Navegando por Palavras-chave "Crack Cocaine"
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- ItemAcesso aberto (Open Access)Caracterização da cultura de crack na cidade de São Paulo: padrão de uso controlado(Faculdade de Saúde Pública da Universidade de São Paulo, 2008-08-01) Oliveira, Lúcio Garcia de [UNIFESP]; Nappo, Solange Aparecida [UNIFESP]; Centro de Informações sobre Saúde e Álcool; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To characterize the situation regarding crack cocaine use in the city of São Paulo, along with the sociodemographic profile of its users. METHODOLOGICAL PROCEDURES: Qualitative ethnographic study carried out with an intentional sample of crack cocaine users (n=45) and former users (n=17). The participants were recruited by means of the chain sampling method and they underwent a semi-structured interview guided by a questionnaire, in 2004 and 2005. The combination of each question and its respective responses gave rise to specific reports that were interpreted individually. ANALYSIS OF THE RESULTS: The predominating profile of the crack cocaine users was that they were single young men of low socioeconomic class and low schooling level, without formal employment ties. The pattern of use most frequently cited was compulsive, characterized by multiple drug use and carrying out illegal activities in exchange for crack cocaine or money. However, controlled use was also identified. This consisted of non-daily use of crack cocaine mediated by individual factors that were developed intuitively by the user. Controlled use was similar in nature to the strategies adopted by former users to achieve a state of abstinence. CONCLUSIONS: The culture of crack cocaine use has undergone changes regarding the pattern of use. Although most users do so compulsively, the existence of controlled use was observed. This deserves to be investigated in more detail, particularly with regard to the strategies adopted to attain this.
- ItemSomente MetadadadosCriminality and sexual behaviours in substance dependents seeking treatment(Consel Brasil Oftalmologia, 2016) Diehl, Alessandra [UNIFESP]; Pillon, Sandra Cristina; dos Santos, Manoel Antonio; Hussein Rassool, G.; Laranjeira, Ronaldo [UNIFESP]The aim of this study was to investigate the link between violence, crime, and sexual behavior among patients with substance-related disorder admitted to a specialized inpatient care unit. This was a cross-sectional study using a questionnaire on socio-demographic characteristics, drug of choice (DOC), questions about sexual behavior, and instruments to evaluate the severity of dependence (SADD, DAST, FTND), level of impulsivity (BIS-11), and a screening sex addiction scale. The sample consisted of 587 adult subjects, of which 82.3% were men, 66.4% had used cocaine (sniffed and smoked) as their DOC, 24.4% had a history with the criminal justice system, 26.8% had committed crimes, 19.3% had engaged in violent behavior, and 12.2% had been involved in drug trafficking. In this sample, crime was strongly associated with various sexual behaviors and the severity of substance dependence.
- ItemSomente MetadadadosDa função vestibular em usuários de crack: pesquisa vecto-eletronistagmográfica(Universidade Federal de São Paulo (UNIFESP), 1997) Taguchi, Carlos Kazuo [UNIFESP]; Ganança, Mauricio Malavasi [UNIFESP]Nesta pesquisa, desenvolvida no Setor de Equilibriometria da Disciplina de Otoneurologia da Universidade Federal de São Paulo, realizamos a avaliacao da funcao vestibular de 51 usuarios de crack, com idades entre 12 e 38 anos, dispostos em dois grupos separados pela mediana de tempo de consumo da droga. A partir da historia clinica e da VENG, observamos a ocorrencia frequente de casos sem sintomas, porem com sinais de disfuncao vestibular a vestibulometria. A maioria dos usuarios de crack apresentou sinais compativeis com a hipotese diagnostica de sindrome vestibular periferica de tipo irritativo ou deficitario. Os resultados desta pesquisa indicaram que se deve incluir, no roteiro de avaliacao clinica dos usuarios de crack, o exame funcional do sistema vestibular
