Crack cocaine craving: behaviors and coping strategies among current and former users

Cannabinoids for Substance Use Disorder Treatment: What Does the Current Evidence Say?

Background: The prevalence of Substance Use Disorder (SUD) is increasing along with the need to develop approaches to reduce the harm associated with substance use, including investigating alternatives such as cannabinoids, which show promising results, although the current evidence is limited. This scoping review focuses on the limitations and potentials of cannabinoid-based treatments for SUDs. Methods: We examined between-subject randomized controlled trials (RCTs) investigating the use of CBD and THC as pharmacological treatment for SUDs in adults, with the procedures attending the expectations of the Preferred Reporting Items for Scoping reviews and Meta-Analyses (PRISMA) for Scoping Reviews guidelines and assessed risk of bias using the Cochrane Risk of Bias Assessment Tool 2. Results: Ten RCTs were included, with six demonstrating low risk of bias, and positive results were found for treating Cannabis Use Disorder, while contradictory results were found for Opioid Use Disorder, and inconclusive results for treating Cocaine Use Disorder. Conclusions: CBD and THC demonstrate potential for treating some SUDs, but evidence is limited. Robust RCTs with larger samples and longer follow-up periods are necessary to assess carefully developed outcomes for different SUD patients. New cannabinoid-based medications and scientific-based policies may advance SUD treatment. A comprehensive approach to treatment and careful methodological choices may benefit patients with SUD.

Reduction in Substance-Related Composite Harm Scores Through Street Soccer

Introduction Street soccer makes the sport accessible to people affected by homelessness or precarious housing. There is overwhelming evidence that exercise improves physical and mental health. In addition, sport facilitates positive peer pressure that leads to beneficial life changes. Method To examine participants' accounts of the effects of street soccer in a sample of socially disadvantaged players from Western Canada, we collected 73 cross-sectional self-reports of life changes via a questionnaire. The questionnaire included questions on social, mental, and physical health, including substance use. This allowed the calculation of a modified composite harm score. Results Participants reported improved physical (46% of participants) and mental (43% of participants) health, reduced cigarette (50% of smokers), alcohol (45% of users), cannabis (42% of users), and other non-prescribed drug use, increased number of friends (88% of participants), improved housing (60% of participants), increased income (19% of participants), increased community medical supports (40% of participants), and decreased conflicts with police (47% of those with prior recent conflict). Perceived reductions in substance use were supported by significant changes in composite harm score. Conclusion Street soccer appears to promote improved physical, mental, and social health among people affected by homelessness or precarious housing, with reduction in substance use likely to be a key factor. This work builds upon past qualitative research showing the benefits of street soccer and supports future research which may help elucidate the mechanisms by which street soccer has beneficial effects.

Housing characteristics of crack cocaine users in Northeast Brazil, 2011-2013

We compared sociodemographic characteristics, substance use patterns, sexual behavior, use of health services, and criminal records of homeless vs. domiciled users. Data are from the Brazilian National Survey on Crack Use. A discriminant model and correspondence analysis cross-compared characteristics of users according to their housing status. The logistic model revealed associations between "living in the streets" and female gender and intermittent work. "Homelessness" was also associated with the use of tobacco and "oxi" in the previous 30 days, reliance on soup kitchens, low access to public mental health services, and arrests in the previous year. Correspondence analysis highlighted the spatial proximity of the variables as follows: "having traded sex for drugs", "informal work", "age 31 years or older", "access to public mental health services", "problems with law enforcement", and female gender with homeless crack users. People who smoke crack cocaine in Northeast Brazil are seldom studied. Their profiles, stratified according to their housing conditions, show subgroups with specific characteristics. While domiciled users have access to specialized clinics, homeless users basically reported access to free food and harm reduction services.

The Perceptions of Domestic Violence by a Family Member Who Uses Crack or Cocaine: A Secondary Retrospective Cross-Sectional Study

OBJECTIVE

To evaluate the relationship between crack/cocaine use and domestic violence perpetration from the perspective of substance users' families. A secondary retrospective cross-sectional study, with 3162 family members of crack/cocaine users seeking treatment in the Recomeço Família Programme in São Paulo/Brazil was undertaken. Family members of crack/cocaine users reported that their relatives were more involved in domestic violence such as stealing (money and objects) at home [Odds Ratio Adjusted ORA = 2.17 (CI 95% 1.87; 2.53)], the family gave money to the user to buy drugs [ORA = 1.27 (1.08; 1.48)], and having problems with the judiciary [ORA = 1.48 (CI 95% 1.28; 1.71)]. Relatives of snorted cocaine users reported that there was physical and interpersonal violence, such as fathers being assaulted [ORA = 2.50 (CI 95% 1.08; 5.82)], assaulted someone else [ORA = 1.86 (CI 95% 1.32; 2.60)], threats of violence fights, arguments when the family talk about problematic drug use [ORA = 1.50 (CI 95% 1.13; 1.96)] and threatened some family members [ORA = 1.52 (CI 95% 1.14; 2.04)]. In this sample, there was a connection between crack/cocaine use and the perpetuation of domestic violence, corroborating with important implications for public policies, substance use treatment and prevention of domestic violence interventions.

IL-10 (-819C/T), TNFA (-30G/A) and ENOS (-786T/C) Polymorphisms Modulating the Outcome Related to Mental Disorders in Crack Addicted Users

Background

Cocaine/crack use affects immune system molecules and development of mental disorders has been identified.

Objective

To investigate the relationship of polymorphisms in the TNFA (-308G/A), IL-10 (-819C/T) and ENOS (-786T/C) genes with mental disorders in cocaine and crack users.

Methods

A case-control study was carried out, which included 107 cocaine and crack users and 115 controls who never used healthy cocaine and crack. The SNPs in the TNFA (-308G/A), IL-10 (-819C/T) and ENOS (-786T/C) genes were genotyped by real time PCR.

Results

As for the individuals included in this study, the average age of 31.4 years (± 8.59). We identified that the G/A genotype to TNFA (-308) (OR = 0.24; p = 0.03) and the A allele (OR = 0.30; p = 0.03) were associated with reduced risk for dysthymic disorder. The T allele of the IL-10 (-819) polymorphism was associated with decreased risk of developing panic disorder (OR = 0.44; p = 0.01), while the C allele was correlated with an increased risk for alcohol dependence (OR = 1.97; p = 0.04), alcohol abuse (OR = 1.81; p = 0.04) and psychotic syndrome (OR = 2.23; p = 0.01). C/C genotype was correlated with increased chances of developing current psychotic syndrome (OR = 4.23; p = 0.01).

