Philippe Bourgois | University of California, Los Angeles (original) (raw)
Papers by Philippe Bourgois
Expanding Addiction: Critical Essays, 2014
Antropologia, 2008
La sofferenza sociale e un tema fondamentale dell’antropologia medica da quando i sistemi medici ... more La sofferenza sociale e un tema fondamentale dell’antropologia medica da quando i sistemi medici sono emersi imponendosi per il loro attivo ruolo nella societa, e cio in ragione della rilevanza che ha il disagio fisico, emotivo o psichico nella vita di tutti i giorni. L’attenzione etnografica riservata alla sofferenza e essenzialmente politica, fosse anche al livello di un mero umanesimo populista. Essa richiede infatti solidarieta e sollecitudine da parte dell’antropologia, perche orienta l’analisi e l’osservazione verso quelle “categorie vicine all’esperienza (...) che hanno una prepotente rilevanza pratica” per gli individui che vengono studiati (Kleinman, Kleinman, 1991, p. 277).
Heritage colonial, dominations ethnique et de classe (discrimination a l'egard des Miskito pe... more Heritage colonial, dominations ethnique et de classe (discrimination a l'egard des Miskito perpetuee par les metis et les creoles) comme contexte a la « question » miskito. De la lutte armee a la negociation politique
Human Rights Quarterly, 2019
This article explores family separation and reunification of the disappeared Salvadoran children ... more This article explores family separation and reunification of the disappeared Salvadoran children separated from their families during El Salvador's civil war (1980-1992) from the perspectives of adult relatives. During separation, adult relatives experienced an "unresolvable loss." Following reunion, families experienced an immediate relief that was often accompanied by an "ambiguous reunification." Emotions were especially complicated and painful when the separation had been a "forced choice" by the parent under coercive wartime political conditions. Adoptive parents strongly influenced reunification. Findings suggest that disappeared children and biological and adoptive family members need psycho-social support throughout separation and reunification. I. INTRODUCTION Family separation and reunification impacts millions of families worldwide each year. 1 This article will describe the process of family separation and reunification from the perspectives of adult family members of the disappeared children of El Salvador. The article will provide historical context on the disappeared Salvadoran children, describe the research team's prior
Drug and Alcohol Dependence, 2021
California's Welfare and Institutions code 5150 allows for a temporary psychiatric hold (TPH) of ... more California's Welfare and Institutions code 5150 allows for a temporary psychiatric hold (TPH) of individuals who present a danger to themselves or others and/or may be gravely disabled due to mental illness. Little is known about the frequency and predictors of involuntary holds among people who inject drugs (PWID). Methods: We sought to identify the prevalence and predictors of recent TPHs (within the past 12 months) among a community-recruited sample of PWID in Los Angeles and San Francisco, California during 2017-2018 (N=531). Multivariable logistic regression modeling was used to evaluate demographic (e.g., age), economic (e.g., homelessness), drug use (e.g., types of drugs used), incarceration (e.g., recent arrest history) and mental health (e.g., lifetime mental health diagnosis) variables associated with recent TPH.
