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ABSTRACT: In the past year, the Brazilian Federal Government and society have reported and acted on a crack use epidemic, which has been exacerbated by the media. This study hypothesized that crack use has not increased at the rate suggested by the Brazilian media. A cross-sectional survey was carried out in 2010 usinga multistage probabilistic representative sample of Brazilian middle and high school students in the country's 27 state capitals. A total of 50,890 valid questionnaires were weighted, analyzed and results compared to the 2004 national school survey dataset. Considering lifetime and past year crack use, no change in consumption was found between 2004 and 2010. Official data in Brazil on middle and high school students does not support the assertion of a crack epidemic widely publicized by the media. Government measures to treat and prevent crack use are encouraged; however, the term epidemic has been inappropriately used to represent the static prevalence of crack consumption among students.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 09/2012; 28(9):1643-9. · 0.83 Impact Factor
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ABSTRACT: Illicit drug consumption among youngsters is a public health concern that requires attention. However, little research has highlighted the importance of "drug information availability" among protection factors. The objective of the study is to identify, from the point of view of youngsters at risk, what factors could prevent them to try illicit drugs, focusing on the importance of "drug information availability". An intentional sample was selected, composed by 62 youngsters divided into two groups: (NU) non illicit users N=32 and (U) users N=30. The sample was recruited through key-informants and snowball and each participant was submitted to an in-depth semi-structured interview. According to NU, "drug information availability" was reported as the main protector factor. Family-based information was the main source of knowledge followed by observation of the drug negative consequences on lives of friends who have already consumed illicit drugs in a regular-basis. Among users, a lack of drug knowledge or availability of partial information was reported. Among youngsters at risk, drug information availability is the main protection factor against experimental and regular drug consumption. Family based information was reported as its main source.
Ciencia & saude coletiva 01/2011; 16 Suppl 1:1257-66.
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ABSTRACT: Brazil is currently experiencing a growing number of newly recorded cases of HIV infection among women, with transmission mainly occurring by sex. This increase may be associated with the development of sexually risky behavior among female crack users who, according to informal reports, prostitute themselves for drugs or for money to be used for buying drugs. Since epidemiologic studies have not yet addressed this phenomenon, the aim of this study was to investigate this in depth using a qualitative ethnographic approach. An intentional sample was utilized, composed of 75 female crack users in S?o Paulo, who were selected by specific criteria using the snowball strategy and key informants. Fourteen different chains of users were investigated, allowing us to include the largest possible number and variety of users. Each participant was submitted to a semi-structured in-depth interview that was guided by a questionnaire. Verbal information was corroborated and extended using participative observation. These 14?45-year-old women, who had little schooling and no job connections, opted to sell their bodies as a strategy to obtain drugs and to satisfy their compulsive use of crack. The subjects engaged in up to nine acts of sexual intercourse per day, in unsafe locations and with multiple partners who were approached in a besieging way and selected using subjective criteria. These crack users generally exchanged sex under craving for ridiculously low prices and left the use of protection up to the client. Because the users used inadequate pipes to smoke crack, it was common for them to have lesions on their lips and mouths. Since they often provided oral sex, they exposed themselves to considerable risk for infection with STDs including HIV, because of the contact of their partners? semen with their open wounds. These women make up an important risk group with respect to the transmission of STDs including AIDS.
Substance Use & Misuse 01/2011; 46(4):476-85. · 1.10 Impact Factor
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ABSTRACT: In Spain, crack cocaine use is silently increasing. In Barcelona, an intentional sample was selected to describe the general characteristics of this consumption. Participants were submitted to an interview and data were analyzed through qualitative research procedures. Users are young males and of low socioeconomic status and formal education. The major pattern of use is compulsive. Illegal income activities are the choice for crack cocaine or money acquisition, increasing individual and social health costs. Polydrug use is a matter of concern. Although these findings can not be generalized, they should be considered for the development of public policies to adequately address crack cocaine users' needs.
Substance Use & Misuse 11/2010; 45(13):2291-300. · 1.10 Impact Factor
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ABSTRACT: Illicit drug consumption among youngsters is a public health concern that requires attention. However, little research has highlighted the importance of "drug information availability" among protection factors. The aim of this article is to identify, from the point of view of youngsters at risk, what factors could prevent them to try illicit drugs, focusing on the importance of "drug information availability". An intentional sample was selected, composed by 62 youngsters divided into two groups: (NU) non illicit users N=32 and (U) users N=30. The sample was recruited through key-informants and "snowball" and each participant was submitted to an in-depth semi-structured interview. According to NU "drug information availability" was reported as the main protector factor. Family-based information was the main source of knowledge followed by observation of the drug negative consequences on lives of friends who have already consumed illicit drugs in a regular-basis. Among users, it was reported a lack of drug knowledge or availability of partial information. We can conclude that among youngsters at risk, drug information availability is the main protection factor against experimental and regular drug consumption. Family based information was reported as its main source.
