ABSTRACT
In the last decades, the
initiatives implemented under the conceptual umbrella of Harm Reduction have
gained momentum, with a vigor and scope (both from a geographic and social
perspective) never seen before. A more balanced reevaluation could and should
rather say such initiatives have resumed, to a large extent, ideas and actions
launched much earlier, in the first decades of the 20th century.
Notwithstanding, the dissemination of HIV/AIDS in recent years conferred an
exceptional visibility and legitimacy to proposals formerly viewed as
subsidiary or openly neglected. Nowadays, initiatives inspired by the Harm
Reduction philosophy have faced an "identity crisis", not secondary
(according to our perspective) to challenges faced by its concepts and
operations, but rather as consequence of a world in a turmoil. Such
fast-changing dynamics have reconfigured both drug scenes and the patterns and
prospects of HIV/AIDS worldwide. This article briefly summarizes some of such
recent, ongoing, changes, which have been deeply affecting both concepts and
practices to the point of asking for a deep reformulation of most of the
initiatives implemented so far.
...Drug scenes have been changing under a fast pace worldwide.
The in-depth assessment of such new scenarios and trends has been addressed by
recent reviews, some of them with a focus on the interface between the new drug
scene and the prevention of HIV/AIDS9.
Both in Brazil and in the vast majority of other countries,
worldwide, the habit of injecting illicit drugs has experiencing a fast and
pronounced decline10.
Exception made to some "hot spots", in which the injection of illicit
substances remains a relatively frequent habit, such as some countries from
Southern Asia and Eastern Europe, injection has been progressively replaced by
alternative ways; people use classic substances, as cocaine, snorting, smoking
and by other routes (e.g. ingesting, applying dermal patches, etc.), as well as
by a growing number of modified/different (many times, brand new)
non-injectable substances.
Even in some places where injection was especially prevalent
and had been one of the key drivers of HIV and HCV spread, such as in Estonia,
Eastern Europe, injection has becoming a less frequent habit in recent years11.
However, the deep and fast transition of drug markets and
scenes in recent years is much broader than the changes associated with
new/renewed routes people may use substances. First of all, the very nature and
composition of substances have been reconfigured and (re)designed. Some of
these changes correspond to different presentations of a single or related
group of substances, such as the increase of smoked crack cocaine in detriment
of snorted powder cocaine in contemporary Brazil12.
From a different, maybe complementary perspective, markets and drug scenes have
been flooded by brand new drugs, most of them undetectable by current
toxicological analyses. Due to the illicit nature of such markets and the very
fact such substances are specifically designed to evade detection, it is very
difficult and many times impossible to track their dissemination and to better
understand the profile, habits and risks faced by their consumers.
Anyway, sooner or later, substances initially regarded as
local, sometimes idiosyncratic, have become global commodities, as happened to
ecstasy over the last decade, a substance which is nowadays the
"lubricant" of the disco party scenes all over the world.
To the best of our knowledge, exception made to compounds
based on salvia divinorum,
a plant which is native to many different Brazilian regions, there is no sound
information on the putative misuse of such different substances, which may or
may not be used in Brazil. These new substances may include: bath salts and
other cathinones13,
untraceable amphetamine-like substances14,
new synthetic cannabinoids14 etc.
Such vast and highly heterogeneous group of substances has been studied under
the conceptual umbrella of "legal highs", i.e. substances with
psychoactive effects which do not belong to the classic lists of substances
under control, are virtually untraceable, and are not amenable to any modality
of medical or legal surveillance15.
Despite the undeniable relevance of such substances in the
American, Western European and Australian markets, as recently summarized by
UNODC, in its 2012 Annual Report
(http://www.unodc.org/documents/data-and-analysis/WDR2012/WDR_2012_web_small.pdf),
there is no clear information about the putative association of their use and
misuse with the acquisition and transmission of HIV and/or other sexually
transmitted infections, either as mind-altering substances that might
compromise the consistent use of condoms or substances that may be eventually
injected, as have been seldom reported16.
One thing is pretty clear to experts and policy-makers: the
markets and scenes of drug trafficking and use will be deeply impacted by such
new substances, as well as by alternative modes of administration and habits,
many of them navigating "under the radar" of surveillance systems
worldwide...
Full article at:
By:
- 1Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.
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