The Journal of Drug Issues 21(1),121-140,1991
EXPERIENCE OF CRACK USE: FINDINGS FROM
A COMMUNITY-BASED SAMPLE IN TORONTO
Yuet W. Cheung
Patricia G. Erickson
Tammy C. Landau
Thispaperpresents Canadian data on crackuse collected from
a community-based study of seventy-nine crack users in
Toronto, and compares thesefindings withpopular images of
crackand itsusers. Crack wasportrayed in themedia andpolice
reports as extremely dangerous becauseofthequick and intense
highfrom smokingit and its powerfuladdictive property. Data
from the study show that, while the quick and intensehigh was
whatcrackuserslikedmost, adversephysical, psychologicaland
financialconsequences ofcrackaddiction have also cautioned
users. The overall frequencies of use in the past month, past
year, and lifetimewere quitelow, suggesting thatcrackuse is not
necessarily compulsive. The majorfactoraffecting levelofuse
wasperceived riskofharm. Crack users were likelyto bepowder
cocaineusers as well, and they did not differsignificantly from
powder users with respect to sociodemographic characteristics.
Treatment and prevention implications of the findings are
discussed.
Introduction
tarting in 1988, crack use and its impact on the individual user and society
have dominated the public's attention to the illicit drug scene in Canada.
Despite the near hysteria reflected at times, very little scientific findings on
crack in Canada have been available thus far. The purpose of this paper is to
report some findings from a community-based sample of crack users in Toronto.
S
Yuel W. Cheung, Ph.D., is with the Drug Policy Research Program at the Addiction Research
Poundation, 33 Russell Street, Toronto, Ontario Canada MSS 251 and the Department of Behavioral Science, University of Toronto. Patricia G. Erickson, Ph.D., is head of the Drug Policy
Research Program at the Addiction Research Foundation. Tammy C. Landau, M.A. ,was a senior
research assistant at the Drug PolicyResearch Program and is nowa doctoral student at the Centre
of Criminology, University of Toronto.
C Journal of Drug Issues, Inc. 0022-0426/91/01/121·140 $1.00
121
CHEUNG, ERICKSON, LANDAU
While "crack" is a new label, it is not at all a new drug. A form of freebase
cocaine, it is prepared by mixing cocaine hydrochloride (powder or "street"
cocaine) with water and baking soda, and heating the solution to remove the
hydrochloride.' The mixture thickens and becomes a waxy rock that "cracks"
in the glass pipe or other smoking device when burned. Crack is described in
the medical literature as more addictive than snortable cocaine (e.g., Lancet
1986; Mofenson et al. 1987). Ingestion through the lungs makes it effective in
just ten seconds, whereas the onset for intranasal ingestion may take several
minutes. While the "high" from smoking crack comes very quickly, it also lasts
for a shorter time, so that more "hits" are needed to maintain the same high.
While crack can be prepared by individual users, the "new bottle" for this "old
wine" is that it is pack~ed
and sold in small, ready-for-use quantities on the
street at "cheap" prices.
Before it made its way into Canada, crack had already gained a reputation
as "the most dangerous drug on earth" in the United States (Inciardi 1984).
When it started to appear in major Canadian cities such as Toronto, many
Canadians were alerted to the arrival of a "crack epidemic.,,3 Much of the
popular image of crack has been furnished and reinforced by the media and
police statistics.4 Despite the abundance of anecdotal accounts and reports in
the media and police records about crack users ruining their lives and
threatening society, such reporting provides little information about the
prevalence of crack use and about crack users not identified in the media or by
law enforcement agencies.
Scientific studies of crack use, mostly conducted in the United States,S have
not provided definitive results thus far. Studies of known addicts, including
clinical studies, have yielded results that tend to support the popular view that
crack is powerfully addictive, that the number of crack users is rapidly
increasing, and that crack use entails serious physical, psychological and social
consequences (e.g., Golbe and Merkin 1986; Jekel et al. 1986; Kissner et al.
1987; Strang et al. 1990; Washton et al. 1986; Zamora-Quezada et al. 1988).
However, because such studies selected subjects from treatment programs,
hospitals or other institutions, who were mostly heavy users requiring treatment
or other assistance, their samples did not include addicts who had not come to
official attention and lighter users.
Surveys of adult and student populations in the United States have generally
indicated low prevalence levels of crack use (e.g., Johnston et al. 1988; National
Institute on Drug Abuse 1989). In Canada, where data on crack mainly come
from a few surveys, similar findings have been found. In their survey of 1,040
Ontario adults aged eighteen and over during 1987, Smart and Adlaf (1987a)
found that only 0.7% (n = 8) of all respondents reported ever using crack, and
these respondents were not very different from other cocaine users (n = 64) in
the sample. In their 1989 survey of 1,101 Ontario adults, the percentage of
respondents who had used crack was still less than 1% (Adlaf and Smart 1989).