Ciencia & saude coletiva 05/2010; 15(3):699-708.
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ABSTRACT: To provide access to the results of a randomized cross-sectional study conducted by the Brazilian Center for Information on Psychotropic Drugs in 2001.
This survey involved a random sample of individuals ranging from 12 to 65 years of age and residing in the 107 largest cities (over 200,000 inhabitants) in Brazil, which represented 27.7% of the Brazilian population, estimated to be 169,799,170 inhabitants at the time. A total of 8,589 interviews were conducted. The Substance Abuse and Mental Health Services Administration questionnaire, translated and adapted for use in Brazil, was used in the interviews.
Of the sample as a whole, 41.1% of the interviewees reported having experimented with tobacco products. The prevalence of daily smokers was 17.4% (20.3% among males and 14.8% among females). We found that 9% of the sample (10.1% of the men and 7.9% of the women) were nicotine-dependent, according to the criteria of the National Household Survey on Drug Abuse.
The prevalence of current smoking in the 107 largest cities of Brazil is significantly lower in this decade than was the national prevalence at the end of last century.
Jornal brasileiro de pneumologia: publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia 12/2009; 35(12):1204-11.
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ABSTRACT: Cognitive changes due to crack cocaine consumption remain unclear.
For clarification, 55 subjects were assigned to three groups: control group, crack cocaine current users, and ex-users. Participants were submitted to Mini-Mental State Examination (MMSE) and tasks evaluating executive functioning and verbal memory. Mood state was also measured. Intergroup comparisons were carried out.
Control group performance on the MMSE was better than that of users and ex-users. Verbal memory performance for logical memory of users was impaired. Ex-users scored lower on DSST and Trail Making Test (Part B).
Chronic crack cocaine use seems to disrupt general cognitive functioning (MMSE), verbal memory, and attentional resources, but findings suggest that some of these effects could be reversed by abstinence.
Substance Use & Misuse 01/2009; 44(13):1941-57. · 1.10 Impact Factor
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ABSTRACT: To characterize the situation regarding crack cocaine use in the city of São Paulo, along with the sociodemographic profile of its users.
Qualitative ethnographic study carried out with an intentional sample of crack cocaine users (n=45) and former users (n=17). The participants were recruited by means of the chain sampling method and they underwent a semi-structured interview guided by a questionnaire, in 2004 and 2005. The combination of each question and its respective responses gave rise to specific reports that were interpreted individually. ANALYSIS OF THE RESULTS: The predominating profile of the crack cocaine users was that they were single young men of low socioeconomic class and low schooling level, without formal employment ties. The pattern of use most frequently cited was compulsive, characterized by multiple drug use and carrying out illegal activities in exchange for crack cocaine or money. However, controlled use was also identified. This consisted of non-daily use of crack cocaine mediated by individual factors that were developed intuitively by the user. Controlled use was similar in nature to the strategies adopted by former users to achieve a state of abstinence.
The culture of crack cocaine use has undergone changes regarding the pattern of use. Although most users do so compulsively, the existence of controlled use was observed. This deserves to be investigated in more detail, particularly with regard to the strategies adopted to attain this.
Revista de Saúde Pública 08/2008; 42(4):664-71. · 1.33 Impact Factor
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ABSTRACT: Although many studies have suggested that risk and protective factors are related to the use of drugs, their role has not been given due importance. More attention to protective factors could make them a fundamental tool in prevention programs. Since low socioeconomic level and adolescence are known as risk factors, the aim of this study was to identify which factors would prevent Brazilian adolescents from low-income families from using drugs. A qualitative method and an intentional sample selected by criteria were adopted for this investigation. During 2003, sixty-two youngsters, ages 16 to 24 years old, 30 drug users, and 32 nonusers were administered a semistructured interview. The subjects perceived family and religiosity as important protective factors in their lives. With regard to religiosity, 81% of nonusers believed in and practiced a religion, whereas only 13% of users considered themselves as being religious. The belief in and practice of a religion were also more evident among family members of nonusers (74%) than those of users (33%). These results indicated that religion may be a relevant protective factor for the sample studied, helping the family unit in keeping youth away from drugs. The study's limitations were noted.
Substance Use & Misuse 08/2008; 43(10):1476-86. · 1.10 Impact Factor
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ABSTRACT: To analyze the role of emerging religious interventions in the recovery from drug addiction.
