Criminal justice involvement of crack cocaine users in the city of Rio de Janeiro and Greater Metropolitan Area: Implications for public health and the public security agenda

BackgroundThe international literature has expressed different and sometimes contrasting perspectives when addressing criminal involvement by crack cocaine users, highlighting psychopharmacological aspects, the cycles of craving and pressing economic need, and the interplay with overall deprivation and structural violence. The current study aims to identify variables associated with the arrest and imprisonment of regular crack cocaine users.MethodsInterviewees were recruited from open drug scenes in the city of Rio de Janeiro and Greater Metropolitan Area from September 2011 to June 2013. Multilevel logistic regression models were fitted to the data.ResultsMost of the recruited crack cocaine users were male (78.2% [95%CI: 76.3–79.4]), 18–30 years old (64.7% [95%CI: 62.5–66.2]), non-white (92.9% [95%CI: 91.2–93.4]), single (68.9% [95%CI: 66.8–70.3]), and with 0–7 years of schooling (70.6% [95%CI: 68.5–71.9]). Factors independently associated with arrest were history of inpatient addiction treatment (adjOR 4.31 [95%CI: 1.70–11.32]); male gender (adjOR 2.05 [95%CI: 1.40–3.04); polydrug use (adjOR 1.82 [95%CI: 1.32–2.51]); and 0 to 7 years of schooling (adjOR 1.64 [95%CI: 1.17–2.32]). As for the outcome variable lifetime history of incarceration, the independently associated factors were: male gender (adjOR 2.47 [95%CI: 1.74–3.55]) and longer use of crack cocaine and related substances (e.g., free base and local varieties/denominations of coca products) (adjOR 1.05 [95%CI: 1.01–1.10]).ConclusionThe study’s findings support the use of comprehensive multisector interventions, integrating health promotion and mental health rehabilitation, access to quality education, and management of combined/concomitant use of different substances to reduce and/or prevent criminal involvement by individuals that use crack cocaine and other substances, as well as to prevent/manage relapse.     

Sexual Risk and HIV Infection Among Drug Users in New York City: A Pilot Study

Measures of sexual health were assessed during 2008–2009 in a New York City sample of 102 injection and noninjection users of heroin, cocaine, or crack. There was considerable overlap and transitioning between crack smoking and injecting. Crack users were also significantly more likely to be gay, lesbian, or bisexual than other drug users. In multivariate analysis, HIV infection was independently associated with crack use and with being gay or bisexual. In New York City, HIV prevention for drug users has focused on syringe access, safe injection, and drug user treatment, but further progress in HIV control will require strategies to address sexual health among people who use drugs. The study's limitations are noted.     

Marijuana: Your Legal Rights

Abstract

This article offers a perspective on the use of volatilized alkaloidal cocaine in its free base and crack forms and on the pulmonary consequences of such use. The inhalational route of administration of free base and crack cocaine exposes the lung to their combustion products, raising concern about possible adverse pulmonary effects. A brief historical review of cocaine and its methods of use precedes the presentation of data concerning current modes and patterns of use and some pulmonary complications of crack and free base use. Results from a systematic study of a large sample of cocaine users document a high frequency of occurrence of acute respiratory symptoms in temporal association with cocaine smoking. No relationship was detected between the prevalence of acute pulmonary symptoms and identifiable aspects of techniques of cocaine administration. These results suggest that the respiratory consequences of alkaloidal cocaine are most likely attributable to the inhaled cocaine itself, rather than to variable characteristics of usage.     

