title: Drug use patterns in the presence of crack in downtown Montréal.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  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.
authors.affiliation: University of Sherbrooke, Faculty of Medicine and Health Sciences, Addiction Research Study Program, Longueuil, Canada. elise.roy@usherbrooke.ca
authors.forename: Elise
authors.initials: E
authors.lastname: Roy
authors.forename: Nelson
authors.initials: N
authors.lastname: Arruda
authors.forename: Eric
authors.initials: E
authors.lastname: Vaillancourt
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Boivin
authors.forename: Carole
authors.initials: C
authors.lastname: Morissette
authors.forename: Pascale
authors.initials: P
authors.lastname: Leclerc
authors.forename: Michel
authors.initials: M
authors.lastname: Alary
authors.forename: Philippe
authors.initials: P
authors.lastname: Bourgois
mesh_terms: D000293:Adolescent; D000328:Adult; D019970:Cocaine-Related Disorders / Q000453:epidemiology*; D016578:Crack Cocaine; D003625:Data Collection; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D011208:Powders; D011792:Quebec / Q000453:epidemiology; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D016578:Crack Cocaine; D011208:Powders