How can we provide strong, effective and relevant services to crack cocaine users?


Danny Hames, Chair of NHS SMPA, offers insight:

I read the serious violence strategy, recently produced by the Home Office, with great interest.

Leaving aside the debates in the media regarding Police numbers and budgets, I was drawn to growing concerns regarding the prevalence and purity of crack cocaine in UK markets, and consequently its link to increasing levels of serious violence across the country.

The report indicates that the East of England has seen an 18% increase in the estimated number of users of opiates and/or crack cocaine. This is alongside a 21% increase in the estimated number of crack cocaine users in the South East. Speaking anecdotally to our operational colleagues in the East of England area, they are noticing a steady increase.

As a practitioner in the noughties (both in London and Southampton) I saw the prevalence of, and damage caused by, crack cocaine. The worrying increases we are seeing now prompted me to reflect on what ensures a drug and alcohol treatment service meets the needs of these service users.  

As NHS providers, we have been at the forefront of providing services to those using crack cocaine and cocaine for many years in our drug and alcohol services, as well as alongside colleagues in mental and physical healthcare services, and those working in primary care.

It seems relevant at this point that we outline what NHS SMPA believes is good solid practice to ensure that we provide strong, effective and relevant services for crack cocaine users. Here are our five ‘get the basics right’ principles:

  1. Make sure your service is accessible. When a crack cocaine user presents, really take the opportunity to engage and start building a relationship, as the window of opportunity will be small.

  2. Have strong case management which is clearly shared and communicated with the service user and steadily transitions responsibility for the plan from practitioner to service user.  Provide stability and direction amidst the chaos.

  3. Ensure that your staff, volunteers and peer mentors are well trained and supported to understand the impact of crack cocaine. This will support them to build a relationship with the service user.

  4. Ensure your risk management is robust. It needs to be protective to all and also ensure that interventions can be provided effectively – quality psychosocial interventions provided in the right dose at the right time are vitally important.  Close working with psychiatry and psychology is invaluable.

  5. Build strong local relationships to ensure there is a broad range of recovery interventions available to those affected – both the service user and their family.

However, in order to deliver on these principles, NHS substance misuse services need to be appropriately funded. As unfortunate as it may be, it is unsurprising to see the negative correlation between the reduction in our budgets, and an increase in violent crime.

Danny Hames – Chair of the NHS Substance Misuse Providers Alliance