Sao Paulo strategy to help drug addicts in Cracolandia

Sao Paulo implements a “harm reduction” programme in Crackland approaching addiction as a health issue, not a crime.

Open Arms beneficiaries Priscilla Arlen Jorge, right, and Claudio Nascimento [Sam Cowie/Al Jazeera]
Correction22 Oct 2016
Correction: A previous version of this article attributed the 2016 study to the Open Society Foundation. While the organisation financed the study, research was conducted by CEBRAP and the University of Campinas.

Sao Paulo, Brazil – The open-air drug market known as Cracolandia, or “Crackland”, is located in central Sao Paulo. The streets are filled with rubbish and makeshift wooden dwellings line them. Hundreds of drug addicts along both sides of the shantytown roads huddle in small groups – some visibly pregnant women among them – smoking crack cocaine out in the open. Some use broken car aerials or plastic water cups as pipes.

Long decadent and abandoned, the heart of Crackland covers just a few city blocks, with grim hotels and bars operating inside. The area is monitored by police, who patrol the streets from a distance, watching for outbreaks of violence and other crimes.

A wave of gentrification is slowly overtaking the surrounding areas. New housing, a technical college as well as a concert hall and a leisure centre can be seen from Crackland. During the day, wide-eyed addicts roaming for goods to sell for crack walk alongside the smartly dressed employees sprinting through the streets.

Priscilla Arlen Jorge found herself on the streets of Crackland in her mid-20s, after she was released from prison having served a sentence for robbery.

Abandoned as a child and having spent most of her life on Sao Paulo’s streets with nowhere else to go, the 32-year-old addict lived in Crackland for four years, taking drugs and staying awake for days at a time, then collapsing and sleeping on the streets.

“When I left prison I had no expectations of life,” she said. “I ended up in Crackland because I was disillusioned.”

Jorge said that unlike other addicts she knows, she never resorted to prostitution to pay for her drugs, although she committed petty theft and traded in recyclable goods. She became pregnant, but due to her chaotic life on the streets and her addiction, her baby died just 15 days after birth.

Today, Jorge is more optimistic and she feels things are getting better for her. She is one of 450 beneficiaries of the drug recovery programme called Open Arms (De Bracos Abertos), a Sao Paulo city government initiative that has drawn both praise and criticism.

Harm reduction

In the programme, beneficiaries receive a small weekly cash allowance of 130 reals ($40), as well as regular meals and shelter under the condition that they work in city maintenance projects, completing tasks such as street cleaning or gardening. The participants are assigned the work on the basis of their skills, must complete a set number of hours, and are monitored to ensure compliance.

Unlike other rehabilitation programmes, however, beneficiaries of Open Arms are not required to undergo rehabilitation or even to stop using drugs. Instead, they are encouraged to try to cut back at their own pace, quitting entirely if and when they choose.

The region known as Crackland in Sao Paulo's city centre [Sam Cowie/Al Jazeera]
The region known as Crackland in Sao Paulo’s city centre [Sam Cowie/Al Jazeera]

Proponents of the programme say that through productive work, vulnerable addicts can rebuild self-esteem and are less likely to engage in harmful behaviours such as prostitution or stealing to feed their addiction.

This approach known as “harm reduction” is being championed by drug reformist groups in recent years after years of failed, forced abstinence-based programmes.

“We spent months going there [to Crackland] and talking to people. We found that most wanted to give up [drugs], that they wanted shelter, but that they also wanted to work,” Sao Paulo’s outgoing mayor, Fernando Haddad – who launched Open Arms in January 2014 – said of the programme. He faces scepticism from the traditional rehabilitation professionals over its approach of not enforcing drug abstinence. 

Critics of the programme have argued that it is irresponsible to pay addicts cash for the work they do because the money will end up back in the hands of drug dealers, leading to a continued cycle of addiction and crime.

Joao Doria, Sao Paulo’s mayor-elect, said he intends to close the programme when he takes office next year.

In a note to Al Jazeera, Doria’s campaign team wrote that they “will end the programme Open Arms, which failed from the start and works as a crack grant,” saying that the initiative was simply “putting money in the hands of the dependent, making them even more vulnerable to traffickers”.

In a corresponding email response to Al Jazeera about the possible closure of the programme, Haddad’s campaign defended it, saying: “Above the political struggle and ideologies should prevail the idea that investment in harm reduction gives addicts more dignity and [has] their rights respected, gradually allowing them to quit crack cocaine and other drugs.”

READ MORE: Drug war consumes Brazil’s Amazonian capital

Drug addiction as a health issue

Brazil’s National Institute for Public Policy Research on Alcohol and Other Drugs estimates that Brazil has one million crack users, making it the world’s leading consumer of crack. The well-respected Oswaldo Cruz Foundation research institute estimates there are 370,000 crack users across Brazil’s 27 state capitals.

Crackland formed in the 1990s. At its peak, as late as 2013, Sao Paulo’s authorities who spoke with Al Jazeera say the city hosted 1,500 drug users. With a hit costing less than $1, an estimated 200kg of crack cocaine was consumed each month.

Open Arms began with an initial investment of $1.7m from the municipal government, increasing to $2.1m in 2015, following years of repressive, failed police operations to try to clear Crackland, after which addicts and traffickers always returned and regrouped.