Epidemiological estimates of risk in the process of becoming dependent upon cocaine: cocaine hydrochloride powder versus crack cocaine

Rationale To estimate the risk of experiencing clinical features of cocaine dependence within 1–2 years of starting cocaine use, and to examine whether crack smoking might increase this risk.Methods A national sample of recent-onset cocaine users was identified within public data files of the National Household Surveys on Drug Abuse (NHSDA) for the years 1995 through 1998. The sample included 572 recent-onset users of cocaine HCl powder but not crack, and 190 recent-onset users of crack, some of whom had also started use of cocaine powder no more than 23 months prior to assessment. A separate group of 93 recent-onset crack users was identified; this comparison group had started using cocaine HCl powder 2+ years before assessment. Cocaine dependence was assessed via seven standardized questions about clinical features experienced within 12 months of assessment, such as feeling unable to cut down. Multivariate response regressions were used to evaluate crack-associated excess risk and clinical profiles of cocaine dependence.Results Among persons who had recently started to use cocaine HCl powder but not crack cocaine, about 5–12% experienced clinical features of cocaine dependence. Most clinical features occurred 2–3 times more often among crack smoking users as compared to those using powder only, even with statistical adjustment for frequency of cocaine use (P<0.01). This crack-associated excess risk is more prominent for several clinical features of cocaine dependence, including tolerance associated with cocaine use and narrowed behavioral repertoire attributed to cocaine use.Conclusions This new epidemiological evidence suggests that crack-smoking may increase risk of cocaine dependence once cocaine use starts, but we cannot rule out the possibility that crack users start out with a greater susceptibility to become cocaine dependent.     

A profile of adolescent cocaine use in Northern Ireland

BackgroundThe image of cocaine as a ‘party’ drug used by more affluent members of society has begun to change as the levels of use of the drug rise amongst school aged young people.MethodsCocaine use patterns amongst young people aged 13–16 years who were participating in the Belfast Youth Development Study, a longitudinal study of adolescent drug use was explored. Data was collected through an annual datasweep in participating schools. This paper includes data collected in years 3, 4 and 5 of the study.ResultsThe results show higher levels of cocaine use amongst this age group than reported in much of the existing harm reduction literature. Lifetime use was 3.8% at age 13–14 years, rising to 7.5% at 15–16 years. The profile indicated that adolescent cocaine users were more likely to be female, live in disrupted families and experience social deprivation which is similar to existing adolescent drug use profiles. There was also some evidence of experimental cocaine use amongst the sample.ConclusionsThese findings provide further evidence for the development of age appropriate school focused harm reduction initiatives and continued monitoring of contemporary trends of use of cocaine amongst school aged young people.     

A Qualitative Study of the Purchasing and Distribution Patterns of Cocaine and Crack Users in England and Wales

This paper presents primarily ethnographic data on the evolution of the cocaine and crack drug scene in Britain between 1990 and 1992. The introduction and marketing of crack as a new commodity has led to distinct market outlets and altered the shape and patterns of the distribution of cocaine. We noted great variety in purchasing patterns, dependent upon availability, market knowledge and the profile of individuals and groups of users. Friends were important contacts for obtaining both cocaine and crack. Crack was more commonly bought from dealers and from street-scenes than was cocaine, a trend which increased during the study period. Emerging supply outlets were built on the existing structure of the irregular or illicit economy.

We identified categories for the purchasing and selling of cocaine and crack based on specific settings (or “arenas”). These were characterised in terms of (heir accessibility to potential drug purchasers and would often be interlinked. We developed a typology of purchasing and selling arenas according to a number of pertinent factors, such as: access, activities permitted, and drug use clientele.

The existence of distinct markets and arenas for purchasing suggests that cocaine and crack use is becoming established amongst broader ranging groups of drug users than had previously been the case. We need to develop targeted interventions that are informed by ethnographic research which highlights the nuances and profiles of specific user groups and drug markets.     

