Skip to main content
Download PDF

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

Public Health Reviews volume 35, Article number: 7 (2013) Cite this article

Abstract

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.

References

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

    Google Scholar 

  2. The World Bank. GDP (current US$). Available from URL: http://data.worldbank.org/indicator/NY.GDP.MKTP.CD (Accessed 13 February 2014).

    Google Scholar 

  3. United Nations Development Programme. Human Development Report 2013–the rise of the south: human progress in a diverse world. Available from URL: http://www.undp.org/content/dam/philippines/docs/HDR/HDR2013ai]20Reportai]20English.pdf (Accessed 1 July 2013).

    Google Scholar 

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

    Article  PubMed  Google Scholar 

  5. The Brazilian Institute of Geography and Statistics. PIB dos municípios revela concentração e desigualdades na geração de renda. Available from URL: http://saladeimprensa.ibge.gov.br/noticias?view=noticia&id=1&busca=1&idnoticia=354 (Accessed 13 February 2014). [In Portuguese]

    Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

  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.

    Article  Google Scholar 

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

    Article  Google Scholar 

  10. European Commission. Brazil–country strategy paper 2007–2013. Available from URL: http://eeas.europa.eu/brazil/csp/07_13_en.pdf (Accessed 15 June 2013).

    Google Scholar 

  11. The Economist. Democracy Index 2012: Democracy is at a standstill. Available from URL: https://www.eiu.com/public/topical_report.aspx?campaignid=DemocracyIndex12 (Accessed 20 July 2013).

    Google Scholar 

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

    Article  Google Scholar 

  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: http://www.anpec.org.br/encontro2008/artigos/200807211718170-.pdf (Accessed 28 June 2013).

    Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    CAS  PubMed  PubMed Central  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  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]

    Google Scholar 

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

    Article  PubMed  Google Scholar 

  21. Presidency of the Republic of Brazil. Lei Nº 12.546 de 2011. Available from URL: http://www.planalto.gov.br/ccivil_03/leis/l9294.htm (Accessed 29 June 2013). [In Portuguese]

    Google Scholar 

  22. Brazilian Ministry of Health. Resolução - RDC Nº 14, de 15 de março de 2012. Available from URL: http://bvsms.saude.gov.br/bvs/saudelegis/anvisa/2012/rdc0014_15_03_2012.html (Accessed 13 February 2014). [In Portuguese]

    Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Presidency of the Republic of Brazil. Decreto Nº 5.658, de 2 de janeiro de 2006. Available from URL: http://www.planalto.gov.br/ccivil_03/_Ato2004-2006/2006/Decreto/D5658.htm (Accessed 25 February 2014). [In Portuguese]

    Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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]

    Google Scholar 

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

    Article  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Google Scholar 

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

    Article  PubMed  Google Scholar 

  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]

    Article  PubMed  Google Scholar 

  43. São Paulo State Government. Lei Nº 14.592 de 19 de outubro de 2011. Available from URL: http://www.alcoolparamenoreseproibido.sp.gov.br/wp-content/uploads/pl698a11-parcial.pdf (Accessed 13 February 2014). [In Portuguese]

    Google Scholar 

  44. Departamento Nacional de Trânsito. Frota brasileira de veículos–2013. Available from URL: http://www.denatran.gov.br/frota2013.htm (Accessed 23 July 2013) [In Portuguese]

    Google Scholar 

  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]

    Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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]

    Article  Google Scholar 

  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]

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

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

    Article  Google Scholar 

  52. Departamento Nacional de Trânsito. Lei Nº 11.705 de 19 de junho de 2008. Available from URL: http://www.denatran.gov.br/publicacoes/download/ctb_e_legislacao_complementar.pdf (Accessed 13 February 2014). [In Portuguese]

    Google Scholar 

  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]

    Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  58. Hayashi N. Beer beats oil as AmBev value rises toward top: corporate Brazil. Available from URL: http://www.bloomberg.com/news/2012-06-18/beer-beats-oil-as-ambev-value-rises-toward-top-corporate-brazil.html (Accessed 20 June 2012).

    Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

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

    Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  Google Scholar 

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

    Article  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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]

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  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]

    Article  Google Scholar 

  74. Agência Nacional de Vigilância Sanitária. Resolução - RDC Nº 52, de 6 de outubro de 2011. Available from URL: http://www.anvisa.gov.br/hotsite/anorexigenos/pdf/RDC%2052-2011%20DOU%2010%20de%outubro%20de%202011.pdf (Accessed 1 July 2013). [In Portuguese]

    Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

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

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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]

    Google Scholar 

  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]

    Article  PubMed  Google Scholar 

  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: http://inpad.org.br/wp-content/uploads/2013/04/Press_Maconha_SIte1.pdf (Accessed 18 July 2013). [In Portuguese]

    Google Scholar 

  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: http://www1.folha.uol.com.br/revista/rf1302200004.htm (Accessed 13 February 2014). [In Portuguese]

    Google Scholar 

  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.

    Google Scholar 

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

    Google Scholar 

  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.

    Article  PubMed  Google Scholar 

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

    Google Scholar 

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

    Article  Google Scholar 

  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]

    Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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]

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  93. Barrionuevo A. Ecstasy ensnares upper-class teenagers in Brazil Available from URL: http://www.nytimes.com/2009/02/15/world/americas/15ecstasy.html?pagewanted=all&_r=1& (Accessed 1 August 2013).

    Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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]

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Google Scholar 

  103. Brazilian Ministry of Health. Reforma psiquiátrica e política de saúde mental no Brasil. Available from URL: http://bvsms.saude.gov.br/bvs/publicacoes/relatorio15_anos_caracas.pdf (Accessed 27 June 2013). [In Portuguese]

    Google Scholar 

  104. Brazilian Ministry of Health. Saúde mental no SUS: os centros de atenção psicossocial. Available from URL: http://www.ccs.saude.gov.br/saude_mental/pdf/sm_sus.pdf (Accessed 29 July 2013). [In Portuguese]

    Google Scholar 

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

    Google Scholar 

  106. Brazilian Ministry of Health. Consultórios de rua do SUS. Available from URL: http://portal.saude.gov.br/portal/arquivos/pdf/consult_rua17_1_11.pdf (Accessed 7 July 2013). [In Portuguese]

    Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  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]

    Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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]

    Google Scholar 

  113. Ilha F, E. R. No RS, dois terços das comunidades não têm condições para funcionar. Available from URL: http://oglobo.globo.com/pais/no-rs-dois-tercos-das-comunidades-nao-tem-condicoes-para-funcionar-9218458 (Accessed 29 July 2013). [In Portuguese]

    Google Scholar 

  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]

    Google Scholar 

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

    Google Scholar 

  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]

    Google Scholar 

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

    Google Scholar 

  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.

    Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  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]

    Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  123. Drugs in Brazil–cracking up. Available from URL: http://www.economist.com/news/americas/21575810-worlds-biggest-crack-market-seeks-better-way-deal-addicts-cracking-up (Accessed 12 July 2013).

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

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

    Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  132. Secretaria Nacional sobre Drogas. Capacitação. Available from URL: http://portal.mj.gov.br/senad/main.asp?ViewID=%7B3A1B2C37-4B6D-4C92-80F8-6BD24F53CBAF%7D&params=itemID=%7B3DE302EF-93BE-4BF5-8921-C45C762640D9%7D;UIPartUID=%7B2868BA3C-1C72-4347-BE11-A26F70F4CB26%7D (Accessed 23 June 2013). [In Portuguese]

    Google Scholar 

  133. Associação Médica Brasileira. Projeto diretrizes. Available from URL: http://www.projetodiretrizes.org.br/amb.php (Accessed 3 June 2013). [In Portuguese]

    Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

  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.

    Article  PubMed  Google Scholar 

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

    Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  140. Fagundes LL, Karl FJ, Silva PC, Leite VM. Comércio ilegal de medicamentos pela Internet: um estudo de caso. Available from URL: http://www.icofcs.org/2012/ICoFCS2012_05.pdf (Accessed 13 February 2014). [In Portuguese]

    Google Scholar 

  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.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  144. How will Uruguay’s marijuana law work? Available from URL: http://www.economist.com/blogs/economist-explains/2013/08/economist-explains-1 (Accessed 10 August 2013).

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

    Article  Google Scholar 

  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]

    Google Scholar 

  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]

    Google Scholar 

  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.

    Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  151. Conselho Federal de Psicologia. Relatório da 4ª inspeção nacional de direitos humanos: locais de internação para usuários de drogas. Available from URL: http://www.crpsp.org.br/portal/midia/pdfs/Relatorio_Inspecao_Direitos_Humanos.pdf (Accessed 13 Februrary 2014). [In Portuguese]

    Google Scholar 

  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: http://www.flacso.org.br/portal/pdf/area_saude_publica_direitos_humanos/2008_DECLARACAO_DIREITOS_DOS_USUARIOS_DROGAS.pdf (Accessed 13 February 2014). [In Portuguese]

    Google Scholar 

  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]

    Article  Google Scholar 

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

    Book  Google Scholar 

  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]

    Google Scholar 

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

    Article  Google Scholar 

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

    Google Scholar 

  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.

    Google Scholar 

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

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

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

    Google Scholar 

  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.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Unidade de Pesquisa em Álcool e Drogas, UNIAD, Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570, 8° andar, conjunto 802, 04038-020, São Paulo (SP), Brazil

    Marcelo Ribeiro MSc, PhD, Luciane Ogata Perrenoud, Sérgio Duailibi MD, PhD, Lígia Bonacim Duailibi MSc & Ronaldo Laranjeira MD, PhD

  2. São Paulo State Government, Reference Center for Alcohol, Tobacco and other Drugs (CRATOD), São Paulo, Brazil

    Marcelo Ribeiro MSc, PhD

  3. National Institute of Science and Technology for Public Policies in Alcohol and Drugs (INPAD), Federal University of Sao Paulo (UNIFESP), São Paulo, Brazil

    Marcelo Ribeiro MSc, PhD, Sérgio Duailibi MD, PhD, Clarice Madruga MSc, PhD, Ana Cecília Petta Roseli Marques MD, PhD & Ronaldo Laranjeira MD, PhD

  4. Brazilian Association for the Study of Alcohol and Other Drugs (ABEAD), Brazil

    Ana Cecília Petta Roseli Marques MD, PhD

  5. Special Advisor for Drug Policy (Programa Recomeço), São Paulo State Government, Brazil

    Ronaldo Laranjeira MD, PhD

Authors
  1. Marcelo Ribeiro MSc, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luciane Ogata Perrenoud
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sérgio Duailibi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lígia Bonacim Duailibi MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Clarice Madruga MSc, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ana Cecília Petta Roseli Marques MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ronaldo Laranjeira MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marcelo Ribeiro MSc, PhD.

Rights and permissions

Open Access  This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/.

The Creative Commons Public Domain Dedication waiver (https://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article

Ribeiro, M., Perrenoud, L.O., Duailibi, S. et al. The Brazilian Drug Policy Situation: The Public Health Approach Based on Research Undertaken in a Developing Country. Public Health Rev 35, 7 (2013). https://doi.org/10.1007/BF03391706

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/BF03391706

Key Words

Public Health Reviews

ISSN: 2107-6952

Contact us