OBJETIVOS: O presente estudo visou estimar a prevalência da comorbidade entre transtornos mentais graves e o abuso de substâncias psicoativas, e estudar os fatores associados a essa comorbidade, em pacientes com transtornos mentais graves residentes em São Paulo. MÉTODO: O estudo teve desenho de corte transversal. Vinte serviços de saúde mental (emergências, hospitais psiquiátricos e ambulatórios) foram pesquisados, a fim de identificar todos os pacientes com idade entre 18 e 65 anos, com diagnóstico clínico de transtorno mental grave, que fossem residentes em um dos 7 distritos administrativos escolhidos para o estudo e que tiveram ao menos um contato com o serviço de saúde no período entre 1/9/1997 e 30/11/1997. Os pacientes incluídos foram avaliados quanto a sintomas psiquiátricos, ajustamento social, uso de álcool e uso de substâncias psicoativas, utilizando-se instrumentos padronizados. RESULTADOS: Dos 620 pacientes identificados, 404 foram aleatoriamente selecionados para serem entrevistados. Foi possível entrevistar diretamente 192 (47,9%) indivíduos. A prevalência de comorbidade nos últimos 12 meses foi de 10,4% (I.C. 95%: 6.5 a 15.6), sendo 7,3% para abuso de álcool e 4,7% para abuso de drogas ilícitas, e mostrou-se maior entre homens, entre migrantes, entre indivíduos separados/divorciados, em indivíduos com 12 ou mais anos de escolaridade, e em indivíduos com o diagnóstico de transtornos do espectro da esquizofrenia. A presença de sintomas negativos de esquizofrenia foi significativamente menor entre os indivíduos que receberam o diagnóstico de abuso de substâncias psicoativas. CONCLUSÃO: Os resultados deste estudo sugerem que na população estudada a prevalência de transtornos decorrentes do uso de álcool e outras drogas é mais baixa do que as prevalências encontradas em outros estudos, realizados nos EUA e Europa. Essa discrepância de resultados pode ser devida a diversos fatores, incluindo o consumo de substâncias pela população geral na qual estão os sujeitos investigados, o ambiente social onde esses sujeito vivem e aspectos culturais relacionados ao consumo de substâncias. / OBJECTIVES: To investigate the prevalence of substance use disorders among patients with severe mental illnesses in São Paulo, Brazil, and to study factors associated with such comorbidity. METHOD: The study had a cross-sectional design. Twenty mental health services (emergency, inpatient and outpatient services) were scrutinized to identify all patients aged 18 to 65 years old, with a clinical diagnosis of severe mental illness, who were resident in one of 7 administrative districts chosen for the study, and had had at least one contact with such services between 1stSeptember and 30th November 1997. Assessments included psychiatric symptoms, social adjustment, and patterns of alcohol and drug use, using standardized instruments. RESULTS: Out of 620 patients identified, 404 were randomly selected to be interviewed. One hundred and ninety two patients (47.9%) were directly interviewed. The prevalence of comorbidity was 10,4% (95%CI: 6.5 to 15.6), being 7,3% for alcohol abuse and 4,7% for drug abuse, and was higher among male subjects migrants, single or separated individuals, those with 12 or more years of education, and among those with schizophrenia-like disorders. Presence of negative symptoms was associated with lower prevalence of comorbidity. CONCLUSIONS: Results of the present study suggest that the prevalence of dual diagnosis in São Paulo is lower than those found in previous studies, carried out in the USA and Europe. Such discrepancy may be due to several factors, including population patterns of substance use, the social environment where patients live, and cultural issues related to the use of alcohol.

