Identifying Emerging Drug Use Trends: The Ethnographic Tool Box 2.0

Jean-Paul C. Grund, PhD CVO – Addiction Research Centre, Utrecht, NL

Department of Addictology, Charles University, Prague, CR

"The best way to get misinformed is to ask a lot of questions."

Jack Black – You Can't Win. Macmillan, 1926

Presentation Outline

• Diffusion of drug use trends (i)

• The Ethnographic Toolbox 1.0

• Diffusion of drug use trends (ii)

• The Ethnographic Toolbox 2.0

Diffusion of drug use trends (i)

• Diffusion of Innovations Theory

Diffusion is the process by which an innovation is communicated through certain channels over time among the members of a social system. (Rogers, 1962)

Diffusion is the acceptance, over time, of some specific item --an idea or practice-- by individuals, groups, or other adopting units, linked to specific channels of communication, to a social structure, and to a given system of values, or culture. (Katz , Levin & Hamilton, 1963)

Diffusion Theory: the Adaptation Curve

This is where we want to be!

Diffusion of innovations: Factors & Processes

• Economic and cultural factors:

– E: prices, supply and purity of drugs

– C: (deviant) subculture around the non-medical use of drugs, with a distinctive set of values, language and norms around drug use

• Primary Diffusion

• Secondary Diffusion

• Virtual Diffusion (Online)

Primary Diffusion

1. A new drug is introduced – Introduction through initial contacts between

producer/supplier and (potential) customer.

– Diffusion into personal network (peer group) of initial user.

Secondary Diffusion

2. A new drug trend spreads beyond the initial consumers to different consumer groups.

• Two processes

– Micro diffusion

– Macro diffusion

Secondary Diffusion

• Micro-diffusion: A drug and the associated cultural knowledge are spread between young people of different social groups by means of communication and exchange between individuals from different networks who live in close proximity to one another.

– Networks overlap in Shared Spaces: pubs, clubs, cafes, street corners, schools

– Thereupon the spread of new drug trends continues along similar lines of friendship and peer networks.

• Macro-diffusion or geographical diffusion supposes that new drug trends emerge in the most densely populated cities and towns, and gradually spread to less heavily populated areas.

– from the big cities – (cultural) capitals and port – to other cities, towns and rural areas.

The Ethnographic Toolbox 1.0

• Ethnographic Observation

• Bean Counting

• Informal and formal qualitative interviews

• Focus Groups

• Delphi Method

• Rapid Assessment & Response (RAR)

• Serendipity

Ethnographic Observation: W5

• What? developing observation protocols

• Who? engaging with relevant research participants

• Where? sampling relevant research sites

• When? activities may vary by both time and place

• Why? reasons for the observed behaviors

Important Issues in Conducting Observational Research – Fieldwork in General

• “Outsiders” (Becker, 1963)

• Overcoming “Them and Us” – Engaging with communities under study

– Research alliances

– Community field workers / peer researchers

• Ethical standards & security issues – Academics & researchers – IRB review; legal status protection

of sources and I.D. data?; exposure to violence

– Peer researchers – idem, vulnerable to arrest, prosecution

– Contacts, informants and respondents – idem

• Technology creates new opportunities – E.g. surveillance camera footage

Bean Counting

• Counting people, events, actions, etc.

• Counting single indicators

• Counting multiple indicators

• The M&M Method

Informal and formal qualitative interviews

• Sampling of respondents – Time – location sampling – Snowball sampling – Respondent Driven Sampling (RDS)

• Gaining trust and report

"His business consisted largely of asking questions and necessarily he acquired much misinformation."

Jack Black – You Can't Win. Macmillan, 1926

– “Them and Us” – Privileged Access Interviewers (PAIs) “A good qualitative interview is, in the experience of the interviewee, like having a nice chat in a bar.”

Focus Groups

• Brings together various stakeholders to generate and discuss information on a specific topic

• Allows for exploring consensus and dissent

• Needs a strong moderator, reporter, etc.

• Challenges:

– dominance of certain participants may skew data

– missing less dominant perspectives

Delphi Technique

Delphi Method

Rapid Assessment & Response (RAR)

• RAR is not a single instrument, but rather a toolbox of different qualitative tools, such as the above.

