"The Box Has Become an Indispensable Part of My Life": A Case Study of Victoria Cannabis Buyers Club and its Consumption Space.

Community-based models of cannabis cultivation, distribution, and consumption-such as cannabis clubs-have been documented across Europe, North America, South America, and New Zealand since the 1990s. For the most part, these models have a history of operating outside existing legislation and regulations. Jurisdictions that have legalized cannabis have approached community-based models in opposite ways (eliminate vs. regulate). Canada legalizing cannabis has resulted in more stringent enforcement and concerted efforts to close these models despite documented health and social benefits. This paper presents a case study of the Victoria Cannabis Buyers Club (VCBC) and its consumption space-The Box. We conducted a survey of VCBC members to explore four domains: demographics, cannabis consumption, access to and use of The Box, and the impact of its temporary closure due to COVID-19. From the survey data (n = 104), descriptive statistics were generated and three conceptual avenues were identified. The majority of respondents were 40 years old and older and identified as White (European descent) cisgendered men and women. The majority reported an income of $40,000 or less and a housing status that prevented them from smoking. Close to 75% of our sample consumed cannabis multidaily for therapeutic purposes primarily, but also for a mix of recreation, social, spiritual, and traditional healing purposes. Smoking was the preferred mode of consumption. Respondents accessed The Box daily or weekly. Reasons and benefits for using The Box fell into three categories: public health, harm reduction, and wellness perspectives. Conceptually, we found that The Box acted as a therapeutic space and offered a much-needed consumption space for smokers. We also identified a need to unpack the concept of safety. Overall, the survey reinforces the need for an equity-informed approach to community-based models and cannabis consumption spaces in Canada.

Psychedelics to Relieve Psychological Suffering Associated with a Life-Threatening Diagnosis: Time for a Canadian Policy Discussion.

In Canada, the conversation to enable access to therapeutic psychedelics is under way. With recent federal initiatives, Canadians can request access to psychedelic-assisted therapies (PATs) to alleviate enduring and intolerable psychological suffering (EIPS) associated with life-threatening conditions on a case-by-case basis. The resurgence of past research concerning the therapeutic potential of PATs, promising preliminary results from contemporary clinical trials, public and media interest and the recognition of traditional Indigenous use of psychedelics have facilitated a change in the popular narrative around these stigmatized substances. A lack of access to PATs for treating EIPS, especially at end of life, is a public policy problem worth addressing.

What is a public health approach to substance use? A qualitative systematic review and thematic synthesis.

BACKGROUND: Psychoactive substance use and the regulations that govern it both have the potential to lead to harm. A 'public health approach' (PHA) is frequently invoked as a means of addressing these harms, but the term is used in inconsistent and contradictory ways. This study systematically reviewed the English-language academic literature to understand how a public health approach to substance use is defined and described. METHODS: This review employed thematic synthesis, a methodology designed to rigorously synthesize qualitative evidence. Eligible articles were published in peer-reviewed journals, in the English language, with full text available, and focused primarily on substance use. There were no limits on year of publication. Original research, opinion/commentary, and reviews were included. The searches were conducted in October 2021 in CINAHL, Embase, Medline, PAIS Index, PsycINFO, Scopus, Sociological Abstracts, and Web of Science. RESULTS: 272 articles from 25 countries, published between 1950 and 2021, were synthesized. Definitions of a PHA have changed over time and differ by substance. The most commonly cited characteristics of a PHA were: for alcohol, regulation, e.g. of price and availability (54% of articles); for cannabis: regulation (68%); for illicit drugs: that a PHA is distinct from a criminal justice approach (63%); for opioids: substance use disorder treatment (55%); and for tobacco: regulation (62%). CONCLUSION: There is no consensus on the definition of a public health approach to substance use, but there is substantial agreement when it comes to PHAs to specific substances. There are also similarities in how they are described for legal substances versus illicit ones. This review found areas of disagreement regarding the extent to which PHAs should focus on individual-level factors. Policymakers, academics, and others developing or implementing PHAs to substance use should be explicit about their aims and objectives - as well as the premises and assumptions underlying them.

Smoke Gets in the Eye: A systematic review of case reports of ocular complications of crack cocaine use.