Conclusion

Our results suggest that genetic polymorphisms promote susceptibility or promote protection for clinical phenotypes of psychiatric comorbidities in cocaine and crack users and be considered as good prognostic markers.

Co-exposure of cocaine and cannabinoids and its association with select biological, behavioural and health outcomes: A systematic scoping review of multi-disciplinary studies

Cocaine use entails severe health- and social-related harms globally. Treatment options for cocaine dependence are highly limited. Benefits of cannabinoids for addiction have been documented, making it opportune to examine existing data on the possible outcomes associated with cannabinoids and cocaine co-use. We conducted a systematic scoping review following the PRISMA guidelines of peer-reviewed, English-language studies published from 2000 to 2021 in four databases (Medline, Web-of-Science, CINAHL Plus, and PsycInfo), assessing the co-exposure of cannabis/cannabinoids with cocaine on behavioural, biological or health outcomes. Both quantitative and qualitative, as well as humans and pre-clinical animals' studies (n=46) were included. Pre-clinical studies (n=19) showed mostly protective effects of cannabidiol (CBD) administration on animal models of addiction (e.g., cocaine-craving, -relapse, and -withdrawal) and cocaine-toxicity. Tetrahydrocannabinol (THC) had more inconsistent results, with both protective and counter-protective effects. Human studies (n=27) were more heterogeneous and assessed natural ongoing cannabis and cocaine use or dependence. Quantitative-based studies showed mostly enhanced harms in several outcomes (e.g., cocaine use, mental health); two available clinical trials found no effect upon CBD administration on cocaine-related treatment outcomes. Qualitative data-based studies reported cannabis use as a substitute for or to alleviate harms of crack-cocaine use. While pre-clinical studies suggest a potential of cannabinoids, especially CBD, to treat cocaine addiction, the few trials conducted in humans found no benefits. Cannabis co-use by cocaine users commonly presents a risk factor, entailing enhanced harms for users. More rigorous, controlled trials are still necessary to investigate cannabinoids' potential considering pre-clinical findings and reported benefits from specific drug users.

Association between alcohol and crack: Prevalence, effects, associated factors and experiences of combined use

Objective

To estimate the prevalence and factors associated with the effect of alcohol on crack cocaine use and to analyze experiences related to combined use. Materials and methods: sequential mixed methods (qualitative and quantitative) research, carried out between August 2014 and August 2015 with people who use crack. In the quantitative approach, a cross-sectional study was conducted with 1,062 participants. Factors associated with “alcohol use with the effect of increasing the effect of crack/crack craving” were estimated by multiple regression. In the qualitative approach, 39 interviews were conducted using Bardin’s content analysis technique.

Results

871 (82.0%) participants reported consuming alcohol, among them, 668 (76.7%) used alcohol combined with crack: 219 (32.8%) reported feeling an effect of reduction in paranoia and/or crack craving and 384 (57.5%) reported feeling an increase in the effect of crack and in the craving to consume the drug. This relationship was also observed in the narratives of the people who use crack, with the possibility of a cyclic effect of consumption of the two substances. Those who related alcohol use to the effect of increasing crack craving (384) were more likely to use alcohol before crack (OR: 1.81; 95%CI: 1.13–2.89); to consume more than 20 stones daily (OR: 1.48; 95%CI: 1.01–2.16); to remain in abstinence from crack for less than one month (OR: 3.20; 95%CI: 1.91–5.35); to use dependence treatment services (OR: 1.85; 95%CI: 1.26–2.71); and to commit physical violence (OR:1.67; 95%CI:1.08–2.56).

Conclusion

The findings of this study indicate that the modulation of the effect of alcohol use on crack cocaine depends on the moment when the drugs are consumed, and the use of alcohol before crack consumption is associated with characteristics that suggest a greater vulnerability to patterns of harmful crack use. Even though combined use is referred to as a way of reducing the negative effects of crack, the damage of this association may be greater than its possible benefits.

Inhibition of Toll Like Signaling Pathway Is Associated With Genomic Instability in Rat Liver Exposed to Crack Cocaine

BACKGROUND/AIM

The aim of the present study was to investigate the biological effects of subacute crack cocaine exposure in rat liver.

MATERIAL AND METHODS

A total of 32 rats were distributed into four groups (n=8): Experimental group 1 (G1) and Experimental group 2 (G2): rats received 18 mg/kg of body weight (b.w) of crack cocaine for 5 days, once a day, group G2 remained 72 h without exposure after the experimental period (5 days)(abstinence); Experimental group 3 (G3): rats received 36 mg/kg of body weight (b.w) of crack cocaine for 5 days, once a day; Control Group (CTRL): rats received only the vehicle (DMSO) administered by the intraperitoneal (i.p) route for 5 days, once a day.

RESULTS

All groups exposed to crack cocaine had an increase in the number of micronucleated hepatocytes and binucleated cells only in the highest tested dose (36 mg/kg). Karyolysis had an increase in the 18 mg/kg dose, in the abstinence group (G2), and 36 mg/kg group (G3); whereas pyknotic nuclei had an increase in the G2 group. The group exposed to 18 mg/kg of crack cocaine also showed high 8 OHdG expression. The p-NF-κB p65 protein decreased in the groups exposed to crack cocaine at doses of 18 and 36 mg/kg, as well as in the abstinence group. MyD88 was also found decreased in the group exposed to crack cocaine at 18 mg/kg.

CONCLUSION

Crack cocaine inhibited toll like signaling pathway whilst being associated with genomic instability in rat liver cells.

Hepatitis E Virus in People Who Use Crack-Cocaine: A Cross-Sectional Study in a Remote Region of Northern Brazil

People who use crack-cocaine (PWUCC) have numerous vulnerabilities and pose a challenge to health and social assistance services. The exposure to pathogens and risk situations occur differently according to each individual, region and social group. This study identified the presence, genotypes and factors associated with hepatitis E virus (HEV) exposure among a community-recruited cohort of 437 PWUCC in northern Brazil. Epidemiological information was collected through community-based assessments and interviews. Thereafter, blood and fecal samples were collected and tested for HEV using an immunoenzymatic assay, and the genotype was identified by PCR. Logistic regressions were used to identify the risk factors independently associated with exposure to HEV. In total, 79 (18.1%) PWUCC were exposed to HEV: 73 (16.7%) for IgG and six for IgG + IgM. HEV RNA was detected in six fecal samples and in two blood samples from PWUCC with IgM + IgG. Subtype 3c was identified in all of the samples. The factors associated with exposure to HEV were low monthly income, unstable housing (e.g., homelessness), crack-cocaine use ≥40 months, and the shared use of crack-cocaine equipment. The current study provides unique initial insights into HEV status and risk factors among PWUCC in a remote area in Brazil, with diverse implications for urgently improved diagnosis, prevention, and treatment intervention needs.

