House of Commons - The Cocaine Trade - Home Affairs Committee

The Cocaine Trade - Home Affairs Committee Contents

3 WHO USES COCAINE?

Nature of addiction

25. Witnesses held differing views about the addictive nature of cocaine. Dr Neil Brener of The Priory clinic told us that "powder cocaine is mainly psychologically addictive, though there are some people who develop some symptoms of a chemical addiction by which they need more and more to get the same effect". The UK Drug Policy Commission agreed, arguing that "there are indications that cocaine is less likely to cause dependence than other drugs".[33] It cited a Home Office study in which the mean severity dependence score (SDS) for those whose primary problem was cocaine was 4.22, compared with 6.10 for crack and 9.09 for heroin.[34] The SDS is a five question scale designed to attach a score to an individual's self-reported level of dependence on individual drugs.[35]

26. Professor Nutt, then Chair of the Advisory Council on the Misuse of Drugs, was however clear that cocaine was physically addictive:

27. We heard varying assessments of the addictive nature of cocaine. Although cocaine powder had a lower severity dependency score (4.22) than crack cocaine (6.10) and heroin (9.09), there was no disputing that users typically developed a very strong psychological or habitual addiction to the drug.

'Problematic' crack vs 'recreational' powder users

28. Despite being made from the same substance and supplied by the same international trade, cocaine powder and crack cocaine tend to have different user profiles and patterns of use. Paul Hayes of the National Treatment Agency described the differences:

29. The Government's 2008 Drug Strategy draws a distinction between Problem Drug Users (PDUs), which it defines as "those who use opiates (heroin, morphine or codeine) and/or crack cocaine",[38] and users of other drugs. In contrast to 'problem drug users' , those taking cocaine powder are often referred to as 'recreational' users. SOCA described 'recreational' use of cocaine, along with other drugs such as ecstasy, as "often related to the UK nightclub scene. Although the health risks from overdosing, adulterated drugs, possible addiction and long-term exposure are serious, most recreational users control their usage, function normally when not using, and pay for their drugs from legitimate income".[39]

30. Not all our witnesses agreed with calling cocaine powder use 'recreational'. Professor McKeganey of Glasgow University told us that "my own view is that it is rather a misnomer to characterise their use as recreational because it may not yet be problematic in the terms which we currently conceive of as problematic use, but they may well be on the road to developing many of those problems…It adds to a culture of acceptability around this pattern of behaviour, and I think that is part of the problem".[40] Steve Rolles of Transform agreed that "recreational suggests it is risk-free or non-problematic; certainly recreational use can be risky, harmful, can lead to dependence".[41]

31. Crack cocaine users are more regularly those with chaotic lifestyles, with a high likelihood of concurrent heroin abuse, and are over-represented in the treatment and criminal justice systems. In this context we understand the use of the term 'recreational' applied to cocaine powder as a shorthand for links between its use and the social context in which it is taken, often characterised by weekend use, and associated with pub and club culture. However, to term cocaine powder users as 'recreational' and their drug use, by contrast with crack users, un-problematic, is inappropriate, misleading and downright dangerous, since it contributes to the misconception that cocaine powder is a relatively non-addictive, 'safe' party drug. We recommend that the Government stop using the term 'recreational' in relation to cocaine.

Cocaine powder is used by a cross-section of society

32. Cocaine powder used to be seen as the drug of choice of the rich and famous. However our evidence suggests that the range of people using cocaine has widened considerably. DrugScope told us:

33. Matthew Atha, Director of the Independent Drug Monitoring Unit (IMDU) agreed:

34. Data from the British Crime Survey (BCS) for 2008/09 on the lifestyle characteristics of cocaine users support the evidence we took, that wealth or economic class is not the most likely determinant of cocaine use. Home Office analysis of the data states that the top four factors showing the strongest associations with last year illicit drug use were: marital status (especially being single); pub visits in the last month; age (being young); and being male. It states:

35. Figures from the BCS 2008/09 record that single adults aged 16-59 were most likely to have taken cocaine powder in the last year compared to all other marital status groups: 6.4% of single people compared, for instance, to 0.7% of those who were married. Households with no children also had significantly higher rates of last year drug use than those with children. [45]

36. For those aged 16-24 last year drug use was significantly higher for those who had visited a nightclub or pub than those who had not done so. Some 2.1% of those who had not visited a club had taken cocaine, as compared to 8.6% of those who had made one to three visits in the last month, and 16.9% of those who had made four or more visits.[46] This link to pub and club culture can also be seen in the results of an online drugs survey of its readers by dance magazine MixMag in February 2010. The survey, predominantly of 18-27 year old dance music fans, found that 81% of those surveyed had taken cocaine within the last year, making it the third most popular illegal drug in the survey (after cannabis and ecstasy).[47]

37. Cocaine use was highest amongst those aged 20-24, followed by those aged 25-29 and those aged 16-20. However, use dropped off sharply in the 30-34 category, and again in the 35-44 age range, as shown in figure 1.

Figure 1: Percentage of those taking cocaine powder in the last year, by age range, British Crime Survey 2008/09

38. Men were twice as likely as women to report last year cocaine power use amongst adults aged 16-59 (4.2% to 1.8%) as well as amongst those aged 16-24 (8.8% to 4.4%). The same proportions by gender were replicated across all illicit drugs.[48]

39. In terms of economic class, although levels of cocaine powder use in the last year were higher in areas classified as 'Urban Prosperity' as compared with all other groups,[49] there was little variation between classes.

