More on crack cocaine at
tigma is of course a double-edged sword. It may well in the past have
deterred people from using crack. But that stigma also reduced access to
services. Some activists in the field, such as Mat Southwell, argued that
‘the demonisation of the drug and its users has fostered the belief that
crack cannot be managed.’ Offer empowerment and tools for control and
we could change behaviour went the argume nt: http://www.drugwise.org.uk/wp-
Others, such as Peter McDermott, writing around the same time challenged this
model and the prospects of ‘managed’ crack use for the majority of users:
So it will be interesting to see the extent to which the current cohort of asset-
rich crack users, unencumbered by the mythos of crack as an unmanageable drug
are, in fact, able to manage their crack use – or if it spirals out of control.
If, as I fear, we are starting to see an upsurge in crack use which sprawls beyond
a core demographic, services are going to have to get ready and, fast. In 2003/4,
when the government and the NTA saw growing levels of crack use as an issue,
resources were put in place, regions and agencies were encouraged to develop
stimulant strategies and some areas appointed lead workers to address the issue.
Although levels of crack use increased, the feared ‘crack epidemic’ never
materialised as envisaged and these strategies gradually got subsumed by other
agendas and strategies.
If, as I suspect, we are going to see a marked increase in crack presentations, the
useful aspects of these strategies need to be exhumed and brought up to date. We
also need to learn what didn’t work and not repeat these mistakes.
As there is currently no model of substitute prescribing for crack, some workers
feel disempowered and people with crack dependencies may feel that there is little
on offer for them. Services therefore need to ensure that through training and
resources, staff are empowered to respond confidently to people presenting with
Regionally, outreach, GP
liaison and arrest referral will
be useful in determining the
scale of the issue locally. As this
nascent crack using population
aren’t currently injecting or
heroin-using, they won’t
automatically have contact
with drug services via, for
example, needle exchange.
resources to address the needs
of crack smokers, polydrug
users (including crack and alcohol, use of opiates or benzos as comedown drugs)
and crack injectors need to be in place. Drug-related deaths strategies should also
address responses to critical incidents involving crack, including the need for rapid
ambulance attendance and CPR.
Services need to ensure that they have the capacity to deliver a rapidly accessible
service to clients in chaos, who may need numerous brief interventions over a short
period of time. Structured, evidence-based day programmes, craving management
interventions, and healthcare to address physical and mental health problems
stemming from crack use, need to be in place sooner rather than later.
It’s always risky pressing the button marked ‘crack problem’, as it’s been pushed
too often. But I’m probably more anxious about crack this time around than I have
ever been working in the field. I hope I’m wrong.
Kevin Flemen runs the drugs education and training initiative, KFx
June 2018 | drinkanddrugsnews | 7