An exploratory qualitative study carried out in the city of Sao Paulo, Southeastern Brazil, in 2004 and 2005. In-depth interviews were held with 85 former drug users who had turned to non-medical religious resources for the treatment of their drug addiction and who were free from drugs for at least six months. The religious groups included in the analysis were Catholics, Evangelicals and Spiritualists. The interviews contained questions relating to sociodemographic data, the religiosity of the interviewee, his or her history of drug consumption, medical treatment for drug addiction, religious treatment and prevention of drug consumption through religion.
There were differences between the religious groups in the way that the drug addict was supported. The group that most used religion as an exclusive form of treatment was the Evangelicals, who rejected the intervention of a doctor andr any kind of pharmacological treatment. The Spiritualists most turned to therapeutic support for alcohol dependence, as well as conventional treatment, on account of their greater purchasing power. Catholics generally relied exclusively on religious therapy, but were less likely to reject the possibility of medical treatment. The importance given to prayer as an anxiolytic method was common in the three treatments. Confessions and pardons--in the forms of (faith) conversions and penitence for Evangelicals and Catholics respectively--served to help to rebuild people's lives and restore their self-esteem.
According to the interviewees, what helped them to maintain their abstinence from drugs was more than just religious faith. Other factors included the support, positive pressure and welcoming offered by the group, and the offer to rebuild their lives with the unconditional support of religious leaders.
Revista de Saúde Pública 05/2008; 42(2):265-72. · 1.33 Impact Factor
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ABSTRACT: To identify a progression in drug use and influencing factors among crack users, a qualitative methodology was used for a more in-depth investigation, taking into consideration the view that the interviewee has of the problem. A long duration and a semi-structured interview was used; a purposeful sampling was outlined and a criterion sampling was achieved. Thirty-one crack users or ex-users were interviewed in order to reach theoretical saturation. Two distinct phases of drug use were detected. The first, with licit drugs, where alcohol and tobacco were the most frequent, the relatives and friends were the ones who encouraged use, and the need for self-assurance was the reason most often reported. The early start and the "heavy use" of one or both drugs were determinant for the beginning of a progression towards illicit drugs. Marijuana was the first drug of the second phase. A stronger attitude for the search of a drug as a source of pleasure replaced the reason previously stated. The study reveals that the progression in drug use seems to be associated more with external decisions (e.g., peer pressure, dealing influence, etc.) than to the preference of the user. Two different progressions were identified: among the younger (<30): tobacco and/or alcohol, marijuana, snorted cocaine, and crack, and among the older (>30): tobacco and/or alcohol, marijuana, intravenous medication, snorted cocaine, intravenous cocaine, and crack. This pilot study's findings are limited in generalizability to its sample. Further research is needed.
Substance Use & Misuse 02/2007; 42(1):177-88. · 1.10 Impact Factor
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ABSTRACT: Although there are many studies on risk factors for drug use, little has been known about the reasons that prevent people away from drug use. The aim of this study was to identify the reasons that would prevent low-income youngsters against psychotropic drug experimentation and use, even when living in a drug dealing environment.
A qualitative study was carried out in an intentional sample selected according to a set of criteria. Sixty-two youngsters, aged between 16 and 24 years, from low-income families who have never used psychotropic drugs (32 subjects) or who were heavy drug users (30 subjects) were interviewed. Each interview lasted on average 110 minutes.
Among non-users, access to information and a protective family structure were identified as major reasons from preventing youngster from drug use. Comprehensive information on the outcomes of drug use and affective bonds between parents and their children, assured by feelings of support and respect, seems to be important in helping them avoid drug use. The importance of these two factors as reasons to keep youngsters away from drugs is emphasized when their lack is mentioned and censured by drug users.
The outlook of those who have never used drugs in their lifetime and their reasons should be considered in the development of drug prevention programs targeting low-income youngsters.
Revista de Saúde Pública 09/2005; 39(4):599-605. · 1.33 Impact Factor
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ABSTRACT: In Brazil, the medicinal misuse of trihexyphenidyl (Artane) has been observed among several segments of society. The present study was conducted in the city of São Paulo during 2002 to characterize this abuse. A sample of 21 users and 16 ex-users was interviewed using qualitative methodology; the subjects were single, unemployed, male polydrug users, who used trihexyphenidyl in order to attain states of mental alterations, mainly hallucinations and deliriums. Trihexyphenidyl is consumed in association with alcohol, other licit drugs (benzodiazepines), or illicit drugs, impairing cognitive functions such as memory, attention, and learning, intervening with some activities of users' daily life.
