{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T01:24:59Z","timestamp":1777857899082,"version":"3.51.4"},"reference-count":30,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2016,11,16]],"date-time":"2016-11-16T00:00:00Z","timestamp":1479254400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J Health Serv"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:p>Calls to address crack-cocaine use in Brazil among homeless and street-frequenting populations who are in urgent need of health services have questioned the capacity of the Brazilian Unified Health System to attend to the nation\u2019s most marginalized citizens. In recent years, Brazil has launched several actions to escalate care for substance users, yet many obstacles hindering accessibility and effectiveness of services remain. Paradoxically, these actions have been implemented in the context of a growing economic crisis, and expanding services for a population of poor and stigmatized substance users while cutting other government programs tends to elicit harsh criticism from citizens. In consequence of such prospects, this commentary aims to discuss barriers marginalized substance users face in accessing health services that are at risk of worsening with government cutbacks. Using Rio de Janeiro as an example, we explore two primary issues: the resource-strained, under-staffed and decentralized nature of the Brazilian Unified Health System and the pervading stigma that bars vulnerable citizens from official structures and services. Abandoning initiated government efforts to increase access to health services would risk maintaining vulnerable citizens at the margins of public structures, inhibiting the opportunity to offer this population humane and urgently needed treatment and care.<\/jats:p>","DOI":"10.1177\/0020731416679351","type":"journal-article","created":{"date-parts":[[2016,11,17]],"date-time":"2016-11-17T20:44:02Z","timestamp":1479415442000},"page":"477-488","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["The Quest to Extend Health Services to Vulnerable Substance Users in Rio de Janeiro, Brazil in the Context of an Unfolding Economic Crisis"],"prefix":"10.1177","volume":"47","author":[{"given":"Noa","family":"Krawczyk","sequence":"first","affiliation":[{"name":"Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deanna","family":"Kerrigan","sequence":"additional","affiliation":[{"name":"Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco In\u00e1cio","family":"Bastos","sequence":"additional","affiliation":[{"name":"Institute for Scientific and Technological Information and Communication in Health (LIS\/ICICT), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2016,11,16]]},"reference":[{"key":"bibr1-0020731416679351","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-13-536"},{"key":"bibr2-0020731416679351","doi-asserted-by":"publisher","DOI":"10.1590\/S0034-89102008000500007"},{"key":"bibr3-0020731416679351","unstructured":"Bastos FI, Bertoni N, eds.\n                      Pesquisa nacional sobre o uso de crack: quem s\u00e3o os usu\u00e1rios de crack e\/ou similares do brasil? Quantos s\u00e3o nas capitais brasileiras?\n                      Rio de Janeiro, Brazil: ICICT\/FIOCRUZ; 2014."},{"issue":"6","key":"bibr4-0020731416679351","first-page":"494","volume":"25","author":"Dinis-Oliveira RJ","year":"2015","journal-title":"Toxicol Mech Methods"},{"key":"bibr5-0020731416679351","doi-asserted-by":"publisher","DOI":"10.3109\/10826084.2015.978198"},{"key":"bibr6-0020731416679351","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-014-0830-3"},{"key":"bibr7-0020731416679351","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2014.04.021"},{"key":"bibr8-0020731416679351","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60715-1"},{"key":"bibr9-0020731416679351","doi-asserted-by":"crossref","unstructured":"Ribeiro JM, Moreira MR, Bastos FI, Inglez-Dias A, Fernandes FM. Access to treatment for those with alcohol, crack or other drug dependency problems-a case study in the municipality of Rio de Janeiro, Brazil.\n                      Ciencia & saude coletiva\n                      . 2016;21(1):71\u201381.","DOI":"10.1590\/1413-81232015211.13752014"},{"key":"bibr10-0020731416679351","unstructured":"Teixeira M, Fonseca Z, eds.\n                      Saberes e pr\u00e1ticas na aten\u00e7\u00e3o prim\u00e1ria \u00e0 sa\u00fade: cuidado \u00e0 popula\u00e7\u00e3o em situa\u00e7\u00e3o de rua e usu\u00e1rios de \u00e1lcool, crack e outras drogas.\n                      1st ed. S\u00e3o Paulo, Brazil: Hucitec; 2015."},{"key":"bibr11-0020731416679351","doi-asserted-by":"publisher","DOI":"10.1590\/1807-57622013.0738"},{"key":"bibr12-0020731416679351","doi-asserted-by":"publisher","DOI":"10.1590\/0102-311X00100513"},{"key":"bibr13-0020731416679351","unstructured":"Campos E. Pr\u00e9via\u2019 do PIB do brasil fecha 2015 com queda de 4,08%, calcula BC.\n                      Valor\n                      . February 18, 2016. http:\/\/www.valor.com.br\/brasil\/4442324\/previa-do-pib-do-brasil-fecha-2015-com-queda-de-408-calcula-bc. Accessed May 27, 2016."},{"key":"bibr14-0020731416679351","unstructured":"Antonelli D. Plano anticrack cumpre s\u00f3 20% da meta.\n                      Gazeta do Povo\n                      . January 21, 2015. http:\/\/www.gazetadopovo.com.br\/vida-e-cidadania\/plano-anticrack-cumpre-so-20-da-meta-ej3b0lw54sy85l3n1wk1yt1la. 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