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). 122 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 124 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 43 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. Wlnterl991 129 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) 130 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 131 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 Winter 1991 133 CHEUNG, ERICKSON, LANDAU 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 134 JOURNAL OF DRUG ISSUES 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. Winter 1991 135 CHEUNG, ERICKSON, LANDAU 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 136 JOURNAL OF DRUGISSUES 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 Winter 1991 137 CHEUNG, ERICKSON, LANDAU controlled to heavy use to abstinence, and from controlled use to abstinence. 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