Cocaine, 2021
Raffy, the bichote [Puerto Rican Spanglish double entendre for "big shot"/"drug boss"/large phall... more Raffy, the bichote [Puerto Rican Spanglish double entendre for "big shot"/"drug boss"/large phallus] is out on the corner to night and invites Tito and me to sit next to him on the stoop of an abandoned row home. Tito is Raffy's "caseworker," the local term for a bichote's second-in-command, who is responsible for managing the shifts of sellers and lookouts on a drug corner. Soon we are surrounded by half-a-dozen of his off-and-on-duty heroin and cocaine sellers, wannabe sellers, and teenage and pre-teenage bored kids. They are all eager-like me-to be around the big shot boss. When he shows up on the block, Raffy becomes the charismatic nexus for action, money, power, potential, and risk. Perhaps most importantly, he is also the only provider of local employment in this desolate, almost all Puerto Rican, formerly industrial inner city neighborhood. philippe bourgois, laurie kain hart, george karandinos, and fernando montero
PLOS ONE, 2019
Background The United States is experiencing a continuing crisis of gun violence, and economicall... more Background The United States is experiencing a continuing crisis of gun violence, and economically marginalized and racially segregated inner-city areas are among the most affected. To decrease this violence, public health interventions must engage with the complex social factors and structural drivers-especially with regard to the clandestine sale of narcotics-that have turned the neighborhood streets of specific vulnerable subgroups into concrete killing fields. Here we present a mixed-methods ethnographic and epidemiological assessment of narcotics-driven firearm violence in Philadelphia's impoverished, majority Puerto Rican neighborhoods. Methods Using an exploratory sequential study design, we formulated hypotheses about ethnic/racial vulnerability to violence, based on half a dozen years of intensive participant-observation ethnographic fieldwork. We subsequently tested them statistically, by combining geo-referenced incidents of narcotics-and firearm-related crime from the Philadelphia police department with census information representing race and poverty levels. We explored the racialized relationships between poverty, narcotics, and violence, melding ethnography, graphing, and Poisson regression.
Third World Quarterly, 2018
The cultural and political-economic valences of psychoactive drugs in the Global South offer crit... more The cultural and political-economic valences of psychoactive drugs in the Global South offer critical insights on local and international fault lines of social inequality and profiteering. Historically, in a classic primitive accumulation process the trafficking of industrially produced euphoric substances across the globe have wreaked havoc among vulnerable populations while extracting profit for the powerful. The complex flows of capital generated both by illegal addiction markets and also by the mobilisation of licit public funds to manage their mayhem, however, suggest the contemporary utility of the concept of 'predatory accumulation'. The Enlightenmentera concept of 'primitive accumulation' usefully highlighted state violence and forcible dispossession in the consolidation of European capitalism. A contemporary reframing of these processes as predatory accumulation, however, highlights contradictory, nonlinear relationships between the artificially high profits of illegal drug sales, repressive governmentality and corporate greed. It sets these patterns of destructive profiteering in the context of our moment in history.
New England Journal of Medicine, 2019
The Structural Violence of Hyperincarceration Mr. M., an uninsured, 44-year-old Puerto Rican man ... more The Structural Violence of Hyperincarceration Mr. M., an uninsured, 44-year-old Puerto Rican man with chronic back pain, diabetes, hypertension, asthma, and a history of incarceration presented to a free clinic with acute exacerbation of back pain triggered by carrying heavy loads of trash at work. A premedical student acting as his health care advocate accompanied him. Mr. M. was hesitant to seek health care because he had no health insurance and mistrusted institutions as a result of his extensive negative experiences with the criminal justice system. He was visibly nervous in the unfamiliar institutional environment of the clinic, which had no Latino staff and was located in a middle-class neighborhood far from his home. The advocate reassured him in Spanish that the doctor was trustworthy and urged him to speak frankly about his health problems, including his challenges in obtaining medication. Embarrassed, Mr. M. reported that during recent back-pain exacerbations he occasionally resorted to purchasing one or two 5-mg oxycodone tablets in the open-air drug market operating on the inner-city block where he lived. The physician gave Mr. M. ibuprofen and a prescription for five 5-mg oxycodone tablets, enrolled him in the clinic's diabetes and hypertension programs, and scheduled a follow-up visit. Mr. M. never filled the prescription and did not return to the clinic, despite repeated entreaties by the advocate both in person and over the phone.
