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For instance, cookers, the small bottle-cap type vessels used to prepare drugs, are often the most efficient containers to share drugs among injectors. While the sharing of syringes has been identified as a primary means of transmitting HIV-1, HBV, and HCV ( Des Jarlais, Friedman, & Stoneburner, 1988), ancillary injection paraphernalia, such as “cookers,” water, and filters have been found to be additional sources of risk for bloodborne pathogens ( Koester, Booth, & Wiebel, 1990). Hence, compared to powder cocaine, crack requires a different set of preparation practices to convert the drug into a soluble form.ĭrug preparation practices are an important component of both HIV risk and protective behaviors. Rather, powder cocaine is typically prepared by adding water to powder and drawing the drug solution into a syringe. In contrast to crack, powder cocaine is water soluble ( Flynn, 1993) and can be prepared for injection without an acid. Previous studies ( Johnson & Ouellet, 1996 Kinzly, 1998 Carlson et al., 2000) have reported that injectors convert crack into a solution by using acids such as lemon juice and vinegar, but these reports do not specify the particular drug preparation details. Consequently, IDUs who seek to inject crack are faced with the problem of transforming the rock into a soluble form that can be pulled into a hypodermic syringe. In contrast to crack, powder cocaine has been injected for over a century, although initially for medicinal purposes and for the treatment of morphine and alcohol addiction ( Freud, 1974).Ĭrack is a combination of cocaine hydrochloride, baking soda, and other adulterants which gives rise to a rock-like substance ( Inciardi, 1987). Additionally, the greater availability and lower costs associated with crack cocaine make it an alternative for IDUs who inject powder cocaine. However, some drug users prefer injection as a mode of administrating crack since injection often increases the intensity and duration of a crack high ( Carlson et al., 2000). The fact that crack cocaine can be injected intravenously surprises many including experienced IDUs, drug treatment providers, and drug researchers – since crack was invented in the mid-1980s as a cheap, smokable form of cocaine ( Fagan & Chin, 1990). Despite the accumulating evidence that crack cocaine is being injected in cities across the United States, no studies have offered detailed descriptions of the practices used to prepare crack for intravenous injection – practices which may place IDUs at increased risk for the transmission of bloodborne pathogens, such as HIV, BBV, and HCV. The emerging practice of injecting crack cocaine merits particular attention since injection drug users (IDUs) of powder cocaine have been shown to be at greater risk for HIV infection than heroin injectors ( Chaisson et al., 1989). She is currently conducting a longitudinal ethnographic study of how the AIDS epidemic informs adolescent development and identity dynamics among youth.Ĭrack cocaine was first reported as an injectable drug in the United States in Chicago in 1996 ( Johnson & Ouellet, 1996), and crack cocaine injection has since been reported in smaller cities, including Bridgeport, Connecticut ( Kinzly, 1998), Austin, Texas ( Community Epidemiology Working Group, 1998), and Dayton, Ohio ( Carlson, Falck, & Siegal, 2000) as well as San Francisco ( Bourgois, Lettiere, & Quesada, 1997), Washington, D.C. Welle, Ph.D., director of youth and Community Development Core of the Institute for International Research on Youth at Risk (IRYAR) at National Development and Research Institutes, Inc. His primary area of interest is public health research with high risk youth populations, with an emphasis on the initiation of risk behaviors. Goldsamt, Ph.D., is deputy director of the Institute for International Research on Youth at Risk (IRYAR) at National Development and Research Institutes, Inc. His principal area of interest is in community epidemiology and the development of community-based public health programs. Clatts, Ph.D., is the director of the Institute for International Research on Youth at Risk (IRYAR) at National Development and Research Institutes, Inc. He conducts research on hidden populations, high-risk youth, and out-of-treatment drug users. Lankenau, Ph.D., is an assistant professor in the Department of Sociomedical Sciences at Columbia University, Mailman School of Public Health.