Powder Cocaine Research Articles

Architecture of the Unconscious

Finally, when Freud unveiled the predominant role of the unconscious in psychic processes, it turned out that our ego does not even rule its own house.— Slavoj Žižek, How to Read LacanGet up off the pavement, brush the dirt up off my psyche …— rapper Earl Sweatshirt, “Chum” In the KitchenPsychoanalysis is known primarily for its preoccupation with the “truth” that “speaks.” Following the critical tradition pioneered by Lacan and now Žižek, I would instead like to shift our attention to the “site[s]” where these pivotal experiments in truth take place—the environments we transform and the objects we fashion as we “learn to live with” the social plight we have inherited. Simply put, the aim of this paper is to explore the architecture of the unconscious. To develop this argument, I draw upon an array of genres and cultural artifacts, including personal memoir, cartoons, and hip hop lyricism.1 This description of cooking is likewise a pun referring to the symbol for Arm & Hammer baking soda—a crucial ingredient for transforming powder cocaine into crack. For annotations on this lyric, see http://rap.genius.com/Los-dont-get-in-my-way-lyrics.

Powder cocaine and crack use in the United States: An examination of risk for arrest and socioeconomic disparities in use

BackgroundIn light of the current sentencing disparity (18:1) between crack and powder cocaine possession in the United States, we examined socioeconomic correlates of use of each, and relations between use and arrest, to determine who may be at highest risk for arrest and imprisonment. MethodsWe conducted secondary data analyses on the National Survey on Drug Use and Health, 2009–2012. Data were analyzed for adults age ≥18 to determine associations between use and arrest. Socioeconomic correlates of lifetime and annual use of powder cocaine and of crack were delineated using multivariable logistic regression and correlates of frequency of recent use were examined using generalized negative binomial regression. ResultsCrack users were at higher risk than powder cocaine users for reporting a lifetime arrest or multiple recent arrests. Racial minorities were at low risk for powder cocaine use and Hispanics were at low risk for crack use. Blacks were at increased risk for lifetime and recent crack use, but not when controlling for other socioeconomic variables. However, blacks who did use either powder cocaine or crack tended to use at higher frequencies. Higher education and higher family income were negatively associated with crack use although these factors were sometimes risk factors for powder cocaine use. ConclusionsCrack users are at higher risk of arrest and tend to be of lower socioeconomic status compared to powder cocaine users. These findings can inform US Congress as they review bills (e.g., The Smarter Sentencing Act), which would help eliminate cocaine-related sentencing disparities.

Powder and Crack Cocaine Use as a Determinant of Sexually Transmitted Infections (STIs) Occurrence among US Juvenile Offenders

The prevention of sexually transmitted infections (STIs) among adolescents is a major concern across the globe, in particular in the United States (U.S.), and A common indicator of risk in documented in the literature for STIs is substance use. Method: Participants were 2260 juvenile offenders in the state of Georgia. Significance tests were conducted using univariate logistic regressions to examine the independent associations of participant’s self-reported crack and powder cocaine use and dichotomized HIV risk behaviour correlates and history of having a prior STI before the most recent incarceration. Results: With respect to specific STI occurrence, participants who reported powder cocaine use were more likely to have reported having been told they had genital warts (OR=1.33, 95% CI=0.58-3.02), Chlamydia (OR=1.27, 95% CI=0.83-1.95), Syphilis (OR=1.33, 95% CI=0.58-3.02) and Trich (OR=1.39, 95% CI=0.82-2.38). Participants who reported past Crack use were three times more likely to having been told they had Syphilis prior (OR=3.39, 95% CI=0.49-23.41). Participants who reported using crack were three and two time to indicate that had been informed prior that they had Herpes (OR=3.04, 95% CI=0.44-2.1.16) and Trich (OR=2.32, 95% CI=0.73-7.41) accordingly. Conclusion: Even across racial/ethnic groups, gender, and geographic locations, several determinants of adolescents' sexual risk taking were identified. Of importance, is the need for STI risk reduction interventions to consider using more measures of overall reproductive health, especially for female juvenile offenders.