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JOURNAL OF DRUG ISSUES
EXPERIENCE OF CRACK USE
In the surveys of 4,267 Ontario high school students in 1987 and 4,500
students in 1989, the same researchers found that the percentages of students
reporting crack use in the past year were 1.4% in 1987 (Smart and Adlaf 1987b)
and 1% in 1989 (Smart and Adlaf 1989). The small percentages of adult and
student crack users fail to confirm the presence of a "crack epidemic" (Smart
1988).
One of the limitations with surveys is that they usually miss currently
institutionalized users and transients. Community-based ones are a third type
which generates self-selected samples from the community, through
advertisement or other campaigns, and/or the snow-ball technique. Samples of
such studies have the advantage of including subjects at various levels and
patterns of use - subjects who are probably more typical of users in the
community than are those in known-addicts studies. Findings of
community-based studies have not only found use to be somewhere between
the two extremes, but have provided more in-depth information on different
patterns of use and characteristics of users (e.g., Inciardi 1987; Waldorf et at.
1990). The major weaknesses of community-based studies are that their
samples are not probability ones, and that they also exclude users currently in
treatment or other institutions.6
To date, there have been very few known-addicts studies or
community-based studies of crack use in Canada. The purpose of this paper is,
therefore, to add to the scanty literature on crack use in Canada by presenting
findings from a recent community-based study of cocaine users in Toronto,
which included a group of crack users.
Method
Sample selection of the study began in early 1989 when advertisements were
placed in the media and posted in public places in Toronto. During the initial
telephone screening, callers who met the criteria of being eighteen or older and
having experience of cocaine and/or crack would be invited for the interview.
If the subject had used crack, he/she would be interviewed with an additional,
shorter questionnaire on crack use. By February 1990, 100 subjects had been
interviewed. Among them, seventy-nine had used crack, and the remaining
twenty-one had used only powder. Of the seventy-nine crack users (i.e.,
ever-in-lifetime users), seventy-four had also used powder, twenty-two had also
injected cocaine, and five had not used other forms of cocaine than crack.
Sample Characteristics
Among the seventy-nine crack users in the sample, three-quarters were
male. Age ranged from eighteen to forty-seven, with over half of the
respondents between the ages of twenty-one and thirty. A majority (70%) were
never married. In education, 40% had finished Grade 13 or under, and 15%
had finished university. Over half of the respondents had full-time
Winter 1991
123
CHEUNG, ERICKSON, LANDAU
employments, and among them, 60% were semi-skilled, lower-skilled or
unskilled workers, whereas 10% had managerial or professional positions.
About 40% were earning $20,000 or less a year, while one-quarter had a gross
personal income between $31,000 and $40,000 and almost 20% earned more
than $40,000. Thus, a majority of our crack users were young, single males, with
relatively low levels of education, occupation and income.
These crack users were also compared with subjects in the entire sample of
cocaine users who used only powder cocaine by snorting (n = 21) with respect
to the above sociodemographic characteristics. Statistical results (not reported
here) showed that none of these sociodemographic characteristics was found
to be significantly (at .05 level) different in the two groups. This echoes the
finding from a previous U.S. study of fifty-three crack users (Waldorf et al. 1990)
that there were few statistically significant differences between snorters
(powder users) and freebasers (crack users).
That crack users were not a distinct group of cocaine users is not difficult to
understand. In our crack users sample, many crack users were current or past
powder users as well. Among those who had used crack in the past month
(n = 25),84% had used powder in the past month, 88% had used powder in the
past year, and 92% had used powder in their lifetime. Even among those who
had not used crack in the past month (n = 53), 23% had used powder in the past
month, 87% had used powder in the past year, and 100% had used powder in
their lifetime. These figures suggest that crack was more commonly used in
addition to powder, rather than as a substitute for it.
Findings
Experience of Crack Use
The respondents were asked a number of questions concerning their
experience of crack use. Results are presented in Table l.
Over three-quarters of respondents had not tried crack more than three
years ago, reflecting the recency of the popularity of crack in Canada (Erickson
et al. 1987:139-140). But since crack as a form of freebase cocaine has existed
for some time (Inciardi 1987), it is not surprising that more than one-fifth of our
users had first used crack four or more years ago.
As in the case of many other drugs, males played a more active role than
females in the introduction of crack to non-users. About three-quarters of the
respondents were introduced to crack by males. The largest percentage (62%)
of introducers were found amongfriends, whereas other introducers included
spouse/common law or intimate friends, co-workers and dealers.
