Safe inhalation pipe provision (SIPP): protocol for a mixed-method evaluation of an intervention to improve health outcomes and service engagement among people who use crack cocaine in England.

BACKGROUND: Over 180,000 people use crack cocaine in England, yet provision of smoking equipment to support safer crack use is prohibited under UK law. Pipes used for crack cocaine smoking are often homemade and/or in short supply, leading to pipe sharing and injuries from use of unsafe materials. This increases risk of viral infection and respiratory harm among a marginalised underserved population. International evaluations suggest crack pipe supply leads to sustained reductions in pipe sharing and use of homemade equipment; increased health risk awareness; improved service access; reduction in injecting and crack-related health problems. In this paper, we introduce the protocol for the NIHR-funded SIPP (Safe inhalation pipe provision) project and discuss implications for impact. METHODS: The SIPP study will develop, implement and evaluate a crack smoking equipment and training intervention to be distributed through peer networks and specialist drug services in England. Study components comprise: (1) peer-network capacity building and co-production; (2) a pre- and post-intervention survey at intervention and non-equivalent control sites; (3) a mixed-method process evaluation; and (4) an economic evaluation. Participant eligibility criteria are use of crack within the past 28 days, with a survey sample of ~ 740 for each impact evaluation survey point and ~ 40 for qualitative process evaluation interviews. Our primary outcome measure is pipe sharing within the past 28 days, with secondary outcomes pertaining to use of homemade pipes, service engagement, injecting practice and acute health harms. ANTICIPATED IMPACT: SIPP aims to reduce crack use risk practices and associated health harms; including through increasing crack harm reduction awareness among service providers and peers. Implementation has only been possible with local police approvals. Our goal is to generate an evidence base to inform review of the legislation prohibiting crack pipe supply in the UK. This holds potential to transform harm reduction service provision and engagement nationally. CONCLUSION: People who smoke crack cocaine in England currently have little reason to engage with harm reduction and drug services. Little is known about this growing population. This study will provide insight into population characteristics, unmet need and the case for legislative reform. TRIAL REGISTRATION: ISRCTN12541454  https://doi.org/10.1186/ISRCTN12541454.

Cuidado em saúde mental com gestantes usuárias de crack / Mental health care with pregnant crack users / Cuidadode salud mental con mujeres embarazadas que utilizan crack

Neste manuscrito, apresentamos uma pesquisa cujo objetivo foi o de compreender como vem sendo produzidas as práticas de cuidado às gestantes usuárias de crack nos serviços de saúde de um município do interior do Rio Grande do Sul. Este estudo de abordagem qualitativa, foi realizado junto a dois serviços públicos, o Programa de Redução de Danos (PRD) e o Centro de Atenção Psicossocial para Álcool e outras Drogas (CAPSad III), com cinco mulheres voluntárias para a pesquisa. As histórias de vida foram reconstruídas a partir de suas narrativas e também de profissionais da saúde que proveram algum tipo de cuidado às participantes. Após a exposição das histórias, refletimos sobre três pistas importantes para pensarmos as práticas de cuidado às gestantes usuárias de crack: saúde mental, uso de drogas e interseccionalidade; direitos humanos, hierarquias reprodutivas e concepções de maternidade; e as práticas de cuidado em saúde. Observamos que as concepções dos profissionais acerca da maternidade direcionam as práticas de cuidado em saúde, caracterizando-se como um cuidado no espectro da saúde materno-infantil, e não um cuidado direcionado à saúde da mulher. Conhecer as demandas de cuidado dessas mulheres é essencial para que possamos pensar em práticas de saúde pautadas pela clínica ampliada. (AU)

In this manuscript, we present a research whose objective was to understand how the practicesof care to the pregnant women users of crack have been being produced in the services of health in a town of Rio Grande do Sul. This study of qualitative approach it was developed jointly to two public services, the Program of Reduction of Harms (PRH) andPsychosocial Care Centers Alcohol and other Drugs (CAPSad), with five voluntary women for the research. The life histories were rebuilt starting from their narratives and also of health's professionals that provided some care to the participants.After exposing the stories, we reflected on three important clues to think about care practices for pregnant women who use crack: mental health, drug use and intersectionality; human rights, reproductive hierarchies and conceptions of motherhood; and health care practices. We observed that the professionals' conceptions about maternity guide health care practices, characterized as care in the spectrum of maternal and child health, and not care directed at women's health.Knowing the care demands of these women is essential for us to think about health practices guided by the expanded clinic. (AU)

En este manuscrito presentamos una investigación cuyoobjetivo fue comprender cómo se ha producidolas prácticas de atención a las embarazadas usuarias de crack en los servicios de salud de una ciudad del interior de Rio Grande do Sul. Este estudio cualitativo se realizó con dos servicios públicos, el Programa de Reducción de Daños (PRD) y el Centro de Atención Psicosocial de Alcohol y Otras Drogas (CAPSad III), con cinco mujeres voluntarias para la investigación. Las historias de vida fueron reconstruidas a partir de sus narrativas y también de profesionalesde la salud que brindaron algún tipo de atención a los participantes. Luego de exponer las historias, reflexionamos sobre tres claves importantes para pensar en las prácticas de cuidado de las embarazadas que consumen crack: salud mental, consumo de drogas y interseccionalidad; derechos humanos, jerarquías reproductivas y concepciones de la maternidad; y prácticas de atención de la salud.Observamos que las concepciones de los profesionales sobre la maternidad orientan las prácticas de atención de la salud, caracterizadas como cuidados en el espectro de la salud maternoinfantil, y no cuidados dirigidos a la salud de la mujer. Conocer las demandas de atención de estas mujeres es fundamental para que pensemos en las prácticas de salud guiadas por la clínica ampliada. (AU)

Assessment of cognitive functioning using the Mini Mental State Examination in men with Alcohol and Crack Cocaine Use Disorder.

