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Please note that the information on this page is based on the EMCDDA Annual report 2011: the state of the drugs problem in Europe. Most statistical data relate to the year 2009 (or the last year available).


Annual report 2011: the state of the drugs problem in Europe
Cocaine and crack cocaine

Published: 15 November 2011

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. More socially integrated problem cocaine users are generally under-represented in the estimates.

National estimates of problem cocaine users are available only for Italy, where the number was estimated to be about 178 000 (between 4.3 and 4.7 per 1 000 aged 15-64) in 2009 (1). Trend data on problem cocaine use and other data sources (e.g. treatment entries) point to a gradual increase in problem cocaine use in Italy.

Crack use is unusual among socially integrated cocaine users, and occurs mainly among marginalised and disadvantaged groups such as sex workers and problem opioid users, and is largely an urban phenomenon (Prinzleve et al., 2004; Connolly et al., 2008). In London, crack use is considered to be a major component of the city's drugs problem. Regional crack cocaine estimates are only available for England (United Kingdom), where there were an estimated 189 000 problem crack cocaine users in 2008/09, which corresponds to 5.5 (5.4-5.8) cases per 1 000 inhabitants aged 15-64. A majority of these crack users were also reported to be opioid users.

Treatment demand

Further insights into problem cocaine use may be gained from data on the number and characteristics of people entering treatment due to cocaine use. Nearly all reported cocaine clients are treated in outpatient centres, although some might be treated in private clinics for which data are not available. Many problematic cocaine users, however, do not seek treatment (Escot and Suderie, 2009; Reynaud-Maurupt and Hoareau, 2010).

Cocaine, mainly powder cocaine, was cited as the principal reason for entering treatment by 17 % of all reported drug users entering treatment in 2009. Among those entering treatment for the first time in their life, the proportion of primary cocaine users was higher (23 %).

Wide differences exist between countries in the proportion and number of primary cocaine clients, with the highest proportions reported by Spain (46 %), the Netherlands (31 %) and Italy (28 %). In Belgium, Ireland, Cyprus and the United Kingdom, cocaine clients represent between 11 % and 15 % of all drug clients. Elsewhere in Europe, cocaine users account for 10 % or less of drug treatment clients, with six countries reporting less than 1 % (2). Overall, Spain, Italy and the United Kingdom report together almost 58 000 of the 72 000 cocaine clients reported by 26 European countries.

The number of clients entering drug treatment for primary cocaine use has been increasing in Europe for several years. Based on 17 countries that have provided data across the period 2004-09, the number of cocaine clients increased from about 38 000 in 2004 to around 55 000 in 2009. Over the same period, the number of cocaine clients entering treatment for the first time in their life increased by almost a third, from about 21 000 to 27 000 (based on 18 reporting countries).

Profile of outpatient treatment clients

Clients entering outpatient treatment for primary use of cocaine, including powder and crack-cocaine, present a high male to female ratio (about five men for every woman), and one of the highest mean ages (about 32 years) among drug treatment clients. The average age is highest in France, Italy and the Netherlands (35 years). Primary users of cocaine report first use of the drug at a mean age of 22.5 years, with 86 % of them starting before the age of 30. The average time lag between first cocaine use and first treatment entry is about nine years. Almost a third of all cocaine clients are reported by the United Kingdom, and their profile differs from that of clients in other countries with a high number of cocaine users in treatment: they are younger on average (31 years), have a lower gender ratio (about three males for every female), and a shorter time lag between first use and treatment entry (around seven years).

Most cocaine clients report snorting (66 %) or smoking (29 %) the drug as their main route of administration. Injecting is reported as the main route of administration by only 3 % of cocaine clients, and a decrease in cocaine injecting has been observed between 2005 and 2009. Almost half of cocaine clients have used the drug one to six times a week in the month before entering treatment, about a quarter have used it daily while the remaining quarter have not used it or have used it only occasionally during that period (3). Cocaine is often used in combination with other drugs, especially alcohol, cannabis, other stimulants and heroin. An analysis of treatment data from 14 countries in 2006 revealed that about 63 % of primary cocaine clients were polydrug users, reporting problems with at least one other drug. The most frequently cited additional problem drug was alcohol, used by 42 % of cocaine clients, followed by cannabis (28 %) and heroin (16 %) (EMCDDA, 2009). Cocaine is also mentioned as a secondary substance (4), and has been increasingly reported by primary heroin users in Italy and the Netherlands.

Analysis of treatment entry data shows that the crack problem remains geographically limited in Europe. In 2009, 10 540 clients were reported entering 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 are reported by the United Kingdom, where they number about 7 500, accounting for 40 % of the country's cocaine clients and 6 % of its drug clients in outpatient centres. The Netherlands reported 1 231 crack clients, accounting for 38 % of the country's cocaine clients and 12 % of all drug clients (5). Heroin use is common among users of crack cocaine entering treatment. In the United Kingdom, for example, around 31 % of primary crack clients reported heroin as a secondary drug, and this proportion is increasing.


(1) See Table PDU-102 (part i) in the 2011 statistical bulletin.

(2) See Figure TDI-2 and Tables TDI-5 (part i) and (part ii) and TDI-24 in the 2011 statistical bulletin; data for Spain refer to 2008.

(3) See Table TDI-18 (part ii) in the 2011 statistical bulletin.

(4) See Table TDI-22 in the 2011 statistical bulletin.

(5) See Table TDI-115 in the 2011 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.

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

Escot, S. and Suderie, G. (2009), 'Usages problematiques de cocaine, quelles interventions pour quelles', Tendances 68, Observatoire Français des Drogues et des Toxicomanies, Paris.

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.

Reynaud-Maurupt, C. and Hoareau, E. (2010), 'Es carrières de consommation de cocaïne chez les usagers «cachés»', Trends, Observatoire Français des Drogues et des Toxicomanies, Saint-Denis (available online).

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Page last updated: Friday, 28 October 2011