Ana Regina Noto

Analysis of prescription and dispensation of psychotropic medications in two cities in the State of São Paulo, Brazil

OBJETIVOS: Analisar a prescricao e dispensacao de medicamentos psicotropicos por meio da analise das receitas/notificacoes retidas em diferentes estabelecimentos de dois municipios do estado de Sao Paulo. METODOS: Em parceria com as Vigilâncias Sanitarias dos municipios, foram coletadas e analisadas as prescricoes retidas em drogarias, farmacias de manipulacao, postos publicos e hospitais no ano de 1999. Os dados contidos nas receitas/notificacoes foram digitados e tabulados. RESULTADOS: Foram processadas 108.215 prescricoes, sendo 76.954 de benzodiazepinicos, 26.930 de anorexigenos, 3.540 de opiaceos e 788 de outros. Os benzodiazepinicos mais frequentes foram: diazepam (31.644), bromazepam (16.911) e clonazepam (7.929) e, entre os anorexigenos, dietilpropiona (14.800) e femproporex (10.942). As mulheres, em geral, receberam mais prescricoes em comparacao com os homens, especialmente para os anorexigenos, com uma relacao dez vezes maior nas prescricoes de dietilpropiona e femproporex. As poucas farmacias de manipulacao (n=6) chegaram a movimentar mais prescricoes do que as drogarias (n=49). Tambem foi detectada uma serie de erros e incoerencias nas prescricoes analisadas. CONCLUSOES: Os resultados confirmam a ocorrencia de uso irracional e uma serie de praticas inadequadas que envolvem a prescricao desses medicamentos no Brasil e, portanto, indicam a necessidade de uma ampla revisao no atual sistema de controle dessas substâncias no pais.

Trends in drug use among students in Brazil: analysis of four surveys in 1987, 1989, 1993 and 1997

The consumption of psychotropic drugs among Brazilian secondary school students was examined by comparing data from four surveys using a questionnaire adapted from the WHOs Program on Research and Reporting on the Epidemiology of Drug Dependence. Students filled out the form in their classrooms without the presence of teachers. The target population consisted of 10-18-year-old students (on average, 15,000 students responded to each survey) in Brazils ten largest state capitals: Belém, Belo Horizonte, Brasília, Curitiba, Fortaleza, Porto Alegre, Recife, Rio de Janeiro, Salvador, and São Paulo. Among the legal drugs, lifetime use (use at least once during life) of tobacco was increased in seven cities (the exceptions were Brasília, Porto Alegre and Rio de Janeiro). There was also a significant increase in frequent use of alcohol (six times or more per month) in 6 of the cities, from an average of 9.2% in 1987 to 15.0% in 1997. With respect to illegal drugs, there was a significant increase in lifetime use of marijuana (a 3-fold increase from 2.8% in 1987 to 7.6% in 1997). Cocaine use increased 4-fold over the survey period (0.5% in 1987 to 2.0% in 1997). Lifetime use of cocaine significantly increased in eight capitals (except Recife and Rio de Janeiro). However, frequent cocaine use increased in only three capitals (Belém, Fortaleza and Porto Alegre), from an average of 1.0% in 1987 to 3.6% in 1997. Lifetime use of medications such as anxiolytics and amphetamines increased 2-fold on average over the survey period. Comparing the four studies, the main conclusion is that there were significant increases in the frequencies for lifetime use, frequent use and heavy use of many drugs.

Uso de drogas psicotrópicas no Brasil: pesquisa domiciliar envolvendo as 107 maiores cidades do país - 2001

The objective was to estimate the prevalence of the use of drugs, alcohol, tobacco and the use of non-medical psychotropics. This study enclosed the 107 biggest cities in Brazil; sample: ages between 12 and 65 years. Sampling in three periods: tax sectors; household and the respondent. Were interviewed 8,589 people. The lifetime use of the alcohol was 68.7%, closer to 70.8% in Chile. The lifetime use of the tobacco was of 41.1%, lower than USA (70.5%). The lifetime use of the marijuana was of 6.9% closer to Colombia (5.4%) and lower than USA (34.2%). The lifetime use of the cocaine was 2.3%, lower than USA (11.2%). The lifetime use of solvent was of 5.8%, much lower than the United Kingdom (20.0%). The stimulants have had 1.5% of lifetime use and the anxiolytics with 3.3%. These findings will allow the implantation of adjusted public politics to our reality in the field of the psychotropics drugs.The objective was to estimate the prevalence of the use of drugs, alcohol, tobacco and the use of non-medical psychotropics. This study enclosed the 107 biggest cities in Brazil; sample: ages between 12 and 65 years. Sampling in three periods: tax sectors; household and the respondent. Were interviewed 8,589 people. The lifetime use of the alcohol was 68.7%, closer to 70.8% in Chile. The lifetime use of the tobacco was of 41.1%, lower than U.S.A. (70.5%). The lifetime use of the marijuana was of 6.9% closer to Colombia (5.4%) and lower than U.S.A. (34.2%). The lifetime use of the cocaine was 2.3%, lower than U.S.A. (11.2%). The lifetime use of solvent was of 5.8%, much lower than the United Kingdom (20.0%). The stimulants have had 1.5% of lifetime use and the anxiolytics with 3.3%. These findings will allow the implantation of adjusted public politics to our reality in the field of the psychotropics drugs.

