COCAINE
There were 1,118 deaths involving cocaine registered in 2023 , which was 30.5 % higher than the previous year ( 857 deaths ) and nearly ten times higher than in 2011 ( 112 deaths ). In 2023 , males accounted for 79.2 % of the deaths involving cocaine ( 886 males compared with 232 females ). Cocaine has consistently been the second most-used drug , after cannabis , in England and Wales over the past decade . Office for National Statistics
choose to join a four-session rolling group programme with other people using the same or similar substances to enhance social support , and explore future mutual aid options if helpful .
This four-session rolling group is facilitated by recovery workers and peer mentors , trained and supervised in use of the intervention . It aligns with NICE guidance in its use of cognitive behavioural therapy principles , motivational interviewing and
Public health campaigns must start from a point of compassion . We ’ ve learnt ... that the most effective approaches are developed in conjunction with people who use drugs .
in the understanding that most people who use cocaine will experience dysphoria . It also uses elements of acceptance and commitment therapy to continue focus on core values as a motivator for continued change .
For some people , use of RECLAIM and engagement with mutual aid – such as SMART Recovery – will be enough to begin to make the desired changes . For others , particularly those with co-occurring mental health difficulties , a longer period of treatment – including groups such as recovery skills and mindfulness-based relapse prevention – would be helpful in terms of sustaining changes in conjunction with work on increasing social support and behavioural activation .
POSITIVE CHANGE Contingency management is the reinforcement of positive behavioural change – such as attendance at appointments or negative urine tests – through a reward such as a voucher payment . Internationally , there ’ s strong evidence for the effectiveness of contingency management in the treatment of cocaine use . However , it ’ s very rarely used .
Where it is used , it ’ s mainly related to physical health interventions and mostly targeted at people using opiates . Barriers to use of contingency management include funding , the administrative burden , and sustainability . Politically , it ’ s not uncontroversial ; however , the increased rates of cocaine use and cocaine related deaths suggest that this is an approach worthy of consideration by government and the sector .
There ’ s a lot we can offer for people using cocaine , including relevant , targeted information which is adapted for different age groups so the decisions people make are based on having the full facts . Cocaine isn ’ t typically associated with drugrelated deaths in the popular imagination , and younger people are also less likely to be aware of their mortality .
JUST A REGULAR NIGHT OUT
Coke ’ s become as socially acceptable as alco hol in my respectable community , says Joanna
When I was at uni I used to find coke very seedy and wouldn ’ t touch it . Plenty of others did it , off mirrors , but I didn ’ t join in . I couldn ’ t do it .
A few years later I was in a pub in London and one of my friends offered me some . I was pissed at the time and I can ’ t really remember how it felt . But I did it again and it started to become very moorish , especially when drinking . In fact I only ever did it when I was drinking , and it still goes hand in hand with drinking for me . I think if I started doing it when I ’ m not drinking it ’ d be time to have a word with myself .
I tend to set parameters with my husband and friends before we start , including a cut-off time for bed so we don ’ t stay up all night . I used to feel bad staying up late and found it hard to function the next day through lack of sleep . Despite our best intentions it doesn ’ t always happen and we can stay up too late – but sleep has become more important as we ’ ve got older . The thing is , I feel worse after a night of just alcohol , and the coke stops you getting so drunk .
I don ’ t do very much coke compared to other friends and can make it last all night . If someone offers me more , I take what I need and give the rest back . It gives me a feeling of wellbeing and confidence . Other people might say it makes me chat shit ! But it makes me feel good .
Everyone ’ s on it . I know so many people that do it and it ’ s become very normalised – ‘ oh yeah , it ’ s just coke ’. It ’ s become much more socially acceptable . And it ’ s very easy to get hold of – it usually turns up in less than ten minutes .
REDUCING HARMS We need to support people to start considering their options with regards to how they can use less cocaine , or use it more safely . Experts have called for a public health campaign to alert people to the risks of the drug , but there is evidence to suggest that ‘ scare tactics ’ simply don ’ t work in changing behaviour .
In one area where Turning Point currently operates , the local police proposed a campaign that linked cocaine use to significant criminal activity , such as domestic abuse , child trafficking or gangs . We supported the police to realign this messaging to focus on reducing harms and increasing understanding of possible health impacts . As providers , it ’ s important that we work with our system partners on the evidence base for behaviour change .
Public health campaigns must start from a point of compassion . We ’ ve learnt from work we have done around promoting naloxone and safer injecting equipment that the most effective approaches are developed in conjunction with people who use drugs .
The 30 per cent increase in cocaine deaths is alarming in itself , but a further consideration for the sector is the change in the opiate market and the possibility that this could also happen within the cocaine supply . This would expedite the rising deaths , and further highlight the need for the sector to respond .
Natalie Travis is national head of service at Turning Point
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