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1.1 Evidence that crack use, production and purity is increasing
In recent years, evidence from several data sources has indicated a rise in the use of crack cocaine in England. This increase follows a general downward trend in crack cocaine use since 2005 to 2006, particularly among younger age groups.
The latest estimates of opiate and crack use found a statistically significant increase of 8.5% in the number of crack cocaine users in England between 2011 to 2012 and 2016 to 2017 (from 166,640 to 180,748). Crack users still account for a very small proportion of the population, at a rate of 5.1 crack users per 1,000 people in England.
The latest substance misuse treatment data from Public Health England (PHE) showed a 19% increase in the number of adults starting treatment for crack cocaine (with and without opiates) in England between the years 2015 to 2016 and 2017 to 2018.
PHE’s latest data on infections and risks among people who inject drugs found an increase in crack use, from 39% in 2013 to 53% in 2017.
There have also been significant increases in cocaine production and purity. The 2018 World Drug Report by the United Nations Office for Drugs Control (UNODC) showed a 56% increase in global cocaine production between 2013 and 2016.
The UK Focal Point annual report reported that crack cocaine purity in England and Wales rose from 36% to 71% over the same period.
1.2 The Serious Violence Strategy
The 2018 Serious Violence Strategy identified drugs as an important reason for the increase in serious violence in England and Wales since 2014. It links drugs to violence directly via their psychoactive effects, indirectly by fuelling robberies to service drug dependence or through violent competition between drug sellers.
The strategy also identified the strong links between violence and crack cocaine markets and committed to working with frontline practitioners and service users to understand more about the recent increase in crack use. A rapid investigation was undertaken to fulfil this commitment, and the findings are summarised in this report.
2. Methods used in the investigation
The investigation was conducted by PHE and Home Office officials, through a series of interviews and focus groups with 3 participant groups: drug treatment workers, service users and police officers.
Drug treatment workers were selected on the basis that they were working with crack users. Service users were selected on the basis of being engaged in treatment for crack problems. And police officers were selected on the basis of working on drug-related issues.
The fieldwork was undertaken in 6 local authority areas across England in 2018, and it explored the following research questions:
- Have respondents observed any recent changes in the prevalence of crack cocaine use in their area?
- If they had, what did they think were the main factors behind these changes?
- What were respondents’ perceptions of the typical demographics and characteristics of crack cocaine users?
- What were respondents’ perceptions of the treatment options available for crack users?
- What were respondents’ perceptions of the links between crack cocaine and crime?
- What were respondents’ perceptions of the links between crack cocaine and exploitation?
Local authority areas were selected for the investigation, based on areas which had seen large increases in numbers starting treatment for crack cocaine since 2015 to 2016 and to cover a number of different regions across England. This is not a random sample, so the findings from these areas may not necessarily represent the wider population.
Focus groups were carried out with approximately 40 treatment workers and 50 service users across the 6 locations. A total of 34 police officers were also consulted through a combination of one-to-one and small group interviews.
Semi-structured questionnaires were used to guide the discussions, which were tailored to each participant group. Notes were taken or the interviews were recorded and transcribed.
The project was approved by the PHE Research Ethics Committee and data collection took place based on the informed consent of research participants.
A thematic analysis of the notes and transcripts was undertaken to identify the main themes emerging from the discussions. Data protection regulations were observed for data collection, management and storage.
3. Main findings
These findings are a summary of the responses gathered across the 6 areas. Although the areas we visited had diverse geographic and demographic profiles, we have drawn out the overarching themes while also acknowledging some of the differences between them.
3.1 Perceptions of recent increases in crack use
Across all of the 6 areas that we visited, there was general agreement among service users and treatment workers that crack use had increased in recent years.
Police officers in 4 areas observed some increases in crack use, but officers in 2 areas had not noticed any changes. The reported time periods for the increase varied slightly by area. Participants in several areas said that crack use had intensified over the past 2 to 3 years, but other areas had seen an increase starting as far back as 2011.
Across all areas, participants from all 3 groups observed that the increase in crack use was mainly visible among existing heroin users. However, it should be noted that this finding may have been influenced by including service users and treatment workers in the sample because crack users who are in treatment are likely to have been also using heroin.
