In May this year, the Institute of Communication and Scientific and Technological Information in Health (Icict) - in partnership with scientists of several units of the Oswaldo Cruz Foundation (Fiocruz) and other institutions - was chosen to perform the Third National Survey on the Drug Use by the Brazilian population, with the support of Fiotec. The research will be coordinated by researcher Francisco Inácio Bastos, who also coordinated the "Crack - Vulnerabilities" project.

In an interview with Fiotec, Francisco explains how this new survey will be done, being the first that can be considered effectively nationwide and that brings news. "For a truly national survey, we need to do something called Over-sample, that is, include more than we would include if the choice were made ​​entirely at random, in some specific areas, because they have a specific interest. For example, rural area, boundaries, and this is specifically described in this notice", he explained.

Read the full interview.

Is this survey complementary to the other two that already existed, or has new purposes?

Brazil, like all countries of the World Health Organization (WHO), has signed an agreement in which member countries undertake to provide information on the consumption of alcohol and drugs, which is consolidated in the annual report on drug abuse, which is compiled by the United Nations Office on Drugs and Crime (UNOC) - the alcohol issue is mentioned, but its relevance for public health is analyzed in detail by the World Health Organization (WHO). In richer and more structured countries, the surveys providing such information have a well-defined periodicity, but in Brazil we have a problem, which I hope is corrected soon, which is the large gap between the surveys. The second survey was conducted in 2005, the next one begins in 2015. Strictly speaking, we do not actually have a survey today that we can indeed call national. The second survey covered cities with over 200,000 inhabitants. There was also another recent survey done by UNIFESP, but with a very small sample, which does not allow disaggregation of data at the regional level, nor does it take into account the rural area or the immense Brazilian border, one of the largest land borders worldwide, comprising 10 countries, according to IBGE data. Another novelty of this survey is that, besides the direct estimation, i.e., asking people what are the characteristics of their use, we ask about the characteristics of people with whom they have contact, which are the networks of each person and defines an estimate strategy we call indirect estimate.

What stage is the project at now? When will the research actually begin?

The project was approved and the final result was published on the website of the National Department of Policies on Drugs (Senad) and in the Official Gazette. For now, we are reviewing specific points relating to adjustments in the work plan. Only after the changes, the project enters the public system and becomes a project signed by both parties, Senad and Fiocruz. The project has two components: infrastructure, which is part of training the team, recruit people who will work in the field. We intend to begin in August, being perhaps too optimistic. Whereas the work referring to "research subjects" depends on the approval of the ethics committee, but as the survey is national, the ideal is that part of training, recruitment, starts well before. The fieldwork will begin only in 2015.

How will this survey happen?

It will have a very similar structure to the National Research by Household Sample (PNAD). The methodology is basically to train a core team that has a managing committee, which is responsible for the research as a whole, and then create regional coordination departments. As the country is very large, very heterogeneous, there is no way you can supervise here in Rio de Janeiro a sampling in Acre, then we have to create regional coordination departments. The experience I had in "Crack - Vulnerabilities" project, as the field research team is in several places at the same time, the problems tend to happen simultaneously and obviously you cannot solve everything in real time. So you must have a filter at local and regional level, and then get to the national level (that is, operate in a decentralized way).

Is there any place where the use of drugs is the greatest and therefore will have greater emphasis on research?

It happens in every country, but this time places that have certain characteristics, such as borders, are included. It is not necessarily in the border that people use more drugs than in other places, but it is necessarily where cocaine is traded, since the domestic cultivation of the coca plant is irrelevant. If we only sampled the general population as a whole, without specificity, we would probably have little chance to, randomly, investigate more than a frontier town, considering that the Brazilian border has three arches (north, central and south) with very different characteristics. Researching in detail the rural area is also a specification of Senad, quite correctly, in my view, because although it currently corresponds to 15% of the population, there are very specific characteristics that need to be known. This survey will be much more complete, to fully incorporate these specific issues.

How is the performance of interviewers?

We have to train the staff so that people can deal with questions that are sensitive because we are dealing with the private behavior of people, some of them illegal. In this sense, we must have very good manuals available, because certain actions can even interrupt an interview. The interviewer visits the houses and asks the questions defined in advance. It is not the responsibility of the interviewer, for example, to send a drug user to a treatment center. They are not, in their vast majority, health professionals, they must fully comply with the determinations of the research manuals.

In your opinion, what are the greatest challenges in a project of this magnitude?

The biggest challenges are the result of the complexity and extent of Brazil, which is a very large and diverse country. With rare exceptions, like China and India, there is no country where it is so complicated to make an inquiry as Brazil. One thing that clearly appeared in the Crack project, and will appear in such research even more, because we will have an emphasis on borders, is the issue of transportation. This is a very complicated problem. In Crack research we had to charter small aircrafts because there is no way to get to certain towns, no roads, it takes a few days to go by boat. When we go to the border there in Oyapock, it will be tricky. The challenges are primarily related to issues of logistics of the places we go.

What is the importance of the support from Fiotec?

The support of Fiotec is essential. Basically you only have a single structure in the country with the capillary needed to do this type of inquiry that is the IBGE, because it has regional offices and does the Census. Fiocruz is an institution of very good capillarity, it is regional, but as yet there are areas where you simply do not have any coverage. So, this brings a huge burden on management, because when you can decentralize through units, you ease the burden on the central management. The management is absolutely vital, otherwise you could not accomplish something of this magnitude and complexity. So if there was a management structure as Fiotec, I would say that this project would be impossible for an institution that was not the IBGE. A simple example: in the South, we have a single unit of Fiocruz, Paraná, with a completely different performance from our investigation, they work with laboratory and technology. From Sao Paulo to Rio Grande do Sul you have no structure in terms of investigations of this nature. So, if we have no administrative support as the one given by Fiotec, we will not be able to travel from São Paulo down to the other places.

You coordinated the "Crack - vulnerabilities" project, also supported by Fiotec. What were the main achievements of this project?

The major achievement of this project was that we did not have the same infrastructure that we are planning for this project and yet we managed to do a research nationwide, working in parallel in the household sector and in the field (consumption scenes). I believe that few people thought it would be feasible, that it would be possible to do a job of such magnitude in such a complicated place with the use scene. We interviewed more than 7000 people in the drug scenes. It is impossible to imagine a more complicated place to work. It is extremely violent. I believe the major difference of this project was to show that it is possible to do that and with quality. If you look back at everything that has been done to date, before the Crack project, it took place in the school or involved very small samples of minors living in the streets or at home. No one had done a job like that in scenes of crack use, or any other drug in the country. So, I think the fact that we managed to do that was a challenge, and it was essential for me and the whole team because we have learned many lessons that will be applied in this new project.