Drugs in the Brazilian Print Media: An Exploratory Survey of Newspaper and Magazine Stories in the Year 2000

Print media is one of the key factors for defining public opinion and setting public policies regarding drugs. Therefore, surveying its content should provide us with a better understanding of the situation. The few existing surveys on this issue in Brazil point out discrepancies between print media and public health. The objective of the present survey is to enhance the analysis of drug-related stories in the Brazilian print media, based on a new time frame, in the year 2000. Major newspapers and magazines of all Brazilian state capitals have been surveyed throughout year 2000, with 4,669 stories presenting drugs as their main topic. A random sample of 964 stories underwent content analysis. Approximately half the stories (49.6%) dealt with smuggling- and repression-related issues. The remainder of the stories (50.4%) approached health, legislation, and public policy issues. Tobacco was the most widely discussed drug, with stories focusing mainly on damage caused by use and on measures for reducing consumption rates among the population. Articles about cocaine, also featured frequently in the print media, dealt mainly with the issues of drug dealing and of damage caused by cocaine use. Regarding marijuana, in addition to the law enforcement repressive approach, some articles dealt with decriminalization and therapeutic use. Articles about alcoholic beverages, featured less frequently in the print media, approached the subject matter from various angles. The number of stories on solvents and psychotropic medication was negligible. The results confirm discrepancies between print media coverage and epidemiology. They also indicate that each drug is approached differently, allowing for a better understanding of the “social climate” in Brazil regarding each drug. Of all possible social interventions for dealing with the issue repression stands out, whereas stories about treatment and damage reduction are relatively scarce. These findings suggest the need for improved communication between journalists and health professionals.     

Children in the Streets of Brazil: Drug Use,Crime, Violence,and HIV Risks

The presence of vast numbers of unsupervised and unprotected children is a phenomenon that is common throughout Latin America, and in few places are the street children more visible, and reviled, than in Brazil. Estimates of their numbers in Brazil have ranged from 7 to 17 million, but more informed assessments suggest that between 7 and 8 million children, ages 5 to 18, live and/or work on the streets of urban Brazil. Accounts of drug misuse among street youths in Brazil are commonplace. Numerous scientific studies and media stories have reported the widespread use of inhalants, marijuana and cocaine, and Valium among street children. Also common is the use of coca paste and Rohypnol. Risk of exposure to HIV is rapidly becoming an area of concern because of the large number of street youths engaging in unprotected sexual acts, both renumerated and nonrenumerated. Moreover, Brazil's street children are targets of fear. Because of their drug use, predatory crimes, and general unacceptability on urban thoroughfares, they are frequently the targets of local vigilante groups, drug gangs, and police “death squads.” Although there have been many proposals and programs for addressing the problems of Brazilian street youth, it would appear that only minimal headway has been achieved. [Translations are provided in the International Abstracts Section of this issue.]     

The scientific/clinical response to the cocaine epidemic: a MEDLINE search of the literature.

Index Medicus (1966-1990) was searched to quantify and characterize the scientific/clinical community's responses to the cocaine epidemic. The rate of growth in the cocaine literature was compared with the rate of growth in the heroin and marijuana literatures in the 1960s and 1970s. Articles on cocaine increased dramatically over the past 7 years suggesting a clear response from the scientific/clinical community to the public health problems presented by the cocaine epidemic. That literature spans a wide range of areas addressing many scientific and health-care issues. This increase in cocaine citations is similar to that which occurred previously in response to use of heroin and marijuana.     

How do Australian news media depict illicit drug issues? An analysis of print media reporting across and between illicit drugs, 2003-2008

Background

Media reporting on illicit issues has been frequently criticised for being sensationalised, biased and narrow. Yet, there have been few broad and systematic analyses of the nature of reporting. Using a large sample and methods commonly adopted in media communications analysis this paper sought to identify the dominant media portrayals used to denote illicit drugs in Australian newspapers and to compare and contrast portrayals across drug types.

Methods

A retrospective content analysis of Australian print media was carried out over the period 2003-2008 from a sample comprised of 11 newspapers. Articles that contained one or more mention of five different drugs (or derivatives) were identified: cannabis, amphetamines, ecstasy, cocaine and heroin. A sub-sample of 4397 articles was selected for media content analysis (with 2045 selected for full content analysis) and a large number of text elements coded for each. Key elements included topic, explicit or implicit messages about the consequences of drugs/use and three value dimensions: overall tone, whether drugs were portrayed as a crisis issue and moral evaluations of drugs/use.

