Crack cocaine in the Dublin region - Health Research Board

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9.5 Improving or providing treatment services: practitioners’perspectivesNine drug-treatment services reported the need for ‘stimulant’ or cocaine-specificservices that is separate from opiate-addiction clinics. It was reported that, owing tostigmas associated with heroin use, non-opiate users would be discouraged by theassociation of cocaine services with those for heroin addiction. Although, in terms ofuser profile, there is a considerable difference between powder cocaine users and crackcocaine/intravenous cocaine users, drug-treatment service personnel did not perceivehuge differences in treatment strategies for cocaine addiction and crack cocaineaddiction:I really believe that you know the addiction services have to engage with the idea of stimulantclinics and working with people in a very holistic way in terms of either black box treatment,cognitive behavioural therapy…and I think it has to be very separate from methadone clinics.I think they’re two completely different drugs. I think they have two completely differentactions on the body and I think particularly from the point of view of crack, I think peoplehave to be picked up very, very quickly. Because if they’re not picked up quickly you knowtheir health suffers. I think you know health is a huge one. And you know their health canvery quickly get out of control. And I think if there were stimulant clinics and all, it wouldprobably take three or four dotted around the city for people to actually attend, and to workwith people who are well used to working with crack users, as opposed to heroin users. AndI think we have to very quickly get out of the mindset that we can treat crack users within thesame framework as a methadone clinic, because I just don’t think that’s realistic.north-inner city, training and education programme (November 2007)However, there were several opposing arguments for creating a ‘stimulant service’:• Three services supported the concept of a crack-specific service. Their logic wasthat, unless services are pinpointed, users will not believe that services can helpthem.• One service pointed out that the majority of powder cocaine users and themajority of crack cocaine users exhibit contrasting social profiles, and that mixingusers with such different profiles would only discourage attendance.In addition to the provision of stimulant-specific services, a number of key areas forimprovement were identified by drug-treatment services. These included:• resources to provide an immediate response or perform a crisis intervention (nineservices);• residential treatment options to address factors that may trigger crack use,particularly for polydrug users (ten services);Crack cocaine in the Dublin region: an evidence base for a crack cocaine strategy97
• more outreach work to identify crack users and encourage them into treatment(seven services);• additional crack-specific training to augment existing core skills (six services);• quicker access to psychiatric services in the case of high-risk patients (threeservices);• the promotion of harm reduction, such as safe crack pipes (three services).9.6 Treating polydrug useAs Section 5 indicated, the majority of treatment services’ clients who present reportingcrack use are polydrug users with a history of opiate dependence in particular. Crack isone of many drugs they may be using along with heroin, methadone, benzodiazepinesand alcohol. Two services argued that services should be geared towards polydruguse and treat all drug misuse rather than setting up structures for one particular drug.Five non-medical services referred to the challenge of treating polydrug use, and someexpressed concerns about the approach of methadone clinics to crack. In particular,these services felt that service providers were ignoring clients’ polydrug use:One person [crack-using client] is on heroin and crack and a few others would be onmethadone…the majority would be [on] methadone, they’re in clinics [where] they are gettingtested, supposedly getting tested for urines but ... are getting away with giving dirty urines orthey are now getting someone else to give urines for them. I don’t know, they could be usingbogey urines. I don’t know how that works. We wouldn’t have that many links in that waywith clinics and it’s probably better for it because if you started kind of linking in with clinicsand saying this person is presenting and he’s using crack and he’s still on the methadone itwould probably upset the clinic a bit I would say – so we tend not to go there.Finglas, drug-treatment service (October 2007)You know I don’t think clinics are helping. And when I say that you know people that arepolydrug using and I know one person at this present time who is injecting coke. Her familyhave rang the doctor. And methadone still hasn’t been reduced. You know and they tell youwhy they are using methadone because they are being treated for heroin dependency. Whyleave her on the same dosage if she is going to put cocaine into her?south inner city, drug-treatment service (September 2007)Oh God I really, really don’t know. You see we haven’t really tackled the other issues yet.Even though we’re saying we have but we haven’t. It’s very hard to move on to, and again,no criticism, nothing personal against the staff or I really think the health board need to sitdown and revise the satellite clinics. And the clinics in relation to the heroin addiction withthe methadone, like, we haven’t got that right if you know what I mean. I know there’s thebenefits, the positives, it cuts the crime rate down and all that but I don’t know, I really don’tknow because, as I said, most of them like what they do.north-east Dublin, drug-treatment service (October 2007)98 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
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Local survey dataA survey in 2006 o
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Respondent 1: I’d say it’s stil
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3 Dublin crack cocaine market3.0 Ov
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sold on the street for as little as
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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 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: Both opiate-dependent and non-opiat
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
Page 139 and 140: Appendix C:Recent HRB series public
Page 141 and 142: 140 Crack cocaine in the Dublin reg
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Crack cocaine in the Dublin region - Health Research Board

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