INTRODUÇÃO: Infecções pelo HIV, HBV, HCV e Treponema pallidum encontram no sistema prisional um ambiente favorável para suas propagações e representam grave problema de saúde pública. Neste estudo buscamos conhecer o perfil epidemiológico dos reeducandos de uma unidade prisional e a dinâmica do seu comportamento associado às infecções estudadas. Foram medidas as prevalências dessas infecções e suas coinfecções, investigados os potenciais fatores de risco, assim como medido o padrão de uso de drogas no presídio com ênfase no crack. MÉTODOS: Estudo epidemiológico transversal realizado de fevereiro a dezembro de 2007, na Penitenciária I de São Vicente. Realizada uma análise descritiva utilizando medidas de frequência, médias e desvio padrão. Foram considerados apenas os diagnósticos sorológicos para definição das infecções. Utilizado o OR (odds ratio) como medida de associação com nível de significância de 5% (?). Utilizada a regressão logística para estimar OR ajustado por algumas variáveis. RESULTADOS: Participaram das entrevistas 546 (84,1%) reeducandos e 514 (94,1%) realizaram as sorologias. Apresentaram um perfil jovem com idade média de 29,8 anos. 52,0% (283) referiram relacionamento conjugal com média de dois filhos. Declararam ser de cor parda 51,5% (280). O tempo médio de prisão foi de 10,5 anos. As prevalências identificadas foram: HIV 1,8% [IC95% = 0,1- 3,3], HBV 21,0% [IC95% = 17,8-25,1], HCV 5,3% [IC95% = 3,5-7,6], e 5,3% [IC95% =3,5-7,6] para a infecção pelo Treponema pallidum. Os fatores de risco associados com a infecção pelo HIV foram: uso de droga injetável (OR=15,38), > 30 anos (OR=13,3), uso de cocaína na vida (OR= 5,36) e uso de crack na vida (OR= 5,21). Nas análises multivariadas as variáveis que se mantiveram associadas com o HBV foram: uso de droga injetável (OR=3,36), ter referido DST (OR= 2,28), > de 30 anos (OR=1,86) e mais de cinco anos de prisão (OR= 2,17); com o HCV foram: uso de droga injetável (OR=9,65), uso de maconha na prisão (OR=2,91) e idade >30 anos (OR=8,41); com o Treponema pallidum foram: relação homossexual (OR=11,92) e ter referido sífilis (OR=10,88). As prevalências das coinfecções foram: 0,8% [IC95%= 0,2-2,0] para HIV/HBV, 1,4% [IC95%=0,5-2,8], para HBV/Treponema pallidum, 1,8% [IC95%= 0,8-3,3] para HBV/HCV, e para a tripla infecção 0,4% [IC95%= 0,5-1,4]. Confirmaram o uso de crack na vida 25,0% (136) dos entrevistados. Idade média de início de uso de drogas ilícitas foi de 15,4 anos. Na prisão, o uso de álcool foi relatado por 8,4% (45), tabaco por 62,0% (318), maconha por 36,5 % (194), cocaína por 9,0% (48), e crack por 11,7% (15), sendo seu uso diário referido por 2,3% (3). Uso de drogas injetáveis na vida foi referido por 5,9% (32) e nenhum uso nos últimos seis meses. As situações de violência relacionadas com drogas para 14,3% (28) foram de ameaças de morte, 16,7% (57) agressões físicas e 27,3% (3) sofreram agressão sexual. Para 15,8% (30) o crack esteve relacionado com estas situações. O seu uso com outras drogas foi referido por 41,5% (54). CONCLUSÃO: As prevalências encontradas na população confinada continuam maiores que as observadas na população geral. O consumo de drogas e praticas sexuais desprotegidas foram mantidas no período de confinamento. O tempo de confinamento mostrou-se fator importante na análise de risco. Os fatores de riscos identificados aparecem como importantes indicadores para a estruturação de estratégias de controle dessas infecções junto à população confinada. / INTRODUCTION: Infection by HIV, HBV, HCV and Treponema pallidum are common in the prison system due to an environment favorable to their propagation and represent a serious public health problem. This study aims to understand the epidemiological profile of the inmates in a prison unit and the behaviors associated with the infectious diseases studied. We estimated the prevalence of these infections and their co-infections, investigated potential risk factors, as well as identified the pattern of drug use in prison, especially crack use. METHODS: A cross-sectional epidemiological study conducted from February to December 2007 at the São Vicente Penitentiary . A descriptive analysis using frequency measures, means and standard deviations was conducted. We considered only the setting for serological diagnosis of infections. Odds ratio (OR) with a significance level of 5% (?) was used as a measure of association and a logistic regression was applied to estimate adjusted OR for some variables. RESULTS: A total of 546 prisoners were interviewed (84.1%). Of these, 514 (94.1%) underwent serological analysis. Results showed a profile of young men with an average age of 29.8 years. Fifty-two percent (283) reported marital relationship with an average of two children, and 51.5% (280) reported being of mixed ethnicity. The average time of arrest was 10.5 years. The prevalences were identified: HIV 1.8% [95% CI = 0.1 - 3.3], HBV 21.0% [95% CI 17.8 to 25.1], HCV 5.3% [95% CI = 3.5 to 7.6] and 5.3% [95% CI = 3.5 to 7.6] for infection with Treponema pallidum. The risk factors associated with HIV infection were injected-drug use (OR = 15.38), > 30 years (OR = 13.3), cocaine use (OR = 5.36) and use of crack during lifetime (OR = 5.21). According to multivariate analyzes, variables associated with HBV were: injected-drug