Parental status and characteristics of women in substance use treatment services: Analysis of electronic patient records

BACKGROUND

Many women receiving substance use treatment services are mothers. Despite this, research has not proved whether substance use treatment services are addressing the specific needs of mothers. This study explored differences in sociodemographic, psychological, patterns of substance use, and treatment characteristics between mothers and women without children, and between mothers whose children were in alternative care.

METHOD

The study extracted data from electronic patient records (EPRs) of women who attended South London and Maudsley (SLaM) National Health Services (NHS) Foundation Trust addiction services between 2013 and 2020 (N = 4370).

RESULTS

The study identified 1730 participants (39.6%) as mothers, of whom 1340 (77.4%) had dependent children. The average number of births was 1.83 (SD = 1.0). Of the participants, 54.3% of mothers did not disclose whether their dependent child(ren) was under their care and 37.5% of mothers indicated that at least one of their child(ren) was in alternative care. Alcohol was the most reported type of substance used in the past 28 days. Mothers also highly reported suicide attempts and hospitalization due to mental health problems. Compared to women without children, mothers were more likely to be young, experience housing problems, use opioids and/or crack-cocaine in the past 28 days and experience lifetime domestic violence victimizations. Mothers were also less likely to have alcohol-related problems, experience overdose, and social isolation than women without children.

CONCLUSION

The study highlights the need for substance use services to invest in approaches to improve mothers' disclosure of parenting and childcare issues. It also demonstrates that EPRs can identify key characteristics of mothers.

A double-blind sham-controlled phase 1 clinical trial of tDCS of the dorsolateral prefrontal cortex in cocaine inpatients: Craving, sleepiness, and contemplation to change

Impaired inhibitory control accompanied by enhanced salience attributed to drug-related cues, both associated with function of the dorsolateral prefrontal cortex (dlPFC), are hallmarks of drug addiction, contributing to worse symptomatology including craving. dlPFC modulation with transcranial direct current stimulation (tDCS) previously showed craving reduction in inpatients with cocaine use disorder (CUD). Our study aimed at assessing feasibility of a longer tDCS protocol in CUD (15 versus the common five/10 sessions) and replicability of previous results. In a randomized double-blind sham-controlled protocol, 17 inpatients with CUD were assigned to either a real-tDCS (right anodal/left cathodal) or a sham-tDCS condition for 15 sessions. Following the previous report, primary outcome measures were self-reported craving, anxiety, depression, and quality of life. Secondary measures included sleepiness, readiness to change drug use, and affect. We also assessed cognitive function including impulsivity. An 88% retention rate demonstrated feasibility. Partially supporting the previous results, there was a trend for self-reported craving to decrease in the real-tDCS group more than the sham-group, an effect that would reach significance with 15 subjects per group. Quality of life and impulsivity improved over time in treatment in both groups. Daytime sleepiness and readiness to change drug use showed significant Group × Time interactions whereby improvements were noted only in the real-tDCS group. One-month follow-up suggested transient effects of tDCS on sleepiness and craving. These preliminary results suggest the need for including more subjects to show a unique effect of real-tDCS on craving and examine the duration of this effect. After replication in larger sample sizes, increased vigilance and motivation to change drug use in the real-tDCS group may suggest fortification of dlPFC-supported executive functions.

[Public policies for people who use drugs: Strategies for the elimination of stigma and the promotion of human rights]

This paper aims to provide theoretically informed practical proposals for the improvement of current drug policies, which are based on a biological model of disease and the criminalization of people who use drugs. First, we present alternatives to a biologically-oriented scientific conception centered around neuroscientific postulates, which support the idea that the etiology of addiction materializes in the brain, in favor of models based on the social sciences where context plays a relevant role in the description and management approaches regarding different uses of psychoactive substances. Second, epistemological models and proposals are offered from a practical perspective to sustain or implement policies and programs in accordance with a more sustainable approach based on the elimination of stigma and the promotion of political participation of people who use drugs. In short, drug policies based on human rights.

Behavioral and neurobiological alterations induced by chronic use of crack cocaine

Crack cocaine is the crystal form of cocaine and can be smoked, and rapidly absorbed, and, in part for this reason, is potently addictive. It is hypothesized that crack cocaine is able to induce important changes in different tissues and organs, and thus dramatically alter behavior. Nevertheless, which alterations in the central nervous system are related to its frequent use is still a matter of discussion. The present study is a literature review of articles published between the years 2008 and 2018 on the theme 'crack cocaine and brain' available in PUBMED, MEDLINE, EMBASE, and Google scholar databases. The results show that the use of crack cocaine induces important behavioral, neuroanatomical, and biochemical alterations. The main behavioral sequelae include cognitive and emotional changes, such as increased anxiety and depressive symptoms, attention and memory deficits, and hyperactivity. Among the neurobiological alterations are reductions in the activity of the prefrontal, anterior cingulate cortex, and nucleus accumbens. Molecular changes include decreases in neurotrophic factors and increases in oxidative stress and inflammatory cytokines, which may be responsible for the morphological alterations observed. It is also hypothesized that these neurobiological changes might explain the emotional and cognitive dysfunctions experienced by crack cocaine addicts.

Violence and substance use in sexual minorities: Data from the Second Brazilian National Alcohol and Drugs Survey (II BNADS)

OBJECTIVE

To describe the prevalence of substance use and the associations between adverse early life experiences, sexual behaviour and violence in sexual minority (SM) individuals.

METHODS

The Brazilian National Alcohol and Drugs Survey is a probabilistic household survey performed in 2012, collecting data from 4067 Brazilians aged 14 years and older.

RESULTS

3.4% of the sample declared themselves as sexual minorities, 53.8% female, 66.5% single, mean age of 29.5 years (standard deviation 16.0 years). A high prevalence of alcohol dependence (15.2%) and binge drinking (22.2%) was identified in the SM group. Respondents were more likely to use crack cocaine and hallucinogens, to have been involved in child prostitution, child sexual abuse and to report suicidal ideation in the previous year. Respondents were also more likely to engage in unprotected sex compared to non-sexual minorities. Nearly one-third referred to having suffered homophobic discrimination in their lives. Respondents also reported higher rates of domestic violence (18.9%) and urban violence (18%) among the SM.

