From the Streets to the Shelter. And Then What?

By Andréa Domínguez and Marina Lemle

According to the State Secretariat of Security in Rio de Janeiro (Seseg), 691 crack users have been taken of city streets and taken into municipal shelters.

What happens to them afterwards? Do they return to the streets at the first opportunity? Do they receive adequate treatment? This concern led the state security secretary José Mariano Beltrame (pictured) to convene a seminar on "Coping with Crack," held in conjunction with the Institute of Public Security of Rio de Janeiro (ISP).

Beltrame says social service networks must work better to gether to attend to crack users. "We are conducting major operations. For example, last week we took 100 crack users off the street, but the police action ends there if there are no other institutions to continue the treatment process and provide assistance to these people," he said.

The secretarat, one of the most respected departments in the Rio government due to the implementation of the Pacifying Police Units in the city's favelas, suggested that other authorities immediately roll up our sleeves and get involved.

"That's what we did with the Pacifiying Police Units (UPP). Everyone knew what needed to be done in these areas (that didn't have permanent police units). There were unpoliced areas that the UPPs came in and policed. But the UPP are only a part of a process. Now we are in the construction phase of doctrines and concepts. With crack, the challenge is similar: we need to introduce a method for society," said Beltrame.

Carla Dalbosco, director of Joint Coordination on Drugs Policy for the National Secretariat on Drugs (Senad) recognized the importance of the Secretariat of Security promoting a debate that goes beyond punishing of drug use.

"I praise the state of Rio for its initiative to bring several areas
together to discuss crack consumption, and seeing that it is not only
addressed by repressive means. Punishment is important, but not enough.
Those tactics alone will not allow us to control the problem.
Accordingly, an integrated approach will sustain the national drug
policy, "said Dalbosco.

She presented the broad outlines of the "National Plan to Combat Crack and Other Drugs" and highlighted two main points: the integration and decentralization of the process. Carla emphasized that social assistance, treatment and education alone are not sufficient to address the issue of crack and other drugs.

"It is essential that the plans contain models of social rehabilitation for people to resume an active and productive life and it is important that the plans have community participation as an element of support," she added.

Dalbosco said integration between institutions at the municipal level is key to success and that Senad supports these efforts through personnel training and funding to expand the health care network. Among the initiatives she highlighted were: the training of religious leaders who already meet informally with crack users in their communities; Senad designed a plan to offer them tools to improve their counseling techniques. The initiative is called "Course on Faith in Prevention"; 839 religous leaders in Rio de Janeiro have registered for this year.

Senad's representative announced that this month, a Fiocruz report on crack consumption in Brazil will be released. It is Brazil's first major epidemiological study on the use of the substance.

In the Dark

The report's lead researcher, epidemiologist Francisco Inacio Bastos, was also at the meeting, whose main audience comprised police and military officers. Bastos said until now, data on crack use had not been collected in a scientific manner that would indicate the number of crack users in the country.

"Every day I see in newspapers statistics about the use of crack, but there is no data at this time. We are doing this research at the FIOCRUZ at Senad's request and our results will be released in late June. Only then will serious data on the extent of crack consumption in the country be available," said Bastos.

The epidemiologist said that the method used to measure the crack consumption in Brazil is known as "scale up", which consists of asking people how many users they know. Taking into account the number of people in a given population and the number of people who belong to the respondent's social sphere, researchers extrapolation that information.

His starting point were patients at the Providência Clinic in the North Zone of Rio de Janeiro, using what scientists call "convenience samples", which are not representative of the general population. These early subjects invite others to join the study, which in turn would bring additional new people, with the aim of obtaining a comprehensive network of the population. Eventually, local networks would join the study.

A Little Light

Any information, even if it is partial, helps to shed light on the debate, said Emmanuel Rapizo from the Public Security Institute of Rio de Janeiro (ISP). Using information provided by the civil police precincts in the state, the ISP analyzed data on complaints related to crack. This helped them to identify the locations for use, sale and violent acts related to drugs.

According to the ISP analysis, almost 50% of the complaints occurred in the state, 30% in the capital, 14% in Baixada Fluminense and 6.2% in greater Niterói. In drug seizure, the capital ranked first, with 45% of cases, followed by the state, with 25%, followed by Baixada Fluminense and Niteroi, with 21.6% and 8%, respectively.

