Characteristics of the sample
The sample, which contained 27 crack cocaine users between the ages of 19 and 49 years (mean 25.9), consisted mostly of 21- to 30-year-old males who had received little education (only elementary school), belonged to a low social class (class E) [26], were unemployed, were living in shelters or on the street without family and were crack cocaine-dependent. All of the participants proved to be crack cocaine-dependent according to DSM-IV [27] criteria, and nearly 70 % of them were also reported to be marijuana-dependent.
Drug use was not always recreational. All of the participants in the sample reported having had problems with some of the drugs cited, but crack cocaine was the drug that most affected all aspects of their lives. Social problems, such as robberies and loss of family, job, and social status, were most commonly cited, followed by physical injuries resulting from assaults, impaired appearance, etc. Cravings and transient paranoid symptoms were described as the effects of the drug that most contributed to these damages.
The participants reported having used various self-devised strategies to either stop crack cocaine use or overcome the problems caused by it, including seeking help in religion, avoiding contact with crack cocaine users, and the use of other drugs combined with crack cocaine.
Combination with other drugs
According to the interviewees’ statements, the combination of crack cocaine and marijuana was not the only drug combination used. Even sporadically, drugs, such as alcohol, hallucinogens (Ecstasy), and snorted cocaine, and medications, such as benzodiazepines, were also used in combination with crack cocaine in an attempt to either increase the pleasurable effects or minimize the unpleasant effects. However, as with the combination of crack cocaine and marijuana, the combination with alcohol was also mentioned often.
The criteria used to choose a drug to be combined with crack cocaine were based on the experience of other users, experimentation, and the individual evaluation of the effects of the combination tested.
Reasons cited for combining crack cocaine with marijuana
Based on the interviewees’ statements, it became evident that in the context of crack cocaine use, the participants attributed a “protection” role to marijuana that was revealed in several ways.
Reduction of unpleasant effects: The participants attributed relaxing properties to marijuana, which interfered with the effects of crack cocaine by decreasing those effects that were considered to be undesirable. Additionally, participants considered that the effects resulting from the combination were pleasant. Transient paranoid symptoms, which are a typical effect of crack cocaine use and according to users can cause fear, distrust, and sometimes violent behavior, were the effects that were most commonly mentioned by the interviewees as being suppressed in the presence of marijuana.
When I mix marijuana with crack, the effect of marijuana is stronger than the effect of crack cocaine, which then curbs paranoia (psychosis) and controls cravings (G38MC).
The “mesclado” (“mix”) makes me fly. It takes away the wickedness of the rock. I do not look for pieces of rock on the ground, like a fool. The effect of the “mesclado” is better; it is very different (V43MC).
Reduction of crack cocaine-seeking behavior: The serenity caused by marijuana helped the participants control their cravings so that the desire to smoke was reduced. Because of this effect, strategies to obtain the drug, such as thefts and robberies, did not need to be used, which protected the users from possible fatalities resulting from these activities. The participants stated that marijuana caused a type of “numbness” of the mind, which made them “forget” about crack cocaine, even if only temporarily. The focus on crack cocaine was displaced by the effects resulting from the combination.
I am alert to everything, but then the effect of marijuana makes me feel calm and I do not think about stealing. I do not think about doing something wrong. I just stay there enjoying that effect, understand? (G38M)
Reduction of aggressiveness: This issue was highlighted as having a marked effect on the crack cocaine use culture. When asked about the influence of marijuana on this effect, the vast majority of participants stated that there was a reduction in, or even absence of, aggressiveness.
The pure rock makes me aggressive because I want to smoke more, and if someone stops me from doing this, I become violent, even if it is a family member. With marijuana, I control this situation because I am more relaxed, less anxious. (G24M)
Quality of life
Participants also reported that the combination of the two drugs allowed for the partial recovery of the quality of life that was lost with crack cocaine use. Basic human needs that were previously compromised by the use of crack cocaine were regained with the use of marijuana combined with crack cocaine. Sleep, hunger, and sex are examples of this well-being that were cited by the interviewees.
…with marijuana, I sleep well. I eat well. I have good sex. It makes me calm; the same feeling as taking diazepam, a tranquilizer. I become more cool (nice)… (V49M)
Savings
According to some interviewees, mixing crack cocaine with marijuana helped them to save money to buy crack cocaine because a portion of their crack cocaine use was replaced by marijuana use. According to the participants’ reports, this resulted in a higher crack cocaine yield.