Powder and Crack Cocaine Use as a Determinant of Sexually Transmitted Infections (STIs) Occurrence among US Juvenile Offenders

Powder and Crack Cocaine Use as a Determinant of Sexually Transmitted Infections (STIs) Occurrence among US Juvenile Offenders

How much of the cocaine market are we missing? Insights from respondent-driven sampling in a mid-sized American city

BackgroundStudying markets for illegal drugs is important, but difficult. Data usually come from a selected subset of consumers, such as arrestees, treatment clients, or household survey respondents. There are rarely opportunities to study how such groups may differ from other market participants or how much of total consumption they represent. MethodsThis paper uses respondent-driven sampling (RDS) of drug users in a mid-sized American city to estimate the shares of cocaine (powder and crack) users and expenditures that are attributable to different combinations of these groups. ResultsWe find that those arrested in the last year accounted for 34% of past-month cocaine users and 40% of past-week cocaine spending in the RDS sample. Augmenting past-year arrestees with those who received treatment in the past year increases these values to 44% (users) and 55% (spending). ConclusionsOur results suggest that estimates based only on people who were arrested and/or treated in the past year would have to be inflated by 100–200% to capture the market totals. Adding those who own or rent their place of residence increased coverage in this study to 76% (users) and 81% (spending), suggesting that in theory the inflation factor could be reduced to 23–32% by supplementing data on arrestees and treatment populations with household data, although in practice rates of under-reporting by survey respondents may make coverage (sampling frame) a secondary concern for household surveys.

Factors associated with initiating someone into illicit drug injection

AimsMost people who inject drugs (PWID) were first initiated into injection by a current PWID. Few studies have examined PWID who assist others into drug injection. Our goal is to describe the prevalence of and risk factors for initiating someone into injection in the last 12 months. MethodsWe recruited a cross-sectional sample of PWID (N=605) in California from 2011 to 2013. We examined bivariate and multivariate risk factors for initiating someone into injection with a focus on behaviors that might encourage injection initiation such as injecting in front of non-PWID, describing how to inject to non-PWID, and willingness to initiate someone into drug injection. ResultsHaving initiated someone into injection was reported by 34% of PWID overall and 7% in the last 12 months. Forty-four PWID had assisted 431 people into injection in the past year. Factors independently associated with initiating someone into injection in the last 12 months were self-reported likelihood of initiating someone in the future (Adjusted Odds Ratio [AOR]=7.09; 95% Confidence Interval [CI]=3.40, 14.79), having injected another PWID in past month (AOR=4.05; 95% confidence interval [CI]=1.94, 8.47), having described how to inject to non-injectors (2.61; 95% CI=1.19, 5.71), and non-injection powder cocaine use in past month (AOR=4.97; 95% CI=2.08, 11.84) while controlling for study site. ConclusionActive PWID are important in facilitating the process of drug injection uptake. Interventions to reduce initiation should include efforts to change behaviors and intentions among PWID that are associated with injection uptake among others.

Correlation between cocaine prices and purity with trends in emergency department visits in a major metropolitan area.

Illicit drug use not only causes acute and chronic adverse health outcomes but also results in a significant burden to health care providers. The objective of this study is to examine the relationship between cocaine prices and purity with emergency department (ED) visits for the Chicago-Naperville-Joliet metropolitan area. Our primary outcome was number of cocaine-related ED visits per quarter provided by the Drug Abuse Warning Network. The predictor variables of cocaine purity and price were provided by the System to Retrieve Information from Drug Evidence database. Autoregressive integrated moving average (ARIMA) regressions were used to estimate the effects of cocaine price and purity on cocaine-related ED visits. Although cocaine prices did not change substantially over time, cocaine purity decreased by over 30 % between 2006 and 2010. ARIMA regression results suggest that cocaine-related ED visits were not significantly associated with powder or crack cocaine prices; however, a decrease in powder cocaine purity was associated with 2,081 fewer ED visits overall from 2007 to 2010. The cocaine trade continues to be a major public health and law enforcement threat to large metropolitan cities like Chicago. Regular monitoring of cocaine purity levels may provide early warning of impending changes in cocaine-related ED visits for law enforcement and health care providers.

