‘What a pity!’ – Exploring the use of ‘pitilho’ as harm reduction among crack users in Salvador, Brazil

Aims: The aim of this study was to explore the use of ‘pitilho’ (the co-smoking of crack and marijuana in a cigarette-like form) among crack users in Salvador, Brazil as a potential harm reduction measure.Methods: In-depth interviews were conducted with two outreach workers who frequently encountered the use of ‘pitilho’ as part of their community outreach programme work, as well as four ‘pitilho’ users who were clients of the programme. Daily field notes were also collected. Transcribed data were analysed for common reasons for ‘pitilho’ use.Findings: Several key reasons crack users have adopted the ‘pitilho’ as a harm reduction tool were uncovered: it was reported to reduce the negative pharmaco-behavioural and physical effects of crack use, is more economical, provides users with better control over their behaviours, and decreases their vulnerability for violence and betters their sub-cultural position.Conclusions: ‘Pitilho’ may offer several relevant short-term benefits to users and therefore may constitute a potentially important ‘harm reduction’ tool in an area where little other targeted prevention measures exist. Our exploratory data need to be investigated in depth by appropriate and rigorous methods.