Notes for an Archaeology of Discarded Drug Paraphernalia

This article explores the values and challenges of an archaeological approach to illicit drug use, based on the study of discarded drug paraphernalia. It builds upon recent archaeological studies of homeless people, refugees and other marginalised communities that have used participative methods to challenge societal stigma and erasure. Following a critique of previous archaeological studies of drug use, the core of the article is a detailed analysis of an assemblage of drug paraphernalia in Oxford, UK. In interpreting this assemblage and its material and emotional contexts we draw on our respective contemporary archaeological and drug user activist experience and expertise. By providing a critical overview of previous studies and a detailed case study, this article aims to provide a practical and conceptual foundation for future archaeological studies of illicit drug use.

Decriminalize Drug-Checking Technologies in Pennsylvania to Prevent Overdose Deaths

Drug-checking technologies (DCTs), such as fentanyl test strips, prevent fatal overdoses caused by the adulteration of drugs. DCTs are currently classified as illegal drug paraphernalia in Pennsylvania (PA), but the recent and significant rise in fentanyl-related overdoses has prompted the PA House and Senate to propose exempting fentanyl test strips from the definition of drug paraphernalia. While fentanyl is currently the leading drug adulterant, other substances may be used to alter drugs. Therefore, we argue that broader reform is required to protect Pennsylvanians against all potential drug adulterants. We recommend that the PA House and Senate Judiciary Committees work to amend the PA Controlled Substance, Drug, Device, and Cosmetic Act to exempt all DCTs from the definition of drug paraphernalia. This proactive intervention will save countless lives by preventing adulterant-related overdoses.

Hepatitis A Virus Survival on Drug Paraphernalia

Background: The ongoing hepatitis A outbreak in the United States has concerned public health authorities since March 2017. The outbreak has already spread throughout 30 states and includes primarily homeless individuals and persons who use drugs, including persons who inject drugs (PWIDs). Contaminated drug injection paraphernalia and sharing of these items are suspected to be one of multiple causes of hepatitis A virus (HAV) transmission in those populations. Methods: We used a standard plaque assay to investigate HAV infectivity. Liquid suspensions of HAV were tested to examine the effects of time and temperature on viral infectivity. We also examined HAV survival on commonly used drug paraphernalia, such as needles, syringes, cookers, tourniquets, and cotton balls/filters frequently shared among PWIDs. We investigated the effect of low pH on HAV survival using citric acid, which is frequently used by PWIDs during dose preparation. We also compared the plaque assay results with those concurrently obtained by RT-PCR to establish whether viral HAV RNA levels could be used as surrogates for plaque assay results. Results: We found that HAV suspended in PBS at room temperature was able to infect FRhk4 cells for >17 weeks. HAV remained viable in syringes and needles (ie, semidry conditions) for up to 10 weeks depending on the size of the needles and the syringe dead volume. HAV survival in dry conditions on cooker, tourniquet, and cotton balls/filter surfaces did not exceed 4 weeks. HAV retained its infectivity for >10 weeks at pH as low as 2. PCR results suggest that RNA is amplified from both infectious and noninfectious HAV. Conclusions: Our findings show that HAV can survive and remain infective in the PWID setting for 4–10 weeks depending on the type of paraphernalia examined. These findings suggest that sharing drug paraphernalia by the homeless and PWIDs can potentially facilitate the transmission of HAV within these populations. Moreover, our results confirm that the plaque assay is currently the only reliable method to determine the infectivity of HAV in vitro.Funding: NoneDisclosures: None

Discourses of Death: Extracting the Semantic Structure of Lethal Violence with Machine Learning

Violent deaths — such as homicides and suicides — can be a source of "senseless suffering.'' Forensic authorities use narratives to trace events surrounding these deaths both in a search for meaning and a desire to prevent them. We examine these narratives, drawing on summaries from over 300,000 violent deaths in the U.S. Our goal is to capture the latent themes and other semantic structures that undergird violent death and its surveillance. To do so, we introduce a flexible model for the analysis of topics ("discourse atoms''), where locations in a semantic embedding space map onto distributions over words. We use this model to extract a high-level, thematic description of discourses of violent death. We identify 225 topics, discussing several in detail including topics about drug paraphernalia, financial difficulties, erratic and impaired behavior, and uncertainty. Our results offer clues into themes surrounding violent death and its administrative surveillance, and our method offers a new way to computationally model discourse.

