Skip to main content


You are viewing the new article page. Let us know what you think. Return to old version

The Brazilian Drug Policy Situation: The Public Health Approach Based on Research Undertaken in a Developing Country


Brazil is one of the largest countries in the world, and is home to significant demographic, social and cultural diversity, as well as intense regional inequality. The country has successfully tackled many of these challenges, and the positive repercussions of these developments on the health care system have been particularly evident over the past two decades. Significant advances have also been made in terms of drug policies. The Brazilian tobacco control policy is one of the most advanced in the world and has helped the country to reduce the number of smokers by one half over the past 30 years. However, the alcohol market remains unregulated and regional alcohol control policies are still very inconsistent, leading to increased alcohol consumption due to a combination of advertising, low cost and high availability. The recent increase in the use of illegal psychoactive substances has also led to higher rates of domestic and urban violence, crime and mortality. The public health system offers several treatment options for individuals with substance disorders, but important services, such as detoxification centers, have yet to be implemented in the country. The national debate about drug policy is still very theoretical in nature and lacks the technical foundation offered by scientific research. In conclusion, in spite of the significant progress made over the past three decades, Brazil still has a long road to travel before developing a consistent and effective drug policy. The aim of the present article was to review the relevant and interesting developments in Brazilian drug policy over recent decades and to discuss framework for future developments in terms of legislation in the area.


  1. 1.

    The Brazilian Institute of Geography and Statistics. Censo demográfico 2010–características da população e dos domicílios. Rio de Janeiro: IBGE; 2011. [In Portuguese]

  2. 2.

    The World Bank. GDP (current US$). Available from URL: (Accessed 13 February 2014).

  3. 3.

    United Nations Development Programme. Human Development Report 2013–the rise of the south: human progress in a diverse world. Available from URL:]20Reportai]20English.pdf (Accessed 1 July 2013).

  4. 4.

    Paim J, Travassos C, Almeida C, Bahia L, Macinko J. The Brazilian health system: history, advances, and challenges. Lancet. 2011;377:1778–97.

  5. 5.

    The Brazilian Institute of Geography and Statistics. PIB dos municípios revela concentração e desigualdades na geração de renda. Available from URL: (Accessed 13 February 2014). [In Portuguese]

  6. 6.

    United Nations Development Programme–Brazilian Office. Relatório de desenvolvimento humano–Brasil 2005: racismo, pobreza e violência. Brasilia: PNUD Brasil; 2005. [In Portuguese]

  7. 7.

    Bethell L. On democracy in Brazil–past and present. London: Institute of Latin American Studies; 1994.

  8. 8.

    Power TJ, Zucco Jr. C. Elite preferences in a consolidating democracy: the Brazilian legislative surveys, 1990–2009. Lat Am Polit Soc. 2012;54:1–27.

  9. 9.

    Hagopian F. Paradoxes of democracy and citizenship in Brazil. Lat Am Res Rev. 2011;46:216–27.

  10. 10.

    European Commission. Brazil–country strategy paper 2007–2013. Available from URL: (Accessed 15 June 2013).

  11. 11.

    The Economist. Democracy Index 2012: Democracy is at a standstill. Available from URL: (Accessed 20 July 2013).

  12. 12.

    Koonigs K. Strengthening citizenship in Brazil’s democracy: local participatory governance in Porto Alegre. Bull Lat Am Res. 2004;23:79–99.

  13. 13.

    Fernandes RR, Sousa HR, Ramos FS. Are the law, democracy and socioeconomic factors related to the level of corruption in Brazilian states? Available from URL: (Accessed 28 June 2013).

  14. 14.

    Laranjeira R, Mitsuhiro SS. Addiction research centres and the nurturing of creativity. National institute on alcohol and drugs policies, Brazil. Addiction. 2012;107:727–32.

  15. 15.

    Monteiro CA, Benicio MH, Iunes R, Gouveia NC, Taddei JA, Cardoso MA. Nutritional status of Brazilian children: trends from 1975 to 1989. Bull World Health Organ. 1992;70:657–66.

  16. 16.

    Raw M, Laranjeira R. Brazil takes steps to control tobacco. BMJ. 1995;311:1046.

  17. 17.

    Szklo AS, de Almeida LM, Figueiredo VC, Autran M, Malta D, Caixeta R, et al. A snapshot of the striking decrease in cigarette smoking prevalence in Brazil between 1989 and 2008. Prev Med. 2012;54:162–7.

  18. 18.

