How Permanent Was Vietnam Drug Addiction?

Robins, Lee N.; Davis, Darlene H.; Nurco, David N.

doi:10.2105/ajph.64.12_suppl.38

Cited by 187 publications

(40 citation statements)

References 3 publications

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“…Although causality cannot be imputed from these studies, they support the conclusion that individuals who become addicts do so as a consequence of factors that extend beyond mere exposure to the drug. For example, the importance of situational factors in the genesis of addiction has been suggested by the observation that Vietnam war veterans who became addicted while serving overseas had far lower recidivism following detoxification and return to the United States than other addict populations (176). Similarly, the potential importance of personality variables is suggested by the high prevalence of psychopathy among addict populations (177,178).…”

Section: Portenoymentioning

confidence: 99%

Opioid Therapy for Chronic Nonmalignant Pain

Portenoy

1995

Pain Research and Management

123

145

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RK Portenoy.Opioid therapy for chronic nonmalignant pain. Pain Res Manage 1996;1(1):17-28. Long term administration of an opioid drug for chronic nonmalignant pain continues to be controversial, but is no longer uniformly rejected by pain specialists. This is true despite concerns that the regulatory agencies that oversee physician prescribing of opioid drugs continue to stigmatize the practice. The changing clinical perspective has been driven, in part, by widespread acknowledgement of the remarkably favourable outcomes achieved during opioid treatment of cancer pain. These outcomes contrast starkly with popular teaching about chronic opioid therapy and affirm the potential for prolonged efficacy, tolerable side effects, enhanced function associated with improved comfort and minimal risk of aberrant drug-related behaviours consistent with addiction. A large anecdotal experience in populations with nonmalignant pain suggests that these patients are more heterogeneous and that opioid therapy will greatly benefit some and will contribute to negative outcomes for others. The few controlled clinical trials that have been performed support the safety and efficacy of opioid therapy, but have been too limited to ensure generalization to the clinical setting. A critical review of the medical literature pertaining to chronic pain, opioid pharmacology and addiction medicine can clarify misconceptions about opioid therapy and provide a foundation for patient selection and drug administration. The available data support the view that opioids are no panacea for chronic pain, but should be considered in carefully selected patients using clinically derived guidelines that stress a structured approach and ongoing monitoring of efficacy, adverse effects, functional outcomes and the occurrence of aberrant drug-related behaviours. Key Words: Addiction, Drug dependence, Nonmaligant pain, Opioids, Pain therapyThérapie opioïde pour la douleur chronique non cancéreuse RÉSUMÉ : L'administration à long terme d'un médicament opioïde pour traiter la douleur chronique non cancéreuse reste sujet à controverse mais n'est plus rejetée de façon uniforme par les spécialistes de la douleur. Ceci est vrai même si l'on s'inquiète de ce que les organismes régulateurs qui supervisent la prescription médicale d'agents opioïdes persistent à stigmatiser cette pratique. Le changement de perspective clinique a été motivé en partie par une reconnaissance généralisée des résultats remarquablement favorables obtenus lors du traitement opioïde de la douleur cancéreuse. Ces résultats contrastent carrément avec ce qui est généralement enseigné sur l'administration à long terme d'un médicament opioïde et, confirment un potentiel d'efficacité durable, des effets secondaires supportables, une augmentation de la capacité fonctionnelle associée à une amélioration du bienêtre et, un risque minimal de comportements aberrants liés au médicament compatibles avec une toxicomanie. Une vaste expérience anecdotique chez des populations souffrant d'une douleur non cancéreus...

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Section: Portenoymentioning

confidence: 99%

Opioid Therapy for Chronic Nonmalignant Pain

Portenoy

1995

Pain Research and Management

123

145

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“…This result is somewhat surprising in that given the current age of this cohort, it would be expected that compared to incarcerated AVF veterans a lower percentage of Vietnam era veterans would be incarcerated for a drug related crime. While Vietnam era veterans possibly experienced higher rates of drug use during their military service (i.e., while they were in Vietnam) than veterans that served in the AVF, as Robins reported, drug use by Vietnam veterans dramatically declined once they were discharged [46,47]. Additionally, it would be expected that drug use by this cohort further fell as they aged, particularly relative to younger more recently discharged veterans.…”

Section: Discussionmentioning

confidence: 99%

Mental Health and Other Risk Factors for Jail Incarceration Among Male Veterans

Greenberg

Rosenheck

2009

Psychiatr Q

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Data derived from the 2002 Survey of Inmates in Local Jails and the 2000 National Survey of Veterans show that having mental health problems in addition to such sociodemographic characteristics as being a member of a minority group, not being married, having less education, and being younger are risk factors for incarceration among veterans, as they are for the general population. As in previous studies veterans who served during the Vietnam Era and to an even greater extent, those who served in the early years of the All Volunteer Force were at greater risk of incarceration than veterans from the most recent period of the AVF, after controlling for age and other factors.

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“…The experience of ‘being high’ was not something that could be produced by drugs alone, but was in fact contingent upon these being interpreted in particular ways that were learned through social processes. Thus, Becker argued that “becoming a marijuana user’ could not happen without social interactions that provided the specific meanings and expectations needed for interpreting marijuana use as an enjoyable experience, worthy of repeating—an insight that has been supported by the findings of a variety of other researchers, including those involved in clinical and laboratory-based studies (Fraser, 2011; Robins, Davis, & Nurco, 1974; Zinberg, 1984). …”

Section: The Potentialities Of Interacting Agentsmentioning

confidence: 99%

Pharmaceutical entanglements: an analysis of the multiple determinants of ADHD medication effects in a Chilean school

Navarro

Vrecko

2017

International Journal of Qualitative Studies on Health and Well

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This article draws upon findings from ethnographic fieldwork conducted in a Chilean school to explore how the effects of globally circulating ADHD medications emerge within the localized contexts of everyday users. An analysis of observations of children on ADHD medications within classroom settings is developed which challenges the assumption, pervasive within biomedical paradigms, that the effects of such medications can be understood as resulting directly from their chemical properties and biological modes of action. Our case study highlights the significance of multiple, interacting determinants of drug effects in an everyday setting, focusing in particular on classroom dynamics, teacher–student relations, and the agency of children taking the medications. We conclude that while ADHD medications may act in part by altering physiological processes, an adequate account of their effects requires that analytic attention extends to the sociomaterial contexts in which medications and users are embedded.

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How Permanent Was Vietnam Drug Addiction?

Cited by 187 publications

References 3 publications

Opioid Therapy for Chronic Nonmalignant Pain

Opioid Therapy for Chronic Nonmalignant Pain

Mental Health and Other Risk Factors for Jail Incarceration Among Male Veterans

Pharmaceutical entanglements: an analysis of the multiple determinants of ADHD medication effects in a Chilean school

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