Cocaine use on the rise – are politicians and city level services prepared for the emerging trend of crack cocaine?

Background: The city of Bergen, Norway, has more than 20 years of experience monitoring drug-specific trends. Since spring 2015, Bergen Early Warning System (BEWS) has reported a considerable and fast-growing increase in cocaine in all three areas of the BEWS monitors: interest in, consumption, and availability of substances. In 2023, the findings also included the use and availability of crack cocaine (cocaine base). These findings correspond with national and European trends and provide new challenges for politicians and practitioners and a need for targeted help and treatment services. 

Method: BEWS is a multi-source and multi-method local drug trend monitor. Over 60 sources containing extensive quantitative data such as seizures, alcohol and medicines sales, treatment data, injections from the local user room, and key informant surveys are analyzed and merged in a main table. Qualitative data (focus groups and text studies) are supplied to the findings. Data are collected every six months, analyzed, and published twice a year. 

Results: More than 20 years of city-level data from BEWS shows an increasing cocaine trend in the early years up until 2008. From 2008 until 2015, the trend was stable. Since then, there's been a rapid increase, particularly from around 2020 - unexpected - as it includes the Covid-19 period. In 2023, BEWS identified crack cocaine for the first time, reported as a significant finding in December. 

Conclusions: The rapid changes in cocaine use and intake of new substances generate changes regarding the need for services, both concerning prevention, treatment, and harm reduction, the latter particularly concerning the use of crack. The BEWS's rapid reporting of new trends in drug use plays a vital role in understanding and informing help services and policymakers of changes in drug use and potential harm. Precise and up-to-date information can provide the ability to scale support and treatment interventions that correspond to the challenges of cocaine and alcohol combination use and the harm threats associated with crack use.