L'Homme, 2012
© École des hautes études en sciences sociales ANTHROPOLOGUE travaillant depuis 1979 sur la viole... more © École des hautes études en sciences sociales ANTHROPOLOGUE travaillant depuis 1979 sur la violence, la pauvreté et les inégalités sociales, en Amérique centrale d'abord, puis aux États-Unis, j'ai craint, au fil des ans, d'être véritablement obsédé par la violence. Hélas, il est plus juste de dire que la violence s'est imposée à moi parce qu'elle est, et a toujours été, au coeur de l'organisation du pouvoir dans la vie quotidienne. L'ethnographe risque bien sûr de contribuer à un voyeurisme, une pornographie de la brutalité. Toutefois, le danger est plus grand encore de ne pas voir la violence ; bien souvent le discours anthropologique n'en tient pas compte alors qu'elle accable les populations étudiées. La violence est inégalement répartie dans le monde. La façon dont elle soutient différentes structures de pouvoir et d'exploitation mérite d'être analysée et dénoncée. Hélas, si la violence physique directe se voit aisément, elle ne représente que la partie émergée de l'iceberg et masque bien souvent, aux yeux des chercheurs, des formes moins flagrantes-et variant insidieusement avec le temps-de coercition, de peur et d'assujettissement. En règle générale, ces déclinaisons de la violence ne sont pas perçues ou reconnues en tant que telles par les victimes et les auteurs de violences (qui bien souvent sont une seule et même personne). Pareil aveuglement légitime aux yeux de l'ensemble de la population les politiques publiques punitives qui infligent des souffrances aux plus vulnérables.
Drug and alcohol dependence, 2017
A robust literature documents generational trends in drug use. We examined the implications of ch... more A robust literature documents generational trends in drug use. We examined the implications of changing national drug use patterns on drug injection histories of diverse people who inject drugs (PWID). Drug use histories were collected from 776 active PWID in 2011-13. Using descriptive statistics, we examine drug use initiation by year and birth cohort (BC) differences in drug first injected. A multivariate linear regression model of time to injection initiation ([TTII] (year of first injection minus year of first illicit drug use) was developed to explore BC differences. The first drug injected by BC changed in tandem with national drug use trends with heroin declining from 77% for the pre-1960's BC to 58% for the 1960's BC before increasing to 71% for the 1990's BC. Multivariate linear regression modeling found that shorter TTII was associated with the 1980's/1990's BC (-3.50 years; 95% Confidence Interval [CI]=-0.79, -6.21) as compared to the 1970's BC. Lo...
L' Homme; revue francaise d'anthropologie, 2016
L'Homme, 2016
© École des hautes études en sciences sociales AUDÉBUTde notre enquête de terrain dans la zone la... more © École des hautes études en sciences sociales AUDÉBUTde notre enquête de terrain dans la zone la plus pauvre du ghetto portoricain de Philadelphie, Congo, un dealer afro-américain charismatique, propriétaire d'un point de vente de drogue, s'était fait tuer par balles sur son perron, sous les yeux de sa famille, par le frère cadet de l'un de ses revendeurs. Il n'avait pas voulu payer la caution de ce dernier après son arrestation. Dans un quartier à plus de 80% portoricain, Congo faisait figure d'outsider, et il avait cultivé la réputation du caïd qui « aimait jouer avec les flingues ». Un de ses anciens employés se souvient : « Tout le monde savait que Congo était fou. Il laissait personne vendre dans le secteur. Une fois, des mecs faisaient leur business dans le coin d'à côté et Congo s'est ramené avec son gun : "Yo niggas ! Vous faites quoi là ?". Ils essayent de discuter [haussant la voix] : "Ah ouais ?! ". Mais Congo leur tire dessus direct, bom, bom, bom, bom, bom ! En plein jour ! Plus tard, un mec Dominicain a essayé de faire son deal en douce [on the DL], Congo est sorti en plein jour et l'a défoncé avec la crosse de son flingue. Ouais et… Congo était costaud. Je veux dire vraiment costaud. Donc les mecs ils savent. Ce mec est solide ». Congo avait commencé à travailler comme petit dealer de rue en s'installant dans le quartier à l'âge de dix-sept ans. Même s'il avait cette réputation d'avoir la gâchette facile, c'était plutôt son implication dans l'économie morale du quartier-un système d'obligations réciproques fondé sur des relations matrimoniales et de parenté-qui avait permis son ascension dans le circuit du narcotrafic local, cinq ans plus tard. Il était tombé amoureux de Julieta (la nièce de l'ancien boss portoricain, Leni), dont il avait adopté les deux jeunes enfants (leur père, un dealer portoricain, avait été assassiné dans un bar au cours d'une rixe quelques mois auparavant).
