Internet Access Monitor 3.9 [REPACK] Crack Cocaine
Smoking crack cocaine is a relatively neglected public health problem in Canada in comparison to injection drug use (IDU), despite indications that crack use in Canada is increasing. The Vancouver Injection Drug Users Study found that crack use in a group of injection drug users in Vancouver almost doubled from about 31% in 1997 to over 60% in 2004; and daily crack smoking in this population rose from
internet access monitor 3.9 crack cocaine
Canadian data also provides evidence of high prevalence of crack use among drug user populations. A recent surveillance report of 794 people who inject drugs across Canada indicated that 52.2% of the total sample had also used crack cocaine in the last 6 months . Another Canadian cohort of illicit opioid users in five cities indicated that 54.6% (371/679) of baseline participants had smoked crack in the 30 days prior to the survey. However, there was considerable regional variation, with crack use reported ranging from 86.2% in Vancouver to 2.4% in Quebec City . On the other hand, in a study of people who smoked crack in Vancouver only 39% of those who smoked crack also reported injecting drugs . In Canada, many services for people who use drugs are targeted to people who inject; therefore, people who only smoke crack may not be linked with appropriate health and social services.
Although harm reduction interventions such as needle/syringe distribution and a supervised injection site are available in the DTES neighborhood, the majority of evidence-based public health responses to problematic drug use in British Columbia (BC) are not tailored for people who smoke crack cocaine and their unique needs. Plastic mouthpieces, push sticks, and, recently, brass screens are provided by the provincial harm reduction program. However, glass stems are not currently available through this program .
Crack cocaine use is a growing concern in Canada with many associated harms. Yet, there is no clear understanding of the perception of harms related to the type of cocaine (powder cocaine versus crack cocaine) and mode of administration (snorting, smoking, and injecting) by people who use crack. The psychosocial determinants and factors related to crack cocaine initiation, continuation, and the trajectory of substance use by mode of administration have not been well identified either. To assist in developing appropriate services there is an urgent need to learn more through a qualitative study of people who smoke crack.
To this end, this study sought to investigate the lived experience of crack smokers, especially in comparison to injected cocaine and other drugs in the context of the DTES. This contributes to our still limited understanding of this population with the ultimate aim to provide health service providers and policy makers with information to better design, plan, and implement prevention programs at an individual and community level.
One of the most explicit examples of controlling chaos came from the subjective high of the drug itself. Smoked crack was described as more gradual in onset, especially when compared to the instantaneous rush of IV cocaine use. Similarly, the sustained drug effect is much more vivid when injecting than smoking.
Crack users do not associate smoking with an increase in risky behaviours as compared to injected cocaine, and in fact, associate injecting with more spontaneity. Specifically with respect to risky sexual practices, participants believe that smoking crack is an inhibitor of spontaneous sex, both genders agreeing that most men cannot achieve an erection and consider it a futile endeavor.
Despite the highly reclusive experience of crack smoking, some participants identified a supervised inhalation site as the most helpful strategy to assist with harm reduction. This was widely supported by all participants, with no participant disagreeing that this would be a beneficial strategy. This location would give users an indoor location to smoke, safe from harassment and police interference often experienced on the street, as well as worry about being disturbed. As well, they would have access to resources for health education and other social resources.
This study represents a novel application of two theoretical frameworks to illuminate the experiences of those who use crack. Drug use has been well studied; however, while a great deal of the literature assumes a measure of equivalence between injection and inhalation, we have found crack inhalation to be notably different from other methods of cocaine consumption.
A number of harm reduction strategies were identified by participants, both directly and by virtue of the obstacles to safer inhalation. Most notably, a supervised inhalation site was ubiquitously supported. According to DeBeck et al., 71% of surveyed crack smokers would use such a facility, and it could serve as a distribution site for safe inhalation supplies and a means to connect people who smoke crack cocaine to health and social service providers . Though men also suggested the benefit of a safe inhalation facility, women seemed especially emphatic when speaking of the risks surrounding the lack of safe space. Handlovsky et al.  also found housing and the concept of safe places to be a key determinant of harm-reduction in female crack smoking populations.
