Woman gives up crack and regains autonomy with marijuana – 02/10/2024 – Health

Woman gives up crack and regains autonomy with marijuana – 02/10/2024 – Health


Franciele Silva, 43, remembers well the date on which life took a turn: August 8, 2008. After an episode of domestic violence, she fled with her three daughters to Curitiba (PR). She was 28 years old and had been married for 12 years.

Without knowing anyone in the capital of Paraná, he started selling sweets on the streets. Two months later, the Child Protection Council collected the children and handed them over to Franciele’s then-husband, father of two of the daughters.

“I lost my ground, my direction. The next day, I smoked my first crack and spent eight days without sleeping or eating. Just smoking and crying. From then on, I started working for a drug dealer and stealing.”

Franciele even tried to go back to live with her husband for two weeks, to be close to her daughters, but she relapsed and, after a new fight, went to live in Cracolândia, in the center of São Paulo.

“I stayed there for seven years. I saw a lot of ugly things, I had tuberculosis, I was arrested for drug trafficking, but I was acquitted because the judge understood that I was a user.”

In 2015, she met a boy on the stream and they both joined the “De Braços Abertos” program, implemented in Cracolândia in 2014 by the Fernando Haddad (PT) administration at São Paulo City Hall and extinguished by his successor João Doria (PSDB).

Based on the harm reduction strategy, the program offered housing, work (participants earned R$15 per day for services such as sweeping and recycling) and medical support. A study showed that two thirds of beneficiaries reduced their use of the drug. The shelter in hotels in the region, however, proved to be reckless: drug trafficking ended up infiltrating these places.

“I didn’t smoke crack for 15 days. To hold back, I started smoking marijuana because I was going to meet his mother [do parceiro] and I didn’t want her to see me with my fingers burned [pelas pedras do crack]. I didn’t promise to stop, but after that I didn’t have the courage to smoke crack. That was on May 28, 2015.”

Almost nine years later, she continues to use cannabis in the form of cigarettes and oil, cannabidiol, provides psychiatric care and uses clonazepam, a medication indicated for the treatment of panic and anxiety disorders. “If I don’t take it, I don’t sleep. I got the after-effects of crack.”

Like Franciele, many patients have given up on pursuing total abstinence from drugs, a condition imposed by many services that offer hospitalization as treatment for addiction, and have managed to regain autonomy and dignity through harm reduction strategies.

“In the best treatments in the world that propose total abstinence, after two years of follow-up, only 20% achieve this goal. It is a great perversity to defend total abstinence as the only acceptable strategy”, says psychiatrist and clown Flávio Falcone, who operates in Cracolândia.

After leaving the stream, Franciele adopted her fourth daughter and became closer to the other three. To survive, she already had a French fries and pastries stand and, since 2020, she registered on an app and works as a recyclables cart in the Higienópolis region (SP).

She has also worked as a technical educator in a damage re-education project in Cracolândia and took a caregiving course. By the end of this year, she hopes to fully recover from treatment for the bowel cancer she was diagnosed with at the end of last year and complete high school.

“By pulling a cart, I got to know this side of sustainability, the environment. I want to continue working with this and also with harm reduction.”

According to Falcone, there is no opposition between the harm reduction model and total abstinence. “Each person has their own path. We build a therapeutic project according to each person’s conditions and this can even result in total abstinence”, he reinforces.

For psychiatrist Luís Fernando Tófoli, professor at Unicamp (State University of Campinas) and drug policy researcher, the central idea of ​​harm reduction is to reduce the impact of problematic drug use. “It is a distorted view to think that harm reduction means giving up abstinence.”

Karin di Monteiro, who coordinates the teaching and research center at the NGO É de Lei, says that this mistaken idea that there is only one path, that of total abstinence, often keeps people away from treatment.

“They try several times, they even manage to stay abstinent, but they come back. This doesn’t mean it’s a failure of the goal. Without us imposing this obligation of abstinence, the person often gets to that place alone, it becomes a key.”

Dartiu Xavier da Silveira, psychiatrist and professor at Unifesp (Federal University of São Paulo), states that, on average, 70% of people who seek treatment for addiction will not be able to remain abstinent.

“Harm reduction is a plan B that works. Many people get jobs, manage to maintain a stable relationship, and take responsibility for their own lives.”

According to him, in the medium term, after a follow-up of two to four years, half of the people included in harm reduction programs are abstinent.

“Although abstinence is not a prerequisite, the fact of tolerating that individual to consume [alguma droga]but not in a harmful way, it is a way for him to also become abstinent.”

Among those who cannot achieve abstinence after this period, 75% maintain harm reduction strategies using other substances in a controlled manner. “She gives up on the project of total abstinence and lives a practically normal life,” says Silveira.

For psychiatrist Alexandre Valverde, harm reduction is a more realistic perspective for the patient. “This idea that the patient will obey and adopt [a abstinência] because you are in your authority as a doctor saying that this is the path is unrealistic. People abandon treatments and generate a circuit of frustration, guilt and punishment, which is totally counterproductive.”

Internationally recognized by the WHO (World Health Organization), harm reduction is official policy in several countries such as the Netherlands, England, Canada and Australia. In 2019, the administration of Jair Bolsonaro (PL) put an end to harm reduction and made abstinence the only public policy.

Silveira, from Unifesp, says that many people who give up on abstinence do not even need to pursue this because, in fact, they are not actually drug addicts, a condition defined as the loss of control over consumption.

“People try [a abstinência] because the country’s culture is punitive and police-like with illicit drugs. They can only use legal drugs, such as alcohol, if they are not classified as drug addicts.”

Silveira explains that chemical dependency affects only a minority of users. For alcohol, for example, the dependence rate is 15%, while for marijuana, 9%, cocaine, 30%, and crack, 40%.

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