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Hope, VD 
ORCID: 0000-0001-5712-5734, McGaff, C, Sharpe, C, Rathod, SD, Platt, L, Scott, J, SIPP Project Team and Harris, M
(2026)
Crack-cocaine use practices, harms and respiratory problems: an analysis of gender differences using data from a cross-sectional survey in England.
BMC Public Health.
ISSN 1471-2458
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Crack-cocaine use practices- harms and respiratory problems an analysis of gender differences using data from a cross-sectional survey in England.pdf - Accepted Version Available under License Creative Commons Attribution. Download (2MB) | Preview |
Abstract
Background
The use of stimulants, such as crack-cocaine, is a global public health concern. Crack-cocaine use is increasing in the UK, but available data is focused on those who inject or also use opioids. To address this gap, characteristics of people using crack-cocaine in England, including respiratory problems among those who smoke, and variation in these by gender are described.
Methods
Adults self-reporting crack-cocaine use in the past 28 days, recruited by specialist services and peer networks in six sites during 2023, completed a self-report survey about demographic characteristics, drug use, crack use practices, health problems and service use. Bivariable analyses and logistic regression were used to explore gender-related differences in crack-cocaine use and crack-related respiratory problems.
Results
The participants’ (n = 731) median age was 42 years and 71% were men. Overall, 54% were stably housed, 71% had ever been imprisoned and 28% reported emergency department attendance in past 6 months. In the past 28 days, 99% had smoked crack-cocaine (44% shared pipes), with 30% injecting crack. Poly-sedative use was common including heroin (78%), pregabalin/gabapentin (41%), and benzodiazepines (28%), with 62% receiving opioid substitution therapy. Use of drugs normally smoked was common (90% tobacco, 62% cannabis and 25% spice). Women reported less polydrug use but more often vaped nicotine. Crack-related respiratory symptoms among those smoking crack were reported by 67% of women and 58% of men. In both men and women these symptoms were associated with increasing time since first crack-cocaine use and pregabalin/gabapentin use. In men they were also associated with food insecurity; smoking tobacco; temporary employment; and use in abandoned buildings or at friend’s place; reduced odds were associated with current heroin use and using with a close friend. Among women, having a respiratory symptom was also associated with sharing pipes.
Conclusions
Respiratory health problems are common among those smoking crack-cocaine, particularly among women. In combination with high poly-sedative use, this poses a mortality risk from respiratory depression. UK service provision is focused on prevention of opiate and injection-related risks. Services for people who use crack-cocaine and low-threshold respiratory care pathways require prioritisation to reduce avoidable morbidity and mortality.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | 1117 Public Health and Health Services; Public Health; 4202 Epidemiology; 4203 Health services and systems; 4206 Public health |
| Subjects: | R Medicine > RA Public aspects of medicine R Medicine > RT Nursing |
| Divisions: | Public and Allied Health |
| Publisher: | Springer Nature |
| Date of acceptance: | 16 March 2026 |
| Date of first compliant Open Access: | 7 April 2026 |
| Date Deposited: | 07 Apr 2026 14:17 |
| Last Modified: | 07 Apr 2026 14:17 |
| DOI or ID number: | 10.1186/s12889-026-27073-1 |
| URI: | https://researchonline.ljmu.ac.uk/id/eprint/28336 |
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