use (OR = 3.36), reported any STD (OR = 2.28), > 30 years (OR = 1.86) and more than five years in prison (OR = 2.17); the variables associated with HCV were: injected-drug use (OR = 9.65), marijuana use in prison (OR = 2.91) and age> 30 years (OR = 8.41); the variables associated with Treponema pallidum were: homosexual intercourse (OR = 11.92) and have referred syphilis (OR = 10.88). The prevalence of co-infections were 0.8% [95% CI = 0.2 to 2.0] for HIV / HBV, 1.4% [95% CI = 0.5 to 2.8] for HBV / Treponema pallidum, 1.8% [95% CI = 0.8 to 3.3] for HBV / HCV infection and for the triple infection 0.4% [95% CI = 0.5 to 1.4]. Average age of onset of illicit drug use was 15.4 years. The use of crack during lifetime was reported by 25.0% (136) of respondents. In prison, alcohol use was reported by 8.4% (45), tobacco by 62.0% (318), marijuana by 36.5% (194), 9.0% for cocaine (48), and crack by 11.7% (15), with the daily use of crack reported by 2.3% (3). Injected-drug use during lifetime was reported by 5.9% (32), but no use in the last six months was reported. Drug-related violence episodes reported were death threats 14.3% (28), 16.7% (57) assaults and 27.3% (3) suffered sexual assault. To 15.8% (30) of the respondents, crack use was associated with violence episodes. The use of crack-cocaine in association with other drugs was reported by 41.5% (54). CONCLUSION: The prevalence found in the confined population is still larger than those observed in the general population. Drug use and unprotected sexual practices were maintained during the period of confinement. The confinement time proved to be an important factor in the analysis of risk of infection. The identified risk factors appear to be important indicators for developing strategies to control these infections in the prison environment.

Background: There is a widespread and increasing use of psychoactive prescription drugs, such as opioid analgesics, anxiolytics, hypnotics and anti-epileptics, but their use is associated with a risk of drug use disorder, misuse and abuse. Today, these are globally recognized and emerging public health concerns. Aim: The aim of this thesis is to estimate the prevalence of psychoactive prescription drug (PPD) use disorders, misuse and abuse, and to investigate the association with some potential risk factors. Methods: A study using register data from forensic cause of death investigations investigated and described cases of fatal unintentional intoxication with tramadol (Study I). Based on register data on spontaneously reported adverse drug reactions (ADRs) reported cases of tramadol dependence were investigated and summarised (Study II). In a study in suspected drug-impaired drivers with a toxicology analysis confirming the intake of one out of five pre-specified PPDs, the prevalence of non-prescribed use was assessed and associated factors were investigated (Study III). From a cohort of patients initiating prescribed treatment with pregabalin, using data on prescription fills, a study investigated longitudinal utilisation patterns during five years with regards to use of the drug above the maximum approved daily dose (MAD), and factors associated with the utilisation patterns (Study IV). Results: In the first study, 17 cases of unintentional intoxications were identified, of which more concerned men, the median age was 44 years and the majority used multiple psychoactive substances (alcohol, illicit drugs and prescription drugs). The second study identified 104 spontaneously reported cases of tramadol dependence, in which more concerned women, the median age was 45 years, and a third reported a history of substance abuse and 40% of past psychoactive medication use. In the third study, more than half of the individuals suspected of drug-impaired driving used the drug without a recent prescription. Non prescribed use was most frequent in users of benzodiazepines and tramadol, and was more likely in younger individuals and in multiple-substance users. In the last paper five longitudinal utilisation patterns were found in pregabalin users, with two patterns associated with a particularly high risk of doses above the maximum approved dosing recommendation. This pattern of use was associated with male sex, younger age, non-urban residency and a recent prescribed treatment with an antiepileptic or opioid analgesic drug. Conclusions: This thesis shows that psychoactive prescription drug use disorders, misuse and abuse occur and may have serious and even fatal consequences. The prevalence varies between different drugs and populations. Abuse and misuse seem to be more common in young people. Fatal intoxications and misuse of prescribed drugs may be more common in men, while drug use disorders following prescribed treatment may be more common in women and non-prescribed use equally distributed between women and men. Individuals with a history of mental illness, substance use disorder or abuse, or of past use of psychoactive medications are likely important risk groups. In summary, the findings suggest a potential for improvements in the utilisation of psychoactive prescription drugs. The results may be useful in the planning of clinical and regulatory preventive interventions to promote the rational, individualised and safe use of such drugs.

