‘Despite the fact that drug use has been decriminalised in Portugal, there seems to be a lasting resistance to framing drug use beyond public health and public disorder issues.’
Despite its centrality in the “heavy drug use over time” (see Rehm et al., 2013) Portuguese landscape, crack cocaine is a largely unknown phenomenon (Curado et al., 2014) unfolding a gap in research, harm reduction policy, and intervention levels. Yet, between 70% and 90% of GIRUGaia clients use crack cocaine regularly or occasionally**
Governmental structures’ reports tend not to distinguish between cocaine and crack cocaine, despite the target market for each drug being highly distinct, if not opposed: on one hand, the “socially integrated” or (frequently) non-problematic users (Cruz, 2015), typically snort cocaine powder; on the other, those under social exclusion tend to inject and/or smoke crack cocaine, sometimes associated with opiates. As a result, there is no available data relating to the two different products. Still, cocaine and crack cocaine display distinct sets, settings and rituals of use as well user profiles, demanding higher conceptual accuracy and distinct HR strategies.
The association between crack cocaine and opiates is not surprising. If Oriol Romaní (999: 153) underlines that psychoactive substances (PS) are “one of the areas of social life that is stigmatized through social construction of the drug problem”; Philippe Bourgois (2003) underlines that ‘political economics and cultural forces’ shape the trajectory of drug epidemics. Despite the pharmacological dissimilarities, both heroin and crack cocaine have similar effects on vulnerable social fringes that are especially at risk of stigmatisation, exclusion, and structural violence.
Is the street junkie lifestyle deeply intermingled with social exclusion, while the pharmacological properties of misused drugs play a secondary role?
As in a circular feedback process, social exclusion and stigma would amplify the problematic side of drug use while vulnerable groups would be (structurally) driven to use types of drugs that are especially devastating. Being aware that welfare practice and social action is conditioned by ideological coordinates that shape a particular care model, action-research, outreach technicians, peers, and users should call for the evidence: on the one hand, the power of PS is mediated “by users’ norms, values, practices and circumstances” (EMCDDA, 2012), on the other, regarding HR principles, outreach teams and peers should contribute with dignity to the PWUS (SICAD 2009, 2017). A bigger barrier is added to this hegemonic war of paradigms of substance use: stigma with “heavy drug use over time” reveals a lack of funding for crack cocaine related materials and structures, such as pipes, drug checking, and drug consumption rooms.
GIRU teams are well familiarised with those dynamics. The need to produce scientific knowledge on the issue and further adapt HR interventions has been identified and stands as a priority for GIRU teams.
HR policy and teams deepen stigma when they frame recreational drug use as an individual choice/right, promoting strategies orientated to risk and pleasure management, leaving aside vulnerable PWUDs, for whom HR policy is framed as a health/hygienic and social order issue.
Tailored HR interventions targeted to crack cocaine use should include cosy and safe drug consumption rooms with trained personnel (Erickson and Cheung, 1999) and drug checking services; safe crack use kits containing a pipe (“L” format preferred), mouthpieces, filters, lip balsams, condoms and lube (Ivsins et al., 2011; Curado et al. 2014); as well as integrated distribution of safer smoking equipment into existing services, and general or preferably peer education (Malchy, Bungay and Johnson, 2008).
Moreover, similarly to what already happens in HR with partygoers, “informed choice” and “right to use drugs” principles must be extended to vulnerable PWUDs, namely by assuring identical opportunities to drug check PS. Otherwise, HR intervention risks deepening the social exclusion processes that it aims to oppose. Despite the fact that drug use has been decriminalised in Portugal, there seems to be a lasting resistance to framing drug use beyond public health and public disorder issues. Individual freedom within human rights discourses must be reinforced.
Ximene Rego, Jakub Greń, Joana Cânedo, Cláudia Rodrigues & Teresa Sousa
*For instance, data gathered regarding registered drug use in March 2017, among GiruGaia clients, shows the following pattern: crack cocaine (70%), heroin (49%) and alcohol (13%). If all months of 2016 are considered, average use of crack cocaine might rise to 90%.
Bourgois, P. (2003), “Crack and the political economy of social suffering”, Addiction Research and Theory, 11 (1): 31-37.
Curado, A., Santa Maria, J., Brás, M. J., Barroso, C., Silva, D., Luz, M., … & Mendão, L. (2014). A pilot harm reduction programme for crack cocaine smokers in lisbon: An Acceptability study.
EMCDDA (2016), European Drug Report: Trends and developments, Lisbon, EU Publications.
Erickson, P. G., & Cheung, Y. W. (1999). Harm reduction among cocaine users: reflections on individual intervention and community social capital. International Journal of Drug Policy, 10(3), 235-246.
Ivsins, A., Roth, E., Nakamura, N., Krajden, M., & Fischer, B. (2011). Uptake, benefits of and barriers to safer crack use kit (SCUK) distribution programmes in Victoria, Canada—A qualitative exploration. International Journal of Drug Policy, 22(4), 292-300.
Malchy, L., Bungay, V., & Johnson, J. (2008). Documenting practices and perceptions of ‘safer’crack use: A Canadian pilot study. International Journal of Drug Policy, 19(4), 339-341.
Rehm, J., Marmet, S., Anderson, P., Gual, A., Kraus, L., Nutt, D.J., Room, R., Samokhvalov, A.V., Scafato, E., Trapencieris, M., Wiers, R.W., & Gmel, G. (2013) Defining substance use disorders: do we really need more than heavy use? Alcohol and Alcoholism, 48(6), 633-640. doi: 10.1093/alcalc/agt127
Romaní, O., & Romaní, O. (2004). Pana una politica sensata respecto a las drogas. In Las drogas: Sueños y razones (pp. 175-203) No. Sirsi. i9788434444669).
SICAD (2015), A situação do país em matéria de drogas e toxicodependência, Lisbon, Relatório Anual.