Eliseu Labigalini Jr, Lucio Ribeiro Rodrigues, Dartiu Xavier Da Silveira
01 October 1999
This study ensued from clinical observations based on spontaneous accounts by crack abusers undergoing their first psychiatric assessment, where they reported using cannabis in an attempt to ease their own withdrawal symptoms.
In the city of São Paulo, the culture of crack use has undergone considerable changes over these 11 years since it was first described. The sociodemographic profile of the users is practically the same and most use is still compulsive, with significant physical, moral and social impairment among them. Sole use of crack has overwhelmingly been replaced by associations between crack and other drugs, thus characterizing users in the city of São Paulo as multiple drug users.
An ethnographic study of women and drug use in inner city neighborhoods in Kingston, Jamaica, revealed that cannabis is commonly used in conjunction with crack cocaine to minimize the undesirable effects of crack pipe smoking, specifically paranoia and weight loss.
The cocaine base, or “pasta”, may be seen as a type of South American crack. Its obligatory method of administration is smoking. A primary condition of the “pasta” smoker is compulsive drug-search behavior and addiction to cocaine base destroys emotional and mental balance. Socio-economic maladjustment is the norm amongst “pasta” addicts. Since 1984 I have recommended the chewing of the coca leaf, between 100 to 200 grams of coca leaf per week for the treatment of cocaine dependence.
This fact sheet explains the Safer Crack Use Program of the Public Health Department of Toronto (Canada). In Toronto, a range of community-based, government and institutional agencies deliver harm reduction services. As with other harm reduction measures, there is no evidence that the distribution of safer crack use kits encourages drug use. Only people who are already using crack cocaine participate in the Safer Crack Use Program.
A number of public health departments and community organizations in Canada distribute safer crack use kits to people who use crack cocaine. The kits typically include mouthpieces, glass stems and screens, as well as condoms and referral information for other health and support services. This document outlines why such health programs are needed and answers a number of legal questions related to the distribution of safer crack use kits.
Clinical observations and scientific evidence - The use of some drugs in Chile remains silenced in official discourses, making it important to clinically observe the various ways those drugs requiring more attention appear, and which are not seen as a priority in mental health. Specifically, this is the case with cocaine paste, widely used by people living in poverty.
Based on two studies carried out in the cities of Buenos Aires and Montevideo, this report examines the origin, characteristics and impact of the explosive increase in cocaine base paste in urban areas. It also highlights the variety of products consumed in these cities and the substance known as crack that is consumed in Brazilian cities. The Brazilian experience with this consumption could serve as an example and a lesson for the Southern Cone.
Jean-Paul Grund, Philip Coffin, Marie Jauffret-Roustide, Minke Dijkstra, Dick de Bruin, Peter Blanken
01 April 2010
Harm reduction programmes targeting stimulants like cocaine and (meth)amphetamines in several countries have shown positive results. However, these programmes are limited to Australia and North America. As the effectiveness of pharmacological and psychosocial interventions for stimulant users is limited, interventions to stabilise and minimise the negative consequences of ongoing methamphetamine use are of paramount importance. A wide range of health and social problems associated with stimulant use are largely unaddressed by current services.
The mayor of Bogota has recently proposed a pilot scheme with crack cocaine addicts to explore the substitution of crack made of cocaine base paste (or bazuco as it is called in Colombia) by marijuana. The substitution treatment plan will include 15 problematic users from the marginalized Bronx area who are already receiving health assistance of the CAMAD operating in that sector of the city. The treatment will last approximately eight months, after which the results will be evaluated.
Mascha Nuijten, Peter Blanken, Wim van den Brink, Vincent Hendriks
18 August 2011
Cocaine, particularly in its base form ('crack'), has become one of the drugs of most concern in the Netherlands, being associated with a wide range of medical, psychiatric and social problems for the individual, and with significant public order consequences for society. Available treatment options for cocaine dependent users are limited, and a substantial part of the cocaine dependent population is not reached by the addiction treatment system.
