral intervention study, we identified predictors of current housing status at baseline and 12-month follow-up time points. The study was conducted in Baltimore, Miami, New York, and San Francisco from 2001 to 2005. Logistic regression, incorporating the general estimating equations (GEE) method was performed. Multivariate analysis found that Miami participants (OR = 0.56) were less likely to report having current housing (
P
< 0.05). Among the potential barriers to housing, lower income (OR = 0.68), injection cocaine/crack use (OR = 0.66) and recent incarceration (OR = 0.10) were statistically significant (
P
< 0.05). Among the potential facilitators of housing, case management (OR = 1.38), outpatient drug treatment attendance (OR = 1.74), and social support (OR = 1.39) were significant. The association between social support and housing was stronger among those who had been recently incarcerated. Additional research is needed to identify types of support and resources beyond what is currently provided in order to better serve housing needs of HIV-seropositive IDUs.
Journal Article
HIV Risk Behaviors Among Asian Drug Users in San Francisco
This study identified patterns of drug use and HIV risk behaviors in relation to cultural factors among Asian drug users in San Francisco. A sample of 92 Asian drug users (35 Chinese, 31 Filipino, 26 Vietnamese) who were not currently enrolled in drug treatment programs were recruited through targeted sampling methods and interviewed using a questionnaire with open-ended questions. The study evaluated responses of the participants based on content analyses. Compared with Chinese and Vietnamese, Filipino drug users had engaged in riskier behaviors in terms of injection drug use, having sex while on drugs, and having sex with injection drug users (IDUs). Cultural factors such as stigma of injection drug use and fear of needles were cited as reasons for not injecting drugs. Among IDUs, half cited trust as a reason for having shared needles. AIDS prevention programs targeting Asian drug users should consider specific cultural factors among high-risk groups (i.e., Filipinos, immigrants, women, and IDUs).
Journal Article
The relationship of substance use during sex to high-risk sexual behavior
Recent research with homosexual samples in San Francisco (Stall, McKusick, Wiley, Coates, & Ostrow, 1986) has shown that the use of alcohol (or other drugs) in conjunction with sexual activity is strongly related to unsafe sex (i.e., high risk for AIDS infection). Analysis of data from a mail survey of the adult population of San Francisco replicated these results: There was a strong relationship between frequency of using alcohol or other drugs in conjunction with sexual activity and the frequency of engaging in risky sexual behaviors. However, risky sexual behavior was not related to the proportion of sexual activity involving drinking and was related to proportion of sexual activity involving cocaine and other drugs in gay men only. Frequency of risky sex in hetersexuals was predicted largely by total frequency of sex, with small amounts of variance contributed by frequency of sex with a partner who was drinking or using drugs. In gay men, use of cocaine or other drugs during sex contributed a substantial amount of explained variance in risky behavior.
Journal Article
ASSOCIATION BETWEEN TIME HOMELESS AND PERCEIVED HEALTH STATUS AMONG THE HOMELESS IN SAN FRANCISCO
The purpose of this study was to describe the perceived health of the homeless, and to measure the effect of time homeless on perceived health status, after controlling for sociodemographic characteristics and health conditions. The design was cross-sectional; the population was a representative sample of homeless in San Francisco, interviewed on health issues. Analysis of predictors of poor or fair health status was by logistic regression. In this sample of 2780 persons, 37.4% reported that their health status was poor or fair as compared to good or excellent. Reporting poor or fair health status was significantly associated with time homeless, after controlling for sociodemographic variables and health problems including results from screening for HIV and Health Interview Survey (NHIS) showed poorer health status among the homeless persons in this study. Standardized morbidity ratios were highest for asthma; there was twice the number of homeless persons reporting asthma, in younger as well as older adults, as would be expected using NHIS rates. There was also an excess of arthritis, high blood pressure and diabetes in those age 18-44 as compared to adults in the Health Interview Survey. The time spent homeless remains associated with self-reported health status, after known contributors to poor health are controlled. Persons who have been homeless for longer periods of time may be the persons to whom health care interventions should be aimed.
Journal Article
Perceived Risks and Criminal Justice Pressures on Middle Class Cocaine Sellers
This is a report of a qualitative study of the perceived risks and criminal justice pressures experienced by middle class cocaine suppliers. In-depth interviews with eighty ex-sellers indicate that most feel that they can avoid arrest by controlling the networks of buyers they sell to and do not believe that the police, police investigations, RICO laws and the activities of the IRS are any real threat. In general, they were much more concerned about informants, disgruntled customers and robberies than the police. Very often the sellers own drug abuse was a regular unanticipated risk that caused them to give up drug sales more than criminal justice pressures.
Journal Article
African-American youth and AIDS high-risk behavior: the social context and barriers to prevention
Uses an ethnographic study of the largest African-American community in San Francisco and a survey of Black adolescent crack users to describe how drug addiction and accompanying increased sexual activity increase the risk of Acquired Immune Deficiency Syndrome (AIDS). Discusses social barriers to AIDS prevention. (FMW)
Journal Article