Drink and Drugs News DDN 1806 - Page 6

cover story CRACKS IN THE MIRROR Could a recent growth in crack cocaine use indicate its move to social acceptability – and how should we respond? Kevin Flemen examines the situation tigma-driven barriers between powder cocaine and crack may be breaking down. Increased availability of crack thanks to ‘county lines’, combined with increased demand and reduced stigma, could see a big upsurge in crack use. But are drug services ready for a growing population of dependent stimulant users? S ‘They weren’t finding their coke use so rewarding anymore… so they’ve moved in to smoking crack.’ This observation by a participant in a recent stimulant training day echoed comments that have been coming up more frequently of late, and it made me very anxious. The users in question had been trades or construction workers in the Telford area. Historically this would have been a cohort who found powder cocaine highly acceptable but would have viewed crack cocaine less favourably. That they were migrating from cocaine powder to crack suggested not just changes in availability of crack, but also changes in attitude. Crack cocaine has, generally, not enjoyed the same kudos and acceptance as cocaine powder. The stereotypes and assumptions – a highly addictive, ‘ghetto’ drug associated with crime, impoverishment and squalor – were on the one hand highly stigmatising. But on the other they acted as a buffer, as many people viewed cocaine powder as ‘acceptable’ but crack cocaine as a ‘dirty’, unacceptable drug. Granted, there had always been those who didn’t subscribe to this simplistic view and there were a fair few North London types who used to drift in to Dalston to sample the dubious pleasures of a crack house before heading back to less edgy areas. There were numerous ‘Professionals Binge on Crack’ type stories in the media 20 years ago (The Guardian, 13 November 2000), but this didn’t translate to more widespread usage. The drugs field too had more than a few of its own workers who believed that the demonisation of crack was unwarranted and that they were more than capable of handling crack or making their own freebase. Some fared OK, others less so. These exceptions aside, the prevailing view of crack as a ‘bad’ drug would, once upon a time, have meant that the Telford trades workers mentioned earlier would generally not have gone near crack. ‘My brother works on a construction site and he’s in his forties. He’s just walked off a job because at the end of the day the rest of the crew are all sitting in the cabin smoking crack.’ 6 | drinkanddrugsnews | June 2018 On all recent courses I’ve been exploring the issue, and repeatedly, similar examples have emerged – established white working-class trades and construction workers who, finding powder cocaine less rewarding, are putting down the tube and picking up the pipe. But subsequent cases suggest that the issue is more widespread. ‘Some of my “friends” have been smoking rocks too. They were finding that their noses were hurting too much from cocaine, so switched to rocks.’ ‘All the cool and edgy kids are doing it. They all go off to a room at the end of the evening or at parties and are smoking rocks. They’d been dipping cigarettes in cocaine and it moved from there.’ The first of these examples was a recently graduated social work student in Staffordshire, and the second related to the artist community in increasingly-gentrified Hackney Wick. They highlighted to me that the increased access and acceptability of crack was resulting in take-up across a range of different social settings. Availability of crack has increased at least in part because of the ‘county lines’ phenomenon, and we are seeing crack markets emerging in areas where it had previously not been a significant issue. These markets had, however, often piggy- backed onto existing opiate markets – expanding market share by offering two-for- one deals or mixed ‘any five for £30’ offers, where the buyer could have four rocks and a bag of heroin for the comedown, or three bags of heroin for an opiate habit and two rocks as a ‘treat’. This expansion into existing heroin markets is, of course, in itself problematic. Experience says that the stability and health of heroin users often markedly deteriorates when they add crack to their repertoire. Treatment requirements change dramatically and engagement can be more difficult. But my tacit assumption was that the size of the market for crack was limited by the size of the heroin market it was latching on to. The stigma relating to crack in the past had offered a degree of protection. What, then, if that stigma has been significantly eroded? What if even just 10-15 per cent of our existing cocaine users start to migrate to crack use? How big would that population be, and how well set up are services to identify and respond to it? www.drinkanddrugsnews.com