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Inquiry calls for targeted crack cocaine treatment services

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Targeted support needs to be made available for the “skyrocketing” number of crack cocaine users in England, experts have warned.

They said the perception among professionals and users was that services were mainly focused on alcohol and heroin.

“We need to do more harm reduction around crack”

Inquiry report

The absence of substitute medication for crack, in contrast to what is available for heroin users, was also described as a “big disincentive” for people to access treatment.

The findings have been published in a report this week by Public Health England and the Home Office, following an inquiry into the increase in crack cocaine use in the country.

It noted that there had been an 8.5% rise in the number of crack cocaine users in England between 2011 and 2017, up from 166,640 to 180,748.

The inquiry determined that crack cocaine use had been on the up since 2013 and said the amount of time it had taken for the issue to reach national attention was “a cause for concern”.

The investigation involved a series of interviews with drug treatment workers, service users and police officers based across six local authority areas where crack cocaine use had risen.

It follows a report last year that found that drugs had been important driver in the increase in serious violence across the country over the past five years.

There was a “general agreement” among service users and treatment workers interview for the inquiry that crack use had increased in recent years.

One patient described crack cocaine as an “epidemic” and said use of the drug was “skyrocketing”.

The report found that the majority of those using crack were also hooked on heroin.

“This report will come as no surprise to those working on the frontline”

Rosanna O’Connor

While heroin users could be offered methadone as a substitute, the same was not available for crack and treatment workers said this was a “big disincentive for people to seek help”.

“Crack users often felt that there was no treatment available for them,” the report noted.

The inquiry raised concerns that treatment services were mainly build for heroin and alcohol users.

“Both treatment workers and service users thought treatment services were mainly focused on heroin and alcohol, and there was not enough awareness of the risks of crack use and the treatment options,” it said.

Evidence was also found of a rise in people injecting crack, with treatment workers reporting more health problems in their patients from infections and wounds caused by poor injecting practice.

One health professional told the inquiry: “We need to do more harm reduction around crack, more crack-specific groups, more investment in crack treatment.”

Treatment workers also highlighted concern about a lack of support for those leaving prison with a drug problem and cited poor communication between prison and community treatment teams.

The report concluded: “This inquiry has highlighted the need to explore more effective methods of getting crack users into treatment and to provide a more attractive treatment offer which is tailored to their specific needs.”

“The government is committed to tackling the illicit drugs trade”

Victoria Atkins

It added services needed ”more effective links from the criminal justice system”.

Rosanna O’Connor, director for drugs, alcohol, tobacco and justice at PHE, said: “This report will come as no surprise to those working on the frontline, who will have seen first-hand this surge in crack use in their communities.

“Local areas, more than ever, need to continue to invest in effective drug services if we are to stop the creep of this highly addictive drug into the wider community and people’s lives being torn apart,” she said.

Ms O’Connor said treatment was “cost-effective”, claiming that with every £1 spent yielded a £2.50 saving on the social costs, including reducing crime.

In addition, she said services needed to “reach out to crack users and offer more attractive and tailored support to meet their specific needs”.

Victoria Atkins, minister for crime, safeguarding and vulnerability, highlighted that the home secretary Sajid Javid had recently appointed Professor Dame Carol Black to carry out a major review of drug misuse.

She added: “The government is committed to tackling the illicit drugs trade, protecting the most vulnerable and helping those with drug dependency to recover.”

Aggressive marketing by dealers and the increase in “county lines” activity – where organised crime groups from the cities set up drug networks in more rural areas – were among the reasons listed in the report for the rise in crack use.

Better availability and affordability of crack and lack of capacity in police forces to focus on drug dealing were also cited.

In addition, treatment workers and drug users told the inquiry that crack cocaine had been destigmatised in recent years.

Some of those who were interviewed for the inquiry reported that crack cocaine was starting to become “more acceptable, even fashionable” among groups who would not previously have taken it, including professionals, students and clubbers.

The report also found that crack cocaine appeared to be becoming more popular among women but that this was not always reflected in the numbers perhaps because they would be afraid that if they did seek help social services would become involved in their parenting.

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