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Report paints picture of global use of cocaine

BMJ 1995; 310 doi: http://dx.doi.org/10.1136/bmj.310.6983.825 (Published 01 April 1995) Cite this as: BMJ 1995;310:825

The pattern of cocaine use around the world varies so greatly that it is impossible to describe the average user, says a new report from the World Health Organisation. The report, the result of the largest ever global study on cocaine, says that snorting of cocaine hydrochloride is by far the most popular form of use.

Information was collected from 22 cities in 19 countries, and the report cites some countries, notably Australia, Bolivia, Canada, and Colombia, which are now examining a range of options to legalise and decriminalise the personal use of cocaine. The studies identified strict limitations to drug control policies that rely “almost exclusively on repressive measures.” The report says: “Current national and local approaches which over emphasise punitive drug control measures may actually contribute to the development of health related problems. An increase in the adoption of more humane, compassionate responses such as education, treatment and rehabilitation programmes is seen as a desirable counterbalance to the over reliance on law enforcement measures.”

Although snorting is by far the most popular method for cocaine users, others smoke coca paste and crack, says the report, and still others inject cocaine hydrochloride. “Generally cocaine users consume a range of other drugs as well. There appears to be very little ‘pure’ cocaine use. Overall, fewer people in participating countries have used cocaine than have used alcohol, tobacco or cannabis. Also, in most countries, cocaine is not the drug associated with the greatest problems.”

The report acknowledges the range of mental health problems associated with cocaine use and says: “There is a complex relationship between cocaine use and crime, particularly theft and violence.”

Most authorities agree, says the report, that it is unrealistic to expect to eradicate the use of cocaine and other drugs. But it says that harm from that drug use need not be inevitable. “In most participating countries, a minority of people start using cocaine or related products, use casually for a short or long period, and suffer little or no negative consequences, even after years of use. This suggests it is possible to reduce, if not entirely eliminate, harmful cocaine use.”

The report urges the WHO to develop a five year programme of activities “to reduce the level of cocaine-related harm throughout the world.” It also wants the organisation to provide support and assistance to countries such as those in the west coast region of Africa, which showed evidence of emerging problems related to use of coca products.

The report says: “WHO should encourage member states to examine cost effective ways to increase access to existing drug treatment services for groups with special needs, such as prisoners, ethnic minorities, street children, sex workers and other socially marginalised groups.”—CLAUDIA COURT, BMJ