Avaliação da cultura do uso de crack após uma década de Introdução da droga na cidade de São Paulo
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Arquivos
Data
2007
Autores
Oliveira, Lúcio Garcia de [UNIFESP]
Orientadores
Nappo, Solange Aparecida [UNIFESP]
Tipo
Tese de doutorado
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ISSN da Revista
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Introdução: Apesar de todas as intervenções governamentais adotadas contra o uso de crack,
mesmo após 15 anos de sua introdução no Brasil, especificamente na cidade de São Paulo,
testemunha-se o aumento na prevalência de seu uso. A persistência de crack em contexto
brasileiro, dentro deste período, pode ser devida a dois possíveis fatores, ou seja, pela modificação
do perfil do usuário, de forma a não ser mais contemplado pelos programas de prevenção,
tratamento e redução de danos disponíveis até então ou pelo desenvolvimento de estratégias
especiais de consumo que possibilitaram ao usuário manter os vínculos sociais pré-existentes
(família, estudo e trabalho), tornando o uso de crack e uma vida social normalizada uma situação
possível e controlável, o que, a longo-prazo, poderia estimular ou disseminar seu uso. Objetivo:
Através da adoção de abordagem qualitativa, o propósito da presente pesquisa consistiu na
caracterização da cultura de crack, da cidade de São Paulo, de forma a identificar, entre outros
aspectos, o perfil do usuário de crack e o padrão de uso da droga. Como parte do estudo foi
conduzida na cidade de Barcelona, aproveitou-se para estabelecer um paralelo entre as culturas de
crack de ambas as cidades, de forma a identificar se as características abordadas são próprias à
cultura ou se dependeriam da influência do contexto sócio-cultural onde esteja inserida. Métodos:
A abordagem qualitativa de pesquisa, em especial a tradição etnográfica, é o melhor caminho para
o estudo de “populações escondidas”, monitorando as tendências no uso de drogas e identificando
práticas comportamentais emergentes e de relevância à saúde pública. No estudo, adotou-se uma
amostra intencional, selecionada por critérios, composta por usuários (N=65) e ex-usuários de
crack (N=27), totalizando a opinião de 92 sujeitos. Recrutada por intermédio de informantes-chave
e método de amostragem em cadeias, especialmente a técnica bola-de-neve (snowball), cada um
dos participantes foi submetido à entrevista semi-estruturada guiada por questionário, com duração
aproximada entre 45 e 150 minutos. Em paralelo, a fim de corroborar com os dados das entrevistas,
conduziu-se estudo de campo pelas regiões sabidamente influenciadas pelo comércio e uso de
crack, adotando-se o diário de campo como a forma mais básica de registro. Os dados, seja das
entrevistas ou do diário, foram submetidos a rigoroso procedimento de análise, de forma que os
resultados foram delineados e hipóteses e teorias puderam surgir. Resultados: Em sua maioria, o
usuário de crack é homem, jovem, de baixo poder aquisitivo, baixo nível de escolaridade e,
geralmente, sem vínculos empregatícios formais. As mulheres, assim como usuários de melhor
poder aquisitivo, existem na cultura, porém, em menor proporção. Geralmente de fácil acesso, o
crack é definido como a droga fim-de-linha. Possibilita duas classes de efeitos, os positivos, ou de
prazer, e os negativos ou desagraváveis. Quanto ao padrão de uso, em sua maioria, é do tipo “binge”, dando-se por horas e dias a fio, descontinuando quando o usuário não tem mais condições
físicas ou financeiras. Na falta de condições financeiras, o usuário dedica-se a atividades atípicas
ou ilegais, submetendo-se à severa degradação moral e social. Assim, relatam a venda de pertences
próprios e familiares, roubos, seqüestros, atividades ligadas ao tráfico e, finalmente, prostituição,
seja feminina ou masculina que, devido aos inúmeros parceiros sexuais e uso inconsistente de
preservativos tem exposto a cultura de crack a considerável risco de contágio por Doenças
Sexualmente Transmissíveis (DST’s) e HIV. O que piora a situação é que, embora tenha sido
identificado o uso exclusivo de crack, para modular seus efeitos, a maioria dos usuários tem o
associado a outras drogas, lícitas ou ilícitas, como álcool, maconha, cloridrato de cocaína, heroína
e metadona, caracterizando o usuário de crack, das cidades de São Paulo e Barcelona, como
politoxicômanos. Ainda quanto ao uso, identificou-se o padrão controlado ou esporádico, uma
forma de controle sobre o uso de crack, subordinando-o às exigências da vida diária, impedindo
que a vida do usuário seja completamente inundada pela droga. Consiste no uso não-diário,
racional e responsável de crack, mediado por fatores protetores individuais gerados intuitivamente.