INTRODUCTION: Consumption of substances has been associated with cognitive impairment. The Mini Mental State Examination (MMSE) is an easy-to-apply screening tool used to assess cognitive functions. OBJECTIVES: To evaluate the cognitive performance of individuals with alcohol (AUD) and/or crack cocaine use disorder (CUD) and polysubstance use using the MMSE and to investigate the impact of substance use profile and the moderation effect of educational level on MMSE performance. METHODS: Cross-sectional study with 508 adult male inpatients diagnosed with substance use disorders (245 with AUD, 85 with CUD, and 178 with polysubstance use). Cognitive performance was assessed using the MMSE scale (total and composite scores). RESULTS: Individuals with AUD had worse total MMSE scores and scored worse for all three MMSE components compared to individuals with polysubstance use (p < 0.001, oral/written language comprehension, p < 0.001, attention/memory, and p = 0.007, motor functions). MMSE scores were positively correlated with educational level (p < 0.017), but were not associated with age, recent drug use, or years of drug use. Educational level moderated the impact of substance use on MMSE performance, especially total score and composite language comprehension score. Individuals with a low educational level (≤ 8 years) had worse performance than those with a high educational level (≥ 9 years), mainly in individuals with AUD (p < 0.001). DISCUSSION: Individuals with a low educational level and alcohol use are more prone to present cognitive impairment than crack cocaine users, especially involving language aspects. Better-preserved cognitive function could impact treatment adherence and might guide the decision of therapeutic strategies.

(Sobre)viver na rua: narrativas das pessoas em situação de rua sobre a rede de apoio / (About) living on the street: narratives of homeless people about the support network / (Sobre)vivir en la calle: narrativas de personas en situación de calle sobre la red de apoyo

A população em situação de rua (PSR), em seu cotidiano, se relaciona com diferentes pessoas, grupos e/ou coletivos ligados à execução das políticas públicas, às organizações não governamentais, familiares ou a membros da sociedade civil. Pensar nessas dinâmicas de trabalho, cooperação e auxílio remete a pensar sobre uma rede de apoio que constrói estratégias com essa população. Tendo presente essas problematizações, este estudo teve como objetivo analisar as narrativas das pessoas em situação de rua sobre como é produzida sua rede de apoio. Para tanto, foi realizado um estudo qualitativo, de orientação etnográfica, sendo utilizada a observação participante, registros em diário de campo e entrevistas narrativas. Participaram seis pessoas em situação de rua que recebem alimentação ofertada por projetos sociais em uma cidade do interior do Rio Grande do Sul. Os dados produzidos foram analisados a partir da Análise Temática. As análises expressam as especificidades das narrativas das trajetórias de vida associadas à chegada às ruas e à composição de uma rede de apoio na rua. Ao conhecer como se produz e opera essa rede de apoio, a partir das narrativas das pessoas em situação de rua, problematiza-se a complexidade dessa engrenagem e o desafio de produzir ações integradas entre as diferentes instâncias da rede. Nisso, destaca-se a potencialidade de práticas que levem conta à escuta, ao diálogo e à articulação na operacionalização de políticas públicas atentas às necessidades dessa população.(AU)

The street population, in their daily lives, relates to different people, groups and/or collectives linked to the execution of public policies, to non-governmental organizations, family members, or to members of civil society. Thinking about these dynamics of work, cooperation, and assistance leads to thinking about a support network that builds strategies with this population. Having these problematizations in mind, this study aims to analyze the narratives of homeless people about how their support network is produced. To this end, a qualitative study was carried out, with ethnographic orientation, using participant observation, records in a field diary, and narrative interviews. Participated in the research six homeless people who receive food offered by social projects in a municipality in the interior of Rio Grande do Sul. The data produced were analyzed using the Thematic Analysis. The analyzes express the specifities of the narratives of life trajectories associated with the arrival on the streets and the composition of a support network on the street. By knowing how the support network is produced and operated, the complexity of this gear and the challenge of producing integrated actions between the different instances of the network are problematized. Thus, it highlights the potential of practices that consider listening, dialogue, and articulation in the operationalization of public policies that are attentive to the needs of this population.(AU)

Las personas en situación de calle en su cotidiano se relacionan con distintas personas, grupos y/o colectivos, que están vinculados a la ejecución de políticas públicas, organizaciones no gubernamentales, familiares o miembros de la sociedad civil. Pensar en estas dinámicas de trabajo, cooperación y ayuda nos lleva a una red de apoyo que construye estrategias con estas personas. Teniendo en cuenta esta problemática, este estudio tiene como objetivo analizar las narrativas de las personas en situación de calle acerca de cómo se produce su red de apoyo. Con este fin, se realizó un estudio cualitativo, etnográfico, utilizando observación participante, registros de diario de campo y entrevistas narrativas. Este estudio incluyó a seis personas en situación de calle que reciben alimentos ofrecidos por proyectos sociales en una ciudad del interior de Rio Grande do Sul (Brasil). Se utilizó el Análisis Temático. Los análisis expresan las especificidades de las narrativas de las trayectorias de vida asociadas con la llegada a las calles y la composición de una red de apoyo en la calle. Al saber cómo se produce y opera la red de apoyo, a partir de las narrativas de las personas en la calle, se problematizan la complejidad de este equipo y el desafío de producir acciones integradas entre las diferentes instancias de la red. Destaca el potencial de las prácticas que tienen en cuenta la escucha, el diálogo y la articulación en la implementación de políticas públicas que estén atentas a las necesidades de esta población.(AU)

Sobre dias em que me senti sem ar: desassossegos do pesquisar / On days when i felt breathless: unrest of search / Sobre días que me sentí sin aliento: disurbios de investigación