ICD-10 mental and behavioural disorders due to use of crack and powder cocaine as treated at a public psychiatric emergency service: An analysis of visit predictors

The present study investigated the predictors of an increased number of visits from individuals with some of the diagnoses noted in chapter F14 of ICD-10, from calls to the emergency psychiatric unit of a general hospital in São Paulo state, Brazil, in the period 2011–2012. Poisson regression models were carried out for the outcome variable, accounting for number of subsequent visits to the psychiatric emergency unit. For the analysis of this outcome we took into account the exposure time of each individual in the study. Our findings point to a population at risk for frequent psychiatric emergency service visits: individuals over 25 years. This population should be targeted for interventions on entry into public healthcare due to increased psychiatric morbidity and greater clinical morbidity already confirmed by previous studies. We discussed the need of these individuals for special attention during the clinical or psychiatric emergency consultation which, unfortunately, may be the access point for the public health system. None of the other variables were related to the outcome of interest, such as those related to the level of individual entry into the care network before and after treatment, and other variables related to medical acts during the visit.

Powder and crack cocaine use among opioid users: is all cocaine the same?

Problematic cocaine use is highly prevalent and is a significant public health concern. However, few investigations have distinguished between the 2 formulations of cocaine (ie, powder and crack cocaine) when examining the characteristics of cocaine use. Moreover, research has yet to assess the patterns of powder and crack cocaine use among opioid users, a clinical population in which problematic cocaine use is increasingly common. Using a within-subjects design, this study examined whether opioid users reported different patterns and features of powder and crack cocaine use, along with distinct trajectories and consequences of use. Seventy-three clients enrolled in a low-threshold methadone maintenance treatment were interviewed regarding their lifetime use of powder and crack cocaine. Compared with crack cocaine, initiation and peak use of powder cocaine occurred at a significantly younger age. In relation to recent cocaine use, participants were significantly more likely to report using crack cocaine than using powder cocaine. Differences in routes of administration, polysubstance use, and criminal activity associated with cocaine use were also found between the 2 forms of cocaine. Results suggest that it may not be appropriate to consider powder and crack cocaine as diagnostically and clinically equivalent. As such, researchers may wish to distinguish explicitly between powder and crack cocaine when assessing the characteristics and patterns of cocaine use among substance users and treat these 2 forms of cocaine separately in analyses.

Crack/cocaine users show more family problems than other substance users

OBJECTIVES:To evaluate family problems among crack/cocaine users compared with alcohol and other substance users.METHODS:A cross-sectional multi-center study selected 741 current adult substance users from outpatient and inpatient Brazilian specialized clinics. Subjects were evaluated with the sixth version of the Addiction Severity Index, and 293 crack users were compared with 126 cocaine snorters and 322 alcohol and other drug users.RESULTS:Cocaine users showed more family problems when compared with other drug users, with no significant difference between routes of administration. These problems included arguing (crack 66.5%, powder cocaine 63.3%, other drugs 50.3%, p = 0.004), having trouble getting along with partners (61.5%×64.6%×48.7%, p = 0.013), and the need for additional childcare services in order to attend treatment (13.3%×10.3%×5.1%, p = 0.002). Additionally, the majority of crack/cocaine users had spent time with relatives in the last month (84.6%×86.5%×76.6%, p = 0.011).CONCLUSIONS:Brazilian treatment programs should enhance family treatment strategies, and childcare services need to be included.

Tobacco use disorder and the risk of completed suicide in VHA

are to calculate TIJ and to examine factors associated with TIJ in a sample of drug injectors. Methods: As part of an exploratory study on injection drug initiation, interviewswere conductedwith drug injectors recruited at outreach sites in Los Angeles and San Francisco, CA (n=549) during 2011–12. Interviews covered demographics, family history, drug use and drug injection initiation among others. TIJ was calculated by subtracting age at first drug injection from age of first illicit drug use. We used multivariate linear regression to determine factors independently associated with TIJ. Results: The sample was 33%White, 32% Black, 25% Latino, 27% female, and 60% homeless. Mean age was 46.9 (IQR 41, 56) and mean years of drug injection were 24.8 (IQR 13, 36). Mean age of first illicit drug use was 13.8 (IQR 12, 15) andmean age of injection initiationwas22.1 (IQR16, 26).MeanTIJ for the samplewas8.4 (IQR 2, 12) years. In a multivariate linear regression model, we found that drug types ever usedwere associatedwith TIJ (crack use =+2.9 years, p =0.004; powder cocaine use =+3.3 years, p<0.001; heroin use =−3.2 years,p=0.009; prescription stimulants use =−2.6 years, p=0.001). Any substance abuse treatment prior to injection was associated with longer TIJ (+3.9 years, p<0.001), while being born after 1979 (−2.9, p=003) and having your first injection administered by a familymember (−3.4 years, p=0.006) or self (−2.1 years, p=0.016) were associated with shorter TIJ. Conclusions: TIJ was influenced by drug type, substance abuse treatment, birth cohort, and injection initiator characteristics. These data highlight the need for surveillance of emerging trends in injection drug use and novel prevention strategies targeting transitions to injection among at-risk populations. Financial support: NIDA grant number R01DA027689 and R01DA030427.