International Journal of Drug Policy, 2016
Journal of Psychoactive Drugs, 2016
Since the 1990s, US heroin consumers have been divided from the full range of available products:... more Since the 1990s, US heroin consumers have been divided from the full range of available products: east of the Mississippi River, Colombian-sourced powder heroin (PH) dominates the market, while to the west, Mexican-sourced "black tar" (BTH) is the main heroin available. By conducting qualitative research in two exemplar cities, Philadelphia (PH) and San Francisco (BTH), we compare users' experiences of heroin source-types, markets, health consequences and consumption preferences. The strict division of heroin markets may be changing with novel forms of powder heroin appearing in San Francisco. Our researchers and interviewees perceived vein loss stemming from the injection of heroin alone to be a particular problem of BTH while among the Philadelphia sample, those who avoided the temptations of nearby cocaine sales displayed healthier injecting sites and reported few vein problems. Abscesses were common across both sites, the Philadelphia sample generally blaming missing a vein when injecting cocaine and the San Francisco group finding several explanations, including the properties of BTH. Consumption preferences revealed a 'connoisseurship of potency', with knowledge amassed and deployed to obtain the strongest heroin available. We discuss the reasons that their tastes take this narrow form and its relationship to the structural constraints of the heroin market.
Academic medicine : journal of the Association of American Medical Colleges, Mar 12, 2016
The authors propose reinvigorating and extending the traditional social history beyond its narrow... more The authors propose reinvigorating and extending the traditional social history beyond its narrow range of risk behaviors to enable clinicians to address negative health outcomes imposed by social determinants of health. In this Perspective, they outline a novel, practical medical vulnerability assessment questionnaire that operationalizes for clinical practice the social science concept of "structural vulnerability." A structural vulnerability assessment tool designed to highlight the pathways through which specific local hierarchies and broader sets of power relationships exacerbate individual patients' health problems is presented to help clinicians identify patients likely to benefit from additional multidisciplinary health and social services. To illustrate how the tool could be implemented in time- and resource-limited settings (e.g., emergency department), the authors contrast two cases of structurally vulnerable patients with differing outcomes. Operationalizin...
Expanding Addiction: Critical Essays, 2014
Antropologia, 2008
La sofferenza sociale e un tema fondamentale dell’antropologia medica da quando i sistemi medici ... more La sofferenza sociale e un tema fondamentale dell’antropologia medica da quando i sistemi medici sono emersi imponendosi per il loro attivo ruolo nella societa, e cio in ragione della rilevanza che ha il disagio fisico, emotivo o psichico nella vita di tutti i giorni. L’attenzione etnografica riservata alla sofferenza e essenzialmente politica, fosse anche al livello di un mero umanesimo populista. Essa richiede infatti solidarieta e sollecitudine da parte dell’antropologia, perche orienta l’analisi e l’osservazione verso quelle “categorie vicine all’esperienza (...) che hanno una prepotente rilevanza pratica” per gli individui che vengono studiati (Kleinman, Kleinman, 1991, p. 277).
Heritage colonial, dominations ethnique et de classe (discrimination a l'egard des Miskito pe... more Heritage colonial, dominations ethnique et de classe (discrimination a l'egard des Miskito perpetuee par les metis et les creoles) comme contexte a la « question » miskito. De la lutte armee a la negociation politique
Human Rights Quarterly, 2019
This article explores family separation and reunification of the disappeared Salvadoran children ... more This article explores family separation and reunification of the disappeared Salvadoran children separated from their families during El Salvador's civil war (1980-1992) from the perspectives of adult relatives. During separation, adult relatives experienced an "unresolvable loss." Following reunion, families experienced an immediate relief that was often accompanied by an "ambiguous reunification." Emotions were especially complicated and painful when the separation had been a "forced choice" by the parent under coercive wartime political conditions. Adoptive parents strongly influenced reunification. Findings suggest that disappeared children and biological and adoptive family members need psycho-social support throughout separation and reunification. I. INTRODUCTION Family separation and reunification impacts millions of families worldwide each year. 1 This article will describe the process of family separation and reunification from the perspectives of adult family members of the disappeared children of El Salvador. The article will provide historical context on the disappeared Salvadoran children, describe the research team's prior
Drug and Alcohol Dependence, 2021
California's Welfare and Institutions code 5150 allows for a temporary psychiatric hold (TPH) of ... more California's Welfare and Institutions code 5150 allows for a temporary psychiatric hold (TPH) of individuals who present a danger to themselves or others and/or may be gravely disabled due to mental illness. Little is known about the frequency and predictors of involuntary holds among people who inject drugs (PWID). Methods: We sought to identify the prevalence and predictors of recent TPHs (within the past 12 months) among a community-recruited sample of PWID in Los Angeles and San Francisco, California during 2017-2018 (N=531). Multivariable logistic regression modeling was used to evaluate demographic (e.g., age), economic (e.g., homelessness), drug use (e.g., types of drugs used), incarceration (e.g., recent arrest history) and mental health (e.g., lifetime mental health diagnosis) variables associated with recent TPH.