• Used in situations where it is difficult to apply commonly used (semi) quantitative questionnaire-based evaluation and assessment methods.

• Several existing data sources are additionally used for triangulation.

• RAR helps to get fast information on cultural interpretations and meanings, on viewpoints of communities, and on needs of e.g. vulnerable groups.

Serendipity

• That quality which, through good fortune and sagacity*, allows a person to discover something good while seeking something else

*: Sagacity (noun): personal alertness, awareness, and understanding; sagacious (adjective): having or showing understanding and the ability to make good judgments; wise

Serendipity

“In the field of observation, chance favors only the prepared mind."

- Louis Pasteur

"Chance favors only those who know how to court her."

- Charles Nicolle

Diffusion of drug use trends (ii): Virtual (Online) Diffusion

• Example: Internet forum discussion between two young men in the Netherlands: – One was high on drug 2CT-7, a psychedelic

phenethylamine

– The other was interested in the drug, searched for information about it, but had not encountered it in his home town, Amsterdam, the Dutch capital, where probably all ‘classic’ drug trends of the previous century commenced.

– Anno 2012, the one high on the drug was living, in his own words, “somewhere in the neighbourhood of Groningen,” thus rural territory.

Effects of Technology on Drug Trends

• Internet changed parameters of diffusion of drug trends – Changed how information on new drugs is acquired and spread – Destroyed monopoly on information of professionals, authorities – No longer need for F2F contact – Information moves much faster – Forums, “use groups” and other internet communities offer a safe

environment to discuss personal drug use of various sorts. – Proliferation of news media (hyping new drug use phenomena)

• Mobile phones drastically changed local drug markets – By 2000 ordering drugs for home delivery did not require more

than ordering a pizza.

• In the 1990s and early 2000s, Internet made Waiting for the Man obsolete. But, until recently, meeting in person continued to be a requirement for drug transactions!

No More Waiting for the Man • Drug markets are in flux • E-Commerce is altering the economic

environment of the diffusion of drug trends. – at this point, the Man is always available, he can be

contacted and transactions made 24-7 online – ordered drugs will be express mailed, inconspicuously

wrapped, to almost anywhere in the world.

• Silk Road, a glimpse of the future of drug markets?

• Serious challenges to drug epidemiology • Both economic and the sociocultural components

of drug diffusion theory in need of revision

The Rise of a New Dawn: New Psychoactive Substances

• 2012: 73 new synthetic drugs detected in the EU – Cannabinoids, cathinones,

psychedelics, other drugs

• Internet

• “Smart” shops

• Other outlets

Recent Developments

• A polluted recreational drug market – 4-Methylamphetamine (4-MA) sold as speed – Methoxetamin sold as MDMA powder – Paramethoxyamphetamine (PMA) and Paramethoxymethamphetamin

(PMMA) in Ecstasy tablets

• NPS moving into PDU populations (NPS leading to problem drug use?) – Mephedrone injecting in UK, Romania – 5% NEP clients Prague inject NPS – “Baxtercaine”

• New drugs meet old habits: Synergy of harms? Potential for merging of different trends: home production and NPS – Sisa (homemade, smokable methampthetamine) in Greece – GHB in the Netherlands – Self-produced methcathinone (Jeff) in Krakow, Poland – made from

medications containing pseudoephedrine

Trends, Hypes & the Speed of Life

The Ethnographic Toolbox 2.0

• EMCDDA Snapshot Methodology – Inventory of online supply: online outlets and

advertisements for New Psychoactive Substances (NPS)

• CVO Snapshot 2.0 – Adjusted EMCDDA method + WebAnalytics

(internet market research tools) • E.g. Google Trends, Alexa

– Allows for analyzing both demand and supply on the internet

Contact

Jean-Paul Grund, PhD

CVO – Addiction Research Centre, Utrecht, NL & Department of Addictology, 1st Faculty of Medicine, Charles University in Prague & General University Hospital in

Prague, CZ

E: jpgrund@drugresearch.nl W3: www.drugresearch.nl