ISSUES: Use of crack cocaine and associated medical complications persists globally. Some reports in medical literature describe a sight-threatening condition commonly referred to as 'crack eye' or 'crack eye syndrome'. The purpose of this review is to describe what is known about crack eye from case reports in peer-reviewed literature. APPROACH: A structured search was completed in MEDLINE, TOXLINE, EMBASE, PsychInfo, Scopus and Biomed Central, to collect case reports and case series on corneal complications attributed to crack cocaine smoking. KEY FINDINGS: Of 111 articles screened, 11 contained case reports or series. Thirty individual cases of 'crack eye' were reported. The majority (63%) of cases had bilateral involvement; 83% of all cases with microbial culture results had corneal infections. Aggressive treatment caused an improvement in 95% of all cases and 23% of all cases were lost to follow up. Of those who received treatment for corneal complications associated with crack cocaine, 22% remained with significant visual impairment (hand motions only) in the affected eye. IMPLICATIONS: Clinicians should consider crack cocaine involvement in patients presenting with corneal disease without known predisposing factors, and elicit comprehensive drug histories to prevent a reduction in visual acuity. CONCLUSION: Corneal complications of crack cocaine smoking are caused by a number of synergistic factors, including direct toxicity of crack cocaine vapours to surface cells, impairment of neurogenic support to corneal epithelial integrity, desiccation of the eye surface due to diminished blinking reflex, low level chemical burns and mechanical denudement of surface cells through eye rubbing.

Rules and Eligibility Criteria for Supervised Consumption Services Feasibility Studies - A Scoping Review.

INTRODUCTION: Supervised consumption services (SCS) reduce HIV risks and overdose for people who use drugs (PWUD) and are known to have wide-ranging public health benefits. Feasibility studies are often conducted as part of program/implementation development. We conducted a scoping review of SCS feasibility/pre-implementation studies to answer: what is known about stakeholders' opinions of SCS rules and eligibility criteria? METHODS: Using the PRISMA-ScR guidelines, we searched Medline, PsychINFO, Embase, CINAHL, and SCOPUS databases for: (a) empirical research, (b) reported in English, (c) focused on SCS, (d) pre-implementation feasibility studies (research conducted prior to implementation of SCS in a given context), (e) examining SCS operational rules and eligibility criteria. Abstracts were reviewed to verify appropriateness; full articles/reports were retrieved; data were extracted and charted. RESULTS: Of the 1,268 data sources identified/reviewed, 19 sources, were included. Manuscripts showed the following criteria that might be considered when determining who can and cannot use SCS: age, pregnancy status, and opioid substitution treatment status. To govern behaviours at SCS, manuscripts focused on: acceptable modes of drug consumption, assisted injections, sharing drugs on-site, pill injecting, and mandatory hand washing, etc. Stakeholders generally agreed that; eligibility restrictions and site rules should be minimal to establish low-barrier services. SCS are often forced to contend with the tension between adhering to a medical or public health model and creating low-barrier services. SCS rules are at the center of this intersection because rules and eligibility criteria implemented to mirror other health services may not align with the needs of PWUD. CONCLUSION: Given the public health significance of SCS, establishing best practices for service delivery is critical for increasing access and addressing implementation issues. Future research should examine other operational elements of SCS, such as design elements, staffing models, and ancillary services. Additional research should also focus on supervised smoking services.

'It's our safe sanctuary': Experiences of using an unsanctioned overdose prevention site in Toronto, Ontario.

BACKGROUND: Overdose prevention sites (OPSs) are spaces where people can consume drugs under the supervision of trained volunteers or staff and receive help in the event of an overdose. Unsanctioned OPSs are a grassroots response to the current opioid crisis in Canada. METHODS: We used rapid evaluation methods to study the experiences of 30 individuals accessing the smoking and injection services at the first unsanctioned OPS in Toronto, Ontario using semi-structured interviews. Data were analyzed using an applied thematic analysis approach to identify emergent themes related to service user experiences, characteristics of the risk environment, and recommended changes to the service model. RESULTS: The OPS represented a safe sanctuary and brought a sense of belonging to a community that often experiences discrimination. Valued aspects included: shelter; protection from violence; safety from overdoses; free equipment; information about health and social services; food and beverages; and socializing and connecting with others. Integrating peer workers in the design and delivery of services encouraged service users to visit the site. The OPS changed the risk environment by: providing access to the first supervised smoking service in Toronto; having few explicit rules and a communal approach to making new rules; allowing assisted injection, and negotiating with police to allow people to access the site with minimal contact. Service users noted the need to ensure a safe space for women and recommended extended hours of operation and moving to a more permanent space with heat and lighting for both smoking and injecting drugs. CONCLUSION: The unsanctioned OPS in Toronto served an important role in defining new, community-led, flexible responses to opioid overdose-related deaths at a time of markedly increasing mortality. Providing harm reduction services in diverse settings and expanding services to include smoking and assisted injection may increase access for marginalized people who use drugs.