Results

The dominant media portrayals depicted law enforcement or criminal justice action (55%), but most articles were reported in a neutral manner, in the absence of crisis framings. Portrayals differed between drugs, with some containing more narrow frames and more explicit moral evaluations than others. For example, heroin was disproportionately framed as a drug that will lead to legal problems. In contrast, ecstasy and cocaine were much more likely to emphasise health and social problems.

Conclusion

Media reporting on illicit drugs is heavily distorted towards crime and deviance framings, but may be less overtly sensationalised, biased and narrowly framed than previously suggested. This is not to suggest there is no sensationalism or imbalance, but this appears more associated with particular drug types and episodes of heightened public concern.     

How the media do drugs: quality control and the reporting of drug issues in the UK print media

Exaggeration, distortion, inaccuracy, sensationalism; each of these labels has been consistently applied to the reporting of drug related issues in the print and other media over the last 40 years and beyond. This research sought to understand what quality control mechanisms are employed by the UK print media in relation to issues related to illicit drugs to ensure accurate, informed and appropriate reporting. It was found that the print media in the UK employ almost no quality control mechanisms to ensure that such reporting takes place and that they predominately rely on the demonstrably insufficient qualities of the 'good reporting' skills that journalists bring to their research and writing. What concerns did exist regarding accuracy related predominately to protecting the publication from being sued for libel and no specific journalistic expertise of drug issues was considered necessary. A discussion of these issues is undertaken followed by the recommendation for the production of a negotiated media guide.     

Key drug use,health and socio-economic characteristics of young crack users in two Brazilian cities

BackgroundCrack use constitutes a major problem in cities across Brazil. While existing data suggest that crack use is generally concentrated among disenfranchised young people with extensive health problems and crime involvement, extensive data gaps exist. To address this issue, this study aimed to assess key characteristics of young crack users in two Brazilian cities.MethodsN = 160 regular and young adult (ages 18–24) crack users were recruited by community-based methods in the cities of Rio de Janeiro (Southeast) and Salvador (Northeast). Assessments included an interviewer-administered questionnaire on key social, drug use, health and service use characteristics, as well as serological testing of HBV, HCV and HIV status, and were conducted anonymously between November 2010 and June 2011. Participants provided informed consent and received transportation vouchers following assessment completion. The study was approved by institutional ethics review boards.ResultsThe majority of participants were: male, with less than high school education, unstably housed (Rio only); gained income from legal or illegal work; arrested by police in past year (Salvador only); had numerous daily crack use episodes and shared paraphernalia (Salvador only); co-used alcohol, tobacco, cannabis and cocaine; had no injection history; rated physical and mental health as ‘fair’ or lower (Salvador only); had unprotected sex; were never HIV tested; were not HIV, HBV or HCV positive; and did not use existing social or health services, but desired access to crack user specific services.ConclusionCrack users in the two Brazilian sites featured extensive socio-economic marginalization, crack and poly-drug use as well as sexual risk behaviours, and compromised health status. Social and health service utilization are low, yet needs are high. There is an urgent need for further research and for targeted interventions for crack use in Brazil.     

Drug Use and the Spread of HIV/AIDS in South America and the Caribbean

We review available data on drug use with respect to the spread of HIV/AIDS in South America and the Caribbean. Although many information gaps remain, the emerging picture clearly shows the significant role of both injected cocaine and crack cocaine in the Brazilian epidemic, and the increasingly large role of injecting cocaine in the Southern Cone. The Caribbean and the Andean regions are thus far spared from extensive diffusion of injecting drugs and its consequences. However, these regions are now experiencing a significant transition, in terms of an increasing role of crack cocaine in the Caribbean HIV/AIDS epidemic, and the recent introduction of heroin and initiation of drug injection in the Andean region. Harm-reduction strategies are being implemented for the first time in recent years after a long delay, but remain primarily restricted to Brazil, and to a lesser extent, Argentina. Yet even in these settings, harm-reduction programmes such as needle-exchange programmes face considerable challenges with respect to restrictive legislation and lack of broader support.     