Resumo Conceitos como o de alteridade, encontro de saberes, polifasia cognitiva, o princípio de familiaridade e de representações sociais operaram na complexa tarefa de compreender como os encontros entre profissionais e usuários sustentavam e/ou transformavam as práticas de acolhimento. Entretanto, a experiência da minha pesquisa de doutorado me levou a questionar os próprios conceitos utilizados da Teoria das Representações Sociais. Ao final do ensaio, após discutir aspectos teórico-metodológicos, o princípio de familiaridade e a questão da tensão e dos afetos nas representações sociais, espero evidenciar como o movimento provocado pelo encontro com usuários e profissionais de uma Rede de Atenção Psicossocial levou-me a questionar pontos essenciais da teoria: o papel domesticador das representações, a forma ainda estática de evidenciar os fenômenos, a separação entre um sujeito que representa e o objeto representado e a dificuldade em usar suas ferramentas conceituais para acompanhar processos me fazem repensar meu lugar e minha função de pesquisador.

Abstract Concepts such as alterity, encounter of knowledge, cognitive polyphasia, the principle of familiarity and the very concept of social representations operated in the complex task of understanding how the encounters between professionals and users supported and / or transformed user embracement practices. However, the experience of my doctoral research led me to question the very concepts used in the Theory of Social Representations. At the end of the essay, after discussing theoretical and methodological aspects, the principle of familiarity and the issue of tension and affects in social representations, I hope to show how the movement caused by the encounter with users and professionals of a Psychosocial Care Network, led me to question essential points of the theory: the domesticating role of representations, the still static way of showing phenomena, the separation between a subject that represents and the object represented and the difficulty in using their conceptual tools to accompany processes makes me rethink my place and role as a researcher.

Resumen Conceptos como la alteridad, el encuentro de saberes, la polifasia cognitiva, el principio de familiaridad y el concepto mismo de representaciones sociales operaron en la compleja tarea de comprender cómo los encuentros entre profesionales y usuarios apoyaron y / o transformaron las prácticas de acogimiento. Sin embargo, la experiencia de mi investigación doctoral me llevó a cuestionar los propios conceptos utilizados en la Teoría de las Representaciones Sociales. Al final del ensayo, después de discutir aspectos teóricos y metodológicos, el principio de familiaridad y el tema de tensión y afectos en las representaciones sociales, Espero mostrar cómo el movimiento provocado por el encuentro con usuarios y profesionales de una Red de Atención Psicosocial, me llevó a cuestionar puntos esenciales de la teoría: el rol domesticador de las representaciones, la forma todavía estática de mostrar los fenómenos, la separación entre un sujeto que representa y el objeto representado y la dificultad para utilizar sus herramientas conceptuales para acompañar procesos, me hace repensar mi lugar y rol como investigador.

Spatial and temporal assessment of crack cocaine use in 13 European cities through wastewater-based epidemiology.

Already in early 2000s, concerns have been growing in the EU about increasing use of cocaine and it is estimated that below 1 % of the population administer the drug by smoking crack cocaine. New available data suggests an increase in the use of crack cocaine and an increase in the number of crack cocaine users entering treatment has been reported in several European countries. Robust estimations of crack cocaine use are however not available yet. The use of crack cocaine has long been associated with severe adverse socio-economic conditions as well as mental health problems, such as suicide ideation and depression. The aim of this study was to assess spatial trends in population-normalized mass loads of crack cocaine biomarkers (i.e., anhydroecgonine and anhydroecgonine methyl ester) in 13 European cities in six countries (the Netherlands, Belgium, Ireland, Portugal, Spain and Italy). Furthermore, temporal trends over a five-year period were evaluated through the analysis of historic samples collected in the Netherlands. Finally, the stability of the crack cocaine biomarkers in wastewater was investigated through batch experiments. The samples were analyzed with a new developed and validated hydrophilic interaction liquid chromatography coupled to mass spectrometry method. Targeted crack cocaine biomarkers were found in all cities. Also, crack cocaine biomarker was detected in wastewater from 2017 to 2021 in the Netherlands, but no significance between the years were found. With respect to biomarker in-sample stability, AEME was found to be stable in wastewater. This study assessed crack cocaine use for the first time on a broad scale, both temporal and in cities across Europe, with wastewater-based epidemiology and it shows the importance of wastewater analysis to monitor community loads of crack cocaine use.

A droga como dispositivo de controle social: uma análise das representações sociais do álcool, maconha e crack na imprensa brasileira / Las drogas como dispositivo de control social: un análisis de las representaciones sociales del alcohol, la marihuana y el crack en la prensa brasileña / Drugs as a social control device: an analysis of the social representations of alcohol, marijuana and crack in the brazilian press

RESUMO. As drogas se consolidam como um dos arquétipos culturais predominantes no cotidiano das sociedades urbanas, sendo sua presença ubíqua em praticamente todas as culturas. Os registros históricos apresentam ampla variabilidade de substâncias que em dado momento eram classificadas como o perigo social da época e que em outro se tornavam banalizadas ou tipificadas como inofensivas. Assim, esse estudo teve como objetivo analisar como dispositivo droga que se consolida em diferentes períodos históricos. Para isso, foram coletadas 4.227 matérias dos jornais Folha da Manhã, Folha da Noite e Folha de São Paulo, que abordassem questões relativas ao álcool (década de 1920), maconha (décadas de 1930 a 1960) e crack (década de 1980 a 2005) e realizada Análise Temática de Conteúdo. Os resultados permitem afirmar que a característica central que define todas as substâncias analisadas nos distintos momentos históricos é o risco social que ela apresenta. A droga se constitui como um risco aos usuários ao mesmo tempo que os institui enquanto uma figura de ameaça social. Ao se referenciar uma substância como uma droga, são ativados sentidos que remetem a um quadro de decadência e criminalidade.

