title: Cocaine use among heroin users in Spain: the diffusion of crack and cocaine smoking. Spanish Group for the Study on the Route of Administration of Drugs.
abstract: OBJECTIVE
  To describe the prevalence and patterns of use of crack and cocaine hydrochloride among heroin users in Spain. To explore if the expansion of heroin smoking is accompanied by a similar phenomenon for cocaine.
  
  
  METHODS
  Cross sectional study in 1995. Face to face interviews using a structured questionnaire.
  
  
  METHODS
  Three cities with different prevalences of heroin use by smoking: high (Seville), intermediate (Madrid), and low (Barcelona).
  
  
  METHODS
  909 heroin users, 452 in treatment and 457 out of treatment.
  
  
  RESULTS
  Last month prevalence of crack use was 62.3% in Seville, 19.4% in Madrid, and 7.7% in Barcelona. Most users in Madrid (86.5%) and Barcelona (100%) generally prepared their own crack, usually with ammonia as alkali; in Seville most users (69.7%) bought preprocessed crack. The proportion of users who began taking cocaine (crack or cocaine hydrochloride) by smoking has increased progressively since the seventies, rising to 74.1% in Seville, 61.5% in Madrid, and 28% in Barcelona in 1992-1995, with the earliest increase in Seville. The factors associated with crack use were: residence in Seville (odds ratio (OR) = 16.3), cocaine hydrochloride use mainly by smoking (OR = 5.0), by sniffing (OR = 2.7) or by injecting (OR = 2.5), heroin use mainly by smoking (OR = 2.8) and weekly use of cannabis (OR = 1.9).
  
  
  CONCLUSIONS
  In Spain smoking cocaine may be progressively diffusing from the south west to the north east, similar to what has happened with smoking heroin, but beginning later in time. The factors associated with smoking cocaine are basically ecological or cultural in nature (characteristics of the available drugs and the main route of heroin administration in each city).
authors.affiliation: Delegación del Gobierno para el Plan Nacional sobre Drogas-DGPNSD, Madrid, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Barrio
authors.forename: L
authors.initials: L
authors.lastname: De la Fuente
authors.forename: L
authors.initials: L
authors.lastname: Royuela
authors.forename: A
authors.initials: A
authors.lastname: Díaz
authors.forename: F
authors.initials: F
authors.lastname: Rodríguez-Artalejo
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D003042:Cocaine; D016578:Crack Cocaine; D003430:Cross-Sectional Studies; D005260:Female; D003932:Heroin; D006556:Heroin Dependence / Q000453:epidemiology; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology*; D013030:Spain / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology*
chemical_list: D016578:Crack Cocaine; D003932:Heroin; D003042:Cocaine