Key drug use, health and socio-economic characteristics of young crack users in two Brazilian cities

Criminality and Sexual Behaviours in Substance Dependents Seeking Treatment

“…This result was unexpected because crack dependence constitutes a major social and health problem in cities and rural areas across Brazil, featuring extensive socio-economic marginalization, violence, sexually risky behavior, and compromised health status (Bastos 2012;Dias et al 2011;Vaughn et al 2010;Santos Cruz et al 2013a).…”

“…The underprivileged conditions in which many crack cocaine users and other polydrug abusers grow up and live may perpetuate risky behaviors, and stigma may further marginalize users from the necessary social opportunities, as well as health and recovery services. There is an urgent need for further research and for targeted interventions aimed at specific drug-related problems in Brazil (Santos Cruz et al 2013a). Reducing stigmatizing and moralizing discourse related to drug users, especially among health and law enforcement personnel, may help encourage users to seek care before their dependence worsens and they become involved in crime.…”

Crack across the Americas – A massive problem in continued search of viable answers: Exemplary views from the North (Canada) and the South (Brazil)

“…Recent Canadian studies reported consistently high rates of HIV (∼10%-45%) and/or HCV infection (∼40%-85%) among crack users (DeBeck et al, 2009;Fischer et al, 2006Fischer et al, , 2010Leonard et al, 2008;Shannon, Rusch, Morgan, et al, 2008;Ti et al, 2012), and have identified crack use as a predictor for both HIV and HCV among street drug users (DeBeck et al, 2009;Fischer et al, 2006;Roy et al, 2001;Shannon, Rusch, Morgan, et al, 2008;Strathdee & Stockman, 2010). In Brazil, recent studies indicating comparably low (e.g., <10%) HIV and HCV prevalence levels, entailing a reduced BBV burden (Carvalho & Seibel, 2009;Cruz et al, 2013;de Azevedo et al, 2007;Nunes, Andrade, Galvão-Castro, Bastos, & Reingold, 2007). While sex work involvement is common across the Americas, crack users' residual BBV incidence in Brazil is largely attributed to sexual risk behaviors (e.g., sex work and sexfor-drug exchanges), with higher rates among females (Carvalho & Seibel, 2009;Nappo, Sanchez, & De Oliveira, 2011;Nunes et al, 2007).…”

“…In the North, most crack users feature elaborate poly-drug use histories and active profiles -e.g., including heroin or other opioids, stimulants, benzodiazepines, in addition to alcohol, tobacco and cannabisand are commonly involved in injection drug use (IDU) (Fischer et al, 2010;Leonard et al, 2008;Shannon, Rusch, Morgan, et al, 2008). Conversely, users in the South also commonly feature the co-use of alcohol, cannabis, cocaine use and/or other stimulants, yet report comparably low rates of IDU (Cruz et al, 2013;de Azevedo, Botega, & Guimaraes, 2007;Inciardi et al, 2006).…”

“…Despite these differences, the basic challenges regarding interventions are similar in both hemispheres: Crack users are universally marginalized and underserved concerning basic health or treatment services (Cruz et al, 2013;Fischer et al, 2006;MacMaster, 2005;Malta et al, 2008;Metsch et al, 1999). While phenomena like opioid dependence or IDU are comprehensively targeted by widely available and effective interventions (e.g., opioid maintenance, NES, SIS) in North America, interventions for crack use are largely scarce and under-utilized even where they exist (Fischer & Coghlan, 2007;Fischer, Tiesmaki, Rudzinski, & Lusted, 2012;Shoptaw et al, 2013).…”