Effectiveness of the rehabilitation for addicted prisoners trust (RAPt) programme

The Rehabilitation for Addicted Prisoners Trust (RAPt) Programme, the largest provider of intensive prison-based drug treatment in the UK, addresses both substance dependence and criminal behaviour through a comprehensive model. This study examined recidivism in a group of male prisoners who completed the RAPt programme (n = 352), a group of male prisoners who did not complete (n = 355) the programme, and a third comparison group of male prisoners who completed another in-prison drug treatment programme (n = 232). 12-month post-release recidivism data for the three groups were assessed with multivariate logistic regression in relation to age, race/ethnicity, length of sentence, prisoners’ drugs of choice, and prisoners’ primary offence for imprisonment. Results indicated that RAPt completers were less likely to re-offend within one year of prison release compared to the Comparison completers and prisoners who started but did not complete RAPt. Prisoners’ drugs of choice were also associated with re-offence with those treated for heroin or cocaine (crack or powder) use being more likely to re-offend compared with those treated for use of any other drugs. Finally, the type of offence for which prisoners were convicted was also a prominent factor with those sentenced for a property offence more likely to reoffend within one year compared to those convicted of a non-property offence. These findings demonstrate the effectiveness of the RAPt programme and identify prisoners with heroin or cocaine dependence at highest risk for recidivism. Programme enhancements may address the additional risk among prisoners who identified heroin or cocaine use as their primary drug of choice.

Role of personality traits in cocaine craving throughout an outpatient psychosocial treatment program

Cocaine dependence is a major international public health concern. Its chronically relapsing nature is possibly related to craving intensity, which can be influenced by diverse biological and psychological aspects. This study aimed to evaluate the role of different personality traits in craving measured throughout a psychosocial treatment program. The sample comprised 66 cocaine-dependent outpatients who were enrolled in an individual and manualized cognitive-behavioral therapy program. The influence of personality traits on craving intensity, frequency, and duration was analyzed using a generalized estimating equations model with an autoregressive correlation structure. Craving varied during treatment. The personality traits of novelty seeking, reward dependence, and harm avoidance interacted with craving intensity, and the personality trait of persistence interacted with craving duration throughout the treatment period. Furthermore, there were significant interactions between drug use and craving intensity, and between different routes of administration and craving intensity. Participants who used cocaine/crack while in treatment and concurrent users of crack (i.e., freebase) cocaine and powder cocaine also had a higher craving intensity. The extent of craving variation can depend on certain personality styles. This study shows that craving is influenced by personality traits, and this may presumably change clinical expression involved in disease.

Erratum to: Predictors of Disapproval toward “Hard Drug” Use among High School Seniors in the US