RESUMEN. Las drogas se consolidan como uno de los arquetipos culturales predominantes en la vida cotidiana de las sociedades urbanas, y su presencia ubicua en prácticamente todas las culturas. Los registros históricos muestran una amplia variabilidad de sustancias que en un momento se clasificaron como el peligro social de la época y en otro momento se trivializaron o tipificaron como inofensivas. Así que este estudio tuvo como objetivo analizar cómo diferentes sustancias psicoactivas se encuentran en la prensa como un riesgo social en diferentes momentos. Para ello, se recogieron 4.227 artículos del periódico Folha da Manhã, Folha da Noite y Folha de São Paulo, que abordasen temas relacionados con el alcohol (1920), marihuana (1930 a 1960) y el crack (1980 a 2005) y se realizó un Análisis Temático de Contenido. Los resultados muestran que la característica definitoria de todas las drogas examinadas en los diferentes momentos históricos es el riesgo social que presenta. La droga se constituye como un riesgo para los usuarios mientras los establece como una figura de amenaza social. Al hacer referencia a una sustancia como droga, se activan sentidos que conducen a un marco de decadencia y criminalidad.

ABSTRACT Drugs are one of the predominant cultural archetypes in the daily life of urban societies, and their ubiquitous presence in almost all cultures. Historical records show a wide variability of substances that at one point were classified as the social danger of the time and at another time trivialized or typified as harmless. Thus, this study aimed to analyze how different psychoactive substances are constituted in the press as a social risk at different times. For this, we collected 4,227 articles of newspapers Folha da Manhã, Folha da Noite and Folha de São Paulo, that addressed issues related to alcohol (1920), marijuana (1930s to 1960) and crack (1980s to 2005) and performed a Thematic Content Analysis. The results indicate that the central defining characteristic of all drugs examined in the different historical moments is the social risk it has. The drug is constituted as a risk to users while establishing them as a figure of social threat. When referring a substance as a drug, senses are activated that denote to a situation of decadence and crime.

Perfil dos usuários de um centro de atenção psicossocial álcool e outras drogas na zona da mata de pernambuco / Profile of users of a psychosocial care center alcohol and other drugs in the area of the forest of Pernambuco / Perfil de usuarios de un centro psicosocial de alcohol y otras drogas en el bosque Pernambuco

Introdução:A implementação de políticas de saúde para garantia da atenção integral aos usuários de álcool e outras drogas vem sendo realizada há algumas décadas e teve sua garantia normativa fortalecida com o passar dos anos através da criação de leis e dispositivosassistenciais cujo objetivo foi redesenhar o cuidado ofertado a essa população. Na atualidade, persistem desafios para a garantia de acesso a uma demanda crescente de pessoas. A implantação de serviços especializados regionais tem sido uma aposta importante para superar alguns desses desafios. Objetivo:analisar o perfil dos usuários de umCentro de Atenção Psicossocial Álcool e outras drogasda zona da mata de Pernambuco. Metodologia:Estudo descritivo, transversal e quantitativo, realizado entre março ejulho de 2018. Foi realizada coleta de dados primários em prontuários dos usuários do referido centro e analisados a partir da estatística descritiva. Resultados:Os usuários do serviço eram homens (93,8%), da cor parda (46,5%), solteiros (42,3%) e desempregados (43,2%). A maioria foi admitida quando jovem-adulto (46,4%) e por demanda espontânea (64,6%). Apresentam histórico familiar positivo (89,5%) e fazem uso predominante do álcool exclusivo (32,5%). A maioria dos usuários reside no município onde o centro supracitado está sediado. Conclusão:Os dados seguem a tendência dos estudos realizados nos últimos anos em saúde mental sobre os transtornos decorrentes do uso de crack, álcool e outras drogas e evidenciam a necessidade de fortalecer as redes regionalizadas, discutindo desde a infraestrutura como o transporte aos serviços até a necessária articulação entre o centro de atenção psicossocial álcool e outras drogas e a Atenção Básica (AU).

Introduction:The implementation of health policies to guarantee comprehensive care for users of alcohol and other drugs has been carried outfor some decades and had its normative guarantee strengthened over the years through the creation of laws and assistance devices whose objective was to redesign the care offered to this population. Currently, challenges persist to guarantee access to a growing demand of people. The implementation of specialized regional services has been an important bet to overcome some of these challenges. Objective:to analyze the profile of users of a Psychosocial Care Center for Alcohol and other drugs in the forest zone of Pernambuco. Methodology: Descriptive, cross-sectional and quantitative study, carried out between March and July 2018. Primary data was collected from medical records of users of that center and analyzed using descriptive statistics. Results:The service users were men (93.8%), brown (46.5%), single (42.3%) and unemployed (43.2%). Most were admitted as a young adult (46.4%) and by spontaneous demand (64.6%). They have a positive family history (89.5%) and make predominant use of exclusive alcohol (32.5%). Most users live in the municipality where the aforementioned center is based. Conclusion:The data follow the trend of studies carried out in recent years in mental health on disorders resulting from the use of crack, alcohol and other drugs and highlight the need to strengthen regionalized networks, discussing from infrastructure such as transport to services to the necessary articulation betweenthe alcohol and other drugs psychosocial care center and the Primary Care (AU).

