Trends in drug use among students in Brazil: analysis of four surveys in 1987, 1989, 1993 and 1997.

The consumption of psychotropic drugs among Brazilian secondary school students was examined by comparing data from four surveys using a questionnaire adapted from the WHO's Program on Research and Reporting on the Epidemiology of Drug Dependence. Students filled out the form in their classrooms without the presence of teachers. The target population consisted of 10-18-year-old students (on average, 15,000 students responded to each survey) in Brazil's ten largest state capitals: Belém, Belo Horizonte, Brasília, Curitiba, Fortaleza, Porto Alegre, Recife, Rio de Janeiro, Salvador, and São Paulo. Among the legal drugs, lifetime use (use at least once during life) of tobacco was increased in seven cities (the exceptions were Brasília, Porto Alegre and Rio de Janeiro). There was also a significant increase in frequent use of alcohol (six times or more per month) in 6 of the cities, from an average of 9.2% in 1987 to 15.0% in 1997. With respect to illegal drugs, there was a significant increase in lifetime use of marijuana (a 3-fold increase from 2.8% in 1987 to 7.6% in 1997). Cocaine use increased 4-fold over the survey period (0.5% in 1987 to 2.0% in 1997). Lifetime use of cocaine significantly increased in eight capitals (except Recife and Rio de Janeiro). However, frequent cocaine use increased in only three capitals (Belém, Fortaleza and Porto Alegre), from an average of 1.0% in 1987 to 3.6% in 1997. Lifetime use of medications such as anxiolytics and amphetamines increased 2-fold on average over the survey period. Comparing the four studies, the main conclusion is that there were significant increases in the frequencies for lifetime use, frequent use and heavy use of many drugs.

Trends in drug use among students in Brazil: analysis of four surveys in 1987, 1989, 1993 and 1997

The consumption of psychotropic drugs among Brazilian secondary school students was examined by comparing data from four surveys using a questionnaire adapted from the WHO's Program on Research and Reporting on the Epidemiology of Drug Dependence. Students filled out the form in their classrooms without the presence of teachers. The target population consisted of 10-18-year-old students (on average, 15,000 students responded to each survey) in Brazil's ten largest state capitals: Belém, Belo Horizonte, Brasília, Curitiba, Fortaleza, Porto Alegre, Recife, Rio de Janeiro, Salvador, and São Paulo. Among the legal drugs, lifetime use (use at least once during life) of tobacco was increased in seven cities (the exceptions were Brasília, Porto Alegre and Rio de Janeiro). There was also a significant increase in frequent use of alcohol (six times or more per month) in 6 of the cities, from an average of 9.2 percent in 1987 to 15.0 percent in 1997. With respect to illegal drugs, there was a significant increase in lifetime use of marijuana (a 3-fold increase from 2.8 percent in 1987 to 7.6 percent in 1997). Cocaine use increased 4-fold over the survey period (0.5 percent in 1987 to 2.0 percent in 1997). Lifetime use of cocaine significantly increased in eight capitals (except Recife and Rio de Janeiro). However, frequent cocaine use increased in only three capitals (Belém, Fortaleza and Porto Alegre), from an average of 1.0 percent in 1987 to 3.6 percent in 1997. Lifetime use of medications such as anxiolytics and amphetamines increased 2-fold on average over the survey period. Comparing the four studies, the main conclusion is that there were significant increases in the frequencies for lifetime use, frequent use and heavy use of many drugs.

Changes in cocaine use as viewed by key informants: a qualitative study carried out in 1994 and 1999 in São Paulo, Brazil.

The characteristics of coca products use in São Paulo, Brazil during the years of 1994 and 1999 were investigated through interviews with 26 key informants (KIs; persons with knowledge of coca product users) in each of these years. The following information was yielded by the KIs: (1) there has been a large increase in coca products use in São Paulo from 1994 to 1999; concomitantly, there has been a decrease of hydrochloride use; (2) the increase has occurred due to the dissemination of crack which became cheap and easily available; (3) reasons for crack use changed greatly: in 1994, use was attributed mostly to pleasurable sensations produced by smoking; in 1999, use was intended to overcome compulsion/dependence or to put up with frustration/family conflicts; (4) crack users in 1999 came from practically all social classes of São Paulo; (5) use of alcohol and/or marijuana to cut down the anxiety and excitement produced by crack increased from 1994 to 1999; (6) even when police repression of traffic was effective, which rarely occurred, it affected only the price of coca products; (7) treatment services available were considered insufficient both in number and quality, and were run by ill-trained health professionals (this situation deteriorated even more in 1999); (8) many KIs heavily criticized the prevention programs because of the use of "scare techniques"; and (9) all KIs in 1999 believed that, unless the government changes its policy toward the drug problem, the situation would become worse in the next few years.

