- Globally, approximately 14-21 million (0.3-0.5%) are cocaine users.
- The prevalence of cocaine use is estimated to be highest in the Americas as it is the second most common illicit drug used.
- Crack-cocaine makes up an extensive proportion of cocaine use and is the most commonly used non-injection drug among street drug user populations.
- Psychiatric problems, HCV, HIV, and tuberculosis are higher among crack-users. Also, mortality rates are 4-8 times higher when compared to the general population.
- Many crack users are socially and economically marginalized, which results in limited social, health, and/or treatment services.
- Due to a lack of targeted prevention and treatment specifically for crack use, the authors provide a comprehensive overview of secondary prevention and treatment interventions with a specific focus on crack-cocaine misuse.
Diverse Psycho-social treatment
- A large body of evidence shows that psycho-social treatment (e.g. cognitive/behavioural therapy, peer-delivered interventions) can reduce drug use, as well as the negative health impacts associated with it. Though limited, it may, be the best treatment currently available for cocaine/crack.
- Psycho-social treatment that incorporates Contingency Management (e.g. housing contingent on drug abstinence, vouchers for cocaine-free urine samples) may be the primary reason for the effectiveness of psycho-social treatment. Contingency Management shows greater efficacy in achieving periods of drug abstinence in crack user populations.
- Many studies explored pharmacotherapy treatment options for cocaine/crack-dependence, however, despite the multiple drugs tested, studies have shown no pharmacological treatments to be overall effective. At this point, the most promising options are glutamatergic and GABA (e.g. topiramate) as well as dexamphetine formulations.
- Immunotherapy is considered a promising preventative-therapeutic approach, however so far the effects appear to be short lived and only in very specific populations. A new vaccine compound shows a reduction in cocaine seeking in animal studies, but it has not yet been studied in humans.
Even though crack use is as common as opioid and injection drug use, currently, there is no ‘gold standard’ prevention and treatment intervention for crack abuse. Further research is vital in order to develop treatments for crack/cocaine comparative to the effectiveness of other interventions such as needle exchange services and opioid maintenance treatment.
Fischer, B., Blanken, P. and Da Silveira, D. et al. (2015). Effectiveness of secondary prevention and treatment interventions for crack-cocaine abuse: A comprehensive narrative overview of English-language studies. International Journal of Drug Policy. Vol. 26. Pp. 352-363.