James Shearer, John Sherman, Alex Wodak, Ingrid van Beek
31 May 2002
The illicit use of amphetamines continues to be a growing problem in many countries around the world, yet treatment responses remain in need of further development. This is particularly true with regards to pharmacotherapy for amphetamine dependence. In this Harm Reduction Digest four authors who bring together considerable research and clinical experience in this area describe the nature of amphetamine-related problems and consider the role of amphetamine agonists in substitution therapy for amphetamine dependence.
In 2004, a team comprised of researchers and service providers launched the Safer Crack Use, Outreach, Research and Education (SCORE) project in the Downtown Eastside of Vancouver, British Columbia, Canada. The project was aimed at developing a better understanding of the harms associated with crack cocaine smoking and determining the feasibility of introducing specific harm reduction strategies.
This paper examined whether use of crack cocaine has become a risk factor for HIV infection. Smoking of crack cocaine was found to be an independent risk factor for HIV seroconversion among injection drug users. This finding points to the urgent need for evidence-based public health initiatives targeted at people who smoke crack cocaine. Innovative interventions that have the potential to reduce HIV transmission in this population, including the distribution of safer crack kits and medically supervised inhalation rooms, need to be evaluated.
Andrew Ivsins, Eric Roth, Nadine Nakamura, Mel Krajden, Benedikt Fischer
30 June 2011
Crack use is prevalent amongst street drug users in Canadian cities, and associated with severe drug use, health and social problems. Whilst few targeted interventions are available for crack use, the common use and sharing of hazardous makeshift paraphernalia are a key concern, as these risks may be associated with oral injury and blood-borne virus (BBV) transmission amongst users. Recently, distribution programmes of so-called 'safer crack use kits' (SCUKs) have been initiated in select Canadian cities, primarily to reduce the use of unsafe materials and paraphernalia sharing amongst crack users. This study explored uptake and benefits of, barriers to, and possible improvements to two recently implemented SCUK distribution programme in Victoria, Canada.
Philippe Lucas, Amanda Reiman, Mitch Earleywine, Stephanie K. McGowan, Megan Oleson, Michael P. Coward, Brian Thomas
19 November 2012
This article examines the subjective impact of medical cannabis on the use of both licit and illicit substances via self-report from 404 medical cannabis patients recruited from four dispensaries in British Columbia, Canada. The aim of this study is to examine a phenomenon called substitution effect, in which the use of one product or substance is influenced by the use or availability of another.
The aim of this report is to provide key findings related to the SCORE project. It is our hope that the insights that we have gained may be of benefit to others engaged in similar initiatives and to ultimately improve the health of individuals who use crack. The SCORE project (Safer Crack Outreach, Research, and Education) grew out of the vision and hard work of the Safer Crack Use Coalition of Vancouver. Before the SCORE Project was funded, this coalition devoted much energy into raising awareness regarding the insufficient resources aimed at preventing the harms related to crack use.
Coca tea has been used for the treatment of cocaine dependence. Two previous reports found that treatment that includes coca tea can be successful in controlling relapse to cocaine dependence. In the current study, coca tea plus counseling was used to treat cocaine dependence in 23 cocaine-addicted coca paste smokers seeking treatment at an outpatient clinic in Lima, Peru.
Marie Longo, Wendy Wickes, Matthew Smout, Sonia Harrison, Sharon Cahill, Jason M. White
18 June 2009
This study tested the impact of a long-acting form of amphetamine as medication to help control dependent use of the closely allied stimulant, methamphetamine. Prescribed usually for the treatment of pathological sleepiness or attention deficit/hyperactivity disorder, effects of the amphetamine tablets prescribed in the study take several hours longer to emerge than normal amphetamine and last three to six hours longer, giving it a 'smoothing' profile similar to methadone for heroin users; non-rapid onset make it less intensely pleasurable, and longer duration suits it to once-daily administration.
Leslie A. Malchy, Vicky Bungay, Joy L. Johnson, Jane Buxton
30 April 2011
Crack smoking has increased in Vancouver despite the harms associated with its use. Many people who smoke crack share their equipment, thereby increasing their risk for infectious disease. This project explored the effects of outreach distribution of "safer crack kits" on smoking practices. While kit distribution made safer use items more accessible, its impact on safer use practice was limited. Our findings highlight the need for targeted distribution of safer use items. Future research should explore the dynamics of unsafe crack smoking practices and ways to leverage safer use messaging.