The use and abuse of illegal drugs appears to be associated with drug trafficking and violence.4 There is growing evidence to support the role of drugs in the spread of violence.4,5 The types of drugs used vary according to region of the world. In many countries, such as Thailand, the United States, and some European nations, heroin is easily accessible, but it is not as easily available in most of countries in South America.6 The 1990s saw a rise in crack cocaine abuse throughout most of the world,6,70 and the literature currently indicates that marijuana and cocaine are the most marketed drugs worldwide.
The use of crack cocaine, or crack, was first reported in 1980 in Europe and the US7 as a new drug with quick, stimulating effects. Crack cocaine is a byproduct of cocaine, obtained from the leaves of a shrub named Erythroxylon coca. The refining process begins with the transformation of the leaves into a product known as basic cocaine paste (BCP). The paste can then be turned into either crack cocaine through chemical treatment with sodium bicarbonate, or into a white powder (cocaine) when it is refined with ether acetone or sulfuric and hydrochloric acids. In its powdered form, the drug can be inhaled, used orally or intravenously; the paste (basuko, merla) and rock (crack cocaine) forms can be smoked either on their own or together with tobacco or cannabis-marijuana (pitillos or mesclado). The powdered and rock forms of the drug are less costly, albeit far more virulent and harmful to health.7
In this study, the use of crack was associated with theft and death threats (OR = 2.97 and 2.27, respectively). In addition, the deaths of friends or acquaintances of crack users accounted for 80% of all deaths related to drug trafficking or use in general. This tells us that violence is expressed in extreme forms among users of crack. Violence and the use of crack and other types of cocaine have previously been found to predict victimization and appear to show a causal relationship with intimate partner violence.26,27
In this study, one of the main substances mentioned in situations involving violence was crack. This was expected, as the literature shows an increase in crack consumption in Brazil since 19908,31,32 and an association between users of injected drugs and users of crack.9,12 It is pertinent, therefore, to assume that the prevalence of parenterally transmitted diseases, such as AIDS, may decrease with changes in the habits of these users, particularly the change from injected drugs to inhaled or smoked crack.33,34 In this study, no association was found between HIV infection and the use of crack or with having a tattoo. The lack of association between HIV infection and tattoos in this study is perhaps because no differentiation was made in the questionnaire between professional tattooists, who practice proper instrument hygeine and amateur tattooing. HIV infection was associated with a history of other sexually transmitted diseases.
Parenteral infection is still the main form of HCV transmission, and an estimated 1.75 million new HCV infections occurred in the world in the year 2015 alone5. Persons that use illegal drugs are often exposed to increased risk of various infectious diseases, basically due to their behaviors and drug consuming habits, in addition to the risks and harms associated with the respective self-administration routes6,7,8,9. Various studies have reported high HCV prevalence rates, especially among people who inject drugs (PWID)10,11,12. As for non-injecting drug users (NIDU), who smoke, inhale, snort, or sniff substances like heroin, [powder] cocaine, and crack cocaine, for example, there are reports of higher HCV prevalence rates than in the general population, suggesting that there may be some other relevant form of transmission, despite persistent controversies on viral viability in straws and other self-administration paraphernalia in a context in which the risks of sexual transmission may be underestimated or imprecisely assessed13,14,15,16.
Selected crack use scenes were visited by trained staff, including recruiters and interviewers, mostly health professionals. Individuals were approached to eligibility verification by recruiters. Those that met the eligibility criteria and signed the free and informed consent form proceeded to answer a questionnaire in a face-to-face interview. Interviewers used a pre-tested paper-and-pencil questionnaire. Data were collected in 2011 and 2012, and 7,381 persons were interviewed. Additional information about the PNC can be found in the Supplementary Material. 2b1af7f3a8