Crack Use Spreads to Different State Capitals in Brazil; Treatment Fails to Attack Underlying Cause

07/10/2017 - 14h05

In Salvador, they can be found roaming through the streets that surround the Pelourinho. In Curitiba, they're mainly in neighborhoods on the outskirts of town. In Fortaleza, you can find them near the metropolitan cathedral and the central market.

According to residents and store owners, these regions have become "minicracolândias" - drug-consumption centers. However, according to the cities' mayors, they are merely "instances of crack use" spread throughout the municipalities.

Folha sought to build a panorama of crack use in seven big capitals and uncovered a lack of data as well as estimates when it came to the number of users, the length of waiting queues for users seeking aid, as well as a failure to map out the various city districts where drug consumption is taking place.

The mayors of Salvador, Rio, Curitiba, Fortaleza, Belo Horizonte, Porto Alegre and Recife all reject the idea of crack centers similar to the one that exists in São Paulo and its main drug consumption center in the downtown area, as well as other areas spread out in different neighborhoods.

In Salvador, for example, crack users mainly loiter around the city's Historical Downtown streets, such as Ladeira da Montanha and Baixa dos Sapateiros, as well as areas like the Pelourinho, where restoration of historical landmarks and attractions has not yet taken place. But other districts such as the Cidade Baixa and even Pituba, a classy neighborhood in Salvador, have also been affected.

In Belo Horizonte, crack consumption mainly takes place in Pedreira Prado Lopes, a district in the city's northwestern region. That's where Maria (a pseudonym), 38, started buying crack after she took her five children to live with her mother.

The lack of data on crack consumption is also one of the main flaws when it comes to elaborating public policies. The most recent study on the issue was conducted by Fiocruz (Fundação Oswaldo Cruz) back in 2013.

Capitals like Salvador, Belo Horizonte and Fortaleza do not have any estimates concerning the number of crack users who have turned to public services in order to seek treatment.

In Recife, there is no information on what drugs are being used, while Porto Alegre only factors in people who seek both treatment from public care as well as social assistance.

Treatment is typically palliative. In most cases it is conducted by psychosocial assistance centers which take in users in moments of acute distress.

In Belo Horizonte, for example, a team of nurses, psychologists, social workers and damage control agents drive around town in four vans, offering on-the-spot support in areas where alcohol and drugs are being consumed. Similar actions take place in Porto Alegre and Salvador.

In Recife, individual and group therapy sessions are offered to users and their families, while Fortaleza offers job training and productive inclusion programs.

In particularly grave cases that require rehabilitation, treatment is offered in hospitals and therapeutic communities. But on many occasions, the number of vacancies isn't enough to absorb the demand.

In Curitiba, consultations can take somewhere between 15 to 20 days. When it comes to locating family members who are addicts in order to re-establish family ties - which is considered a crucial step for recovering - its NGOs who are at the forefront.

Recourse to hospitalizations that go against the will of addicts - whether 'involuntary' (requested by a doctor), or 'mandatory' (authorized by a judge) - is only used in extreme cases, in cities like São Paulo, but other cities are not willing to go that far.

Mandatory hospitalizations are a last recourse in Porto Alegre. Even so, the measure is only adopted following an evaluation alongside the patient's family members who also count on the aid of a public defender.

In Recife, even in extreme cases where mandatory hospitalization is recommended and backed by a judge, a team of specialists will go see the patient and try to get him to seek treatment and reduce drug-inflicted malaise.

Cities such as Salvador, Fortaleza and Rio de Janeiro have not turned to forced hospitalizations - whether 'involuntary' or 'mandatory', but in Belo Horizonte, a judge's order demanding hospitalization will be obeyed.

Rio de Janeiro adopted mandatory hospitalizations from 2011 to 2012, when 2,924 users were forced off the city's streets. But in 2012, the Public Ministry outlawed the measure as it considered that it was merely adopted to get users off the streets, not to treat them.

In São Paulo, ever since the police operation that dismantled the open-air 'drug market' in 'Cracolândia' took place, mayor João Doria (PSDB) claims to have assisted users on 9,600 occasions - a figure which also includes care offered to an addict who was assisted more than once.

According to Mr. Doria's administration, 764 users voluntarily signed up for rehabilitation.

Translated by THOMAS MATHEWSON

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	Paulo Whitaker/Reuters
	A drug user walks in front of riot police during a police operation in a neighborhood known to locals as Cracolandia (Crackland), in downtown Sao Paulo, Brazil