Some service users that we spoke to had initially started drug treatment to address their heroin use, and many of those were still receiving opioid substitution treatment (OST). However, several of them reported a significant shift in the pattern of their drug use in recent years. They described how their use of crack had escalated from being an occasional ‘treat’ (when the opportunity or the funds would allow) to daily use, and eventually, they began to regard crack as their primary drug.
Service users said:
Yes, it [crack use] is out of hand; it’s an epidemic. Use is skyrocketing.
I got clean from heroin for 8 months but swapped heroin for crack. A lot of other people I know are doing the same. It fills the hole.
Four years ago they did snowballs [heroin and crack taken together] as a treat. People used heroin every day but crack only as a treat… now people are using crack every day.
A treatment worker said:
Crack used to be more of a treat. Some clients might think they are doing well by only using heroin twice a week, but crack use has been becoming a daily routine.
A police officer said:
Crack cocaine is now more prevalent than heroin; we’re seeing instances where crack cocaine only is being brought from London.
3.2 Factors influencing the increased use of crack cocaine
Although there was some variation from one area to another, some common themes emerged from the focus groups and interviews about the perceived factors for increased crack use.
Aggressive marketing by dealers
Respondents reported that crack sales were heavily pushed by dealers who tended to target existing heroin users. They observed that encouraging greater dependency on crack was more lucrative for dealers, as dependent crack and heroin users tended to use greater quantities of drugs than people dependent on heroin alone.
Service users described how dealers would offer free samples of crack with their heroin or attractive 3-for-2 deals (“two white and one brown”). This was particularly common when a new dealer was aiming to infiltrate the market and offering cheaper prices or better quality drugs to build a customer base.
Service users said:
There is no longer the option to buy just one of anything.
They stopped me in town, offered me a tester [a free sample of crack]; obviously I was going to take it. And they gave me their number too.
Treatment workers said:
Some users don’t even bother with the heroin they get after a while, and crack has become more of the norm – it is a dealer-led strategy which has created the market.
Dealers often give the crack away for free even if the user doesn’t want it.
Respondents reported that dealers held mobile phones with the numbers of all local heroin and crack users, and sent blanket text messages with the latest ‘special offers’. Dealers would also often give users free drugs in exchange for the numbers of other local drug users.
As well as advertising the ‘deal of the day’, some service users also reported receiving regular messages containing buzzwords (and street names for drugs), such as ‘power’, ‘magic’ and ‘happy hour’, designed to trigger cravings and nudge them towards placing their next order.
Two service users explained that their drug dealers were aware of the dates that they received their benefit payment and would phone them in the morning on that date to take their order.
Service users in some areas reported that there were so many drug dealers competing for business that they were often prepared to offer credit.
A service user said:
There are dealers everywhere and loads will give you ‘tick’ until you can pay – you don’t have to pay up front.
Easy access and availability of crack
All participant groups noted that crack was more widely available than in the past, with a ready supply from dealers and fast delivery described as “quicker than a pizza”. Dealers increasingly operate around the clock and will take orders and deliver at any time of day.
A service user remarked that he had the numbers of several dealers on his mobile phone, and, if he had to wait for more than an hour for one to deliver his drugs, he would try a different dealer next time.
Service users said:
Last couple of years it has become more readily available, and there’s more crack cocaine on the streets.
There are people everywhere. People hanging around on the streets to buy. Shotters [drug runners or dealers] racing around on their bikes.
Several police officers mentioned that while illicit drugs were known to be sold via the dark web and through social media, heroin and crack sales were mainly made through street-level dealing.
Affordability of crack
Treatment workers and police officers thought that crack was being sold in smaller quantities than before to make it more affordable to users, although there were mixed views on whether the actual price per ‘rock’ had dropped. Some participants thought that crack had got cheaper and that the more you bought the better the deal you got, whereas others observed that the prices had stayed the same but that it was now available in smaller quantities.
Service users across the 6 areas quoted a standard price of £20 to £25 for 3 bags or wraps (with various combinations of crack and heroin). Some of those reported being able to buy crack for ‘pocket money prices’, such as £5 per rock. There were also drug treatment workers who said that the purity of crack had gone up in recent years, while the purity of heroin in their local area had gone down, and this made crack use more appealing.
