No abstract

This article presents original mixed method research to describe the use of rare illicit psychoactive substances, with special emphasis on crack cocaine in France. We first introduce a unique monitoring system committed to the observation of hard-to-reach populations. Qualitative findings rely, among others, on perennial ethnographic studies and field professionals’ knowledge to provide guidance to estimate the number of crack cocaine users. We then rely on a set of multilevel capture-recapture estimators, a statistical procedure to indirectly estimate the size of elusive populations. Since prior field evidence suggests an increasing diversity in crack cocaine users’ profiles, we provide a measure of heterogeneity to assess which estimator better fits the data. The calculated estimates are then critically reviewed and debated in light of the previously gathered information. Our results uncover both individual and institutional heterogeneity and suggest that the spread of crack cocaine in France initiated earlier than originally thought. Our case study underlines the need for field-driven assessments to put quantitative results into perspective, a necessary step to tailor efficient health policy responses.