Voilà une vingtaine d’années que le concept d’addiction a été élaboré par quelques psychiatres et chercheurs en neurosciences afin de rendre compte, à travers un nouveau regard, des phénomènes de dépendance (en associant drogues illicites, alcool et tabac). Il a ensuite été utilisé pour la première fois en 1999 dans une politique publique en France, à savoir le plan triennal de la Mission Interministérielle de Lutte contre la Drogue et la Toxicomanie (MILDT).Le processus de construction du problème public des addictions constitue ainsi l’objet de cette thèse. Dans quelles mesures la reconfiguration de certains espaces des champs médical et politico-administratif a partie liée à l’institutionnalisation du paradigme addictologique et comment celui-ci a contribué à transformer les drug policies contemporaines ? Le problème public des addictions doit son émergence au succès politique d’un petit groupe d’acteurs qui a su transposer un concept médical dans le langage de l’action publique. Dans le prolongement des politiques de réduction des risques, les addictions bousculent le mode de régulation des usages de drogues, en favorisant leur sanitarisation plutôt que leur pénalisation. Par le biais d’une sociologie historique et politique de l’action publique, cette thèse retrace ainsi la genèse de l’addictologie et des drug policies françaises jusqu’au plan triennal de la MILDT de 1999. / It has been about twenty years that the addiction concept has been elaborated by some psychiatrists and neuroscientists in order to define dependence phenomena in a new way (by associating illicit drugs with alcohol and tobacco). Then it has been used for the first time in 1999 in a public policy in France, i.e. the three-year plan of the Mission Interministérielle de Lutte contre la Drogue et la Toxicomanie (MILDT).The construction process of the “addiction” public problem constitutes this thesis subject. In which way the reconfiguration of some spaces of the medical and political fields is connected to the institutionalization of the addictological paradigm and how this one has led to transform contemporary drug policies? The “addiction” public problem emerged thanks to the political success of a small group of actors who transposed a medical concept into the language of public policy. In the continuation of harm reduction policies, addictions reshape the regulation model of drug use by promoting their sanitarization rather than their criminalization. Through a political and historical sociology of public policy, this thesis thus traces the genesis of French addictology and drug policies until the MILDT’s three-year plan of 1999.

Magister Artium - MA / The aim of this study was to investigate the impact of peer, community and religious influences on alcohol and tobacco use among high school adolescents from three different dominant groups of South Africa i.e. African, coloured and white adolescents. The investigations were based on two perceived major factors such as their familiy structure and their family's socio-economic status, which may either increase or decrease the likelihood of adolescent substance use. / South Africa

Magister Psychologiae - MPsych / The outcome of child abuse, i.e. physical, emotional and/or sexual, and child neglect is multifactorial. The severity, duration and nature of abuse and the child’s vulnerabilities are all contributory factors with regards the outcome of abuse. Children who are traumatized are likely to be profoundly affected. Studies have shown and nearly every researcher agrees that early childhood traumas lie at the root of many emotional and psychological illnesses. It has been noted that drug abuse is a major problem in the Western Cape. This thesis explored the relationship between subjectively perceived childhood trauma and drug dependence in an in-patient treatment-seeking sample of adults in the Cape Town Metropolitan Area in the Western Cape. This thesis presents the results of a measure of childhood trauma, namely the Childhood Trauma Questionnaire [CTQ] and a measure of drug dependence, the Drug Use Disorder Identification Test [DUDIT]. The sample consisted of 52 participants and included both males and females. Only participants who were identified as drug dependent were included in the study. Patients who were actively psychotic and/or alcohol dependent were not included in the study. Ethical clearance was obtained from the University of the Western Cape’s higher degree ethical committee. The anonymity of the participants, the importance of responding openly and honestly and the sensitive nature of the questions were highlighted during the test administration. Questionnaires were administered in accordance with the guidelines stipulated in the respective manuals. The data was analysed through correlation. The study found a positive correlation between childhood emotional abuse and drug dependence, and childhood physical abuse and drug dependence.