Distribution of Harm Reduction Kits in a Specialty HIV Hospital.

Casey House, a small Toronto, Ontario, hospital for people living with HIV, implemented a harm-reduction kit distribution program in October 2014 to decrease harms from reuse of injection and smoking equipment among its clients-inpatients and outpatients. Program statistics (November 2014-June 2017) show an increase in the number of kits-injection and smoking-distributed each year. The program is perceived by staff to communicate openness and increased willingness of clinicians and clients to discuss drug-related harms.

Education and equipment for people who smoke crack cocaine in Canada: progress and limits.

BACKGROUND: People who smoke crack cocaine experience a wide variety of health-related issues. However, public health programming designed for this population is limited, particularly in comparison with programming for people who inject drugs. Canadian best practice recommendations encourage needle and syringe programs (NSPs) to provide education about safer crack cocaine smoking practices, distribute safer smoking equipment, and provide options for safer disposal of used equipment. METHODS: We conducted an online survey of NSP managers across Canada to estimate the proportions of NSPs that provide education and distribute safer smoking equipment to people who smoke crack cocaine. We also assessed change in pipe distribution practices between 2008 and 2015 in the province of Ontario. RESULTS: Analysis of data from 80 programs showed that the majority (0.76) provided education to clients on reducing risks associated with sharing crack cocaine smoking equipment and about when to replace smoking equipment (0.78). The majority (0.64) also distributed safer crack cocaine smoking equipment and over half of these programs (0.55) had done so for less than 5 years. Among programs that distributed pipes, 0.92 distributed the recommended heat-resistant Pyrex and/or borosilicate glass pipes. Only 0.50 of our full sample reported that their program provides clients with containers for safer disposal of used smoking equipment. The most common reasons for not distributing safer smoking equipment were not enough funding (0.32) and lack of client demand (0.25). Ontario-specific sub-analyses showed a significant increase in the proportion of programs distributing pipes in Ontario from 0.15 (2008) to 0.71 (2015). CONCLUSIONS: Our findings point to important efforts by Canadian NSPs to reduce harm among people who smoke crack cocaine through provision of education and equipment, but there are still limits that could be addressed. Our study can provide guidance for future cross-jurisdiction studies to describe relationships involving harm reduction programs and provision of safer crack cocaine smoking education and equipment.

Public opinions about supervised smoking facilities for crack cocaine and other stimulants.

BACKGROUND: The purpose of this study was to estimate awareness and opinions about supervised smoking facilities (SSFs) for smoking crack cocaine and other stimulants and make comparisons with awareness and opinions about supervised injection facilities (SIFs) in Ontario, Canada. METHODS: We used data from a 2009 telephone survey of a representative adult sample. The survey asked about awareness of, and level of support for, the implementation of SSFs and SIFs. Data were analysed using statistical models for complex survey data, which account for stratified sampling and incorporate sampling weights. RESULTS: A total of 1035 participated in the survey. Significantly fewer had knowledge about SSFs (17.9 %) than about SIFs (57.6 %). Fewer strongly agreed with implementation of SSFs (19.6 %) than SIFs (28.3 %). Just over half (51.1 %) of participants somewhat agreed or disagreed, 15.7 % strongly agreed, and 10.6 % strongly disagreed with implementing both SSFs and SIFs. CONCLUSIONS: Members of the public in Ontario had little knowledge of SSFs compared to SIFs. Recent federal government changes in Canada may provide the leadership environment necessary to ensure that innovative, evidence-based harm reduction programs such as SSFs are developed and implemented.

