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
Of the 294 respondents, 87% (255) reported having witnessed or knowing of a friend or acquaintance killed for drug-related reasons. The average number of deaths witnessed or known about was 5.5 (standard deviation (SD) = 6.1 deaths, median = 2) per participant. Of these, 80% (204) were users of crack. Table 4 shows the association between the different violence related variables and the use of various drugs.
In the sample, all users of inhalants (8) reported having stolen with the intent to obtain drugs. All of those who reported the use of tranquilizers (4) stated that most of the crimes and violence they had been involved in were related to drug trafficking. Theft was found to be related to crack and mixed marijuana use (Table 4). However, when assessing various drugs together, based on ORs, crack use was found to be more influential, mesclado less, and marijuana the same (Table 5). Robbery to obtain drugs was found to be related to the use of crack and mesclado (Table 4) when considered independently. When controlling for the use of various drugs together, crack and mesclado ORs showed little variation (Table 5).
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.
The main characteristic of smoked crack is its powerful stimulating effect. This is likely what makes it a highly addictive drug, attracting increasing numbers of people to use it.6 The early initiation of drug use observed in this study (13.6 and 15.0 years), in relation to both legal and illegal drugs, shows the age range at which preventative actions should be targeted.
The study design also has limitations. Although our sample had many more men (86%) than women (14%), this does not necessarily reflect the reality of drug users in the community. However, there was no trend in relation to the recruitment of participants that would explain the higher participation of men. Some variables, such as prostitution, exchange of drugs for sex, and the use of crack, were more sex-related and proportionately more common in women.
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