    Sebrie EM, Glantz SA. “Accommodating” smoke-free policies: tobacco industry’s Courtesy of Choice programme in Latin America. Tob Control. 2007;16:e6.

  19. 19.

    Bialous SA, Presman S, Gigliotti A, Muggli M, Hurt R. A resposta da indústria do tabaco à criação de espaços livres de fumo no Brasil. Rev Panamericana Salud Publica = Pan Am J Public Health. 2010;27:283–90. [In Portuguese]

  20. 20.

    Bialous SA, Martins S. Brazil: Sao Paulo takes the lead. Tob Control. 2009;18:341.

  21. 21.

    Presidency of the Republic of Brazil. Lei Nº 12.546 de 2011. Available from URL: (Accessed 29 June 2013). [In Portuguese]

  22. 22.

    Brazilian Ministry of Health. Resolução - RDC Nº 14, de 15 de março de 2012. Available from URL: (Accessed 13 February 2014). [In Portuguese]

  23. 23.

    Lee K, Chagas LC, Novotny TE. Brazil and the framework convention on tobacco control: global health diplomacy as soft power. PLoS Med. 2010;7:e1000232.

  24. 24.

    Presidency of the Republic of Brazil. Decreto Nº 5.658, de 2 de janeiro de 2006. Available from URL: (Accessed 25 February 2014). [In Portuguese]

  25. 25.

    Monteiro CA, Cavalcante TM, Moura EC, Claro RM, Szwarcwald CL. Population-based evidence of a strong decline in the prevalence of smokers in Brazil (1989–2003). Bull World Health Organ. 2007;85:527–34.

  26. 26.

    Almeida L, Szklo A, Sampaio M, Souza M, Martins LF, Szklo M, et al. Global Adult Tobacco Survey data as a tool to monitor the WHO Framework Convention on Tobacco Control (WHO FCTC) implementation: the Brazilian case. J Environ Res Public Health. 2012;9:2520–36.

  27. 27.

    Raw M, McNeill A, Murray R. Case studies of tobacco dependence treatment in Brazil, England, India, South Africa and Uruguay. Addiction. 2010;105:1721–8.

  28. 28.

    Morton J, Song Y, Fouad H, Awa FE, Abou El Naga R, Zhao L, et al. Cross-country comparison of waterpipe use: nationally representative data from 13 low and middle–income countries from the Global Adult Tobacco Survey (GATS). Tobacco control. 2013; epub ahead of print.

  29. 29.

    Jurberg C. Brazil and tobacco use: a hard nut to crack. Bull World Health Organ. 2009;87:812–3.

  30. 30.

    Laranjeira R, Pinsky I, Sanches M, Zaleski M, Caetano R. Alcohol use patterns among Brazilian adults. Rev Bras Psiquiatr. 2010;32:231–41.

  31. 31.

    Castro DS, Sanchez ZM, Zaleski M, Alves HN, Pinsky I, Caetano R, et al. Sociodemographic characteristics associated with binge drinking among Brazilians. Drug Alcohol Depend. 2012;126:272–6.

  32. 32.

    Caetano R, Mills B, Pinsky I, Zaleski M, Laranjeira R. The distribution of alcohol consumption and the prevention paradox in Brazil. Addiction. 2012;107:60–8.

  33. 33.

    Pinsky I, Sanches M, Zaleski M, Laranjeira R, Caetano R. Patterns of alcohol use among Brazilian adolescents. Rev Bras Psiquiatr. 2010;32:242–9.

  34. 34.

    Carlini ELA, Noto AR, Sanchez ZVDM, Carlini CMA, Locatelli DP, Abeid LR, et al. VI levantamento nacional sobre o consumo de drogas psicotrópicas entre estudantes do ensino fundamental e médio das redes pública e privada de ensino nas 27 capitais brasileiras. Brasilia: SENAD; 2010. [In Portuguese]

  35. 35.

    Laranjeira R, Romano M. Brazilian consensus on public policies on alcohol. Rev Bras Psiquiatr. 2004;26:68–77.

  36. 36.

    Duailibi S, Laranjeira R. [Alcohol-related public policies]. Rev Saude Publica. 2007;41:839–48. [In Portuguese]

  37. 37.

    Pinsky I, Laranjeira R. Alcohol in Brazil: recent public health aspects. Addiction. 2004;99:524.

  38. 38.

    Pinsky I, Laranjeira R. Ethics of an unregulated alcohol market. Addiction. 2007;102:1038–9; discussion 9–40.

  39. 39.

    Campos VR, de Souza ESR, Duailibi S, Laranjeira R, Palacios EN, Grube JW, et al. Drinking and driving in southeastern Brazil: results from a roadside survey study. Addict Behav. 2013;38:1442–7.

