SÃO PAULO, BRAZIL—Is Brazil experiencing a drug epidemic? The answer to that question has spiraled into a legal battle between scientists and government officials over the release of a national drug use survey done by the renowned Oswaldo Cruz Foundation (FIOCRUZ) in Rio de Janeiro, Brazil. Researchers familiar with the study accuse government officials of suppressing publication of the survey because it contradicts a political assertion that drug abuse is a growing and widespread problem in Brazil.
Commissioned in 2014 by the National Secretariat for Drug Policies (SENAD), the third National Survey on Drug Use by the Brazilian Population interviewed 16,000 people in more than 350 cities about their consumption of legal and illegal substances. FIOCRUZ concluded the study in late 2017, but SENAD never authorized public release of the results, leaving scientists and public health officials in the dark about the current landscape of substance abuse in Brazil. The previous national survey is from 2005. SENAD’s official justification for withholding the data is that FIOCRUZ didn’t follow the sampling methodology specified in the funding call, making the results incomparable with previous surveys—a claim that FIOCRUZ strongly contests.
The dispute started during the administration of Brazil’s previous, very conservative president, Michel Temer, and has continued under current, far-right President Jair Bolsonaro, a fierce defender of the “war on drugs” and the criminalization of drug use.
Bolsonaro’s minister of citizenship, Osmar Terra, recently called FIOCRUZ’s scientific integrity into question. “I don’t trust FIOCRUZ research,” Terra, a physician by training, told O Globo newspaper on 28 May. “If you tell the mothers of these drugged boys around Brazil that FIOCRUZ says there is no drug epidemic, they will laugh at you,” he said. “Unfortunately, FIOCRUZ today is institutionally mobilized in favor of the liberalization of drugs in Brazil; and for that to happen, it cannot admit to the existence of an epidemic,” Terra added in a long statement posted on Twitter on 2 June.
His statements fueled widespread speculation that officials are suppressing the report to protect their political ideologies. But Terra denied being responsible for blocking release of the results, claiming he had no authority to do so.
“FIOCRUZ is proud of the work carried out by its researchers and ensures that [the survey] complied with what was proposed in the public notice, respecting all the methodological, scientific and ethical rigor pertinent to this type of study,” says a statement released by the foundation on 21 May. Created in the early 1900s, FIOCRUZ is a leading research institution in public health and vaccine development, supported by the Ministry of Health.
There is a strong impression of political interference …
FIOCRUZ has asked a special arbitration office of the Attorney General of Brazil for authorization to release the study; a decision is pending but the funding call does give SENAD a clear prerogative to keep it under embargo. The survey cost 7 million reais (about $2 million at the current exchange rate) and was fully funded by SENAD.
Regardless of who made the call to hold the study, “There is a strong impression of political interference” in the process, says Luís Fernando Tófoli, a mental health and drug policy researcher at the University of Campinas in São Paulo state in Brazil, who didn’t participate in the survey but is familiar with the study. He criticized Terra for “attacking the institution” rather than discussing the data. “If FIOCRUZ has a political bias one way or another it doesn’t matter; the methodology is the methodology, and in this case it is very solid,” Tófoli says. “Bolsonaro’s government clearly doesn’t believe in scientific evidence.”
A preliminary version of the study that leaked to the media reveals that less than 1% of Brazilians have ever made use of crack-cocaine—Terra’s main topic of concern—compared with almost 3% who have taken opioid prescription drugs illegally at least once in their lifetime. Marijuana was the most commonly used illicit drug, but still, only 2.5% admitted to having used it in the previous 12 months. Cocaine came next, at 0.9%. “The research really deconstructs the panic that the government is trying to create around crack and illicit drugs,” Dartiu Xavier da Silveira, a medical psychiatrist and drug specialist at the Federal University of São Paulo here, said in a 1 June interview in O Globo.
Meanwhile, the Bolsonaro government has changed the national drug policy to favor abstinence as a preferred treatment strategy, rather than the standard harm reduction approach, and Congress approved a bill in May—originally authored by Terra when he was a congressman—authorizing the involuntary hospitalization of people with substance abuse problems, something experts say should only be used in extreme situations, and not as a general public health policy.