In this paper, I reflect on two of my intertwined research interests. The first is my professional engagement with researching drug use and abuse in Ireland, especially heroin addiction, in applied ethnographic projects, generally answering a specific set of questions on how services for ‘drug addiction’ work. My second interest is the historical construction of ‘addiction’ and the discursive intersections that produce various kinds of power, subjects, and techniques around this concept. I find the dialectical relationship between heroin and methadone in Ireland, especially the emergence of heroin ‘injecting rooms’, as a window into how drugs are social things. Drugs and the bodies who take them live in complex moral worlds, not as inert objects surrounded by abstract human creations. These worlds are an integral part of how ‘addiction’ works and how drugs treating addiction are actually used. Without a deeper understanding of such complexities we will continue to miss key issues in the lives of people we hope to help.

The term ‘amaphara’, possibly derived from ‘parasites’, burst into South African public culture in the 2010s to refer to petty thieves addicted to a heroin-based drug locally called whoonga/nyaope. Drawing on ethnography and media sources to interrogate the rise of ‘amaphara’, this paper argues that South Africa's heroin epidemic magnifies the attention – criticism but also sympathy – directed toward marginalised black men who have few prospects for social mobility. It locates amaphara in the national context where drug policy is largely punitive and youth unemployment rates are painfully high, but gives particular attention to families’ and communities’ experiences with intimate crimes, especially petty thefts. It further shows that amaphara is a contested term: heroin users are brothers, sons and grandchildren and they gain most of their income not from crime but by undertaking useful piece work in communities.

The Swiss trials on medical prescription of injectable diacetylmorphine (pharmaceutical heroin) for “severe” heroin dependence provoked very controversial commentaries. Despite methodological shortcomings, the evaluation of the Swiss heroin trials yielded some interesting findings. Study participants showed substantial improvements in health and well-being and noticeable declines in illicit drug use and criminal activities. Heroin prescription may thus be helpful for some of those who continue to regularly use illicit heroin while maintained on methadone or who refuse other available treatment options. However, research-based evidence suggests that the intravenous (IV) application of heroin under medical supervision may have untoward side effects. Recent studies have shown that heroin injections produce transient, but significant decreases in systemic and cortical oxygenation most likely secondary to respiratory depression. Among others, these effects are the subject of ongoing studies.

Adjuvant effects on disease severity caused by the bioherbicide P. papaveracea on opium poppy were evaluated. Tween 20, Tween 80, Triton X-100, Tactic, CelGard, and Keltrol inhibited appressorium formation but not conidial germination on detached leaves. The disease severity varied from 11 to 83% necrosis in field experiments involving eight adjuvants at various concentrations plus 1 × 106 conidia ml−1 or minus pathogen. The three best-performing adjuvants when combined with pathogen, Tactic (1%, v/v), Bond (1%, v/v), and Tween 20 (1%, v/v), were included along with Tween 20 (0.001%, v/v) in field experiments in 1998. Tween 20 (1%, v/v) plus pathogen (1 × 106 conidia ml−1) caused the most severe disease, averaging 68% necrosis within 2 wk of treatment. Overall, plots treated with adjuvant plus P. papaveracea had a 22% reduction in capsule weight per plot as compared to plots treated with the adjuvant alone. Tactic (1%, v/v), Silwet-L77 (0.1%, v/v), Tween 20 (1%, v/v), and Tween 20 (0.001%, v/v) were included in field experiments in 1999. The treatment with Tween 20 (1%, v/v) plus pathogen (2 × 106 conidia ml−1) caused severe disease, averaging 56% necrosis within 2 wk of treatment. In 1999 plots treated with adjuvant plus pathogen averaged a 27% reduction in capsule weight as compared with plots treated with the adjuvants alone. The inclusion of Tween 20 (1%, v/v) with P. papaveracea conidia greatly enhanced efficacy on opium poppy.

The recreational use of illicit drugs remains an enormous and growing problem throughout the United States of America and around the world. Cocaine is most frequently thought of when considering the cardiovascular toxicity of illicit drugs. The association of cocaine use with sudden death due to myocardial ischaemia and infarction is well recognised, and this risk appears to be amplified by concomitant cigarette smoking and alcohol consumption. Like cocaine, amphetamine and its derivatives lead to indirect stimulation of the autonomic nervous system through the release of norepinephrine, dopamine, and serotonin in nerve terminals of the central and autonomic nervous systems. However, amphetamine lacks the ion channel-blocking properties of cocaine. Also similar to cocaine, coronary artery spasm may be induced in individuals with or without atherosclerotic disease and may lead to myocardial infarction. With the movement across the United States of America to legalise marijuana, or cannabis, for medicinal and recreational purposes, it is important to consider its potential deleterious effects. Marijuana has long been thought to have very few adverse effects with the exception of long-term dependence. There are, however, scattered reports of acute adverse events up to and including sudden death. These appear to be due to myocardial infarction. In conclusion, the incidence of sudden death associated with the use of these drugs varies from rare in the case of marijuana use to not infrequent with some drugs such as cocaine. It is important for care providers to recognise the potential for drug abuse when caring for a sudden cardiac arrest survivor.

Heroin has been prescribed in England for the treatment of heroin addiction for almost 100 years. For many years, England was almost the only country where this occurred, and the British system was consequently the subject of international curiosity. In spite of this long history, very little research has been carried out locally, and until recently, there were no guidelines as to best practice. In 1965, it was decided that only doctors with a Home Office license could prescribe heroin. Since that time, the proportion of opiate addicts treated with heroin has greatly diminished, as has the number of doctors willing to prescribe. One doctor in particular remained an enthusiastic proponent of heroin prescription. His claims impressed some Swiss clinicians, who proceeded to establish a multicentre trial in Switzerland. This was followed by a similar trial in the Netherlands. These trials apparently indicated that a proportion of treatment-resistant opiate addicts could respond well to heroin, although the researchers' conclusions have been disputed. The National Treatment Agency in England is now developing guidelines for good practice based on this new information and is planning to set up some pilot sites. It is likely that practise in England will remain somewhat different from continental practice, particularly with respect to long-term supervised injecting. It is unclear how much funding will be released to support heroin prescription. Without adequate funding, it is likely to disappear.

The evolving role for lofexidine in the treatment of opiate detoxification over the last decade is reviewed. Lofexidine is no better than methadone or clonidine in attenuating withdrawal symptom severity, although it has a more favourable side-effect profile than clonidine. In conjunction with opiate antagonists, lofexidine may facilitate accelerated withdrawal, although activity and low liability for misuse, lofexidine may be more widely acceptable to clinicians than methadone, particularly those working in out-patient, non-specialist and prison treatment settings. Further studies in these treatment settings will be particularly apposite since, apart from the studies highlighted, the evidence base for the clinical value of lofexidine is mainly to be derived from in-patient trials.