CONCLUSION

The findings reinforce that violence directed at individuals in the Brazilian SM community begins early in life and persists into adulthood when compared to non-sexual minorities. This population is also more exposed to substance use disorders.

Symptoms Suggestive of Dysphagia and the Quality of Life in Cocaine and/or Crack Users

Users of cocaine and/or crack may present symptoms of dysphagia due to changes in anatomical structures caused by the use of these substances. The objective of this study was to investigate the presence of symptoms suggestive of dysphagia in users of cocaine and/or crack seeking treatment, as well as to investigate the quality of life of these individuals related to their swallowing condition. A cross-sectional study from September 2015 to December 2016, with 121 users of cocaine and/or crack, was conducted. 59 of them called a telemarketing service and 61 sought treatment at the Centro de Atenção Psicossocial Álcool e Drogas in Porto Alegre (Psychosocial Alcohol and Drug Center). Users were screened and asked to fill the Eating Assessment Tool questionnaire. Users who presented themselves at the center were submitted to the Tool Volume-Viscosity Swallow Test. Users with symptoms of dysphagia responded to the Quality of Life in Swallowing questionnaire. Of all the interviewees, 22.3% (n = 27) reported symptoms suggestive of dysphagia and 2% of the individuals, submitted to swallowing test, presented cough in the liquid consistency. The scores showed a negative impact on quality of life, mainly related to fatigue, sleep, feeding duration, and fear of eating. Significant numbers of users of cocaine and/or crack referred to symptoms suggestive of dysphagia and significant impairments in quality of life, which require specific care in feeding this population in order to assist in their rehabilitation.

Crack cocaine and dreams: the view of users

This paper aims to describe the dream content of crack cocaine users as per their view and analyze its interference in the drug withdrawal process. This is a qualitative research with 21 crack cocaine users. Consuming crack cocaine during the dream meant a proof of failure or compensatory pleasure or warning of potential relapse; not consuming the crack cocaine meant the emergence of withdrawal symptoms or the success at overcoming drug dependence. Dream interpretation may lead users to craving and relapse. The outcomes may contribute to effective therapeutic interventions.

Percepções dos Usuários de Crack sobre as suas Relações Familiares na Infância e Adolescência

Resumo O objetivo principal deste estudo foi compreender a percepção dos usuários de crack sobre suas famílias de origem durante a infância e a adolescência. Realizou-se uma pesquisa qualitativa, da qual participaram 29 usuários de crack de ambos os sexos. Os dados oriundos das entrevistas semiestruturadas foram analisados de acordo com o conteúdo temático e organizados em categorias. Os resultados revelaram que os usuários de crack percebem os vínculos familiares como frágeis. Além disso, mencionaram a vivência de situações de violência e consumo de drogas entre os membros da família. Os dados indicam a necessidade de cuidado dos familiares, os quais, muitas vezes, também enfrentam problemas com o uso de substâncias, e o desenvolvimento de ações educativas preventivas na infância e na adolescência.

Maconha e Representações Sociais em Matérias de Jornal

Resumo A maconha é um objeto social polêmico e polissêmico no contexto brasileiro, sendo constantemente debatida em produções midiáticas. A pesquisa objetivou analisar a construção de representações sociais da maconha a partir de 489 matérias do jornal Folha de S. Paulo (2010-2012). Os dados foram tratados com o software ALCESTE e analisados a partir de seis campos léxicos organizados em dois eixos temáticos: repressão policial ao tráfico de drogas e tensões normativas do uso medicinal e recreativo. Os discursos suscitam dimensões individuais e coletivas relacionadas ao status legal do objeto, seus usos e formas de controle social - coercivas e normativas -, que inscrevem simbolicamente a maconha em disputas sociais de identidades, práticas e instituições.

Histórico de violência entre mulheres que fazem uso de crack no estado de Pernambuco, Brasil

RESUMO Neste artigo, abordou-se o histórico de violência contra mulheres em contexto de uso abusivo de crack. Trata-se de um estudo transversal, envolvendo 243 usuárias de crack atendidas pelo Programa Atitude, em Pernambuco, entre 2014 e 2015. Observou-se que a maioria era jovem, negra, com baixa escolaridade e renda, início precoce da vida sexual, em uso compulsivo de crack, morando na rua e comercializando o corpo como a principal fonte de renda. A maioria (96,2%) relatou histórico de violência: psicológica (83,5%), física (87,7%) e sexual (55,1%), praticadas por parentes/amigos. Fatores como desigualdades sociais e de gênero foram relevantes nas situações de violência observadas.

A vontade em Vygotski: contribuições para a compreensão da “fissura” na dependência de drogas

Resumo A fissura (craving) é questão central no cuidado a pessoas com problemas decorrentes do uso de álcool e outras drogas, sendo considerada uma incapacidade de controlar o desejo pelo consumo. Contudo, não há definição unívoca desse fenômeno. Investigou-se o conceito de vontade em Lev S. Vygotski (1896-1934), considerando-se que sua abordagem poderia contribuir para a compreensão da fissura. Realizou-se uma revisão da literatura acerca do craving e uma análise focal do conceito de vontade em textos selecionados de Vygotski. Não obstante as controvérsias sobre a definição do fenômeno da fissura, a proposição de Vygotski acerca da vontade como função psicológica superior mediada por motivos auxiliares possibilita ampliar a compreensão do craving. O manejo da fissura, assim, depende não somente de uma iniciativa individual, mas também de questionamentos sobre a lógica social, política e histórica que preside os significados sobre o uso de drogas.

[On the sidelines of society: crack use, deviation, criminalization and social exclusion - a narrative review]

The article comprises a narrative review of the scientific literature, aiming to identify and discuss the contexts of vulnerability and social exclusion faced by users of crack cocaine and other substances who live on the sidelines of society in the Brazilian and international context. The paper summarizes insights from different theoretical frameworks, focusing on an integrated perspective of substance use and abuse, with an emphasis on the use of crack and its inter-relationships with social vulnerability, marginalization, social exclusion and deviation. In a first step, broad aspects of qualitative research on drugs are outlined. The subsequent section highlights issues associated with exclusion and social vulnerability of crack users, followed by an assessment of the main associations mentioned in the literature on drug use and criminal involvement. Finally, the concept of "sidelines of society" is discussed, as exemplified by situations and events experienced by users of crack and other substances, as mentioned in the literature.

