Integrating place into research on drug use, drug users’ health, and drug policy

Abstract

Over the past 15 years, place has become increasingly prominent in research on drug use, drug users’ health, and drug policy. This line of inquiry, however, is not new. Interest in the ways in which place characteristics shape drug use and drug users’ health has varied over time, often in tandem with paradigm shifts in the extent to which contextual factors have figured as possible determinants of health and well-being. The 1800s witnessed an intensification of interest in how place characteristics and other contextual factors shaped health in general and substance misuse in particular. In 1826, for example, Villerme analyzed tax and death records in Parisian arondissements and concluded that mortality rates were highest in impoverished neighborhoods.(Susser & Stein, 2009) Twenty years later, Virchow attributed the typhus epidemic in Upper Silesia (Prussia) to the local confluence of several sociopolitical factors, including the rise of the plutocracy and the immiseration of the working class.(Brown & Fee, 2006) Likewise, physicians in the 1880s–1890s commonly ascribed opiate misuse among affluent White men in US cities to the strains of constructing civilization in the midst of rapid industrialization.(Cooper, 2004) This focus on context and place diminished between World War I and the 1960s, and was replaced by an emphasis on individual-level factors. During these decades, hysteria about communism made it difficult to propose that social factors (e.g., poverty) shaped any form of health-related outcome,(Krieger, 2000) and the rise of successful biomedical interventions (e.g., widespread access to antibiotics) and the ascendance of psychology and psychiatry rendered individual-level frameworks attractive (Ellen, 1995). During this period, for example, physicians attributed opiate addiction to individual psychopathology, rather than to broader social factors.(Cooper, 2004) Contextual factors were restored to etiologic frameworks in the latter decades of the 20th century. This restoration was prompted in part by widespread social movements that highlighted the power of social structures and by the challenges that HIV/AIDS posed to exclusively individual-level frameworks.(Fee & Krieger, 1993; Krieger) During this period, place moved to the foreground of research on drug use, drug users’ health, and drug policy(Cooper, Bossak, Tempalski, Des Jarlais, & Friedman, 2009; Strathdee et al., 2010; Thomas, Richardson, & Cheung, 2008; Tempalski & Mcquie, 2009), most notably with the formulation of Rhodes’ Risk Environment Model, which defined the risk environment as the “space … [where] factors exogenous to the individual interact to increase the chances of HIV transmission”.(Rhodes, Singer, Bourgois, Friedman, & Strathdee, 2005, p. 1027) Though a focus on place is not new in research on drug use, drug users’ health, and drug policy, major challenges remain. Key challenges include theorizing place and place-making processes; defining place and measuring place characteristics; and delineating causal processes that link place characteristics to relevant outcomes. Additionally, work in this content area has been largely limited to specific countries (e.g., the US, Canada, Australia) and to specific subpopulations within these countries. This special issue has been designed to strengthen the resurgence of work on place, drug use, users’ health, and drug policy by responding to these challenges.