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Open Access Publications from the University of California

Scholarly Works (49 results)

  • Article
  • Peer Reviewed
UC San Francisco Previously Published Works (2017)
The current “opioid epidemic” provides an opportunity to identify age-old social anxieties about drug use while opening up new lines of inquiry about how and why drug use epidemics become gendered. This paper reflects on the intertwined phenomena of opioid and benzodiazepine prescribing to U.S. women to examine how gender, race, and class inform social anxieties about reproduction and parenting. Multiple discourses abound about the relationship between women and the “opioid epidemic.” Epidemiological reports attribute premature death among White women to the deadly combination of opioids and antianxiety medications. The National Institute on Drug Abuse reports that “every 25 minutes a baby is born suffering from opioid withdrawal,” leading to costly hospital stays for infants and the potential for mother–child separation and other forms of family adjudication postpartum. Primary care providers are reluctant to distinguish diagnoses of chronic noncancer pain from anxiety among their female patients. Taken together, these discourses beg the question: What exactly are we worried about? I compare and contrast the narratives of two anxious women on opioids to raise larger structural questions about pregnancy, parenting, and drug use and to interrogate the public narrative that women on opioids threaten the American family and thwart the American Dream.
    Cover page: Women on the Edge
    • Thesis
    • Peer Reviewed
    UC San Francisco Electronic Theses and Dissertations (2021)

    Within medicine devoted to LGBTQ+ health, data are everywhere. Large databases teem with numbers waiting for evaluation, buggy online surveys offer rickety drop-down menus filled with identity terms, and clinic bulletin boards host calls for research participants to “stand up and be counted.” This dissertation will trace the life of what I will call “queer data” - that is, data documenting queer subjects as well as data that might potentially be understood as “queered” - as it is produced, analyzed, and mobilized. A rich moment for anthropological study emerges when quantification techniques requiring bounded categories are confronted by the foundational fluidity of queerness. This project draws from from anthropological fieldwork within research projects and clinical spaces in the California Bay Area, semi-structured interviews with individuals across the United States, as well as objects and virtual spaces that serve as ethnographic objects. Tracing such queer data through medical settings and discourses provides a unique opportunity to explore questions around the evidence-base of queerness and the ways in which queerness soaks into data processes in transformative ways.In this dissertation, I describe how this queer data production emerges as a co-constitutive process through which community norms and experiences shape the options for categorization, while at the same time such categories affect how individuals and communities make meaning around their identities, bodies, and desires. I examine how debates around the use of statistics within medical education reanimates counting as a contested space that exposes the political stakes of quantifying queerness and the affective impact of numbers. Data are also a potent force within clinical spaces. Through examinations of clinical intake forms, I describe how efforts to create healthcare spaces that are affirming to queer patients position data as a form of care. How such healthcare data are transformed by bureaucratic reporting requirements is discussed as an example of how queerness both resists and is subsumed by aggregation. The organ inventory is also taken up as an ethnographic object and explored for the ontological claims it makes around what a body is and how it should be cared for. By tracing such queer data, this dissertation explores how quantifying queerness is an act of transformation, but one that is necessarily incomplete. The ever-evolving nature of queerness leaves it in excess of static categories in a way that can productively draw attention to the generative work of quantification.

      Cover page: Queer Data: Medical Quantification and What Counts About Counting
      • Thesis
      • Peer Reviewed
      UC San Francisco Electronic Theses and Dissertations (2023)

      In this dissertation, I explore chronic pain experiences among Filipino-American U.S. military veterans. Chronic pain remains the most diagnosed medical condition in the U.S., with veterans experiencing chronic pain at disproportionately higher rates (40%) compared to the civilian general population (25%). Among veterans, chronic pain is a condition overwhelmingly tied to U.S. military service. More conceptually, I explore how histories of colonization and war come to reside and persist in peoples’ bodies as felt pain. I examine these topics as they relate to Filipinos, the multiple colonialisms of the Philippines, and how the afterlife of American colonization and militarization of the Philippines informs health outcomes among Filipino-Americans today.

      I used ethnographic methods to carry out this anthropological research. First, I conducted semi-structured interviews with a wide range of stakeholder groups. I also volunteered and conducted in-person participant observation in community-based settings. In addition, I wrote up field notes for interviews and in-person events. Finally, I conducted historical and archival research.

      I make a case for how, among socially marginalized people, expressions of pain—bodily, psychic, and emotional—often point to deeper dynamics of ongoing harm, both historically and in the present. Given this, I propose an expanded framework for examining chronic pain as a bio-psycho-social-structural-historical condition, and argue for the importance of attending to the specificities of individual histories in pain care.