Home was the most common situation for both first and subsequent use of
crack. Half of the respondents first tried crack at a friend's home, and one-fifth
in their own homes. About 80% reported that the most common situation for
later crack use was either friends' homes or own home. Clubs and bars were
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JOURNAL OF DRUG ISSUES
EXPERIENCE OF CRACK USE
Table 1
Experience of Crack Use (N =78)*
(%)
(n)
41.5
13.0
11.7
2.6
5.2
2.6
23.4
18
32
10
9
2
4
2
(2) Sex of introducer
Male
Female
More than one person
74.4
19.2
6.4
58
15
5
(3) Introducer's relationship to respondent
~ouse/com n-Iaw/int mate
friend
ther friends
Co-worker
Dealer
Other
10.3
61.5
6.4
11.5
10.3
8
48
5
9
8
(4) Situation of first use (N = 77)
Own home
Friend's home
At work
At school
Club/bar
Street/other outdoor public place
Other
22.1
51.9
1.3
1.3
2.6
3.9
16.9
17
40
1
1
2
3
13
2.7
5.5
9.6
9.6
19.2
2
4
7
7
14
(1) Years ago fIrst used crack (N = 77)
1 year
2 years
3 years
4 years
5 years
6 years
7 years
(5) Most common situation for use (N = 73)
Club/bar
Parties
Own home alone
Own home with others living there
Own home with friends
Friend's home
Other situation
Varies a lot
(6) Friends who sometimes use crack
None
Only a few
About half
Almost all
Don't know
Wlnterl991
38.4
10.9
4.1
19.2
48.7
11.5
19.2
1.3
28
8
3
15
38
9
15
1
us
CHEUNG, ERICKSON, LANDAU
(%)
(n)
(7) Availability of crack
Very difficult
Difficult
Sometimes difficult
Easy
Very Easy
6.4
1.3
9.0
11.5
71.8
5
(8) Amount of crack used on each occasion
0.025 to 0.25 gram
0.26 to 1.00 gram
1.01 to 2.00 gram
2.01 to 3.00 gram
3.01 to 4.00 gram
Over 4 grams
No answer
20.5
21.8
23.1
3.8
3.8
6.4
20.5
16
(9) Average price of crack (per gram)
$10 - 50
$51 - 100
$101- 150
$151- 200
Over $200
No answer
12.8
29.5
24.4
3.8
1.3
28.2
10
23
19
3
1
22
(10) Effects of crack liked most (selected responses)
43.6
(i) "Rush"
16.7
(il) Euphoric feeling
34
(11) Effects of crack liked least (selected responses)
i) "Coming down"
11.9
ii) Short "high"
11.5
iii) Craving to use more
21.8
iv) Financial cost
..
15.4
v) Various adverse physical effects
43.6
j
1
7
9
56
17
18
3
3
5
16
13
14
9
17
12
34
(12) Frequency of craving for crack
N~
Rarely
Sometimes
Most times
Always
~9
17.9
15.4
14.1
16.7
(13) Perceived risk of harm in trying crack once or twice
No~k
10.3
Slight risk
15.4
Moderate risk
19.2
Great risk
55.1
126
28
14
12
11
13
8
12
15
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JOURNAL OF DRUG ISSUES
EXPERIENCE OF CRACK USE
(%)
(14) Perceived risk of harm in using crack occasionally
No risk
2.6
Slight risk
12.8
Moderate risk
17.9
Great risk
66.7
(n)
2
10
14
52
(15) Perceived risk of harm in using crack regularly
No risk
1.3
Slight risk
0.0
Moderate risk
7.7
Great risk
91.0
71
(16) Ever concerned about becoming addicted
No
Yes
No answer
48.7
48.7
2.6
38
38
2
(17) Preferred form of cocaine
Powder
Crack
No preference/don't know
No answer
47.4
46.2
5.1
1.3
37
36
4
1
1
o
6
• N was reduced from 79 to 78 because of one missing case.
usual crack use settings for only 3% of users. Even parties were not popular
occasions for crack use, as only 6%usually used crack at parties. This finding
is consistent with those of previous studies (e.g., Waldorf et al. 1990) that crack
use is quite an anti-social or socially isolated practice.