Abortion and sex-related conditions in substance-dependent Brazilian patients

Abortion is a very sensitive issue with relevance to public health; however few clinical or population-based studies have examined induced abortion among drug users. The study aims to evaluate the prevalence of induced abortion and sex-related conditions in an inpatient drug user sample. A cross-sectional design study was conducted in an inpatient addiction treatment unit in São Paulo, Brazil, with a sample of 616 patients, aged 18-75. Sociodemographic data, sexual behavior, and dependence severity were evaluated in relation to induced abortion. Approximately 27% of patients reported having a history of abortion (themselves in the case of women or partners in the case of men). The mean age was 34.6±10.9 years old, 34.9% diagnosed with severe alcohol dependence, 33% were diagnosed with severe levels of dependence on other drugs, 69.6% were diagnosed cocaine users (inhaled and smoked), and alcohol was the drug of choice for 30.4%. Chances of having a history of abortion is greater for women than for men with a odds ratio (OR = 2.9; 95%CI: 1.75-4.76), (OR = 1.7; 95%CI: 1.09-2.75) of no condom use; (OR = 2.0; 95%CI: 1.35-3.23) of history of STI and (OR = 3.2; 95%CI: 1.29-5.73) use of morning-after pill. Drug- and alcohol-dependent patients have high-risk behaviours of sporadic use or no-condom use which contribute to unplanned pregnancy and induced abortion, making this vulnerable population a group which deserves special attention in sexual health prevention programmes and health promotion efforts for the reduction of induced abortion.

Health outcomes associated with crack-cocaine use: Systematic review and meta-analyses

BACKGROUND

Crack-cocaine use is prevalent largely in socio-economically marginalized populations in the Americas. Its use has been associated with diverse health outcomes, yet no recent or systematic reviews of these exist.

METHODS

A systematic review of health outcomes associated with crack-cocaine use was performed, using MEDLINE, Scopus, Web of Science, CINAHL, PsycINFO, and LILACS up to October 2016. Search terms included crack-cocaine and health outcome-related keywords, targeting peer-reviewed studies on quantified health outcomes associated with crack-cocaine use. Random effects meta-analyses produced pooled odds ratios. Levels of evidence for major results were assessed using the GRADE approach. A review protocol was registered with PROSPERO (CRD42016035486).

RESULTS

Of 4700 articles returned, 302 met eligibility criteria, reporting on health outcomes for 14 of 22 ICD-10 chapters. Conclusive evidence and meta-analyses showed positive associations between crack-cocaine use and blood/sexually transmitted diseases (HIV and hepatitis C virus, others); moderate evidence and meta-analyses supported associations with neonatal health, and violence. There were mixed associations for mental and other health outcomes, yet insufficient evidence to perform meta-analyses for many categories (e.g., mortality). Most underlying research was of limited or poor quality, with crack-cocaine commonly assessed as a secondary covariate.

CONCLUSIONS

Crack-cocaine use was associated with a range of health outcomes, although it was unclear if there was direct causal impact, interactions between risk factors, or external drivers of both crack-cocaine use and outcomes. Rigorous epidemiological studies are needed to systematically assess health outcomes of crack-cocaine use and underlying pathways, also to inform evidence-based interventions.

Anxiolytic Effect of Citrus aurantium L. in Crack Users

The objective of this study was to investigate the anxiolytic effects of the essential oil (EO) of Citrus aurantium L. in patients experiencing crack withdrawal. This was developed with internal users in therapeutic communities in Paraíba, Brazil. The test population consisted of 51 volunteers, subdivided into three groups. To elicit anxiety, the Simulated Public Speaking (SPS) method was used. Physiological measures were assessed at specific phases during the experiment using appropriate equipment. Psychological measures of anxiety were assessed using the Trait-State Anxiety Inventory (IDATE) and the Analog Smoke Scale (HAS). EO was administered by nebulization. The experiment was developed in individual sessions and consolidated to four phases. The results demonstrated that the test subjects in the groups that were given the EO maintained controlled anxiety levels during SPS, when compared to the Control Group (no treatment). Subjects who used the EO also maintained levels of "discomfort" and "cognitive impairment" during SPS. It was concluded that individuals who are experiencing internal crack cocaine withdrawal present high anxiety traits and that nebulization of the EO of Citrus aurantium L. provided an acute anxiolytic effect in crack cocaine users exposed to SPS.

Examining the link between cocaine binging and individual, social and behavioral factors among street-based cocaine users

AIMS

To estimate the prevalence of cocaine binging and examine associated factors, to characterize binge episodes and to study the relationship between cocaine binging and HIV and HCV risk behaviors among street-based cocaine users.

METHODS

A prospective cohort study was conducted in Montréal, Canada. Interviewer-administered questionnaire were carried out at 3-month intervals. Cocaine binging was defined as using large quantities of cocaine, without stopping, over a limited period of time, until resources run out or until being physically incapable of consuming. Generalized Estimation Equations (GEE) analyses were used. Covariates considered included demographic, behavioral, mental health and social risk factors.

FINDINGS

In total, 605 participants were recruited. Prevalence of cocaine binging over the month prior to recruitment was 24.5%. Correlates of cocaine binging were older age (AOR 1.46), homelessness (AOR 1.44), criminal/marginal income strategies (AOR 1.61), high psychological distress (AOR 1.31), high cocaine dependence (AOR 3.71), drug overdoses (AOR 1.56) and smoking as the main route of cocaine administration (AOR 1.38). Additional GEE analyses showed that cocaine binging was significantly associated with the sharing of drug paraphernalia (AOR 1.35) and sexual relations under the influence of cocaine (AOR 1.21).

CONCLUSION

Cocaine binging is frequent among street-based cocaine users and is associated with markers of vulnerability. It is also associated with increased odds of both sexual and drug use risk behaviors. Interventions need to be tailored in order to help cocaine bingers develop personal strategies that could prevent binging. Harm reduction programs should help cocaine bingers adequately assess their drug equipment needs.

Revisão sistemática da literatura sobre crack: análise do seu uso prejudicial nas dimensões individual e contextual

RESUMO Este artigo visa investigar como se conformam, no Brasil e internacionalmente, as abordagens ao uso prejudicial do crack e outras drogas. Foi realizada uma revisão crítica da literatura acerca do padrão de consumo do crack e os fatores a ele relacionados com busca sistemática em bases eletrônicas no período de 2010 a 2016. Foram analisados 37 artigos por autor, ano, país do estudo, metodologia; padrão de consumo de crack e fatores individuais e contextuais relativos a esse uso. Conclui-se que a abordagem ao uso de drogas deve estar focada na perspectiva da redução de danos, na promoção da autonomia e dos direitos humanos, e não na utopia de eliminação do consumo e da produção de drogas.