  40. 40.

    Seligman, M., 2005. Alcoolismo e responsabilidade social. Presented at the International Forum of Quality of Life and Health–Alcoholism: Who Pays the Bill?, Porto Alegre, Brazil, April 8.

  41. 41.

    Laranjeira R, Hinkley D. Evaluation of alcohol outlet density and its relation with violence. Rev Saude Publica. 2002;36:455–61.

  42. 42.

    Romano M, Duailibi S, Pinsky I, Laranjeira R. [Alcohol purchase survey by adolescents in two cities of State of Sao Paulo, Southeastern Brazil]. Rev Saude Publica. 2007;41:495–501. [In Portuguese]

  43. 43.

    São Paulo State Government. Lei Nº 14.592 de 19 de outubro de 2011. Available from URL: (Accessed 13 February 2014). [In Portuguese]

  44. 44.

    Departamento Nacional de Trânsito. Frota brasileira de veículos–2013. Available from URL: (Accessed 23 July 2013) [In Portuguese]

  45. 45.

    Instituto de Pesquisa Econômica Aplicada, Departamento Nacional de Trânsito. Impactos sociais e econômicos dos acidentes de trânsito nas rodovias brasileiras. Brasilia: IPEA/DENATRAN/ANTP; 2006. [In Portuguese]

  46. 46.

    Bacchieri G, Barros AJ. Traffic accidents in Brazil from 1998 to 2010: many changes and few effects. Rev Saude Publica. 2011;45:949–63.

  47. 47.

    de Carvalho Ponce J, Munoz DR, Andreuccetti G, de Carvalho DG, Leyton V. Alcohol-related traffic accidents with fatal outcomes in the city of Sao Paulo. Accid Anal Prev. 2011;43:782–7.

  48. 48.

    Abreu AMM, Lima JMB, Matos LN, Pillon SC. [Alcohol use and traffic accidents: a study of alcohol levels]. Rev Latino-Am Enfermagem. 2010;18:513–20. [In Portuguese]

  49. 49.

    Santos Modelli ME, Pratesi R, Tauil PL. [Blood alcohol concentration in fatal traffic accidents in the Federal District, Brazil]. Rev Saude Publica. 2008;42:350–2. [In Portuguese]

  50. 50.

    Dualibi S, Pinsky I, Laranjeira R. Prevalence of drinking and driving in a city of Southeastern Brazil. Rev Saude Publica. 2007;41:1058–61.

  51. 51.

    Massara VM. Brief synopsis of the Brazilian freight transport and future development. J Infrastructure Dev. 2012;4:77–90.

  52. 52.

    Departamento Nacional de Trânsito. Lei Nº 11.705 de 19 de junho de 2008. Available from URL: (Accessed 13 February 2014). [In Portuguese]

  53. 53.

    Mello Jorge MHP, Koizumi MS. Acidentes de trânsito causando vítimas: possível reflexo da lei seca nas internações hospitalares. Rev ABRAMET. 2009;27:16–25. [In Portuguese]

  54. 54.

    Campos VR, de Souza e Silva R, Duailibi S, dos Santos JF, Laranjeira R, Pinsky I. The effect of the new traffic law on drinking and driving in Sao Paulo, Brazil. Accid Anal Prev. 2013;50:622–7.

  55. 55.

    Pinsky I, Labouvie E, Pandina R, Laranjeira R. Drinking and driving: pre-driving attitudes and perceptions among Brazilian youth. Drug Alcohol Depend. 2001;62:231–7.

  56. 56.

    Pechansky F, Chandran A. Why don’t northern American solutions to drinking and driving work in southern America? Addiction. 2012;107:1201–6.

  57. 57.

    Laranjeira R, Marques AC, Ramos Sde P, Campana A, Luz E, Jr., Franca J. Who runs alcohol policy in Brazil? Addiction. 2007;102:1502–3.

  58. 58.

    Hayashi N. Beer beats oil as AmBev value rises toward top: corporate Brazil. Available from URL: (Accessed 20 June 2012).

  59. 59.

    Caetano R, I. P, Laranjeira R. Should soccer and alcohol mix? Alcohol sales during the 2014 World Soccer Cup games in Brazil. Addiction. 2012;107:1722–3.

  60. 60.

    Vendrame A, Pinsky I. [Inefficacy of self-regulation of alcohol advertisements: a systematic review of the literature]. Rev Bras Psiquiatr.. 2011;33:196–202.