The Elephant in the Room

Over a three-month period in early 2017, the Hennepin County Medical Examiner’s Office investigated nine apparent opioid toxicity deaths that occurred in three separate urban, suburban, and rural counties in our jurisdiction. All decedents were known substance abusers and had reportedly recently used heroin; most were found with drug paraphernalia. Complete autopsies variably showed classic stigmata of opioid overdose with no significant injury or natural disease to explain death. Initial toxicology screens failed to identify heroin or other narcotic substances. Several cases were presumptively positive for fentanyl by immunoassay, yet failed to confirm positive for fentanyl. Following American Board of Forensic Toxicology reporting standards, these cases were reported as negative for fentanyl by the laboratory. Due to the discrepant scene and toxicology findings suggestive of an opioid toxicity death, further discussion between the medical examiners and toxicologists prompted additional testing at a referral laboratory. This resulted in quantifiable blood carfentanil in all cases (mean 0.26 ng/mL, range 0.12 – 0.64 ng/mL). Cointoxicants included ethanol (n=2), methamphetamine (n=3), benzodiazepines (n=3), and cocaine (n=1). No case had definitive evidence of acute heroin intoxication, but two cases had low concentrations of morphine present (0.03 and 0.06 ng/mL), and two others had 6-monoacetyl morphine in the urine without morphine in the blood, suggesting recent use. All deaths were certified as accidental acute or mixed carfentanil toxicity. These cases present additional information about carfentanil-related deaths and highlight the importance of collaboration between forensic pathologists and toxicologists.

Evaluation of supervised injection facilities as an ethically sound approach to treatment of injection drug abuse

Novel approaches are needed to address the issue of injection drug use in Canada, which can have negative consequences for drug users and society. Supervised injection facilities (SIFs) are legally sanctioned facilities in Canada where drug users can receive sterile drug paraphernalia, referral to cessation programs and timely medical care if necessary. SIFs operate under the principle of harm reduction, which aims to reduce rates of infection and death due to overdose among drug users. SIFs are largely driven by the utilitarian ideal of maximizing benefit for the greatest number of people, through supervision of active drug users and appropriate referral for those wishing to quit. Deontological theory may support SIFs depending on how one applies the categorical imperative. Studies of the first SIF in North America, Insite, have shown demonstrable reductions in adverse health and societal consequences of injection drug use, rationalizing their implementation under consequentialism. SIFs are, therefore, suitable for greater adoption by the healthcare system.

Figurine Traditions from the Amazon

Stone and ceramic figurines occurred in many pre-Columbian cultures of Amazonia but only appear as recurrent, traditional objects late in the cultural history of the region, primarily in the large settlements which flourished along the Lower Amazon and its estuaries. Marajoara and Santarém ceramics include an array of figurines depicting humans and animals, in languages emphasizing body transformation and reproduction, and, sometimes, decapitation. Some also performed as rattles, or maracas, an instrument traditionally related to shamanic power. Stone figurines from the Lower Amazon present similar modes of body representation and seem to be part of the drug paraphernalia used in shamanic rituals. Rather than being a marker for the appearance of more complex, agrarian societies, Amazonian figurines seem to be related to the intensification of deeply rooted shamanic practices. This chapter reviews the context and repertoires of figurine traditions within the different models proposed in Amazonian archaeology for pre-Columbian societies.

Opioid Toxicity

In recent years, there has been a substantial increase in opioid use and abuse, and in opioid-related fatal overdoses. The increase in opioid use has resulted at least in part from individuals transitioning from prescribed opioids to heroin and fentanyl, which can cause significant respiratory depression that can progress to apnea and death. Heroin and fentanyl may be used individually, together, or in combination with other substances such as ethanol, benzodiazepines, or other drugs that can have additional deleterious effects on respiration. Suspicion that a death is drug-related begins with the decedent's medical and social history, and scene investigation, where drugs and drug paraphernalia may be encountered, and examination of the decedent, which may reveal needle punctures and needle track marks. At autopsy, the most significant internal finding that is reflective of opioid toxicity is pulmonary edema and congestion, and frothy watery fluid is often present in the airways. Various medical ailments such as heart and lung disease and obesity may limit an individual's physiologic reserve, rendering them more susceptible to the toxic effects of opioids and other drugs. Although many opioids will be detected on routine toxicology testing, more specialized testing may be warranted for opioid analogs, or other uncommon, synthetic, or semisynthetic drugs.