When asked how many of the people with whom respondents usually
socialized sometimes used crack, one-fifth reported "none" and almost half
mentioned "only a few." "Heavy" peer use ("about half" or "almost all" of
friends) was reported by only 30% of respondents. That low peer use was
reported by a majority of crack users is indirect evidence that crack use may not
be as widespread as the media have depicted.f
Crack is believed to be easily available because of the sale of ready-far-use
lumps of crack on the street. Indeed, the majority (83%) of respondents
pointed out that it was either "easy" or "very easy" to get crack. However, many
ofthem prepared crack cocaine themselves (or had friends prepare it) rather
than buying it off the street.s Thus, the easyavailability of crack to this sample
of users may just reflect the availability of powder cocaine in general rather than
the packaging and marketing of "rocks" on the street.
The amount of crack consumed on anyone occasion varied a great deal
among the users, ranging from .025 grams to 7 grams, with 1.5 grams as the
median amount. However, answers given to this question might not be as
accurate as we would like, as those users who prepared crack themselves would
Winter 1991
127
CHEUNG, ERICKSON, LANDAU
not know the exact weight of crack after it was cooked from powder. They might
be just reporting the amount of powder used for cooking. One-fifth of the
respondents were unable to estimate the amount of crack consumed on each
occasion.
The average price for crack also varied tremendously. Over 40% got it at
$100 or less per gram, whereas one-quarter got it between $101 and $150.
Again, like the previous question on amount, some might have just reported the
price of powder cocaine. About 30% were unable to give a definite answer.
One of the central issues about crack use is the immediacy and intensity of
its efforts. Much of what our respondents reported about effects of crack
supports the popular media image of the drug, as well as that described in the
medical literature. When asked to give up to three responses about effectsthey
liked most, almost half mentioned "the rapid, intense reaction" (the "rush") as
one of their three responses. About one-fifth mentioned "the really good or
euphoric feeling." Other pleasurable effects reported included "the boost of
energy," "sexual arousal," "improvement in sociability," "escape from worries
and tensions," "new experience," "keeping me awake," "light headedness," "the
taste of it," "talkativeness," and even "ringing in ears."
Likewise, respondents were asked to name up to three effectsthey likedleast.
From media accounts, the short duration of the "high" and the "coming down"
that follows would be the most unpleasant experience for crack users. Indeed,
18% and 12% of users in our sample mentioned "coming down" and "the short
high," respectively, as the things they liked least. It should be noted, however,
that there were other equally important worries. Almost half disliked the
adverse physical effects due to crack. Among the physical effects described
were "nausea," "overstimulation," "faster heart rate," "sweating," "burnt
lungs," and "headache." Besides physical effects, psychological effects such as
anxiousness and depression were also bothersome to some (13%). Also, 15%
complained about "the financial cost" of use.
Crack has been described as extremely addictive, so that one hit would
inevitably lead to subsequent uncontrollable use. In our sample, twenty-two
percent considered "the urge/craving to use more" to be what they liked least
about crack. When asked how often, if ever, have they experienced a craving or
uncontrollable urge to take crack, over half (54%) of users replied "rarely" or
"never," suggesting that at least for them, crack use had not become compulsive.
However, it should also be noted that 15% "sometimes" experienced such an
urge, and as many as 31 % "always" had that experience or had it "most of the
time."
Given that a large variety of negative effects of crack were mentioned and
that 46% of users had experienced some extent of an uncontrollable urge, there
seemed to be a recognition of the risk of harm in using crack. Indeed, when
asked how much they thought people risk harming themselves if they used crack,
many users perceived great risk, and the percentage of users perceiving great
128
JOURNAL OF DRUG ISSUES
EXPERIENCE OF CRACK USE
risk increased with hypothetical heavier use. More than half said there would
be "great risk" if people "try crack once or twice," two-thirds perceived great
risk if people "use crack occasionally," and nine-tenths mentioned great risk if
they "use crack regularly."
The perception of risk of harm due to crack use might have caused concern
in users who had experienced, at least sometimes, an uncontrollable urge to take
crack (about 46% as noted above). When the respondents were asked whether
they had ever felt concernedaboutbecomingaddictedto crack, half replied "yes"
and half said "no."
Lastly, when asked whichfonn ofcocainetheypreferred, only 46% said they
preferred crack to powder. A similar percentage actually preferred snortable
powder cocaine to crack. The remaining 6% either had no preference or gave
no answer. Given the popular image of crack, this finding seems surprising.
However, it is not unsettling because the negative physical, psychological and
financial effects of crack, the perceived risk of harm in occasional and regular
crack use, and the concern about addiction might have alerted a large number
of crack users to the possible dangers of heavy use. Indeed, as willbe discussed
later, a large percentage of respondents had actually stopped use for a month
or even a year. After all, as pointed out earlier, crack was used among
respondents in this study as an addition to powder, not a substitute. As such, it
seems reasonable that powder remained the "main staple," whereas crack
served as an additional diet for satisfying sporadic desires for the "rush" and
euphoria.
