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THE HSE IS planning a harm reduction information campaign in response to a significant increase in use of crack-cocaine in Dublin city centre.

Drug service workers on both sides of the Liffey have noticed an increase in availability and use of the drug since last summer.

“Crack-cocaine isn’t new – it would come and go as a drug trend but this is more sustained use,” said Tony Duffin of the Ana Liffey Drug Project.

A smokeable form of cocaine made by chemically altering cocaine powder to form crystals or rocks, crack-cocaine produces a short but intense high with effects much stronger than the powdered version of the drug.

Duffin said the rise in availability of cocaine in the capital had led to an increase in the amount of crack being manufactured.

He explained:

There was something that happened around the summer of last year – a rock of crack would cost around €50. Dealers began to make smaller rocks for €25 so people could buy them for cheaper.

Duffin, who’s CEO of the Abbey Street-based addiction and outreach organisation, said there was a cohort of around 40 people in the north inner city area regularly using crack-cocaine.

Tony Geoghegan of Merchant’s Quay Ireland, on the city’s south quays, said that out of almost 1,300 individuals using of their needle exchange services in the first three months of the year, 242 people reported using crack-cocaine.

The figures, which cover 1 January to 15 March, are collated from 5,930 individual visits to the MQI centre.

Most users smoke the drug, but a smaller number inject it intravenously and it’s often taken in combination with other substances.

Said Geoghegan:

All the staff are saying we’re getting much more people using it. We’re getting more requests for paraphernalia, for crack pipes to give out.

Similar to the approach taken to needle exchange, drug services offer clean crack pipes to service-users as part of their harm reduction efforts in a bid to cut down on the spread of hepatitis C and other blood-borne disease.

“With the pipes there are individual mouthpieces,” the Merchant’s Quay CEO said.

While smoking crack is obviously physically harmful in terms of the respiratory system, if it’s being smoked in a pipe rather than something someone has made ad-hoc it would be less harmful.

Users tend to manufacture pipes with plastic bottles and tin-foil, he explained, “and they’d tend to inhale some of the plastic as well. It really adds to the harm.”

People who use crack are also at increased health risk as the effects of the drug mean they stay awake for longer, Geoghegan said.

“People have the capacity to use a lot more than they do on heroin. If people are using heroin they can only take so much and then people fall asleep.

With crack it’s the opposite direction – people will stay up for days at a time so you can actually see people, when they go on crack binges, that they physically deteriorate much, much quicker.

You can see weight falling off people, you can see their skin breaking out in acne and things like that.

Increase in cocaine use 

The latest drug treatment report from the Health Research Board, published last week, points to an increase in cocaine use in recent years. In 2016, the most recent year for which data is available, problem cocaine use was reported in 12.6% of all treated drug use cases – the highest figure since 2010.

That report, which covered a seven-year period from the start of the decade, also pointed to continuing high rates of polydrug use (the use of a combination of substances, often with alcohol).

An ad-hoc crack pipe found on the streets of Dublin TheJournal.ie TheJournal.ie

Tony Duffin said that in many cases people who used crack-cocaine were often doing ‘speedballs’ (a mixture of crack and heroin) or taking the drug in addition to alcohol or sedatives like benzodiazepines.

People using crack, he said, “can be quite agitated and there are reports of people being threatening, but the truth is that people are people and our team work very closely with the people who present to them – it just means we have to be cognisant of the behaviours and of any risk and to manage those risks”.

Those people are the same people they have always been. They are taking different types of drugs but engaging is the most important thing we can do and we will carry on doing that.

One of the primary priorities, he said, as with needle exchange, is to make things safer for the person by giving the right advice and clean equipment “but also to engage with them and try and encourage them to make healthier choices”.

I think the most important harm reduction aspect of it is that you’re getting to engage with the person and that you’re able to leverage that and build rapport with people to try and make a difference.

A spokesperson for the HSE said it was now finalising a specific harm reduction information campaign focusing on cocaine and crack-cocaine.

Health-based response to drug use 

The government last week opened its public consultation on possession of small amounts of illegal drugs for personal use, including the launch of an online questionnaire.

It follows on from a recommendation in 2015 by an Oireachtas committee that recommended changing to a system whereby “the possession of a small amount of illegal drugs for personal use, could be dealt with by way of a civil/administrative response rather than via the criminal justice route”.

The Ana Liffey Drug Project is holding a series of town hall-style public meetings on the issue in the coming months, beginning at the Wood Quay venue in Dublin next week.