Fatores associados ao uso pesado de álcool entre estudantes das capitais brasileiras

OBJETIVO: Analisar a associacao entre o uso pesado de alcool entre estudantes e os fatores familiares, pessoais e sociais. METODOS: Estudo transversal realizado com estudantes de dez a 18 anos de escolas publicas de 27 capitais brasileiras, em 2004. Os dados foram coletados por meio de questionario anonimo, de autopreenchimento, adaptado de instrumento desenvolvido pela Organizacao Mundial da Saude. A amostra representativa, composta por 48.155 estudantes, foi estratificada por setores censitarios e por conglomerados (escolas). Associacoes entre o uso pesado de alcool e os fatores estudados foram analisadas por meio de regressao logistica, considerando nivel de significância de 5%. RESULTADOS: Do total de estudantes, 4.286 (8,9%) fizeram uso pesado de alcool no mes anterior a entrevista. A analise por regressao logistica mostrou associacao entre relacoes ruins ou regulares com pai (OR=1,46) e mae (OR=1,61) e uso pesado de alcool. Seguir uma religiao (OR=0,83) mostrou-se inversamente associado a este tipo de consumo de alcool. A pratica de esportes e o fato de a mae se percebida como liberal nao mostraram significância no modelo. Houve maior prevalencia de uso pesado de alcool entre os estudantes que trabalhavam. CONCLUSOES: Ligacoes familiares mais coesas e seguir uma religiao podem prevenir o uso abusivo de alcool entre estudantes.

Drogas e saúde na imprensa brasileira: uma análise de artigos publicados em jornais e revistas

This article analyzes information recently published by the Brazilian press on the use of psychoactive drugs and its implications on health. A sample of 502 newspaper and magazine articles published in 1998 was researched using content analysis. The drugs most frequently featured in the headlines were tobacco (18.1%), coca-derived drugs (9.2%), marijuana (9.2%), alcoholic beverages (8.6%), and anabolic steroids (7.4%). Solvents were featured in only one article, although they are the most commonly used drug in Brazil, second only to alcohol and tobacco. These data indicate an imbalance between the journalistic approach and the epidemiological profile of psychoactive drug consumption in Brazil. Dependence was the most frequent consequence mentioned in the articles (46%), followed by violence (9.2%), withdrawal syndrome (8.0%), and AIDS (6.8%). The focus of the articles varied according to the drug in question. While articles on marijuana focused on its therapeutic use and legalization, those on cocaine-related issues discussed both the damage caused by consumption as well as various interventions (treatment and repression).

Social factors associated to binge drinking: a cross-sectional survey among Brazilian students in private high schools

BackgroundBinge drinking (BD) seems to be related to health and social complications among adolescents. Considering that knowledge about BD in developing countries is limited and that in Brazil high socioeconomic status is a risk factor for alcohol abuse, this study sheds light about this phenomenon among adolescents from a different cultural background than prior North-American and European studies.MethodsBrazilian students (n = 2691) selected through a representative, stratified and clustered sampling method were asked to answer a self-report questionnaire. The questionnaire contained questions about patterns of alcohol consumption, religious beliefs, leisure activities, family structure and relationships. Data were analyzed with basic contingency tables with Chi-square tests followed by a decision tree analysis and weighted logistic regression.ResultsAlmost thirty-five percent of the students reported recent binge drinking. BD in the past month was positively associated with older age (aOR = 1.5[1.2-1.7]), male gender (aOR = 1.5[1.2-2.0]) going out with friends almost every night (aOR = 33.9[14.2-80.7]), not living with mother (aOR = 2.4[1.3-4.7]), believing in God with little conviction (aOR = 1.6[1.2-2.0]) and rarely talking to parents about anything (aOR = 1.7[1.3-2.2]) or always about drugs (aOR = 1.8[1.3-2.5]). Factors inversely associated with BD were: paying lower monthly tuition fees (aOR = 0.5[0.4-0.9]), living with people who do not get drunk (aOR = 0.6[0.4-0.7]) and frequent engagement in worships (aOR = 0.7[0.5-0.9]).ConclusionThe habit of BD in adolescents enrolled in private high schools in Brazil is strongly linked to the frequency with which they go out with friends at night. Factors such as religiosity, expressed by trust in God and participation in worship, and being enrolled in a school with cheaper tuition fees were associated with avoidance of BD in this population.