Usuários de Crack que Buscam Tratamento em Brasília / Crack Cocaine Users Seeking Treatment in Brasília

RESUMO Objetivando identificar o perfil de pacientes ambulatoriais que procuram tratamento para problemas relacionados com crack em Brasília, 132 usuários que recebem serviços psicológicos preencheram o Questionário sobre o Perfil de Consumo de Crack e o Cocaine Craving Questionnaire-Brief. Os participantes eram homens (83,6%), solteiros (38,8%) e possuíam residência (100%). O primeiro uso foi motivado pela curiosidade (65,9%), influência dos pares (58,3%) e fácil acesso (50,8%). A maioria (65,2%) relatou poliuso. O mais longo período de abstinência foi de quatro anos (1,5%) e a maioria (46%) relatou menos de 30 dias. O poder letal, dependência e contextos de vulnerabilidade social associados ao crack foram questionados neste estudo. São necessários esforços para melhor atender aos que não acessam o sistema de tratamento.

ABSTRACT Aiming to identify the profile of outpatients seeking treatment for crack cocaine-related problems in Brasília, 132 clients receiving psychological services completed the Profile of Crack Consumption Questionnaire and the Cocaine Craving Questionnaire-Brief. Most participants were male (83.6%), single (38.8%), and housed (100%). First use was motivated predominantly by curiosity (65.9%), peer influence (58.3%), and easy access (50.8%). Most (65.2%) reported polysubstance use. The longest period of abstinence attained was four years (1.5%), and most (46.2%) reported less than 30 days of abstinence. The stereotypes of extreme social vulnerability of crack users and high lethal and addiction potential of the crack were challenged by this study. Efforts are needed to better serve those missed by the treatment system.

Initiation Stories: An Examination of the Narratives of People Who Assist With a First Injection.

BACKGROUND: Research in the area of initiation to injection drug use that focuses on the perspective of initiators, or those who help with a first injection, is rare. OBJECTIVE: To explore the process of initiation to injection drug use from the point of view of initiators. METHODS: Semi-structured, in-depth qualitative interviews were conducted at a harm reduction program in Toronto, Canada. Twenty participants who had injected drugs in the last 30 days and who reported ever having initiated another person to injection drug use were recruited. A narrative analytic approach was used to explore the spectrum of narratives surrounding their experiences initiating others to injection drug use. RESULTS: Initiation events arise in a complex interplay of individual circumstances and social contexts. People who inject may assist with a first injection for a variety of reasons, from conceding to social pressure, to wanting to help reduce a perceived risk of harm, to assisting because it provides a sense of pride at possessing a skill or of having helped someone achieve a desired state, to assisting to obtain drugs or to cope with withdrawal, or a mix of several of these reasons at once. CONCLUSIONS/IMPORTANCE: Narratives reveal that preventing all instances of initiation is unrealistic. Combining elements from existing interventions that focus on enhancing reluctance to assist with initiation with safer injection training has the potential to reduce initiations and perhaps reduce injection related harm for novices if initiation occurs.

The use of drugs between university student and the relation with abuse during childwood and adolescence / O uso de drogas entre os estudantes universitários e sua relação com o maltrato durante a infância e a adolescência / El uso de drogas entre los estudiantes universitarios y su relación con el maltrato durante la niñez y la adolescencia

Panamá, país de tránsito para productores y consumidores de drogas, generando economía emergente, cultura de violencia y maltrato en la familia y comunidad, siendo niños y adolescentes vulnerables al uso y abuso de drogas por exposición prolongada al maltrato. Se determina independencia o relación entre uso y abuso de droga con el maltrato durante la niñez y la adolescencia en estudiantes en una universidad en la ciudad de Panamá. Se aplicó el método cuantitativo, diseño transeccional, correlacional, muestreo estratificado, muestra de 377 estudiantes de 12 facultades por afijación proporcional. Instrumento aplicado: "Cuestionario Uso de Drogas y Experiencias Adversas de la niñez". La prueba chi-cuadrado, test de independencia, comprobó no independencia entre uso y abuso de drogas posterior al maltrato como abuso sexual, con p-valor asociado 0,021, al 95% nivel de confianza, con significancia de p< de 0,05; determinantes para consumo posterior: madre maltratada, separación o divorcio de padres, pares consumidores.