Cocaine, 2021
Raffy, the bichote [Puerto Rican Spanglish double entendre for "big shot"/"drug boss"/large phall... more Raffy, the bichote [Puerto Rican Spanglish double entendre for "big shot"/"drug boss"/large phallus] is out on the corner to night and invites Tito and me to sit next to him on the stoop of an abandoned row home. Tito is Raffy's "caseworker," the local term for a bichote's second-in-command, who is responsible for managing the shifts of sellers and lookouts on a drug corner. Soon we are surrounded by half-a-dozen of his off-and-on-duty heroin and cocaine sellers, wannabe sellers, and teenage and pre-teenage bored kids. They are all eager-like me-to be around the big shot boss. When he shows up on the block, Raffy becomes the charismatic nexus for action, money, power, potential, and risk. Perhaps most importantly, he is also the only provider of local employment in this desolate, almost all Puerto Rican, formerly industrial inner city neighborhood. philippe bourgois, laurie kain hart, george karandinos, and fernando montero
PLOS ONE, 2019
Background The United States is experiencing a continuing crisis of gun violence, and economicall... more Background The United States is experiencing a continuing crisis of gun violence, and economically marginalized and racially segregated inner-city areas are among the most affected. To decrease this violence, public health interventions must engage with the complex social factors and structural drivers-especially with regard to the clandestine sale of narcotics-that have turned the neighborhood streets of specific vulnerable subgroups into concrete killing fields. Here we present a mixed-methods ethnographic and epidemiological assessment of narcotics-driven firearm violence in Philadelphia's impoverished, majority Puerto Rican neighborhoods. Methods Using an exploratory sequential study design, we formulated hypotheses about ethnic/racial vulnerability to violence, based on half a dozen years of intensive participant-observation ethnographic fieldwork. We subsequently tested them statistically, by combining geo-referenced incidents of narcotics-and firearm-related crime from the Philadelphia police department with census information representing race and poverty levels. We explored the racialized relationships between poverty, narcotics, and violence, melding ethnography, graphing, and Poisson regression.
Third World Quarterly, 2018
The cultural and political-economic valences of psychoactive drugs in the Global South offer crit... more The cultural and political-economic valences of psychoactive drugs in the Global South offer critical insights on local and international fault lines of social inequality and profiteering. Historically, in a classic primitive accumulation process the trafficking of industrially produced euphoric substances across the globe have wreaked havoc among vulnerable populations while extracting profit for the powerful. The complex flows of capital generated both by illegal addiction markets and also by the mobilisation of licit public funds to manage their mayhem, however, suggest the contemporary utility of the concept of 'predatory accumulation'. The Enlightenmentera concept of 'primitive accumulation' usefully highlighted state violence and forcible dispossession in the consolidation of European capitalism. A contemporary reframing of these processes as predatory accumulation, however, highlights contradictory, nonlinear relationships between the artificially high profits of illegal drug sales, repressive governmentality and corporate greed. It sets these patterns of destructive profiteering in the context of our moment in history.