  61. 61.

    Pantani D, Sparks R, Sanchez ZM, Pinsky I. ‘Responsible drinking’ programs and the alcohol industry in Brazil: killing two birds with one stone? Soc Sci Med. 2012;75:1387–91.

  62. 62.

    Wolburg JM. How responsible are “responsible” drinking campaigns for preventing alcohol abuse? J Consum Mark. 2005;22:176–7.

  63. 63.

    de Andrade AG. Ethics of alcohol policy in Brazil: why it is possible to be independent when we sit at the same table with the alcohol industry. Addiction. 2008;103:854–5.

  64. 64.

    Diadema–Police Department. Violence records, Diadema: 1995–2005. Diadema: Diadema Police Department; 2005.

  65. 65.

    Duailibi S, Ponicki W, Grube J, Pinsky I, Laranjeira R, Raw M. The effect of restricting opening hours on alcohol-related violence. Am J Public Health. 2007;97:2276–80.

  66. 66.

    Carvalho MF, Pascom AR, Souza-Junior PR, Damacena GN, Szwarcwald CL. Utilization of medicines by the Brazilian population, 2003. Cadernos Saude Publica. 2005;21 Suppl:100–8.

  67. 67.

    Pereira FS, Bucaretchi F, Stephan C, Cordeiro R. Self-medication in children and adolescents. J Pediatria. 2007;83:453–8.

  68. 68.

    Kapczinski F, Amaral OB, Madruga M, Quevedo J, Busnello JV, de Lima MS. Use and misuse of benzodiazepines in Brazil: a review. Subst Use Misuse. 2001;36:1053–69.

  69. 69.

    Noto AR, Carlini EA, Mastroianni PC, Alves VC, Galduróz JCF, Kuroiwa W, et al. Analysis of prescription and dispensation of psychotropic medications in two cities in the State of São Paulo, Brazil. Rev Bras Psiquiatr 2002;24:68–73.

  70. 70.

    Orlandi P, Noto AR. [Misuse of benzodiazepines: a study among key informants in São Paulo city]. Rev Latino-Am Enfermagem. 2005;13:896–902. [In Portuguese]

  71. 71.

    Spanemberg L, Nogueira EL, da Silva CT, Dargel AA, Menezes FS, Cataldo Neto A. High prevalence and prescription of benzodiazepines for elderly: data from psychiatric consultation to patients from an emergency room of a general hospital. Gen Hosp psychiatry. 2011;33:45–50.

  72. 72.

    Nappo SA, de Oliveira EM, Morosini S. Inappropriate prescribing of compounded antiobesity formulas in Brazil. Pharmacoepidemiol Drug Saf. 1998;7:207–12.

  73. 73.

    Carneiro MFG, Guerra Júnior AA, Acurcio FA. [Prescription, dispensing, and regulation of psychoactive anorexigenic drugs in Belo Horizonte, Minas Gerais, Brazil]. Cad Saúde Pública. 2008;24:1763–72. [In Portuguese]

  74. 74.

    Agência Nacional de Vigilância Sanitária. Resolução - RDC Nº 52, de 6 de outubro de 2011. Available from URL: (Accessed 1 July 2013). [In Portuguese]

  75. 75.

    Mariotti Kde C, Ortiz RS, Souza DZ, Mileski TC, Froehlich PE, Limberger RP. Trends in counterfeits amphetamine-type stimulants after its prohibition in Brazil. Forensic Sci Int. 2013;229:23–6.

  76. 76.

    Itaborahy C, Ortega F. [Methylphenidate in Brazil: a decade of publications]. Ciênc Saúde Coletiva. 2013;18:803–16. [In Portuguese]

  77. 77.

    Palhares-Alves HN, Vieira DL, Laranjeira RR, Vieira JE, Nogueira-Martins LA. Clinical and demographic profile of anesthesiologists using alcohol and other drugs under treatment in a pioneering program in Brazil. Rev Bras Anestesiologia. 2012;62:356–64.

  78. 78.

    Carlini EA, Galduróz JCF, Silva AAB, Noto AR, Fonseca AM, Carlini CM, et al. II levantamento domiciliar sobre o uso de drogas psicotrópicas no Brasil: estudo envolvendo as 108 maiores cidades do país. São Paulo: CEBRID/SENAD; 2006. [In Portuguese]

  79. 79.

    Bastos FI, Bertoni N, Hacker MA, Grupo de Estudos em Populacao SeA. [Drug and alcohol use: main findings of a national survey, Brazil 2005]. Rev Saude Publica. 2008;42 Suppl 1:109–17. [In Portuguese]

  80. 80.

