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NewScientist.com: Injecting crack cocaine is surprisingly common

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Crack cocaine is being injected - not just smoked - by a significant number of US drug users, reveals the first large survey of the practice. The phenomenon is particularly worrisome because it is associated with more high-risk behaviour, such as sharing needles and having unprotected sex, than other intravenous drugs.

Cocaine is nature's most powerful stimulant and is used by an estimated 14 million people worldwide. In powdered form, it is a hydrochloride salt and can either be snorted or dissolved in water and injected.

But in the 1980s, people began using baking soda to strip away the hydrochloride, forming a rock crystal, or crack, that can be smoked. And sometime in the mid-1990s, people began mixing crack with vinegar or other acids to make an injectible form of the drug.

"But we weren't sure how common this behaviour was," says Scott Santibanez, an epidemiologist at the Centers for Disease Control and Prevention in Atlanta, Georgia, US.
Ethnic differences

So he and colleagues analysed data taken in the late 1990s on the behaviours and blood test results from almost 2200 young, intravenous drug users. The study sampled six sites around the US. "We found out crack injection was more common than we expected," Santibanez told New Scientist.

About one in seven (15%) of those interviewed had injected crack at some time in their lives. The users did not show significant differences by gender, age, or sexual orientation.

There were differences by ethnicity, with non-Hispanic whites representing the largest group of crack "injectors" and Hispanics the smallest. Such cultural differences may explain the vast gap in the practice's popularity among the sites surveyed.

In the largely Hispanic neighbourhood of Harlem in New York City, just 1.5% of those interviewed had injected crack. But a few kilometres away in New York's mostly white Lower East Side, that figure climbed to 26.4%. New Orleans, Los Angeles, and Chicago also scored high in the practice, while Baltimore had few intravenous crack users. "It's possible it was emerging at the time and hadn't caught on in some sites," says Santibanez.

High-risk behaviours

The surprisingly high prevalence of crack injectors is a big concern, he says. These users all took other street drugs as well and were more likely to inject daily, share needles, have unprotected sex, and be infected with hepatitis than other intravenous drug users. "The biggest public health issue is these people are practicing a number of different high-risk behaviours," he says.

The study did not probe why people inject rather than smoke crack, but some users have reported the high after injecting it lasts longer than the 5 to 10 minutes of euphoria they derive from smoking it.

And health officials say the reason people turn to crack over powdered cocaine is largely down to cost. "It's a cheaper high," says one administrator at a needle exchange program in Bridgeport, Connecticut, who preferred to remain nameless. A slab "rock" of crack there sells for just $5, while a bag of powdered cocaine goes for at least $20.

For a number of years, the needle exchange program has been giving crack injectors citric acid to use in their injections rather than vinegar, which produces "horrible abscesses", says the administrator. "But regardless, a crack injection is going to burn your veins."

Journal reference: Drug and Alcohol Dependence (vol 77, p 227)