When a drug becomes stronger and cheaper, the two necessary ingredients to create a problem are in play. While the potency of cocaine has increased in recent years, the price has fallen, providing a drug that represents increasingly good value and not one that requires deep pockets. The human cost of this is revealed, with data released this year showing a seven per cent rise in those seeking help with the drug.
It may seem like a small rise but this comes after annual increases since 2012, adding up to a 52 per cent increase in those presenting problems with cocaine use. For crack cocaine, the rise wasn’t quite as sharp but still up by 36 per cent in the last six years.
It’s important to understand that those using crack cocaine are not the same group as those using powder cocaine. There are elevated problems with housing, employment, and other social issues among those using crack, which aren’t seen to the same extent for those using powder cocaine. The supply and distribution of these drugs are also distinct, so it is unlikely that someone dealing cocaine would offer crack as an option.
There are also differences in treatment outcomes; while 70 per cent of those using powder cocaine achieve abstinence, only 34 per cent of those using crack cocaine do. This does not represent a failure in treatment; instead, it highlights the complex and varied issues that those using crack cocaine experience in comparison to those using the powder version. For example, crack tends to be used alongside heroin, so injecting rates are higher, which compromises an individual’s health and increases the risk of contracting infections like hepatitis or HIV. Abstaining from crack is a tough ask, especially if you have no roof over your head or are involved in commercial sex.
It is no coincidence that problems with crack cocaine are not evenly distributed across the country. The link between social deprivation and elevated drug problems are stubbornly wedded. While Rutland in the East Midlands has a rate of two people per thousand of the population, Middlesbrough has a rate thirteen times that at 26 people per thousand. Like crack cocaine, problems with alcohol are concentrated in Northern areas of social deprivation. Alarmingly, Public Health England estimates that 82 per cent of people with an alcohol problem are not in treatment.
What we do know from the treatment data is that those presenting with problems due to cocaine tend to be younger than their peers using crack cocaine. Almost two thirds are aged between 18 and 34. Those under 25 has risen dramatically from only 16 per cent in 2006 to 32 per cent in the last year. Clearly, engaging with treatment earlier is critical and improves the chances of someone escaping a life stagnating due to dependence.
It is rare for an individual to present to treatment using only one drug; most will be using at least two or more. Some drugs are also likely to be used together. Alcohol and cocaine are known bedfellows, using cocaine when drinking alcohol extends the capacity to drink, as cocaine balances the sedative effect of alcohol. Unfortunately, the majority of people with an alcohol problem are not in treatment, which is problematic as many will also have developed a dependency on cocaine.
Cocaine like many other drugs often requires more than one episode of treatment to achieve abstinence, and for many this will involve four or more attempts with the support of specialist treatment. The challenge for services delivering treatment is that not only do people present with multiple drug use, they are also more likely than not to have co-occurring mental health problems. Invariably, staff in these services are not trained or don’t have the scope to effectively treat these parallel mental health issues despite the negative impact mental illness has on recovery from a drug problem.
We know that people who have a mental health problem, like those with a drug problem, are more likely to smoke tobacco. Despite the fact 58 per cent of people in treatment are smokers, only three per cent are offered smoking cessation services. This leaves this group way behind the rest of the population in terms of the support provided to help them quit. This lack of intervention signals another way in which we collectively don’t value this group of people.
But the most obvious way we don’t value the potential these individuals have is our unwillingness to invest in support when they need it. Not only have treatment budgets been cut and look likely to be facing further cuts but reductions in funding have been greatest in areas of deprivation, amplifying an injustice where those with the greatest need are provided with the least in the way of treatment. This injustice is obvious to us all including those with the power to change it. By not doing so, the message is also obvious – we don’t care.