Forced Treatment for Brazil Crack Addicts

By Lucy Jordan, Senior Contributing Reporter

BRASÍLIA, BRAZIL – In an attempt to tackle Brazil’s growing crack epidemic, the city of Rio de Janeiro has begun a program of involuntary hospitalization for users, one month after Brazil’s biggest city São Paulo began a similar program. At least 99 addicts have been hospitalized, 29 involuntarily, since the program launched one week ago, according to local media tallies.

With its long, porous border adjoining the world’s top three drug producers – Bolivia, Peru and Colombia – Brazil has historically been a transit country for drug trafficking to the U.S. and Europe.

Yet increasingly, Brazil has become a drug destination, with a Federal University of São Paulo study released last year showing that Brazil is now possibly the world’s largest market for crack-cocaine, with as many as one million users.

Some feel it it the approaching 2014 World Cup and 2016 Olympics that has prompted officials to ramp up efforts to present a clean, safe, tourist-friendly image.

Critics say that forcing addicts into rehabilitation treatment is ineffective, as the vast majority of users will quickly start using drugs again once discharged.

“When an addict is interned unwillingly, he can remain abstinent as long as he remains hospitalized,” Psychiatrist Dartiu Xavier da Silveira, who coordinates the renowned Guidance and Treatment of Addiction program of the Federal University of São Paulo (Unifesp), told The Rio Times.

“When he returns to his normal life (and his usual problems), the vast majority of users go back to using the drug as before,” Professor Silveira added. “Proposals for compulsory hospitalization as a measure of public health has no support in scientific evidence.”

Ronaldo Laranjeira, who heads up Unifesp’s Research Unit on Alcohol and Drugs and is a leading authority on the subject, said that the nature of crack addiction is so extreme that ordinary addiction treatment is inappropriate, and patients should be treated as psychiatric patients.

“In terms of crack users, the cases are so severe, people are so aggressive, so impulsive, sometimes psychotic, for me they are [not just addicts but] severe cases of psychiatric diseases,” he told The Rio Times. “That’s why for many people we have to use involuntary admission.”

“The clinical structure we have is basically only outpatients’ clinics and they cannot cope with these more severe cases,” he added. Long-term, Professor Laranjeira says that more specialized clinics for chemical dependency are required.

Professor Silveira agrees that involuntary hospitalization is appropriate for some patients who present psychiatric problems, but says these patients make up less than fifteen percent of crack addicts.

Brazil is by no means the first country to try coercive treatment for drug addiction. It is particularly common in Asia, and in the United States, some studies have shown that as much as fifty percent of publicly funded drug treatment referrals come from the criminal justice system. Coercive treatment for psychiatric treatment is common in much of Europe and the U.S.

In Dec 2011, the federal government launched a R$4 billion program to tackle the spread of crack-cocaine, focusing on prevention, care and policing. Health Minister Alexandre Padilha called the problem an “epidemic” and said drug addiction in Brazil had increased ten-fold between 2003 and 2011.

However, Professor Laranjeira said that very little of that money has actually reached state governments, and that this could adversely affect Rio’s ability to cope with demand for beds. “São Paulo has nearly a thousand beds for chemical dependency treatment; Rio doesn’t have even fifty,” he said.

“The huge contrast between Rio and São Paulo is that in São Paulo they are using state money to finance this service while in Rio they are relying too much on the federal government, and the money the federal government is putting on this treatment of crack is very small.”

Since São Paulo started its program in mid-January, 223 people have been admitted to hospital, but only seventeen of the admissions were involuntary.