Cocaine in the UK
Background to IDMU Surveys
For this paper, data from surveys between 1997 and 2008 have been consolidated into a single data file and analysed to monitor long term trends, with specific emphasis on changes in the demographics of cocaine users, and differences in usage and attitudes between different socioeconomic groups.
Cocaine & Crack
General comments on cocaine
Cocaine is a stimulant drug with effects similar to amphetamine, but which are generally of shorter duration. Cocaine stimulates the release of noradrenalin from synaptic terminals, and inhibits the reuptake of noradrenalin, dopamine and serotonin, thus prolonging the effects of these neurotransmitters. It has been described as “the most powerful reinforcing drug known” . The prevalence of cocaine use in the UK has never escalated to US levels, quite probably due to the availability of cheap amphetamine powders, which produce similar effects lasting several hours.
While the general view is that physical dependence is not normally found, there can be a powerful psychological dependence such that a heavy user will fall from a euphoric state to a severe depression within a relatively short time. Repeating the dose can stave off the depression. There is evidence that tolerance develops to the desired effects, such that an increased dose is required to produce the same psychological effect. This, combined with the depression caused by abstinence, can lead the user to consume ever larger amounts, leading the a substantial risk of overdose and cardiac failure , , or to a paranoid psychotic state, mimicking some forms of schizophrenia, if the user has been on an excessive cocaine "binge" for several days .
There are few quantitative or statistical studies specifically investigating the amounts of cocaine used by individuals. Most studies are of small samples of users, many of whom have already sought counselling or treatment for their dependency. Larger scale UK studies of the general population or of poly-drug users , , , have shown that although daily use is not the norm, and occasional or recreational use is common, the heaviest use tends to occur in binges lasting up to several days, followed by a period of abstinence and recuperation. A heavy user who indulges in a binge every weekend could consume a prodigious amount.
When smoked, the cocaine vapourises and may be inhaled by the user, either in the form of a cigarette, pipe, or by inhaling fumes from a heated rock by a similar method to that of heroin users who "chase the dragon". I have witnessed cocaine users (in Berlin during 1983) smoking cannabis and freebase cocaine as a “cocktail” in a rolled cigarette, a practice which has also been reported by Arif , Bean , Negrette and Siegel . Smoking cocaine in cannabis cigarettes is not an efficient method of delivery. Much cocaine is wasted by this method, as it may be oxidised (burned), lost in the side smoke of a cigarette, or may condense out on to the cooler surfaces of a cardboard filter or a pipe. Siegel indicates that only 5% of available freebase (crack) cocaine is normally obtained from smoke in tobacco-based cigarettes or in pipe, although techniques may improve this yield. This effectively means more cocaine has to be smoked to deliver the same “high” as snorting or intravenous use.
There is some debate as to whether crack cocaine produces a physical addiction. Stutman the Drug Enforcement administration official who first warned the UK about the dangers of crack cocaine, stated that 75% of people who tried it three times become addicted. Few experts would now support that view.
As the effects of crack cocaine are so transitory, usually lasting approximately 10 minutes, the temptation to repeat the dose on a regular basis can be great. A common pattern of use is the binge, where the user maintains the stimulation over a period of 24-48 hours, or longer in some cases, followed by exhaustion and a prolonged sleep. During a binge, all the available stimulant can be used in a single session.
Literature Review – Cocaine & Crack Usage
Note that this review is now dated, there is insufficient time available to produce an updated review at the present time.
The Institute for the Study of Drug Dependence (now Drugscope), in their audit of Drug Misuse in 1992 stated the following in respect of cocaine and crack:
"The typical weekend (cocaine) users might sniff 1/4 gram over a weekend, heavy users might consume one or two gr5ams a day."
"Crack ... is available in major cities at around £25 a rock weighing 150mg and 88% pure."
"Users can get through several grams at a stretch."
"...doses may have to be repeated as often as every 20 minutes."
In a study of individual crack users in Nottingham , respondents describe the compulsive nature of crack use:
"if the rock is there I can't leave it",
and the frequently solitary nature of use
I take crack alone now, I prefer it because I know there's not going to be any hassle. I want more and I don't want to share".
A 1989 study of crack use in Liverpool reports daily crack users taking an average of 11 “hits” per day (range 1-30), spending an average £118 per day (range £30 to £300). A report of the Scottish Cocaine Research Group contains little quantitative data, although it is a relatively large sample. The most extreme category of use referred to more than 100mg/day, which was reported by 49% of users during "heaviest period". As 100mg is less than one rock of crack cocaine, the study is of little value in assessing the consumption of heavy users.
A national study involving anonymous questionnaires completed by 412 cocaine and crack users compared the results from respondents recruited from community drugs teams and voluntary agencies with users recruited by researchers in the wider community. When those who had used cocaine "in the last four weeks" were asked to estimate their consumption on an "average day" researchers found that 57% of agency clients and 31% of the community sample reported using over one gram per day.
A survey based on interviews with 150 cocaine users not in contact with law enforcement or treatment , found that the overall average amount consumed was 1.2g per day. The 60 crack smokers studied (40%) averaged 1.01g per day. Only 3% of injectors of cocaine were black, compared to 16% of snorters and 23% of smokers of the drug. 41% of the cocaine smokers were in employment, compared to 63% of snorters and 22% of injectors. In a personal Communication, Dr John Marks, consultant psychiatrist and former director of the Widnes drug dependency clinic, stated that crack cocaine users who were referred to the clinic for maintenance prescriptions were prescribed from 200mg to 1000mg (1g) per day free base cocaine.
IDMU Surveys – Cocaine & Crack Usage
Initiation to Cocaine/Crack