Baseline Neurocognitive Profiles Differentiate Abstainers and Non-Abstainers in a Cocaine Clinical Trial

ABSTRACT

Previous studies have shown that cocaine users have higher levels of impulsivity and impaired decision making; however, few have examined these factors as predictors of treatment success. We obtained baseline neurocognitive measures from 75 cocaine-dependent individuals participating in a 12-week clinical trial targeting impulsivity with behavioral therapies and pharmacotherapy. Participants treated with citalopram had higher cocaine abstinence rates compared to placebo-treated participants. The aim of this secondary analysis study was to determine whether profiles of performance on neurocognitive measures administered at baseline discriminated among patients who achieved abstinence and those who did not. Participants completed the Immediate and Delayed Memory Task, Barratt Impulsiveness Scale–11, and Iowa Gambling Task. Profile analysis results showed different patterns of performance on these baseline measures as a function of outcome. Compared with non-abstinent participants, abstinent participants had higher scores on the Barratt Impulsiveness Scale–11 Non-Planning subscale and better performance on the Iowa Gambling Task. Profile differences for the two outcome groups did not vary as a function of treatment condition. Results suggest that cocaine-dependent patients entering treatment with higher impulsivity and less impaired decision-making abilities may respond favorably to targeted behavioral interventions. Neurocognitive profiles may be useful in understanding population heterogeneity and predicting differential outcomes in subgroups of cocaine abusers.     

Methods for population size estimation of problem drug users using a single registration

BackgroundThe number of problem drug users is used as a key indicator to monitor the drug situation in the European Union. An alternative approach to estimate the number of problem drug users is given by ‘the one-source capture–recapture analysis’ that uses a single registration.MethodsTwo variants of the one-source capture–recapture analysis were applied to a single registration: the truncated Poisson regression model (TPR) and the Zelterman regression model. These models were applied to data about clinical drug-related hospital admissions derived from the Dutch Hospital Registration (LMR). The TPR accounts for heterogeneity in capture probabilities by allowing for covariates and the Zelterman regression model relies on the problem drug users that were seen only once or twice in the hospital; the latter model is known to be robust against unobserved heterogeneity.ResultsThe TPR model was found to have a bad fit due to unobserved heterogeneity. The Zelterman regression model estimated the population size at 10,415 problem drug users (95% CI is 8400–12,429). This figure is an estimate of the number of problem drug users who are at risk of a clinical hospital admission due to the medical consequences of their drug use. The model can also provide estimates of different subgroups of problematic drug users.ConclusionThe method presented here offers a promising alternative for estimating the number of problem drug users, including different subgroups of drug users. In addition, observed and unobserved heterogeneity can be accounted for in these estimates.     

Predictors of Illicit Drug Use Among Prisoners

Background: The United States of America currently has the highest incarceration rate in the world, and approximately 80% of incarcerated individuals have a history of illicit drug use. Despite institutional prohibitions, drug use continues in prison, and is associated with a range of negative outcomes. Objectives: To assess the relationship between prison drug use, duration of incarceration, and a range of covariates. Results: Most participants self-reported a history of illicit drug use (77.5%). Seven percent reportedly used drugs during the previous six months of incarceration (n = 100). Participants who had been incarcerated for more than a year were less likely than those incarcerated for longer than a year to report using drugs (OR = 0.50; 95% CI = 0.26–0.98). Participants aged 37–89 were less likely than younger prisoners to use drugs (OR = 0.39; 95% CI = 0.19–0.80). Heroin users were twice as likely as nonheroin users to use drugs (OR = 2.28; 95% CI = 1.04–5.03); crack cocaine users were also twice as likely as participants with no history of crack cocaine usage to report drug use (OR = 2.53; 95% CI = 1.13–5.69). Conclusions: Correctional institutions should be used as a resource to offer evidence-based services to curb drug usage. Drug treatment programs for younger prisoners, heroin and crack cocaine users, and at the beginning of a prisoner's sentence should be considered for this population.     

