Academic Journal
Recent increases in crack injection and associated risk factors among people who inject psychoactive drugs in England and Wales.
| Title: | Recent increases in crack injection and associated risk factors among people who inject psychoactive drugs in England and Wales. |
|---|---|
| Authors: | Edmundson C; National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK. Electronic address: Claire.Edmundson@ukhsa.gov.uk., Croxford S; National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK; St Helens and Knowsley Teaching Hospitals NHS Trust, Warrington Rd, Rainhill, Prescot, L35 5DR, UK., Emanuel E; National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK., Njoroge J; National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK., Ijaz S; National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK., Hope V; National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK; Public Health Institute, Liverpool John Moores University, Henry Cotton Building 15-21 Webster St, Liverpool, L3 2ET, UK., Phipps E; National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK., Desai M; National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK. |
| Source: | The International journal on drug policy [Int J Drug Policy] 2025 Oct; Vol. 144 (Pt 1), pp. 104262. Date of Electronic Publication: 2023 Nov 29. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Elsevier Country of Publication: Netherlands NLM ID: 9014759 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-4758 (Electronic) Linking ISSN: 09553959 NLM ISO Abbreviation: Int J Drug Policy Subsets: MEDLINE |
| Imprint Name(s): | Publication: 1998- : Amsterdam ; New York : Elsevier Original Publication: Liverpool, England : International Journal on Drug Policy |
| MeSH Terms: | Substance Abuse, Intravenous*/epidemiology , Crack Cocaine*/administration & dosage , Psychotropic Drugs*/administration & dosage , Cocaine-Related Disorders*/epidemiology, England/epidemiology ; Wales/epidemiology ; Humans ; Female ; Male ; Adult ; Risk Factors ; Young Adult ; Prevalence ; Middle Aged ; Surveys and Questionnaires ; Adolescent |
| Abstract: | Background: Crack use is higher in the United Kingdom (UK) than other European countries. Crack is a stimulant with a short half-life, requiring frequent injection to maintain its euphoric effects, thus increasing the risk of blood borne viruses (BBVs) and skin and soft tissue infections (SSTIs). We assessed trends in the prevalence of current crack injection among people who inject drugs (PWID) and investigated harms and other factors associated with its use. Methods: We used data from the annual Unlinked Anonymous Monitoring Survey of PWID, which recruits people who have ever injected psychoactive drugs through specialist services. Participants provide a biological sample and self-complete a questionnaire. We included participants from England and Wales who had injected in the past month. We examined trends in crack injection over time (2011-2021) and factors associated with crack injection using multivariable logistic regression (2019-2021). Results: The proportion of people self-reporting crack injection in the past month almost doubled between 2011-2020/21, from 34 % (416/1237) to 57 % (483/850). Crack injection was more frequently reported by males than females (adjusted odds ratio 1.46, 95 % confidence interval: 1.15-1.87) and injected alongside heroin (6.67, 4.06-10.97) more frequently than alone. Crack injection was independently associated with injecting equipment sharing (1.64, 1.30-2.07), groin injection (2.03, 1.60-2.56) in the past month, overdosing in the past year (1.90, 1.42-2.53), homelessness in the past year (1.42, 1.14-1.77) and ever having hepatitis C infection (1.64, 1.31-2.06). Conclusion: Crack injection has increased significantly over the past decade in England and Wales. People injecting crack are more likely to engage in behaviours that increase the risk of BBV and SSTI acquisition, such as needle/syringe sharing, groin injection and polydrug use. Harm reduction and drug treatment services should adapt to support the needs of this growing population of people injecting stimulants. (Copyright © 2023. Published by Elsevier B.V.) |
| Competing Interests: | Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. |
| Contributed Indexing: | Keywords: Cocaine; Crack; Drugs; Injecting; People who inject drugs; Risk factors |
| Substance Nomenclature: | 0 (Crack Cocaine) 0 (Psychotropic Drugs) |
| Entry Date(s): | Date Created: 20231129 Date Completed: 20250916 Latest Revision: 20260618 |
| Update Code: | 20260619 |
| DOI: | 10.1016/j.drugpo.2023.104262 |
| PMID: | 38030466 |
| Database: | MEDLINE |
| ISSN: | 1873-4758 |
|---|---|
| DOI: | 10.1016/j.drugpo.2023.104262 |