Substance Use & Misuse 02/2005; 40(4):473-82. · 1.10 Impact Factor
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ABSTRACT: In order to establish prevention programs regarding psychotropic drug use that are adapted to specific populations it is, first of all, important to have data on the realities of such consumption. Single data points are not enough for drawing up a profile of society in relation to drugs.
The aim of this household survey was to determine the incidence of illegal drug, alcohol, tobacco and psychotropic medication use, and thus the number of persons dependent on drugs, alcohol and nicotine, and to evaluate their perception regarding how easy it is to obtain psychotropic drugs.
Epidemiological survey.
All of the 24 cities in the State of Sao Paulo with more 200,000 inhabitants participated in the study.
The sampling was constructed from weighted probabilistic stratified conglomerates obtained via two-stage selection. In each municipality sampled, census sectors (generally 200-300 households) were first selected. Then, households and a respondent were selected to provide information from his/her point of view. The SAMHSA questionnaire (Substance Abuse and Mental Health Services Administration) of the U.S. Department of Public Health was used, after translation and adaptation to Brazilian conditions.
A total of 2,411 persons aged 12-65 years old were interviewed, of whom 39.9% were men. Lifetime use of any psychotropic drug other than alcohol and tobacco was 11.6%: much less than in the U.S. (34.8%). The alcohol dependence rate was 6%, similar to findings from other countries. Marijuana was the illegal drug most cited as used daily (6.6%): a prevalence much lower than in the U.S. (32.0%): Inhalant use was next in frequency of use (2.7%): about 10 times less than in the United Kingdom (20%). Cocaine use (2.1%) was about 5 times less than in the U.S. (10.6%). There was no report of heroin use, although there was a surprisingly high perception regarding the case of obtaining heroin: 38.3% sold if was easy to obtain.
This study supports the implementation of better prevention programs regarding drug abuse in Sõ Paulo state.
Sao Paulo Medical Journal 12/2003; 121(6):231-7. · 0.71 Impact Factor
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ABSTRACT: The present study aimed to analyze 219 notifications of suspected adverse reactions (AR) produced by psychoactive medicaments (ARPM), notified by Brazilian psychiatrists, during a 3-month period (April 1999 up to September 2001).
A notifying card for adverse reactions possibly produced by psychoactive medications was quarterly sent to all psychiatrists affiliated to the Brazilian Association of Psychiatry. Once each notification, dully filled in, was received, the possible adverse reaction was analyzed in order to verify the causality.
The psychiatrists classified as severe 50 of the ARPMs; 150 others were not considered as severe. Among the severe ones there were 3 deaths, 12 life-threatening reactions, 26 ARPMs required or prolonged hospitalization and 9 notifications described temporary disability of the patients. Among the medications, antidepressants ranked first with 122 ARPMs being notified, followed by neuroleptics (46 ARPMs) and antiepiletic medicaments (25 ARPMs). The three main organs and systems affected by the ARs were the Central Nervous System with 102 ARs, skin and mucosa with 44 and gastrointestinal with 21 ARPMs.
Considering causality, i.e., the association between the medication and the described AR, 24 cases were considered as Definite (with positive dechallenge and rechallenge, i.e., withdrawal and reintroduction of the medication) and 134 other ARPMs were classified as Probable (only dechallenge positive; only with medication withdrawal; rechallenge was not performed).
Revista Brasileira de Psiquiatria 11/2003; 25(4):200-5. · 1.20 Impact Factor
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ABSTRACT: To establish a progression on drug use and its intervening factors among crack users.
A qualitative methodology was applied for an in-depth investigation, taking into consideration the interviewees' viewpoint of the problem. Long interviews using a semi-structured questionnaire were conducted. A purposeful sampling was outlined to create a criterion sampling. For theoretical saturation, 31 crack users and former users were interviewed.
Two distinct phases of drug use were identified. In the first phase there predominate licit drugs, mostly alcohol and tobacco, encouraged by the parents and friends and the users' need of self-assurance. An early age start and heavy use of one or both drugs are determinant for the progression to illicit drugs. Marijuana is the first drug used in the second phase, characterized by an active attitude towards drugs which are regarded as a source of satisfaction.
The progression on drug use seems to be more associated to external decisions (e.g. peer pressure, drug dealers' encouragement, etc.) than to users' preference. Two different kinds of progression were identified: in younger users (<30 years old): tobacco and/or alcohol, marijuana, snorted cocaine, and crack; in older users (>30 years old): tobacco and/or alcohol, marijuana, intravenous medication, snorted cocaine, intravenous cocaine, and crack.
Revista de Saúde Pública 08/2002; 36(4):420-30. · 1.33 Impact Factor