Profile and pattern of crack consumption among inpatients in a Brazilian psychiatric hospital

INTRODUCTION

Crack cocaine use is associated with polydrug abuse, and inpatients dependent on crack exhibit profiles of serious consumption patterns. Use of alcohol and tobacco and other drugs is a risk factor for experimentation of additional drugs, including crack cocaine.

OBJECTIVES

The present study describes the characteristics and crack consumption patterns among inpatients in treatment during 2011 and 2012 at the Hospital Psiquiátrico São Pedro (Porto Alegre, Brazil). An additional objective was to identify the sequence of alcohol and tobacco consumption prior to crack use.

METHODS

The participants were 53 male inpatients addicted to crack with a mean age of 27.5±7.3 years. A sociodemographic questionnaire; the Alcohol, Smoking and Substance Involvement Screening Test and the Mini Mental State Examination were all administered to participants. Inclusion criteria were crack cocaine dependency (based on the 10th edition of the International Classification of Diseases [ICD-10]) and being abstinent for 7 days. Patients with cognitive difficulties who were unable to understand and/or respond to the questionnaires were excluded from the sample.

RESULTS

The participants were young male adults with low educational level and low incomes and were polydrug users. The majority had made more than one attempt to quit. Use of legal drugs in early adolescence, prior to crack use, was identified.

CONCLUSIONS

The profiles of the inpatients addicted to crack treated at this hospital indicate a serious usage pattern among those who seek specialized support. Crack use is frequent and is associated with use of other drugs and with difficulty sustaining abstinence. The pattern of progression from alcohol and tobacco use to crack cocaine dependency demands the attention of those responsible for prevention policies.

Padrão de uso e possibilidade de cessação do consumo do crack: estudo transversal

O objetivo desta pesquisa foi analisar a relação entre o padrão de consumo de crack nos últimos seis meses de uso ativo e a condição de abstinência ou não no momento das entrevistas. Trata-se de um estudo transversal com amostragem de conveniência, sendo que foram entrevistadas 495 pessoas entre os 14 e os 54 anos de idade. Foram estimadas razões de prevalência por Regressão de Poisson robusta para a condição abstinente por 12 semanas ou mais, segundo os padrões de consumo referidos, ajustando para sexo, idade, escolaridade, tempo desde o primeiro contato com a droga, uso de medicação e hospitalização em função do crack. Identificou-se associação entre o uso frequente e pesado e a cessação do consumo (RP 1,06 [IC95%: 1,01 - 1,12] p = 0,019). Esse achado amplia o leque de particularidades em relação ao crack e reforça os investimentos terapêuticos para todos os padrões de consumo.

Hospitalization due to drug use did not change after a decade of the Psychiatric Reform

OBJECTIVE

To investigate whether the psychiatric hospitalization rates due to use of psychoactive substances and average time of hospitalization suffered any changes after the first decade of effective implementation of the psychiatric reform in Brazil.

METHODS

This article examines the evolution of hospitalizations due to disorders arising from the use of alcohol or other substances in the state of Santa Catarina, Southern Brazil, from 2000 to 2012. This is an ecological, time-series study, which uses data from admissions obtained by the Informatics Service of the Brazilian Unified Health System. Hospitalization rates by 100,000 inhabitants and average time of occupancy of beds were estimated. Coefficients of variation of these rates were estimated by Poisson Regression.

RESULTS

The total and male hospitalization rates did not vary (p = 0.056 and p = 0.244, respectively). We observed an increase of 3.0% for the female sex (p = 0.049). We did not observe any significant variation for occupancy time of beds.

CONCLUSIONS

The deployment of services triggered by the Brazilian psychiatric reform was not accompanied by a reduction of hospitalization rates or mean occupancy time of hospitalized patients during this first decade of implementation of the reform.

Cross-cultural adaptation of the drug-taking confidence questionnaire drug version for use in Brazil

BACKGROUND

The Drug-Taking Confidence Questionnaire evaluates a drug user's confidence in his or her ability to resist the urge to consume psychoactive substances in high-risk situations. This study's objective was to develop a cross-cultural adaptation of the eight-item version of the Drug-Taking Confidence Questionnaire (DTCQ-8) for all drugs except alcohol and to verify its content validity and reliability in a pre-test stage.

METHODS

The following steps were taken: (1) implementation of the translation protocol and transcultural adaptation, (2) validation of the adapted content, and (3) assessment of reliability. Nine experts participated in the process of adaptation, and the trial's sample comprised 40 drug users in treatment at a Psychosocial Care Center for Alcohol and Other Drugs (CAPSad).

RESULTS

The average indices of semantic agreement (0.989; 0.989; 1.00), idiomatic (0.967), experiential (0.956), conceptual (0.978) and content validity with respect to language clarity (0.972), practice relevance (0.958), theoretical relevance (0.958) and theoretical dimension (1.00) showed that the adaption was successful. The mean total score of the DTCQ-8 version for other drugs was 477.00 + 234.27-SD, and 57.5 % of the users were classified as having moderate self-efficacy to resist the urge to use drugs in high-risk situations. The Cronbach's alpha coefficient was 0.889 for the complete instrument and 0.863-0.890 between items.

CONCLUSIONS

The DTCQ-8 version for other drugs proved to be easy to use and understand, and its process of adaptation was satisfactory for use in the Brazilian context. In this sample, the questionnaire was adequate to measure users' self-efficacy to resist the urge to consume these substances in high-risk situations.

Epidemiology of Injection Drug Use: New Trends and Prominent Issues

After more than 30 years of research, numerous studies have shown that injection drug use is associated with a wide range of adverse health outcomes such as drug overdoses, drug-related suicidal behaviours, comorbid psychiatric disorders, bloodborne pathogens and other infectious diseases, and traumas. This review explores new trends and prominent issues associated with injection drug use. The dynamic nature of injection drug use is underlined by examining its recent trends and changing patterns in Canada and other "high-income countries." Three research topics that could further contribute to the development of comprehensive prevention and intervention strategies aimed at people who inject drugs are also discussed: risk behaviours associated with the injection of prescription opioids, binge injection drug use, and mental health problems as determinants of injection risk behaviours.

