"I can taste ammonia," says Suzie when she can catch her breath long enough to form sentences between hacking coughing fits. "I can't tell you what it tastes like, but I know it's ammonia from where the crack was washed up. It's like it's leaving my body now."
The 24-year-old has been using crack cocaine on and off for the past ten years, but hasn’t smoked it for a few days now. She decided to try to get clean again, this time for good, after a recent stay in hospital made her realise the devastating and likely irreversible effect the drug is having on her health – both physically and mentally.
She is facing a diagnosis of incurable chronic obstructive pulmonary disease – or "crack lung", as it's named colloquially. And if she doesn't stop smoking the freebase form of cocaine, her blood oxygen saturation level – which already frequently drops to dangerously low levels of about 88 percent – will continue to plummet. She will eventually have to depend on an oxygen tank to stay alive.
Smoking crack – which Suzie does with a DIY pipe made out of an empty asthma inhaler and foil that's been punctured with a needle to create a gauze – also doesn't give her the "buzz" she used to enjoy any more, but that doesn't make it any easier to quit. "I just get paranoid now," she says. "It's just the addiction, the routine of doing it. That's hard to stop. Crack takes over your life."
Suzie is one of a growing cohort of users in England hoping to recover from crack, which is two to three times more addictive than cocaine powder. The number of people seeking help to come off the drug has jumped by 23 percent in a year, from 2,980 to 3,657, according to the latest National Drug Treatment Monitoring System figures. This growth dwarfs the much smaller 3 percent rise seen the year before.
The surge in people presenting to services with crack problems specifically is made all the more stark when you consider the wider picture; it comes after a 3 percent fall in the overall number of individuals receiving treatment for alcohol and drugs – the largest drop seen over the last six years.
The increase in people seeking help for crack addiction over the last 12 months was seen across nearly all age groups, but perhaps most alarming is the huge 30 percent spike in under-25s entering treatment for the drug, marking the first rise in crack presentations in this age group for a decade. Equally, the overall number of young adults seeking help with all types of drug and alcohol addiction has fallen by 45 percent since 2005/06.
These figures, unsurprisingly, sit alongside data that shows more people are taking crack today than in recent years. The latest estimate puts the number of users in England at 182,828, which translates to a 10 percent increase between 2011/12 and 2014/15. And more people are injecting it – up 18 percent over a decade. Police seizures of crack are also at their highest level since 2008, after a rise of 16 percent in a year from 4,718 to 5,484.
Crack’s comeback is being driven by a number of factors, but most crucial is the fact it's getting purer and cheaper. DrugWise says the purity levels for crack are "unprecedented", at an average of 74 percent – but informants suggest they could sometimes be as high as 90 percent. This degree of purity is also underlined as a contributing factor to the 16 percent increase in cocaine-related deaths (the powder and rock form aren't distinguished in the data from the Office for National Statistics) in England and Wales in a year.
Meanwhile, the price of crack has tumbled by 13 percent since 2007; a 0.2g wrap can be picked up for as cheap as £15 to £20 in some areas.
Dolly, 42, who had her first pipe – "on a Coke can" – after an Oasis gig at Manchester's G-Mex in 1997, and ended up using for 11 years solid, now works in the addiction treatment sector. She would spend up to £700 a day on the drug, and notes how the price of a rock of crack has remained unchanged for decades.
"If you look at inflation, crack is the only one that’s stayed the same price since the early-90s," she says. "The price of other drugs fluctuate, but crack has never fluctuated. It’s always consistently been the same price, regardless of how shit it is."
Today's dealers are also marketing money-off incentives when buying multiple bits of crack and heroin. "You can get deals of three bits for £25, six for £50, 12 for £100," says Suzie. "The more you want, the more money you get off. You can do a pick and mix of heroin and crack. I used to get two crack and one heroin, or four and two if I had £50."
Geographical changes in drug distribution networks are also thought to be fuelling crack's growth in popularity. The "county lines" phenomenon, in particular, has opened up new supply routes, with urban gangs branching out and operating through foot soldiers – often young boys aged between 15 and 17 – to deliver both crack and heroin at street level in coastal and rural areas.
Crack's physical constitution makes it an ideal substance for county lines networks to transport easily over long distances. "It’s a stable product," says Ian Hamilton, a substance use and mental health researcher at the University of York. "And seizures indicate smaller amounts are being found, which suggests that police are finding more lots of smaller amounts. I suspect dealers are breaking it up into smaller bits and then shifting it into the country."
Suzanne Sharkey, a LEAP UK (Law Enforcement Against Prohibition) board member and former police constable and undercover operative, is concerned this pattern of dealing will continue to see crack use rising. "Children are now bringing high quality crack into sleepy county towns, and the competition is really heating up," she says. "It doesn’t take long for one group to say, 'You get a free rock if you bring me a customer.' Markets always find a way to be self-incentivising. We don’t fully know what influence county lines will have on the market just yet, but it isn’t looking good at the moment, and we need to be accessing options and employing the best evidence. There’s an increasing expectation that crack use will keep going up due to county lines."
While drug trade networks have been advancing their operations, has the drug treatment sector been doing the same to help the growing number of people hoping to recover from addiction and the complex side effects of crack use? Research into treatment is being performed, with one study finding that cannabis – something Suzie has found helpful in easing cravings – may offer some potential in reducing crack use, However, Hamilton says it remains a "tricky one".
There is still no tailored medical or psychological treatment, with benzodiazepine being the main option for prescribers. But benzos come with their own set of challenges, especially in the wake of cuts to drugs services.
"Addiction psychiatrists have been all but decimated – they’re just too expensive for treatment services to employ now," Hamilton explains. "So what you have is nurse prescribers, and they’re a very different bunch. To put it simply, they often don’t go to the same level as doctors can go to. Nurses tend to stick to within the BNF – the British National Formulary guide to prescribing – limits. But that’s of no use to many crack cocaine users."
Hamilton is also concerned about the number of crack users finding themselves stuck in a "catch 22", between different services without a proper solution to their problems. Crack and cocaine can cause multiple psychiatric problems, with paranoia occurring in 84 percent of cocaine users, and crack associated with more frequent and intense symptoms. Both Dolly and Suzie describe experiencing drug-induced psychosis, anxiety and PTSD symptoms.
The problem with this is that users, Hamilton says, end up pushed between drug treatment and mental health services. "It’s partly to do with knowledge gaps, but it’s partly vicious gatekeeping," he explains. "Services are underfunded and under-resourced, and this is one of the ways of coping as a unit. If you get someone referred to you in a mental health unit who takes drugs, you refer them back on to the drug treatment team. They land at the drug treatment team, and they sniff out the fact that they’ve got mental health problems and refer them back to mental health. We need an integrated service."
Rosanna O'Connor, director of alcohol, drugs and tobacco at Public Health England, says her organisation is starting a piece of work to better understand what has driven the increase in crack use so it "can ensure that the treatment system continues to respond effectively".
"Success rates for people in treatment have also improved, although those who use opiates alongside crack achieve lower rates of success," she adds. "Clinical guidelines are clear on the importance of psychosocial interventions. We therefore provide support and guidance to local authorities so they can provide better care for people with co-occurring mental health, and alcohol and drug use conditions."
Dolly, who still lives with the physical and psychological impact of "smashing her system to bits for a really long time", says there is hope and that people can overcome crack addiction.
"I feel really blessed that I survived it, because I shouldn’t have," she says. "I was a raging, using crackhead for 11 years, and if I can fucking do it, anyone can do it. We're stronger than a white lump of chemical."
UPDATE 06/03/18: A comment from Rosanna O'Connor of Public Health England was added to the article.
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