*Disclaimer: Please note that parts of this English blog were automatically translated.*
If you keep up with the news, it will not have escaped your attention: the crack problem in the Netherlands is regularly discussed, and is also becoming increasingly visible on the streets. Two former police officers produced a short report drawing comparisons with the heroin epidemic of the 1980s, and Pointer also ran a special feature (1,2). Femke Halsema sounded the alarm at the end of August: “You see truly appalling conditions in parks” (3). So the visibility of crack use is increasing, but are we actually facing a crack epidemic?
Crack is a processed form of cocaine. This processing makes the cocaine smokable: as a result, it enters the body more quickly, which makes the effects more intense and the risks greater (4). Recently, the Trimbos Institute published a news report on 10 years of drug use in the Netherlands (5). By 2025, approximately 2.7 per cent of Dutch adults will have used cocaine in the past year: that is around 380,000 people. They also report an increase in cocaine use amongst men and adults aged 30 and over between 2015 and 2025. These developments certainly provide cause to monitor cocaine use closely, but do not necessarily mean that we can speak of a crack epidemic. An important caveat is that this study does not distinguish between different forms of cocaine. Furthermore, these figures say nothing about the frequency of use, and we do not know whether these users are addicted or what health risks they face. This makes it more difficult to draw conclusions about the current situation, as a percentage of the total population does not tell the whole story regarding, for example, the concentration of problematic use within specific groups or environments. In short: these new figures on cocaine use do not provide us with all the information needed to gain a complete picture of the scale of the current problem.
The fact that we do not know exactly how big the problem is and who it affects most also makes it more difficult to provide the necessary (addiction) care. Of those struggling with this, very few end up receiving addiction care (3). This means that the pattern of use remains unclear, and that at present we do not know exactly who becomes addicted to (crack) cocaine, why, and how. Furthermore, there are no medicines proven to be effective for cocaine addiction (6), and treatment remains complex: it can therefore be difficult to access appropriate help (7). However, researchers are looking into this. The REDUCE study is testing a treatment using long-acting dexamfetamine, a medicine currently used, for example, to treat ADHD and narcolepsy (8). Unfortunately, this study has recently been put on hold due to the discontinuation of the medicine’s production.
It therefore remains difficult to determine, based on the available information, whether we are actually facing a crack epidemic. What is clear, however, is that we need to look beyond the figures. A sound drugs policy should not only focus on how many people are using drugs, but also on which groups are developing serious problems and how we can best reach and help them.
This blog was written by Joëlle Schokker (Radboud University) for RAD-blog, the blog about smoking, alcohol, drugs and diet.
References
- https://www.at5.nl/artikelen/240035/oud-agenten-vele-crackgebruik-begint-te-lijken-op-heroine-epidemie-uit-de-jaren-80
- https://pointer.kro-ncrv.nl/pointer-special-hoe-crack-nederland-verwoest
- https://www.nu.nl/binnenland/6409279/crackprobleem-steeds-zichtbaarder-maar-stap-om-hulp-te-vragen-is-moeilijk.html
- https://www.jellinek.nl/vraag-antwoord/wat-is-crack-of-basecoke/
- https://www.trimbos.nl/actueel/nieuws/wat-tien-jaar-onderzoek-laat-zien-over-drugsgebruik-in-nederland/
- https://www.parc-addictionresearch.nl/projecten-volwassenen/reduce
- https://www.amsterdam.nl/nieuws/nieuwsoverzicht/behandeling-crackverslaving/
- https://brijder.nl/zo-werkt-brijder/wetenschappelijk-onderzoek/onze-onderzoeken/reduce
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