Frequent heavy drinking represents a serious risk to the health of many cocaine users. The differences in alcohol consumption patterns confirm the importance of distinguishing between use of cocaine powder and crack cocaine. Few of the sample had received treatment for cocaine or alcohol problems. Healthcare professionals working in primary care or accident and emergency settings may need to be trained to detect, assess, and respond to concurrent alcohol and cocaine problems.

The observed differences are not understood clearly but may be influenced by differential effects of route of administration upon absorption, bioavailability and the balance of euphoric/dysphoric effects. Research studies of the combined use of cocaine and alcohol should distinguish explicitly between the use of cocaine by different routes of administration, and this should be specified in the description of subject samples.

Doubling in provision of opiate substitute treatment has occurred, alongside significant improvements in the nature of this treatment. These positive changes have occurred in the direction of six out of seven of the UK national guidelines.

Community pharmacy continues to play an important role in delivering treatment, including prescribing services, to drug misusers. There still appears to be untapped capacity, and moderate support for newer roles.

No abstract