Os Usos de Crack em um Contexto de Vulnerabilidade: Representações e Práticas Sociais entre Usuários

Resumo O objetivo deste estudo foi compreender os contextos de uso do crack. Para isso, foram entrevistados 14 usuários de crack de diferentes localidades e realizada Análise Temática de Conteúdo das informações obtidas. Os resultados indicam que as representações encontradas nesses contextos situam o crack como droga da destruição, o qual acaba por influenciar no modo de consumir a droga, descrito por episódios de ingestão intensa, com deterioração orgânica e prejuízos para a saúde. Diante dessa discussão, conclui-se que a consideração do contexto enquanto unidade de análise implica em uma possibilidade teórica de abarcar a circularidade do saber, pois retoma a produção de sentidos, sem torná-la estagnada a um grupo ou população.

Social inequalities and access to health: challenges for society and the nursing field

Objective to present a critical reflection upon the current and different interpretative models of the Social Determinants of Health and inequalities hindering access and the right to health. Method theoretical study using critical hermeneutics to acquire reconstructive understanding based on a dialectical relationship between the explanation and understanding of interpretative models of the social determinants of health and inequalities. Results interpretative models concerning the topic under study are classified. Three generations of interpretative models of the social determinants of health were identified and historically contextualized. The third and current generation presents a historical synthesis of the previous generations, including: neo-materialist theory, psychosocial theory, the theory of social capital, cultural-behavioral theory and the life course theory. Conclusion From dialectical reflection and social criticism emerge a discussion concerning the complementarity of the models of the social determinants of health and the need for a more comprehensive conception of the determinants to guide inter-sector actions to eradicate inequalities that hinder access to health.

Acesso aos serviços de atenção em álcool, crack e outras drogas – o caso do município do rio de Janeiro, Brasil

Resumo A reforma psiquiátrica enfatizou garantias individuais, restrições a internações involuntárias, desincentivo a internações psiquiátricas e formação de redes comunitárias de atenção. A diversificação de clientelas e as normativas do Ministério da Saúde se adaptaram às necessidades de suporte aos indivíduos e familiares e às demandas decorrentes crescentes da agenda de atenção aos usuários de drogas. A escassez de serviços públicos comunitários favoreceu a difusão de serviços com práticas clinicamente não padronizadas e o debate sobre internações involuntárias. Analisamos a oferta de serviços de atenção em álcool, crack e outras drogas no município do Rio de Janeiro e observamos barreiras de acesso para serviços públicos especializados e de caráter comunitário de 24 horas e escassez de psiquiatras nas equipes multiprofissionais. Há uma difusão experimental de serviços privados, religiosos ou não, e de abrigos públicos, em resposta às novas demandas. O processo observado configura uma trajetória de experimentalismo na política setorial e são efetuadas recomendações sobre políticas governamentais.

Abordagem de usuários de crack na Atenção Primária à Saúde: uma revisão sistemática

Objetivo: identificar abordagens efetivas para o manejo de adultos usuários de crack no contexto da Atenção Primária à Saúde (APS). Métodos: revisão sistemática realizada nas principais bases de dados eletrônicos e estudos adicionais, que incluiu os estudos sobre “crack” ou “crack/cocaína” no contexto da pesquisa, publicados nos últimos dez anos. A avaliação de evidências foi realizada por dois pesquisadores independentes, por meio de instrumentos distintos, um para estudos observacionais, outro para os de intervenção. Resultados: foram incluídos na análise de evidências 16 estudos identificados a partir de 2017 referências. O tipo de delineamentos nas investigações incluiu estudos observacionais (6) e estudos de intervenção (10). Dois artigos observacionais apresentaram boa qualidade de evidência, e a melhor evidência encontrada entre os artigos de intervenção foi de nível moderado (um artigo). Conclusão: a revisão sistemática não obteve artigos que apresentassem evidências de alta qualidade para serem orientadas ao contexto da APS, pois nenhum estudo avaliando as atribuições da APS ou especificando o manejo dos profissionais neste nível foi encontrado. Permanecem as evidências geradas no período anterior ao estipulado pela revisão.

The interplay between drug-use behaviors, settings, and access to care: a qualitative study exploring attitudes and experiences of crack cocaine users in Rio de Janeiro and São Paulo, Brazil

Background

Despite the growing attention surrounding crack cocaine use in Brazil, little is understood about crack users’ histories, use patterns and the interplay of drug-use behaviors, settings, and access/barriers to care. Qualitative studies seldom cross-compare findings regarding people who use crack from different settings. This study aims to explore the insights of regular crack users in two major Brazilian cities and to examine how social and contextual factors, including stigma and marginalization, influence initial use and a range of health and social issues.

Methods

In-depth interviews and focus groups were conducted with 38 adult crack cocaine users recruited from impoverished neighborhoods in Rio de Janeiro and São Paulo. Interviews and focus groups were audio recorded and transcribed verbatim. Qualitative analysis was carried out, and content was organized and analyzed by recurrent themes relevant to study interests.

Results

For study participants from both cities, frequent crack cocaine use plays a central role in daily life and leads to a range of physical, psychological, and social consequences. Common concerns among users include excessive crack use, engagement in risky habits, infrequent health service utilization, marginalization, and difficulty reducing use.

Conclusions

Disadvantaged conditions in which many crack cocaine users grow up and live may perpetuate risk behaviors and stigma may further marginalize users from necessary health and recovery services. Reducing stigma and moralizing discourse related to drug use, especially among health professionals and law enforcement personnel, may help encourage users to seek necessary care. New harm-reduction-based care and treatment alternatives for marginalized drug users are being developed in parts of Brazil and elsewhere and should be adapted and expanded for other populations in need.

Comportamento violento entre usuários de crack

<p>Considerando a relevância do uso abusivo de crack na atualidade brasileira e sua relação com a violência, este estudo propõe-se a analisar a associação entre comportamento violento —delitivo, auto e hetero<br />agressivo— entre os usuários de crack e variáveis sociodemográficas e de uso de drogas. Realizado estudo quantitativo, transversal, com amostra de conveniência, com 72 homens usuários de crack em tratamento nas Comunidades Terapêuticas de seis cidades da região Oeste<br />do Estado de Minas Gerais (Brasil). Os dados foram analisados estatisticamente no Statistical Package for<br />the Social Sciences Versão 17.0, utilizando-se teste qui-quadrado para verificação de diferenças estatisticamente<br />significantes. Os resultados apontam associação do tráfico com número de pedras consumidas e de tratamentos realizados; de prisão ou detenção com baixa escolaridade,<br />ser solteiro e idade de início do uso de droga ilícita; de tentativa de suicídio com o tempo máximo de<br />abstinência e de heteroagressão com idade de início do uso de droga ilícita e frequência diária do uso de crack. O uso de crack pode contribuir para o desenvolvimento de comportamento violento —delitivo, auto e heteroagressivo.</p>

Factors that lead to the use of crack cocaine in combination with marijuana in Brazil: a qualitative study

Background

In Brazil, crack cocaine use remains a healthcare challenge due to the rapid onset of its pleasurable effects, its ability to induce craving and addiction, and the fact that it is easily accessible. Delayed action on the part of the Brazilian Government in addressing the drug problem has led users to develop their own strategies for surviving the effects of crack cocaine use, particularly the drug craving and psychosis. In this context, users have sought the benefits of combining crack cocaine with marijuana. Our aim was to identify the reasons why users combine crack cocaine with marijuana and the health implications of doing so.

