has been growing in the EU about increasing use of cocaine;
however, actual trends in cocaine use and their consequences
across the EU are difficult to verify. Firstly, national data,
for example, from surveys or treatment centres do not reflect
changes in prevalence and problems that occur in geographic
patches within specific cities or changes which are concentrated
in particular social milieus. Secondly, current information
about cocaine often lacks clear, scientific definitions - for
example, information systems rarely distinguish cocaine 'base/crack'
from cocaine hydrochloride or between the different 'base/crack'
These different forms of cocaine have different
market features, different patterns of use, and contribute
to different problems, all of which need to be understood
for effective policy-making and demand reduction responses.
are cocaine and crack?
Cocaine is a stimulant drug extracted
from leaves of the Erythroxylon coca bush and
was developed to treat a wide variety of illnesses
in the mid-19th century. The chemical name of
the processed drug is cocaine hydrochloride and
it is generally sold 'on the street' as a crystalline
powder, known by a range of street names, such
as 'coke', 'snow' and 'Charlie'. It is generally
taken intranasally and less frequently dissolved
in water and injected.
Cocaine 'base/crack' is a street
term for cocaine that has been treated for use
by smoking or inhaling vapours to provide immediate
and intense effects. There are at least three
methods of 'base/crack' manufacture (1). One method
results in a clean product - by adding hot water
and ammonia or sodium bicarbonate and discarding
the excess liquid layer containing diluents.
Another method results in lower
cocaine concentration - by heating a paste of
cocaine and sodium bicarbonate in a microwave
with all diluents remaining in the final product.
Cocaine and 'base/crack' are usually distinguished
on the basis of physical appearance and purity
and further complicated because some cocaine 'base/crack'
is physically similar to cocaine hydrochloride.
patterns, and problems
Neither general population surveys
nor school surveys reveal a general increase in levels of
cocaine use in the EU. Only in the United Kingdom has there
been a confirmed increase in lifetime prevalence of cocaine
use among young adults aged 16 to 29. The Italian national
focal point reports that a range of sources in Italy has shown
that cocaine use is in second place to cannabis and higher
than amphetamine or ecstasy use.
A 1999 European schools survey shows that
experimental use of cocaine (lifetime prevalence) amongst
students aged 15 to16 remains low and is much lower than for
cannabis. In all the Member States included in the survey,
cocaine was reported to be less available than ecstasy although
there was considerable variation between countries. Cocaine
is reported to be easily available by the greatest percentages
of 15 to 16-year-olds in Ireland and the United Kingdom (21
% and 20 % respectively) and by the lowest percentage in Finland
(6 %). However, in all the EU countries surveyed, availability
of cocaine was considerably less than to the same age group
in the United States (2). Disapproval of cocaine use is very
high and more or less equal in strength throughout all the
participating countries and equals the levels of disapproval
applied to heroin.
Although nothing dramatic is
occurring in the general population at national level, there
are more marked levels of cocaine use in certain social settings.
Past research on cocaine users showed that firm boundaries
distinguish recreational users of cocaine powder (hydrochloride)
from problem 'base/crack' users, and cocaine injectors. A
wide range of recreational cocaine powder consumption patterns
is found among groups of people who frequent nightclubs and
dance settings and who use powder cocaine for social and utilitarian
purposes. These recreational users are distinct from the marginalised
groups, such as homeless young people, sex workers and problem
heroin users who smoke 'base/crack', or inject cocaine mixed
with heroin, in geographic patches within specific cities.
However, the boundary between powder cocaine and 'base/crack'
may be weakened by an emerging trend in cocaine smoking in
recreational and nightlife settings and in recent changes
in the market. Firstly, a new trend of mixing cocaine 'base/crack'
with tobacco in a 'joint' for smoking has been reported in
five Member States - the Netherlands, France, Greece, the
United Kingdom and Italy. Secondly, forensic science services
have reported that some cocaine 'base/crack' is physically
similar to cocaine powder (hydrochloride), which makes it
difficult for police and inexperienced users to make any distinction
(8). And thirdly, in the United Kingdom, there are indications
that cocaine 'base/crack' for smoking is being reconstructed
and commodified with new names such as 'rock' and 'stone'
and these serve to distinguish ready-to-smoke cocaine from
'base/crack' and push its image up-market and closer to powder
Prevalence of cocaine use is much higher
among subpopulations with high prevalence of other drug taking
than it is among the general population of young adults. Table
3 (Lifetime prevalence of cocaine in targeted user settings)
illustrates a substantial difference between the relatively
high lifetime prevalence of cocaine taking amongst young 'dance
goers/clubbers' and the much lower rates amongst the more
general population of young adults. The relatively high costs
of cocaine, combined with the short duration of its effects,
mitigate against regular recreational use and a high level
of disposable income may be a significant factor in regular
use. In recreational nightlife settings, there is a tendency
for some people to drink significantly more alcohol than usual
with cocaine. Cocaine serves to increase sociability by moderating
the undesirable effects of alcohol.
