Crack cocaine use continues to rise

Public Health England research reveals new evidence that crack use, production and purity are all increasing.

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Last week (25 March 2019) Public Health England (PHE) and the Home Office published a summary of findings from the Increase in crack cocaine use inquiry, an investigative report on crack cocaine use in 6 areas of England.

This publication follows evidence reported in the 2018 Serious Violence Strategy, that drugs have been an important driver of the increase in serious violence in England and Wales since 2014.

Key findings from the ‘Increase in crack cocaine use inquiry’ include:

  • the majority of people using crack were observed to be existing heroin users, often with co-occurring mental health problems and at risk of being homeless
  • the rise in crack use is likely to be caused by increased availability (linked to a surge in global production of cocaine), affordability and aggressive ‘marketing’ by dealers
  • changes in attitudes and stigma associated with crack use, and a reduced focus by police on drug dealing
  • clear evidence of ‘county lines’ operations – but this varied across different areas

The latest comprehensive prevalence estimates by Liverpool University – published today alongside this report – show that while there was a sharp rise in crack use between 2011 to 2012 and 2014 to 2015, it has now levelled, but remains much higher than previously.

The study is based on interviews and focus groups with drug treatment workers, service users and police officers in the six areas which had shown the greatest increase in the use of crack over recent years. It is important to remember that the research is focused on these high use areas and the findings may not be applicable to all parts of the country.

© Alexis Barrera (Al Bar) of Oaktown Crack Comics Creative Commons


The findings support other data sets which show an increase in crack cocaine use. These data sets and this inquiry indicate that the trend began to develop several years ago, around 2013.

The amount of time that passed before it was clear at a national level that crack use was rising is a cause for concern, and government needs more up-to-date data and intelligence on the trends in heroin and crack prevalence to monitor this trend more effectively in the future.

Factors influencing the rise in crack use

This investigation has identified several factors which may have influenced the rise in crack use, including increased availability and affordability of crack and aggressive marketing of the drug by dealers. These factors are likely to be linked to the surge in global production of cocaine since 2013, as organised crime groups have potentially taken advantage of excess supply to push crack cocaine onto a captive market of entrenched heroin users and groups of new users.

The United Nations Office of Drugs and Crime reported that global opium production increased by 65% in 2017 to a record high so it will be important to monitor whether this has an impact on the availability and prevalence of heroin in England.

Other factors linked to the increase in crack cocaine use, which were not directly linked to the increased supply, were changes in the stigma about crack and a lack of police focus on targeting drug dealing. It was not clear from this enquiry whether ‘county lines’ drug dealing operations had driven the increase in crack use, given that use had also increased in areas where county lines were not prevalent.

However, the findings support existing evidence, including from the National Crime Agency, about the expansion of county-lines activity in recent years.

There was a widespread view among police officers, treatment workers and service users that county-lines groups were much more likely than local groups to engage in serious violence and to exploit vulnerable young people and drug users.

Characteristics of crack users

The feedback from all participants suggests that the increase in crack use has been mainly among existing heroin users, but there have also been suggestions of a new, ‘hidden’ group of crack users who are not heroin users and who have not engaged with treatment services.

There is a need for more research which explores the demographics of this group and its pathways into crack cocaine use. Many individuals are vulnerable individuals who are exploited by having their homes taken over by drug dealers to use as a base to sell drugs from, a process known as “cuckooing”.

Treatment for crack users

This inquiry has highlighted the need to explore more effective methods of getting crack users into treatment and to provide a more attractive treatment offer which is tailored to their specific needs.

It has also identified the need for more effective links from the criminal justice system into treatment services for these individuals, for example through greater availability of arrest referral schemes and improved monitoring of drug rehabilitation requirements.


The report does not comment on the fact that austerity has resulted in a very much reduced Drugs Intervention Programme whose purpose was exactly that of the last research finding – to identify and engage into treatment dependent drug users involved in crime to fund their dependency.

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Dame Carol Black’s Review of Drugs looks at recent increases in the number of people using crack cocaine.

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