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Journal of Public Health Advance Access originally published online on April 28, 2006
Journal of Public Health 2006 28(2):96-103; doi:10.1093/pubmed/fdl010
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© The Author 2006, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.

Crack/cocaine use in a rural county of England



Roberto Vivancos, Honorary Lecturer, School of Medicine, Health Policy & Practice, University of East Anglia, Norwich, NR4 7TJ, UK1

Viviene Maskrey, Research Associate, School of Medicine, Health Policy & Practice, University of East Anglia1

Daphne Rumball, Consultant Addictions Psychiatrist, Norfolk & Waveney Mental Health Partnership, Norwich, Norfolk NR2 2PA, UK2

Ian Harvey, Professor of Epidemiology and Public Health, School of Medicine, Health Policy & Practice, University of East Anglia1

Richard Holland, Senior Lecturer in Public Health Medicine, School of Medicine, Health Policy & Practice, University of East Anglia1
1 School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK
2 Norfolk and Waveney Mental Health Partnership

Address correspondence to Richard Holland, E-mail: r.holland{at}uea.ac.uk

Crack/cocaine use is an increasing problem in the UK. This study is the first to ascertain the magnitude of the crack/cocaine problem in a rural county of the UK and to determine users’ needs for treatment services. A questionnaire on drug dependence and risk behaviour was completed by 306 users of drug treatment services, and focus groups were conducted with 45 self-selected crack/cocaine users. It is estimated that 31% (95% C.I., 26% to 37%) of drug users in treatment services have moderate/severe dependence on crack/cocaine. Factors associated with severe crack/cocaine dependence are severe dependence on benzodiazepines, increasing number of drugs used, engaging in sex work and non-white ethnicity. Those with severe dependence have a higher prevalence of hepatitis B and C compared with those with moderate or no dependence. All focus group participants describe a frenzied drug life so when entering treatment they require additional support to give structure to their lives to prevent relapse. Current service provision appears not to provide help to crack/cocaine users. Given the lack of pharmacological treatment, programmes should incorporate a wide range of activities and interventions to provide structure to clients’ lives. Learning from ex-users was perceived as an important component of treatment.

Keywords: blood borne virus, crack, cocaine, dependence, drug misuse, drug treatment services, viral hepatitis


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