Cocaine and crack use and dependence in Europe - Experts view on an increasing public health problem

Background: The spread of cocaine and crack use in Europe poses a challenge to the European health-care systems. The assessment of the extent of the problem as well as the support needs of the users require involving all relevant parties in research and future planning. Method: Within the framework of a European multi-center and multi-modal research project, experts of nine European cities were interviewed according to a standardised structural interview protocol. Results: Cocaine use is considered to be on the increase in Europe. The prevalence rates vary substantially between countries and the problem emerges in different target groups in distinct patterns of use. Although cocaine and crack specific risks can be diagnosed, health risks follow basically the general risks of illicit drug use. Proposals for future planning include the broadening of the existing services and the implementation of evidence-based approaches to the problem. Conclusion: In dealing with the cocaine problem in Europe, a comprehensive public health approach is appropriate. An overall strategy should include preventive, harm reductive as well as rehabilitative measures. Consequently, cross-national guidelines should be established and their implementation as well as evaluation should be monitored.