Introducción:La implementación de políticas de salud para garantizar la atención integral a los usuarios de alcohol y otras drogas se viene realizando desde hace algunas décadas y ha tenido su garantía normativa fortalecida a lo largo de los años a través de la creación de leyes y dispositivos asistenciales cuyo objetivo fue rediseñar la atención ofrecida. a esta población. Actualmente, persisten los desafíos para garantizar el acceso a una demanda creciente de personas. La implementación de servicios regionales especializados ha sido una apuesta importante para superar algunos de estos desafíos. Objetivo:analizar el perfil de usuarios de un Centro de Atención Psicosocial por Alcohol y otras drogas en la zona forestal de Pernambuco. Metodología:Estudio descriptivo, transversal y cuantitativo, realizado entre marzo y julio de 2018. Se recogieron datos primarios de las historias clínicas de los usuarios de ese centro y se analizaron mediante estadística descriptiva. Resultados:Los usuarios del servicio fueron hombres (93,8%), morenos (46,5%), solteros (42,3%) y desempleados (43,2%). La mayoría ingresó como adulto joven (46,4%) y por demanda espontánea (64,6%). Tienen antecedentes familiares positivos (89,5%) y hacen un uso predominante de alcohol exclusivo (32,5%). La mayoría de usuarios vive en el municipio donde tiene su sede el mencionado centro. Conclusión:Los datos siguen la tendencia de los estudios realizados en los últimos años en salud mental sobre los trastornos derivados del uso de crack, alcohol y otras drogas y destacan la necesidad de fortalecer las redes regionalizadas, discutiendo desde la infraestructura como el transporte hasta los servicios hasta los necesarios. articulación entre el centro de atención psicosocial de alcohol y otras drogas y la Atención Primaria (AU).

Atenção à saúde no território como prática democrática: ações em cenas de uso de drogas como analisadores da democracia brasileira / Health care as a democratic practice: actions in drug use settings to analyze democracy in Brazil / Atención de la salud en el territorio como práctica democrática: acciones en escenas de uso de drogas como analizadores de la democracia brasileña

Propomos articular democracia, produção de saúde e cuidado com grupos vulnerabilizados. Utilizamos como analisadores ações estatais em cenas de uso de drogas ilícitas em São Paulo e no Rio de Janeiro, que coadunam com estratégias de intervenções sobre regiões tornadas negócios e sobre grupos que habitam tais regiões e, por isso, precisam ser removidos, que podem ser consideradas intervenções próprias ao neoliberalismo e seu correlato jurídico, o Estado de Exceção permanente. Entendemos que políticas de governo que pautam suas ações pela abstinência e internação dos usuários classificados como dependentes químicos estão em sinergia com a chamada guerra às drogas. Nosso objetivo é sinalizar que a atenção ao uso de substâncias psicoativas como preconizado pela estratégia da redução de danos tem potencial para capilarizar as diretrizes do Sistema Único de Saúde (SUS), da Reforma Psiquiátrica Brasileira e, desse modo, do escopo democrático nos territórios de maior vulnerabilidade social. (AU)

This article articulates democracy, health and health care among vulnerable groups. We use state actions in drug use settings in São Paulo and Rio de Janeiro carried out in conjunction with interventions to evict drug users living in districts that have become commercial areas to analyze democracy in Brazil; typical interventions associated with neoliberalism and its legal counterpart, the State of Permanent exception. We understand that government policies based on abstinence and internment of drug addicts are in tune with the so-called war on drugs. We highlight that the approach to the use of psychoactive substances embodied in harm reduction strategies has the potential to increase the capillarity of the guiding principles of the Brazilian National Health System (SUS), Mental Health Reform and, therefore, democracy in socially vulnerable areas. (AU)

Proponemos articular democracia, producción de salud y cuidado con grupos en situación de vulnerabilidad. Como analizadores utilizamos acciones estatales en escenas de uso de drogas ilícitas en São Paulo y Río de Janeiro, juntamente con intervenciones estratégicas sobre regiones convertidas en negocios y grupos que habitan tales regiones y que por eso tienen que ser retirados. Intervenciones propias del neoliberalismo y su correlación jurídica, el Estado de Excepción Permanente. Entendemos que políticas de gobierno que rigen sus acciones por la abstinencia e internación de los usuarios clasificados como dependientes químicos están en sinergia con la denominada guerra a las drogas. Nuestro objetivo es señalizar que la atención al uso de substancias psicoactivas conforme determinado por la estrategia de la reducción de daños tiene potencial para capilarizar las directrices del Sistema Brasileño de Salud (SUS), de la Reforma Psiquiátrica Brasileña y, de ese modo, del alcance democrático en los territorios de mayor vulnerabilidad social. (AU)

Concepções de gestores de serviços de saúde sobre a rede de atenção psicossocial a usuários de crack / Conceptions of health services managers about the psychosocial care network to crack users

Objetivo: o objetivo deste estudo foi conhecer a concepção de gestores de serviços de saúde sobre a rede de atenção psicossocial a usuários de crack. Métodos: pesquisa qualitativa, do tipo avaliativa, com a utilização do referencial da Avaliação de Quarta Geração. Foi realizada em um Centro de Atenção Psicossocial álcool e outras Drogas de um município do Estado do Rio Grande do Sul, Brasil. A coleta de dados ocorreu entre janeiro e maio de 2013, a partir de entrevistas orientadas pela utilização do círculo hermenêuticodialético. Resultados e Discussões: os gestores revelam uma concepção de rede intersetorial, reconhecendo os serviços da rede de atenção psicossocial e a articulação entre eles. Além disso, entendem a importância da parceria com dispositivos oriundos de outros setores da sociedade. Conclusões: os gestores do município têm se empenhado em constituir uma política de saúde mental centrada no usuário, com articulação intersetorial, defendendo os princípios da reforma psiquiátrica e da atenção psicossocial.(AU)

Objective: the objective of this study was to understand the concept of health service managers about the psychosocial care network for crack users. Methods: qualitative research, evaluative type, using the Fourth Generation Evaluation reference. Alcohol and other drugs in a city in the state of Rio Grande do Sul, Brazil took place in a Psychosocial Care Center. Data collection took place between January and May 2013, based on interviews guided by the use of the hermeneutic-dialectic circle. Results and Discussions: managers revealed a concept of intersectoral network, recognizing the services of the psychosocial care network and the articulation between them. Also, they understood the importance of partnering with devices from other sectors of society. Conclusions: city managers have endeavored to establish a user-centered mental health policy, with intersectoral articulation, defending the principles of the psychiatric reform and psychosocial care.(AU)