Use of Drugs Among Street Children in Brazil

The purpose of this study has been to assess drug consumption among children in five Brazilian state capitals during 1993. The sample was composed of street children who were given assistance in institutions, and data was collected by means of anonymous individual interviews. Five hundred sixty five boys and girls were interviewed: 74.3% reported having used drugs (not including alcohol and tobacco) at least once in their life. Solvents, followed by marijuana, were the most cited drugs. Important regional differences were observed concerning other drugs. Consumption of cocaine, including crack, seems restricted to the southeast region, whereas psychotropic medication was consumed more in the northeast of the country. Drug initiation among these children seems to be a consequence of street life and is part of their group lifestyle.

First household survey on drug abuse in São Paulo, Brazil, 1999: principal findings

CONTEXT In order to establish prevention programs regarding psychotropic drug use that are adapted to specific populations it is, first of all, important to have data on the realities of such consumption. Single data points are not enough for drawing up a profile of society in relation to drugs. OBJECTIVE The aim of this household survey was to determine the incidence of illegal drug, alcohol, tobacco and psychotropic medication use, and thus the number of persons dependent on drugs, alcohol and nicotine, and to evaluate their perception regarding how easy it is to obtain psychotropic drugs. TYPE OF STUDY Epidemiological survey. SETTING All of the 24 cities in the State of Sao Paulo with more 200,000 inhabitants participated in the study. METHOD The sampling was constructed from weighted probabilistic stratified conglomerates obtained via two-stage selection. In each municipality sampled, census sectors (generally 200-300 households) were first selected. Then, households and a respondent were selected to provide information from his/her point of view. The SAMHSA questionnaire (Substance Abuse and Mental Health Services Administration) of the U.S. Department of Public Health was used, after translation and adaptation to Brazilian conditions. RESULTS A total of 2,411 persons aged 12-65 years old were interviewed, of whom 39.9% were men. Lifetime use of any psychotropic drug other than alcohol and tobacco was 11.6%: much less than in the U.S. (34.8%). The alcohol dependence rate was 6%, similar to findings from other countries. Marijuana was the illegal drug most cited as used daily (6.6%): a prevalence much lower than in the U.S. (32.0%): Inhalant use was next in frequency of use (2.7%): about 10 times less than in the United Kingdom (20%). Cocaine use (2.1%) was about 5 times less than in the U.S. (10.6%). There was no report of heroin use, although there was a surprisingly high perception regarding the case of obtaining heroin: 38.3% sold if was easy to obtain. CONCLUSION This study supports the implementation of better prevention programs regarding drug abuse in Sõ Paulo state.

Use of anorectic amphetamine-like drugs by Brazilian women.

The history of anorectic drug use was investigated in 2370 subjects in São Paulo and Brasília cities. Socio-demographic data and the number of previous treatments to lose weight were obtained. When the last treatment was drug-based, the substance(s) used, its duration, the occurrence of adverse reactions, and whether it was adequate were studied. There was a prevalence of female patients, 92.7%, in both cities and as many as 72.4% of them had already undergone from 1 to >10 previous treatments. Out of those patients, 75.37% had undergone pharmacological treatment, 79.2% of those with amphetamine-like anorectic drugs. Treatment was longer than 3 months in half of the cases, and 60% of the subjects had a Body Mass Index below 29.9. Over 50% of the subjects was given amphetamine-like drugs through compounded formulas containing four or more substances, which had been specifically tailored by the doctor for each patient. On the other hand, 86.3% of all the subjects reported adverse reactions to the amphetamine-like drugs, 37.4% of them sought medical advice, and 3.9% required hospitalization. In conclusion, the use of amphetamine-like drugs in Brazil is particularly prevalent among women and this use is strongly related to the culture of slimness as a symbol of beauty.

Comparison between two household surveys on psychotropic drug use in Brazil: 2001 and 2004

CEBRID (Brazilian Center of Information on Psychotropic Drugs) conducted two household surveys on drug use in Brazil, the first in 2001 and the second in 2005, making it possible for researchers, for the first time ever, to have a timeline comparison using this type of methodology. The universe studied corresponded to the Brazilian population living in 107 Brazilian cities with more than 200.00 inhabitants. 8,589 people were interviewed in the first survey in 2001, and 7,939 people in the second. Data on prevalence of lifetime use for psychotropic drugs showed that there was a significant increase only in the number of people who had made lifetime use of psychotropic substances (including tobacco and alcohol). In 2001, 19.4% of the interviewees reported having used some type of drug, and the ranking of lifetime drug use in 2004 was 22.8%, a statistically significant increase. There was also a statistically significant increase in lifetime use of alcohol and tobacco in comparison between the two surveys.