Between 1994 and 1999 the
number of clients seeking treatment for problems associated
with cocaine as their main drug - as a proportion of the total
clients seeking treatment - increased substantially in Spain
and the Netherlands. Germany, Greece and Italy also show a
proportional increase in cocaine treatment and Ireland showed
an increase until 1998.
The United Kingdom and the French
and Flemish-speaking parts of Belgium also reported an increase.
There is a lack of comparable research on cocaine users in
treatment in the EU and the proportional increases in clients
seeking help for cocaine problems may indicate a real increase
in cocaine problems but may also be the result of a reduction
in the number of clients seeking help for opiate problems
or a result of former opiate clients switching their main
drug problem to cocaine. The development of services that
are increasingly attractive to cocaine users may also influence
treatment figures. Some drug treatment services have reported
that, among clients in treatment for heroin dependence, there
has been an increase in cocaine use, particularly smoked as
'base/crack' or taken intravenously with heroin.
Figure 23 provides an example of the
localised increase in 'base/crack' users which are not reflected
at national level. In Frankfurt, the percentage of 'crack'
users amongst the total addicts registered by police increased
fourfold between 1996 and 1999.
Health service providers and cocaine users
rarely report fatalities, or negative physical health, as
a direct consequence of sniffing powder cocaine and because
recreational users tend to use cocaine alongside large amounts
of alcohol, or other drugs, it is difficult to identify the
causes of negative experiences. However, Luxembourg, the Netherlands,
and Italy report an increase in the number of drug fatalities
and Spain reports an increase of hospital emergencies in which
cocaine was implicated in addition to other drugs. Raised
awareness among hospital emergency staff of the potential
role of cocaine in cardiovascular disturbances could lead
to higher rates of reporting (4).
Severe health, social and psychological
problems associated with smoking cocaine 'base/crack' have
been identified, particularly among marginalised groups, such
as problem opiate users, homeless and other disadvantaged
youth, and female sex workers. The extent to which problems
are direct consequences of the use of this form of cocaine
per se, or the frequency and amount of its use, or of pre-existing
social/psychological and drug problems, is not clear.
In 1999, the number of cocaine
seizures increased markedly in Luxembourg and Sweden whilst
they decreased in Austria, Belgium and Denmark. Retail level
prices of cocaine reported range from EUR 24 per gram to EUR
170 with cities such as Amsterdam and Frankfurt at the lower
end and Member States such as Sweden and Finland at the higher.
In the United Kingdom and France, retail prices have decreased
but purity remained generally high between 55 and 70 % until
late 1999 when, in the United Kingdom, there was a sharp decline
in the mean purities of crack (10). Geographical variations
in price within Member States are marked. Small quantities
of cocaine, in parts of a gram or in the form of 'balls' or
'rocks', are available for less than EUR 15 in some cities,
particularly in those with open drug scenes and where the
cocaine concentrations may drop substantially (for example,
Frankfurt, Milan, Paris, London, Manchester and Liverpool).
Cocaine distribution takes place primarily through chains
of friends of friends but in some cities open dealing takes
place within recreational nightlife and street settings. House
dealing and delivery services have been greatly facilitated
by the increased convenience and protection (in the form of
anonymity) afforded to dealers by mobile telephones (4, 5,
Increased availability of ready-to-smoke
('base/crack') cocaine in a number of European cities (Amsterdam,
Rotterdam, London, Liverpool, Manchester, Frankfurt, Milan
and Paris) has been reported but methods for preparing it
(and the subsequent cocaine concentration levels, which can
rise to 100 %) vary and create confusion for drug information
systems, and the lack of scientific definition for street
terms such as 'crack' and 'base' pose problems for education
and prevention responses. At street level, cocaine may be
sold already mixed with heroin.