South Africa has experienced a notable increase in adolescent drug use during the country’s transition from apartheid to democracy (Central Drug Authority [CDA], 2006). These findings are verified by epidemiological studies and two national youth risk behaviour surveys, highlighting the need for effective drug prevention interventions. Whilst drug use spans across age, gender and social strata, the rapid increase in both legal and illicit drug use among adolescents in the Northern Areas communities of Port Elizabeth has been particularly pronounced. The South African Community Epidemiology Network on Drug Use (SACENDU) statistics, which reflects on racial demographics in accordance with the Population Registration Act of 1950 (South Africa, 1950), reports that, in the year 2011, the ‘Coloured’ population constituted 62 percent of those individuals seeking treatment for drug abuse, compared to 15 percent ‘African’ treatment seekers in Port Elizabeth (Dada, Plüddemann, Parry, Bhana, Vawda & Fourie, 2012:44). Furthermore, methamphetamine use by persons under the age of 20 years in Port Elizabeth increased fivefold in a three-year period, i.e. from 7 percent in 2008 to 39 percent in 2011 (Dada et al., 2012), with the ‘Coloured’ population group accounting for the majority of methamphetamine users. These statistics reinforce a long-standing racial stereotype that associates ‘Coloured’ racial identity with an enhanced susceptibility to drug use. The National Drug Master Plan (South Africa, 2012a), and the Prevention of and Treatment for Substance Abuse Act (Act no 70 of 2008) propose that drug prevention programmes should address the values, perceptions, expectations and beliefs that the community associates with drug abuse (South Africa, 2008b). This view emphasises the importance of drug preventions interventions that are culturally sensitive and contextually relevant. The current study was guided by two conceptual frameworks, i.e. the Social Constructionist Framework and the Ecological Risk/Protective Resilience Framework, and focused on the Northern Areas of Port Elizabeth, a historically marginalised community inhabited by a predominantly ‘Coloured’ indigenous/ethnic group. The goal of the study was to enhance understanding of the socio-cultural meaning attributed to cultural identity, drug use, non-use and drug prevention in the Northern Areas of Port Elizabeth, with the view to developing guidelines for drug prevention interventions that are culturally sensitive and contextually relevant. The following objectives were formulated in order to achieve the goal of the study: • To explore adolescent narratives regarding the constructs ‘Coloured’, drug use, non-use and drug prevention programmes of three distinct groups of adolescents (drug users, non-users, and TADA peer mentors) from the Northern Areas. • To explore and describe the social service practitioners’ (social workers and social auxiliary workers’) constructions of drug use, non-use and drug abuse prevention in relation to adolescents from the Northern Areas, and how such constructions inform the drug prevention services rendered to adolescents from these communities. • To review the data collected from the adolescent narratives and the social service practitioners’ reflections on their drug prevention programmes against existing theory and models for drug prevention. • To synthesise the above information with a view to developing guidelines for culturally sensitive drug prevention programmes relevant and responsive to the specific social constructions of adolescents from the Northern Areas. A qualitative research approach, located in a narrative tradition of inquiry research design, was employed to achieve the goal of the study (Riessman, 2008). The study was conducted in two phases. The first phase involved an empirical study with the four sample groups (i.e. adolescent drug users, adolescent non-drug users, Teenagers against Drug Abuse [TADA] peer mentors and social service professionals (i.e. social workers and social auxiliary workers)). Phase two involved the co-construction of the practice guidelines for culturally sensitive and contextually relevant drug prevention interventions. Phase one started with the informal exploration of community stakeholders’ views on the identified research problem and the process of gaining access to the research population. Several gatekeepers (i.e. teachers, social workers, the Families Against Drugs [FAD] Support Group representatives, a minister of religion and a community stakeholder) were engaged to assist in recruiting participants from the four sample groups. A non-probability purposive sampling method was employed to purposively recruit 29 adolescent non-drug users and ten adolescent peer mentors (via the TADA Programme at one school). The same sampling method, followed by a snowball sampling technique, was employed to recruit the two remaining sample groups of ten adolescent drug users (in the recovery process) and nine social workers and social auxiliary workers respectively. The sample sizes were determined by the principle of data saturation.The data generation method used in respect of the non-users took the form of semi-structured written narratives, administered in a group context during school time, followed by a second round of data generation. The life-grid (Wilson, Cunningham-Burley, Bancroft, Backett-Milburn & Masters, 2007:144), a qualitative visual tool for mapping important life events, was employed to guide the co-construction of the biographical narratives generated during the individual semi-structured interviews with the sample of adolescent drug users. Focus group