    Instituto Nacional de Ciência e Tecnologia para Políticas Públicas do Álcool e Outras Drogas. II levantamento nacional de álcool e drogas–o uso de maconha no Brasil. Available from URL: (Accessed 18 July 2013). [In Portuguese]

  81. 81.

    Zanatta K, Almeida AO, Pinheiro A, Michelotti G. Será que vicia? Universidade cria ambulatório para usuários de maconha e reacende polêmica sobre a droga Available from URL: (Accessed 13 February 2014). [In Portuguese]

  82. 82.

    Jungerman FS, Laranjeira R. Characteristics of cannabis users seeking treatment in Sao Paulo, Brazil. Rev Panamericana Salud Publica = Pan Am J Public Health. 2008;23:384–93.

  83. 83.

    United Nations Office on Drug and Crime. World Drug Report–2010. Vienna: United Nations; 2010.

  84. 84.

    Abdalla RR, Madruga CS, Ribeiro M, I. P, Caetano R, Laranjeira R. Prevalence of cocaine use in Brazil: data from the II Brazilian National Alcohol and Drugs Survey (BNADS). Addict Behav. 2014;39:297–301.

  85. 85.

    United Nations Office on Drug and Crime. World Drug Report–2012. Vienna: United Nations; 2012.

  86. 86.

    Duailibi LB, Ribeiro M, Laranjeira R. Profile of cocaine and crack users in Brazil. Cadernos Saude Publica. 2008;24 Suppl 4:s545–57.

  87. 87.

    Carvalho HB, Bueno R. Infecção pelo HIV e seus determinantes em sete cidades brasileiras. In: Mesquita F, Seibel S, (editors). Consumo de drogas: desafios e perspectivas. São Paulo: Hucitec; 2000. p. 21–53. [In Portuguese]

  88. 88.

    Hacker MA, Leite IC, Renton A, Torres TG, Gracie R, Bastos FI. Reconstructing the AIDS epidemic among injection drug users in Brazil. Cadernos Saude Publica. 2006;22:751–60.

  89. 89.

    Lampe E, Espirito-Santo MP, Martins RM, Bello G. Epidemic history of Hepatitis C virus in Brazil. Infect Genet Evol. 2010;10:886–95.

  90. 90.

    Barbosa Junior A, Szwarcwald CL, Pascom ARP, Souza Junior PB. [Trends in the AIDS epidemic in groups at highest risk in Brazil, 1980–2004]. Cadernos Saude Publica. 2009;25:727–37. [In Portuguese]

  91. 91.

    Pechansky F, Woody G, Inciardi J, Surratt H, Kessler F, Von Diemen L, et al. HIV seroprevalence among drug users: an analysis of selected variables based on 10 years of data collection in Porto Alegre, Brazil. Drug Alcohol Depend. 2006;82 Suppl 1:S109–13.

  92. 92.

    Hacker MA, Leite I, Friedman SR, Carrijo RG, Bastos FI. Poverty, bridging between injecting drug users and the general population, and “interiorization” may explain the spread of HIV in southern Brazil. Health Place. 2009;15:514–9.

  93. 93.

    Barrionuevo A. Ecstasy ensnares upper-class teenagers in Brazil Available from URL: (Accessed 1 August 2013).

  94. 94.

    de Almeida SP, Silva MT. Ecstasy (MDMA): effects and patterns of use reported by users in Sao Paulo. Rev Bras Psiquiatr. 2003;25:11–7.

  95. 95.

    Battisti MC, Noto AR, Nappo S, Carlini Ede A. A profile of Ecstasy (MDMA) use in Sao Paulo, Brazil: an ethnographic study. J Psychoactive Drugs. 2006;38:13–8.

  96. 96.

    Paulin LF, Turato ER. [The prelude to psychiatric reform in Brazil: the contradictions of the 1970s]. Hist Cienc Saude-Manguinhos. 2004;11:241–58. [In Portuguese]

  97. 97.

    Fusar-Poli P, Bruno D, Machado-De-Sousa JP, Crippa J. Franco Basaglia (1924—1980): three decades (1979—2009) as a bridge between the Italian and Brazilian mental health reform. Int J Soc Psychiatry. 2011;57:100–3.

  98. 98.

    Mari Jde J, Saraceno B, Rodriguez J, Levav I. Mental health systems in Latin America and Caribbean countries: a change in the making. Psychol Med. 2007;37:1514–6.

  99. 99.

