Transitions in the route of cocaine administration‐characteristics, direction and associated variables

Aims. To examine transitions in the route of administration of cocaine and the variables associated with them. Design. A cross‐sectional study undertaken between January 1996 and October 1997. Setting. Fifteen different services that offer treatment, counselling or assistance to drug users or HIV positive patients in the State of Sao Paulo, Brazil. Participants. Two hundred and ninety‐four current or ex‐cocaine and crack cocaine users. Measurements. A structured interview schedule was developed consisting of 246 questions covering socio‐demographic details, drug history, cocaine transitions and HIV‐risk behaviours. Findings. 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.