Spain, Belgium and the Netherlands are reported
to be major transit points for cocaine from Latin America
(Colombia, Brazil and Venezuela in particular) to the rest
of the EU. In 1999, six cocaine processing laboratories were
reported as having been dismantled in Spain and subsequent
increases in the wholesale price of cocaine in Spain have
been attributed to this.
projects and new approaches
The EU response to the increase
in cocaine and crack use has taken three main forms in the
field of demand reduction. During the 1990s, a small number
of cities developed specialised services to address the need
of primary cocaine problems and to target especially vulnerable
groups, such as Jugendberatung und Jugendhilfe e.V. in Frankfurt
and 'Take five' in Rotterdam. Some Member States report efforts
to adapt existing structures to meet the needs of problem
cocaine and crack users. For example, in France and the United
Kingdom multidisciplinary strategies are being developed among
involved professionals to collect and exchange information
about the needs of cocaine and crack users in order to develop
appropriate training and adapt existing models and treatment
services to provide the type of services which will be more
effective in meeting the needs of cocaine and 'crack' users.
Thirdly, some Member States have placed emphasis on the need
to address the criminality and health consequences of multiple
drug use in general.
Data on responses to cocaine problems from
the private sector are difficult to obtain but, nevertheless,
this sector is likely to play a significant role in the treatment
of more socially privileged cocaine problem users.
of treatment for cocaine problems
Few treatment responses have
been described in the reports from the Member States. However,
Germany and the Netherlands highlighted interventions specifically
designed for cocaine problems.
In Frankfurt, the youth organisation, Jugendberatung
und Jugendhilfe e.V. offers a treatment process targeted at
cocaine addiction, which is tailored to the needs of each
individual client. The initial 'crash phase', lasting a few
days, takes place either in an outpatient setting with psychosocial
support or as a detoxification process in a hospital. The
next phase involves six weeks of inpatient treatment where
the client follows a daily schedule, including group and individual
treatment sessions. The recovery phase, either in an outpatient
or inpatient setting, aims at re-establishing or improving
contacts and relations with family, relatives or partners.
In Rotterdam, 'Take five', a treatment programme
for heavy 'base/crack' users has been running since 1996.
The programme, administered by municipal health services,
operates like a low-threshold service. In the first phase,
street workers contact 'base/crack' users at different locations
such as drug dealing spots, user rooms or crisis centres.
In the second phase, the patient frequents a so-called 'time
out location' which offers support 24 hours a day with a general
practitioner and psychiatrists available on request. The aim
of the third phase is to stabilise the health of the client
and start rehabilitation. The Rotterdam experiment reports
that acupuncture is very popular among their clients for relaxation.
In the EU there is a market of recreational
drug consumers with disposable incomes who are either wary
of the unreliable content of 'ecstasy' tablets and the possibility
of associated acute and long-term health risks, or are jaded
with their past experiences of MDMA and its unpleasant early
to mid-week after effects. Research shows that, from the perspective
of recreational cocaine users, cocaine is considered more
predictable, versatile and unobtrusive than ecstasy and the
after effects of cocaine are considered less severe or unpleasant
and shorter-lived than the after effects of ecstasy or amphetamines
Research on cocaine users has identified
clear social distinctions and sharply separate subcultures
between users of cocaine powder (hydrochloride) and smokers
of 'base/crack' - but the boundaries may be called into question
by the recent changes in the market and an emerging trend
of smoking cocaine 'base/crack' mixed with
tobacco in 'joints' in recreational and nightlife settings.
The result of such changes may weaken the taboos against 'base/crack'
smoking, which have existed and which have been providing
informal controls to prevent diffusion of crack into mainstream
recreational drug culture. These signs of erosion in informal
social controls over the use of 'base/crack' cocaine make
early response all the more urgent.
A positive utilitarian, and 'up-market'
image of cocaine powder and perhaps also of cocaine 'base/crack',
combined with the existence of affluent potential consumers,
could lead to a diffusion of cocaine use in the EU, including
'base/crack'. This potential for diffusion should be treated
with caution as biased news coverage about 'base/crack' can
lead to the construction of myths about its use, which may
divert attention from persistent structural problems facing
some inner city areas (9).