New England Journal of Medicine, 2019
The Structural Violence of Hyperincarceration Mr. M., an uninsured, 44-year-old Puerto Rican man ... more The Structural Violence of Hyperincarceration Mr. M., an uninsured, 44-year-old Puerto Rican man with chronic back pain, diabetes, hypertension, asthma, and a history of incarceration presented to a free clinic with acute exacerbation of back pain triggered by carrying heavy loads of trash at work. A premedical student acting as his health care advocate accompanied him. Mr. M. was hesitant to seek health care because he had no health insurance and mistrusted institutions as a result of his extensive negative experiences with the criminal justice system. He was visibly nervous in the unfamiliar institutional environment of the clinic, which had no Latino staff and was located in a middle-class neighborhood far from his home. The advocate reassured him in Spanish that the doctor was trustworthy and urged him to speak frankly about his health problems, including his challenges in obtaining medication. Embarrassed, Mr. M. reported that during recent back-pain exacerbations he occasionally resorted to purchasing one or two 5-mg oxycodone tablets in the open-air drug market operating on the inner-city block where he lived. The physician gave Mr. M. ibuprofen and a prescription for five 5-mg oxycodone tablets, enrolled him in the clinic's diabetes and hypertension programs, and scheduled a follow-up visit. Mr. M. never filled the prescription and did not return to the clinic, despite repeated entreaties by the advocate both in person and over the phone.
L'Homme, 2012
© École des hautes études en sciences sociales ANTHROPOLOGUE travaillant depuis 1979 sur la viole... more © École des hautes études en sciences sociales ANTHROPOLOGUE travaillant depuis 1979 sur la violence, la pauvreté et les inégalités sociales, en Amérique centrale d'abord, puis aux États-Unis, j'ai craint, au fil des ans, d'être véritablement obsédé par la violence. Hélas, il est plus juste de dire que la violence s'est imposée à moi parce qu'elle est, et a toujours été, au coeur de l'organisation du pouvoir dans la vie quotidienne. L'ethnographe risque bien sûr de contribuer à un voyeurisme, une pornographie de la brutalité. Toutefois, le danger est plus grand encore de ne pas voir la violence ; bien souvent le discours anthropologique n'en tient pas compte alors qu'elle accable les populations étudiées. La violence est inégalement répartie dans le monde. La façon dont elle soutient différentes structures de pouvoir et d'exploitation mérite d'être analysée et dénoncée. Hélas, si la violence physique directe se voit aisément, elle ne représente que la partie émergée de l'iceberg et masque bien souvent, aux yeux des chercheurs, des formes moins flagrantes-et variant insidieusement avec le temps-de coercition, de peur et d'assujettissement. En règle générale, ces déclinaisons de la violence ne sont pas perçues ou reconnues en tant que telles par les victimes et les auteurs de violences (qui bien souvent sont une seule et même personne). Pareil aveuglement légitime aux yeux de l'ensemble de la population les politiques publiques punitives qui infligent des souffrances aux plus vulnérables.
Drug and alcohol dependence, 2017
A robust literature documents generational trends in drug use. We examined the implications of ch... more A robust literature documents generational trends in drug use. We examined the implications of changing national drug use patterns on drug injection histories of diverse people who inject drugs (PWID). Drug use histories were collected from 776 active PWID in 2011-13. Using descriptive statistics, we examine drug use initiation by year and birth cohort (BC) differences in drug first injected. A multivariate linear regression model of time to injection initiation ([TTII] (year of first injection minus year of first illicit drug use) was developed to explore BC differences. The first drug injected by BC changed in tandem with national drug use trends with heroin declining from 77% for the pre-1960's BC to 58% for the 1960's BC before increasing to 71% for the 1990's BC. Multivariate linear regression modeling found that shorter TTII was associated with the 1980's/1990's BC (-3.50 years; 95% Confidence Interval [CI]=-0.79, -6.21) as compared to the 1970's BC. Lo...
