Crack cocaine in the Dublin region - Health Research Board

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7.6 Key findings• A significant proportion of crack users in treatment are homeless or live inunstable accommodation such as prisons, halfway houses, homeless hostels, orbed and breakfasts. Crack users reported having become homeless because ofnon-payment of rent, theft, or violence and anti-social behaviour inflicted onfamily members.• The lifestyles of such users appear to be too chaotic to sustain a legitimate sourceof income. Only 6% of new crack cases entering treatment were employed.• Crack users who were in employment reported that they funded their use fromtheir wages, and used crack only on days when they were not at work.• Crack use may prevent entry into employment schemes. Individuals in recoveryfrom heroin addiction who are receiving training to provide them with skills tore-enter the job market risk expulsion if their crack use is detected or if use isprompting disruptive behaviour during training.• Compulsive crack users reported neglecting their children, often diverting theirfinancial resources towards buying crack.• Given the high cost of crack, users often acquired debts very quickly which, whenleft unpaid, led to intimidation from crack dealers. This intimidation was oftendirected not only at the users themselves but also at their parents or other familymembers.• Few drug-treatment services reported that members of their local communitieswere concerned about crack cocaine use in the area. There were no reportsof crack-specific discarded drug paraphernalia, such as pipes, littering localpublic spaces.Crack cocaine in the Dublin region: an evidence base for a crack cocaine strategy85
8 Health consequences of crack use8.0 OverviewThis section considers findings from international research with regard to the healthcomplications associated with crack use. Data from previous studies and in-depthinterviews and focus groups with service providers are then examined to describe themain physical and psychological health consequences associated with crack use in theDublin region.8.1 Introduction: health consequences of crack useLong-term use of crack is associated with a range of physical and mental healthproblems (GLADA 2004a). The physical effects of crack use on people include narrowedblood vessels, dilated pupils, increased temperature, faster heart rate, and high bloodpressure. These medical symptoms can lead to chest pain, disturbances in heartrhythm, lack of oxygen to the heart muscle, respiratory failure, strokes, seizures andheadaches (NIDA 2004). Because crack has a tendency to decrease appetite, manychronic users can become malnourished. Further potential risks include ammoniapoisoning from protracted use of poorly manufactured crack and the use of acetone(used to reclaim cocaine from crack pipes) may cause kidney, liver and nerve damage(NACD 2007b).In terms of maternal crack use, it is important to dispel erroneous myths such as thatof the incidence of ‘crack babies’ portrayed in the US media in the 1980s (NIDA 2004).The specific effect(s) of crack on the foetus remains unknown. However, the effects ofmaternal crack cocaine use may include premature birth, low birth weight and smallerhead circumference (NIDA 2004), although these symptoms may be caused by otherconcomitant factors such as alcohol use, tobacco use and/or poor diet.As is the case with users of other illicit drugs, crack users may be at risk of contractingHIV, hepatitis B and hepatitis C through sharing injecting equipment, sharing crackpipes, and engaging in risky sexual behaviour. Research has underlined that drug use,including crack use, can ‘interfere with judgement about risk-taking behaviour, andcan potentially lead to reduced precautions regarding sexual behaviours, the sharing ofneedles and injection paraphernalia, and the trading of sex for drugs, by both men andwomen’ (NIDA 2004: 6). Recent research in Canada has demonstrated the link betweencrack smokers who share makeshift glass or aluminium pipes, which may cut their lips,and thereby facilitate the transmission of hepatitis C (CARBC 2007).86 Crack cocaine in the Dublin region: an evidence base for a crack cocaine strategy
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HRB Research Series6Crack cocaine i
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This publication should be cited as
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HRB Research Series publicationsto
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ContentsList of tables and figures
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7 Social consequences of crack use
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List of tables and figuresTablesTab
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AbbreviationsADRUGNDUHRBISCCSGLDTFN
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Glossary of termsBenzos: The street
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Executive summaryBackground and stu
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phone and buyers are directed to sp
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Part 1IntroductionCrack cocaine in
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In the light of these concerns, it
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extensive reporting in the US about
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Ten interviews were conducted with
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also offers potential to trace supp
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Part 2Crack cocaine in the Dublin r
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2.2 Criminal justice data - cocaine
Page 36 and 37: Prevalence of crack use among homel
Page 38 and 39: Local survey dataA survey in 2006 o
Page 40 and 41: Respondent 1: I’d say it’s stil
Page 42 and 43: 3 Dublin crack cocaine market3.0 Ov
Page 44 and 45: sold on the street for as little as
Page 46 and 47: Like, I was down on M… Street in
Page 48 and 49: 3.4 Marketing crackFour interviewee
Page 50 and 51: While crack was generally bought al
Page 52 and 53: • Although a number of dealers, o
Page 54 and 55: 4.2 Crack use and genderAccording t
Page 56 and 57: From about 16 to 21 I would say - t
Page 58 and 59: Table 4.4Number of new cases who li
Page 60 and 61: 5.2 Crack and other drugsMany of th
Page 62 and 63: Whether treated cases reported crac
Page 64 and 65: cases of intravenous cocaine use, t
Page 66 and 67: Table 5.5Number (%) of new cases wh
Page 68 and 69: Part 3Consequences of crack useCrac
Page 70 and 71: etween heroin, cocaine and crime. T
Page 72 and 73: So, they would talk about the kind
Page 74 and 75: Crack and prostitutionNine services
Page 76 and 77: On the other hand, reports from two
Page 78 and 79: often with a prevalence of opiate d
Page 80 and 81: The data provided by the NDTRS in S
Page 82 and 83: But you know it would be about kind
Page 84 and 85: So, debt is another significant iss
Page 88 and 89: There are considerable long-term ps
Page 90: 8.3 Psychological consequences of c
Page 93 and 94: 9 Treating crack use9.0 OverviewIn
Page 95 and 96: Some services were in a position to
Page 97 and 98: Both opiate-dependent and non-opiat
Page 99 and 100: • more outreach work to identify
Page 101 and 102: 10 Policing crack markets10.0 Overv
Page 103 and 104: local communities. There is growing
Page 105 and 106: He’d know me, I’d know him, you
Page 107 and 108: Table 10.1 Number of new cases who
Page 109 and 110: 108 Crack cocaine in the Dublin reg
Page 111 and 112: 11 Discussion and research implicat
Page 113 and 114: 11.2 Responding to crack markets an
Page 115 and 116: 11.3 Reducing the harm that crack c
Page 117 and 118: Shoplifting, burglary and robbery w
Page 119 and 120: Bourgois P (2003b) Crack and the po
Page 121 and 122: Furey M and Browne C (2004) Opiate
Page 123 and 124: Loughran H and McCann ME (2006) A c
Page 125 and 126: San Diego Police Department (1998)
Page 127 and 128: Appendix A:An evidence base for tre
Page 129 and 130: note that providing information on
Page 131 and 132: MedicationsA number of studies have
Page 133 and 134: interpersonal psychotherapy. Americ
Page 135 and 136: Jurisdiction Intervention/Descripti
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Jurisdiction Intervention/Descripti
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Appendix C:Recent HRB series public
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140 Crack cocaine in the Dublin reg
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