Is Ayahuasca an Option for the Treatment of Crack Cocaine Dependence?

The low efficacy of crack cocaine addiction treatment available in Brazil has led Brazilian users to find alternatives to reduce drug consumption or even to reach abstinence. One of them is the use of entheogenic substances, like ayahuasca, an infusion obtained from two native plant species from the Amazon. The present report aimed to understand how crack cocaine users recover from drug addiction by consuming ayahuasca tea in a religious context. This is a qualitative study with a purposeful sample of 40 crack cocaine users, based on in-depth, semi-structured interviews. Participants reported that ayahuasca allowed them to access a consciousness dimension which enabled them to solve problems and traumas and reduce crack cocaine consumption. The religious ceremony increased the user’s spirituality and the reception from the community gave them a sense of self-esteem, strengthening them in an emotional and social way. That positive experience has been incorporated into the daily routine of most participants. Findings indicate that ayahuasca, in a religious context, may have therapeutic value for crack cocaine dependence treatment.     

Prevalence of Cocaine Use in Brazil: Data from the II Brazilian National Alcohol and Drugs Survey (BNADS)

Objective

To determine the current prevalence rates of cocaine use and dependence in a representative sample of the Brazilian population, and to investigate possible associations with sociodemographic factors.

Method

The Second Brazilian Alcohol and Drugs Survey (II BNADS) interviewed 4607 individuals aged 14 years and older from the Brazilian household population including an oversample of 1157 adolescents (14 to 18 years old). The survey gathered information on alcohol, tobacco and illegal substances use as well as on risk factors for abuse and dependence. The Severity of Dependence Scale was used to evaluate cocaine dependence rates among users.

Results

Last year consumption of crack-cocaine was 2.2% in the overall population excluding the elderly group. Lifetime and last year prevalence rate of snorted cocaine was 3.9% and 1.7%, respectively. Smoked cocaine use in Brazil was estimated in 1.5% for lifetime and 0.8% for last year use. Cocaine addiction was identified in 41.4% between users in the prior year.

Conclusions

The prevalence rates of snorted and smoked cocaine in Brazil suggests that the country is amongst the nations with greatest annual consumption rates becoming one of the biggest consumer markets of cocaine worldwide. Prevention and treatment policies should take this into consideration and strengthen the focus on cocaine use in the country.     

Cross-cultural approaches to harm reduction research: some considerations on the Brazil experience

Harm reduction initiatives for drug users comprise a range of approaches, including drug-user treatment, advocacy for changes in drug policy, needle exchange programs, bleach distribution, and broad-based interventions that focus on both safer drug use and less risky sexual behaviors. In many developing nations, harm reduction is a relatively new strategy, which focuses almost exclusively on the connections between drug use and the spread of HIV infection. In Brazil, harm reduction programs are few, and little has been documented about their scope, experience, and effectiveness. This paper reviews the status of Brazilian harm reduction initiatives in general, with a specific focus on lessons learned from the conduct of cross-national research in Rio de Janeiro. The study demonstrated the feasibility of implementing a community-based prevention program among an at-risk population of cocaine users in Brazil, and in other countries where there is little tradition of research with out-of-treatment drug users. Finally, the paper addresses aspects of the harm reduction movement that tend to hamper its progress in both developed and developing nations.     

Normal drug use: ethnographic fieldwork among an adult network of recreational drug users in inner London

A key debate in late 1990s Britain is the "normalization" of illicit drug use among young people. This qualitative research study explores recreational drug use (mainly cannabis and cocaine) among an adult friendship network in an inner London neighborhood. It finds that the use of these drugs is accepted as a normal and routine aspect of daily life. In addition to patterns of drug consumption and drug dealing, some aspects of risk perception are also described. Adults are neglected in current UK drug policy debates. "Normal" adult recreational drug use poses the need for a new public health policy agenda for the new century.     