A treatment worker said:
In the past, people were wary of starting with crack because it was difficult and expensive to get more – but now you can always get more. It is readily available.
Increase in county-lines activity
‘County lines’ drug dealing operations were reported as being a significant issue by people in 3 of the 6 areas we visited, and they thought it was linked to increasing availability and aggressive marketing of crack.
In these areas, treatment workers, service users and police officers described how ‘out of town’ dealers from organised crime groups based in cities such as London, Liverpool, Manchester and Birmingham, had infiltrated the local market, sending runners to deal drugs and displace local dealers. They identified this as a trend that had begun or intensified, in the past few years.
Service users said:
Gangs are sending people down from London to put them in hotels and get them grafting for a couple of weeks.
Crack is coming from London, Liverpool and Manchester. There are lots of dealers now, more than 10 in each area.
There is too much money to be made, and they [groups from London, Liverpool and Manchester] have flooded the area. They see vulnerable people, and they take advantage. If you got in debt in the past you would get punched. You could usually work it out with the local dealers as you have some rapport with them - they know you. You settled the debt, and it would not get violent. Out of towners are more violent.
In the other 3 areas, both treatment workers and police officers thought that local criminal groups were too well-established to allow county-lines groups to gain a foothold in the area, although there were a few reports of conflicts with out-of-town dealers who were attempting to infiltrate the market.
Respondents in these 3 areas reported local dealers using similar tactics to sell drugs such as heroin and crack, including aggressive marketing and using phones as a ‘line’ where users and dealers could easily make contact with each other. Although there was a sense that county-lines dealers could be more ruthless than local criminal groups, crack use increased in all 6 areas. As a result, it is difficult to determine the extent to which the expansion of county lines is driving the increase in crack use.
Less stigma associated with crack use
Treatment workers and service users commented that the stigma associated with using crack had declined over recent years. The reason for this change was not clear, although they suggested that marketing by dealers might be a factor. For example, dealers were marketing crack as ‘smokable cocaine’ and more ‘user-friendly’ than heroin because smoking needed less “skill” than injecting. However, police officers in an area where the increase in crack use appeared less pronounced, said that there was a negative perception of ‘crackheads’ and young people tended to avoid crack because of this.
Lack of police focus on drugs
Treatment workers and service users observed that there were generally fewer police on the streets, and there appeared to be less capacity to target drug dealers or people carrying small amounts of drugs. Also, some police officers reported that their forces no longer had dedicated drugs squads.
Participants in several areas said that deals were often carried out quite publicly, and some dealers made little effort to hide their activities. Police officers also commented that a lack of capacity made it difficult to prioritise drug-dealing, as they had to prioritise serious violence or crimes with a safeguarding element, such as those involving children and vulnerable adults.
3.3 Characteristics of crack users
Treatment workers had not seen significant changes in the types of people starting crack treatment as they tended to be established heroin users. In all 6 areas that we visited, users of crack were predominantly white British and crack use was not very common among ethnic minority communities or linked to recent patterns of migration.
Crack use was often linked to unemployment and homelessness and to sex work for women. Some service users felt that although a small number of dependent heroin users might be able to hold down a job, this was very unlikely for dependent crack users.
Treatment workers and service users observed some drug users moving from using powder cocaine to crack cocaine, although treatment workers thought that this was relatively rare. Police officers tended to see crack and powder users as very separate groups and demographics, with powder cocaine use concentrated among the more affluent.
However, some treatment workers and service users had seen that more young people were using crack as a “first drug of choice” and that more young males (in their 20s) were coming to treatment services with crack problems. This varied by location, with some areas reporting more older users coming to treatment.
There were also some suggestions of a ‘hidden cohort’ of crack users who were not engaging in treatment and therefore much less visible. Some service users said that they were aware of young people starting to use crack. Other service users reported that crack use was beginning to become more acceptable, even fashionable among groups who would not previously have taken it. This included professionals, students and clubbers. In one area with a large university student population, there was a view that dealers were successfully infiltrating these groups.
Service users said:
Lots of young people are using crack – my daughter’s 17 and her friends are using it at the parties she goes to.
Kids are using it. They think that crack is not as serious as heroin – it’s not a dirty drug.