Além de importantes como estratégia de redução de danos, entre os ex-usuários, não submetidos a
tratamento médico e tampouco religioso, foram ressaltados como importantes medidas para o
alcance do estado de abstinência. Finalmente, no que concerne às formas de uso, variações do
emprego inalado têm sido relatadas. Antes feito em cigarros de tabaco, de maconha e em
cachimbos, atualmente têm-se despontado novas técnicas, dentre elas o “shotgunning” e “dar-se a
segundinha”, que têm predisposto a cultura a consideráveis riscos de contágio por DST’s e HIV, já
que o usuário tem associado-as à atividade sexual freqüente e desprotegida. Conclusões: Tomadas
em conjunto, percebe-se que na cidade de São Paulo, a cultura de crack tem sofrido profundas
modificações, o que poderia justificar a não-adesão dos usuários às medidas de intervenção
disponíveis. Quanto ao uso, embora ainda seja, em sua maioria, compulsivo e submetido a uma
série de riscos, tem sido identificado o padrão controlado, mediado por estratégias que poderiam
ser, satisfatoriamente, introduzidas como eficientes medidas de redução de danos, podendo, até
mesmo funcionar, a longo-prazo, como meios de atingir-se o estado de abstinência. Porém, o dado
mais intrigante refere-se à semelhança de uso entre as cidades de São Paulo e Barcelona, indicando
que, a cultura pareça ser mais um produto do crack em si que do contexto social em que esteja
inserido.
Introduction: Despite of all government interventions adopted against crack-cocaine use, even after 15 years of crack-cocaine introduction in Brazil, specifically in the city of São Paulo, we have witnessed an increasing in its prevalence of use. Its persistence in the Brazilian context, in this period of time, may be due to 2 possible factors, i.e., or due to the modification of the crackcocaine user profile, not being contemplated by the available prevention, harm reduction and treatment strategies or due to the development of especial strategies for crack-cocaine use, which seem to keep the user social bonds (concerning especially on family, school and job activities), making the crack-cocaine use and a normal social life a possible and controllable situation, which in a long-term basis could stimulate or spread its use. Aim: Through a qualitative approach, this research aimed to characterize the crack-cocaine culture in the city of São Paulo, Brazil, identifying, among other issues, the crack-cocaine user profile and the crack-cocaine pattern of use. As a piece of this research was also conducted in the city of Barcelona, Spain, it was made a comparison between the crack-cocaine culture from both cities to verify if the characteristics presented depend on the drug itself or if depend on the social-cultural context where it belongs. Methods: Qualitative research, particularly the ethnography tradition, is the best way to study “hidden populations”, monitoring drug use trends and identifying emerging behavioral practices of relevance to public health. In this research, an intentional sample selected by criteria was adopted, composed by crack-cocaine users (N=65) and ex-users (N=27), a total of 92 subjects. Recruited through key-informants and snowball sampling method, each participant was submitted to a semistructured interview, guided by a questionnaire, which lasted between 60 and 150 minutes each one. In order to compare to the interview generated data, a fieldwork was conducted at regions where crack-cocaine use and trafficking were common, using a diary for field notes. For analysis, data from both the fieldwork and interviews were submitted to a rigorous series of procedures, allowing