Cocaine-assisted treatment: a possible response to the crack crisis?

Abstract

Crack use is increasing throughout Europe, particularly among socially marginalized groups in urban areas. Current pharmacological treatments for cocaine use disorder show limited efficacy. Cocaine-assisted treatment, modeled on heroin-assisted approaches, may offer a harm-reduction alternative. It combines medical supervision, controlled dosing, and better alignment with user preferences. Three administration routes are discussed: pharmaceutical-grade powder, user-prepared crack, or ready-to-use inhalable form. Such a strategy could reduce health risks, improve treatment adherence, and support structured care by tailoring the formulation and pharmacokinetics to different treatment phases.