Objetivo: el objetivo de este estudio fue comprender el concepto de los administradores de los servicios de salud sobre la red de atención psicosocial para usuarios de crack. Métodos: investigación cualitativa, tipo evaluativa, que utilizó el marco de referencia de la evaluación de cuarta generación. El estudio se llevó a cabo en un Centro de Atención Psicosocial alcohol y otras drogas de una ciudad del estado de Rio Grande do Sul, Brasil. La recogida de datos se efectuó entre enero y mayo de 2013, con entrevistas según la técnica del círculo hermenéutico-dialéctico. Resultados y debates: los administradores revelan un concepto de red intersectorial que reconoce los servicios de dicha red de atención y la articulación entre ellos. Además, entienden la importancia de asociarse con dispositivos de otros sectores de la sociedad. Conclusiones: los administradores de la ciudad se han esforzado por establecer una política de salud mental centrada en el usuario, con articulación intersectorial, defendiendo los principios de la reforma psiquiátrica y de la atención psicosocial.(AU)

Assessment of components of crack users' attention network.

OBJECTIVE: Assess components of the Psychosocial Attention Network (RAPS) in crack user care in a Rio Grande do Sul municipality. METHOD: Qualitative study based on Fourth Generation Evaluation. Data collection occurred in 2014, through participating observation and interviews based on the Hermeneutic-Dialectic Circle. Ten uses, eleven family members, seven managers and eight workers at a Psychosocial Attention Center participated. The Constant Comparative Method was used for data analysis. RESULTS: Difficulties were observed in the network articulation with the general hospital, due to prejudice and the lack of structure of the team. SAMU's (Mobile Emergency Care Service) dependence on the Military Brigade for the service indicates a frailty of the network. The need to re-think the way therapeutic farms operate in the network is a consensus. CONCLUSION: RAPS is being implemented and its concretization depends on the involvement of professionals, managers and social control of users and family members.

Treatment versus Punishment: Understanding Racial Inequalities in Drug Policy.

CONTEXT: Many observers believe that the policy response to the opioid crisis is less punitive than the crack scare and that the reason is that victims are (stereotypically) white. METHODS: To assess this conjecture, we compile new longitudinal data on district-level drug-related deaths and (co)sponsorship of legislation on drug abuse in the House of Representatives over the past four decades. Using legislator fixed effects models, we then test how changes in drug-related death rates in legislators' districts predict changes in (co)sponsorship of treatment-oriented or punitive legislation in the subsequent year and assess whether these relationships vary by race of victim or drug type. FINDINGS: Policy makers were more likely to introduce punitive drug-related bills during the crack scare and are more likely to introduce treatment-oriented bills during the current opioid crisis. The relationship between district-level drug deaths and subsequent sponsorship of treatment-oriented legislation is greater for opioid deaths than for cocaine-related deaths and for white victims than for black victims. By contrast, district-level drug deaths are not significantly related to sponsorship of punishment-oriented bills. CONCLUSIONS: These results suggest that the racial inequalities and double standards of drug policy still persist but in different forms.

Criminal Justice or Public Health: A Comparison of the Representation of the Crack Cocaine and Opioid Epidemics in the Media.

CONTEXT: The opioid epidemic is a major US public health crisis. Its scope prompted significant public outreach, but this response triggered a series of journalistic articles comparing the opioid epidemic to the crack cocaine epidemic. Some authors claimed that the political response to the crack cocaine epidemic was criminal justice rather than medical in nature, motivated by divergent racial demographics. METHODS: We examine these assertions by analyzing the language used in relevant newspaper articles. Using a national sample, we compare word frequencies from articles about crack cocaine in 1988-89 and opioids in 2016-17 to evaluate media framings. We also examine articles about methamphetamines in 1992-93 and heroin throughout the three eras to distinguish between narratives used to describe the crack cocaine and opioid epidemics. FINDINGS: We find support for critics' hypotheses about the differential framing of the two epidemics: articles on the opioid epidemic are likelier to use medical terminology than criminal justice terminology while the reverse is true for crack cocaine articles. CONCLUSIONS: Our analysis suggests that race and legality may influence policy responses to substance-use epidemics. Comparisons also suggest that the evolution of the media narrative on substance use cannot alone account for the divergence in framing between the two epidemics.

Baseline cocaine demand predicts contingency management treatment outcomes for cocaine-use disorder.

Cocaine use disorder (CUD) is a significant public health issue. Behavioral interventions such as contingency management (CM) have been demonstrated to be highly effective in promoting cocaine abstinence. However, identifying individual characteristics associated with cocaine relapse may help improve treatment outcomes. Cocaine demand is a behavioral economic measure that shares a scientific foundation with CM. In the current study, we assessed baseline cocaine demand using a hypothetical cocaine purchasing task. Participants (N = 58) consisted of treatment-seeking individuals with CUD. All participants received 1 month of CM treatment for cocaine abstinence, and treatment responders were defined as presenting 6 consecutive cocaine negative urine samples from thrice weekly clinic visits. Demand data were well described by the exponentiated demand model. Indices of demand (intensity of demand [Q0], elasticity [α]) were significantly associated with recent (last 30 days) cocaine use. Importantly, linear regression revealed that CM treatment nonresponders presented significantly higher Q0 (p = .025). Subsequent quantile regression analyses examining the relationship between CM treatment response and Q0 revealed statistically reliable effects of being a nonresponder across 3 of the lower percentiles (i.e., 15, 25, and 30). Overall, these findings provide further support for the utility of exponentiated demand model. To our knowledge, this is the first study to demonstrate an association between baseline demand and contingency management response and systematically extend the findings of prior demand research to a novel drug class, cocaine. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Assessment of components of crack users' attention network / Evaluación de componentes de la red para atención de los usuarios de crack / Avaliação de componentes da rede para o atendimento a usuários de crack