    Caldas de Almeida JM, Horvitz-Lennon M. Mental health care reforms in Latin America: an overview of mental health care reforms in Latin America and the Caribbean. Psychiatr Serv. 2010;61:218–21.

  100. 100.

    Csillag C. Psychiatric reform law comes into effect in Brazil. Lancet. 2001;357:1346.

  101. 101.

    Andreoli SB, Almeida-Filho N, Martin D, Mateus MD, Mari Jde J. Is psychiatric reform a strategy for reducing the mental health budget? The case of Brazil. Rev Bras Psiquiatr. 2007;29:43–6.

  102. 102.

    Laranjeira R, Elbreder MF, Perrenoud LO, Ribeiro M. Moradias assistidas para dependentes químicos. In: Ribeiro M, Laranjeira R, (editors). O tratamento do usuário de crack. Porto Alegre: Artmed; 2012. p. 514–9.

  103. 103.

    Brazilian Ministry of Health. Reforma psiquiátrica e política de saúde mental no Brasil. Available from URL: (Accessed 27 June 2013). [In Portuguese]

  104. 104.

    Brazilian Ministry of Health. Saúde mental no SUS: os centros de atenção psicossocial. Available from URL: (Accessed 29 July 2013). [In Portuguese]

  105. 105.

    Número de vagas está longe do previsto e prometido. Em Discussão–Rev Audiências Públicas Senado Federal 2011;8:38. [In Portuguese]

  106. 106.

    Brazilian Ministry of Health. Consultórios de rua do SUS. Available from URL: (Accessed 7 July 2013). [In Portuguese]

  107. 107.

    Larrobla C, Botega NJ. Restructuring mental health: a South American survey. Soc Psychiatry Psychiatr Epidemiol. 2001;36:256–9.

  108. 108.

    Duailibi LB, Ribeiro M. Enfermaria especializada. In: Ribeiro M, Laranjeira R, (editors). O tratamento do usuário de crack. Porto Alegre: Artmed; 2012. p. 540–7. [In Portuguese]

  109. 109.

    Reabilitação desafia a sociedade. Em Discussão–Rev Audiências Públicas Senado Federal. 2011;8:32–5. [In Portuguese]

  110. 110.

    Comunidades oferecem 80% das vagas e querem ajuda do Estado. Em Discussão–Rev Audiências Públicas Senado Federal. 2011;8:60–2. [In Portuguese]

  111. 111.

    Siqueira MM, Barbosa DA, Laranjeira R, Hopkins K. Psychoactive substances and the provision of specialized care: the case of Espirito Santo. Rev Bras Psiquiatr. 2007;29:315–23.

  112. 112.

    Fracasso L, Landre M. Comunidade terapêutica. In: Ribeiro M, Laranjeira R, (editors). O tratamento do usuário de crack. Porto Alegre: Artmed; 2012. p. 503–13. [In Portuguese]

  113. 113.

    Ilha F, E. R. No RS, dois terços das comunidades não têm condições para funcionar. Available from URL: (Accessed 29 July 2013). [In Portuguese]

  114. 114.

    Laranjeira R, Zaleski M. Políticas públicas. In: Ribeiro M, Laranjeira R, (editors). O tratamento do usuário de crack. Porto Alegre: Artmed; 2012. p. 633–52. [In Portuguese]

  115. 115.

    Iniciativas de assistência e reinserção social ainda engatinham. Em Discussão–Rev Audiências Públicas Senado Federal 2011;8:55–6. [In Portuguese]

  116. 116.

    Ribeiro MM. Aspectos legais. In: Silveira DX, Moreira FG, (editors). Panorama atual de drogas e dependência. São Paulo: Atheneu; 2006. p. 469–76. [In Portuguese]

  117. 117.

    Secretaria Nacional sobre Drogas. Legislação e políticas públicas sobre drogas no Brasil. Brasilia: SENAD; 2010. [In Portuguese]

  118. 118.

    Geffray C. Social, economic and political impacts of drug trafficking in the state of Rondônia, in the Brazilian Amazon. In: Geffray C, Fabre G, Schiray M, (editors). Globalisation, drugs and criminalization–final research report on Brazil, China, India and Mexico. Marseille: UNESCO/MOST; 2001.

  119. 119.

    Mingardi G. Money and the international drug trade in Sao Paulo. Int Soc Sci J. 2001;53:379–86.

  120. 120.

    Zaluar A. Violence in Rio de Janeiro: styles of leisure, drug use, and trafficking. Int Soc Sci J. 2001;53:369–78.

  121. 121.

