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New São Paulo Mayor Scaling Down Successful Harm Reduction Programme

A programme providing housing and employment to people with problematic crack cocaine use in São Paulo will be scaled down over the coming months, despite its success at reducing drug misuse, the city’s new mayor has said.

The programme – With Open Arms (De Braços Abertos) – was launched in 2014 by Fernando Haddad, the city’s previous mayor, in the city’s so-called Cracolândia (“Crackland”) district, where problematic drug use was rife.

As TalkingDrugs reported in July, the programme provides housing in hotel rooms, daily meals at a local diner, access to healthcare facilities, and the opportunity to work and earn an income through cleaning. It does not require abstinence from drug use.

The rationale behind With Open Arms is that individuals can reduce their problematic drug use on their own accord if provided with the opportunity to improve their quality of life, and, importantly, when they are not being criminalised and punished by strict drug laws.

The programme is now set to be scaled down by the city's new mayor, João Doria, who plans to reintroduce the criminalisation of people who use drugs in Cracolândia .

Doria, who was inaugurated as mayor in January, defended the planned policy shift by describing the current situation in Cracolândia as "a bad image for the people, a bad image for the city, and a bad image for Brazil. This image, we hope, will soon be an image of the past".

Under Doria's intended approach, a programme called Redenção (Redemption), "people [with problematic drug use] can have medical care. They can be rescued from their own lives, [but] those who are criminals will [face] the force of law; they will be arrested," he said in early February.

Doria has previously lent his support to an abstinence-based approach. After his election, but prior to his inauguration, he said that he intended to return to the city’s former programme for countering problematic drug use, Recomeço (Restart), which is coercive and abstinence-focused.

Recomeço, Doria described in October, involves the involuntary “hospitalisation [and] confinement of those who are victims of crack […] so that […] with medical treatment, they can stay away from drugs.

The plans to scale down from With Open Arms are particularly controversial due to the programme's success.

As of late 2016, With Open Arms was serving 467 people, of whom over 84 per cent were undergoing health treatment, and 72 per cent were in employment – Agencia Brasil reportsAlmost two-thirds of those using the programme reduced their drug intake within one year, according to a 2016 report published by the Brazilian Centre for Analysis and Planning.

Mayor Doria’s call for scaling down With Open Arms during his campaign, and his decision to follow through with his plans, have provoked vocal opposition from academics.

Dartiu Xavier, Professor of psychiatry at the Federal University of São Paulo, criticised Doria for advocating "treatment focused on abstinence". Xavier ridiculed this approach for being premised on the idea that "the whole problem of human misery is only caused by drugs".

Roberta Marcondes Costa, an anthropologist who has studied Cracolândia, defended With Open Arms’ health focussed approach: "countries in Europe have been using harm reduction for much longer, not because they are left-wing or advanced, but because pragmatically harm reduction is much more efficient [than the prohibitionist approach]".

A note published by the Brazilian Platform on Drug Policy in December offered perhaps the bluntest criticism of Doria’s plans: “the abrupt extinction of With Open Arms in no way collaborates with what is expected of a drug policy, namely: that it be fair, supportive, rational and scientific”.

Indeed, studies suggest that compulsory rehabilitation can have the inverse of the intended effect. People with problematic opioid use, for example, are more likely to relapse if they are forced into a compulsory drug detention centre than if they are offered voluntary methadone treatment, evidence suggests.

These may be the final few months of a successful harm reduction approach to problematic crack cocaine use in Cracolândia for some time.

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