Drink and Drugs News DDN 1806 - Page 7

More on crack cocaine at www.drinkanddrugsnews.com 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- content/uploads/More-than-a-pipe-dream.pdf 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: http://www.drugwise.org.uk/wp-content/uploads/Crack-harm-reduction.pdf 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 S www.drinkanddrugsnews.com crack dependency. 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. Harm reduction interventions, including 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