GOOD PRACTICE IN LOW AND MIDDLE INCOME COUNTRIES, LATIN AMERICA. THE PERSPECTIVE OF BRAZIL

UNODC Scientific Consultation – December 2015

GOOD PRACTICE IN LOW AND MIDDLE INCOME COUNTRIES, LATIN AMERICA. THE PERSPECTIVE OF BRAZIL

Ronaldo Laranjeira Professor of Psychiatry, Federal University of São Paulo

The II Brazilian National Drug and Alcohol Survey released in 2013 showed that there are 3,5 million people using cannabis and 2,8 million using cocaine in several forms, with at least 1 million people using crack cocaine, the largest number in one country found in the literature. 42% of cannabis users also use cocaine. This epidemiological data shows that the Brazilian drug consumption is complex:

a)  the number of cocaine users is close to the cannabis users; 


b)  the use of the combination of cannabis and cocaine by the population is very 
high; 


c)  57% of the cocaine users were involved in some forms of violence in the previous 
months. 


The challenge to organize a good practice to this clinical population is huge. Moreover in many parts of Brazil, in particular in the city of São Paulo, there exists an Open Market Scene where hundreds of users are consuming crack on the streets. We recently published an editorial in ADDICTION: “The Brazilian ‘Cracolândia’ open drug scene and the challenge of implementing a comprehensive and effective drug policy” where the main aspects of this experience is discussed.

In the second part of the presentation, we discuss the treatment system created and funded by the State of São Paulo (population 40 million) in May 2013. The Project Recomeço (translated as “New Beginning”) installed tents and mobile offices inside Cracolândia with a team of nurses, social workers and 80 community health agents. A family advice program was also established. Inside the drug zone, an 11-floor building was renovated offering shower, bathroom, barber-shop and a sports center, as well a variety of work-shops and training opportunities. A detoxification unit and housing facilities will also be available soon.

All these services are organized by the Reference Center for Alcohol, Tobacco and Other Drugs (CRATOD) - an addiction treatment centre located not far from Cracolândia, which offers two services: an out-patient unit, with a capacity to treat 400 users and offers 3500 monthly appointments; and an emergency care facility with 40 beds. Patients can be transferred to detoxification clinics (1173 beds), or to therapeutic communities (1703 places) if required. In order to facilitate drug users’ access to justice, a judge, a public prosecutor, a public defender and volunteer lawyers are all based within its facilities. The presentation discusses the development and the results of this drug service organization strategy.

About the author

Professor Ronaldo Laranjeira. Full Professor of Psychiatry at Federal University of São Paulo, Brazil. Medical doctor with PhD at the National Addiction Center, Maudsley Hospital, London University. Principal Investigator of the National Institute of Alcohol and Drug Policies, which is the leading research group in Brazil. Two main lines of research of this group are epidemiological studies (has produced two national surveys on alcohol and drug use patterns), and services organization for alcohol and drug users (the team coordinates the state of São Paulo response in terms of range of services, from outreach work in an open market of crack use to psychiatric wards for comorbid). All services are evidence based and produce information to guide the state policy. The most recent paper that summarizes the work of our institute is an editorial of Addiction: The Brazilian ‘Cracolândia’ open drug scene and the challenge of implementing a comprehensive and effective drug policy.