The association between cocaine product use and violence outcomes in Brazil: A comprehensive, systematized review

Violence is a major adverse outcome associated with cocaine use. Brazil presents a unique case study with high levels of cocaine use. We present a systematized, comprehensive review of peer-reviewed studies investigating the association between cocaine product use and the perpetration or victimization of physical violence in Brazil since 2000. A systematized search strategy containing MeSH-based indexing terms focusing on cocaine use and physical violence was applied to five databases. Twenty-five studies were identified, comprising primarily quantitative-based investigations assessing associations of violence-related outcomes involving cocaine/crack-cocaine use in general, socially vulnerable, or treatment populations. Comparatively high levels of victimization or perpetration of violence in cocaine users were identified, including robbery, assault, homicide, and sexual abuse, and high rates of toxicology-positive tests for cocaine in victims of violent injuries or deaths (e.g., homicides). Violence outcomes appear to be disproportionately associated with cocaine use and represent a major component of cocaine use-related adverse outcomes for users and others in Brazil. Improved studies assessing factors associated with cocaine use and violence are necessary, also towards developing more effective intervention strategies to reduce the harm outcomes of cocaine use. The role of other psychoactive substance use influencing violence in cocaine users, especially alcohol, should be further investigated.