People who smoke crack cocaine are described as chaotic and more likely to engage in risky sex, polysubstance use and contract infectious diseases. However, little is known about how individuals perceive smoking crack as compared to other forms of cocaine use, especially injection. We explored the lived experience of people who smoke crack cocaine. Six gender-specific focus groups ( ) of individuals who currently smoke crack in Vancouver, Canada, were conducted using a semi-structured interview guide. Focus groups were transcribed and analyzed by constant comparative methodology. We applied Rhodes’ risk environment to the phenomenological understanding that individuals have regarding how crack has affected their lives. Subjects reported that smoking rather than injecting cocaine allows them to begin “controlling chaos” in their lives. Controlling chaos was self-defined using nontraditional measures such as the ability to maintain day-to-day commitments and housing stability. The phenomenological lens of smoking crack instead of injecting cocaine “to control chaos” contributes a novel perspective to our understanding of the crack-smoking population. This study examines narratives which add to prior reports of the association of crack smoking and increased chaos and suggests that, for some, inhaled crack may represent efforts towards self-directed harm reduction. 1. Introduction Smoking crack cocaine is a relatively neglected public health problem in Canada in comparison to injection drug use (IDU), despite indications that crack use in Canada is increasing. The Vancouver Injection Drug Users Study found that crack use in a group of injection drug users in Vancouver almost doubled from about 31% in 1997 to over 60% in 2004; and daily crack smoking in this population rose from <10% in 1996 to 40% in 2002/05 period [1]. Canadian data also provides evidence of high prevalence of crack use among drug user populations. A recent surveillance report of 794 people who inject drugs across Canada indicated that 52.2% of the total sample had also used crack cocaine in the last 6 months [2]. Another Canadian cohort of illicit opioid users in five cities indicated that 54.6% (371/679) of baseline participants had smoked crack in the 30 days prior to the survey. However, there was considerable regional variation, with crack use reported ranging from 86.2% in Vancouver to 2.4% in Quebec City [3]. On the other hand, in a study of people who smoked crack in Vancouver only 39% of those who smoked crack also reported injecting drugs [4]. In Canada, many services for people
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