Drugs In Brazil Research Articles

META-ANALYSIS OF THE THERAPEUTIC USE OF DIPYRONE IN DOGS: PHARMACOLOGICAL EFFECTS AND CLINICAL SAFETY

Dipyrone (metamizole) is well-known for its powerful effect with central and peripheral activity. This meta-analysis involved articles published between 1973 and 2021, revealing that Brazil is the country which most published scientific articles relating the use of dipyrone in dogs, and this drug is widely recommended as an analgesic to control pain in cases of postoperative and cancer. Dipyrone is one of the favorite drugs used in small animal clinic in Brazil, and 12 commercial brands are available to use in dogs at doses among 25 to 50mg/kg for oral, intravenous and intramuscular administration. The effects of dipyrone may be potentiated when used in combination with other analgesic agents such as tramadol. In several studies, the occurrence of vomiting has been observed as an adverse effect, especially when the drug is used during surgical procedures, but metamizole has presented a low potential to cause gastric ulceration. The meta-analysis study of the use of dipyrone in dogs shows the clinical importance of this drug in Brazil, being an effective and safe medication, as long as it is used in the indicated dose of 25 mg/kg.

Testes farmacogenômicos de medicamentos oncológicos no Instituto Nacional de Câncer (INCA)

The implementation, current status and future perspectives of the pharmacogenetics/genomics (PGx) testing program developed at Instituto Nacional de Cancer (INCA) are presented. Initial selection of drug-gene pairs for PGx testing was based on clinically-validated PGx associations and availability of international guidelines with PGx-informed dosing recommendations. The selected pairs were fluoropyrimidines-DPYD, irinotecan-UGT1A1, and thiopurines-TPMT/NUDT15. The aims and rationale for the implemented PGx tests, frequency of the interrogated genetic variants and assigned metabolic phenotypes, and the individual dosing recommendations are reviewed. Planned developments, such as collaboration with other cancer treatment centers, testing of additional drug-gene pairs (e.g., tamoxifen-CYP2D6), and inclusion of PGx testing in the routine workout of targeted patients at INCA were impacted by the outbreak of the COVID-19 pandemics. The Brazilian Society of Clinical Oncology is invited to play a leading role in the evaluation of the clinical utility of PGx tests of germline variants for oncology drugs in Brazil.

Clinical trials with drugs in Brazil: an analysis of the main characteristics

Introdução: Os resultados de ensaios clínicos são utilizados pelas agências regulatórias de todo o mundo para fins de registro e comercialização de medicamentos. A Agência Nacional de Vigilância Sanitária (Anvisa) é a responsável pelos registros de tecnologias em saúde no Brasil e regras para análises técnicas de ensaios clínicos. A Anvisa vem atuando para atualizar seu arcabouço regulatório a respeito de ensaios clínicos com medicamentos no país, para reduzir tempo de análise e harmonizar conforme regras internacionais. Objetivo: Caracterizar os ensaios clínicos de fase III, com medicamentos, realizados no Brasil a partir da publicação da RDC n° 9, de 20 de fevereiro de 2015, da Anvisa. Método: Estudo exploratório e descritivo realizado em três etapas: (1) análise quantitativa pré e pós RDC n° 9/2015; (2) análise da população participante de ensaio clínico que embasou registros de medicamentos; (3) caracterização dos ensaios clínicos realizados no Brasil. Resultados: Houve redução em 20% de ensaios clínicos realizados no Brasil quando se compara o período anterior e posterior à publicação da RDC n° 9/2015 da Anvisa; apenas 33% dos ensaios clínicos que embasaram registros de medicamentos no país foram realizados com população brasileira; os medicamentos sintéticos e biológicos somam 96% da intervenção estudada nos ensaios clínicos; placebo ainda é muito utilizado como comparador (37%); a indústria farmacêutica é majoritariamente o patrocinador dos ensaios clínicos (86%). Conclusões: Diante deste cenário, é imperativo que se fortaleçam as ações de farmacovigilância no Brasil, a fim de conhecer os perfis de efetividade e segurança dos medicamentos após exposição da população brasileira.

