Crack cocaine has become increasingly problematic for some marginalised communities. The recent identification of particular sites in Ballymun, Dublin associated with crack cocaine use has raised serious concerns of an emerging crack cocaine problem in the local area, similar to other communities. Despite the increase in levels of usage and treatment-seeking for crack cocaine use, there is limited national and international research available on the nature and extent of its use. Local anecdotal evidence in Ballymun suggests that the problem is widespread and having a detrimental impact on the health and wellbeing of users, their families, and the wider community. While drug issues and related harms are not a new phenomenon in this community, this is the first time that Ballymun has faced a crack cocaine issue of such proportions. In light of these developments, a recent study explored crack cocaine use experiences in the Ballymun community with a view to informing the establishment of a local policy and practice/intervention evidence base for crack cocaine in Ballymun.1 

Methodology

The research used a qualitative study design, and data were collected through 22 semi-structured interviews and four focus groups during the period September 2018 to February 2019. Data collection consisted of individual semi-structured interviews with former and current users of crack cocaine, family support members, local community representatives, An Garda Síochána, and local treatment and rehabilitation service providers. 

Findings

The main findings are discussed below. 

Crack cocaine use and motivations for use

Among current crack users, 17 interviewees were polydrug users, and identified the use of heroin, alcohol, benzodiazepines and pregabalin along with their use of crack cocaine. The most widely used substance alongside crack cocaine was methadone. Thirteen (76.5%) of those interviewed were prescribed methadone and two (11.8%) had previously been prescribed methadone. Interviewees described several reasons for their use of crack cocaine. These reasons ranged from being introduced to it through their drug-using peer networks to a more deliberate decision-making process to help them forget about and escape other difficult life issues, and to enhance self-confidence. 

Availability and accessibility

Research participants expressed their concerns in terms of the availability and visibility of both crack cocaine usage and dealing; the accessibility of crack through aggressive targeting and overt dealing; young people’s involvement in the crack cocaine market; and the role of environmental factors influencing the local crack cocaine market. In particular, the perceived increased availability of crack cocaine in the community was also identified by local service providers encountering and working with individuals who are using crack cocaine; by those engaged in broader community work; and by An Garda Síochána. The current availability of crack in the community was believed to have increased over the previous two years. 

Physical and mental health

The two main physical health issues associated with crack cocaine use and experienced by interviewees were breathing problems and weight loss due to decreased appetite and desire to eat. Interviewees described the mental health consequences they experienced in connection with their crack cocaine use as being far greater than and more consequential than the physical health consequences experienced. Interviewees stated that they experienced confusion, depression, paranoia, and anxiety while using crack cocaine. They also discussed the self-harm and suicidal thoughts they experienced and which they directly attributed to their use of crack cocaine. Some interviewees described periods of time spent in mental health facilities as a direct consequence of the mental health issues they attributed to their use of crack cocaine. 

Family and community impacts

Family members described being frightened in their homes as they experienced aggression and intimidation from their adult children. This aggression and intimidation were attributed to their adult children’s use of crack cocaine and their seeking of money for crack. The stigma associated with the use of cocaine was also experienced by family members of those using crack. Family members described their difficulty in accepting and acknowledging that a family member was using crack cocaine as they perceived this substance and its usage to be far worse than any other substance. 

Community representatives and local service providers described the community’s concerns in relation to crack cocaine use. Participants described feeling frightened and intimidated by gangs, by the visible drug market, and by the evident crime and violence in the community. Overall, a sense of feeling unsafe within the community was expressed by many interviewees and research participants along with a heightened sense of risk to personal safety. 

Responses and interventions

Service providers described the responses available within current service provision along with the prevailing challenges encountered in working with and providing a service to individuals who are using crack cocaine. Drop-in services, outreach – including street work and home visits – advocacy, one-to-one key working, and the distribution of food parcels were identified as core interventions and responses currently provided. 

Crack pipe distribution was identified as a key intervention as both a tool for engagement and a harm reduction response. This intervention was implemented on foot of interagency discussions and the agreed need for an interagency approach to crack cocaine use in the community. Crack pipes are distributed on site in the Ballymun Youth Action Project and by the Health Service Executive (HSE) Addiction Service. 

Conclusions

In light of the study findings, the report authors made a number of recommendations to support local crack cocaine policy and practice development. In particular, they recommend the establishment of a multiagency working group, including community representation, to develop and implement an action plan and that prioritisation be given to the following actions at both a local and national level:

• Accessible interventions: The lack of accessible crack-cocaine specific interventions emerged in the research. The need for early access to adequate crack cocaine services, including the provision of residential respite and stabilisation beds, is recommended. 

• Mental health: Given the mental health consequences experienced by individuals using crack cocaine in this study and evidenced in previous studies, improved cooperation between drug services and mental health services is required. A local strategy responding to the dual diagnosis needs of individuals using crack cocaine is recommended. 

• Outreach: Due to the chaotic nature of some crack cocaine use, the importance of outreach to individuals using crack cocaine is reinforced in this research. Building on existing local outreach services, the need for a more targeted and crack-cocaine specific outreach is recommended. This would include out-of-hours outreach and signposting to existing services. 

• Basic needs: Given the personal adverse consequences experienced with crack cocaine use, the provision of services and interventions that respond to the physical and psychological wellbeing of individuals using crack cocaine, thus ensuring that basic needs such as food, light, heat, and primary healthcare are being met, is recommended. The potential role of contingency management should be considered further. 

• Accommodation: Housing issues and hostile takeovers emerged as a key issue for individuals using crack cocaine. Building further on the existing interagency work that has taken place with regard to accommodation-related issues is recommended. 

• Policing: Given the issues of fear, safety, and security which emerged in the research along with the increased availability of crack cocaine in the community, continued cross-agency and community engagement with An Garda Síochána is recommended.

1 O’Reilly L and Mac Cionnaith C (2019) Crack cocaine use in Ballymun: an evidence base for interventions. Dublin: Ballymun Youth Action Project. https://www.drugsandalcohol.ie/31345/