Drug use patterns in the presence of crack in downtown Montréal

Abstract

Introduction and Aims: A study was undertaken to verify reports of an increasing presence of crack in downtown Montréal, and to investigate the influence of crack availability on current drug use patterns among street-based cocaine users. Design and Methods: The study combined both qualitative and quantitative methods. These included long-term intensive participant-observation carried out by an ethnographer familiar with the field and a survey. The ethnographic component involved observations and unstructured interviews with 64 street-based cocaine users. Sampling was based on a combination of snowballing and purposeful recruitment methods. For the survey, structured interviews were conducted with a convenience sample of 387 cocaine users attending HIV/HCV prevention programs, downtown Montréal. Results: A gradual shift has occurred in the last ten years, with the crack street market overtaking the powder cocaine street market. Although the data pointed to an increase in crack smoking, 54.5% of survey participants both smoked and injected cocaine. Drug market forces were major contributing factors to the observed modes of cocaine consumption. While the study focused primarily on cocaine users, it became apparent from the ethnographic fieldwork that prescription opioids (POs) were very present on the streets. According to the survey, 52.7% of participants consumed opioids, essentially POs, with 88% of them injecting these drugs. Discussion and Conclusions: Despite the increased availability of crack, injection is still present among cocaine users due at least in part to the concurrent increasing popularity of POs.

Exploration of a Crack Use Setting and Its Impact on Drug Users’ Risky Drug Use and Sexual Behaviors: The Case ofPiaulesin a Montréal Neighborhood

“…Similar observations were made in recent epidemiological studies demonstrating that street-based drug users in Montréal still injected, and that cocaine-opiate co-use (heroin and/or prescription opioids) as well as polyroutes of administration were common Roy et al, 2013). In addition to increased availability of crack, Montréal is witnessing a growing popularity of prescription opioid injection among street-based drug users, which certainly contributes to maintaining injection prevalence in the city (Roy, Arruda & Bourgois, 2011;Roy et al, 2012).…”

“…From a public health perspective, the transformation of "shooting galleries" into drug use settings where only crack can be smoked seems advantageous since shooting galleries have long been associated with injection risk behaviors and drug-related harms (Neaigus et al, 1994;Latkin et al,1994;Klein & levy, 2003;Deren et al, 2004). However, despite the greater presence of crack, some street-based users continue to inject drugs, especially long-term IDUs who persist in injecting cocaine or opiates (prescription opioids or heroin) (Roy, Arruda & Bourgois, 2011;Roy et al, 2012;Roy et al, 2013). Quite a few people met during the ethnographic fieldwork injected drugs, mostly in a pattern of polyconsumption (cocaine-opiates).…”

“…In recent years, cities across Canada have experienced a marked increase in the use of crack cocaine (Haydon & Fischer, 2005;Fischer et al, 2006;Werb et al, 2010;Roy et al, 2012). Yet, there is a scarcity of research regarding the social organization of crack houses (or analogous drug use settings) and the role they could play in HIV and HCV transmission.…”

Cocaine – Characteristics and addiction

“…Obecnie na czarnym rynku bez większych problemów można nabyć gotowe kryształy kokainowe. Kanadyjskie badania w Montrealu sugerują nawet zmniejszenie dystrybucji proszku kokainowego na rzecz cracku [37]. Podobne zjawisko obserwuje się w Nowym Jorku, Amsterdamie i Brazylii [38][39][40].…”

Prevalence and temporal trends of crack injection among injection drug users in eastern central Canada

“…It is plausible that the regional variations and reversed trends observed in our study correspond to differences in local cocaine markets. The fact that powder cocaine has always been the drug most commonly injected by SurvUDI network participants (Roy et al, 2011) (Bourgois and Bruneau, 2000;Roy et al, 2012). Powder cocaine sales strategies changed considerably during this period.…”