1602P Estimated years of potential life lost from lack of access to crizotinib: NSCLC ALK+

Brazil has a well-established public health system (SUS), but the approval process and incorporation of new drugs can be complex and bureaucratic. More than 75% of the Brazilian population depends on SUS for oncology treatment. Considering that Lung Cancer (LC) is the major cause of cancer mortality in the country, and its huge impact on social burden an estimation of Years of Potential Life Lost (YPLL) due to the lack of Crizotinib, an anaplastic lymphoma kinase (ALK) inhibitor, in SUS was made necessary. For this study was considered the time frame from the approval by the National Health Surveillance Agency (ANVISA) in 2016 to 2019. The Number of Eligible Patients (NEP) with NSCLC ALK+ was taken from our National Cancer Institute (INCA). Pts with life insurance and other histologies, not NSCLC, were disregarded. For the YPLL calculation purpose the NEP between the years 2016 & 2019 was multiply by the difference of the documented improvement in the overall survival of the therapeutic regimen, according PROFILE 1014; 59,8 months and 19,2 months for crizotinib and chemotherapy regime respectively. For a conservative calculation, we assume that all eligible pts would have had access at the time of first approval in the country. INCA estimates 28220 (years: 2016 & 2017); 31270 (years: 2018 & 2019) new cases of LC/year in Brazil. Of these, 76.3% are considered to be treated by SUS, upon which 89% are NSCLC and 71.7% have adenocarcinoma histology. Of these 44% have metastasis at diagnosis, and 43%, 7%, 6% are diagnosed in stages III, II and I, respectively. It was used a recurrences rate of 53.79% in stage III, 46.49% in II and 26% in I in 5 years from diagnosis, totalizing 395 (per years 2016 & 2017) & 438 (per year 2018 & 2019): 1466 NEP with ALK+ from 2016 until 2019, resulting in a loss of approximately 5000 YPLL due to the lack of Crizotinib. The number of potential years of life lost during the interval between the approval process and the lack of availability of this drug in Brazil is substantial. Demonstrating the impact that these legal and bureaucratic difficulties in accessing Crizotinib have caused. Collaborative national initiatives are needed to address this major barrier to access to treatment.

Use of drugs for gastrointestinal disorders: evidence from National Survey on Access, Use and Promotion of Rational Use of Medicines.

ABSTRACTObjective To estimate the prevalence of use of drugs to treat gastrointestinal disorders, according to demographic, socioeconomic, and health characteristics of the Brazilian population.Methods This is a population-based survey that interviewed individuals residing in cities of the five regions in Brazil. The study sample was composed of 32,348 individuals aged 20 or more years. The profile of use of drugs for gastrointestinal disorders was evaluated considering the variables sex, age, healthcare plan, region, and number of chronic diseases. We also analyzed the frequency of individuals who declared using other drugs, besides those already employed for treatment of gastrointestinal disorders. Additionally, the estimated frequencies of the drug classes used were determined.Results The prevalence of use of drugs for gastrointestinal disorders in Brazil was 6.9% (95% confidence interval − 6.4-7.6), higher in females, among persons aged over 60 years, in those who had a private healthcare insurance, and presented with two or more chronic diseases. It was noted that 42.9% of the aged who used drugs for gastrointestinal disorders were also on polypharmacy. As to the classes of drugs, 82% corresponded to drugs for the food tract and metabolism, particularly proton pumps inhibitors.Conclusion The use of drugs for treatment of gastrointestinal disorders was significant among women and elderly. In this age group, consumption may be linked to gastric protection due to polypharmacy. This study is an unprecedented opportunity to observe the self-reported consumption profile of these drugs in Brazil and, therefore, could subsidize strategies to promote their rational use.

Pharmacoepidemiology of the antiglaucoma drugs in Brazil from 2012 to 2018

Abstract Purpose: To outline the epidemiological profile of clinical treatments for glaucoma provided by the Brazilian Unified Health System (SUS, acronym in Portuguese) between January 2012 and December 2018. Methods: A quantitative and descriptive study was conducted using available data based on the outpatient information system from SUS (SIA/SUS, acronym in Portuguese). The variables were monocular treatment with first, second, and third-line drugs; monocular treatment with combinations of two drugs and three drugs from different lines; binocular treatment with first, second, and third-line drugs; and binocular treatment with combinations of two drugs and three drugs from different lines. Results: During the analysis period, the prevalence of clinical therapies for glaucoma increased from 2012 to 2017 and decreased from 2017 to 2018. Of the clinically treated patients, 96% were carriers of binocular glaucoma. Among the regions of Brazil, the Northeast had the highest prevalence of binocular glaucoma (about 60% of the number of cases), and the most common therapy was combinations of two drugs from different lines. The Southeast region had the highest concentration of monocular glaucoma (53% of cases), and the predominant therapy was combinations of three drugs from different lines. The Midwest region had the lowest prevalence of monocular-treatments for glaucoma (less than 6%). Conclusion: In Brazil, the highest number of treatments offered by the public health system was in the Northeast and Southeast regions. There is a high national prevalence and potential for the morbidity of this disease. Therefore, it is necessary to strengthen programs aimed at early diagnosis and appropriate treatment to reduce adverse outcomes.