The original version of this article unfortunately contained a systematic error in the reporting of unadjusted odds ratios (ORs) for some variables reported in Tables 3-5. Although these updated ORs do not affect the overall outcomes of the study (which are determined by the adjusted ORs), the author has provided the corrected ORs in the table below along with an updated corresponding section in the Results: With respect to disapproval towards use of powder cocaine (Table 3), identifying as a female or religious was associated with increased odds of disapproval, and cigarette, alcohol, marijuana and hard drug use decreased the odds of disapproval in unadjusted models. In the adjusted model, however, both alcohol use and marijuana use (AOR=1.05, 99 % CI=0.80-1.38) lost significance. In the adjusted model, identifying as black decreased the odds of disapproval. Regarding crack disapproval (Table 3), identifying as female or religious, increased odds for disapproval towards crack use, and use of alcohol, cigarettes, or hard drugs, reduced odds of disapproval in unadjusted models. In the adjusted model, however, the significance of alcohol disappeared, and marijuana use remained non-significant (AOR=1.20, 99 % CI=0.88-1.62). In the adjusted model, identifying as black decreased odds for disapproval, and use of only one hard drug was not associated. With regard to LSD disapproval (Table 4), identifying as female or religious increased the odds for disapproval, and identifying as black, and alcohol, cigarette, marijuana and hard drug use decreased the odds of disapproval. In the adjusted model, identifying as black and alcohol use lost significance, and marijuana use (AOR= 0.58, 99 % CI=0.40-0.84, p<.001) decreased odds for LSD disapproval. The odds of heroin disapproval (Table 4) were increased by identifying as a female or religious, and those who used alcohol, cigarettes or hard drugs were at lower odds for disapproval. However, in the adjusted model, the significance of sex (female) and alcohol use disappeared. Marijuana (AOR=1.00, 99 % CI=0.59-1.70) and use of a single hard drug were not significant. The odds of amphetamine disapproval (Table 5) were increased by identifying female, Hispanic or religious, and identifying as black, residing in a small MSA, and use of alcohol, cigarettes, marijuana or hard drugs lowered odds for disapproval. In the adjusted model, however, the significance of identifying as black, Hispanic or female was lost, as was the association for alcohol use; and high parent education, residing in a small MSA, and marijuana use lowered odds for disapproval (AOR=0.60, 99 % CI= 0.41-0.88, p<.001). Finally, the odds for ecstasy disapproval (Table 5) were increased by identifying as female, Hispanic or religious, and odds were reduced in those who resided in a small MSA, or used alcohol, cigarettes, marijuana or hard drugs in their lifetime. In the adjusted model, significance of identifying and Hispanic and alcohol use was lost. Identifying as black, high parent education and marijuana use (AOR=0.62, 99 % CI= 0.44-0.87, p<.001) significantly decreased the odds for disapproval. The online version of the original article can be found at http://dx.doi.org/ 10.1007/s11121-013-0436-0.

Near‐Infrared‐Light‐Mediated Imaging of Latent Fingerprints based on Molecular Recognition

Photoluminescence is one of the most sensitive techniques for fingerprint detection, but it also suffers from background fluorescence and selectivity at the expense of generality. The method described herein integrates the advantages of near-infrared-light-mediated imaging and molecular recognition. In principle, upconversion nanoparticles (UCNPs) functionalized with a lysozyme-binding aptamer were used to detect fingerprints through recognizing lysozyme in the fingerprint ridges. UCNPs possess the ability to suppress background fluorescence and make it possible for fingerprint imaging on problematic surfaces. Lysozyme, a universal compound in fingerprints, was chosen as the target, thus simultaneously meeting the selectivity and generality criteria in photoluminescence approaches. Fingerprints on different surfaces and from different people were detected successfully. This strategy was used to detect fingerprints with cocaine powder by using UCNPs functionalized with a cocaine-binding aptamer.

Near‐Infrared‐Light‐Mediated Imaging of Latent Fingerprints based on Molecular Recognition

AbstractPhotoluminescence is one of the most sensitive techniques for fingerprint detection, but it also suffers from background fluorescence and selectivity at the expense of generality. The method described herein integrates the advantages of near‐infrared‐light‐mediated imaging and molecular recognition. In principle, upconversion nanoparticles (UCNPs) functionalized with a lysozyme‐binding aptamer were used to detect fingerprints through recognizing lysozyme in the fingerprint ridges. UCNPs possess the ability to suppress background fluorescence and make it possible for fingerprint imaging on problematic surfaces. Lysozyme, a universal compound in fingerprints, was chosen as the target, thus simultaneously meeting the selectivity and generality criteria in photoluminescence approaches. Fingerprints on different surfaces and from different people were detected successfully. This strategy was used to detect fingerprints with cocaine powder by using UCNPs functionalized with a cocaine‐binding aptamer.

Recreational drug use in men who have sex with men (MSM) attending UK sexual health services is significantly higher than in non-MSM

IntroductionThe aim of this study was to investigate the pattern of recreational drug use in patients attending a genitourinary medicine clinic, and to determine whether drug use was greater among...