In several areas both treatment workers and service users had the impression that more women were using crack, but that this was not always reflected in more women coming to treatment. One group of treatment workers suggested that this could be due to these women being afraid that social services would become involved in their parenting.
More research is needed to explore the characteristics of ‘hidden’ crack users who are not currently in treatment.
3.4 Perceptions of treatment options for crack users
Treatment workers reported seeing small numbers of people who used crack without heroin, in comparison to those using heroin on its own or crack and heroin together. Treatment workers explained that the absence of substitute treatment (as exists for heroin) was a big disincentive for people to seek help. Crack users often felt that there was no treatment available for them.
A treatment worker said:
Psychosocial intervention is all you can offer, and people really feel they want a medical intervention.
Treatment workers and service users also said that some new drug users started with crack but then later used heroin to help manage the comedown. For these individuals, it was their heroin use, rather than their crack use, that brought them to treatment, although this was not believed to be a widespread trend. Both treatment workers and service users thought treatment services were mainly focused on heroin and alcohol, and there was not enough awareness of the risks of crack use and the treatment options.
A service user said:
Treatment services are brilliant if you’re using heroin, but they are not on top of the crack problem… if I was a crack user and came in here, I’d think it wasn’t for me.
Treatment workers in one area commented that treatment for crack needed to “fill up people’s days” and involve activities. They had observed that the first 5 days of stopping crack use were the hardest. Service users explained that having activities to do and a sense of community with others also going through treatment was a significant factor in helping them to stop their crack use.
In several areas, treatment workers and service users reported an increase in injecting crack, which was clearly more common among long-term heroin users who were more experienced in using needles. The practice of ‘snowballing’ or ‘speedballing’ (injecting crack and heroin together) was regularly mentioned, and people in one area reported that dealers were offering a pre-prepared wrap of heroin and crack ready for injecting. Treatment workers had found increasing health problems among their client group as a result of infections and wounds caused by poor injecting practice.
A service user said:
Most smoke but some inject. Very few inject crack on its own, they snowball instead.
A treatment worker said:
We need to do more harm reduction around crack, more crack-specific groups, more investment in crack treatment.
Treatment workers reported that since the end of the Drugs Intervention Programme (DIP), a nationally funded initiative to engage offenders with drug problems in treatment, they received fewer referrals from police custody suites. The general view among treatment workers was that the Liaison and Diversion scheme had yet to fill the gap left by DIP and arrest referral schemes.
Treatment workers said:
There used to be 8 DIP workers, now just have 2 CJS [criminal justice system] workers. No more workers sitting in police stations; it’s someone for an hour every now and then.
There’s no longer any arrest referral in place in the county.
Treatment workers believed that drug rehabilitation requirements (DRRs), a court-imposed requirement for offenders with drug problems to attend treatment, were not adequately monitored or enforced by community rehabilitation companies (CRCs) and that there were usually no consequences for breaching a DRR. A few service users reported positive outcomes for DRRs in their personal experience.
Police officers highlighted general pressure on the police, but also that a lack of resourcing for other local services had left them to take on cases that mental health and social services would have handled before. Treatment workers also thought that there was a lack of support for those leaving prison with a drug problem and a lack of communication between prison and community treatment services.
3.5 Links between crack cocaine and crime
The Serious Violence Strategy links drugs to violence directly because of their psychoactive effects and indirectly by fuelling robberies to service drug dependence, or through violent competition between drug sellers. In areas where participants have seen a recent increase in serious violence, they generally identified violence between drug dealers as the main factor behind this increase.
In the 3 areas affected by county lines, service users and treatment workers thought that there had been a significant increase in violence, mainly related to violence perpetrated by drug dealers, and often by county-lines groups. These participants said that there were more dealers carrying and using weapons, mainly knives but also firearms. The use of pickaxes, hammers and corrosive substances was also mentioned.
Dealer-on-dealer violence sometimes involved ‘turf wars’ between London-based groups in areas where county lines dealing was taking place. There were also reports of violence between county-lines groups and local drug-dealing groups, as the county-lines groups tried to move into the local drugs market.
In areas not affected by county lines, changes in violent crime appeared to be less pronounced. Treatment workers and police officers said that although there was violence linked to drug disputes and feuding between rival groups, local crime families tended to have control of the local heroin and crack market. In 2 areas, treatment workers suggested that violence had increased due to the “opening of markets” and competition between local dealers.