Prevalence of use and sources of antihypertensive medicine in Brazil: an analysis of the VIGITEL telephone survey.

The prevalence of hypertension in Brazil and worldwide has been increasing in recent decades, and drug therapy is one of the strategies used to control this condition. The objective of this study was to estimate the prevalence of use and identify the sources for obtaining antihypertensive drugs in Brazil, according to sociodemographic variables, comparing three periods: 2011, 2014 and 2017. Data from individuals aged ≥20 years who reported a medical diagnosis of hypertension, interviewed by Vigitel in 2011, 2014 and 2017 were used. Frequency and prevalence of drug use in addition to the sources for obtaining medication were estimated by sociodemographic variables, with 95% confidence intervals. The differences between proportions were verified by Pearson's chi-square test (Rao-Scott), with a significance level of 5%. The prevalence of antihypertensive drug use remained stable (80%). Regarding the sources for obtaining these medicines, there was variation in the period, indicating a decrease in usage through the Brazilian Unified Health System (SUS) (44.2% in 2011; 30.5% in 2017). This decrease was accompanied with increase in PFPB (16.1% in 2011; 29.9% in 2017). The prevalence of other sources for obtaining medicine (private pharmacies/drugstores) showed stability in the period. The prevalence of medication use remained high and there was a change in the pattern of use according to sources, demonstrating migration between SUS pharmacies to the PFPB, and suggesting a reduction in the availability of medicines from public pharmacies universally, and for free.

Use of trigger tool to identify Adverse Drugs Events in dogs.

The highlight of the shortcomings in the regulation and surveillance of veterinary drugs in Brazil is the absence of a system to report adverse drug events (ADEs). The aim of this study was evaluate the use of triggers in dogs to detect ADEs by estimating the prevalence of ADE and identifying the possible triggers. We screened medical records for ADEs and degree of harm caused by an ADE, using known triggers, with the Global Trigger Tool: translated, adapted and validated for use in animal health. The triggers comprised two-fold increase in blood urea nitrogen or serum creatinine levels compared to baseline, administration of vitamin K, administration of diphenhydramine or promethazine, excessive sedation or hypotension, administration of an antiemetic, abrupt cessation of medication, or others. The association between the occurrence of ADEs and variables, such as age, race, duration of hospitalization, polypharmacy, and clinical outcome was evaluated. A total of 148 medical records were analyzed. The trigger tools identified the known triggers 109 times in 68 medical records. Additionally, 14 ADEs were identified; the prevalence of ADEs was 9.5%. Positive predictive values of the triggers were 12.8%, and “vitamin K administration” had the best performance. The duration of hospitalization (p-value = 0.030) and polypharmacy (p-value < 0.001) were associated with the occurrence of ADEs. Approximately 46% of the hospitalized dogs presented with at least one trigger. One out of five hospitalized dogs suffered from temporary harm due to an ADE. The duration of hospitalization and polypharmacy were found to be risk factors for ADEs in dogs.

Detection of Impurities in Anti-infective Generic Drugs in Brazil by Liquid Chromatography-Mass Spectrometry

Impurities found in generic medicinesmay contribute to loss of efficacy and adverse side effects when administered to patients suffering from various diseases. Methods of analysis of the quality of drug products are well advanced. Herein, we used Liquid Chromatography with Diode Array Detector coupled to Mass Spectrometry to detect the presence of organic impurities and determine the quantity of the Active Pharmaceutical Ingredient (API) present in representative Antibiotics (2) and Antifungals (2). Possible impurities were detected in some of the generic drugs in both classes of anti-infective drugs. No impurities were detected in the amoxicillin. The compounds 3’-N,N-Di(demethyl) azithromycin (azithromycin impurity E) and 3’-De(dimethylamino)-3’-keto azithromycin (azithromycin impurity N) were detected in generic azithromycin. For itraconazole, the compounds cis-[2-(2,4 dichlorophenyl)-2-(1H-1,2,4-triazol-4-yl-methyl)-1,3-dioxolan-4 yl] methylmethanesulfonate and trans-[2-(2,4-dichlorophenyl)-2-(1H 1,2,4-triazol-1-yl-methyl)-1,3-dioxolan-4-yl]methylmethanesulfonate, besides a third substance identified as 2- (2-Butyl) -4-{4-[4-(4-methyloxy-phenyl)-piperazin-1-yl]-phenyl}-2,4-dihydro-[1,2,4]-triazol-3-one were detected as possible impurities. Interestingly, an additional peak was noted in the chromatogram for the generic fluconazole, in addition to the peak of the API; however, none of known impurities of fluconazole were identified. We conclude that tests in addition to bioequivalence measurements may be required to assess post-market generic quality. Such surveillance of generic quality should be performed routinely.

