Small-Town Heroin Use and the Pains of Place

• In Event: 4461 - Space and Place Across the Urban-Rural Axis

Abstract

How do the places people live shape their experiences with drugs, and the health risks that result? This question is particularly timely because the United States is enduring the worst period of drug-related mortality in its history. Deaths from overdose in the United States have more than quadrupled since 2000, surpassing 70,000 in 2017. About two-thirds of fatal overdoses involve opioids, such as pharmaceutical analgesics, heroin, and illicitly manufactured fentanyl. Opioid-related mortality has risen more rapidly in nonurban places than in cities, and many of the places with the highest overdose rates are rural or remote from urban centers. However, most research on opioid use, including nearly all ethnographic studies, focus on large cities. In this article, I contribute to our limited understanding of drug use practices and drug-related health risks in nonurban places by describing how people buy, sell, and use heroin in a small and remote California town that I call Hazel. Based on 24 months of participant-observation in Hazel and in-depth interviews with practitioners in health and human services, substance use treatment, and law enforcement, as well as with people who use drugs, I describe how heroin use developed in Hazel, illustrate the everyday lives of people who use heroin there, and document some distinctive drug-related health risks they face. I discuss the implications of these findings for drug policy in the United States as well as for future research on the health effects of place-based inequalities.

Author

• David Showalter, University of California, Berkeley