    Sapori LF, Sena LL, Silva BFA. A relação entre o comércio do crack e a violência urbana na região metropolitana de Belo Horizonte. In: Sapori LF, Medeiros R, (editors). Crack–um desafio social. Belo Horizonte: Editora PUC Minas; 2010. p. 38–80. [In Portuguese]

  122. 122.

    Ribeiro WS, Mari Jde J, Quintana MI, Dewey ME, Evans-Lacko S, Vilete LM, et al. The impact of epidemic violence on the prevalence of psychiatric disorders in Sao Paulo and Rio de Janeiro, Brazil. PloS One. 2013;8:e63545.

  123. 123.

    Drugs in Brazil–cracking up. Available from URL: (Accessed 12 July 2013).

  124. 124.

    Paim Kessler FH, Barbosa Terra M, Faller S, Ravy Stolf A, Carolina Peuker A, Benzano D, et al. Crack users show high rates of antisocial personality disorder, engagement in illegal activities and other psychosocial problems. Am J Addict. 2012;21:370–80.

  125. 125.

    Santos Cruz M, Andrade T, Bastos FI, Leal E, Bertoni N, Villar LM, et al. Key drug use, health and socio-economic characteristics of young crack users in two Brazilian cities. Int J Drug Policy. 2013;24:432–8.

  126. 126.

    Duailibi L, Ribeiro M, Laranjeira R. [Sociodemographic study with crack users from Luz District–downtown São Paulo City (“Cracolândia”)]. Available from URL: (Accessed 12 July 2013). [In Portuguese]

  127. 127.

    Ribeiro M, Dunn J, Laranjeira R, Sesso R. High mortality among young crack cocaine users in Brazil: a 5-year follow-up study. Addiction. 2004;99:1133–5.

  128. 128.

    Degenhardt L, Singleton J, Calabria B, McLaren J, Kerr T, Mehta S, et al. Mortality among cocaine users: a systematic review of cohort studies. Drug Alcohol Depend. 2011;113:88–95.

  129. 129.

    Ribeiro M, Dunn J, Sesso R, Dias AC, Laranjeira R. Causes of death among crack cocaine users. Rev Bras Psiquiatr. 2006;28:196–202.

  130. 130.

    Goncalves DA, Fortes S, Campos M, Ballester D, Portugal FB, Tofoli LF, et al. Evaluation of a mental health training intervention for multidisciplinary teams in primary care in Brazil: a pre- and posttest study. Gen Hosp Psychiatry. 2013;35:304–8.

  131. 131.

    Tomlinson M, Rudan I, Saxena S, Swartz L, Tsai AC, Patel V. Setting priorities for global mental health research. Bull World Health Organization. 2009;87:438–46.

  132. 132.

    Secretaria Nacional sobre Drogas. Capacitação. Available from URL:;UIPartUID=%7B2868BA3C-1C72-4347-BE11-A26F70F4CB26%7D (Accessed 23 June 2013). [In Portuguese]

  133. 133.

    Associação Médica Brasileira. Projeto diretrizes. Available from URL: (Accessed 3 June 2013). [In Portuguese]

  134. 134.

    Instituto Nacional de Câncer. Tabagismo–um grave problema de saúde pública. Rio de Janeiro: INCA; 2007. [In Portuguese]

  135. 135.

    Instituto Nacional de Câncer. Pesquisa Especial de Tabagismo (PETab)–relatório Brasil. Rio de Janeiro: INCA; 2011. [In Portuguese]

  136. 136.

    Azevedo e Silva G, Valente JG, Almeida LM, Moura EC, Malta DC. Tobacco smoking and level of education in Brazil, 2006. Rev Saude Publica. 2009;43 Suppl 2:48–56.

  137. 137.

    Pantani D, Pinsky I, Monteiro A. Publicidade de tabaco no ponto de venda. São Paulo: INPAD; 2011. [In Portuguese]

  138. 138.

    Caetano R, Laranjeira R. A ‘perfect storm’ in developing countries: economic growth and the alcohol industry. Addiction. 2006;101:149–52.

  139. 139.

    Holmes D. Prescription drug addiction: the treatment challenge. Lancet. 2012;379:17–8.

  140. 140.

    Fagundes LL, Karl FJ, Silva PC, Leite VM. Comércio ilegal de medicamentos pela Internet: um estudo de caso. Available from URL: (Accessed 13 February 2014). [In Portuguese]

  141. 141.

    Noto AR, Pinsky I, Mastroianni Fde C. Drugs in the Brazilian print media: an exploratory survey of newspaper and magazine stories in the year 2000. Subst Use Misuse. 2006;41:1263–76.

