Organized by Intercambios Asociación Civil
Pablo Cymerman, Intercambios AC: This research is particularly important for our region. In our region there is a high use of cocaine and use is increasing. There are currently few studies on this particular use of cocaine. This research was led by TNI.
Pien Metaal, Transnational Institute: This has been a long lasting effort to unite data on the market of smokable cocaines, not just because there is little evidence and data available on how it is used, how it effects the users and the lack of policy responses. Those who use cocaine are amongst the most marginalised populations, most hard to reach communities and most vulnerable, mostly living on the streets. And it was difficult to reach these people specifically international to harm reduction. Currently harm reduction primarily focuses on stimulant-opioid use, not smokable cocaine. There is little attention to the community using smokable cocaine. We invited those who work on the streets to participate. We decided to focus on the markets in order to understand their dynamics, and aimed to use as much scientific evidence possible in order to suggest a policy response. There has been hardly any attention given to smokable cocaines in UNODC reports, its primarily powdered cocaine. We have had participants from 10 or 11 countries in this study. They contributed to data about the kind of substance, the culture around the substance, the way its consumed, administered, what the prices are, what the quality or purity is. There is one country that has never looked at this. Often we don’t know what we are talking about when talking about smokable cocaines. We are interested in helping develop more harm reduction instruments We call on national governments and policy institutes to refrain from criminalising the use, mainly because most users are exposed to vulnerabilities already by living in the street.
Pablo Cymerman, Intercambios AC: In this presentation, we thought we want to make a conversation. We will present the results, but then we will open it to the floor, which is not very usual in these spaces.
Ernesto Cortés, ACEID: We worked with 10 countries and the initiative sought to fill a gap when it comes to knowledge on stimulants. What smokable cocaine? The areas where it’s produced matters here (Andean countries). After it gets out of production areas, it tends to become crack cocaine. The process by which coca is turned into cocaine, produces substances, and residues, that are smokable. The cocaine base paste and cocaine base are prevalent in the Andean countries and neighbouring countries. Not a lot of research regarding these products and the use of these products. Some by the OAS, some by countries, some by civil society. In the CICA study, we found that the samples analysed were different in terms of samples (Chile: 12 thousand, Argentina: 75, Brazil: Not as much), and sources (most from the police). The evidence doesn’t clearly show what’s in the market. We need to do more chemical analysis of smokable cocaine. What is the market? There’s open air markets, like El Bronx, in Bogotá; and Cracolandia, in Sao Paulo. In the latter, up to 800 people used drugs there and this was a bit of an area of tolerance were law enforcement didn’t attend. We see a lot of bartering (crack in exchange for shoes, for instance). The ways of using it: cans, makeshift pipes, modified test tubes, etc. Important opportunity of harm reduction here, because some pipes burn people’s mouths. In some cases, users developed harm reducing pipes. Important to highlight also that a few years ago we saw harm reduction interventions develop in El Bronx and Cracolandia. They were low-threshold services; basic assistance.
Pien Metaal, Transnational Institute: Contrary to the perception of most people, those in the streets weren’t in the streets because of drug use; they started using as a coping method to cope with the hardships of homelessness.
Ernesto Cortés, ACEID: We were also told people who weren’t from there, or homeless, used crack in those spaces. Going back to the services: medical, psychological, art interventions. But in Sao Paulo, Braços Abertos – the biggest project of the sort in Latin America. A whole range of services: housing, culture, normalisation of identity documents, etc. I wanted to show also these images of repression of these two areas. The programmes were partially closed or de-funded. And law enforcement raided the area and in cases displaced them. The depiction of people who use smokable cocaines as violent was used as an excuse to intervene violent. And the consequence was also that people in these areas ended up moving to all over the city and dispersing, which made interventions harder. PSF published ‘Crack: Reducing harms’, which set out a series of principles for programmes: proximity (work for and with people in situations of vulnerability), territoriality (go to people), advocacy (address their conditions of stigma, marginalisation and discrimination), intersectionality, networking (bring people who use drugs to other systems of support too). In terms of Braços Abertos, the absolute majority said the programme was positive (58%) or very positive (37%). The most important according to people? Housing -within or outside of cracolandia, work -daily jobs, income, support – assistance to get better on people’s own terms. There are also projects developed to provide safe use kits: to reduce harms on lips, mouth, throat and lungs, to reduce hepatitis infections, to promote safer sex, to engage with people who smoke cocaine as part of an outreach intervention and programme. Now, we also saw a pharmacological substitution among people who use smokable cocaine: with cannabis, with ATS (like methylphenidate, because some users want the stimulating effect), with coca mild stimulants (coca chewing), with entheogens (with ayahuasca, iboga – these mostly as paths towards abstinence). This has started to appear in research, but there aren’t randomised controlled trials yet. We use the Latin American and US drug policy conferences to share our insights.
Question & Answers
Mick Webb: It seems most of the work is about stopping people using drugs. How come?
Pien Metaal, TNI: We try to speak from the perspective of users. The focus wasn’t abstinence. They work with users. And the programmes’ purpose is not abstinence.
Ernesto Cortés, ACEID: We have very few programmes in Latin America. Most users say they want to quit, and this might be due to stigma. But the programmes that we looked into are not aiming to making people who use drugs abstinent. The idea is reducing harm and providing comprehensive care. It might have been confusing that I mentioned the ayahuasca treatment, which is abstinence-orientated; but that’s because it’s for people that are aiming to quit using drugs.