In sum, a crack user was likely to have tried crack less than three years ago,
be introduced to crack by a male friend, and to use crack at own or friend's
home. Crack use, however, was not too common among friends. Crack was
easily available. The rush and euphoria were what users liked most about crack.
The short high, the coming down, adverse physical effects, and the craving to
use more were what users liked least. Also, users generally perceived high risks
of harm for both occasional and regular use of crack.
Besides these similarities among them, crack users were found to vary in
other aspects of crack use: the amount of crack used on each occasion, the price
of crack they paid, the frequency of experiencing craving or uncontrollable urge,
their concern about becoming addicted, and the form of cocaine they preferred.
Frequency of Useand User Type
If, for some users, crack use may entail craving to use more and undesirable
physical, psychological and financial consequences, different users may exhibit
different levels of use, according to individual preference and physical and
financial constraints. What were the frequencies of use in our sample?
The respondents were asked about use in lifetime, the past year, and the past
month. Results are presented in Table 2.
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CHEUNG, ERICKSON, LANDAU
Table 2
Frequency of Crack Use (N = 79)
Frequency
Never
1- 2 times
3 - 5 times
6 - 9 times
10 -19 times
20 - 39 times
40 - 99 times
100 times or more
Use in Lifetime
(%)
(n)
0.0
(0)
11.4
(9)
11.4
(9)
3.8
(3)
8.8
(7)
5.1
(4)
22.8 (18)
36.7 (29)
Use in Past Year Use in Past Month
(%)
(n)
(%)
(n)
67.1 (53)
13.9 (11)
13.9 (11)
13.9 (11)
5.0
(4)
10.1
(8)
3.8
(3)
0.0
(0)
10.1
(8)
5.1
(4)
6.3
(5)
6.3
(5)
12.7 (10)
1.3
(1)
29.1 (23)
1.3
(1)
Data in Table 2 show an infrequent pattern of crack use. In the past month,
67% had not used it, while 19% had used it less than 10 times, 5% had used it
between ten and nineteen times, 6% had used it twenty to thirty-nine times, and
3% had used it forty times or more. If we treat twenty times or more in the past
month as "heavy use," 9% of the respondents were currently "heavy users."
Findings on use in the past year and in the lifetime suggest that use was not
heavy in these two periods either. Half (52%) had not used crack twenty times
or more in the whole year, and 60% had not used it forty times or more in their
lifetime.
The above data show the trend of use for the whole group, but cannot
capture the individual user's difference in use between two or more time
periods. We therefore constructed a typol0&r of users based on frequency of
use in the past year and that in the past month. Because of the thin distribution
of cases in various categories of times of use for past month (see Table 2), we
collapsed all such categories into a "have used" category, so that frequency 01
use consists of only the "have used" and "have not used" categories. Also, we
did not combine frequency with amount of crack used each time to form a level
of use index because of the crude measure of frequency, and because of possible
inaccuracy of responses to the amount question mentioned above. With the
frequency dimension ("have used" or "have not used") and the time dimension
("past year" and "past month"),l0 we obtained three types of users, whose labels
and distributions are presented in Table 3.
Users who had used crack both in the past year and in the past month are
designated as continuous users. This type of users comprised 32% (n = 25) of
the sample. Some users had used crack in the past year, but had not used it in
the past month. Such users, 54% (0 = 42) of them in the sample, had become
inactive users, because they had currently stopped use. There were 14% (n = 11)
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JOURNAL OF DRUG ISSUES
EXPERIENCE OF CRACK USE
Table 3
User Type (N=78)*
Past Year
Past Month
Have Used
Have used
Continuous User
[32.1% (n=25)]
Have not used
Inactive User
[53.8% (n=42)]
Have Not Used
Abstainer
[14.1% (n = 11)]
• One missing case.
who belonged to a third type of users - abstainers, who had stopped use for
one whole year.
The fact that only 32% of all respondents were currently "continuous users"
and that among them, only 28% were "heavy" (twenty times or more per month)
users, suggests that crack use is not necessarily compulsive after a period of time
since first use. Others in the sample had even refrained from use, for either a
year or a month at time of interview. It is not unreasonable to predict that many,
if not all, of the "inactive users" and "abstainers" would continue to not use in
future, although the present typology of users cannot be used to infer future use
patterns.
User Typeand Experience of Crack
Did the three types of users differ in their experience of crack use? Nine
out of the seventeen experience items discussed above were selected for
comparison.v' They were: (i) number of friends using crack; (ii) liked rush
most; (iii) least liked coming down/short high/craving; (iv) frequency of craving;
(v) concern about becoming addicted; (vi) preferred form of cocaine;12 (vii)
perceived risk of harm in trying crack once or twice; (viii) perceived risk of harm
in using crack occasionally; and (ix) perceived risk of harm in using crack
regularly.