Police officers acknowledged that disputes could sometimes flare up, but they were less sure that violent crime had genuinely increased and were more likely to attribute a large proportion of it to improvements in police recording. In one area, police officers said that their major threat was violent disputes between organisations dealing in powder cocaine, because there was a large market for the drug and dealers viewed it as more lucrative than crack.
A police officer said:
We have spells don’t we; a little war will start between 2 groups, and we’ll have shootings every couple of days or once a week, and then something big happens; the government come in and throw a load of money at it, it stops and dies off for a bit until the next one.
Although disputes between organised crime groups were often about money and drugs, police officers thought that the dynamics were complex and incidents could be caused by other issues such as a desire not to lose face.
A police officer said:
It’s not all about drugs; there’s a lot more to it than that. In the organised crime world it’s not just about drugs, but it’s about losing face, girls. You know, you speak to a girl on a night out, or you call me and I call you, and that’s it then: there is a big feud over ‘this is what happened to you, what happened to me’.
Participants emphasised that dealers perpetrated the majority of drug-related violence rather than drug users. The crimes most commonly associated with crack use were acquisitive crimes typically committed by heroin users to fund their drug use, such as shoplifting and burglary. It was also reported that some crack users financed their habits through begging, low-level drug dealing and sex work. Service users pointed out that maintaining a crack habit was more expensive than maintaining a heroin habit.
A service user said:
Four years ago you could manage on £200 a day to pay for your drug use… now you need £400 a day.
Service users in 2 areas commented that CCTV and more co-ordinated action by shopping centre security guards had made shoplifting more difficult, leading to other acquisitive crimes such as robberies and burglaries, although this was not specific to crack use.
Treatment workers and service users believed that crack use was responsible for causing mental health problems, paranoia and the tendency to make users more aggressive. They thought that the highly addictive nature of the drug could lead people to commit more desperate acts than heroin users, for example committing robbery rather than other acquisitive crimes like shoplifting. They also noted that these acts might not necessarily be committed while under the influence of crack, but could be linked to long-term psychosis caused by long-term crack use.
However, this was not a widespread finding, and there was no clear evidence from this investigation to suggest that violent crimes committed while under the influence of crack, or in order to finance a crack habit, were a major contributor to recent increases in serious violence.
Participants also mentioned the continuing use of Spice, a name given to herbal mixtures containing synthetic cannabinoids, in several areas. But this was generally limited to a fairly small population of rough sleepers, ex-prisoners and prisoners, and was seen as quite separate from the population of heroin and crack users.
Police officers said that due to the cheap price and limited demand, Spice was unlikely to be an attractive proposition for drug-selling groups. They argued that Spice use was therefore unlikely to be a major contributor to violence between drug-dealing groups. They also reported that violence committed by Spice users tended to take the form of low-level assaults against other users, rather than acts of serious violence or use of weapons.
3.6 Vulnerability and exploitation of drug users
Participants reported exploitation of vulnerable individuals across all 6 areas to varying extents and was linked to both heroin and crack. The 3 areas affected by county lines identified ‘cuckooing’ as a problem, which is when vulnerable adults have their homes taken over by drug dealers to use as a base to sell drugs from.
Many service users said that they had been victims themselves at some point. There were reports of dealers forcing ‘cuckooed’ individuals to run drugs, and there were reports of people with mental health problems or disabilities having their homes taken over. Participants did report cuckooing in areas not affected by county lines, but to a much lesser degree.
Some service users who had experienced cuckooing reported that they had initially consented to the arrangement because they were being rewarded with free drugs, but that over time the relationship became more exploitative and abusive. Two female service users reported losing their tenancies and being made homeless as a result of being cuckooed.
Service users said:
I was running for them – and they were using the flat I was in. I was getting X amount for free, but my life was taken over. It was supposed to be 1 or 2 people, but before I knew it there were 6 or 7 in there. They did leave when I said I couldn’t do it anymore. So I was lucky because I’ve heard that other people have difficulty getting rid of people.
They give you drugs so that you will do the running for them and do their shopping. They get you to do everything.
