Crack cocaine use, street life and migrant population. An Italian observatory by ItaRdd, Cnca, Forum Droghe.

Background
Street life and drug use in northern and central Italy (Turin, Venice/Mestre, Reggio Emilia, Florence, Bologna, Rome) have undergone significant changes in the last three years with an emerging increase in crack cocaine use, particularly among the migrant population. In 2022, 500,000 foreigners were estimated in irregular conditions in Italy (IDOS). Several migrants are asylum seekers without papers, live on the street and/or in abandoned houses or former industrial complexes, suffer from trauma due to their migration path and are not entitled to receive health and social assistance.  
Methods
Direct observation, research and exchange of good practice. The national group of street units of six cities organized under umbrella organizations (itardd, CNCA, Forum Drugs) is following this phenomenon in their regular harm reduction interventions by meeting the population of migrants who use crack and other drugs, providing them with information material, counselling and harm reduction equipment, such as the distribution of sterile equipment for use, such as crack pipes, socio-sanitary and legal support, liaison with local treatment specializing in drugs.
Results
The consumption of licit and illicit substances has increased in some cities of North and Central Italy among migrants from Africa. This has led to increased consumption, changes in consumption patterns and health and social consequences. Crack cocaine is now consumed by young or very young migrants living in the streets, with a past use of more substances, including alcohol, cannabis, psychiatric drugs and tramadol hydrochloride. Crack cocaine use began in urban settings with the development of dynamic local markets referenced by the new population group. 
The availability of crack cocaine has increased in urban environments leading to increased use and a high level of public nuisance. Law enforcement intervenes by forcing the user community to leave and find other places to live. Some of them have gone from crack cocaine use to more risky behaviour, such as smoking heroin, with an increased risk of overdose in a population not aware of the risk. The phenomenon has been accompanied by an increase in physical violence, including gender-based violence, aggression, the onset of mental disorders and a general increase in risk for this population. 
Conclusions
The emergence of this phenomenon has demonstrated the need for targeted health and social measures. Street units have defined a coordination between cities for the creation of spaces dedicated to drug use in urban settings, the provision of harm reduction interventions, peer education, coordination between harm reduction services and specialised drug treatment, as well as with law enforcement. It is important to promote interventions that do not create further stigmatisation around the migrant population and that address the issue of the drug problem and its consequences on the basis of scientific evidence.