- ItemAcesso aberto (Open Access)Ensaio clínico de medicamento para controle da fissura em usuários de crack sob cuidados na RAPS: um estudo de caso(Universidade Federal de São Paulo (UNIFESP), 2019) Jezierski, Marta Ana [UNIFESP]; Rios, Ademar Arthur Chioro dos [UNIFESP]; http://lattes.cnpq.br/9454572596499303; http://lattes.cnpq.br/4844930507147288; Universidade Federal de São Paulo (UNIFESP)Introduction: According to data from the Fundação Oswaldo Cruz (Fiocruz) on crack use in Brazil, only 0.5% of the Brazilian population use crack cocaine regularly. The motivation to start using reported by 29.2% of the interviewees was related to family problems, important affective losses and social pressure. As scientific studies on the subject can be carried out through different types of research, in 2016, a randomized clinical trial (RCT) was proposed among crack users under Mental Health Services (MHS) care to investigate the efficacy of a drug designed to relieve fissure (abstinence crisis) by crack. However, in the course of its development, the study encountered barriers and faced so many biases that it became completely unfeasible. Objectives: The objective of this doctoral was to carry out a case report on the RCT from the identification and discussion of the critical nodes of the originally research design, the challenges related to care with crack users, as well as the problems and challenges related to MHS as a space to produce scientific research. Methods: The Consolidated Standards of Reporting Trials (Consort, 2010) was used for the critical analysis of the RCT. A Bibliographic Review was performed for the analysis on the subjects to whom the potential benefits of the drug’s use were destined and the MHS structure for the care of these subjects. Results: The critical analysis carried out with Consort, showed that the proposed RCT failed to fulfill 17 of the 25 evidence-based requirements set out in the guideline. The RCT sample should have 150 patients allocated in 2 groups (control and experimental), but only 5 participants concluded the protocol, and it is not possible to validate the RCT. The methodological biases were basically derived from the choice and vulnerability of the study population. Conclusion: This critical analysis invites a reflection on the difficulties and limits involved in conducting an RCT in the MHS with population samples under high vulnerability. The development and analysis of research should consider mapping the imperceptible networks developed by drug users and other street individuals beyond the formal points of the MHS and taking as a starting point the user in their life context, relationships and treatment, having as guiding the Individual Therapeutic Project.
- ItemAcesso aberto (Open Access)Evolução do consumo de crack em coorte com histórico de tratamento(Faculdade de Saúde Pública da Universidade de São Paulo, 2011-10-01) Dias, Andréa Costa [UNIFESP]; Araújo, Marcelo Ribeiro; Laranjeira, Ronaldo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Instituto Nacional de Políticas do Álcool e DrogasOBJECTIVE: To analyze the evolution of drug use among treated crack cocaine users. METHODS: A cohort originally comprising 131 crack addicts admitted to a detoxification unit in the city of São Paulo, Southeastern Brazil, between 1992 and 1994 were followed up on three occasions: 1995-96, 1998-99, and 2005-06. Variables investigated included demographical data, risky sexual behaviors, intake patterns for crack and other substances, incarceration, disappearance, and death. Statistical analysis was carried out using chi-square tests, multinomial logistic regression and Cox regression. RESULTS: Among the patients evaluated, 43 were crack-free (12 months or longer), 22 were users, 13 were imprisoned, two were missing, and 27 were deceased. Three groups with distinct post-discharge drug use patterns were identified. Safe sexual behavior (condom use) was correlated with stable abstinence (p=0.001). Positive HIV test upon admission (p=0.046), use of snorted cocaine in the last year (p=0.001), and lifetime use of snorted cocaine (132 months or longer) (p=0.000) were associated with long term use of crack cocaine. History of intravenous cocaine use increased the probability of death at 12 years by 2.5 fold (p=0.031) (95%CI: 1.08; 5.79). CONCLUSIONS: Recurrence and persistence of crack use in the years following discharge reflect new modalities of drug use. On the other hand, stable abstinence patterns provide evidence of the feasibility of recovery from crack addiction.
