A theoretical concept of a harm reduction device for current users of smokable cocaine forms

By Fabian P Steinmetz & Heino Stöver

Although there are great regional differences, smokable forms of cocaine (crack, free-base, paco, etc.) are a drug complex associated with often harmful and problematic drug use patterns. While strategies based on drug prohibition did not eradicate the consumption of smokable cocaine forms, prohibition itself led to many harmful effects, such as criminalisation, stigmatisation, unpredictable smokable cocaine forms quality and hardly any safer-use education. While there are many positive insights from heroin-assisted treatment programs with regard to heroin users, there are no comparable programs for problematic users of smokable cocaine forms. Smokable cocaine forms are challenging due to their different pharmacology and particularly their short duration leading to often many administrations per day. In this manuscript a device for a heroin-assisted treatment-like program for problematic users of smokable cocaine forms is suggested. This device is a cocaine-e-cigarette which could be prescribed to problematic users of smokable cocaine forms to reduce the risk of lung damage, exclude potentially harmful adulterants, limit intake (by formulation and/or technical settings) and also to bring users of smokable cocaine forms into the medical system to address comorbidities and risk factors, for example cardiovascular conditions, insomnia, depression, etc. This manuscript describes basic functionality and general specifications of a cocaine-e-cigarette as a medical device treating people with respective cocaine use disorder when cessation and substitution are not considered an option.

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