Brazil debates treatment options in crack epidemic
Bobo has a method: Cocaine gets him through the day, when he cruises with a wheelbarrow around a slum on Rio's west side, sorting through trash for recyclables to sell. At night, he turns the day's profit into crack.
"Sometimes I don't sleep at all; I'm up 24 hours," says Bobo, a former soldier who doesn't use his given name for safety reasons. "I work to support my addiction, but I only use crack at night. That drug takes my mind away. I lose all notion of what I'm doing."
Bobo says balancing crack with cocaine keeps him working and sane. On the shantytown's streets, life can be hell: Addicts unable to strike Bobo's precarious balance use crack day and night, begging, stealing, prostituting themselves, and picking through trash to make enough for the next hit. For them, there's no going home, no job, nothing but the drug.
With a boom in crack use over the past decade, Brazilian authorities are struggling to stop the drug's spread, sparking a debate over the legality and efficiency of forcibly interning users. Brazil today is the world's largest consumer of both cocaine and its crack derivative, according to the Federal University of Sao Paolo. About 6 million adults, or 3 percent of Brazilians, have tried cocaine in some form.
Rio de Janeiro has taken the lead in trying to help the burgeoning number of users with an approach that city leaders call proactive, but critics pan as unnecessarily aggressive. As of May 2011, users living in the streets have been scooped up in pre-dawn raids by teams led by the city's welfare department in conjunction with police and health care workers. By Dec. 5, 582 people had been picked up, including 734 children.
The sight is gut-wrenching. While some people go meekly, many fight, cry, scream out in desperation in their altered states. Once they're gone, their ratty mattresses, pans, sweaters and few other possessions are swept up by a garbage removal company.
Adults can't be forced to stay in treatment, and most leave the shelters within three days. But children are kept in treatment against their will or returned to parents if they have a family. In December, 119 children were being held in specialized treatment units.
Demand for crack has boomed in recent years and open-air "cracolandias," or "crack lands," popped up in the urban centers of Rio and Sao Paulo, with hundreds of users gathering to smoke the drug. The federal government announced in early 2012 that more than $2 billion would be spent to fight the epidemic, allotting money to train health care workers, buy thousands of hospital and shelter beds, and create transitional centers for recovering users.
Mobile street units stationed near cracolandias are among the most important and visible aspects of the government's approach. The units, housed in metal containers, bring doctors, nurses, therapists and social workers to the areas where users concentrate. Slowly, by offering health care and other help, the units' workers gain the trust of users and refer them to treatment centers.
Studies suggest the approach can work: 47 percent of the crack users surveyed in Sao Paulo said they'd welcome treatment, according to the Federal University of Sao Paulo study.
Ethel Vieira, a psychologist on the raid team, thinks their persistence is paying off.
"Initially, they'd run away, react aggressively, throw rocks," she said of users. "Now most of them understand our intention is to help, to give them a chance to leave the street and to connect with the public health network."
Human rights groups object to the forced commitment of children, saying treatment delivered against the will of patients is ineffective. They also oppose the sweeps, which they describe as violent.
"There are legal procedures that must be followed and that are not being followed. This goes against the law and is unconstitutional," Margarida Pressburguer, head of the Human Rights Commission for Brazil's Association of Attorneys, said during a debate last year.
Rio Mayor Eduardo Paes suggested in October that the city would start forcing adults into treatment. "A crack addict isn't capable of making decisions," Paes said from the Jacarezinho shantytown in the week after police stormed the area and seized control of what was then Rio's largest cracolandia.
The Rio state Attorney General's Office responded by telling city officials "the compulsory removal of adults living in the streets has no legal foundation." It said adults can be committed only when they become a danger to themselves or others and outpatient treatment options have run out.
"They give us a place to sleep, food, clothes, everything," said Bobo. "I've been picked up by the city and I liked it. They are doing this for our good."
But even as Bobo endorsed the city's approach, a friend was stepping over to the drug stand for more cocaine. Bobo asked for $5 worth of drugs - cocaine for now, crack for later. Then he rolled up a bill and dumped a small mound of white powder in his palm for snorting.
With a nose full of cocaine, he set off, ready for another day.