Panamá, país de trânsito para produtores e consumidores de drogas, gera economia emergente, cultura de violência e maltrato na família e a comunidade, sendo meninos e dolescentes vulneráveis ao uso e exposição prolongada ao abuso de drogas. Para determinar a independência ou a relação entre o uso e abuso de drogas durante a infância e adolescência em estudantes de uma universidade na cidade do Panamá. Método quantitativo aplicado, projeto transacional, busca, de amostragem, amostra de 377 alunos de 12 faculdade por aposição proporcional estratificada. Instrumento aplicado "uso de questionário de drogas e experiências negativas da infância". O teste de qui-quadrado, teste de independência, encontrado não independência entre uso e abuso de drogas após o abuso tais como abuso sexual, com p-valor associado 0,021, 95% nível de confiança, com uma significância de p < 0,05; Eles são outros determinantes para consumo posterior: mãe agredida, separação ou divórcio dos pais, pares de altos problemas.

Panama, country of traffic between drugs producers and consumers, generating emergent economy, culture of violence and maltreatment in the family and community, being vulnerable children and adolescents due long term exposition to maltreatment, presenting risk behaviors such as drugs use and abuse. To determine independence or relationship between drug use and abuse and maltreatment during childhood and adolescence in university students of an university in panama city. Quantitative study, transeccional correlacional design, stratified sampling 377 students of 12 faculty by proportional distribution, using "drugs use and abuse and adverse experience during childhood" questionnaire. The test chi square independence test proved no independence between drug use and abuse with maltreatment, highlighting sexual abuse during childhood and adolescence. Maltreatment indicators for drug use and abuse were: mistreated mother, separation and divorce of parents of the student, the influence of university student peer consumers.

What is low threshold methadone maintenance treatment?

BACKGROUND: Low threshold methadone maintenance (MMT) was developed for clients who do not have abstinence as a treatment goal. We explored how MMT programs in Canada defined low threshold and the challenges they faced. METHODS: Using semi-structured interviews, we collected data from clients (n=46), nurses/counsellors (n=15) and physicians (n=9) at three low threshold MMT programs. All participants were asked to define low threshold MMT and describe how it was implemented in practice. Interviews were taped, transcribed, verified and analysed using an iterative thematic coding technique. RESULTS: Low threshold MMT was defined by an explicit rejection of abstinence from opiates and other drugs as an over-arching treatment goal. In the absence of guidelines defining a set of practices as low threshold, programs implemented practices they believed would reduce barriers to admission and help retention. There was not always agreement between professional groups or across the programs regarding these practices. For physicians, there was a tension between accepting poly-drug use during treatment as a means to improve retention, with an obligation to do more good than harm for their patients. Missed prescribing appointments generated few to severe consequences and revealed differential focus on reducing barriers versus encouraging client 'ownership' of treatment. Differences of opinion regarding appropriate urine drug testing practices revealed power dynamics between medical and non-medical staff. CONCLUSION: Our findings show that there are potentially more ways to reduce barriers to MMT than those presented in the current literature. Our findings are important given the growing number of people with opiate dependence across the world and calls to increase access to MMT. To fully develop the low threshold model, it will be important to evaluate what policies and practices can achieve the goals of reducing barriers to admission and improving retention in treatment.

Design considerations for supervised consumption facilities (SCFs): preferences for facilities where people can inject and smoke drugs.

BACKGROUND: Supervised consumption facilities (SCFs) aim to improve the health and well-being of people who use drugs by offering safer and more hygienic alternatives to the risk environments where people typically use drugs in the community. People who smoke crack cocaine may be willing to use supervised smoking facilities (SSFs), but their facility design preferences and the views of other stakeholders have not been previously investigated in detail. METHODS: We consulted with people who use drugs and other stakeholders including police, fire and ambulance service personnel, other city employees and city officials, healthcare providers, residents, and business owners (N = 236) in two Canadian cities without SCFs and asked how facilities ought to be designed. All consultations were audio-recorded and transcribed. Thematic analyses were used to describe the knowledge and opinions of stakeholders. RESULTS: People who use drugs see SSFs as offering public health and safety benefits, while other stakeholders were more sceptical about the need for SSFs. People who use drugs provided insights into how a facility might be designed to accommodate supervised injection and supervised smoking. Their strongest preference would allow both methods of drug use within the same facility with some form of physical separation between the two based on different highs, comfort regarding exposure to different methods of drug administration, and concerns about behaviours often associated with smoking crack cocaine. Other stakeholders raised a number of SSF implementation challenges worthy of consideration. CONCLUSION: Decision-makers in cities considering SCF or SSF implementation should consider the opinions and preferences of potential clients to ensure that facilities will attract, retain, and engage people who use drugs.

