Graduation Year

2022

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Anthropology

Major Professor

Rebecca Zarger, Ph.D.

Co-Major Professor

Jason Wilson, M.D., M.A., FACEP

Committee Member

Heidi Castañeda, Ph.D., M.P.H.

Committee Member

Daniel Lende, Ph.D.

Committee Member

Roberta Baer, Ph.D.

Committee Member

Dinorah Martinez-Tyson, Ph.D., M.P.H.

Keywords

Clinical Anthropology, Clinically Applied Medical Anthropology, Emergency Medicine, Ethnographically Informed Care, Healthcare Trajectories, Structural Determinants of Health

Abstract

Historically, there has been no clear treatment pathway for opioid use disorder (OUD) patients who seek emergency care. Utilizing a trajectories of addiction framework, this dissertation presents insights from an applied anthropology of addiction study in an acute care setting to build a medication for opioid use disorder (MOUD) treatment pathway, aiming to break down the stigma related to opioid use disorder (OUD) and mitigate a lack of treatment options. This dissertation took place in an urban trauma center in Florida, from 2018 to 2021. With almost 1500 hours of participant observation, hundreds of informal interviews, and 30 formal interviews, I consider both the qualitative and quantitative outcomes of the BRIDGE (Building Recovery Integration for DruG users into Emergency medicine) pathway, created in conjunction with emergency medicine physicians.

The research findings include : (1) Drawing on ethnographic interviews, observations, and field notes, the study examines how the BRIDGE was developed based on ethnographic analysis of OUD patient/physician experiences and how it has transformed emergency care for OUD for patients, physicians, and community treatment providers; (2) Quantitative outcomes for assessing the success of patient care suggest implementation of this hybrid pathway has the potential for success; (3) Previous lack of engagement with opioid use patients by physicians can be better understood by examining the concept of learned helplessness within the context of clinical care and education; (4) Strategies such as integrating ethnographically-informed care and person-first care strategies into acute encounters with interventions such as the BRIDGE are necessary; (5) Uncovers the possibility of a learned helplessness in relation to those perceived to be in positions of power; (6) Critically examines the concept of a ‘fixed trajectory’ in addiction, where addiction is seen as fixed state of permanency and largely untreatable; (7) Explores the benefits of creating applied clinical interventions with physicians as stakeholders.

This work further investigates, extends, and applies findings from, “I am More Than my Addiction: Perceptions of Stigma and Access to Care in Acute Opioid Crisis”, which was an Emergency Department-based ethnography of the acute care experiences of multiple actors related to providing and seeking care for opioid-related emergencies, as well creating the space for considering how anthropology can be clinically applied in acute spaces, while still taking a critical view of the biomedical system. This dissertation adds to medical anthropology theory through the consideration of how ethnography can be infused into the clinical space, and function as an actionable next step in creating targeted interventions to improve patient experiences and treatment. Moreover, how these interventions can be utilized to empower physicians in providing care, which may bolster against the effects of helplessness and burnout that often lead to poor patient outcomes. Finally, this study adds to an anthropology of addiction with the addition of a ‘fixed trajectory’ regarding drug use, where the user is seen as a fixed, static, and homogenous archetype considered untreatable in biomedicine and unfixable in society.

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