Results ofstatistical tests (not reported here) indicate that user type was not
significantly (at .05 level) related to friends' use, what was liked most and least,
frequency of craving, concern about addiction, and preferred form of cocaine.
They also did not differ in their view of regular crack use, as most or 90% of
them accorded great risk in such use (see Table 4). They only differed
significantly in their perception of risk of harm in trying crack once or twice and
in occasional use (Table 4).
Winter 1991
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CHEUNG, ERICKSON, LANDAU
Table 4
User Type and Perceived Risk of Harm in Trying, Occasional Use and
Regular Use (%)
Abstainers
(n=11)
User Type *
Inactive Users
(n=42)
Continuous Users
(n=24)
0.0
9.1
54.5
36.4
9.5
9.5
9.5
71.4
16.0
28.0
20.0
36.0
0.0
0.0
36.4
63.6
0.0
9.5
11.9
78.6
8.0
24.0
20.0
48.0
0.0
0.0
0.0
100.0
0.0
0.0
7.1
92.9
4.0
0.0
12.0
84.0
Risk of harm in trying
crack once or twice
No risk
Slight risk
Moderate risk
Great risk
(r=-22; p=.026)
Risk of harm in using
crack occasionally
No risk
Slight risk
Moderate risk
Great risk
(r=-.28; p=.OO6)
Risk of harm in using crack
regularly
No risk
Slight risk
Moderate risk
Great risk
(No statistical test was
performed due to large
number of empty cells.)
• N = Tl due to two missing cases.
Data in Table 4 clearly depict a significant association between level of use
(user type) and amount of perceived risk in trying and occasionally using crack.
For trying, abstainers and inactive users had higher percentages (90% and 80%,
respectively) perceiving great or moderate risk than continuous users (56%).
Conversely, the percentage perceiving no risk or only slight risk was higher in
continuous users (44%) than in inactive users (19%) and abstainers (9%).
132
JOURNAL OF DRUG ISSUES
EXPERIENCE OF CRACK USE
Similarly, for occasional use, abstainers and inactive users had larger
percentages perceiving great or moderate risk (100% and 90%) than
continuous users (68%). Over 30% of continuous users perceived no or slight
risk, whereas only 10% of inactive users and none of the abstainers held the
same view.
In sum, the three groups of users did not differ significantly in the various
items of experience of crack use, except perceived risk in crack use. However,
the groups had dissimilar views in lower levels of use only (trying and
occasional), with continuous users perceiving less risk than abstainers and
inactive users. All three groups perceived great risk in regular use. That may
be why the use of crack was infrequent even among continuous users (Table 2).
Summary and Discussion
The purpose of this paper was to present findings from a community-based
study of seventy-nine crack users in Toronto. It also compared these findings
with some popular images of crack use and users. Crack as portrayed in the
media and police sources is an extremely dangerous drug because of the quick
and intense high from smoking it, its powerful addictive property, and the
serious health and financial consequences entailed in the use of it.
Findings from the present study lend support to only part of the above
description about crack. The "rush" and euphoria from smoking crack were,
indeed, what our respondents were attracted to. However, there was a lack of
strong evidence to support the view that the use of the drug is necessarily
compulsive. Over half of the respondents had never or rarely experienced a
craving to take crack. Almost half were not concerned about becoming
addicted. Less than half preferred crack to powder cocaine. What is even more
noteworthy is the overall low frequency of use. At time of interview, two-thirds
of the respondents had not used crack for a month, and 14% had even stopped
use for a year. Only 30% had used it continuously in the past year. Daily users
comprised only 6% of the sample. Thus, to a majority of our respondents, crack
was not "the drug of choice." Our data do not show whether or not a
respondent's use of crack had been uncontrollable in the initial period. What
is clear, though, is that, even if compulsive use had occurred before, reduction
to infrequent use or abstinence would be the pattern for the majority of crack
users over a period of time. 13
If crack use is not necessarily compulsive for a long period of time, just what
are the factors that determine various levels of use? Our data have shown that
it was exactly the possible dangerous physical, social and financial consequences
of crack addiction that have cautioned most users not to engage in regular use.
The greater the perceived riskofharm in crack use, the lower the level of use.14
After all, crack users in this study are not a different group of cocaine users.
Comparisons of the crack users group and a group who had used only powder
in the same study showed that there were no significant differences between the
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two groups with respect to sociodemographic characteristics. As a matter of
fact, crack users in this study were very likely to be powder users at the same
time. Crack was usually used in addition to powder, not as a substitute.