Two 'tiers' of user

40. Analysis by the Forensic Science Service of street-level seizures of cocaine show increasingly wide fluctuations in the purity levels—in 2008/09 the average purity of police seizures was 27%, but ACC Matthews of ACPO told us that "the vast majority" were less than 10% purity.[50] This suggests the emergence of a more fragmented market serving 'customers' with differing requirements. Witnesses suggested that this was not purely a result of the cocaine supply being constricted, but rather was driven by demand. It seems that a two- or even three-tier market has emerged, with different quality cocaine available at different prices. The UK Drug Policy Commission told us that:

41. The Independent Drug Monitoring Unit even reported the existence of a three-tier market since 2006, offering various types of cocaine:

a) 'Peruvian' which is essentially uncut from importation, and has typical purities of 60% with street prices of £50-60 a gram

b) 'Street'—the bulk of cocaine, typically 30-50% purity with street prices of £40-50 a gram

c) 'Budget'—low purity cocaine (under 25%) sold at a discounted price (between £20-£40 per gram).[52]

Use may be more endemic in certain professions

42. We heard arguments that cocaine use was more frequent amongst certain professions, particularly those in which drug-induced erratic behaviour might be interpreted as 'creative talent'. Sarah Graham told us:

43. One characteristic of cocaine powder use does seem to be the user's ability to continue to function 'normally', at least for some time. Sarah Graham, an ex-addict and BBC producer, told us that "people have this perception that an addict is somebody who is taking a drug 24/7 and that you cannot function… I actually functioned at a very high level, and for me my denial was tied in with cocaine because I saw cocaine as being part of the successful package".[54]

44. Dr Brener from The Priory suggested that "people working in the financial industry are more likely to run into problems. They have a high pressured job and they often start using it to keep themselves going in highly pressured situations".[55]

Polydrug use is commonplace

45. The BCS defines 'polydrug' use as "more than one drug being taken at the same time (simultaneous use) or more than one drug being taken within the same period of time, for example, in the last year (concurrent use)".[56] The 2008/09 BCS shows that 4% of adults aged 16 to 59 used more than one illicit drug in the last year. Cocaine was the second most commonly used drug (after cannabis) by polydrug users, with 66% of polydrug users having taken it.[57]

COMBINATION WITH ALCOHOL

46. There is a strong link between use of alcohol and use of illicit drugs, in particular cocaine. BCS data show that, for young people aged 16-24, levels of last year overall drug use were significantly higher for those who had drunk alcohol, than those who had not drunk alcohol, and as frequency of alcohol consumption increased, so did last year drug prevalence.[58] The survey by dance music magazine MixMag found that 61% of respondents always drank alcohol when snorting cocaine.[59]

47. The BCS also shows that the proportion of adult drug users who took three or more drugs in the last year increased with increasing frequency of pub visits in the past month. Some 38% of drug users who went to a pub nine or more times in the last month took three or more illicit drugs, a proportion around three times greater than those not visiting a pub at all.[60] Data provided by the UK Drug Policy Commission showed that arrestees who had used cocaine in the last year were more likely than heroin or crack cocaine users to be dependent on alcohol. Of those who had used cocaine in the past year, 78% were considered to be dependent alcohol users.[61]

48. The recent study of sudden deaths in south-west Spain found that 81% had smoked cigarettes and 76% had taken ethanol (alcohol) at the same time as taking cocaine. It concluded that "the association of cocaine and cigarette smoking may be considered as a 'lethal cocktail'",[62] and that cocaethylene, produced through the combination of alcohol and cocaine, was "more toxic than cocaine or ethanol alone and has been associated with a 25-fold increase in sudden death".[63]

49. Sarah Graham told us that, as it had for her, "for many, many people alcohol addiction and cocaine addiction do go hand in hand".[64] Paul Hayes of the National Treatment Agency thought that "for a significant minority of people in their 20s/early 30s it has become an adjunct to a Friday or Saturday night out along with alcohol".[65] Professor Nutt suggested that it was not uncommon for "people to go into pubs and order a gin and tonic and a line of coke".[66]

COMBINATION WITH HEROIN

50. Crack cocaine users frequently also use heroin, a combination known as "speedballing". However, it seems that users who take both drugs tend to present for treatment with a primary heroin addiction, rather than a primary crack cocaine addiction. Professor Strang told us that, out of the total number of people presenting for drug treatment in 2008/09, 75% had a primary heroin addiction, many with secondary drug use including cocaine. By contrast, only 15% had a primary cocaine addiction.[67]

51. Whilst crack cocaine and cocaine powder continue to have different user profiles, the characteristics of those using cocaine powder has broadened from the 'rich and famous' to a far wider cross-section of society. The broadening of its appeal seems to be related to the emergence of a two- or even three- tier market for cocaine powder, with cheaper, less pure cocaine available at a lower price, and purer cocaine at a higher price.

52. Cocaine powder is increasingly being taken simultaneously with alcohol. The two drugs combine to form a highly toxic third substance, cocaethylene, which a recent medical study reported to be associated with a 25-fold increase in sudden deaths.

33 Ev 154 Back

34 Home Office, Drug Treatment Outcome Research Study (DTORS) Baseline Report Appendices (2008), Table 21, p.22: http://www.homeoffice.gov.uk/rds/pdfs07/horr03append.pdf Back

35 Home Office, Drug Treatment Outcome Research Study (DTORS) Summary Research Report 23 (December 2009), p.v: http://www.dtors.org.uk/reports/DTORS_Key_Summary.pdf Back

36 Q 304 Back

37 Q 241 Back

38 Home Office, Drugs: Protecting Families and Communities, The 2008 Drug Strategy (February 2008), p.50 Back

39 SOCA, UK Threat Assessment of Organised Crime 2008/09, p.32 Back

40 Q 132 &Q 134 Back

41 Q 132 Back

42 Ev 106 Back

43 Q 107 Back

44 Home Office Statistical Bulletin 12/09, Drug Misuse Declared: Findings from the 2008/09 British Crime Survey(July 2009), p.45 Back