Executive Summary

In response to the cocaine “epidemic” witnessed in the United States in the mid to late 1980’s, a number of investigations into the use of cocaine in Australia were conducted. The results of these studies did not give cause for serious concern as the prevalence of cocaine use was found to be low and there appeared to be few problems associated with such use. It was recognized, however, that there was a need to continually monitor the situation and look out for changes in the dynamics of the cocaine market.

Recent research has indicated that the prevalence of cocaine use among injecting drug users has increased substantially over the last few years. The route of cocaine administration amongst this group is overwhelmingly by injection, and as cocaine is typically injected more frequently than other drugs, the increased severity of injection-related problems that has been recently noted is of particular concern.

The current study aimed to investigate the use of cocaine in Sydney. The prevalence and patterns of cocaine use among injecting drug users were examined, as were the patterns of cocaine use among non-injectors. In order to investigate the effect of route of administration, the prevalence and nature of cocaine-related harms among cocaine injectors and non-injectors were compared.

A sample of 153 injecting drug users and 35 non-injecting cocaine users were interviewed about their patterns of cocaine use, problems they had experienced as a result of such use, health, psychosocial functioning, and criminality.

Cocaine use and injecting was found to be highly prevalent among injecting drug users in Sydney, with the majority (86%) having used cocaine in the past and two-thirds (67%) having used the drug in the previous six months. Cocaine use among this group was associated with higher levels of unemployment, criminality, heroin use, polydrug use/injection, and injecting frequency, as well as a greater number of injection-related health problems.

In several respects, the cocaine use patterns of non-injectors were either heavier than or similar to those of injectors. However, while non-injectors were more likely to report physical problems directly associated with cocaine use, they were generally in better physical and psychological health, were more socially functional, and had lower levels of criminality than injectors.

Cocaine dependence was prevalent among both injecting and non-injecting cocaine users, with 34% of injectors, and 17% of non-injectors, meeting the proposed SDS criteria for dependence. Dependence was associated poorer physical and psychological health, regardless of the preferred route of administration.

In summary, route of administration was revealed as an important factor to consider when examining the correlates of cocaine use, with injecting cocaine use being associated with greater overall harm to the user. The most influential mediator in the relationship between cocaine use and associated harm, however, appeared to be dependence. Cocaine dependence was associated with a greater severity of harm regardless of whether cocaine was injected or administered otherwise. As such, the role of dependence should be one of the primary considerations in the designs of future cocaine research.