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Stephen E. Lankenau, Ph.D., is an assistant professor in the Department of Sociomedical Sciences at Columbia University, Mailman School of Public Health. He conducts retìm kiếm on hidden populations, high-risk youth, & out-of-treatment drug users. Muchael C. Clatts, Ph.D., is the director of the Institute for International Research on Youth at Risk (IRYAR) at National Development and Research Institutes, Inc. (NDRI). His principal area of interest is in community epidemiology và the development of community-based public health programs. Lloyd A. Goldsamt, Ph.D., is deputy director of the Institute for International Research on Youth at Risk (IRYAR) at National Development and Retìm kiếm Institutes, Inc. (NDRI). His primary area of interest is public health retìm kiếm with high risk youth populations, with an emphasis on the initiation of risk behaviors. Dorindomain authority L. Welle, Ph.D., director of youth & Community Development bộ vi xử lý Core of the Institute for International Retìm kiếm on Youth at Risk (IRYAR) at National Development và Research Institutes, Inc. (NDRI). She is currently conducting a longitudinal ethnographic study of how the AIDS epidemic informs adolescent development và identity dynamics aước ao youth.

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Abstract


This article examines the behavioral practices và health risks associated with preparing craông xã cocaine for injection. Using an ethno-epidemiological approach, injection drug users (n=38) were recruited between 1999 & 2000 from public settings in Thủ đô New York City & Bridgeport, Connecticut & responded to a semistructured interview focusing on craông chồng injection initiation và their most recent crack injection. Study findings indicate that methods of preparing crachồng for injection were impacted by a transforming agent, heat applied lớn the “cooker,” heroin use, age of the injector, và geographic location of the injector. The findings suggest that crachồng injectors use a variety of methods to lớn prepare crack, which may carry different risks for the transmission of bloodborne pathogens. In particular, crack injection may be an important factor in the current HIV epidemic.


Introduction

Crachồng cocaine was first reported as an injectable drug in the United States in Chicago in 1996 (Johnson & Ouellet, 1996), và craông xã cocaine injection has since been reported in smaller cities, including Bridgeport, Connecticut (Kinzly, 1998), Austin, Texas (Community Epidemiology Working Group , 1998), & Dayton, Ohio (Carlson, Falông chồng, & Siegal, 2000) as well as San Francisco (Bourgois, Lettiere, & Quesada, 1997), Washington, D.C. (CEWG, 2000), and Boston (CEWG, 2000). The emerging practice of injecting crack cocaine merits particular attention since injection drug users (IDUs) of powder cocaine have sầu been shown to be at greater risk for HIV infection than heroin injectors (Chaisson et al., 1989). Despite the accumulating evidence that craông chồng cocaine is being injected in cities across the United States, no studies have sầu offered detailed descriptions of the practices used lớn prepare crack for intravenous injection – practices which may place IDUs at increased risk for the transmission of bloodborne pathogens, such as HIV, BBV, & HCV.

The fact that craông chồng cocaine can be injected intravenously surprises many including experienced IDUs, drug treatment providers, & drug researchers – since crachồng was invented in the mid-1980s as a cheap, smokable form of cocaine (Fagan & Chin, 1990). However, some drug users prefer injection as a mode of administrating crack since injection often increases the intensity & duration of a crachồng high (Carlson et al., 2000). Additionally, the greater availability và lower costs associated with craông chồng cocaine make it an alternative for IDUs who inject powder cocaine. In contrast lớn craông xã, powder cocaine has been injected for over a century, although initially for medicinal purposes và for the treatment of morphine và alcohol addiction (Freud, 1974).

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Crachồng is a combination of cocaine hydrochloride, baking soda, & other adulterants which gives rise lớn a rock-like substance (Inciardi, 1987). Consequently, IDUs who seek lớn inject craông chồng are faced with the problem of transforming the roông xã into a soluble khung that can be pulled into lớn a hypodermic syringe. Previous studies (Johnson & Ouellet, 1996; Kinzly, 1998; Carlson et al., 2000) have reported that injectors convert crachồng into a solution by using acids such as lemon juice & vinegar, but these reports vì not specify the particular drug preparation details. In contrast lớn craông chồng, powder cocaine is water soluble (Flynn, 1993) và can be prepared for injection without an acid. Rather, powder cocaine is typically prepared by adding water to lớn powder & drawing the drug solution into lớn a syringe. Hence, compared khổng lồ powder cocaine, craông xã requires a different phối of preparation practices khổng lồ convert the drug inlớn a soluble form.

Drug preparation practices are an important component of both HIV risk & protective behaviors. While the sharing of syringes has been identified as a primary means of transmitting HIV-1, HBV, & HCV (Des Jarlais, Friedman, & Stoneburner, 1988), ancillary injection paraphernalia, such as “cookers,” water, and filters have sầu been found to lớn be additional sources of risk for bloodborne pathogens (Koester, Booth, & Wiebel, 1990). For instance, cookers, the small bottle-cap type vessels used khổng lồ prepare drugs, are often the most efficient containers khổng lồ nội dung drugs aao ước injectors. Consequently, a cooker may be contaminated with HIV when it touches other paraphernalia used lớn prepare or inject drugs, such as a syringe, a filter, or water.

Recent ethnographic retìm kiếm demonstrated that cookers may also play a chất lượng protective sầu role in reducing exposure lớn bloodborne pathogens aý muốn IDUs. Clatts, Heimer et al. (1999), who observed injectors preparing different forms of heroin, found that injectors of tar heroin commonly heated the cooker (also containing water) with a flame to lớn transsize the resin-like substance into lớn an injectable solution, whereas injectors of powder heroin typically did not heat the cooker prior lớn injection. Laboratory studies modeling these observations revealed that heating a cooker introduced with HIV-1 isolates for 15 seconds or more reduced HIV-1 viability below detectable levels. Hence, an IDU who applies a flame to lớn a cooker for 15 seconds or more may deactivate HIV contained in the cooker prior to pulling the drug solution into lớn a syringe. Additionally, this retìm kiếm highlights how different forms of the same drug – powder vs. tar heroin – impact upon drug preparation practices, which may ultimately have implications for exposure to lớn bloodborne pathogens.

In this article, we describe how craông chồng – a hardened khung of powder cocaine –is prepared for injection, the drug solutions injected, & the injection paraphernalia utilized based upon ethnographic interviews with samples of injectors living in Thành Phố New York City & Bridgeport, Connecticut. Additionally, we provide data on craông chồng injection initiation, which may help lớn locate the emergence of crack injection as a new form of injection drug use.