Adaptations of the pilot of the Unplugged#tamojunto program for health promotion and drug prevention in Brazilian schools.

The prevention of the use of alcohol and other drugs in Brazil is markedly discontinuous with a predominant model not based on evidence. In 2013, the General Coordination Office of Mental Health, alcohol and other drugs (Ministry of Health) implemented the European school program Unplugged#Tamojunto in the municipalities of São Paulo (SP), São Bernardo do Campo (SP) and Florianópolis (SC), involving 2,161 public school students. The research aimed to elaborate recommendations to adapt the program to the Brazilian context. The qualitative study is based on the Constructivist Grounded Theory and analyzed the institutional documents: "Cartographic Diaries", "Logical Spreadsheet of Cultural Adaptation" and a research report titled "Results of the Implementation of the Unplugged Pilot Program in São Paulo and Santa Catarina" (UFSC and UNIFESP). The theoretical formulations were organized from the Theory of Dissemination of Innovations and revealed that the following is required: a paradigmatic change in the professional approach to drugs, greater adherence to interactive methodologies, adaptation of class time, commitment to school management, promotion of intersectoriality between health and education, consolidation of the monitoring process and ethical alignment with the principles of health promotion.

O abuso de psicofármacos na atualidade e a medicalização da vida

The use of psychoactive drugs in Brazil and in the world has been growing in recent years, so that the term “medicalization of life” has become a routine expression, a tide, becoming a global public health problem. It is essential to investigate and question the therapeutic use of these substances, especially benzodiazepine anxiolytics, to promote the rational use of drugs. The present article of opinion aims to address some factors that may lead the living to resort to the use of psychoactive drugs as a form of anesthesia of their anguish. Historically, the pathologization of life is intricate with its medicalization, reinforcing the perception that the body is a machine that must be maintained at all costs in high performance, with immediate eradication of psychic suffering, without permission (or without the need?) of suffering, of dealing with anxieties or anguishes. Several mechanisms may be involved in this phenomenon, including the pharmaceutical industry and its various forms of (dis) information, since it doesn´t do exclusively marketing, but mainly subjectivities, inducing the perception that anxiolytics constitute magical objects covered by the glow of supposedly filling in the existential emptiness. Swimming against the tide, it is urgent to think public and educational policies that can go beyond the medicalizer and perpetuating model of the anesthesia of suffering.

Análise da legislação sanitária para auxiliar na obtenção e na adequação do registro de medicamentos destinados às doenças negligenciadas no Brasil

Introduction: The sanitary registration is a precondition for the commercialization of a medicine in the national market. Objective: This manuscript makes a critical analysis of Brazilian sanitary legislation to subsidize the obtainment and adaptation of registration of medicines destined to neglected diseases. Method: The development of this article was based on a critical analysis of the legislation available on the website of the National Agency of Sanitary Surveillance (Anvisa). This analysis was compared with international guidelines, in addition to the daily practice of the Regulatory Affairs Sector of an Official Pharmaceutical Laboratory. Results: The data obtained showed that there is no specific legislation for registration and post-registration of medicines for neglected diseases. Thus, there are gaps in the legislation applicable to these drugs. The absence of reference drugs in Brazil, and the lack of active ingredient suppliers that comply with current legislation, impairing the adequacy of these registries and obtaining new record are examples of the existing gaps. Conclusions: Nowadays, keeping a record of this class of medicine at Anvisa becomes a significant challenge, and each registry must be explicitly treated with the regulatory agency.

