No. 17: Cocaine use in Europe: implications for service delivery 

Cocaine use presents new challenges for Europe’s drug treatment services.  Although services can leverage experiences gained in responding to other types of drug problems, the pharmacology of cocaine, the social diversity of users and the concurrent use of other psychoactive substances complicate the development and targeting of responses. And unlike treatment for opioid users, there are no proven effective substitution or pharmacological treatment options currently available for cocaine users. This paper addresses a number of important issues for the delivery of services for cocaine users. How can the different groups of users be reached and helped? What type of treatment should be made available for dependent cocaine users? Are new specialised services needed, or should existing ones be adapted? 

 Key issues at a glance.

1.              Some 4.5 million European adults (1.3%) have used cocaine in the last year. Last year cocaine prevalence has shown an overall upward trend over the last decade, although with variations between EU Member States, ranging from 0.1% to 3.0% of the population.

2.              Cocaine use can lead to dependence and treatment demand related to cocaine has increased. Psychiatric, cardiovascular and other health problems are also associated with cocaine use. Injecting cocaine carries the risk of transmission of blood-borne diseases such as HIV and hepatitis C.

3.              Three core groups of problem cocaine users can be identified: socially well-integrated individuals; opioid users, some of whom are substitution treatment clients; and marginalised crack users.

4.              These groups differ in drug use patterns, health and living conditions. Their needs range from access to information about cocaine-related risks to specific treatment or harm reduction interventions.

5.              Current responses to cocaine-related problems draw largely on existing services targeted at opioid use and drug use in recreational settings. These existing services may need adapting to meet the specific needs of cocaine and crack users.

6.              Improvements could include: specific cocaine and crack strategies; training and research on the treatment of cocaine dependence; outreach interventions; and tailored treatment services for specific groups of cocaine and crack users. 

Conclusions and policy considerations

1.              Specific strategies targeting cocaine or crack cocaine use should be developed in areas where the extent of the problem, such as in some European countries and cities, requires a concerted response. Elsewhere, drug policies should address the growing diversity in drug use patterns and needs of problem drug users.

2.              Prevention and harm reduction approaches related to cocaine use need to be developed, in particular information on risks (cardiovascular, psychiatric, elevated toxicity of some forms of polydrug use). Both occasional and regular cocaine users should be targeted.

3.              Interventions to reach and help socially integrated problem cocaine users can be developed by adapting existing services or, in some cases, providing dedicated treatment services.

4.              Crack users, and other marginalised populations of drug users, should have access to harm reduction outreach interventions including service referral.

5.              In all treatment settings, training in psychosocial interventions should have high priority as this kind of intervention has shown the best results. Exchanging knowledge and best practice among clinicians and other drug workers should be encouraged.

6.              Research on psychosocial interventions and on new pharmaceutical agents to treat cocaine-dependent clients should be promoted. There is also an urgent need to better understand polydrug use involving cocaine, its multiple variants and consequences.

Conclusions and policy considerations