        Cover page: Chronic Pain in the Afterlife of Colonization: A Bio-Psycho-Social-Structural-Historical View Among Filipino-American U.S. Military Veterans
        • Article
        • Peer Reviewed
        UC San Francisco Previously Published Works (2024)
        In 2020, three crises coalesced to transform the clinical care landscape of addiction medicine in the United States (US). The opioid overdose crisis (crisis #1), which had been contributing to excess US mortality for over two decades, worsened during the COVID-19 pandemic (crisis #2). The racial reckoning (crisis #3) spurred by the murder of George Floyd at the hands of police impacted clinical care, especially in safety net clinical settings where the majority of people targeted by police violence, and other forms of structural violence, receive healthcare to mend both physical and psychological wounds. Collectively, the three crises changed how providers and patients viewed their experiences of clinical surveillance and altered their relationships to the violence of US healthcare. Drawing from two different research studies conducted during the years preceding and during the COVID-19 pandemic (2017-2022) with low income, safety net patients at risk for opioid overdose and their care providers, I analyze the relationship between surveillance and violence in light of changes wrought by these three intersecting health and social crises. I suggest that shifting perceptions about surveillance and violence contributed to clinical care innovations that offer greater patient autonomy and transform critical components of addiction medicine care practice.
          Cover page: The Clinical Evolutions of Surveillance and Violence During Three Contemporary US Crises: Opioid Overdose, COVID-19, and Racial ReckoningCreative Commons 'BY' version 4.0 license
          • Thesis
          • Peer Reviewed
          UC San Francisco Electronic Theses and Dissertations (2010)

          This dissertation is focused around a singular ethnographic question which engages both science studies and critical medical anthropology: What happens when the socially dead reproduce?

          Homeless, pregnant, drug-addicted women embody a specific form of social death in the urban American landscape. Their interactions with institutions, everyday lives and drug use foreclose future possibilities; their unborn children represent a site of critical intervention to ensure the production of a healthy life from a diseased one. The irrationality of the pregnant addict is re-interpolated through emergent scientific claims about addiction as a "brain disease" and the increasing diagnosis of bi-polar disorder to contain both the mania and depression of traumatized homeless women. Epidemiologists and clinicians - "category makers" - must document behavior, blood and urine to substantiate diagnoses that count, those which translate into monetary and social capital. Mental health bureaucrats - "neurocrats" - are charged with processing pregnant addicts' claims for social legibility, tapping institutions to gain access to public dollars and a room inside. Women who cannot, or refuse to, meet diagnostic criteria are left to circulate in predatory and violent drug-sex economies. Without social legibility, these pregnant addicts negotiate daily life and income generation with the "proto-capitalists", hotel manager pimps to whom women become indebted for shelter. The medical anthropologist - an "info-vulture" - struggles to make sense of it all by self-reflectively analyzing the logics of science, bureaucracy, and the streets.

          How these key figures - the pregnant addict, the category maker, the neurocrat, the protocapitalist, and the info-vulture - position their narratives relative to the reproduction of social death becomes a question of evidence. As the story of the pregnant, homeless, drug-addicted woman travels from the street - to the lab - to the policy maker's desk, she is reconstituted. When the socially dead reproduce we are all morally implicated. We seek to produce and digest evidence that explains both the death and its reproduction.

            Cover page: Trick(y): The production of evidence and the reproduction of social death among pregnant addicts in California
            • Article
            • Peer Reviewed
            UC San Francisco Previously Published Works (2006)
            Examining the narratives of eighteen heterosexual drug-injecting men living with HIV, this study seeks to understand how HIV-positive men negotiate issues of masculinity, sexuality, and emotional intimacy. It focuses specifically on strategies HIV-positive men use to manage emotional vulnerability in sexual encounters. We identify a core theme of "splitting," in which men compartmentalize the domains of sexuality and emotional intimacy. We examine how this aspect of masculinity is at times exacerbated as a strategy to minimize emotional investment in sexual partners. By splitting the emotional and sexual domains, the men are able to perform sexually with casual sex partners while minimizing both the risk of infecting intimate partners and a fear of rejection from those they care about or desire most. However, the tensions created by splitting the emotional and sexual domains may disintegrate intimate interpersonal relationships that serve as a base of much-needed emotional support. © 2006 Sage Publications.
              Cover page: Split EndsCreative Commons 'BY' version 4.0 license
              • Article
              • Peer Reviewed
              UC San Francisco Previously Published Works (2019)

              Background

              The prevalence of opioid-associated morbidity and mortality underscores the need for research on non-opioid treatments for chronic non-cancer pain (CNCP). Pain is the most common medical condition for which patients request medical cannabis. Limited research indicates that patients are interested in cannabis as a potential addition to or replacement for opioid medication. This analysis reports on CNCP patient and clinician perceptions about the co-use of cannabis and opioids for CNCP management.

              Methods

              We interviewed 23 clinicians and 46 CNCP patients, using semi-structured interview guides, from six safety-net clinics across the San Francisco Bay Area, and 5 key stakeholders involved in CNCP management. We used a modified grounded theory approach to code and analyze transcripts.

              Results

              CNCP patients described potential benefits of co-use of cannabis and opioids for pain management and concerns about dosing and addictive potential. Patients reported seeking cannabis when unable to obtain prescription opioids. Clinicians stated that their patients reported cannabis being helpful in managing pain symptoms. Clinicians expressed concerns about the potential exacerbation of mental health issues resulting from cannabis use.