Today, the area is policed by hundreds of officers and municipal guards who watch for robberies and violence but don’t intervene with drug consumption or dealing – instead treating drug addiction as a health issue.

A study released in 2016 by the Brazilian Center for Analysis and Planning (CEBRAP) and the the University of Campinas reported that 65 percent of the programme’s beneficiaries reduced their drug intake in the first year of the programme.

A separate study by the Sao Paulo city hall, taken two years after the programme began, reported that on average 88 percent of beneficiaries reduced their intake by 60 percent.

Critics of Open Arms argue that it is irresponsible to pay addicts in cash for their work because the money will go to pay for drugs [Sam Cowie/Al Jazeera]
Critics of Open Arms argue that it is irresponsible to pay addicts in cash for their work because the money will go to pay for drugs [Sam Cowie/Al Jazeera]

Off and on the streets

Before Open Arms, Sao Paulo’s drug and alcohol treatment programmes were traditional internment and forced abstinence programmes, with limited numbers of drug addicts being treated in hospitals and privately owned therapeutic communities.

The programmes were an umbrella for all types of addiction, costing the state around $2,500 per person for a six-month stay, according to Marcelo Ribeiro, technical director of Sao Paulo’s Reference Centre for Alcohol, Tobacco and Other Drugs.

After working for decades with these failed, one-size-fits-all forced abstinence internment programmes, drug reformist groups and harm reduction advocates praise the approach of Open Arms, which accepts that addicts may not want – or even be able – to give up drugs, but with help, can make positive contributions to society.

“Whether you’re talking China, Vietnam, Brazil, USA or Mexico, you see again and again that offering people a single option and putting them under lock and key to take that option hasn’t really worked,” said Daniel Wolfe, international harm reduction development director at Open Society Foundation, an international organisation that advocates for more progressive drug policies.

“What you’re seeing in Open Arms is an intervention that actually recognises that the last round [of forced abstinence policies] wasn’t very effective. You take people off of the streets, and they come back,” said Wolfe.

Open Arms beneficiary Tiago Queiroz Genezini, 27, says that he interned himself voluntarily in the abstinence-based programmes six times, but as he lacked structure in his life he always ended up back in Crackland.

“Every time I got out, I did the same thing,” he told Al Jazeera.

Now on the Open Arms programme, he says his ultimate goal is to gain full-time employment with work benefits. Genezini says he is speaking with his father again after years of estrangement, though he says his father is scornful of the programme and tells him he should find “man’s work”.

READ MORE: Brazil’s police crack down on drug gangs

A fragile project

Yet, critics remain unconvinced. Another main criticism of the programme is that beneficiaries are housed in Crackland’s grim, flophouse-style hotels – paid for by the city government – with easy access to drugs.

“Drug traffickers have control of those hotels and end up benefiting from public money given to users,” said Ronaldo Laranjeira, coordinator of Recomeco, a drug recovery programme operated by Sao Paulo’s state government that advocates lengthy stays in hospitals or therapeutic communities.”A recovering user needs to be in a structured environment away from crack. [Open Arms is] a well-meaning project, but technically fragile,” Laranjeira said.

Mayor Fernando Haddad has responded to these critics, saying that he had planned to extend the number of programme vacancies and has already begun moving work tasks and housing away from Crackland.

Yet while proponents hope that the programme could serve as a possible model for Brazil, Open Arms will most likely be closed by next year when Haddad leaves office.

Earlier this year, Brazil’s President Dilma Rousseff was impeached and a more conservative government installed, with new social development minister Osmar Terra saying he is against decriminalisation of drugs and that drug users “should be punished”.

Addicts roaming for goods to sell for crack walk alongside the smartly dressed employees along the streets of Crackland in Sao Paulo [Sam Cowie/Al Jazeera]
Addicts roaming for goods to sell for crack walk alongside the smartly dressed employees along the streets of Crackland in Sao Paulo [Sam Cowie/Al Jazeera]

A long-awaited decriminalisation bill is currently stalled and Brazil continues to lag behind its Latin American neighbours such as Argentina and Colombia in terms of drug policy [PDF], where users are less likely to be jailed for carrying small, personal-use amounts of drugs.

Brazil has the fourth-highest prison population after the United States, China and Russia, and in the Sao Paulo prison system – the country’s largest with 220,000 inmates – 39 percent of male and 70 percent of female prisoners are serving time for drug possession or trafficking.

“The shame is that Brazil, with so many innovations in health – such as HIV treatment and progressive prevention campaigns – is losing the opportunity to be an example to the world on this issue [of drugs treatment],” said Ilona Szabo, executive director of the Igarape Institute, a think-tank that advocates for drug decriminalisation.

“But there is a lot that can be done on the municipal level for harm reduction, so I expect this practice to evolve even if we see a setback in Sao Paulo,” she said. “Mayors are looking for solutions.”

No matter what the future mayor decides, Jorge can attest to the benefits of the current Open Arms programme, saying that she used to spend all day smoking crack but now, two years into the programme, she smokes just a few rocks a day as opposed to the dozens she smoked before.

“I’m forgetting about crack,” she told Al Jazeera, during her work at an art recycling workshop. “With all of this joy around me” – she said pointing to her colleagues – “why would I think about crack?”

the University of Campinas 

Source: Al Jazeera