Cocaine use and HIV risk in out of treatment drug abusers

During the initial phases of the HIV epidemic, epidemiological and prevention initiatives included a necessary focus on injection drug use which targeted, for the most part, heroin injectors. More recently, cocaine users have become a central focus for many HIV prevention interventions. This illustrates how researchers and public health practitioners have adapted to the changing and intersecting epidemics of HIV and drug abuse in order to more efficiently prevent the spread of HIV among drug abusers. In this special issue of Drug and Alcohol Dependence, the contributing authors focus attention on the HIV risk behaviors of cocaine abusers using data from the National Institute on Drug Abuse (NIDA) Cooperative Agreement for AIDS Community-Based Outreach/Intervention Research Program. The Cooperative Agreement consists of 23 sites, with 22 sites located in the US (including Puerto Rico) and one site in Brazil, and has included over 28,000 subjects recruited using street outreach. All Cooperative Agreement subjects were administered the NIDA risk behavior assessment (RBA) which provides detailed information about injection drug use behaviors, crack cocaine use and sexual behaviors. The RBA serves as the source of basic data for all papers in this issue which includes work describing local studies in St. Louis, North Carolina and Brazil as well as analysis of the National Database from researchers in Denver, Washington and Kentucky. In general, the studies focus on the etiology of HIV risk behaviors by empirically identifying the antecedents of individual HIV risk behaviors among cocaine users. These predictors of risk and protective behavior include the severity of crack cocaine, comorbid antisocial personality disorder and depression, alcohol consumption, and typologies of crack and injection drug use. Overall, the studies show that NIDA's prevention intervention is feasible and effective in many settings. The success of the studies which are included in this special issue is a testament to the feasibility of NIDA's science-based prevention interventions.     

Presenting features of meningococcal disease, public health messages and media publicity: are they consistent?

AIMS: To investigate whether the presenting features of meningococcal disease as promoted in public health awareness material and in the print media accurately reflect the clinical features in patients admitted to Auckland hospitals with meningococcal disease January 1998 to June 1999. METHODS: Hospital record, public health message and newspaper article review, with analysis by presenting feature, age group and disease complex. RESULTS: The most common presenting features were fever (95%), rash (65%), vomiting and nausea (64%), lethargy (62%), headache (44%), refusing food and drink (35%), irritability (33%), muscle ache and joint pains (27%) and stiff neck (26%). Public health messages gave appropriate emphasis to the key features, whereas newspaper articles under-emphasised these. The term 'meningitis' was used more frequently in newspapers (65%) than in public health messages (30%), despite meningitis alone presenting less frequently (38% of cases) than meningococcal septicaemia, and having a less serious prognosis. CONCLUSIONS: Presenting features currently noted in the Ministry of Health's health education resource material are appropriate. Public health specialists dealing with the media should ensure that appropriate messages are incorporated into media reports. A greater use of the term 'meningococcal disease' by both public health agencies and media would convey to the public the message that this disease has a spectrum of presenting features, with those of septicaemia more common, but also indicating an even greater need for urgency of action than with 'classical' meningitic features.     

A policy of free access to asthma medicines in Brazil: an opportunity for pharmacists to optimize asthma treatment

Asthma is a chronic inflammatory disorder of the airways that is characterized by recurrent symptoms associated with airflow limitation and by bronchial hyper-responsiveness. Free asthma treatment has been guaranteed in Brazil since 2003, notably after the Brazilian government decided to support drugs for the most serious forms of the disease. The asthma treatment access policy in Brazil offers a new opportunity for pharmacists to work closely with patients, and for caregivers and health care teams to promote educational activities and patient counselling about asthma. Pharmacists have an important role in the management of drug therapy within the health care team. Pharmacists should be prepared to engage with the latest concept of health care delivery proposed for Brazilian Unified Health System. These are centred on forming health care networks and strengthening multidisciplinary teams to integrate all professionals who are in charge of patient care.     

Consumption of ayahuasca by children and pregnant women: medical controversies and religious perspectives

In 2010, the Brazilian Government agency responsible for drug-related issues formulated official Resolutions that categorized the consumption of ayahuasca by pregnant women and children in the Santo Daime and Uni?o do Vegetal ayahuasca-based religions as an "exercise of parental rights." Although ayahuasca groups do enjoy a relative degree of social legitimacy and formal legal recognition in Brazil, the participation of pregnant women and children nevertheless continues to provoke heated discussion. This article raises the main issues involved in the public debate over this subject. In the first part, a diverse group of biomedical and health specialists was consulted, and their opinions were briefly analyzed. In the second, a full interview with a follower of one branch of Santo Daime, mother of four children who took ayahuasca during all her pregnancies, and whose children all drink ayahuasca, is presented. Her interview reveals important cultural parameters of ayahuasca consumption. The article explores common themes and contradictions found between the biomedical, anthropological, and ayahuasca-users' discourses. It raises central issues regarding the limits of freedom of religion and the state's right to interfere in family matters. The following analysis also has implications regarding the role of science in influencing policy decisions on drug use.     

