Virado: a new method of crack consumption in Brazil.

Crack emerged in the late 1980s in Brazil. This emergence was a critical moment for public health; the growing AIDS epidemic led intravenous cocaine users to migrate toward crack use to avoid the use of injection drugs. At the same time, young consumers of marijuana also began using crack, largely due to market strategies in drug trafficking that led to a shortage of marijuana and the availability of crack as a substitute.1 Twenty years later, crack use has spread throughout the country and among all social classes, creating a social burden on the State.2,3 This situation has led crack users to develop survival strategies, which, at times, increase the risks to users rather than protecting them.4 In this context, the use of virado has recently been identified in the city of Recife (northeast of Brazil). This letter is intended to comment on a new form of crack use, not previously described or quantified in epidemiological studies, which was identified during a large ethnographic study of crack cocaine use in Recife. In this study, several “cracklands” (places where crack users gather to consume the drug) were observed, and indepth interviews were conducted with crack users. They described the use of virado, which involves the transformation of crack cocaine rocks into a powder through the addition of an equal amount of boric acid, which is legally sold in drugstores as an antiseptic.5 The solid mass that results from heating this mixture is cut, and these slices are turned into powder, which is snorted through a straw. Virado is a salt form of cocaine (cocaine borate) that allows the drug to be absorbed through the nasal mucosa. According to users, this pathway of absorption provides a longer-lasting effect and lower levels of craving and paranoia than smoked crack.