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Powder and Crack Cocaine Use Among Opioid Users: Is All Cocaine the Same?

Stewart, Melissa J. MA; Fulton, Heather G. PhD; Barrett, Sean P. PhD

doi: 10.1097/ADM.0000000000000047
Original Research

Objectives: Problematic cocaine use is highly prevalent and is a significant public health concern. However, few investigations have distinguished between the 2 formulations of cocaine (ie, powder and crack cocaine) when examining the characteristics of cocaine use. Moreover, research has yet to assess the patterns of powder and crack cocaine use among opioid users, a clinical population in which problematic cocaine use is increasingly common. Using a within-subjects design, this study examined whether opioid users reported different patterns and features of powder and crack cocaine use, along with distinct trajectories and consequences of use.

Methods: Seventy-three clients enrolled in a low-threshold methadone maintenance treatment were interviewed regarding their lifetime use of powder and crack cocaine.

Results: Compared with crack cocaine, initiation and peak use of powder cocaine occurred at a significantly younger age. In relation to recent cocaine use, participants were significantly more likely to report using crack cocaine than using powder cocaine. Differences in routes of administration, polysubstance use, and criminal activity associated with cocaine use were also found between the 2 forms of cocaine.

Conclusions: Results suggest that it may not be appropriate to consider powder and crack cocaine as diagnostically and clinically equivalent. As such, researchers may wish to distinguish explicitly between powder and crack cocaine when assessing the characteristics and patterns of cocaine use among substance users and treat these 2 forms of cocaine separately in analyses.

From the Department of Psychology & Neuroscience (MJS, SPB), Dalhousie University, Halifax, Nova Scotia, Canada; and Burnaby Centre for Mental Health and Addiction (HGF), Burnaby, British Columbia, Canada.

Send correspondence and reprint requests to Sean P. Barrett, PhD, Department of Psychology & Neuroscience, Dalhousie University, Life Sciences Centre, 1355 Oxford St, Halifax, NS B3H 4R2, Canada. E-mail:

Supported by the Canadian Institutes of Health Research (SPB, HGF), Killam Doctoral Research Award (MJS, HGF), and Social Sciences and Humanities Research Council (MJS).

The authors declare no conflicts of interest.

Received September 23, 2013

Accepted April 14, 2014

© 2014 American Society of Addiction Medicine