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Please note that the information on this page is based on the EMCDDA Annual report 2010: the state of the drugs problem in Europe. Most statistical data relate to the year 2008 (or the last year available).


Annual report 2010: the state of the drugs problem in Europe
Cocaine and crack cocaine

Published: 10 November 2010

Problem cocaine use and treatment demand

Regular cocaine users, those who use it over long periods and those who inject the substance are defined, by the EMCDDA, as problem cocaine users. Estimates of the size of this population provide an approximation of the number of people potentially in need of treatment. Socially integrated problem cocaine users are, however, underrepresented in these estimates, though they may also be in need of treatment. National estimates of problem cocaine users are available only for Italy, while regional and crack cocaine estimates are available for the United Kingdom (England). In Italy, the number of problem cocaine users was estimated at about 172 000 (between 4.2 and 4.6 per 1 000 aged 15–64) in 2008 (1). Trend data on problem cocaine use and other data sources point to a gradual increase in cocaine use in Italy.

Crack use is very unusual among socially integrated cocaine users, and occurs mainly among marginalised and disadvantaged groups such as sex workers, problem opioid users and, sometimes, specific ethnic minorities (e.g. France, Netherlands, United Kingdom). It is mainly observed in some European cities (Prinzleve et al., 2004; Connolly et al., 2008). Most of the treatment demands related to crack use and most of the crack seizures in Europe are reported by the United Kingdom. Crack use is also considered to be a major component of London’s drugs problem. Estimates of problem crack-cocaine use in England from 2006/7 range from 1.4 to 17.0 cases per 1 000 inhabitants aged 15–64, with a national average of 5.2–5.6 cases per 1 000 (2). It is estimated that more than two-thirds of problem crack users are also problem opioid users.

In the countries with the highest prevalence levels, powder or crack cocaine is often used by opioid users undergoing substitution treatment (mainly Spain, Italy, Netherlands, United Kingdom). Cocaine and alcohol use are also correlated among patients in substitution treatment.

Treatment demand

Cocaine, mainly powder cocaine, was cited as the principal reason for entering treatment by about 17 % of all drug treatment clients in 2008, corresponding to about 70 000 cases in 27 European countries. Among those entering treatment for the first time in their life, the proportion of primary cocaine users was higher (24 %).

There are wide differences between countries regarding the proportion and number of primary cocaine clients. The highest proportions are reported by Spain (46 %), the Netherlands (33 %) and Italy (28 %). In Belgium, Ireland, Cyprus, Luxembourg and the United Kingdom, cocaine clients represent between 11 % and 15 % of all drug clients. Elsewhere in Europe, cocaine accounts for less than 10 % of drug treatment clients, with eight countries reporting less than 1 % (3).

The number of clients entering drug treatment for primary cocaine use has been increasing in Europe for several years, though the trend is strongly influenced by a few countries (Spain, Italy, Netherlands, United Kingdom). Based on 17 reporting countries, the number of cocaine clients entering treatment increased from about 37 000 in 2003 to 52 000 in 2008, while their proportion grew from 17 % to 19 % of all clients. Among clients entering drug treatment for the first time, the number of cocaine clients increased from about 18 000 to 28 000 and their proportion from 22 % to 27 % (based on 18 countries). Among the countries with the highest numbers of cocaine clients, since 2005 a stable situation or a downward trend in the number and proportion of new clients citing cocaine as their principal drug is reported in Spain, Italy and the Netherlands, while the United Kingdom reports an increase (4).

Profile of treatment clients

Nearly all cocaine clients are reported by outpatient treatment centres, although some cocaine users might be treated in private clinics, which are almost unrepresented in the current monitoring system.

Outpatient cocaine clients have one of the largest male to female ratios (five men for every woman) and one of the highest mean ages (about 32 years) among drug treatment clients. This is particularly the case in some countries with large numbers of primary cocaine clients, especially Italy, where their sex ratio is 6:1 and the mean age is 34 years. Primary users of cocaine report an older age at first use of their main drug (22.3 years, 87 % before the age of 30) compared to primary users of other drugs, and the average time lag between first cocaine use and first treatment entry is about nine years.

Most cocaine clients snort (63 %) or smoke (31 %) the drug, while only 3 % report injecting it (5). Almost half of them have used the drug one to six times a week in the month before entering treatment, 26 % have used it daily and 25 % have not used it during that period (6). An analysis of treatment data from 14 countries in 2006 revealed that about 63 % of cocaine clients are polydrug users. Among them, 42 % also use alcohol, 28 % cannabis and 16 % heroin. Cocaine is also mentioned as a secondary drug among 32 % of outpatient clients, especially primary heroin users (EMCDDA, 2009).

In 2008, about 10 000 clients are reported to have entered outpatient treatment for primary use of crack cocaine, representing 16 % of all cocaine clients and 3 % of all drug clients entering outpatient treatment. Most crack clients (about 7 500) are reported by the United Kingdom, where they account for 42 % of the cocaine clients and 5.6 % of all drug clients. The Netherlands also reports that crack clients made up a sizeable proportion of all treatment entrants in 2008 (7).

Overall, two main groups of cocaine clients have been identified in treatment: socially integrated individuals using powder cocaine; and a more marginalised group of clients, using cocaine, often crack cocaine, in combination with opioids. The first group typically reports snorting the drug, and sometimes consuming it in conjunction with other substances such as alcohol or cannabis, but not with opioids. Some members of this group are referred to treatment by the criminal justice system. The second group often reports injecting drugs, uses both cocaine and opioids, sometimes smokes crack, and presents precarious health and social conditions. In this group, which includes former heroin users re-entering drug treatment for cocaine use, the identification of the primary drug can be difficult (NTA, 2010) (8).

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(1) See Table PDU-102 (part i) in the 2010 statistical bulletin.

(2) See Table PDU-103 (part ii) in the 2010 statistical bulletin.

(3) See Figure TDI-2 and Tables TDI-5 (part i) and (part ii) and TDI-24 in the 2010 statistical bulletin; data for Spain refer to 2007.

(4) See Figures TDI-1 and TDI-3 in the 2010 statistical bulletin.

(5) See Table TDI-17 (part iv) in the 2010 statistical bulletin.

(6) See Table TDI-18 (part ii) in the 2010 statistical bulletin.

(7) From 2008, the Netherlands considers cocaine clients reporting ‘smoking’ as the route of administration as crack users. This has led to a marked increase on the numbers reported in previous years. Insufficient identification of crack clients may also exist in other countries.

(8) See Tables TDI-10, TDI-11 (part iii), TDI-21 and TDI-103 (part ii) in the 2010 statistical bulletin.

Bibliographic references

Connolly, J., Foran, S., Donovan, A.M. et al. (2008), Crack cocaine in the Dublin region: an evidence base for a Dublin crack cocaine strategy, HRB Research Series 6, Health Research Board, Dublin (available online).

EMCDDA (2009d), Polydrug use: patterns and responses, EMCDDA Selected issue, Publications Office of the European Union, Luxembourg.

NTA (2010), Powder cocaine: how the treatment system is responding to a growing problem (available online).

Prinzleve, M., Haasen, C., Zurhold, H. et al. (2004), ‘Cocaine use in Europe: a multi-centre study: patterns of use in different groups’, European Addiction Research 10, pp. 147–55.

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The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is the reference point on drugs and drug addiction information in Europe. Inaugurated in Lisbon in 1995, it is one of the EU’s decentralised agencies. Read more >>

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Page last updated: Tuesday, 26 October 2010