Britain’s 2nd most popular drug

The recent (12 March 2015) Advisory Council on the Misuse of Drugs (ACMD) report on cocaine confirms what most people already know but provides some interesting detail.

Here are the headline findings:

• Cocaine has become increasingly popular over the last twenty years but probably peaked in 2008/9 with use decreasing since
• Cocaine is the 2nd most commonly used illegal drug, after cannabis
• Cocaine is now an “equal opportunity” drug used by many people irrespective of wealth, class or most other factors
• There is now a two tier market; very low-purity, cheaper cocaine, in parallel with a smaller trade in a more expensive version of higher purity.
• Many people use cocaine in combination with drinking alcohol on a night out

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Patterns of use and risks

The ACMD found that “the majority of users consume cocaine powder relatively infrequently and, even among users, there appears to be a reasonable level of awareness that cocaine powder is not a ‘safe’ drug.”

The main risks from regular or excessive use are:

• Heart and chest problems
• Necrosis of the septum from snorting
• An association with psychosis and depression
• Dangers from cutting agents

The other main risk is of course becoming dependent with all the associated problems of a life that is dominated by addiction.

The graphic from the report reproduced below shows the association between using cocaine powder and going out to the pub:

Treatment

Because so many people use cocaine on an intermittent, recreational basis and do not necessarily see drug treatment agencies as providing a service for them, as opposed to heroin users, the ACMD found it hard to reach any definitive conclusions about levels of treatment needed and treatment accessibility.

The ACMD says that the evidence for pharmacological treatment of cocaine (prescribing substitute medication) is weak but that CBT, Contingency Management and 12-step interventions are all regarded as helpful.

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Conclusion

Although the ACMD associates the substantial drop in the purity of much cocaine with the drug’s prevalence across the class and income divide, I am less convinced that this was the primary driver. The graph below shows that purity started to fall in 2003/4 by which time it was well established in many working people’s Friday and Saturday nights, although clearly the significant drop in purity and price did allow even more people to buy cocaine.