A drug use survey among clients of harm reduction sites across British Columbia, Canada, 2012

BackgroundIn British Columbia (BC), understanding of high-risk drug use trends is largely based on survey and cohort study data from two major cities, which may not be representative of persons who use drugs in other regions. Harm reduction stakeholders, representing each of the five geographic health regions in BC, identified a need for data on drug use to inform local and regional harm reduction activities across the province. The aims of this project were to (1) develop a drug use survey that could be feasibly administered at harm reduction (HR) sites across all health regions and (2) assess the data for differences in reported drug use frequencies by region.MethodsA pilot survey focusing on current drug use was developed with stakeholders and administered among clients at 28 HR supply distribution sites across the province by existing staff and peers. Data were collated and analysed using univariate and bivariate descriptive statistics to assess differences in reported drug use frequencies by geography. A post-survey evaluation was conducted to assess acceptability and feasibility of the survey process for participating sites.ResultsCrack cocaine, heroin, and morphine were the most frequently reported drugs with notable regional differences. Polysubstance use was common among respondents (70%) with one region having 81% polysubstance use. Respondents surveyed in or near their region's major centre were more likely to report having used crack cocaine (p < 0.0001) and heroin (p < 0.0001) in the past week as compared to those residing >50 km from the major centre. Participants accessing services >50 km from the regional centre were more likely to have used morphine (p < 0.0001). There was no difference in powder cocaine use by client/site proximity to the regional centre. Participating sites found the survey process acceptable, feasible to administer annually, and useful for responding to client needs.ConclusionsThe survey was a feasible way for harm reduction sites across BC to obtain drug use data from clients who actively use drugs. Drug use frequencies differed substantially by region and community proximity to the regional centre, underlining the need for locally collected data to inform service planning.

Butyrylcholinesterase Genetic Variants: Association with Cocaine Dependence and Related Phenotypes

ObjectiveThe search for genetic vulnerability factors in cocaine dependence has focused on the role that neuroplasticity plays in addiction. However, like many other drugs, the ability of an individual to metabolize cocaine can also influence susceptibility to dependence. Butyrylcholinesterase (BChE) metabolizes cocaine, and genetic variants of the BChE gene (BCHE) alter its catalytic activity. Therefore, we hypothesize that cocaine users with polymorphisms in BCHE can show diverse addictive behaviors due to differences in effective plasma concentrations of cocaine. Those polymorphisms might also influence users to prefer one of the two main preparations (crack or powder cocaine), despite having equal access to both. The present work investigates polymorphisms in BCHE and if those genetic variants constitute risk factors for cocaine dependence and for crack cocaine use.MethodsA total of 1,436 individuals (698 cocaine-dependent patients and 738 controls) were genotyped for three single nucleotide polymorphisms (SNPs) in BCHE: rs1803274, rs4263329, and rs4680662.ResultsFor rs4263329, a nominal difference was found between cases and controls. For rs1803274 (the functional SNP), a statistically significant difference was found between patients who used crack cocaine exclusively and those who used only powder cocaine (P = 0.027; OR = 4.36; 95% CI = 1.18–16.04). Allele frequencies and genotypes related to other markers did not differ between cases and controls or between the two cocaine subgroups.ConclusionsOur findings suggest that the AA genotype of rs1803274 is a risk factor for crack cocaine use, which is more addictive than powder cocaine use. Further studies are needed in order to confirm this preliminary result and clarify the role of BCHE and its variants in cocaine dependence.

Demographic and socioeconomic correlates of powder cocaine and crack use among high school seniors in the United States

Objectives: Rates of powder cocaine and crack use have fluctuated among adolescents over recent decades. Little attention has been paid to recent trends, particularly regarding differences between users of powder cocaine and crack—two forms of the substance that are commonly reported together as “cocaine” use, despite having different effects and rates of adverse outcomes. Methods: We examined data from nationally representative samples of high school seniors who participated in the Monitoring the Future study during years 2005–2011 (weighted N = 65 717). Results: Many demographic and socioeconomic variables were similarly correlated with lifetime use of powder cocaine and crack. Income of >$50/week from job increased the odds for use, and income of >$50/week from sources other than a job more than doubled the odds for use. High religiosity, high parent education, identifying as black, and residing with one or two parents reduced odds for use. Hispanic students were at higher odds for use of crack and females were at lower odds for using powder cocaine. Among cocaine users, residing with one or two parents lowered odds for using both forms, and more religious students and Hispanics were at higher odds for crack-only use. Conclusions: Those interested in preventing initiation and adverse consequences of cocaine use should take into account the overlapping, yet different risk profiles of powder cocaine and crack users when developing programming. This is particularly important when considering differences in legal consequences for these pharmacologically similar forms of cocaine.