Inappropriate prescribing of compounded antiobesity formulas in Brazil.

Volunteers posing as patients underwent paid medical consultations at the offices of 107 Brazilian doctors (in two Brazilian cities) with the purpose of obtaining an antiobesity prescription. In 80.3% of 71 São Paulo visits, as well as in 47.2% of 36 Recife visits, compounded preparations were prescribed. Four to six active components predominated, but there were prescriptions listing as many as 17 components. All contained anorectic substances and benzodiazepines. Diuretics, thyroid agents, laxatives, medicinal plants, and a variety of other substances were often included. The prescribed doses were frequently above recommended limits, reaching amounts as much as five times the internationally defined standard doses. In some instances two anorectic substances were prescribed simultaneously. Most doctors failed to warn volunteers of the possible occurrence of adverse reactions to the prescribed substances. Furthermore, in the case of all volunteers involved, antiobesity prescriptions would be completely unnecessary, a fact that points to improper medical conduct on the part of doctors. It is concluded that the practice by some Brazilian medical doctors of prescribing manipulation formulas based on anorectic and benzodiazepine drugs is a greater hazard than a benefit to patients.

Use of drugs among street children in Brazil.

The purpose of this study has been to assess drug consumption among children in five Brazilian state capitals during 1993. The sample was composed of street children who were given assistance in institutions, and data was collected by means of anonymous individual interviews. Five hundred sixty five boys and girls were interviewed: 74.3% reported having used drugs (not including alcohol and tobacco) at least once in their life. Solvents, followed by marijuana, were the most cited drugs. Important regional differences were observed concerning other drugs. Consumption of cocaine, including crack, seems restricted to the southeast region, whereas psychotropic medication was consumed more in the northeast of the country. Drug initiation among these children seems to be a consequence of street life and is part of their group lifestyle.

Crack use in São Paulo.

Documented crack use emerged in São Paulo, Brazil, from 1991 onward. Therefore, it is a recent behavior among drug users. The present work draws a profile of São Paulo crack users, employing an ethnographic approach. Twenty-five crack users were interviewed on selected social and demographic characteristics, on the drug itself and its consumption, and on the consequences of this use. Crack cocaine is harmful for the user, leading within a short period to a condition of dependence. The crack users reported ultimately lapsing into "marginality" due to social isolation, neglect of bodily needs, and breakdown of family ties and other relationships.

Consumption of anorexigenic amphetamine-like drugs (diethylpropion, fenproporex and mazindol) and of d,1-fenfluramine in Brazil during the years of 1988 and 1989.

Brazilian consumption of psychostimulant anorexigenic drugs--diethylpropion, fenproporex, and mazindol--and of 3,1-fenfluramine was studied, and results are presented in terms of DDDs/1000 inhabitants/day. As of 1988, consumption of these drugs in Brazil was equal to 4.59 DDDs/1000 inhabitants/day; in the following year it had risen by 43.8%. However, if only the population that can afford to buy medicines is considered, actual consumption figures are at least three times higher. Such numbers point to a very high rate of anorexigenic consumption in Brazil, in contrast with other countries where use of these drugs is smaller. It was also found that 68.6% of total consumption in 1988--and 39.4% in 1989--corresponded to prescription formulas prepared by specialized pharmacies, while the remainder was consumed in the form of ready-made medicines produced by pharmaceutical industries. The most used drugs were mazindol in 1988, and fenproporex in 1989; d,1-fenfluramine was the least used of these substances in both years. These reasons are discussed for this increased consumption in Brazil and the absence of an adequate controlling attitude on the part of public health authorities.

Preliminary finding: consumption of benzodiazepines in Brazil during the years 1988 and 1989.

This work investigates consumption of benzodiazepines in Brazil during the years 1988 and 1989, using the following sources of information provided to the Brazilian Ministry of Health by institutions that deal with benzodiazepines: (a) benzodiazepine stocks recorded at the beginning and end of each year; (b) Brazilian (internal) production of benzodiazepines; (c) imported and exported amounts of benzodiazepines; (d) amounts employed in the manufacture of brand-name products and in the making of prescription formulas. The records a, b and c furnished the 'calculated consumption', of benzodiazepines, in kilograms. The d records, on the other hand, directly furnished the 'informed consumption', also in kilograms. The data obtained were also expressed in terms of defined daily doses (DDDs)/1,000 inhabitants/day, considering the informed consumption and the Brazilian population. As for the DDDs/1000 inhabitants/day, they were found to be 23.03 and 18.48 for the years 1988 and 1989, respectively. A striking discrepancy was detected between the calculated and the informed consumption figures, the latter having exceeded the former by 2096 kg in 1988 and by 4909 kg in 1989. Diazepam was the primary drug responsible for this difference. Such results may suggest that an illicit, unrecorded trade of benzodiazepines is occurring in Brazil.