Frequent food insecurity among injection drug users: correlates and concerns.

BACKGROUND: Food insecurity and nutrition are two topics that are under-researched among injection drug users (IDUs). Our study examined the extent and correlates of food insecurity among a sample of IDUs and explored whether there is an association between food insecurity and injection-related HIV risk. METHODS: A cross-sectional survey was conducted using interviewer-administered questionnaires. Data were collected at a needle exchange program in London, Ontario, Canada between September 2006 and January 2007. Participants included 144 English-speaking IDUs who had injected drugs in the past 30 days. Participants were asked about their socio-demographic characteristics, HIV risk behaviours, food insecurity, and health/social service use. RESULTS: In the past 6 months, 54.5% of participants reported that on a daily/weekly basis they did not have enough to eat because of a lack of money, while 22.1% reported this type of food insecurity on a monthly basis. Moreover, 60.4% and 24.3% reported that they did not eat the quality or quantity of food they wanted on a daily/weekly or a monthly basis, respectively. Participants reported re-using someone else's injection equipment: 21% re-used a needle, 19% re-used water, and 37.3% re-used a cooker. The odds of sharing injection equipment were increased for food insecure individuals. CONCLUSIONS: Findings show that IDUs have frequent and variable experiences of food insecurity and these experiences are strongly correlated with sharing of injection-related equipment. Such behaviours may increase the likelihood of HIV and HCV transmission in this population. Addressing food-related needs among IDUs is urgently needed.

Reducing widespread pipe sharing and risky sex among crystal methamphetamine smokers in Toronto: do safer smoking kits have a potential role to play?

BACKGROUND: Crystal methamphetamine smoking is associated with many negative health consequences, including the potential for transmission of hepatitis. We examined whether or not a kit for crystal methamphetamine smoking might have some potential to reduce the negative health effects of crystal methamphetamine smoking. METHODS: Five focus groups were conducted with crystal methamphetamine smokers recruited by community health agencies and youth shelters in Toronto, Canada. Target groups included homeless/street-involved youth, sex workers, men who have sex with men, and youth in the party scene. Participants (n = 32) were asked questions about motivations for crystal methamphetamine use, the process of smoking, health problems experienced, sharing behaviour, risky sexual practices, and the ideal contents of a harm reduction kit. RESULTS: Pipe sharing was widespread among participants and was deemed integral to the social experience of smoking crystal methamphetamine. Heated pipes were unlikely to cause direct injuries, but participants mentioned having dry, cracked lips, which may be a vector for disease transmission. Many reported having sex with multiple partners and being less likely to use condoms while on the drug. Demand for harm reduction kits was mixed. CONCLUSIONS: Changing pipe sharing behaviours may be difficult because many participants considered sharing to be integral to the social experience of smoking crystal methamphetamine. Within the context of a broader health promotion and prevention program, pilot testing of safer smoking kits to initiate discussion and education on the risks associated with sharing pipes and unprotected sex for some communities (e.g., homeless/street-involved youth) is worth pursuing.