L' Homme; revue francaise d'anthropologie, 2016
L'Homme, 2016
© École des hautes études en sciences sociales AUDÉBUTde notre enquête de terrain dans la zone la... more © École des hautes études en sciences sociales AUDÉBUTde notre enquête de terrain dans la zone la plus pauvre du ghetto portoricain de Philadelphie, Congo, un dealer afro-américain charismatique, propriétaire d'un point de vente de drogue, s'était fait tuer par balles sur son perron, sous les yeux de sa famille, par le frère cadet de l'un de ses revendeurs. Il n'avait pas voulu payer la caution de ce dernier après son arrestation. Dans un quartier à plus de 80% portoricain, Congo faisait figure d'outsider, et il avait cultivé la réputation du caïd qui « aimait jouer avec les flingues ». Un de ses anciens employés se souvient : « Tout le monde savait que Congo était fou. Il laissait personne vendre dans le secteur. Une fois, des mecs faisaient leur business dans le coin d'à côté et Congo s'est ramené avec son gun : "Yo niggas ! Vous faites quoi là ?". Ils essayent de discuter [haussant la voix] : "Ah ouais ?! ". Mais Congo leur tire dessus direct, bom, bom, bom, bom, bom ! En plein jour ! Plus tard, un mec Dominicain a essayé de faire son deal en douce [on the DL], Congo est sorti en plein jour et l'a défoncé avec la crosse de son flingue. Ouais et… Congo était costaud. Je veux dire vraiment costaud. Donc les mecs ils savent. Ce mec est solide ». Congo avait commencé à travailler comme petit dealer de rue en s'installant dans le quartier à l'âge de dix-sept ans. Même s'il avait cette réputation d'avoir la gâchette facile, c'était plutôt son implication dans l'économie morale du quartier-un système d'obligations réciproques fondé sur des relations matrimoniales et de parenté-qui avait permis son ascension dans le circuit du narcotrafic local, cinq ans plus tard. Il était tombé amoureux de Julieta (la nièce de l'ancien boss portoricain, Leni), dont il avait adopté les deux jeunes enfants (leur père, un dealer portoricain, avait été assassiné dans un bar au cours d'une rixe quelques mois auparavant).
International Journal of Drug Policy, 2016
Journal of Psychoactive Drugs, 2016
Since the 1990s, US heroin consumers have been divided from the full range of available products:... more Since the 1990s, US heroin consumers have been divided from the full range of available products: east of the Mississippi River, Colombian-sourced powder heroin (PH) dominates the market, while to the west, Mexican-sourced "black tar" (BTH) is the main heroin available. By conducting qualitative research in two exemplar cities, Philadelphia (PH) and San Francisco (BTH), we compare users' experiences of heroin source-types, markets, health consequences and consumption preferences. The strict division of heroin markets may be changing with novel forms of powder heroin appearing in San Francisco. Our researchers and interviewees perceived vein loss stemming from the injection of heroin alone to be a particular problem of BTH while among the Philadelphia sample, those who avoided the temptations of nearby cocaine sales displayed healthier injecting sites and reported few vein problems. Abscesses were common across both sites, the Philadelphia sample generally blaming missing a vein when injecting cocaine and the San Francisco group finding several explanations, including the properties of BTH. Consumption preferences revealed a 'connoisseurship of potency', with knowledge amassed and deployed to obtain the strongest heroin available. We discuss the reasons that their tastes take this narrow form and its relationship to the structural constraints of the heroin market.
Academic medicine : journal of the Association of American Medical Colleges, Mar 12, 2016
The authors propose reinvigorating and extending the traditional social history beyond its narrow... more The authors propose reinvigorating and extending the traditional social history beyond its narrow range of risk behaviors to enable clinicians to address negative health outcomes imposed by social determinants of health. In this Perspective, they outline a novel, practical medical vulnerability assessment questionnaire that operationalizes for clinical practice the social science concept of "structural vulnerability." A structural vulnerability assessment tool designed to highlight the pathways through which specific local hierarchies and broader sets of power relationships exacerbate individual patients' health problems is presented to help clinicians identify patients likely to benefit from additional multidisciplinary health and social services. To illustrate how the tool could be implemented in time- and resource-limited settings (e.g., emergency department), the authors contrast two cases of structurally vulnerable patients with differing outcomes. Operationalizin...