Transitions in the route of cocaine administration-characteristics, direction and associated variables

• Published in: Addiction (Abingdon, England) Vol. 94; no. 6; pp. 813 - 824
• Main Authors: Dunn, John, Laranjeira, Ronaldo R.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Carfax Publishing, Taylor & Francis Ltd 01.06.1999; Blackwell; Blackwell Publishing Ltd
• Subjects: Addiction; Addictive behaviors; Administration, Inhalation; Adolescent; Adult; Adult and adolescent clinical studies; Age Factors; Analysis of Variance; Biological and medical sciences; Brazil; Brazil - epidemiology; Child; Cocaine; Cocaine - administration & dosage; Cocaine-Related Disorders - epidemiology; Cohort Effect; Cross-Sectional Studies; Drug Abuse; Drug Addiction; Drug Injection; Drug use; Female; HIV; Human immunodeficiency virus; Humans; Interviews as Topic; Male; Medical sciences; Middle Aged; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Social research; Substance abuse; Substance Abuse, Intravenous - epidemiology; Therapy; Brazil; Consumption; Human; Drug addiction; Age of onset; Evolution; Cocaine; Heroin
• ISSN: 0965-2140; 1360-0443
• DOI: 10.1046/j.1360-0443.1999.9468135.x

Aims. To examine transitions in the route of administration of cocaine and the variables associated with them. Design. A cross‐sectional study undertaken between January 1996 and October 1997. Setting. Fifteen different services that offer treatment, counselling or assistance to drug users or HIV positive patients in the State of Sao Paulo, Brazil. Participants. Two hundred and ninety‐four current or ex‐cocaine and crack cocaine users. Measurements. A structured interview schedule was developed consisting of 246 questions covering socio‐demographic details, drug history, cocaine transitions and HIV‐risk behaviours. Findings. Eighty‐seven per cent of patients began using cocaine by snorting and 74% subsequently underwent a transition of route‐ 68% towards smoking and 20% to injecting. Half of all transitions occurred in the first 3 years following initiation into cocaine use. Factors associated with transitions were: younger age at cocaine initiation, more frequent use at peak usage, initial use of cocaine by snorting or injecting, a lower level of scholastic attainment and experience with a wider range of drug classes. A cohort effect was apparent with younger cocaine users and those who had begun using after 1990 being more likely to undergo a transition to smoking crack and less likely to start injecting. Conclusions. Cocaine transitions are very common and are usually towards routes associated with a higher dependency potential and increased HIV‐risk behaviour. Further research is needed to see if transitions can be prevented by early identification of potential cases.