Crack cocaine in the Dublin region - Health Research Board

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There are considerable long-term psychological consequences of crack use. Crack usemay result in increased anxiety, agitation, insomnia, depression, psychotic illness andeating disorders. Use of psycho-stimulants such as crack cocaine may also be linked tosuicide (NIDA 2004; Warner 1993). Insomnia may emerge as problem, and may result inusers turning to sedatives such as alcohol, benzodiazepines and opiates to recover theirsleeping patterns or to relax after using crack.8.2 Physical consequences of crack useIn Ireland, there are no routine data sources that collect information on the physicalconsequences of crack cocaine use. As a result, data in this area are limited to onceoffstudies. In March 2004 CityWide published the results of a survey on the extent towhich 27 community-based drug projects were dealing with the problems of cocaineuse (CityWide 2004). The follow-up survey reports a deterioration in the general healthof clients with problematic cocaine use, with 39% of the projects surveyed reportinga rise in the number of clients experiencing abscesses and wounds due to poorinjecting habits. Projects also reported increases in weight loss; sexually transmittedinfections (STIs); heart conditions; amputations; incidences of opiate users who hadbeen previously stabilised on methadone now destabilising through cocaine use; andrisk-taking behaviours among clients using cocaine. The health consequences of crackuse are relatively similar to those associated with the use of powder cocaine (NIDA2004). However, the different means of taking cocaine can also produce differentdiverse effects. Regularly snorting powder cocaine can lead to complications – suchas loss of smell and nose bleeds – while smoking crack cocaine may cause breathingcomplications.The majority of known users in Dublin are most likely to be polydrug users, particularlyformer heroin and/or methadone users. Reports from users and services suggest thatmany have already suffered considerable ill effects from injecting opiates such ascontracting HIV or hepatitis C, soft-tissue infections, blood-clotting problems, or havinghad an amputation. In general, the main crack-specific ill effects reported were rapidweight loss (13 reports) and heart/breathing problems (9 reports). The findings of theCityWide (2004) study support the experiences reported by participants in the in-depthinterviews.Crack cocaine in the Dublin region: an evidence base for a crack cocaine strategy87
Nonetheless, a small number of participants reported more severe complications. Onedrug-treatment worker and one user reported instances of crack-related deaths (a heartattack and fatal seizure):Like the majority of deaths that we would have within the organisation – like I think we havehad two in the last week. One of them wasn’t a client of ours. She was a girlfriend of a client,died last Thursday, and we had a young man died two weeks ago on the Friday. Both werecrack-related. The young girl that died, I think she was 36. She had a massive heart attack.We still don’t know how the young man died.Location anonymised, drug-treatment services (October 2007)Another female user reported that one of her son’s friends had suffered a fatal seizureor fit while smoking crack cocaine. His death did not deter her son from using crack:It’s killing so, my youngest, the one I’m talking about, his friend died four or five weeks ago.Doing it on the pipe and he didn’t know he took fits. Took a fit, took a few fits that night I amtold, they were all with him. They all done it again the next night. Like, they don’t get afraid.The next night on the Friday, he’s dead about five weeks, he was a lovely little young fella aswell, but I don’t know whatever was mixed with it was like splinters of glass or something,because you can mix anything white, do you know? When he took the pipe, after about 10 or15 minutes, I’d say he went through, probably, another pipe. The blood started coming out ofhis nose, ears, mouth – dead. Yeah, it didn’t stop them again. Do you know the way?north-east Dublin, current user (October 2007)Another former user had suffered multiple organ failure after years of powder cocaine/crack use:Yeah. I was using drugs right up until April/May of last year and my kidneys failed, cocaineabuse, ended up very sick in hospital. Organ failure, heart under pressure, liver, I’d behepatitis C positive. So it was, I was dead, not that I was dead, my kidneys had failed, mylegs had swollen, my body wasn’t processing fluid and I was just getting sicker and sickeruntil I collapsed. I ended up on a life-support machine in Navan Hospital and it was my lastchance to do anything about my drug problem.Former crack user, unspecified location (October 2007)One former user believed she had miscarried because of respiratory problems linked tocrack use:The crack was affecting my lungs. I have asthma anyway. So I hadn’t enough oxygen formyself, so there was no oxygen for the baby, so the baby’s lungs weren’t developing…he onlylasted three days and I know for a fact that was through crack cocaine so it was.north-east Dublin, former crack user (September 2007)88 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
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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 86 and 87: 7.6 Key findings• A significant p
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
Page 137 and 138: 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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Crack cocaine in the Dublin region - Health Research Board

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