  142. 142.

    Crippa JA, Hallak JE, Zuardi AW. Marijuana, feijoada and the debate on drug legalization. Front Psychiatry. 2013;4:7.

  143. 143.

    Hawken A, Caulkins J, Kilmer B, Kleiman M. Quasi-legal cannabis in Colorado and Washington: local and national implications. Addiction. 2013;108:837–8.

  144. 144.

    How will Uruguay’s marijuana law work? Available from URL: (Accessed 10 August 2013).

  145. 145.

    Andrade TM. [Reflections on drug policies in Brazil]. Ciênc Saúde Coletiva. 2011;16:4665–74. [In Portuguese]

  146. 146.

    Conselho Regional de Medicina do Estado de São Paulo. Avaliação dos centros de atenção psicossocial (CAPS) do Estado de São Paulo. São Paulo: CREMESP; 2010. [In Portuguese]

  147. 147.

    Ribeiro M, Perrenoud LO. Ambulatório especializado: estrutura, funcionamento e indicações. In: Ribeiro M, Laranjeira R, (editors). O tratamento do usuário de crack. Porto Alegre: Artmed; 2012. p. 521–30. [In Portuguese]

  148. 148.

    Teixeira LP. Bangkok 2004. The spread of harm-reduction programs in Brazil. HIV/AIDS policy & law review / Canadian HIV/AIDS Legal Network. 2004;9:94–5.

  149. 149.

    Room R. Working towards harm reduction in Brazil. Addiction. 2002;97:1488–9.

  150. 150.

    Domanico A, Malta M. Implementation of harm reduction toward crack users in Brazil: barriers and achievements. Subst Use Misuse. 2012;47:535–46.

  151. 151.

    Conselho Federal de Psicologia. Relatório da 4ª inspeção nacional de direitos humanos: locais de internação para usuários de drogas. Available from URL: (Accessed 13 Februrary 2014). [In Portuguese]

  152. 152.

    Curso de Extensão Universitária ‘Drogas e Direitos humanos’ PCeDU,,. Declaração de direitos dos usuários de drogas por uma política de redução dos danos. Available from URL: (Accessed 13 February 2014). [In Portuguese]

  153. 153.

    Santos VE, Soares CB, Campos CMS. [Harm reduction: analysis of the concepts that guide practices in Brazil]. Physis. 2010;20:995–1015. [In Portuguese]

  154. 154.

    Kallert TW, Mezzich JE, Monahan J. Coercive treatment in psychiatry–clinical, legal and ethical aspects. Hoboken (NJ): Wiley-Blackwell; 2011.

  155. 155.

    Lancetti A, Chioro A, Vargas B, Zaparoli C, Petuco DRS, Castilho EWV, et al. Drogas e cidadania: em debate. Brasilia: CFP; 2012. [In Portuguese]

  156. 156.

    McKeganey N. Harm reduction at the crossroads and the rediscovery of drug user abstinence. Drugs Educ Prev Pol. 2012;19:276–83.

  157. 157.

    Pulverizados, órgãos e iniciativas não conseguem se articular. Em Discussão–Rev Audiências Públicas Senado Federal. 2011;8:50. [In Portuguese]

  158. 158.

    Boyum DA, Caulkins JP, Kleiman MAR. Drugs, crime and public policy. In: Wilson JQ, Petersilla J, (editors). Crime and public policy. New York (NY): Oxford University Press; 2011. p. 368–410.

  159. 159.

    Wacquant L. The militarization of urban marginality: lessons from the Brazilian metropolis. Int Pol Sociology. 2008;2:56–74.

  160. 160.

    Strang J, Babor T, Caulkins J, Fischer B, Foxcroft D, Humphreys K. Drug policy and the public good: evidence for effective interventions. Lancet. 2012;379:71–83.

  161. 161.

    Briggs D. Crack cocaine users: high society and low life in South London. London: Routledge; 2011.

  162. 162.

    da Costa e Silva VL, Pantani D, Andreis M, Sparks R, Pinsky I. Bridging the gap between science and public health: taking advantage of tobacco control experience in Brazil to inform policies to counter risk factors for non-communicable diseases. Addiction. 2013;108:1360–6.

Download references

Author information

Correspondence to Marcelo Ribeiro MSc, PhD.

Rights and permissions

Reprints and Permissions

About this article

Key Words

  • Drug policy
  • substance abuse
  • epidemiology
  • Brazil
  • tobacco abuse
  • alcohol abuse
  • substance abuse treatment centers