interviews were used to enhance an understanding of the peer mentors and social service practitioners’ views on the construct ‘Coloured’ and their existing drug prevention programmes. Each of the individual and focus group interviews was audio-recorded, transcribed and complemented by the field notes. Informal data gathering occurred through participant observation of two drug prevention programmes, attendance of a FAD Support Group meeting, and interviews with community volunteers and the South African Police Services (SAPS) Youth Development Forum. Both the content and the context of the narratives were analysed to arrive at the research themes, sub-themes and categories. The content of the narratives was analysed by employing categorical content analysis, whilst the form of the narratives (i.e. how the stories were told) was analysed by using the socio-cultural approach to narrative analysis (Grbich, 2007:130). The journey metaphor emerged from the adolescent drug users’ narratives, depicting a prototypical storyline of a drug use journey, starting with experimentation and culminating in abuse and dependence for some and an early exit from the journey for others. The conclusions that can be drawn from these findings illuminate key protective factors and processes at a multisystemic level that can be strengthened to enhance the adolescents’ resistance to drug use and/or delay the onset of use. Embedded in the participants’ narration of the drug use journey were nuances relating to internalised stereotypes of ‘White’ supremacy and ‘Coloured’ inferiority as an explanatory framework for venturing onto and prolonging the journey.The two themes that emerged during the process of content and narrative analysis of the qualitative data (from both adolescent drug users and non-users) were as follows: Constructing drug use as a ‘Coloured’ phenomenon and reconstructing ‘Coloured’ identity; Risk and protective factors located at individual, family, peer, school, community and societal domains. The four themes that emerged during the data analysis of the peer mentors and social service practitioners’ narratives were as follows: Construction of ‘Coloured’ identity; socio-cultural meaning construction about the reasons for drug use amongst adolescents from the Northern Areas; description of drug prevention services rendered in the Northern Areas; and reflection on barriers to rendering drug prevention interventions.

Introduction: Social networks have shown promise in curbing drug dependency and infectious diseases among marginalized populations. The purpose of this study is to elucidate how relationship strength in social networks is associated with risk behaviours for infectious diseases. Methods: Two reviews were conducted: 1) a systematic review exploring the association between risk behaviours and relationship strength 2) a review on the utilization of respondent driven sampling (RDS). We also analyzed network data to determine the association between recent injection drug use and recent crack use. Results: Our reviews revealed that few studies link relationship strength and risk behaviours; moreover, RDS is effective method of sampling from marginalized populations. Finally, our analysis demonstrated that close relationships are associated with drug use. Conclusion: “Close” relationships are important in arbitrating injection drug use and crack smoking. More research addressing the issues of using data from dynamic social processes and hard-to-reach populations is needed.

Made available in DSpace on 2017-06-01T18:18:08Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-10-27 / The objective of this study is to demonstrate in detail the phenomenon of free supply of medicine to the brazilian citizens by court order. This study considered the social state and the plexus of fundamental rights and guarantees brought with the Brazilian Federal Constitution of 1988, especially those pertaining to health, including the provision of pharmaceutical SUS, focusing on the approach of the specific legislation and case law of the Brazilian Federal Courts, notably the Supreme Federal Court and The Superior Court of Justice. Through this study, our major issue is to contribute to the improvement of public health considering the notoriously precarious public health service developed in Brazil and the helplessness of the poor population of a country that recognizes its poverty in its own Constitution itself when it says in item III of in article art. 3, which is a key objective of the Republic ― to eradicate poverty and marginalization and reduce social and regional inequalities / O presente trabalho visa detalhar o fenômeno da dispensação judicial de medicamento, ou seja, o fornecimento gratuito de medicamento ao cidadão pelo poder público mediante determinação judicial. Esse estudo evolui a partir do Estado social e do plexo de direitos e garantias fundamentais trazidos com a Constituição de 1988, em especial aqueles atinentes à saúde, nele incluído à prestação farmacêutica do Sistema Único de Saúde (SUS), concentrando-se no enfoque da legislação e jurisprudência dos nossos Tribunais, notadamente do Supremo Tribunal Federal (STF) e do Superior Tribunal de Justiça (STJ). Cremos de relevo o tema dado a dura, lamentável, e notória precariedade do serviço prestacional de saúde pública desenvolvidos no Brasil, e o desamparo da população pobre de um país que reconhece a sua pobreza no texto da própria Constituição quando diz no inciso III, do seu art. 3º, que é objetivo fundamental da República ―erradicar a pobreza e a marginalização e reduzir as desigualdades sociais e regionais

Adolescent parolee revocations.