Crack Cocaine Users

Crack cocaine first appeared in England in 1983, with its initial identification on All Saints Road in West London. At this point, the drug seemed mysterious and dangerous, shaped by the alarming US media reports reaching the UK. This potent, smokable form of cocaine quickly became notorious for its addictive properties and rapid, intense high. The drug's initial proliferation was closely monitored and heavily criminalised, setting the tone for its future in the UK.

From the outset, crack cocaine was entangled with the criminal justice system. The drug was perceived as a significant threat to public order, leading to stringent laws and aggressive policing tactics. The media and political discourse often portrayed crack users as inherently violent and criminal, reinforcing stereotypes and justifying harsh legal measures.

Racial stereotyping around crack cocaine has historically been damaging. During the 1980s and 1990s, the media and political discourse in the United States heavily associated crack cocaine use with African American communities. News outlets often depicted crack users and dealers as predominantly Black, focusing on urban areas while neglecting to report on crack use in suburban or white communities. The crack epidemic was portrayed as an urban, minority problem, despite evidence that crack use was prevalent across racial lines. These stereotypes contributed to the mass incarceration of African Americans and exacerbated racial inequalities in the criminal justice system.

While the stereotypical image of crack users has been that of violent criminals, recent trends in the UK reveal a broader demographic. Increasingly, individuals from various professions, including construction workers such as scaffolders and bricklayers, are seeking treatment for crack addiction. This shift highlights the widespread reach of the drug and challenges preconceived notions about its users.

The move from cocaine to crack among these professionals underscores the drug's potent addictive qualities and accessibility. Unlike cocaine, which is often associated with higher socioeconomic status, crack's deceptively lower cost and immediate high can make it more attractive to a wider range of users.

Traditionally, drug services in the UK have focused primarily on opiates, reflecting the historical prevalence of heroin dependency. However, the rising use of crack cocaine among various demographics has prompted a shift in focus. Services are increasingly adapting to address the needs of crack users, developing specialised programs and interventions, though these were cut back severely during the years of austerity.

In recent years, crack cocaine has made significant inroads into the opiate-using community. This dual use presents unique challenges for treatment and rehabilitation services. The number of people who used both opiates and crack has increased by 24% from 2016 to 2017 to 2019 to 2020. In the same period, the number of people who only used crack (and not opiates) rose by 19% and the number of people who used opiates but not crack decreased by 9%.

Obtaining accurate statistics on primary crack users is challenging because many individuals do not seek help from drug services, believing these services are primarily focused on opiate addiction. This perception results in underreporting and inadequate representation of crack users in data collected by the National Drug Treatment Monitoring System (NDTMS). Consequently, many primary crack users remain untracked, leading to gaps in understanding the full scope of crack cocaine use and its impact.

Effective treatment for crack dependency requires tailored approaches that consider the drug's unique effects and the diverse backgrounds of its users. Integrating crack-specific psycho-social treatments into broader drug rehabilitation services is a necessary step toward more comprehensive and effective support. Harm reduction strategies and better access to mental health services have also shown promise in mitigating the adverse effects of crack dependency.

The increase in crack cocaine use has been linked to various social and economic factors. Areas with higher levels of unemployment, poverty, and social inequality tend to report higher rates of substance use. Regions with higher rates of economic deprivation, such as the North East, report the highest rates of crack use in England.

The SIPP (Safe Inhalation Pipe Provision) study is a mixed-methods evaluation aiming to reduce health harms and enhance service engagement among crack cocaine users in England. The intervention includes distributing safe inhalation crack kits, providing peer-to-peer harm reduction information, and training service providers through an e-learning module. This project, supported by local police forces and various community partners, seeks to inform legislative review and improve harm reduction services for this marginalised population.