I got stabbed by a dealer and a claw hammer to my head because I didn’t want him in my property… you let them in in the first place because they are waving drugs in your face.
All 3 participant groups said that they knew about violence by dealers against users, for example retaliation for drug debts or against victims of cuckooing who were trying to get dealers out of their property. Service users noted that ‘out-of-towners’ were more violent than the local dealers they had bought from before.
Treatment workers and police officers commented that much of the dealer-on-user or dealer-on-dealer violence was likely to go unreported. For example, some police officers had intelligence about dealer-on-user violence which was unreported, such as people being burnt with irons and threatened or beaten with belt buckles. They said that it was difficult to take these cases forward because victims and witnesses were afraid of the consequences.
A few service users said that they had instigated cuckooing and had taken over other users’ homes to deal drugs from. It was not clear whether they had been coerced by dealers higher up the chain or had freely done it themselves.
The question of consent here is difficult; drug users might appear to be complicit in cuckooing or drug running, but they might also be vulnerable to exploitation or threats of violence from others. Service users in 3 areas described how they got involved in running drugs, referred to as ‘shotting’, to maintain steady access to crack.
A service user said:
I’d only been using crack for a little while before it quickly escalated. I was quick and that’s why I was a good runner.
The service user quoted above explained that he was running “24/7 over the weekend”. His dealer would provide him with a set amount of drugs to sell for an agreed return. He quickly got into problems because he began using some of the drugs and soon owed his dealer a large amount of money. He said he was fortunate because his dealer received a prison sentence for robbery before he had a chance to enforce the debt.
Treatment workers and police officers reported that teenagers (some as young as 13) were working as drug runners for heroin and crack dealers, particularly for county-lines groups. The drug runners usually came from London and were often missing persons, although there were reports of county-lines groups recruiting local children as well. Police in one area had found some instances of students running a system like a county-lines operation from a university campus.
This inquiry has explored perceptions of recent developments in crack use by conducting an investigation in 6 areas which had the largest increases in people starting treatment for crack cocaine. This is not a random sample, so these findings might not be representative of the broader national picture.
4.1 Confirming the rise in crack use
The findings support other data sets which show an increase in crack cocaine use. These data sets and this inquiry indicate that the trend began to develop several years ago, around 2013.
The amount of time that passed before it was clear at a national level that crack use was rising is a cause for concern, and government needs more up-to-date data and intelligence on the trends in heroin and crack prevalence to monitor this trend more effectively in the future.
4.2 Factors influencing the rise in crack use
This investigation has identified several factors which may have influenced the rise in crack use, including increased availability and affordability of crack and aggressive marketing of the drug by dealers. These factors are likely to be linked to the surge in global production of cocaine since 2013, as organised crime groups have potentially taken advantage of excess supply to push crack cocaine onto a captive market of entrenched heroin users and groups of new users.
The United Nations Office of Drugs and Crime reported that global opium production increased by 65% in 2017 to a record high so it will be important to monitor whether this has an impact on the availability and prevalence of heroin in England.
Other factors linked to the increase in crack cocaine use, which were not directly linked to the increased supply, were changes in the stigma about crack and a lack of police focus on targeting drug dealing. It was not clear from this enquiry whether ‘county lines’ drug dealing operations had driven the increase in crack use, given that use had also increased in areas where county lines were not prevalent.
However, the findings support existing evidence, including from the National Crime Agency, about the expansion of county-lines activity in recent years.
There was a widespread view among police officers, treatment workers and service users that county-lines groups were much more likely than local groups to engage in serious violence and to exploit vulnerable young people and drug users.
4.3 Characteristics of crack users
The feedback from all participants suggests that the increase in crack use has been mainly among existing heroin users, but there have also been suggestions of a new, ‘hidden’ group of crack users who are not heroin users and who have not engaged with treatment services.
We would encourage research which explores the demographics of this group and its pathways into crack cocaine use.
4.4 Treatment for crack users
This inquiry has highlighted the need to explore more effective methods of getting crack users into treatment and to provide a more attractive treatment offer which is tailored to their specific needs.
It has also identified the need for more effective links from the criminal justice system into treatment services for these individuals, for example through greater availability of arrest referral schemes and improved monitoring of drug rehabilitation requirements.