Abstract
People who smoke crack cocaine are described as chaotic and more likely to engage in risky sex, polysubstance use and contract infectious diseases. However, little is known about how individuals perceive smoking crack as compared to other forms of cocaine use, especially injection. We explored the lived experience of people who smoke crack cocaine. Six gender-specific focus groups (n = 31) of individuals who currently smoke crack in Vancouver, Canada, were conducted using a semi-structured interview guide. Focus groups were transcribed and analyzed by constant comparative methodology. We applied Rhodes' risk environment to the phenomenological understanding that individuals have regarding how crack has affected their lives. Subjects reported that smoking rather than injecting cocaine allows them to begin “controlling chaos” in their lives. Controlling chaos was self-defined using nontraditional measures such as the ability to maintain day-to-day commitments and housing stability. The phenomenological lens of smoking crack instead of injecting cocaine “to control chaos” contributes a novel perspective to our understanding of the crack-smoking population. This study examines narratives which add to prior reports of the association of crack smoking and increased chaos and suggests that, for some, inhaled crack may represent efforts towards self-directed harm reduction.
Highlights
Smoking crack cocaine is a relatively neglected public health problem in Canada in comparison to injection drug use (IDU), despite indications that crack use in Canada is increasing
The Vancouver Injection Drug Users Study found that crack use in a group of injection drug users in Vancouver almost doubled from about 31% in 1997 to over 60% in 2004; and daily crack smoking in this population rose from
We posit that for some, especially those with long-standing drug use careers, smoking crack may represent an increase in efforts to control chaos, and the observed polysubstance abuse is a mechanism for reducing overall crack consumption
Summary
Smoking crack cocaine is a relatively neglected public health problem in Canada in comparison to injection drug use (IDU), despite indications that crack use in Canada is increasing. A recent surveillance report of 794 people who inject drugs across Canada indicated that 52.2% of the total sample had used crack cocaine in the last 6 months [2]. Another Canadian cohort of illicit opioid users in five cities indicated that 54.6% (371/679) of baseline participants had smoked crack in the 30 days prior to the survey. In a study of people who smoked crack in Vancouver only 39% of those who smoked crack reported injecting drugs [4]. In Canada, many services for people who use drugs are targeted to people who inject; people who only smoke crack may not be linked with appropriate health and social services
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