Policonsumo simultâneo de drogas entre estudantes de graduação da área de ciências da saúde de uma universidade: implicações de gênero, sociais e legais, Santo André - Brasil / Simultaneous polydrugs use among undergraduate students of health sciences of one university: gender, social and legal implications, Santo André - Brazil / Policonsumo simultáneo de drogas en estudiantes universitarios de pregrado del área de ciencias de la salud en una universidad: implicaciones de género, sociales y legales, Santo André - Brasil

Estudo transversal que teve por objetivo entender os padrões de policonsumo simultâneo de drogas e suas implicações de gênero, sociais e legais entre estudantes universitários. Participaram 275 estudantes de Ciências da Saúde de uma universidade em Santo André, Brasil. O policonsumo foi detectado em 27,9% dos estudantes da amostra. Combinações: álcool + cannabis; álcool + medicamentos prescritos; álcool + tabaco + cannabis; tabaco + cannabis; e tabaco + medicamentos prescritos. As justificativas foram: ajudar a relaxar; perder inibições; permanecer acordado; ajudar a fazer algo que aborrece e melhorar o efeito de outras substâncias. Não se observou associação entre situações legais e sociais, os homens admitiram utilizar mais o policonsumo que as mulheres, a religião representou fator de proteção ao policonsumo, que foi inferior ao encontrado na literatura. Por se tratar de futuros profissionais de saúde, políticas institucionais devem ser discutidas no intuito de diminuir a exposição e vulnerabilidade destes às substâncias psicoativas.

Cross sectional study that aims to understand the patterns of polydrugs use and its gender, social and legal implications among undergraduate students. 275 undergraduate students from the Faculty of Health Sciences from one university in Santo André, Brazil, participated in the study. The simultaneous polydrug use was detected in 27.9% of the sample. Combinations: alcohol + cannabis; alcohol + prescription drugs; alcohol + tobacco + cannabis; tobacco + cannabis; and tobacco + prescription drugs. Reasons: To help relaxing, to lose inhibitions, to help staying awake, to help on doing something upsetting, and to improve the effect of other substances. There was no observed association between legal and social circumstances, men used more poly consumption than women, and religion represented a protective factor to simultaneous polydrug use, which was lower than described in the literature. Considering that subjects in the represent future health care professionals, institutional policies should be discussed in order to reduce exposure and vulnerability to these substances.

Estudio transversal que busca comprender los patrones de poli-consumo simultáneo de drogas y sus consecuencias de genero, sociales y legales entre estudiantes universitarios. 275 estudiantes de las ciencias de la salud de pregrado de una universidad en Santo André, Brasil participaran en el estudio. El policonsumo simultáneo estuvo presente en 27,9% de los estudiantes de la muestra. Combinaciones: alcohol + marihuana; alcohol + medicamentos de prescripción; alcohol + tabaco + cannabis; tabaco + cannabis; y tabaco + medicamentos de prescripción. Razones: Para relajarse, perder inhibiciones, mantenerse despierto, ayudar a hacer algo que genera molestia y mejorar el efecto de otras sustancias. No se observó asociación entre circunstancias jurídicas y sociales, los hombres presentaron mayor poli-consumo que las mujeres, y la religión se presentó como un factor de protección para el poli-consumo, que fue menor que la encontrada en la literatura. Dado que se trata de futuros profesionales de la salud, las políticas institucionales deben ser analizadas con el fin de reducir la exposición y la vulnerabilidad a estas sustancias psicoactivas.

Características del policonsumo simultáneo de drogas en estudiantes de pregrado de carreras de ciencias de la salud de una universidad, Santiago - Chile / Characteristics of simultaneous polydrug use among undergraduate students of health sciences programs of one university, Santiago - Chile / Caracteristicas do policonsumo simultâneo de drogas em alunos de graduação da área de ciências da saúde em uma universidade, Santiago - Chile

Estudio transversal cuyo objetivo fue establecer los patrones de policonsumo simultáneo de drogas en estudiantes universitarios de pregrado de carreras de medicina y enfermería, en una universidad de la ciudad de Santiago - Chile. Contó con una muestra de 188 estudiantes. Resultados: 42.3% de los estudiantes refirieron policonsumo simultáneo; edad promedio de inicio 16 años; combinaciones más comunes fueron alcohol + tabaco + marihuana y tabaco + alcohol + drogas de prescripción. Aprenden de las combinaciones de drogas a través de amigos, consumen en grupos mixtos, fuera de la universidad (clubes nocturnos) y lo hacen para relajarse o disfrutar de la compañía de amigos. Es fundamental desarrollar estrategias integrales si se desea contribuir a mejorar la salud de esta población de jóvenes, quienes estarán a cargo de la salud de las generaciones futuras.

