Sarah Giulietta Mars

Sarah Giulietta Mars
University of California, San Francisco | UCSF · Department of Family and Community Medicine

PhD

About

43
Publications
46,139
Reads
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1,399
Citations
Citations since 2017
11 Research Items
1129 Citations
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2017201820192020202120222023050100150200
2017201820192020202120222023050100150200
2017201820192020202120222023050100150200
Additional affiliations
September 2003 - February 2022
London School of Hygiene and Tropical Medicine
Position
  • Visiting Research Fellow
May 1999 - August 2003
Education
September 1989 - June 1992
University of Cambridge
Field of study
  • History

Publications

Publications (43)
Article
Full-text available
In the United States, HIV outbreaks are occurring in areas most affected by the opioid epidemic, including West Virginia (WV). Cultural Theory contends that multiple cultures co-exist within societies distinguished by their differing intensities of rules or norms of behavior (‘grid’) or degree of group allegiance/individual autonomy (‘group’). Acco...
Article
Full-text available
Background: West Virginia is a largely rural state with strong ties of kinship, mutual systems of support and charitable giving. At the same time, wealth inequalities are extreme and the state's drug overdose fatality rate stands above all others in the USA at 51.5/100,000 in 2018, largely opioid-related. In recent years, harm reduction services ha...
Article
Full-text available
Background and aims Using mathematical modeling to illustrate and predict how different heroin source-forms: “black tar” (BTH) and powder heroin (PH) can affect HIV transmission in the context of contrasting injecting practices. By quantifying HIV risk by these two heroin source-types we show how each affects the incidence and prevalence of HIV ove...
Preprint
Full-text available
Background and Aims Using mathematical modeling to illustrate and predict how different heroin source-forms: “black tar” (BTH) and powder heroin (PH) can affect HIV transmission in the context of contrasting injecting practices. By quantifying HIV risk by these two heroin source-types we show how each affects the incidence and prevalence of HIV ove...
Article
Full-text available
Commentary to: Illicit fentanyls in the opioid street market: desired or imposed?
Article
Full-text available
Background Illicitly manufactured fentanyl and its analogues are appearing in countries throughout the world, often disguised as heroin or counterfeit prescription pills, with resulting high overdose mortality. Possible explanations for this phenomenon include reduced costs and risks to heroin suppliers, heroin shortages, user preferences for a str...
Article
Full-text available
Background: Internationally, overdose is the primary cause of death among people injecting drugs. However, since 2001, heroin-related overdose deaths in the United States (US) have risen sixfold, paralleled by a rise in the death rate attributed to synthetic opioids, particularly the fentanyls. This paper considers the adaptations some US heroin i...
Article
Full-text available
Since 2001, heroin-related overdose deaths in the United States have risen six-fold, a rise unaccounted for by the expanding user population. Has heroin become a more dangerous drug? Reports of fentanyl and its analogs, often concealed in or sold as heroin, have also increased sharply. This article investigates heroin injectors' perceptions and exp...
Article
Full-text available
Background: The US is experiencing an unprecedented opioid overdose epidemic fostered in recent years by regional contamination of the heroin supply with the fentanyl family of synthetic opioids. Since 2011 opioid-related overdose deaths in the East Coast state of Massachusetts have more than tripled, with 75% of the 1374 deaths with an available...
Article
Full-text available
Since the 1990s, U.S. heroin consumers have been divided from the full range of available products: east of the Mississippi River, Colombian-sourced powder heroin (PH) dominates the market while, to the west, Mexican-sourced "black tar" (BTH) is the main heroin available. By conducting qualitative research in two exemplar cities, Philadelphia (PH)...
Article
Full-text available
Introduction: Little is known about trends in national rates of injection-related skin and soft tissue infections (SSTI) and their relationship to the structural risk environment for heroin users. Use of Mexican-sourced "Black Tar" heroin, predominant in western US states, may have greater risk for SSTI compared with eastern US powder heroin (Colo...
Article
Full-text available
Heroin overdose, more accurately termed 'heroin-related overdose' due to the frequent involvement of other drugs, is the leading cause of mortality among regular heroin users. (Degenhardt et al., 2010) Heroin injectors are at greater risk of hospital admission for heroin-related overdose (HOD) in the eastern United States where Colombian-sourced po...
Article
Full-text available
Background and AimsHeroin-related overdose is linked to polydrug use, changes in physiological tolerance and social factors. Individual risk can also be influenced by the structural risk environment including the illicit drug market. We hypothesized that components of the US illicit drug market, specifically heroin source/type, price and purity, wi...
Article
This qualitative study documents the pathways to injecting heroin by users in Philadelphia and San Francisco before and during a pharmaceutical opioid pill epidemic. Data was collected through in-depth, semi-structured interviews (conducted between 2010 and 2012) that were, conducted against a background of longer-term participant-observation, ethn...
Article
Full-text available