to the generation of the research results and hypotheses and theories to emerge. Results: The majority of crack-cocaine use is performed by young men, characterized by low purchasing power, low educational level and no formal work income activities. Women, as well as users of a better purchasing power were also detected but in a lower prevalence. Generally easily accessible, crack-cocaine is defined as an “end line” drug. Crack-cocaine makes possible two categories of effects, the positive or pleasure ones and the negative or unpleasant ones. “Binging” is the most common crack-cocaine pattern of use, which lasts for hours or days, till subject has no more financial resources or physical conditions to go on it. When financial resources lack, crack-cocaine users engage in atypical or illegal income generating activities, submitting themselves to severe moral and social degradations. They report selling proper and family belongings, robberies, kidnappings, activities related to drug and crack-cocaine trafficking and, finally, prostitution, either among females and males. Due to the uncountable sexual partners and inconsistent condom use, the crack-cocaine culture has been exposed to considerable risks concerning on SDT and HIV transmission. It has been identified exclusive crack-cocaine users, but the majority of the users report using other drugs, licit or illicit, to modulate crack-cocaine effects. So, it has been reported the use of alcohol, marijuana (or haxixe), cocaine chloridrate, heroin and methadone, defining the crack-cocaine user, from São Paulo and Barcelona cities, as polydrug users. Concerning on pattern of crack-cocaine use, the controlled or sporadic one has been identified, reported as a way to control crack-cocaine use, subordinating it to the exigencies of daily life rather than allowing user lives to be completely overtaken by the drug. In fact, it is a long-term, responsible and non-daily crack-cocaine use, mediated by individualized internal protective factors which stem from the subjects’ self. Besides important for harm reduction, they were reported from ex-users, not submitted to medical nor religious treatment, as important measures to reach the abstinence state. Finally, concerning on the forms of crack-cocaine use, variations of the inhalation administration have been reported. Previously made in tobacco cigarettes, marijuana joints and in crack-cocaine pipes, nowadays, new techniques have been developed, among them “shotgunning” and “giving the second one”, which have predisposed the crack-cocaine culture to considerable risks to STD and HIV transmission, since user has associated them to the engagement on frequent and unconcerned sexual activity. Conclusions: Considering these findings together, it is observed that the crack-cocaine culture in the city of São Paulo has suffered profound modifications, which could justify the reasons why crack-cocaine users have not been submitted to the available health interventions. Concerning on crack-cocaine use, although still compulsive and submitted to relevant health risks, it has been reported the controlled pattern of use, mediated by control strategies that could be introduced as efficient measures of harm reduction, even being able to function as abstinence measures when took in a long term-basis. However, the most intriguing data has been about the similarity of the crack-cocaine culture between the cities of São Paulo and Barcelona, pointing to the fact that its characteristics could be a function of the pharmacologic crack-cocaine effects rather than the socio-cultural context where it belongs.