Cross sectional study whose objective was to establish the patterns of simultaneous poly-drug use among students in undergraduate medical and nursing careers, at a university in Santiago - Chile. A sample of 188 students was studied. Results: 42.3% of students refered simultaneous poly-drug use, average age of onset of 16 years; most common combinations were alcohol + tobacco + marijuana and tobacco + alcohol with prescription drugs. They learn about drug combinations through friends, consume in mixed groups outside the university (nightclubs) and do it to relax or enjoy the company of friends. It is essential to develop comprehensive strategies in order to improve the health of this population of youngsters, who will be responsible for the health of future generations.

Estudo transversal, cujo objetivo foi estabelecer os padrões de policonsumo de drogas entre estudantes de Medicina e de Enfermagem, em uma universidade de Santiago - Chile. A amostra foi composta de 188 alunos. Os resultados indicam que 42,3% dos alunos são poli-consumidores, simultaneamente, com idade média de aparecimento de 16 anos e as combinações mais comuns foram álcool + tabaco + maconha e tabaco + álcool + medicamentos prescritos, além de aprendizagem através de amigos, e consumido em grupos mistos fora da universidade (discotecas) para fazê-los relaxar ou aproveitar a companhia dos amigos. É essencial desenvolver estratégias globais, se quiser contribuir para melhorar a saúde da população, e particularmente a este grupo de jovens, que serão responsáveis pela saúde de gerações futuras.

Medio social y uso simultáneo de alcohol y tabaco en estudiantes universitarios de pregrado de carreras de ciencias de la salud de una universidad, Cundinamarca - Colombia / Social enviroment and simultaneous use of alcohol and tobaco among undergraduate students in health sciences programs from one university, Cundinamarca - Colombia / Ambiente social e uso simultâneo de álcool e tabaco entre estudantes universitarios dos cursos de graduação em ciências da saúde de uma universidad, Cundinamarca - Colômbia

Estudio transversal cuyo objetivo fue describir el medio social relacionado con el policonsumo simultáneo de alcohol y tabaco, por parte de los estudiantes universitarios de pregrado de las carreras de ciencias de la salud, en una universidad de Cundinamarca, Colombia. Se aplicó un cuestionario a 451 estudiantes. Resultados: 22.6% de los estudiantes reportaron usar en forma simultánea alcohol y tabaco. Se identificaron las siguientes situaciones como de mayor prevalencia: el aprendizaje de esta combinación es a través de amigos y se consume predominantemente fuera de la universidad; este se hace para relajarse y disfrutar la compañía de los amigos, controlando así el estrés que generan las tareas universitarias y los conflictos familiares. Consideramos necesario desarrollar programas preventivos de alto impacto para ayudar a esta población universitaria, quienes a futuro estarán a cargo del bienestar de la población en general.

A transversal study whose aim was to describe the social environment associated with simultaneous polydrug use of alcohol and cigarettes, by the undergraduate students of careers of health sciences, at a university in Cundinamarca, Colombia. A questionnaire was administered to 451 students. Results: 22.6% of students reported using alcohol simultaneously cigarette aged between 18 and 26 years in the social environment represented by the triad (person-environment-psychoactive substances), identifies the following situations: this combination is learning through friends outside the university, they can relax and enjoy the company of friends, thus controlling the stress of academic tasks, and family conflict, facing conflict in their interpersonal relationships. We need to develop high-impact preventive programs to control a situation of great social cost worldwide.

Estudo transversal, cujo objetivo foi descrever o ambiente social associado ao uso simultâneo de múltiplas drogas, pelos estudantes de graduação na área de Ciências da Saúde, de uma universidade em Cundinamarca, Colômbia. Um questionário foi aplicado a 451 alunos. Resultados: 22,6% dos alunos, com idade entre 18 e 26, relataram uso de álcool, simultaneamente com tabaco, no ambiente social, representado pela pessoa (tríade ambiente de substâncias psicoativas). Foram identificadas as seguintes situações: aprendizagem para o uso de drogas através de amigos fora da universidade; entendem que podem relaxar e desfrutar da companhia dos amigos, e assim, controlar o stress das tarefas escolares e de conflitos familiares e em suas relações interpessoais. Conclui-se que é necessário desenvolver alto impacto de programas preventivos para controlar uma situação de grande custo social no mundo inteiro.