Redução de danos em contexto de festas

Portas da Percepção

hempadao 28 outubro, 2016

A redução de danos (RD) é uma estratégia de cuidados com uma trajetória de respeito. Não surgiu ontem e seus resultados são, em distintas ações, incontestáveis. Um exemplo é o trabalho dos redutores de danos na troca de seringas para usuários de drogas injetáveis, iniciado em 1984 na Holanda (BUNING, 2006). A troca de seringas foi capaz, em diferentes contextos, de reduzir bruscamente o contágio de hepatite B e do vírus de imunodeficiência humana (VIH) entre usuários de substâncias injetáveis (CAVALCANTI, 2006). Com a redução, em diversos cenários, do uso de substâncias injetáveis, além de outras mudanças políticas, a RD teve que encontrar-se com o uso de diferentes substâncias e em settings específicos. Há, no contexto atual, abundante literatura sobre a redução de danos com várias substâncias e também como política pública.

por Fernando Beserra

O psicanalista Antonio Lancetti (2008) significa a RD como uma política e uma prática de saúde pública, que busca atenuar os resultados adversos no consumo de substâncias psicoativas, sem que se exija a abstinência enquanto meta. Além disso, o psicanalista argentino julga que a RD não parte propriamente – ou simplesmente – de uma redução, de maneira que seu próprio nome poderia ser problematizado, na medida em que a RD aposta na autonomia do sujeito e não em sua fraqueza. Neste sentido, não promove ao usuário a ideia de que ele é fraco e deveria sempre evitar o consumo de uma ou mais substâncias, mas busca conhecer a singularidade do usuário e de seu uso, de maneira a catalisar uma transformação na relação deste sujeito com a substância de escolha. Pode-se entender a RD, por conseguinte, como uma exaltação das potencialidades (RAMÔA; SERRA; VAISSMAN, 2008) que suscita um olhar atencioso à positividade.

Do ponto de vista histórico, a RD possui dois surgimentos. O primeiro deles ocorre na Inglaterra, em 1926, com a publicação do Relatório Rolleston. Neste documento era indicada a prescrição médica de opiáceos para farmacodependentes dessas drogas. O segundo surgimento é demarcado em meados da década de 1970 na Holanda, em Amsterdã e Rotterdã, bem como em cidades britânicas como Liverpool; este segundo início é organizado não apenas por especialistas e autoridades locais, mas igualmente por representantes de usuários de drogas (BUNING, 2006), a exemplo da liga dos junkies (junkiebonden). O protagonismo dos usuários é aqui tornado, de uma vez por todas, como fundamental para a RD. Nada sobre mim sem a minha participação.

No entanto, muito embora sua história não seja recente, há uma ampliação do paradigma da redução de danos em curso e um grande conjunto de discussões está ocorrendo na atualidade. Em mais de uma conversa com o redutor de danos Denis Petuco, o mesmo me sinalizou que estes novos atores, dentre os quais os redutores de danos que trabalham nas festas e festivais, além dos redutores que tem articulado a RD com outras pautas, estão trazendo novos ares e são fundamentais para o futuro da redução de danos. É animador ouvir isso: um alento para a alma.

No contexto de festas e festivais, deve-se estar muito atento a um problema produzido pela política de drogas proibicionista: as substâncias tornadas ilícitas não estão sujeitas a controles sanitários de produção, armazenamento ou distribuição, desta forma, as substâncias que circulam no mercado ilícito encontram grandes variações de potência, composição e pureza, aumentando exponencialmente os riscos do consumo. Destaca-se como uma das ações fundamentais para reduzir os riscos e danos nestes cenários a testagem das substâncias (drug checking) (MARTINS; VALENTE; PIRES, 2015). No Brasil as análises são feitas por reagentes que tem sido cada vez mais e melhor estudados. Na Associação Psicodélica do Brasil (APB), por exemplo, já contamos com reagentes colorimétricos (Erlich, Marquis, Mandelin) para testagem e com material didático acerca de um grande conjunto de reagentes e testagens. Em Portugal, o grupo Checkin já realiza análise com cromatografia em camada fina. Estou certo que no Brasil ainda chegaremos a testagens tão elaboradas. Historicamente, os serviços de testagem são recentes. Na Holanda, no início da década de 1990, surgiu o DIMS (Drug Information Monitoring System) que realizava diversos serviços, dentre os quais análise das substâncias e partilha de informações acerca de efeitos e riscos do consumo de substâncias (MARTINS; VALENTE; PIRES, 2015). Outros projetos surgiram como o Eve & Rave, na Alemanha; Techno Plus (França); Energy Control (Espanha), etc. Embora nosso foco aqui seja, prioritariamente, nas substâncias psicodélicas sintéticas ou semissintéticas, a prática da adulteração não é moderna. Nos mercados sem controle sanitário, esta prática é recorrente. Em 1854 foram analisadas: “35 amostras de ópio pelas autoridades sanitárias no Reino Unido e apenas uma não apresentava qualquer adulteração” (HASSAL apud MARTINS; VALENTE; PIRES, 2015, p.648). Atualmente diversas substâncias psicodélicas aparecem adulteradas, tais como: MDMA, LSD, Ketamina, etc. No caso do MDMA, enquanto um relatório da polícia técnico-científica de São Paulo indicou que menos de 50% das balas apreendidas no Estado brasileiro continham MDMA, em Portugal o Drug Chekin encontrou 73% de MDMA sem adulterantes.

Cabe ressaltar que este marco na testagem é apenas uma das ações de redução de riscos e danos em contextos de festas e festivais. Tão ou mais importante é o acolhimento de experiências difíceis, mas este tópico fica para outro momento. A testagem de substâncias pode ser o primeiro contato dos usuários com as equipes de RD, funcionando como os insumos das abordagens tradicionais. A partir do contato é possível troca de informações, construção coletiva de estratégias de cuidado, de maneira a realizar uma verdadeira promoção de saúde, minimizando a chance de que aquelas pessoas necessitem acessar o serviço de RD pela via de um uso inadvertido ou abusivo.

Multiplicam-se grupos de RD que atuam em festas e festivais no Brasil. Para que este cenário floresça, entretanto, ainda é preciso mais. É preciso que os usuários solicitem a presença de grupos de RD nos eventos e, mais do que isso, é preciso que as pessoas que promovem pequenos, médios e grandes eventos tenham a consciência da importância do trabalho da redução de riscos e danos. Vidas podem ser salvas. Adoecimentos e mal-estares desnecessários prevenidos. E, mais do que isso, pode-se estimular uma cultura de cuidado de si e do outro, por meio da promoção de uma cultura de autonomia.

REFERÊNCIAS:

BUNING, Ernst. Vinte e cinco anos de redução de danos: a experiência de Amsterdã. In: SILVEIRA, D. X. da et MOREIRA, F. (ORGS). Panorama atual de drogas e dependências. São Paulo: Atheneu. 2006.

CAVALCANTI, L. Os Novos Desafios da Redução de Riscos. Paris, 2006.

LANCETTI, A. Clínica Peripatética. 3ª edição. São Paulo: Hucitec, 2008.

MARTINS, D.; VALENTE, H.; PIRES, C. Cheking: a última fronteira para a redução de riscos em contextos festivos. Saúde Soc. São Paulo, v. 24, n.2, p.646-660, 2015.

VAISSMAN, M.; RAMÔA, M.; SERRA, A. S. V. Panorama do tratamento dos usuários de drogas no Rio de Janeiro In: Saúde em Debate v.32 Jan/dez. 2008.



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