Experiences of Illicit Drug Overdose: An Ethnographic Study of Emergency Hospital Attendances
Neale, Joanne, Contemporary Drug Problems
Illicit drug overdose is a major public health concern across the globe (Kaa, 1992; Davoli et al., 1993; Hser, Anglin & Powers, 1993; Cain, 1994; Marx, Schick & Minder, 1994; Sanchez et ad., 1995; Darke, Ross & Hall, 1996; Hulse, et al., 1999; Powis et al., 1999). Although there is now a large body of overdose research, current knowledge remains limited in two fundamental respects. First, most studies have involved retrospective investigations of fatal rather than non-fatal overdose. Second, existing research has largely been based on data collected from coronial records and hospital admission cards-not from interviews with those who have witnessed or experienced overdoses (Darke et al., 1996). In consequence, the data available are quantitative rather than qualitative, providing little insight into drug users' views and experiences of the problem.
To date there is very little information relating to how drug users feel at the time of, and immediately following, loss of consciousness; why drug users think they have overdosed; the experience of waking up in a hospital ward having overdosed on illicit drugs; victims' views of their needs and concerns; how they feel about the treatment they receive in the hospital setting; or their expectations of future overdose and drug-taking behavior. Equally, there appear to be no sociological accounts either of how drug users behave or what actually happens to them in the emergency ward. In the absence of such qualitative data, there is a danger that public health strategies designed to reduce the incidence of drug overdose-and clinical interventions intended to manage and deal with those who are drug overdose victims-are being formulated and implemented without important background information.
Drug overdose in context
The present paper offers an in-depth insight into the overdose situation that might inform and improve prevention of the problem and responses to it. Providing an important backdrop to this issue are three sources of literature: (i) a growing body of research relating to professionals' attitudes to providing services to drug users; (ii) accounts of the various barriers between drug users and the health care system; and (iii) ethnographic studies conducted within hospitals, particularly in the emergency room. Two key themes underpinning these three sources of literature are "stigma" and "the moral evaluation of patients by professionals." (i) Professionals' attitudes to providing services to drug users
Various studies have shown that many health professionals have negative views of drug users and are reluctant to work with them. Disapproving attitudes have been identified among general practitioners (Roche, Guray & Saunders, 1991; Greenwood, 1992); psychiatrists (Tantam et al., 1993); pharmacists (Bond & Matheson, 1997); and general nursing staff (Carroll, 1993). Factors offered to account for this unwillingness to be involved with drug users include attitudinal factors, occupational constraints, and a lack of motivation to learn about drug-related issues (Albery et al., 1996). (ii) Barriers between drug users and the health care system
Research has also found that various barriers exist between drug users and general health care services (Chitwood et al., 1999) and drug users and drug treatment services (Batey, 1997; Fraser, 1997). In her study of women who self-managed change in their alcohol and other drug dependence, Copeland (1997) found that the principal barriers to formal treatment included social stigma and labeling; lack of awareness of the range of treatment options; concerns about child care; the perceived economic and time costs of residential treatment; concerns about the confrontational models used by some treatment services; and stereotypical views of clients of treatment services. According to Lewis (1999), meanwhile, methadone maintenance treatment is underutilized because of inaccessibility, underfinancing, stigma, cumbersome regulations, and exaggeration of the problem of methadone diversion. …