ABSTRACT Objective: Assess components of the Psychosocial Attention Network (RAPS) in crack user care in a Rio Grande do Sul municipality. Method: Qualitative study based on Fourth Generation Evaluation. Data collection occurred in 2014, through participating observation and interviews based on the Hermeneutic-Dialectic Circle. Ten uses, eleven family members, seven managers and eight workers at a Psychosocial Attention Center participated. The Constant Comparative Method was used for data analysis. Results: Difficulties were observed in the network articulation with the general hospital, due to prejudice and the lack of structure of the team. SAMU's (Mobile Emergency Care Service) dependence on the Military Brigade for the service indicates a frailty of the network. The need to re-think the way therapeutic farms operate in the network is a consensus. Conclusion: RAPS is being implemented and its concretization depends on the involvement of professionals, managers and social control of users and family members.

RESUMEN Objetivo: Evaluar los componentes de la Red de Atención Psicosocial (RAPS) en la atención de los usuarios de crack en una ciudad de Rio Grande do Sul. Método: Investigación cualitativa basada en la evaluación de cuarta generación. La recolección de datos se produjo en 2014, a través de la observación participante y entrevistas, basadas en el Círculo Hermenéutico-Dialéctico. Participaron diez usuarios, once familiares, siete gerentes y ocho trabajadores de un Centro de Atención Psicosocial. El Método Comparativo Constante fue adoptado para el análisis de datos. Resultados: Se identificaron dificultades en la articulación de la red con el hospital general debido a los prejuicios y la falta de estructura del equipo. La dependencia del Servicio Móvil de Atención de Emergencia (SAMU) en la Brigada Militar para proporcionar servicio demuestra una debilidad de la red. Existe consenso sobre la necesidad de repensar la forma en que operan las granjas terapéuticas en la red. Conclusión: La Red de Atención Psicosocial se está implementando y su implementación depende de la participación de profesionales y gerentes, y del control social de los usuarios y sus familias.

RESUMO Objetivo: Avaliar componentes da Rede de Atenção Psicossocial (RAPS) no cuidado ao usuário de crack em um município do Rio Grande do Sul. Método: Estudo qualitativo, baseado na Avaliação de Quarta Geração. A coleta de dados ocorreu em 2014, através de observação participante e entrevistas, com base no Círculo Hermenêutico-Dialético. Participaram dez usuários, onze familiares, sete gestores e oito trabalhadores de um Centro de Atenção Psicossocial. O Método Comparativo Constante foi adotado para a análise dos dados. Resultados: Foram identificadas dificuldades na articulação em rede com o hospital geral devido ao preconceito e falta de estrutura da equipe. A dependência do SAMU na Brigada Militar para realizar atendimentos aponta uma fragilidade da rede. Há consenso sobre a necessidade de repensar o modo como as fazendas terapêuticas operam na rede. Conclusão: A RAPS está em implementação e sua efetivação depende do envolvimento dos profissionais e gestores, e do controle social de usuários e familiares.

O que o crack tem a ver com a rua? Uma revisão narrativa com implicações políticas (2011-2017) / What does crack have to do with the street? A narrative review with political implications (2011-2017)

Resumo Objeto: Produção científica sobre o crack e a rua publicada em periódicos brasileiros indexados no SciELO e portal CAPES. Objetivo: Revisar tal produção, trabalhando os resultados a fim de investigar a recente associação entre pessoas que fazem uso de crack e que se encontram em situação de rua. Metodologia: Busca na base online de artigos do SciELO e portal CAPES, utilizando-se 3 out. 2017 como corte temporal, "crack AND rua", "crack AND moradores de rua" e "crack AND população em situação de rua" como "termo pesquisado" a partir de 2011 a outubro de 2017. Identificaram-se 63 referências, cujos resumos foram analisados, chegando-se aos 20 artigos que, efetivamente, dizem respeito à questão da associação entre crack e rua. Análise: critérios institucionais (título, periódico e data de publicação). Categorias: "crack e população em situação de rua"; "crack e o espaço da rua" e "indexadores históricos das ruas". Resultados: Dentre os 20 artigos consultados, 18 vinculam diretamente o consumo de crack à população em situação de rua e/ou ao espaço da rua. A associação entre crack e rua é notável não só na produção científica nacional sobre o consumo da "droga", mas também na produção normativa e governamental.

Abstract Object: Scientific production on crack and street published in Brazilian journals indexed in SciELO and CAPES portal. Objective: To review such production, working on the results in order to investigate the recent association between people who use crack and who are on the street. Methodology: Search the SciELO articles online database and CAPES portal, using 3 out. 2017 as a temporal cut, "crack AND street", "crack AND homeless people" and "crack AND homeless people" as "search term" from 2011 to October 2017. We identified 63 references, whose abstracts were analyzed, arriving at the 20 articles that, effectively, concern the issue of the association between crack and street. Analysis: institutional criteria (title, periodical and date of publication). Categories: "crack and homeless people"; "Crack and street space" and "historical street indexes". Results: Among the 20 articles assessed, 18 directly linked the consumption of crack to the population living on the street and / or to the street space. The association between crack and street is notable not only in national scientific production on the consumption of "drugs", but also in normative and governmental production.

Assessing service and treatment needs and barriers of youth who use illicit and non-medical prescription drugs in Northern Ontario, Canada.

