Crack-cocaine injection : a retrospective analysis of clients in Merseyside specialist drug treatment agencies

ENGLISH :
Aims: Drugs intelligence systems in Merseyside have identified a growing number of treatment-seeking clients who express a preference for injecting crack cocaine. We investigated the history of crack-cocaine injecting behaviours in individuals attending Merseyside drug-treatment agencies. Methods: Data were drawn from the regional National Drug Treatment Monitoring System (NDTMS) database for all those individuals reported to have presented for structured treatment from 1 April 1999 to 31 March 2002 in Merseyside. This resulted in a sample size of 4055. Subjects were grouped according to whether they reported injection of crack cocaine. Details including demographics, current drug-use profile and behaviours surrounding drug use were derived from the NDTMS dataset. Prevalence ratios were calculated and significant variables were subsequently entered into a backwards stepwise logistic regression model to assess the relative strength of association between subject characteristics and incidences of crack-cocaine injection. Findings: Clients that had injected crack cocaine and those that had not were well matched on demographic details and drug use other than heroin. Controlling for area of residence, crack-cocaine injectors were more likely to report use of injected heroin (p<0.001), use of non-injected cocaine (p<0.01), and less likely to report use of non-injected heroin (p<0.001). Logistic regression showed that crack injection was significantly predicted by heroin injection (p<0.001) and being a Liverpool resident (p<0.05). Conclusions: This preliminary investigation suggested that heroin injection is also a strong indicator of crack-cocaine injection. Crack-cocaine injectors may represent a subset of heroin users rather than a distinct population. Patterns of crack-cocaine administration were locally determined and require a dynamic response from service providers at the local level. It is vital that intervention strategies adapt to varieties and changes in drug administration behaviours in order to remain effective. (Author's abstract.)