The historical patterns of opiate use show that sources and methods of access greatly influence who is at risk. Today, there is evidence that an enormous increase in the availability of prescription opiates is fuelling a rise in addiction nationally, drawing in new initiates to these drugs and changing the geography of opiate overdoses. Recent effo...
Book
In the 1980s after a period of peaceful co-existence, a bitter conflict arose between National Health Service psychiatrists and private doctors treating drug addiction in England. Continuing into the twenty-first century, the battle ended with most private addiction doctors being struck from the medical register. This book examines how the conflict...
Chapter
It might be surprising that a new system of specialist, state-funded Clinics could be set up with so little idea of how to approach their task, but seen through the eyes of senior psychiatrist Thomas Bewley, such was the situation in the early days of the Clinics. According to the minutes of a meeting of Clinic leaders and civil servants in 1969, w...
Chapter
Unorganised and leaderless, the eight years between the Association of Independent Doctors in Addiction’s passing and the Association of Independent Prescribers beginning saw private prescribers lose any foothold in the policy community. Yet conversely, this was a time when the message of their former leaders had been taken into the heart of the po...
Chapter
From the 1930s through the 1950s, while England faced and fought fascism in Europe and rebuilt in its aftermath, the country’s drug scene was relatively peaceful. The rest of the 20th century, however, saw a dramatic transformation in the ways drugs were obtained and used, stimulating growing public and professional interest. Between 1970 and 1999...
Chapter
There was no question of a really serious long-term option of prescribing forever... That's something were actually trying to stop... Because all over London there were these geriatric junkies to put it very rudely, people who had been prescribed out of the Sixties... a rump of people who have just never changed... So, rather than again give these...
Chapter
This book began by asking how decisions about addiction treatment have been made in England and how conflicts between doctors affected national treatment policies. By now, it is clear that there are many answers to these questions. Who makes these decisions has changed, with doctors dominating in the 1960s and 1970s but gradually having to concede...
Chapter
In the 1980s, as co-founder and leader of the Association of Independent Doctors in Addiction (AIDA), Ann Dally spoke out vehemently against the Clinic system. During this time the General Medical Council (GMC) brought two disciplinary cases against her. The process of these cases shaped the role of AIDA in the public-private debate and revealed mu...
Chapter
After Ann Dally left the drugs scene, her organisation, the Association of Independent Doctors in Addiction (AIDA), collapsed; but its short life and that of two other doctors’ groups can help us answer a question central to The Politics of Addiction. Why were the London consultants able to fend off outside regulation and set the standards by which...
Chapter
From its origins in 19162 to its demise in 2007 the Home Office Drugs Inspectorate gained and then lost great influence over British drugs policy and the regulation of prescribing. The Inspectorate was just one strand in a web of control systems, both state and professional, which emerged over the 20th century to regulate the fate of pharmaceutical...
Book
The Politics of Addiction examines power and policy-making in the context of a bitter conflict between private and publicly employed doctors treating addiction. Regulation was used by both the profession and the state to shape the treatment of addiction and who could provide it, with the media feeding into the process. The study is based on over 50...
Article
Full-text available
Over the last 50 years, tobacco has been excluded from and then included in the category of addictive substances. We investigated influences on these opposing definitions and their application in expert witness testimony in litigation in the 1990s and 2000s. A scientist with ties to the tobacco industry influenced the selection of a definition of a...
Article
Full-text available
The role of evidence and "expert" opinion in forming drug treatment policies is explored though the case of the first clinical guidelines on drug misuse (1984). Developed to secure the ascendancy of one particular treatment model and impose this on all doctors, they cited no supporting research evidence. The experience of an expert committee was de...
Article
Full-text available
This glossary arises out of research interests in the 19th and 20th century in the history of drugs, including the contemporary history of drug policy. It is necessarily brief, and British and American focused; it is also concentrated on narcotic drugs rather than alcohol and tobacco. However, the comments take on board the recent discussions of co...

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Projects

Projects (4)
Archived project
To examine the historical development of the relationship between public and private treatment for drug users in the last part of the twentieth century. It considered how policy-making by politicians, civil servants, senior doctors and other members of the policy community influenced the provision of treatment services for the treatment of drug addiction. The project used in-depth oral history interviews with key participants, archival sources and published literature. The results were published in the peer reviewed book "The Politics of Addiction: Medical Conflict and Drug Dependence in England" (Macmillan: 2012) part of the Science, Technology and Medicine in Modern History series.