Mortality among cocaine users: A systematic review of cohort studies

AimsTo conduct a systematic review of mortality among cohort studies of cocaine users.MethodsThree electronic databases were searched (EMBASE, Medline and PsychINFO); other online databases were searched using online libraries and repositories of reports and literature in the drug and alcohol field, with requested contributions from trained librarians and experts. Searches and extraction were undertaken using protocols and cross-checking of decisions by two authors. Additional data were requested from study investigators where studies did not report relevant data.Results1911 articles and 2 reports were identified from searches, with data from another four studies located from review articles. Seven cohorts of “problem” or dependent cocaine users reported data that permitted mortality rates to be estimated. Crude mortality rates ranged from 0.53 (95% CI: 0.10–1.58) to 6.16 (95% CI: 5.21–7.11) per 100PY. Standardised mortality ratios (SMRs) reported in four studies suggested that mortality was four to eight times higher among cocaine users than age and sex peers in the general population.ConclusionsThere are limited data on the extent of elevated mortality among problematic or dependent cocaine users and it is unclear how generalisable the results of these studies may be to other populations of problematic cocaine users. Greater attention to both the method of recruitment, and the characteristics of cocaine users, would enhance our understanding of the mortality risks of problematic cocaine use.     

Key drug use,health and socio-economic characteristics of young crack users in two Brazilian cities

BackgroundCrack use constitutes a major problem in cities across Brazil. While existing data suggest that crack use is generally concentrated among disenfranchised young people with extensive health problems and crime involvement, extensive data gaps exist. To address this issue, this study aimed to assess key characteristics of young crack users in two Brazilian cities.MethodsN = 160 regular and young adult (ages 18–24) crack users were recruited by community-based methods in the cities of Rio de Janeiro (Southeast) and Salvador (Northeast). Assessments included an interviewer-administered questionnaire on key social, drug use, health and service use characteristics, as well as serological testing of HBV, HCV and HIV status, and were conducted anonymously between November 2010 and June 2011. Participants provided informed consent and received transportation vouchers following assessment completion. The study was approved by institutional ethics review boards.ResultsThe majority of participants were: male, with less than high school education, unstably housed (Rio only); gained income from legal or illegal work; arrested by police in past year (Salvador only); had numerous daily crack use episodes and shared paraphernalia (Salvador only); co-used alcohol, tobacco, cannabis and cocaine; had no injection history; rated physical and mental health as ‘fair’ or lower (Salvador only); had unprotected sex; were never HIV tested; were not HIV, HBV or HCV positive; and did not use existing social or health services, but desired access to crack user specific services.ConclusionCrack users in the two Brazilian sites featured extensive socio-economic marginalization, crack and poly-drug use as well as sexual risk behaviours, and compromised health status. Social and health service utilization are low, yet needs are high. There is an urgent need for further research and for targeted interventions for crack use in Brazil.     

Follow-Up Study of Crack Cocaine Users: Situation of the Patients After 2, 5, and 12 Years

ABSTRACT

The purpose of this study was to follow-up 131 crack users and examine drug use, treatment experience, employment status, and mortality at 2, 5, and 12 years. Consecutive crack dependent patients were re-interviewed in 1995–1996, 1998–1999, and 2005–2006. Of those subjects not using cocaine at 2 years, 19 (63%) were still abstinent at 5 years. Almost half of the users were abstinent at the same period. The abstinent group was still the most prevalent at 12 years. Twenty-seven (20.6%) patients had died by the 12-year follow-up, with homicide being the most common cause (n = 16). After 2000, however, it declined sharply with only 2 deaths in 7 years. There was a progressive movement toward abstinence over the follow-up period, with the evidence that once abstinence had been achieved it was maintained. On the other hand, the mortality rate was extremely high and probably more related with socioeconomic factors instead of the drug use itself.     

Does Concurrent Cocaine Use Compromise 1-Year Treatment Outcomes for Opiate Users?

The current study aimed to determine whether cocaine use compromises treatment outcomes for opiate users. Data were collected from 404 opiate users at treatment intake and 1-year follow-up as part of a national treatment outcome study. Because of higher intake measures, cocaine users improved in more outcomes than nonusers, but comparisons between groups found that cocaine users had more coexisting problems. Regression analysis revealed that those who used cocaine at intake were more likely to use cocaine at 1-year follow-up, to commit crime, and to be homeless. It is concluded that treatment for opiate use “works” even in the presence of concurrent cocaine use.     