              Conclusion

              Clinicians are hampered by a lack of clinically relevant information about cannabis use, efficacy and side-effects. Currently no guidelines exist for clinicians to address opioid and cannabis co-use, or to discuss the risk and benefits of cannabis for CNCP management, including side effects. Cannabis and opioid co-use was commonly reported by patients in our sample, yet rarely addressed during clinical CNCP care. Further research is needed on the risks and benefits of cannabis and opioid co-use.
                Cover page: Patients’ and clinicians’ perspectives of co-use of cannabis and opioids for chronic non-cancer pain management in primary care
                • Article
                • Peer Reviewed
                UC San Francisco Previously Published Works (2005)
                In an effort to deepen our understanding of how circumstances of forced separation and the interdiction of physical contact affect women's sexual behavior, we investigated the development and maintenance of heterosexual couples' intimacy when the male partner is incarcerated. As HIV-prevention scientists who work with women visiting men at a California state prison, we recognize that correctional control extends to these women's bodies, both when they are within the facility's walls visiting their mates and when they are at home striving to remain connected to absent men. This paper analyzes the impact of a peculiar public "place", a penitentiary, on couples' romantic and sexual interactions, drawing out the implications of imprisonment for relationship decision making, sexual health, and HIV risk. Using qualitative interviews with 20 women who visit their incarcerated partners and 13 correctional officers who interact with prison visitors, we examined how institutional constraints such as the regulation of women's apparel, the prohibition of physical contact, and the lack of forums for privacy result in couples forging alternative "spaces" in which their relationships occur. We describe how romantic scripts, the build-up of sexual tension during the incarceration period, and conditions of parole promote unprotected sexual intercourse and other HIV/STD risk behavior following release from prison.
                  Cover page: “You can't do nothing in this damn place”: Sex and intimacy among couples with an incarcerated male partnerCreative Commons 'BY-NC' version 4.0 license
                  • Article
                  • Peer Reviewed
                  UC San Francisco Previously Published Works (2014)

                  Objectives

                  We determined associations between co-occurring psychiatric conditions and violence against homeless and unstably housed women.

                  Methods

                  Between 2008 and 2010, we interviewed homeless and unstably housed women recruited from community venues about violence, socioeconomic factors, and psychiatric conditions. We used multivariable logistic regression to determine independent correlates of violence.

                  Results

                  Among 291 women, 97% screened positive for 1 or more psychiatric conditions. Types of violence perpetrated by primary partners and persons who were not primary partners (non-primary partners) included emotional violence (24% vs 50%; P < .01), physical violence (11% vs 19%; P < .01), and sexual violence (7% vs 22%; P < .01). The odds of primary partner and non-primary partner violence increased with each additional psychiatric diagnosis and decreasing levels of social isolation.

                  Conclusions

                  All types of violence were more commonly perpetrated by non-primary partners, suggesting that an exclusive focus on domestic violence screening in health care or social service settings will miss most of the violence in this population. Contrary to some previous studies, the odds of violence decreased as social isolation increased, suggesting that social isolation may be protective in homeless and unstably housed communities with high levels of comorbidity and limited options.
                    Cover page: Recent violence in a community-based sample of homeless and unstably housed women with high levels of psychiatric comorbidity.
                    • Article
                    • Peer Reviewed
                    UC San Francisco Previously Published Works (2024)

                    Background

                    Against the backdrop of North America's overdose crisis, most overdose deaths are occurring in housing environments, largely due to individuals using drugs alone. Overdose deaths in cities remain concentrated in marginal housing environments (e.g., single-room occupancy housing, shelters), which are often the only forms of housing available to urban poor and drug-using communities. This commentary aims to highlight current housing-based overdose prevention interventions and to situate them within the broader environmental contexts of marginal housing. In doing so, we call attention to the need to better understand marginal housing as sites of overdose vulnerability and public health intervention to optimize responses to the overdose crisis.

                    Harm reduction and overdose prevention in housing

                    In response to high overdose rates in marginal housing environments several interventions (e.g., housing-based supervised consumption rooms, peer-witnessed injection) have recently been implemented in select jurisdictions. However, even with the growing recognition of marginal housing as a key intervention site, housing-based interventions have yet to be scaled up in a meaningful way. Further, there have been persistent challenges to tailoring these approaches to address dynamics within housing environments. Thus, while it is critical to expand coverage of housing-based interventions across marginal housing environments, these interventions must also attend to the contextual drivers of risks in these settings to best foster enabling environments for harm reduction and maximize impacts.

                    Conclusion

                    Emerging housing-focused interventions are designed to address key drivers of overdose risk (e.g., using alone, toxic drug supply). Yet, broader contextual factors (e.g., drug criminalization, housing quality, gender) are equally critical factors that shape how structurally vulnerable people who use drugs navigate and engage with harm reduction interventions. A more comprehensive understanding of these contextual factors within housing environments is needed to inform policy and programmatic interventions that are responsive to the needs of people who use drugs in these settings.
                      Cover page: Using alone at home: What’s missing in housing-based responses to the overdose crisis?
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