Drug use patterns in the presence of crack in downtown Montréal.

INTRODUCTION AND AIMS A study was undertaken to verify reports of an increasing presence of crack in downtown Montréal, and to investigate the influence of crack availability on current drug use patterns among street-based cocaine users. DESIGN AND METHODS The study combined both qualitative and quantitative methods. These included long-term intensive participant observation carried out by an ethnographer familiar with the field and a survey. The ethnographic component involved observations and unstructured interviews with 64 street-based cocaine users. Sampling was based on a combination of snowballing and purposeful recruitment methods. For the survey, structured interviews were conducted with a convenience sample of 387 cocaine users attending HIV/HCV prevention programs, downtown Montréal. RESULTS A gradual shift has occurred in the last 10 years, with the crack street market overtaking the powder cocaine street market. Although the data pointed to an increase in crack smoking, 54.5% of survey participants both smoked and injected cocaine. Drug market forces were major contributing factors to the observed modes of cocaine consumption. While the study focused primarily on cocaine users, it became apparent from the ethnographic fieldwork that prescription opioids (POs) were very present on the streets. According to the survey, 52.7% of participants consumed opioids, essentially POs, with 88% of them injecting these drugs. DISCUSSION AND CONCLUSIONS Despite the increased availability of crack, injection is still present among cocaine users due at least in part to the concurrent increasing popularity of POs.