Diagnostic, treatment and aftercare approaches to cocaine abuse

The general public feels that cocaine is not particularly dangerous because it does not produce a well defined physical dependency and abstinence syndrome. However, when addiction is defined as compulsion, loss of control and continued use in spite of adverse consequences, cocaine drug hunger can be seen as an agent of addictive disease. Withdrawal from cocaine dependence usually involves depression, anxiety and lethargy. These usually clear within a week, leaving only the "drug hunger" to contend with. Medication is rarely needed. When cocaine is the primary addiction, after withdrawal the most effective treatment is group therapy with other recovering cocaine abusers. We incorporate the principles of recovery and define positive and constructive alternatives in dealing with cocaine hunger. Recovery programs should be flexible and involve individual and family education on recovery and the nature of addictive disease. Exercise that produces cardiopulmonary stimulation is a helpful means of reducing drug hunger and anxiety during recovery therapy.     

The children of mama coca: coca, cocaine and the fate of harm reduction in South America

The paper reviews the main findings from substance misuse research carried out over the last two decades in South America looking at the main initiatives aimed at reducing drug related harm and curbing the spread of HIV/AIDS and other sexually transmitted and blood-borne diseases. The current challenges faced by harm reduction in the region are analysed from the perspective of the history of coca and its different uses in South America. Except in Brazil and Argentina, the implementation of initiatives to reduce drug related harm in South America has been very cautious. The paper aims to link the analysis of harms associated with the use of illicit substances, with the often paradoxically harmful effects of supply-side drug policies in the world's largest coca/cocaine producing area. Despite the undeniable success of many initiatives, the broader context of harm maximization through structural violence and entrenched corruption acts as a major disincentive for the comprehensive adoption of sound public health policies.     

Drug safety and the media

This article reviews the problems that may arise as a result of media coverage of drug safety issues. In order to promote more balanced coverage and avoid unnecessary scares, professionals working in the area of drug safety should rethink their strategies for dealing with the media.     

NORMAL DRUG USE: ETHNOGRAPHIC FIELDWORK AMONG AN ADULT NETWORK OF RECREATIONAL DRUG USERS IN INNER LONDON

A key debate in late 1990s Britain is the “normalization” of illicit drug use among young people. This qualitative research study explores recreational drug use (mainly cannabis and cocaine) among an adult friendship network in an inner London neighborhood. It finds that the use of these drugs is accepted as a normal and routine aspect of daily life. In addition to patterns of drug consumption and drug dealing, some aspects of risk perception are also described. Adults are neglected in current UK drug policy debates. “Normal” adult recreational drug use poses the need for a new public health policy agenda for the new century. [Translations are provided in the International Abstracts Section of this issue.]     

CROSS-CULTURAL APPROACHES TO HARM REDUCTION RESEARCH: SOME CONSIDERATIONS ON THE BRAZIL EXPERIENCE

Harm reduction initiatives for drug users comprise a range of approaches, including drug-user treatment, advocacy for changes in drug policy, needle exchange programs, bleach distribution, and broad-based interventions that focus on both safer drug use and less risky sexual behaviors. In many developing nations, harm reduction is a relatively new strategy, which focuses almost exclusively on the connections between drug use and the spread of HIV infection. In Brazil, harm reduction programs are few, and little has been documented about their scope, experience, and effectiveness. This paper reviews the status of Brazilian harm reduction initiatives in general, with a specific focus on lessons learned from the conduct of cross-national research in Rio de Janeiro. The study demonstrated the feasibility of implementing a community-based prevention program among an at-risk population of cocaine users in Brazil, and in other countries where there is little tradition of research with out-of-treatment drug users. Finally, the paper addresses aspects of the harm reduction movement that tend to hamper its progress in both developed and developing nations. [Translations are provided in the International Abstracts Section of this issue.]