Cocaine now occupies an established place in the British illicit drug
scene. The available data point to London and several other metropolit
an areas as core centers of the problem. Smokable cocaine (crack) repr
esents a notable and worrying new feature of cocaine use in the 1990s.
There remain substantial gaps in knowledge about the natural history
of cocaine problems in Britain. This review addresses the prevalence a
nd problems associated with cocaine in Britain and includes a brief su
mmary of the effects of the drug and the development and distribution
of illicit cocaine products in Britain. Following discussion of the pr
evalence of cocaine use and associated problems, the orientation of ex
isting services toward cocaine users is described and future challenge
s for responding effectively to cocaine users in need of treatment ser
vices are identified.