Similarly, users described various strategies for reducing crack use, largely by mitigating cravings with alcohol and cannabis. Beyond the health effects of reducing crack use, the agency exercised in rationing crack may be empowering and encouraging. A significant risk characteristic in crack smoking is the uncertainty surrounding drug quality and cutting agents. Employing initiatives aimed at improving quality and consistency of crack cocaine would allow for a much more predictable high and reduce the risk of immune compromise from levamisole.
For logistical reasons, the sample of study participants was recruited from individuals already using the two support service organizations. This poses a potential bias, as users connected to peer support agencies may represent a subset of drug users who have greater access to resources or are at a specific place in terms of their drug use trajectory. This may yield insight into why there is an abundance of previous injection use amongst study participants despite the claim that there is no clear escalation from one method to the other and that many new users begin by smoking crack. Additionally, the median age of our sample population was 47 years and may reflect a longer drug use career, implying higher chance of damaged veins, maturity, and a specific trajectory that is not representative of the greater crack smoking population. Were it feasible, a broader demographic range may reveal disparate trends between newer cocaine users and those who have been using it for several decades.
Smoking crack is, in fact, very different than other forms of cocaine in both subjective experience and impact on the lives of users. Employing a phenomenological framework yielded many insights into the lived experience of crack inhalation, but more importantly, contributed the qualitative dimension of meaning to previously documented observations regarding populations who smoke crack. Through this lens, we posit that for some, especially those with long-standing drug use careers, smoking crack may represent an increase in efforts to control chaos, and the observed polysubstance abuse is a mechanism for reducing overall crack consumption. The conclusions of this study are not intended to describe the entirety of crack using populations, but rather to highlight an alternative understanding that illustrates one of the many ways that some individuals view crack use as compared with injected cocaine and other drugs.
Race has been and remains inextricably involved in drug law enforcement, shaping the public perception of and response to the drug problem. A recent study in Seattle is illustrative. Although the majority of those who shared, sold, or transferred serious drugs in Seattle are white (indeed seventy percent of the general Seattle population is white), almost two-thirds (64.2%) of drug arrestees are black. The racially disproportionate drug arrests result from the police department's emphasis on the outdoor drug market in the racially diverse downtown area of the city, its lack of attention to other outdoor markets that are predominantly white, and its emphasis on crack. Three-quarters of the drug arrests were crack-related even though only an estimated one-third of the city's drug transactions involved crack. Whites constitute the majority of those who deliver methamphetamine, ecstasy, powder cocaine, and heroin in Seattle; blacks are the majority of those who deliver crack. Not surprisingly then, seventy-nine percent of those arrested on crack charges were black. The researchers could not find a "racially neutral" explanation for the police prioritization of the downtown drug markets and crack. The focus on crack offenders, for example, did not appear to be a function of the frequency of crack transactions compared to other drugs, public safety or public health concerns, crime rates, or citizen complaints. The researchers ultimately concluded that the Seattle Police Department's drug law enforcement efforts
The racial dynamics reflected in Seattle's current drug law enforcement priorities are long-standing and can be found across the country. Indeed, they provided the impetus for the "war on drugs" that began in the mid-1980s. Spearheaded by federal drug policy initiatives that significantly increased federal penalties for drug offenses and markedly increased federal funds for state anti-drug efforts, the drug war reflected the popularity of "tough on crime" policies emphasizing harsh punishments as the key to curbing drugs and restoring law and order in America. The drug of principal concern was crack cocaine, erroneously believed to be a drug used primarily by black Americans. The use of cocaine, primarily powder cocaine, had increased in the late 1970s and early 1980s, particularly among whites, but powder cocaine use did not provoke the "orgy of media and political attention" that occurred in the mid-1980s when a cheaper, smokable cocaine in the form of crack appeared.