Introduction: Despite of all government interventions adopted against crack-cocaine use, even after 15 years of crack-cocaine introduction in Brazil, specifically in the city of São Paulo, we have witnessed an increasing in its prevalence of use. Its persistence in the Brazilian context, in this period of time, may be due to 2 possible factors, i.e., or due to the modification of the crackcocaine user profile, not being contemplated by the available prevention, harm reduction and treatment strategies or due to the development of especial strategies for crack-cocaine use, which seem to keep the user social bonds (concerning especially on family, school and job activities), making the crack-cocaine use and a normal social life a possible and controllable situation, which in a long-term basis could stimulate or spread its use. Aim: Through a qualitative approach, this research aimed to characterize the crack-cocaine culture in the city of São Paulo, Brazil, identifying, among other issues, the crack-cocaine user profile and the crack-cocaine pattern of use. As a piece of this research was also conducted in the city of Barcelona, Spain, it was made a comparison between the crack-cocaine culture from both cities to verify if the characteristics presented depend on the drug itself or if depend on the social-cultural context where it belongs. Methods: Qualitative research, particularly the ethnography tradition, is the best way to study “hidden populations”, monitoring drug use trends and identifying emerging behavioral practices of relevance to public health. In this research, an intentional sample selected by criteria was adopted, composed by crack-cocaine users (N=65) and ex-users (N=27), a total of 92 subjects. Recruited through key-informants and snowball sampling method, each participant was submitted to a semistructured interview, guided by a questionnaire, which lasted between 60 and 150 minutes each one. In order to compare to the interview generated data, a fieldwork was conducted at regions where crack-cocaine use and trafficking were common, using a diary for field notes. For analysis, data from both the fieldwork and interviews were submitted to a rigorous series of procedures, allowing to the generation of the research results and hypotheses and theories to emerge. Results: The majority of crack-cocaine use is performed by young men, characterized by low purchasing power, low educational level and no formal work income activities. Women, as well as users of a better purchasing power were also detected but in a lower prevalence. Generally easily accessible, crack-cocaine is defined as an “end line” drug. Crack-cocaine makes possible two categories of effects, the positive or pleasure ones and the negative or unpleasant ones. “Binging” is the most common crack-cocaine pattern of use, which lasts for hours or days, till subject has no more financial resources or physical conditions to go on it. When financial resources lack, crack-cocaine users engage in atypical or illegal income generating activities, submitting themselves to severe moral and social degradations. They report selling proper and family belongings, robberies, kidnappings, activities related to drug and crack-cocaine trafficking and, finally, prostitution, either among females and males. Due to the uncountable sexual partners and inconsistent condom use, the crack-cocaine culture has been exposed to considerable risks concerning on SDT and HIV transmission. It has been identified exclusive crack-cocaine users, but the majority of the users report using other drugs, licit or illicit, to modulate crack-cocaine effects. So, it has been reported the use of alcohol, marijuana (or haxixe), cocaine chloridrate, heroin and methadone, defining the crack-cocaine user, from São Paulo and Barcelona cities, as polydrug users. Concerning on pattern of crack-cocaine use, the controlled or sporadic one has been identified, reported as a way to control crack-cocaine use, subordinating it to the exigencies of daily life rather than allowing user lives to be completely overtaken by the drug. In fact, it is a long-term, responsible and non-daily crack-cocaine use, mediated by individualized internal protective factors which stem from the subjects’ self. Besides important for harm reduction, they were reported from ex-users, not submitted to medical nor religious treatment, as important measures to reach the abstinence state. Finally, concerning on the forms of crack-cocaine use, variations of the inhalation administration have been reported. Previously made in tobacco cigarettes, marijuana joints and in crack-cocaine pipes, nowadays, new techniques have been developed, among them “shotgunning” and “giving the second one”, which have predisposed the crack-cocaine culture to considerable risks to STD and HIV transmission, since user has associated them to the engagement on frequent and unconcerned sexual activity. Conclusions: Considering these findings together, it is observed that the crack-cocaine culture in the city of São Paulo has suffered profound modifications, which could justify the reasons why crack-cocaine users have not been submitted to the available health interventions. Concerning on crack-cocaine use, although still compulsive and submitted to relevant health risks, it has been reported the controlled pattern of use, mediated by control strategies that could be introduced as efficient measures of harm reduction, even being able to function as abstinence measures when took in a long term-basis. However, the most intriguing data has been about the similarity of the crack-cocaine culture between the cities of São Paulo and Barcelona, pointing to the fact that its characteristics could be a function of the pharmacologic crack-cocaine effects rather than the socio-cultural context where it belongs.
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Citação
OLIVEIRA, Lúcio Garcia de. Avaliação da cultura do uso de crack após uma década de introdução da droga na cidade de São Paulo. 2007. 330f. Tese (Doutorado em Ciências) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2007.