Therefore, crack use and its consequences should be understood within the
context of cocaine use in general.
In a recent detailed review of animal studies, clinical studies, population
surveys and studies of community samples of cocaine users, Erickson and
Alexander (1989) have shown that the "addictive liability" of cocaine has been
overstated, as only 5% to 10% of those who try cocaine will progress to more
intensive use such as weekly or more often. Our data on crack use revealed a
similar pattern. At the most, only 9% of current users were in the "heavy use"
category (twenty times or more per month). Others either maintained a very
low level of continuous use, or simply abstained from use for various lengths of
time.
The discrepancy between popular beliefs about crack and findings in this
study is due to the fact that the former focus only on the effects of the
pharmacological property of crack on the user as a vulnerable biological
mechanism. It does not take into account the subjective factor of the user's
perception of risk which would also shape his/her crack use behavior. Many
users of addictive drugs are able to weigh the pleasure derived from using the
drugs with perceived undesirable consequences. Some of them maintain a level
of continuous use that their physical, social and financial conditions allow.
Others may simply quit because the risk is too high for continuous use. The
strong association between perceived risk and level of use in our sample of crack
users supports this view.
Findings from this study have several implications for treatment and
prevention. First, like the case of cocaine scare during the 1980s, which has
greatly inflated the estimate of cocaine users requiring treatment and related
services (Erickson and Alexander 1989:264), the present "crack menace" may
also lead to a prediction of treatment needs that is higher than realistic levels.
Second, the "crack menace" has also provided a classic example of the
"targeting" problem of law enforcement. Studies in the United States have
suggested that the police, with both pressure from and support of the
community, are directing their attention and resources at highly selected
segments of the drug users population, such as racial minorities and the poor
(Reinarrnan and Levine 1989). Crack users also face stiffer penalties than other
drug offenders in court, and the large number of arrests for crack in urban
centers is itself putting additional burdens on the criminal law system (Belenko
and Fagan 1987 and 1988; Belenko et al. 1990).
To addicts, the over-emphasis on the pharmacological effects of crack may
send the wrong message that treatment isjust a matter of medical manipulation.
Such a message may mislead them into overlooking the need to change their
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EXPERIENCE OF CRACK USE
lifestyle, re-arrange priorities, and re-develop normal social relationships,
which are very crucial in their regaining control from the drug.
The portrayal of an extreme view of the power of crack could dilute the
effects of prevention efforts. The worst scenario of crack addiction depicted in
the media and prevention programs is not likely to be the experience of most
current users. For potential users, the credibility of such prevention
information could be drastically eroded once they learn from current users that
the worst scenario is an exception rather than a rule. Thus, the real risks of
crack addiction should be spelled out, so that potential users can have an
accurate perception of the risks involved if they start use.
If perception of risk is an important factor in shaping a person's drug use,
the reference point for perception would include not only health and financial
conditions, but also social and psychological factors. Indeed, as shown by
Waldorf et al. (1990) in their study of crack users in the United States, many
crack users stopped use because of their social backgrounds. For example,
quite a number of middle-class users made painful efforts to quit because they
could not afford to lose their good jobs, ruin their social status, destroy their
families, or become physically incapacitated. People who have a stake in
maintaining a "proper" and respectable life are subject to greater constraints
for heavy drug use. Conversely, people who have not fared well in employment,
family relationships or social circles have much less to lose if they indulge in
addictive use. Thus, there is a need for prevention work to be more focused on
this segment of the population.
This paper has reported findings from one of the earliest community-based
studies of crack use in Canada. While these findings should be tested by more
community-based studies, the longitudinal component of this study will provide
more insights into crack use patterns and the addictive liability of crack. Apart
from community-based and ethnographic studies, more studies are also needed
in other streams of research - studies of known-addicts and clinical samples,
and surveys - for a more balanced and accurate understanding of crack use
and its individual and social impacts in Canada.
ACKNOWLEDGEMENTS
The authors wish to thank Reg Smart for his comments and Valerie Watson,
Tim Weber and Christine Leonard for their research assistance. Data for this
paper were extracted from the project entitled "A Longitudinal Study of
Cocaine Users: The Natural History of Cocaine Use and its Consequences
Among Canadian Adults," which was funded by the National Health and
Research Development Program, Health and Welfare Canada (Reference
Number 6606-3929-DA). The views expressed in this paper are those of the
authors and do not necessarily reflect those of the Addiction Research
Foundation or the University of Toronto.