The ISP data also identified the profiles of crack users and those arrested for selling the drug. The institute found that among users, 49% are between 18 and 24 years and 8.7% are under 17 years. 94.7% are male and 40% defined themselves as mestizo, 34% as white and 24% as black. Meanwhile, most of those arrested for dealing were between 18 and 24 years, but a high number (22%) were under 17.

Safety Nets

There are three sectors responsible for the care and treatment of drug users. They are: the departments of Social Assistance and Human Rights, Health and Civil Defense, and Education. Much-discussed integration is nothing but the joint work of these three sectors, their staff and their physical infrastructure.

Leonardo Pecoraro, from the Secretariat of Social Assistance and Human Rights, said that among the department's priorities is the development and implementation of policies for users on the streets, the inclusion of police in prevention programs, training officers to address users on the street, educating them on the different options available for users: from temporary shelters, rehabilitation centers, and detention centers for users in critical condition.

The representative from the Secretariat of Health and Civil Defense,
Marcos Gago (photo), stressed the importance of modernizing the concept
of assistance so that it ceases to be fragmented and focused solely on
healing and hospitalization. "We can not continue working with the
misconception that the patient is hospitalized and everything is
resolved. It isn't. The work is long term," he said.

Gago said that what the network can offer is small when compared to what is needed, and also said that this network should extend beyond hospitals, Psychosocial Care for Alcohol and Other Drugs Centers (CAPS AD), referring to therapeutic communities, walk-in clinics, and rehabilitation centers.

Representing the Department of Education, Jacinta Tania Barbosa, spoke of the role of education in preventing drug use by providing extracurricular activities and also by integrating drug education into the curriculum. "Prevention is the best policy. We talk with our students about HIV, teenage pregnancy and drugs, "said Barbosa.

How to Access Crack Users

The psychosocial coordinator of Viva Comunidade, Fabiana Lustosa Gaspar, is also concerned with this population's difficulty in accessing the public health system and community health workers' difficulties in reaching this population. "Everybody talks about Cracolândias, but nobody can access [these patients]," she says. Gaspar participated in a debate on drug policy held at the Sergio Arouca National School for Public Health (ENSP / Fiocruz) the day after the event in Seseg.

Legalize, Tax, Control, Prevent and Treat

Also participating in the meeting at Fiocruz, was sociologist Julita Lemgruber, who spoke in favor of legalizing the use and distribution of all drugs. "We can no longer ignore the serious damage that criminalization causes. The levels of violence would be much lower if drugs were taxed and controlled like alcohol," she argued. Lemgruber compared it to 'covering the sun with a sieve': "Drugs have always been a part of cultures and customs of various societies," she said.

According to the sociologist, although current law decriminalizes the user, it lacks objective criteria (definitions of quantities) to distinguish between users and dealers. Without such criteria, the subjective decision is up to the judge; prisons end up full of end users and small dealers, contributing to the overcrowding of prisons.

She said that in 15 years, Brazil's prison population more than tripled, making the country the fourth largest jailer in the world, second only to the U.S., China and Russia. "Today there are about 200,000 inmates without jobs. And that population is growing because drug trafficking has grown and lawmakers have stiffened the penalties. In five years, the number of inmates for drug trafficking tripled. It is an illusion that tough legislation will bring more security," she said.

Lemgruber described the profile of someone convicted for trafficking: according to a UFRJ survey conducted by lawyer Luciana Boiteux between October 2006 and May 2008, on people incarcerated for trafficking in Rio de Janeiro, 66.4% were first-time offenders and only 14 % had a weapon when they were arrested. "A portrait of Brazil would look similar. There are very few Fernandinho Beira-Mars. It's the small-time drug dealer who is arrested, many of whom are drug addicts," she concluded.

At the end of the seminar, a multidisciplinary working group was established, with representatives from Public Security and the departments of Health and Civil Defense, Education and Social Assistance and Human Rights. Among other measures, the group will be responsible for creating a guideline of procedures for public safety professionals on how do attend to crack users on the streets.

Photos: State Secretariat of Security in Rio de Janeiro (Seseg)

Photo of Marcos Gago: Wagner de Oliveira

Translated by Danielle Renwick