The Courts and I–Ruminations,Retorts and Remnants

Abstract

The impact of crack cocaine use on number of sex partners was examined using bivariate analyses and a logistic model on a national treatment cohort of 4,939 individuals. Number of sex partners over the last 12 months was dichotomized as none/one versus multiple partners for the logistic analyses. The model included 11 independent variables not including prostitution or use of crack cocaine. For both genders, the bivariate analyses showed significant positive associations between crack use and number of partners regardless of type of sexual activity; those who used crack had more partners for all sexual activities queried, compared to those who did not. Cocaine, whether in powder or crack form, was positively associated with prostitution for both genders. For men the odds ratio for crack cocaine use ranged from 1.6 (heterosexual anal) to 5.5 (homosexual anal) and for women from 2.9 (heterosexual oral) to 4.1 (homosexual oral). If prostitution is added to the model the odds ratios are reduced for homosexual activities for men and reduced dramatically for all types of sexual activity for women.     

An Exploratory Attempt to Distinguish Subgroups Among Crack-Abusing African-American Women

Abstract

Despite the significant emergence of research on female addiction over the last two decades, specific research on African-American women substance abusers, particularly crack cocaine users, is limited. The identification of meaningful subgroups of substance abusing populations, particularly minority women is important both clinically, and because of their over-representation in the epidemiological data on crack cocaine use in many urban centers across this country. An extensive battery of instruments was administered to 110 women entering treatment in an intensive outpatient substance abuse treatment program in Philadelphia, serving women who are primarily indigent, African-American, and whose primary substance of abuse is crack cocaine. Factor analysis and cluster analysis procedures were utilized to classify women into subgroups across relevant clinical, behavioral, and background concerns relevant to studying substance abusing populations. Five conceptually meaningful subgroups emerged which classified women across various indicators such as HIV sex risk factors, personality traits/Axis II dimensions, clinical syndromes, psychological symptomatology, lifetime and recent drug and alcohol use, prior physical and sexual abuse, and social context variables such as parental addiction, and whether they live with a substance abuser. Attempts to classify women into identifiable clinical subtypes is essential in order to better inform treatment initiatives designed to serve this group, as well as prevention and community outreach intervention strategies which attempt to bring them into treatment.     

Modelling crack cocaine use trends over 10 years in a Canadian setting

Introduction and Aims. Crack cocaine use among illicit drug users is associated with a range of health and community harms. However, long‐term epidemiological data documenting patterns and risk factors for crack use initiation remain limited especially among injection drug users. We investigated longitudinal patterns of crack cocaine use among polydrug users in Vancouver, Canada. Design and Methods. We examined the rate of crack use among injection drug users enrolled in a prospective cohort study in Vancouver, Canada between 1996 and 2005. We also used a Cox proportional hazards regression analysis to identify independent predictors of crack use initiation among this population. Results. In total, 1603 injection drug users were recruited between May 1996 and December 2005. At baseline, 7.4% of participants reported ever using crack and this rate increased to 42.6% by the end of the study period (Mantel trend test P < 0.001). Independent predictors of crack use initiation during the study period included frequent cocaine injection, crystal methamphetamine injection, residency in the city's drug using epicenter and involvement in the sex trade (all P < 0.05). Discussion and Conclusions. These findings demonstrate a massive increase in crack use among injection drug users in a Canadian setting. Our findings also highlight the complex interactions that contribute to the initiation of crack use among injection drug users and suggest that evidence‐based interventions are urgently needed to address crack use initiation and to address harms associated with its ongoing use.[Werb D, DeBeck K, Kerr T, Li K, Montaner J, Wood E. Modelling crack cocaine use trends over 10 years in a Canadian setting. Drug Alcohol Rev 2010]