BACKGROUND: Illicit drug use rates are high among Canadian youth, and are particularly pronounced in Northern Ontario. The availability and accessibility of effective substance use-related treatments and services are required to address this problem, especially among rural and remote Northern communities. In order to assess specific service and treatment needs, as well as barriers and deterrents to accessing and utilizing services and treatments for youth who use illicit drugs in Northern Ontario, we conducted the present study. METHODS: This study utilized a mixed-methods design and incorporated a community-based participatory research approach. Questionnaires were administered in conjunction with audio-recorded semi-structured interviews and/or focus groups with youth (aged 14-25) who live in Northern Ontario and use illicit drugs. Interviews with 'key informants' who work with the youth in each community were also conducted. Between August and December 2017, the research team traveled to Northern Ontario communities and carried out data collection procedures. RESULTS: A total of 102 youth and 35 key informants from eleven different Northern Ontario communities were interviewed. The most commonly used drugs were prescription opioids, cocaine and crack-cocaine. Most participants experienced problems related to their drug use, and reported 'fair' mental and physical health status. Qualitative analyses highlighted an overall lack of services; barriers to accessing treatment and services included lack of motivation, stigmatization, long wait-lists and transportation/mobility issues. Articulated needs revolved around the necessity of harm reduction-based services, low-threshold programs, specialized programming, and peer-based counselling. CONCLUSIONS: Although each community varied in terms of drug use behaviors and available services, an overall need for youth-specific, low-threshold services was identified. Information gathered from this study can be used to help inform rural and remote communities towards improving treatment and service system performance and provision.

Acompanhamento de crianças filhas de mulheres usuárias de drogas: um relato de experiência / Keeping up with children of women that use drugs: an experience report / Acompañamiento de niños de mujeres usuarias de drogas: un relato de experiencia

Relatar experiências do projeto de extensão "Promoção da saúde no território: acompanhamento de crianças filhas de mulheres usuárias de crack, álcool e outras drogas, realizado por meio de visitas domiciliares aos filhos cujas mães fizeram uso de substâncias psicoativas na gestação. Desde o ano de 2013, são acompanhadas pelo projeto quatro famílias captadas pelos serviços de atenção aos usuários de álcool e drogas do município. Percebeu-se durante avaliação de exame físico realizado nas crianças desde o nascimento, além do acompanhamento, observação e leitura da carteira de vacinação, que as crianças acompanhadas não apresentaram síndrome de abstinência e demonstraram desenvolvimento senso-motor adequado para a idade. É importante a reflexão dos profissionais de saúde em relação às perspectivas teóricas endurecidas, desconstruindo a ideia de que apenas o uso da substância deve ser considerado no cuidado, mas sim o indivíduo em todos seus aspectos biopsicossociais.

To report experiences of the extension project "Promotion of health in the territory: follow-up of children daughters of women who use crack, alcohol and other drugs" through home visits to children whose mothers used psychoactive substances during pregnancy. Since the year 2013, four families have been monitored by the services of attention to alcohol and drug users in the municipality. It was noticed during the evaluation of the physical examination carried out in the children from birth, besides the monitoring, observation and reading of the vaccination card, that the children followed up did not present with withdrawal syndrome and demonstrated a sense-motor development adequate for the age. It is important the reflection of the health professionals against the hardened theoretical perspectives, deconstructing the idea that only the use of the substance should be considered in the care, but the individual in all its biopsychosocial aspects.

Relatar experiencias del proyecto de extensión "Promoción de salud en el territorio: acompañamiento de niños de mujeres usuarias de crack, alcohol y otras drogas", realizado a través de visitas domiciliarias a niños de los que la madre hice uso de substancias psicoactivas durante el embarazo. Son acompañadas cuatro familias captadas por los servicios de atención a los usuarios de alcohol y drogas en la ciudad. Se percibió durante la evaluación del examen físico realizado en los niños desde el nacimiento, además del seguimiento, observación y lectura de la cartera de vacunación, que los niños acompañados no presentaron síndrome de abstinencia y demostraron un desarrollo senso-motor adecuado para la edad. Es importante reflectar como profesionales de salud delante las perspectivas teóricas endurecidas, deconstruyendo la idea de que solamente el uso de substancia debe ser considerado en el cuidado, pero si el individuo en todos sus aspectos biopsicosociales.

Predictors of mental health and substance use disorder treatment use over 3 years among rural adults using stimulants.

Background: Persons using substances, living in rural communities, tend to underutilize mental health (MH) and substance use disorder (SUD) treatment compared with their urban peers. However, no studies have examined longitudinal predictors of MH and SUD treatment use among rural persons using stimulants. Methods: Data were collected through interviews conducted between 2002 and 2008 from a natural history study of 710 adults using stimulants and living in rural counties of Arkansas, Kentucky, and Ohio. Each study site recruited participants using respondent-driven sampling (RDS). Participants were adults, not in drug treatment, and reporting past-30-day use of methamphetamine, crack cocaine, or powder cocaine. Study participants completed face-to-face baseline assessments and follow-up interviews using computer-assisted personal interviews. Follow-up interviews were conducted at 6-month intervals for 3 years. Results: Our results show that being male, nonwhite, and having a prior lifetime history of MH or SUD treatment use were associated with lower odds of using MH and SUD treatment over time; having medical insurance and living in a state with potentially greater availability of MH and SUD treatment were associated with higher odds of using MH and SUD treatment over the 3-year period. Further, reporting greater legal problems and alcohol severity were associated with greater odds of using MH and SUD care, whereas greater employment problems was associated with higher odds of SUD but not MH treatment use. Conclusions: Findings from this study could be used to inform clinical and public health strategies for improving linkage to MH and SUD care in this population. Our findings also highlight the importance of having medical insurance as a potential facilitator to utilizing SUD care in this population and support the need for health care policies that increase the ability of rural adults who use stimulants to pay for such services.