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".
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.
The SDS is a five question scale designed to attach a score to
an individual's self-reported level of dependence on individual
26. Professor Nutt, then Chair of the Advisory Council
on the Misuse of Drugs, was however clear that cocaine was physically
Addiction is a physical process of changing the
brain and there are thousands of papers showing that cocaine use
changes the brain, often in a way that makes it very, very difficult
for people to give up using cocaine and that is why success rates
are not as good as they are for other forms of addictive drugs
because it does change the brain.
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'
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:
The people who are using crack cocaine like the
people who use heroin are the people who are at the most vulnerable
end of our society. The people who use powder cocaine, some of
them are at the most vulnerable end of society, but there are
also the City traders, the pop stars, the normal metropolitan
professionals. When they begin to experience problems they can
sort out their problems, they have enough personal social capitalthey
can draw on family support, on the safety net of a good income
to get themselves out of the mess whereas the people towards the
bottom end of society are more likely to spiral into decline.
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",
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".
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
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".
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
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
While the 'champagne' image of powder cocaine
persists to this day, the dramatic fall in price has made powder
cocaine an unremarkable aspect of leisure time for an increasingly
broad cross-section of British society.
33. Matthew Atha, Director of the Independent Drug
Monitoring Unit (IMDU) agreed:
The highest levels of cocaine use are actually
amongst the unemployed and the lowest levels amongst students,
so we find that it is through all levels of society, it is not
just a rich man's drug. When the celebrities are taking it they
get snapped by the paps and they get outed by the press but Joe
Bloggs, down the council estate never comes to the attention of
the media, so it has this image of being a glamorous, celebrity-associated
drug which is probably a false image.
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:
Marital status is the strongest factor associated
with predicting illicit drug use-the odds of illicit drug use
are significantly higher for those who are single, as compared
to those who are married or cohabiting.
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. 
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.
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).
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.
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,
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 levelsin 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.
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
The increase in use may be partly explained by
the creation of a 'two-tier' cocaine market, with drug dealers
selling a cheaper, less pure product to a new market of consumers
who were previously unable to afford cocaine (and were more likely
to use other, cheaper, stimulants).
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).
Use may be more endemic in certain
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:
One of the things about the media and certain
other careers is that as your addiction progresses certain behaviours,
which would not be tolerated in a normal job, actually can be
spun to be part of your creative genius or part of your extraordinary
personality. Some of those people are still in place. Some of
them are behaving in off-the-wall ways and are enabled left, right
and centre. Some of those City traders have still got their jobs.
They have taken incredible risks partly because the cocaine has
been affecting their decision-making. Their gambling addiction
combined with their cocaine addiction has meant that they have
gone out on a limb but they are still in post.
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".
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".
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)".
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.
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.
The survey by dance music magazine MixMag found that 61% of respondents
always drank alcohol when snorting cocaine.
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.
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
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'",
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".
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".
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
Nutt suggested that it was not uncommon for "people to go
into pubs and order a gin and tonic and a line of coke".
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.
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
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
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
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
Q 304 Back
Q 241 Back
Home Office, Drugs: Protecting Families and Communities, The 2008
Drug Strategy (February 2008), p.50 Back
SOCA, UK Threat Assessment of Organised Crime 2008/09, p.32 Back
Q 132 &Q 134 Back
Q 132 Back
Ev 106 Back
Q 107 Back
Home Office Statistical Bulletin 12/09, Drug Misuse Declared:
Findings from the 2008/09 British Crime Survey(July 2009), p.45 Back
Ibid., p.42 Back
Ibid., p.41 Back
MixMag magazine (February 2010), p.44ff Back
Home Office Statistical Bulletin 12/09, Drug Misuse Declared:
Findings from the 2008/09 British Crime Survey(July 2009), p.39 Back
Ibid., p.44 Back
Home Office data records that the average purity of police seizures
analysed by the Forensic Science Service in 2008/09 was 27%: Home
Office Statistical Bulletin 16/09, Seizures of Drugs in England
and Wales, 2008/09 (October 2009), Summary Table 6: http://www.homeoffice.gov.uk/rds/drug-seizures.html
. ACC Matthews told us that "the vast majority" of police
seizures in the 18 months to November 2009 had been less than
10% purity: Q 402. Back
Ev 153 Back
Ev 128 Back
Ev 31 Back
Q 169 Back
Q 248 Back
Home Office Statistical Bulletin 12/09, Drug Misuse Declared:
Findings from the 2008/09 British Crime Survey, England and Wales,
(July 2009), p.56 Back
Ibid., p.55 Back
Ibid., p.41 Back
MixMag magazine, 10 February 2010, p.50 Back
Ibid., p.61 Back
Ev 155, citing Home Office, The Arrestee Survey 2003-2006 (2007):
European Heart Journal (12 January 2010), Lucena, J. et al, Cocaine-related
sudden death: a prospective investigation in southwest Spain,
doi: 10.1093/eurheartj/ehp557, p.8 Back
Ibid., p.6 Back
Q 161 Back
Q 228 Back
Q 320 Back
Q 11 Back