Smoking, alcohol consumption and mental health: Data from the Brazilian study of Cardiovascular Risks in Adolescents (ERICA)

IntroductionPrevious researches have indicated a strong association of alcohol and tobacco use with psychiatric disorders, but the relationship with depression and anxiety symptoms is still uncertain. We investigated the association of psychological distress and alcohol consumption, tobacco use and exposure to secondhand smoke (SHS) among adolescents in a developing country. MethodsThe authors evaluated 73,399 individuals (12–17 years) who participated in the Cardiovascular Risks Study in Adolescents (ERICA), a cross-sectional, national and school-based study, carried out in 124 Brazilian municipalities. The variables considered were alcoholic beverages (experimentation, consumption in the previous month and frequency of use) and smoking (experimentation, current smoking habits, frequent smoking and SHS exposure). Psychological distress was defined as a score ≥ 3 points in GHQ-12. Analyses included multiple logistic regression modeling. ResultsThe frequency of individuals with psychological distress was higher in the group who smoked for at least 7 consecutive days (53.3% vs 31.2%; OR: 2.17; 95%CI: 1.65–2.86), were exposed to SHS indoors (37.8% vs 29.8%; OR:1.30; 95%CI: 1.14–1.48), and outdoors (37.7% vs 26.6%; OR: 1.49; 95%CI: 1.28–1.74), and among young people who consumed at least 1 drink of alcohol in the previous 30 days (42.4% vs 28.6%; OR: 1.70; 95%CI: 1.46–1.97), when compared to adolescents not exposed. ConclusionsSmoking (passively and actively) and the consumption of alcoholic beverages are associated to psychological distress in the adolescent population. Avoiding smoking and the use of alcohol may have beneficial effects on the mental health. Our data reinforce the urgent necessity to prevent effectively underage access to legal drugs in Brazil.

When access to drugs meets catch-up: Insights from the use of CL threats to improve access to ARV drugs in Brazil

Access to affordable lifesaving medicines is considered a human right. This leads to a question largely understudied in the catch-up literature on accumulation of industrial capabilities. Can the need to improve access to an essential commodity impact the sectoral catch-up trajectory of the corresponding industry? In 1996, Brazil initiated a policy of universal and free access to highly-active ARV therapy, which put an enormous pressure on the Brazilian Ministry of Health (MoH). In order to ensure an adequate supply of ARVs in the public healthcare system with a limited budget, MoH started negotiating price reductions for high-cost patented drugs, often deploying the threat of using compulsory licensing. Through a scoping review of the literature and construction of the Brazilian case study, the paper explores how the need to access is impacted by prior catch-up in the pharmaceutical sector and triggers in turn future sectoral catch-up. It shows that price negotiations may or may not impact both catch-up and access positively. Catch-up can provide bargaining strength in price negotiations and have a positive inter-temporal impact on both future catch-up and access. However, results suggest that only successful catch-up can lead to long term access, as the capabilities accumulated in aborted catch-up are not sufficient for large scale production of low cost essential medicines. Thus, industrial policy and health policy can impact one another and twining between catch-up and access can be helpful.

Optimism in a sea of uncertainties: the journalistic coverage on the research of new medicines in Brazil

This paper deals with the journalistic coverage of biologically active compounds presented as promising drugs in Brazil. The sample consists of 214 journalistic stories on 40 compounds published in two daily newspapers and a monthly science magazine from January 1990 to December 2016. After 27 years, although journalists and scientists had claimed that all compounds would become drugs in a few years, only two completed the evaluation tests and were approved for commercialisation. The paper provides a series of strategies to build a more analytical view on drug research and development.

Percepções e práticas de agentes comunitários de saúde na atenção a usuários de drogas

Introdução: No âmbito das políticas públicas vigentes no Brasil sobre atenção à saúde de pessoas que usam álcool e outras drogas, os Agentes Comunitários de Saúde da Estratégia de Saúde da Família (ACS) são profissionais de significativa importância para a busca ativa e para o cuidado dessa população. No entanto, eles têm muita dificuldade em realizar tais ações, provavelmente devido à insuficiente qualificação técnica que recebem sobre abordagem adequada de usuários de drogas. Objetivo: Descrever as percepções e as expectativas de um grupo de Agentes Comunitários de Saúde sobre usuários de álcool e outras drogas, sobre as quais fundamentam suas práticas de cuidado. Métodos: Pesquisa clinico-qualitativa, aprovada por Comitê de Ética em Pesquisa com Seres Humanos, baseada na entrevista de dez Agentes Comunitários de Saúde experientes em cuidar de usuários de drogas. As entrevistas foram tratadas por estratégia ideográfica e organizadas nomoteticamente por conteúdos temáticos, os quais foram analisados sob os referenciais da clínica ampliada. Resultados: Os Agentes Comunitários de Saúde querem cuidar adequadamente dos usuários de drogas, mas não sabem como fazê-lo porque ainda convivem com noções leigas sobre essas pessoas e não recebem formação técnica suficiente. Conclusão: Esses ACS percebem a necessidade de se qualificarem e desejam essa qualificação para cuidar melhor de pessoas que usam álcool e drogas ilícitas. Portanto, para que as políticas públicas destinadas ao cuidado de quem tem problemas com o uso de drogas sejam eficazes, é indispensável a aplicação de estratégias de educação permanente capazes de transformar as práticas e as percepções desses profissionais.

