Crack widespread among Rio's homeless

It took a long while to arrive in Rio de Janeiro, but in half a dozen years it has become an inescapable reality in the lives of the city’s most vulnerable residents: its homeless. A recent survey estimates that approximately 90% of the children and youths sleeping rough and living on Rio’s sidewalks use crack, the cocaine derivative that is easy to use, low cost and quick to act, having irrevocably replaced glue.

“Perhaps the best side of crack use in Rio, if there is one to speak of, is that it has helped make children and youths who live on the streets visible,” said Sandra Arôca, (right) director of the Drugs and Alcohol Psychosocial Care Center, (Centro de Atenção Psicossocial Álcool e Drogas) CAPSad Mané Garrincha, in Rio de Janeiro. Arôca, one of the organizers of the Harm Reduction Awareness Workshops held this September in a number of areas in Rio, said the city is still largely unaware of the issue, and that the workshops have resulted from the Brazilian Ministry of Health’s concerns with crack use across the nation.

The workshops have a strong emphasis on harm reduction. “We cannot wage war on a substance,” said Arôca,” adding that such strategies end up sacrificing drug users, who either end up turning into collateral damage, or are isolated and left to fend for themselves. “We cannot take away from the drug user the only thing that has any meaning in his or her life. If you prohibit the substance, you also stop the state from getting to that user.”

The workshops are part of the Ministry of Health’s Emergency Plan for Preventive Care in Alcohol and Drugs, Pead, in 108 cities. Rio is a priority, “What we want to do is to train professionals who are at the front lines, people who work in Emergency Care Units, in schools, in the police forces, they need to know how to deal with drug and alcohol abuse in the population,” said Arôca.

Harm Reduction is a concept, not a strategy

Harm reduction emerged as a concept in the 1980’s in an attempt to slow down the spread of the AIDS virus among intravenous drug users. Today, according to Arôca, with the exception of Porto Alegre in the south, intravenous cocaine use has all but disappeared in Brazil. Still the concept of harm reduction has been growing as a way to lower the harmful effects of drug use among users and third parties.

“Harm reduction is not a type of treatment, its a philosophical approach” said Sandra. In the case, for example, of crack, a form of smokable cocaine, a harm reduction strategy helps one make contact with users so that they can access services such as medical care and care for their bodies. “Instead of simply gathering them up and taking them out of the streets, or punishing them, we would help crack users care for their teeth, make their own pipes instead of using tin cans that release toxins. Success in these little things may lead a crack user to rethink his relation with his own body, to value contact with people outside his or her immediate circle and eventually, consider substituting crack for a less aggressive drug,” said Arôca. The concept is simple, but in her view, it is still a challenge for the public in Rio de Janeiro.

Addiction: not the worst symptom

Addiction is no longer the keyword for substance abuse today, according to neurologist José Mauro Braz de Lima (right), head of the São Francisco de Assis Teaching Hospital and the Alcohol and Drugs Program at Rio de Janeiro’s Federal University, UFRJ. “The traditional view of drug addiction as a disease has undergone criticism, it was a construct of the 20th century. The substance is no longer a problem, the issue today is  related risk,” said Braz de Lima.

“One can compare cocaine and crack, just as we can compare beer and hard liquors. The substance is the same, but they are used differently and their results, - their ills- are equally different,” said Braz de Lima. “One  can be a frequent user of a substance without developing an addiction, and even so, harm others. Just think of someone who restricts his alcohol intake to weekends, but when this person does drink, is more likely to be involved in a car accident or to batter a member of the family.”

In Braz de Lima's view, successful public policies are those that prevent problems based on detailed knowledge of substances, whether they are legal or not, abused for leisure or for medical purposes, and the behavior of drug users.

Braz de Lima goes further, saying it is a mistake to demonize the use of alcohol and drugs, a field that, in his view, is still plagued by prejudice and lack of information, even among professionals. “We cannot have doctors, psychologists, social workers and nurses who lack a deep knowledge of the problems related to the use of alcohol and other drugs,” said Braz de Lima added.

When crack enters childhood

“There is no magic, there is data. When homeless children and youths start using crack, instead of glue, it is because it is easy to use and cheap. They are highly vulnerable in their environment. Their suffering and stress is so great that any drug will do to alleviate their pain. Drugs take away the fear of death and the need for self-affirmation,” said Braz de Lima.

Psychologist Sandra Arôca noted how in the case of Rio de Janeiro, the vital issue is the encounter between the substance and children and youths. “Noone is worried about adults smoking crack. The police is probably already keeping an eye on them. We need to look at those who are still growing up, and doing so on crack. What is the role that crack plays in their lives, and what role to they have in the rest of society. These people need to be heard.” Arôca also questions the current policy of removing homeless individuals off the streets and into shelters. “The shelters have become a meeting point for youths who have been exiled from their communities, youths who are in debt with drug traffickers, people coming from areas controled by rival factions, there is always the risk that violence will erupt,” she said.

There are reasons for using drugs in every social class, that have to do with an individual's subjectivity. There are three levels to it: individual, family, society. In the case of the homeless, we must ask ourseleves, what is the role of society. What is the policy for them?” Arôca adds.

According to Braz de Lima, it is a consensus that the attempt to combat drug use through the judicial system has been a failure. The neurologist believes that the state has an important role to play, one that has been absent, it must educate, inform and improve the quality of life of its citizens.

That was the goal the Harm Reduction Awareness Workshops held by the Ministry of Health. Workshops held in September included specialists in harm reduction from other cities, among them Melissa Azevedo from the Mais Vida project in Recife, and Marco Manso, from  the harm reduction organization Abareda in Bahia.

“But there were empty chairs at the meetings,” said Sandra Arôca, “that to me is a sign of how much resistence there is to the topic in Rio. There is very good work being done in other Brazilian states. Here we are still taking our first steps, there is practically noone doing harm reduction. There is still a long road ahead of us in raising awareness of harm reduction.”

Among those who came to the workshops, Arôca mentioned the presence of social workers, the municipal guard, and members of the corrections systems, who raised their own concerns with drug use inside prisons.

The workshops are part of an initiative of the Ministry of Health that plans to finance services, alternative therapies, greater access to service delivery to users of alcohol and drugs in multidisciplinary settings that combine health care, sports, leisure, cultural activities and social services.

Translated by Lis Horta Moriconi