LECUCA: Analysis of Brazil's largest open drug scene using time-series cross-sectional survey data

The "Survey of Drug Use Scenes in Capitals," known by its Portuguese acronym “LECUCA” provides time-series crossectional data to inform decision makers and healthcare service providers the demands of their territories, contributing to the prioritization of public policies and services provision. 

Performed since 2016, all 5 series applied time-space sampling methodology to obtain representative samples of the location-based population residing in the largest open drug scene (ODS) in the country known as “Crackland”, in Sao Paulo. The survey’s historical and pivotal role providing reliable epidemiologic indicators in Sao Paulo supported its replication in Central and Northeast Regions of Brazil (Brasília and Fortaleza) between 2021 and 2022. 

The findings confirm that the predominant drug of choice within this population remains cocaine, whether snorted or smoked. Prevalence of opioid use among this group is below 1%, with 15% of residents reporting only alcohol use. Consistent observation across all historical series reveals a continuous influx of newcomers into the ODS, this result underscores the demand for secondary prevention strategies through the implementation of early intervention practices in primary care services and an expanded array of treatment modalities, and enhancement of accessibility in peripheral areas of the city and in economically disadvantaged regions. Rates of individuals visiting the ODS for the sole purpose of buying drugs was minimal, most established long-term residence within the territory, surpassing 5 years.

Despite the prevalent homelessness, most respondents had not experienced living on the streets before reaching the ODS. In fact, 70% transitioned directly from their homes to the ODS, reinforcing the need for secondary prevention measures, such as policies promoting family support, aiming to enhance access to specialized services that address addiction in its early stages.

The surveillance of harm reduction efforts showed that although most individuals reported undergoing testing for tuberculosis and Sexual Transmitted Infections only a small proportion had recently taken these tests. Nearly one third of women declared not using any contraceptive method and 8.7% were pregnant. Despite of the widespread availability of contraceptive implants in Sao Paulo, only 17% of women had adopted this method, with a decline observed in 2019. 

Presently, decision-makers at both state and city levels actively use the indicators furnished by this survey, especially in Sao Paulo, where panel data models allow a comprehensive understanding of the impact of actions over time, and the  findings play a pivotal role in guiding the planning, adjusting and prioritizing policies for the ODS population. Ultimately this contributes to the improvement of the quality of life of individuals grappling with addiction coupled with social vulnerability.