Sporotrichosis: an update on epidemiology, etiopathogenesis, laboratory and clinical therapeutics.

In the late 90's there was a change in both the route of transmission and the people at risk for sporotrichosis. This zoonotic cat-man alternative transmission route elicited changes in strategies to control the epidemic. There was a progressive increase in the number of cases involving especially children and the elderly. In addition to becoming hyperendemic, uncommon clinical pictures like immunoreactive clinical presentations or severe systemic cases have emerged. New species were identified and classified through molecular tools using more virulent clinical isolates, like S. brasiliensis, compared to the environmental isolates. Likewise, different species of Sporothrix have been associated with different geographic regions. The serological and molecular techniques are used as an auxiliary tool for the diagnosis and/or for species identification, although the isolation and the identification of Sporothrix spp. in clinical specimen is still the gold standard. Currently sporotrichosis epidemics requires the knowledge of the epidemiological-molecular profile to control the disease and the specific treatment. Itraconazole, potassium iodide, terfinafine, and amphotericin B are the available drugs in Brazil to treat sporotrichosis. The drug of choice, its posology, and treatment duration vary according to the clinical presentation, the Sporothrix species, and host immune status. New treatment choices, including a vaccine, are being developed; nevertheless, more clinical trials are required to confirm its efficacy.

PCN48 - High-Cost Oncology Drugs in Brazil and Mexico: Access Differences Between the Public and Private Settings

PCN48 - High-Cost Oncology Drugs in Brazil and Mexico: Access Differences Between the Public and Private Settings

Pela metade: implicações do dispositivo médico-criminal da “Nova” Lei de Drogas na cidade de São Paulo

Este texto aborda as implicações da atual lei de drogas no Brasil, analisada como um dispositivo de poder médico-criminal. A análise está voltada, mais especificamente, para algumas implicações da lei n. 11 343 de 2006 – “Nova” Lei de Drogas – no sistema de justiça criminal na cidade de São Paulo, tendo como pano de fundo o fenômeno da intensificação do encarceramento por tráfico de drogas no país após o advento da mesma lei no ano de 2006. São apresentados dados sobre prisões por drogas no Brasil e, em seguida, utiliza-se um modelo de série temporal interrompida [interrupted time series designs] em conjunto com um modelo de regressão binária logística com dados relativos à cidade de São Paulo, para indicar como se dá a atual administração estatal das drogas e como se desenvolvem práticas no interior do sistema de justiça criminal que privilegiam a pena de prisão, mesmo depois do suposto fim desta para o usuário de drogas, com a aprovação da lei de 2006.

Consumo de drogas, opinião pública e moralidade: motivações e argumentos baseados em uso

Este artigo analisa dados de um survey nacional de 2013, representativo da população brasileira com 16 anos e mais, que abordou percepções, práticas e opiniões sobre o uso de drogas psicoativas no Brasil. Descreve o comportamento de diferentes segmentos sociodemográficos quanto ao consumo de álcool, tabaco e drogas ilícitas, relacionando-o a uma escala atitudinal, construída como síntese de oito variáveis com opiniões sobre consumo e política para drogas hoje ilegais. Recorre à técnica de regressão logística multinomial para identificar as variáveis preditoras de dois posicionamentos à primeira vista contraditórios, em termos de dissonância entre comportamento declarado e atitude manifesta: os usuários de drogas ilícitas proibicionistas – favoráveis à manutenção da política de drogas vigente, que criminaliza o consumo e prioriza o enfoque do problema como questão de segurança pública – e os não usuários antiproibicionistas. Analisa tais posicionamentos à luz da teoria psicossocial construtivista da moralidade, desenvolvida por Jean Piaget e Lawrence Kohlberg, expondo o potencial da mesma para compreendê-los e para abordar a discussão das políticas públicas voltadas para lidar com o fenômeno universal do consumo de substâncias psicoativas.