Brazil has the third largest prison population in the world. The number of people incarcerated for drug-related offences tripled in the country after 2006 after a new law was brought in which meant people could be imprisoned for possessing even a small amount of drugs. Impoverished and Black communities have been disproportionately targeted by this law. It also carries a huge financial toll: over 205,000 people were incarcerated for drug-related offences during the first half of 2024, at a cost of at least USD 7.9 million per month.

In São Paulo, punitive policies were proving so ineffective at reducing drug use and associated crime that the decision was made to shift to a health and social-based approach to drug use. The De Braços Abertos (Open Arms) programme opened in January 2014 in an area of São Paulo known as Cracolandia (Crackland) due to high levels of crack use among its residents. De Braços Abertos provided people with daily meals, housing and employment assistance, comprehensive healthcare, including harm reduction, and support to reconnect with families and communities. The programme made a significant difference to individual lives, communities and public health.

After two years, 84% of participants were receiving health treatments, 88% had reduced their crack consumption, 72% had gained employment, 52% had reconnected with family and crime had reduced. A change in mayor led to the programme being closed in 2017. Since then, the number of people in prison has increased, as has the number of people killed or injured during police proceedings and violence against minority and marginalised communities.