It lasts longer. Assuming that I smoke a crack cocaine rock that costs 10 Brazilian reais (approximately $5) in a half hour, with marijuana, it will take one hour. I split it into small bits, I stop, and then I smoke more.” (R27M)
The combination of crack cocaine with marijuana was not always perceived as beneficial by the user. Those who disliked the combination of crack cocaine with marijuana attributed this dislike to the reasons outlined below.
Decrease in the potency of the drug: A small number of participants did not consider the combination of crack cocaine with marijuana to be beneficial; specifically, the action of marijuana on the effects of crack cocaine (i.e., reducing its intensity) was not well accepted by everyone. The calm and relaxation promoted by the combination that represented a gain for some of the participants was the cause of displeasure for others, so that the participants started using the “mesclado”, but after a period of time, they went back to smoking crack cocaine alone, without combining it with marijuana.
I lost interest because the “mesclado” makes the person much more quiet… And I do not want to be quiet, not in that way… so I tried the pure crack cocaine and found that the pure crack cocaine made me more alert… (P34M)
Undesirable effects: Participants reported the occurrence of undesirable psychological effects when marijuana was used, reinforcing the idea that drug use is an individual experience.
If I smoke some marijuana, I do not feel good. I feel depressed. I feel very bad. I think it is because I used too much crack, so it affected my brain a bit. If I smoke a joint today, I feel worse than if I had smoked a rock. I feel very depressed. (M23F)
The sequence of the marijuana and crack cocaine combination
The sequence of the marijuana and crack cocaine combination seemed to be of great importance in the effects resulting from combining the two drugs. Some of the participants preferred to use marijuana before smoking crack cocaine, whereas others preferred to use it after smoking crack cocaine, but the simultaneous use of marijuana and crack cocaine was most commonly observed in this sample (“mesclado” or “pitilho”).
Simultaneous use of marijuana and crack cocaine (mesclado)
As mentioned previously, the “mesclado” was the preferred manner of combining these two drugs. The participants attributed this preference to several factors, which are outlined below.
Does not attract attention on the street: According to the interviewees, smoking from a pipe makes crack cocaine use obvious; they are identified as users anywhere they use a crack pipe. Using a cigarette, in which marijuana is mixed with the rock (crack cocaine), is more “protective”. These users face no discrimination because they are not identified as crack cocaine users (known as a “craqueiro” in Brazil). Additionally, some of the interviewees stated that the unpleasant effects, mainly the transient paranoid symptoms, disappeared, and the combined use of marijuana and crack cocaine also helped them to remain calmer, which contributed to greater social acceptance and consequently decreased the high degree of marginalization to which they were subjected.
I can smoke in a park without any problem. Using only the rock, I get paranoid (psychotic), suspicious of everyone. I just want to be hidden from view. I think about stealing all the time. (R31M)
The interval between consumption is increased: The interviewees stated that when they smoked the “mesclado”, it took longer for them to want to smoke it again, resulting in them consuming a smaller amount of crack cocaine. With the “mesclado”, 1 to 2 h elapsed before they repeated the drug use; in contrast, when they used only crack cocaine, this period of time was reduced to 5 or 10 min.
Use of marijuana before crack cocaine
A few interviewees reported using marijuana before crack cocaine because they claimed that in such circumstances, they became more relaxed and calmer and would not consume crack cocaine afterwards while they experienced this tranquility. Some of the interviewees revealed that the only way to change this condition was to consume alcohol to “break” this state and then return to smoking crack cocaine after marijuana use. These implications led them to stop using marijuana in this manner, replacing it with other manners of use, the most common of which was the “mesclado”.
Use of marijuana after crack cocaine
Marijuana was used in this sequence with the same goal as that of the previous sequence, which was the reduction of the undesirable effects of crack cocaine. Those who consumed marijuana after crack cocaine reported that it prevented them from seeking more crack cocaine to continue using it.
I smoked it [marijuana] afterwards to stop, understand? Because after the effect of marijuana… that was it! Then, I was relaxed.” (C33M)
Some users reported a slightly different goal: after they had consumed all of the crack cocaine and did not have the possibility of getting more of the drug, they smoked marijuana to abolish the desire to smoke more crack.
It is important to highlight that in this sample, combinations with other drugs were aimed at reducing the undesirable effects of crack cocaine and allowing the users to smoke it in a calmer manner. Accordingly, with the exception of one user, none of the participants attempted to replace crack cocaine with another drug (in this case, marijuana). Despite the positive results promoted by the use of marijuana before crack, some of the interviewees altered the sequence of this combination due to the unfavorable environment created by this drug, which made the use of crack cocaine more difficult.