After opiates and cannabis, cocaine is the most common drug reported as the principal drug used by those entering drug treatment and accounts for about 10 % of all treatment demands across the EU. However, this overall figure reflects a wide variation between countries: in most countries treatment demands related to cocaine use are quite low, but Spain and the Netherlands the proportion of all clients who ask for treatment for cocaine use is 26 % and 38 % respectively (93). In most countries, the percentages of new clients demanding treatment for primary cocaine use are higher than for all clients overall (94). Cocaine is also reported as a secondary drug by 13 % of new clients seeking treatment in outpatient treatment centres (95).
Many countries report increases in cocaine use among clients seeking treatment; from 1996 to 2003, the proportion of new clients demanding treatment for cocaine use grew from 4.8 % to 9.3 %, and the number of new clients asking for treatment for primary cocaine use rose from 2 535 to 6 123. In the Netherlands, in 2003, for the first time, new clients demanding treatment for cocaine use exceeded those demanding treatment for opiate use. From an analysis of treatment data produced in London, during the period 1995–96 to 2000–01, the number of clients using cocaine more than doubled (GLADA, 2004), albeit from a low baseline (735 to 1 917).
These data are probably influenced by a small but growing crack cocaine (smokable cocaine base) problem, of which there have been indications from both the Netherlands and the United Kingdom, where the number of crack cocaine clients has increased in recent years. Although the numbers of problematic users are low, they tend to be concentrated in a few major urban areas and therefore are most visible in reports from city-based monitoring.
Crack cocaine users tend to have a different social background from users of cocaine powder. Crack cocaine users are more likely to be socially disadvantaged, and there is some evidence to suggest that ethnic minority populations may be particularly vulnerable to crack cocaine problems: two thirds of black people requesting drug treatment in London are primary crack cocaine users (GLADA, 2004) and 30 % of crack cocaine clients in the Netherlands have a non-Dutch background. Despite worries about crack cocaine, it should be remembered that, although the drug is associated with particular damage to both the individuals who use it and the communities in which they live, this problem remains highly localised in Europe. It should be noted that crack cocaine clients are mainly reported by two countries (the Netherlands and the United Kingdom).
Overall, most cocaine treatment demands in Europe are not related to crack cocaine. Around 70 % of new cocaine clients are using cocaine hydrochloride (cocaine powder) (most sniffing the drug) and the remaining 30 % are using crack cocaine. Around 5 % of new cocaine clients report injecting cocaine.
New clients asking for treatment for primary cocaine use are predominantly males (3.7:1 male to female ratio). Differences between countries are found in the gender distribution (96). A qualitative research study carried out in Italy on clients requesting treatment for use of stimulants, mainly cocaine, reports that women almost equal men among consumers, but among people demanding treatment for cocaine and other stimulants the male to female ratio is strongly biased towards males (Macchia et al., 2004).
New clients using cocaine as the primary drug are on average older than other drug consumers (mean age of 30 years, with most in the 20–34 year age group); a smaller, although important, proportion of clients is reported to be between 35 and 39 years (97).
Cocaine is often used in combination with another subsidiary drug, often cannabis (40 %) or alcohol (37 %). Local studies of drug injectors suggest that, in some areas, the combination of heroin and cocaine within an injection is becoming more popular (sometimes referred to by drug injectors as ‘speedballing’). If this is the case, it is not evident in the overall treatment demand data from most countries, in which only a small proportion of clients report the combined use of heroin and cocaine. However, this is not true for all countries; for example, in the Netherlands, an analysis of treatment demand data for cocaine users suggests that many cocaine clients are polydrug consumers and that the largest group is composed of those using both cocaine and heroin (Mol et al., 2002).
(92) Data analysis is based on clients demanding treatment in all treatment centres for the general distribution and the trends, and on outpatient treatment centres for profiles of clients and patterns of use.
(96) See Table TDI-22 in the 2005 statistical bulletin and Differences in patterns of drug use between women and men.