At the end of the 1980s the threat of a crack epidemic in the UK loomed large as we scrambled to take heed of dire warnings from America. Mike Ashton and Natalie Davies delve into the Findings Effectiveness Bank to separate fact from fiction.
In its various guises, no drug has widely been considered so enticing as cocaine. Such beliefs played a part in lurid fears that cocaine would undermine the World War I war effort – for the Times, a drug even ‘more deadly than bullets’. However, modern-day concern over cocaine in Britain can be traced back to 20 April 1989, when Robert Stutman, head of the Drug Enforcement Administration (DEA) in New York, addressed Britain’s chief police officers.
His subject was the new smokable form, manufactured as small ‘rocks’ called ‘crack’. While snorted cocaine powder had a reputation as the drug for the champagne set and business high-flyers, crack lent itself to mass distribution in small quantities to the ‘persistent poor’ of US cities. Rapid onset created what, for some, was an appealing ‘rush’ – otherwise available only at greater expense and/or by injecting.
A powerful speaker credited by himself with bringing crack to national attention in the USA and ‘single-handedly changing the policy of the United States DEA’, Stutman set about waking Britain up to the threat.
His story of an ‘explosion’ of crack use and related violence in New York ignited worries that crack could turn Toxteth, Handsworth and Deptford into US-style drug ghettos.
Most startling was the revelation that ‘a study that will be released in the next two to three weeks will probably say that of all of those people who tried crack three or more times, 75 per cent will become physically addicted at the end of the third time… We now know that crack is… certainly the most addicting drug available in Europe. Heroin is not even in the same ballpark.’ Without immediate action, Britain would, he warned, undergo the US experience within two years.
He was not alone. Addressing UK police chiefs in September 1989, Dr Tuckson, commissioner of public health in Washington, challenged notions that milder Britain would not react to crack in the same way as some of the USA’s poor black neighbourhoods: ‘There is nothing particularly unique about the water… in your country that would prevent the neurotransmitters and the pleasure centres of the brains of your citizens [being] overwhelmingly affected by the instantaneous and powerful euphoria that this drug presents. All you have to do is do it once and I guarantee you any, almost any, human being would want to do it again.’
Later in 1989 Bob Stutman was paired at a conference on crack with Dr Mark Gold, founder of the USA’s 1-800 Cocaine helpline. While Stutman told the London audience his tales from the street, Dr Gold offered scientific evidence of crack’s addictiveness and violence-inducing properties.
They had been invited by the City of London Corporation, whose delegation had been ‘deeply shocked’ by a visit to New York. The conference ended with a resounding attack from the City’s Lord Mayor on the ‘doubting Thomases’ in Britain who were the ‘biggest problem’ because they did not believe the clear evidence about crack, such as that three hits can ‘effectively kill the brain’.
The same year, ‘Three Hits Can Get You Hooked’ was the Sun’s headlined version of Stutman’s ‘terrifying statistics’. In the Times the as yet unseen study he’d trailed had become a ‘survey’ which ‘showed’ these disturbing facts, later attributed to the Home Office itself.
The Independent revealed that senior British police officers had ‘attempted to trace the studies and the figures he quoted and found they don’t exist’. Still, in 1989 an emergency report from the Commons Home Affairs Committee highlighted these same ‘facts’. The following year a BBC investigation found Stutman’s address ‘littered with misinformation’. The claim that 73 per cent of child-battering deaths in New York in 1988 were perpetrated by crack-using parents was based on just two deaths, one involving chronic alcoholism, and Stutman remained unable to produce the ‘three hits and you’re addicted’ study.
If study and ‘facts’ were illusory, so too was the forecast explosion of crack use and violence. It was not that crack never became a problem – it did, and in some localities, a big one – but Britain’s problems never rivalled the US experience. If it emerged at all, the supposed hooking power of the drug came from a constellation of circumstances, not deterministically from merely trying it a few times – and circumstances were different in the UK.
Rather than an explosive epidemic, crack crept up to become a feature of the UK drug scene and of the treatment caseload. In line with population trends, that caseload has been declining since around 2008. Instead of being hard to stop using, crack as well as cocaine, turned out to be hard to continue to use. And rather than ‘not even in the same ballpark’, heroin seems harder to leave behind.
As the patient’s primary drug, across the UK since 2010 cocaine/crack has accounted for about one in eight entering treatment for drug problems, down from about one in seven in 2008/09. In contrast, in the early 2000s opiates accounted for well over half, falling by 2015 to 21 per cent as cannabis took prime position. Total treatment entrants have fallen, meaning that cocaine/crack treatment entrants too have fallen from about 20,200 in 2008/09 to about 12,500 in 2015.
Where in the early 2000s crack was the main variant, by 2015 it was the primary drug for just 3 per cent of treatment entrants compared to 9 per cent for cocaine powder. Among patients starting treatment for the very first time, crack as a primary drug is even less apparent, accounting in 2015 for just over 2 per cent – only about 720 patients across the UK. Cocaine powder is more prominent, accounting for 14 per cent. Though uncommon as the main substance for patients entering treatment, crack is more common as a secondary drug, especially in England, where in 2015 its use was reported by 43 per cent of primary opiate users.
As well as the peak for treatment numbers, at 3 per cent, 2008/09 was the peak in the proportion of 16 to 59-year-olds in England and Wales who, when surveyed, said they had used cocaine in the past year. In 2015/16, all but 0.2 per cent of the 2.4 per cent had done so in the form of cocaine powder. Across the UK, most past-year users had taken it just a few times – well short of dependence.
Studies of problem drug use in England have instead estimated crack use by triangulating from treatment and criminal justice statistics, confirming that problem crack use is rare – in 2011/12 involving 166,640 adults, about one in 200 of the population. Most were using crack alongside opiates like heroin; about 38,000 were using crack without also using opiates. Crack’s peak in these estimates came in 2005/06, since when numbers have fallen by 16 per cent.
As for the ‘not in the same ball park’ claim about the comparative addictiveness of crack and heroin, that seems partly true, but in the opposite direction. In the latest English national drug treatment study, three to five months after starting treatment 44 per cent of followed-up heroin users had stopped using, and after a year, 49 per cent. Corresponding figures for crack were 53 per cent and 61 per cent, and for cocaine powder, 75 per cent and 68 per cent.
Confirmation comes from treatment completion and non-return figures, considered indicative of successful treatment. In England, 44 per cent of primarily crack-dependent patients entering treatment between 2005/06 and 2013/14 were recorded as not having returned after completing treatment and leaving free of dependence. For cocaine powder, the proportion was 55 per cent – both much higher than the 27 per cent for opiates.
The champagne of drugs may be a bubbly treat, and crack a marketing revolution, but neither can match more mundane intoxicants for staying power and mass appeal.
This article is based on the ‘hot topic’, ‘The ‘explosion’ that never happened; crack and cocaine use in Britain’ at http://tinyurl.com/yb6djeam. See for further details and links to source documents.