Methods

The present study is a qualitative study, using in-depth interviews and criteria-based sampling, following 27 crack cocaine users who combined its use with marijuana. Participants were recruited using the snowball sampling technique, and the point of theoretical saturation was used to define the sample size. Data were analyzed using the content analysis technique.

Results

The interviewees reported that the combination of crack cocaine use with marijuana provided “protection” (reduced undesirable effects, improved sleep and appetite, reduced craving for crack cocaine, and allowed the patients to recover some quality of life).

Conclusions

Combined use of cannabis as a strategy to reduce the effects of crack exhibited several significant advantages, particularly an improved quality of life, which “protected” users from the violence typical of the crack culture.

Crack use is considered a serious public health problem in Brazil, and there are few solution strategies. Within that limited context, the combination of cannabis and crack deserves more thorough clinical investigation to assess its potential use as a strategy to reduce the damage associated with crack use.

A Randomized Placebo-Controlled Trial of Targeted Prefrontal Cortex Modulation with Bilateral tDCS in Patients with Crack-Cocaine Dependence

BACKGROUND

Transcranial direct current stimulation over the dorsolateral prefrontal cortex has been shown to be clinically useful in the treatment of drug addiction.

METHODS

We conducted a double-blind randomized clinical trial aiming to assess the effects of bilateral dorsolateral prefrontal cortex transcranial direct current stimulation (left cathodal/right anodal) on crack-cocaine addiction. We defined craving as the primary outcome, and other clinical measurements, including depressive and anxiety symptoms, and quality of life, as secondary outcomes. Seventeen male crack-cocaine users (mean age 30.4 ± 9.8 SD) were randomized to receive 5 sessions of active transcranial direct current stimulation (2 mA, 35 cm(2), for 20 minutes), every other day, and 19 males (mean age 30.3 ± 8.4 SD) to receive sham-transcranial direct current stimulation (placebo) as control group.

RESULTS

Craving scores were significantly reduced in the transcranial direct current stimulation group after treatment when compared with sham-transcranial direct current stimulation (P = .028) and baseline values (P = .003), and decreased linearly over 4 weeks (before, during, and after treatment) in the transcranial direct current stimulation group only (P = .047). Changes of anxiety scores towards increase in the sham-transcranial direct current stimulation and decrease in the transcranial direct current stimulation group (P = .03), and of the overall perception of quality of life (P = .031) and of health (P = .048) towards decrease in the sham-transcranial direct current stimulation group and increase in the transcranial direct current stimulation group differed significantly between groups.

CONCLUSIONS

Repetitive bilateral transcranial direct current stimulation over the dorsolateral prefrontal cortex reduced craving for crack-cocaine use, decreased anxiety, and improved quality of life. We hypothesize that transcranial direct current stimulation effects may be associated with increased prefrontal processing and regulation of craving behavior.

A review of Brazilian scientific output on crack - contributions to the political agenda

Object: scientific literature about crack abuse published in Brazilian journals indexed in SCIELO.Objective: systematic review of literature treating findings as a framework for agenda-setting orienting policy decision makers.Methodology: SCIELO online journals research since 02/06/2013 on tag crack as "key word searched" and in indexes as "research amplitude". An amount of 199 references were identified and their abstracts were analyzed getting to a final group of 59 articles specifically studying crack issues in Brazil. Analysis: institutional criteria (journal, subject area, and publishing time) and analytical categories created by the authors: "Social Risk", "Treatment", "Use/Abuse", "Profile", "Social Relations", and "Study".Results: crack use impact Brazilian journals since 2011; health field is prominent; articles about "Associated Risk" and "Treatment" prevail; SUS cannot face demand;investment improvement in CAP and harm reduction; therapeutic communities need to match with SUS standards; youngers, black people and poor express users profile; rave style use; repressive policies were not well succeeded; and multidisciplinary approach are necessary.

Sociodemographic conditions and patterns of crack use among women

The aim of this study was to characterize the sociodemographic conditions and patterns of crack use among women. A descriptive-exploratory study with a qualitative approach was performed in January 2012, using semi-structured interviews with 16 women who use or used crack, and were enrolled in the Damage Reduction Strategy of the municipality of Pelotas, in the state of Rio Grande do Sul, Brazil. Data were analyzed using the thematic content analysis. A group of young women was identified with low levels of education and income, which perform informal labor activities and have at least one child. The pattern of crack use among these women was identified as the "binge" type, interfering with daily activities, and characterizing the group of women as abusive users. The pattern of crack use among the women, and its relation to issues of gender, pointed to the production of new insertions and discourses, bringing into question pre-defined behaviors in society.

Comparing key characteristics of young adult crack users in and out-of-treatment in Rio de Janeiro, Brazil

Background

Crack use is prevalent among street drug users in Brazilian cities, yet despite recent help system reforms and investments, treatment utilization is low. Other studies have identified a variety of – often inconsistent – factors associated with treatment status among crack or other drug users. This study compared socio-economic, drug use, health and service use characteristics between samples of young adult crack users in- and out-of-treatment in Rio de Janeiro, Brazil.

Findings

Street-involved crack users (n = 81) were recruited by community-based methods, and privately assessed by way of an anonymous interviewer-administered questionnaire as well as biological methods, following informed consent. In-treatment users (n = 30) were recruited from a public service in-patient treatment facility and assessed based on the same protocol. Key indicators of interest were statistically cross-compared. Not-in-treatment users were less likely to: be white, educated, stably housed, to be involved in drug dealing, to report lifetime marijuana and current alcohol use, to report low mental health status and general health or addiction/mental health care; they were more likely to: be involved in begging and utilize social services, compared to the in-treatment sample (statistical significance for differences set at p < .05).

Conclusions

In-treatment and not-in-treatment crack users differed on several key characteristics. Overall, in-treatment users appeared to be more socio-economically integrated and connected to the health system, yet not acutely needier in terms of health or drug problems. Given overall low treatment utilization but high need, efforts are required to facilitate improved treatment access and use for marginalized crack users in Brazil.