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NOTES
1. Another form of freebase cocaine, which has a longer history than crack, is
prepared by extracting cocaine hydrochloride with ammonia (an alkali) and
then mixing it with ether (a solvent). The freebase material is obtained by
separating the solvent fraction. Smoking this form of freebase cocaine is more
dangerous because ether is flammable and explosive. For a detailed description
ofthe history of cocaine smoking, see Siegel (1982).
2. While a gram of cocaine powder may cost $60 or more, the same amount can
produce five to thirty "rocks." Each rock could be purchased for five, ten or
twenty dollars (Inciardi 1987:470).
3. Crack has also become a concern of the British government, and the Home
Affairs Committee (1989) visited the United States in 1985 to study the threat
of crack and other "hard" drugs.
4. For example, the "crack problem" is considered to be "the greatest threat to
society in general, of any single development over the past 15 years" (Toronto
Star, 24 February 1989). Police reported that much of the 73.7 kilograms of
cocaine seized in Metro Toronto in 1989 was crack (Toronto Star, 1 February
1990). Crack use was reported to be strongly linked to criminal involvement, as
the powerful addictiveness of crack was thought to lead users to do anything for
another hit (Globe and Mail, 11 February 1989). Crack is portrayed as "a
one-way ticket to hell for the user" (Toronto Star, 16 June 1989), and crack use
has reached "crisis proportions" (Globe and Mail, 11 February 1989) in urban
America. Users are characterized as "a very, very paranoid, psychotic group"
(Globe and Mail, 11 February 1989). Unlike the elite, upscale image of cocaine
in the late 1970s and the early 198Os, crack is seen as "the poor man's cocaine"
and the "T.V. dinner version of freebase cocaine" (Toronto Star, 7 May 1989),
having its most devastating effects in poorer neighborhoods (Globe and Mail,
11 February 1989).
5. To add to the scanty but growing literature on crack, two special issues of
Contemporary Drug Problems (Winter 1989 and Spring 1990) were devoted to
topics related to crack and its use.
6. For brief discussions on advantages and disadvantages of studies of known
addicts, surveys of general populations, and community-based studies, see for
example, Erickson and Alexander (1989) and Cheung (1989).
7. The low peer crack use among crack users is in contrast with peer cocaine
use and peer cannabis use. For example, in a study of 111 cocaine users,
Erickson and Murray (1989) reported that about 50% of the subjects had half
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EXPERIENCE OF CRACK USE
or all of their friends using cocaine, and about 90% had half or all of their friends
using cannabis.
8. During the initial telephone screening and the interview, respondents were
generally uncomfortable with the suggestion that smoking freebase cocaine
which they prepared from cocaine hydrochloride is the same as smoking crack.
They maintained that crack is something that is brought off the street, and if
they are making it themselves, it is not crack.
9. Data on lifetime use were not included in the construction of the typology
for two reasons. First, lifetime frequencies are less reliable than past-year and
past-month ones because of recall inaccuracy. Second, low frequency of
lifetime use suggests that a user's frequency of use beyond past year would
probably be very low, so that his/her use within the past year could reflect a more
stabilized frequency after the initial period of trying crack.
10. It should be mentioned that siuce "number of years ago first used crack"
was calculated from the difference between "age" and "age first tried crack," a
difference of one year might not necessarily mean one whole year. That is, a
respondent could have used crack for less than a year even though he/she was
placed in the "first used crack 1 year ago" category. For such cases, we would
actually be comparing use in past month with use in less than a year. That is
acceptable in our typology, because we can still capture the individual user's
change in use over time. The respondents could not have first tried crack within
the past month, because if they had, their value for "year ago first used crack"
would have been zero. There was, however, no respondent with this value
regarding number of years ago first used crack.
11. The other experience items were not included because they were apparently
not important for the present analysis. Such items included those concerning
first crack use, situation of use (mostly home), availabilityof crack (mostly easily
available), amount used each time (unreliable answers) and price (unreliable
answers).
12. There were two cases in the "no preference/don't know" category. They
were excluded in the analysis of the relationship between user type and
preferred form of cocaine because of the lack of clarity of this category and the
extremely small number of cases which, if included in statistical operations,
might unduly affect statistical values.
13. Changes in use patterns over time were also found among cocaine users.
For example, in an 11-year follow-up study of a network of twenty-one cocaine
users, Murphy et al. (1989) found four main types of career use patterns:
continuous controlled use, from controlled to heavy to controlled use, from
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controlled to heavy use to abstinence, and from controlled use to abstinence.
Only one user maintained continuous heavy use.
14. This finding is strikingly similar to the case of cocaine users. In a previous
Canadian study of a community-based sample of 111 cocaine users, Erickson
and Murray (1989) reported that perceived health threats was one ofthe most
important factors affecting intention to quit cocaine use.
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