Transitions in the route of cocaine administration--characteristics, direction and associated variables.
OBJECTIVE
To examine transitions in the route of administration of cocaine and the variables associated with them.


METHODS
A cross-sectional study undertaken between January 1996 and October 1997.


METHODS
Fifteen different services that offer treatment, counselling or assistance to drug users or HIV-positive patients in the State of São Paulo, Brazil.


METHODS
Two hundred and ninety-four current or ex-cocaine and crack cocaine users.


METHODS
A structured interview schedule was developed consisting of 246 questions covering socio-demographic details, drug history, cocaine transitions and HIV-risk behaviours.


RESULTS
Eighty-seven per cent of patients began using cocaine by snorting and 74% subsequently underwent a transition of route--68% towards smoking and 20% to injecting. Half of all transitions occurred in the first 3 years following initiation into cocaine use. Factors associated with transitions were: younger age at cocaine initiation, more frequent use at peak usage, initial use of cocaine by snorting or injecting, a lower level of scholastic attainment and experience with a wider range of drug classes. A cohort effect was apparent with younger cocaine users and those who had begun using after 1990 being more likely to undergo a transition to smoking crack and less likely to start injecting.


CONCLUSIONS
Cocaine transitions are very common and are usually towards routes associated with a higher dependency potential and increased HIV-risk behaviour. Further research is needed to see if transitions can be prevented by early identification of potential cases.
Dunn
J
J
Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil. jdunn@psiquiatria.epm.br
Laranjeira
R R
RR
D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D001938:Brazil / Q000453:epidemiology; D002648:Child; D003042:Cocaine / Q000008:administration & dosage*; D019970:Cocaine-Related Disorders / Q000453:epidemiology; D015988:Cohort Effect; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D015819:Substance Abuse, Intravenous / Q000453:epidemiology
D003042:Cocaine