Urban crack users in The Netherlands: Prevalence, characteristics, criminality and potential for new treatments

Today, crack is the primary drug for a large proportion of ‘problematic’ drug users in the Netherlands. However there is neither a reliable estimate nor a representative profile of this population. The aim of this study was to estimate the size of the urban population of frequent crack users in the three largest Dutch cities and to assess their socio-demographic characteristics and patterns of use, to determine problems associated with crack use, including the involvement of crack users in drug-related crime, and to gain insight into their initial willingness to participate in pharmacological treatments. 1,039 crack users were recruited and interviewed through respondent-driven and institutional samples to compare sampling methods, and capture-recapture estimates were performed.
Respondent-driven sampling showed a different profile of crack users than institutional samples. The number of crack users in Dutch cities is small relatively to the general population but similar to, for example, that of heroin users and largely non-Western. A significant proportion of crack users participated in the drugs trade in order to support their own use with a low level of profit. Property crimes were less common and violence was not frequent. Heavier drug use, lack of housing and financial constraints were related to problematic use and criminality Addressing these conditions and foreseeing ways to differentiate ‘minimally commercial supply’ from more profit-oriented supply was advised. Finally, searching for new forms of pharmacological treatment for crack users was encouraged, as many reluctant crack users would be willing to attend treatment if these were available.