- ItemAcesso aberto (Open Access)Fissura por crack: comportamentos e estratégias de controle de usuários e ex-usuários(Faculdade de Saúde Pública da Universidade de São Paulo, 2011-12-01) Chaves, Tharcila Viana [UNIFESP]; Sanchez, Zila van der Meer [UNIFESP]; Ribeiro, Luciana Abeid [UNIFESP]; Nappo, Solange Aparecida [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To understand crack cocaine craving among users and describe craving behaviors and coping strategies. METHODOLOGICAL PROCEDURES: Qualitative study with a non-random criterion sample consisting of 40 current and former crack cocaine users conducted in São Paulo, southeast Brazil, in 2007 and 2008. Respondents were selected using snowball sampling technique. In-depth semi-structured interviews were conducted until theoretical saturation was attained. All interviews were transcribed and content analysis was performed to construct inferences and hypotheses based on the narratives. ANALYSIS OF RESULTS: The respondents showed a similar gender distribution, were 18 to 50 years of age, and had different levels of education. Most were from low-income background. In addition to craving resulting from crack cocaine withdrawal and environmental and emotional cue effects, it was found that crack cocaine itself triggers craving. The latter appeared to be a strong trigger of binge episodes. Binge episodes made them lose their moral values, and act dangerously to get more drug. The most common ways reported to get crack cocaine or money to buy it were: prostitution, manipulation of other people, go into debt, sell personal belongings to buy drug and theft. The respondents reported strategies to overcome their cravings as well as pharmacological and behavioral approaches to prevent cravings such as eating, having sex, playing soccer, working, avoiding social situations of crack use and taking depressants. CONCLUSIONS: Crack cocaine binges are caused by a craving induced by the effects of crack cocaine itself. Users develop self-control strategies to cope with their cravings that may help improve their drug use and treatment effectiveness.
- ItemAcesso aberto (Open Access)O impacto econômico da dependência química no contexto brasileiro: custos diretos e indiretos de usuários moderados e graves de drogas(Universidade Federal de São Paulo (UNIFESP), 2019-04-12) Becker, Paula [UNIFESP]; Razzouk, Denise [UNIFESP]; http://lattes.cnpq.br/2570757108117687; http://lattes.cnpq.br/2526225947636656; Universidade Federal de São Paulo (UNIFESP)The economic impact of substance-related disorders can be measured by the higher consumption of health services, lower productivity and spending on the purchase of drugs. In Brazil, there has been an increase in the prevalence of early onset of drug use. There is a lack of economic studies on the societal impact of the early onset of drug use in Brazil. Objectives: To evaluate the direct, indirect and total costs of people with moderate and severe drug use under society perspective and to verify what are their relationships with early and late onset of drug use and others psychosocial aspects such as quality of life, social participation, self-perception of family support and generalized anxiety, in the context of a Psychosocial Care Center for Alcohol and Drugs users (CAPS-ad). In addition, it was aimed to estimate the CAPS-ad total costs for the public health provider. Methods: It was a retrospective cross-sectional cost analysis from the societal perspective. The main hypothesis of the study was that the early onset of drug use contributes to a higher total cost of substance-related disorders in adulthood. It was interviewed 105 subjects with moderate and severe scores for at least one drug according to ASSIST. These subjects constituted a sample of the CAPS-ad users population. The groups were compared through the age of drug use onset: early exposure (younger than 15 years) and late exposure (15 years old or more). Direct and indirect costs were estimated with the application of the Client Socio demographic and Service Receipt Inventory- CSSRI. Direct costs were those related to health services use, medication and transportation to treatment. Indirect costs were those related to unemployment, absenteeism and amount spent in drugs purchase. Social participation, self-perception of family support, quality of life, sociodemographic profile and screening for generalized anxiety variables were analyzed to verify its possible interference on costs. Data analysis: For the descriptive analysis of the association between two categorical variables it was applied the Qui-square or the Fisher’s Exact tests, Student’s t-test was applied to compare treatment costs means with normal distribution and Mann-Whitney non-parametric teste for the other variables. After the descriptive analysis, an inferential analysis was conducted in which the effects of the predictor variables on the dependent variables, Direct Cost, Indirect Cost and Total Cost were studied through Generalized Linear Models. Results: Regarding CAPS-ad total costs for the public health system, the service’s mean monthly cost in 2015 was BRL 64,017.54, and federal government funded 62.1% of this cost, while municipal management absorbed the remaining 37.9%. The early exposure to drugs did not act as a predictive variable of the total costs of subjects with moderate or severe drug use in adulthood. The direct and indirect costs of moderate and severe drugs users did not showed variation according to early or late exposure to drugs. The monthly direct, indirect and total mean costs of subjects in the year 2015 were, ____________________________________________________________________________ - 10 - respectively, BRL 863.80, BRL 1,718.72 and BRL 2,349.61. Indirect costs represented 73.1% of substance-related disorders total costs. For each year later in which the onset of drugs use happens it was observed a 1.5% increase on direct costs of those users in adulthood. Marijuana, cocaine or crack dependents who were also alcohol abusers had a mean direct cost 2 times higher than alcohol addicts and 4.4 times higher than addicts that did not use alcohol. Subjects with early exposure to drugs developed greater severity of marijuana use in adulthood. The more severe the use of cocaine/crack, the greater the user's indirect costs to society. The indirect cost to society of each additional point in the final ASSIST-Cocaine score was R$18.90 in 2015. Cocaine/crack abuser’s total costs to society were 53% higher than subjects that did not use cocaine/crack. The younger the user, the higher the indirect costs. Users with generalized anxiety disorders symptoms presented higher indirect costs than those without the symptoms. Conclusions: Regarding the CAPS-ad II total costs, the results may support a better planning and management of both federal and municipal governments and point to the need for governmental agencies and the national academic community to focus mental health policies not only on expanding treatment coverage but on the best allocation of resources in terms of costs and outcomes. Adolescents aged 10 to 15 years may be the target population of public policies to prevent drugs dependence and other mental disorders in the country, especially regarding marijuana use. Public policies and action programs focused on the population orientation regarding the risks of problematic use of alcohol, marijuana and crack/cocaine, that acts in early diagnosis of anxiety disorders, and that help in the development of networks to support the treatment for drugs users can reduce the economic impact of mental and behavioral disorders related to drug use in Brazil.
- ItemAcesso aberto (Open Access)Is there a crack epidemic among students in Brazil?: comments on media and public health issues(Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, 2012-09-01) Nappo, Solange Aparecida [UNIFESP]; Sanchez, Zila van der Meer [UNIFESP]; Ribeiro, Luciana Abeid [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)In the past year, the Brazilian Federal Government and society have reported and acted on a crack use epidemic, which has been exacerbated by the media. This study hypothesized that crack use has not increased at the rate suggested by the Brazilian media. A cross-sectional survey was carried out in 2010 usinga multistage probabilistic representative sample of Brazilian middle and high school students in the country's 27 state capitals. A total of 50,890 valid questionnaires were weighted, analyzed and results compared to the 2004 national school survey dataset. Considering lifetime and past year crack use, no change in consumption was found between 2004 and 2010. Official data in Brazil on middle and high school students does not support the assertion of a crack epidemic widely publicized by the media. Government measures to treat and prevent crack use are encouraged; however, the term epidemic has been inappropriately used to represent the static prevalence of crack consumption among students.
- ItemAcesso aberto (Open Access)Profile of cocaine and crack users in Brazil(Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, 2008-01-01) Duailibi, Lígia Bonacim [UNIFESP]; Ribeiro, Marcelo [UNIFESP]; Laranjeira, Ronaldo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)This article aims to systematize the profile of cocaine and crack users in Brazil. The study adopted a literature review of the MEDLINE, LILACS, Cochrane Library databases and CAPES thesis/dissertation database. Data were grouped in thematic categories: national household surveys, surveys of specific population groups, profile of patients that seek treatment, and mortality and morbidity. Within each category the principal findings from the Brazilian literature were described and then discussed. The article concludes that the information on cocaine and crack consumption in Brazil is still incipient, but that the scientific community can already draw on a relevant theoretical corpus that can be used to update current public policies on this issue.