Cocaine

What Kind of Drug Is It?

Cocaine is a natural substance that comes from the leaves of the coca (pronounced KOH-kuh) plant. This plant should not be confused with the cocoa (pronounced KOH-koh) plant, which is the source of chocolate. Cocaine acts as both a stimulant and an anesthetic.

Overview

The coca plant grows in only one part of the world: the northwestern and central regions of South America. A huge portion of the great Andes Mountain system lies along the western coast of the continent. The warm, humid air and rich soil found among these mountain highlands are well suited for the growth of coca. More than a third of the world's supply of coca leaf is grown in Colombia, a South American coastal nation surrounded by the Pacific Ocean to the west and the Caribbean Sea to the north. The rest is grown in the nearby countries of Peru and Bolivia, which share portions of the massive mountain ranges.

Since the mid-1960s, the huge cocaine trade has been the source of violence and political unrest in Colombia. According to Paul M. Gahlinger in Illegal Drugs: A Complete Guide to Their History, Chemistry, Use, and Abuse, nearly 700 million pounds of coca leaf is produced in South America each year. That is enough leaves to produce well over 500 tons of cocaine. Gahlinger explained that the majority of it "is destined for the United States." The southern part of Colombia is the location of coca leaf processing laboratories. From these labs, converted cocaine powder is shipped to the United States, usually arriving through Mexico; Puerto Rico; Miami, Florida; or New York City.

Official Drug Name: Powder cocaine (cocaine hydrochloride), crack cocaine

Also Known As: Blow, C, coke, nose candy, powder, snow; crack cocaine sometimes referred to as rock

Drug Classifications: Schedule II, stimulant

A Longtime South American Tradition

South Americans in the Andes Mountains have chewed coca leaves for generations. For more than 4,000 years, the mountain people have used coca in much the same way Europeans and North Americans use coffee: for its mild stimulating effects. The leaves are not simply plucked and chewed. Rather, a bit of lime or plant ash is added to the leaves and then the mixture is chewed together. This process helps the naturally

occurring cocaine alkaloid to be released and absorbed into the user's cheek. After about a half an hour, the wad is spit out.

The leaves are also recognized for their medicinal value. When chewed or made into tea, they reportedly ease digestive troubles and reduce the symptoms of certain psychological ills. When used in whole-leaf form, cocaine does not produce a "high" and is not addictive.

Attempts to introduce coca leaves to North American and European nations were largely unsuccessful. The leaves of the coca plant tend to rot quickly. This caused considerable problems with shipping, because the stimulating effects and the medicinal value of the plant were both lost before it could reach its destination. In 1858, however, German chemist Albert Niemann managed to separate cocaine from the coca leaf. In doing so, he unleashed the world's most powerful naturally occurring stimulant. The salt form (cocaine hydrochloride), commonly known as powder cocaine, travels quite well. Soon, large quantities were being consumed far beyond the Andes Mountains.

Cure-All or Curse?

From the 1860s through the early 1900s, cocaine was thought to be a "cure-all." Medical experts mistakenly believed that, like the whole-leaf form, powder cocaine was also non-addictive. For more than four decades, cocaine use was unregulated and widespread in both Europe and the United States. No prescription was necessary to obtain the drug, and it could easily be purchased at grocery stores, at drugstores, and through mail-order catalogs. Containers of 99.9 percent pure powder cocaine were available for sale on the open market.

Cocaine-laced beverages were extremely popular as well. One coca wine known as Vin Mariani was widely recommended by doctors for improving health. The original formula for Coca-Cola, a beverage created by John Pemberton in the 1880s, is said to have contained 60 milligrams of cocaine per serving. However, claims about the exact amount used have not been backed up by solid evidence. (Coca-Cola no longer uses any cocaine in its products.) Cocaine was seen as a remedy for many conditions, including fatigue, toothaches, hay fever, asthma, seasickness, and vomiting during pregnancy.

Although experts maintained that powder cocaine was not an addictive drug, frequent and heavy users began showing unmistakable signs of physical and psychological dependence. By the close of the nineteenth century, reports of nasal damage, addiction, and cocaine-related deaths had surfaced. The toxic and addictive nature of cocaine became public knowledge. By the time the U.S. government stepped in to ban cocaine in 1914, most people were already shunning it.

Usage Decreases until the 1970s

Over the next fifty or so years, cocaine use and abuse was very low. Then, in the 1970s, powder cocaine use began to skyrocket. This trend was followed in the 1980s by a surge in the use of a new form of cocaine called crack. Because crack cocaine is cheaper than powder, it became more readily available to the young and the poor. Crack addiction and crime began to increase rapidly. Television coverage of the epidemic was massive. In response to public concern, the Anti-Drug Abuse Act of 1986 and 1988 was passed. This federal law includes mandatory minimum sentences for first-time offenders. The penalties are much harsher for possession of crack cocaine than powder cocaine.

The Real Thing

It is true that when Coca-Cola was first produced in the mid-1880s, it contained cocaine. In fact, the drink derives its name from its two main ingredients—South American coca leaves and African kola nuts. By 1905 all cocaine had been eliminated from Coca-Cola, but the term "Coca" has remained a part of the popular beverage's name for more than a century.

Andrew Weil and Winifred Rosen noted in their book From Chocolate to Morphine: "Many people can't leave this drug alone if they have it, even though all they get from it after a while is the unpleasant effects characteristic of all stimulants used in excess: anxiety, insomnia, and general feelings of discomfort." Because of

its addictive and destructive nature, a worldwide effort is under way to reduce the production and illicit use of cocaine.

What Is It Made Of?

Cocaine is the most powerful naturally occurring stimulant known. It is found as an alkaloid in the leaves of the Erythroxylon coca trees native to the Andes Mountains. Coca leaves contain 0.5–1.8 percent cocaine, which can be refined to nearly 100 percent purity. The chemical formula for cocaine is C₁₇H₂₁NO₄.

Cocaine in Its Various Forms: Leaves, Paste, Powder, and Freebase

"Drugs and Chemicals of Concern: Cocaine," part of the U.S. Department of Justice, Drug Enforcement Administration (DEA), Diversion Control Program Web site, states that "all mucous membranes readily absorb cocaine." That is why it can be taken in so many different forms. Cocaine is ingested in its mildest form by chewing coca leaves. In addition to cocaine, the leaves contain protein, minerals, vitamins, and more than a dozen alkaloids. Instead of experiencing a rush or a high, chewers first notice numbness of the mouth followed by increased alertness and a general sense of well-being. This form of cocaine use is completely legal and socially acceptable in the mountain regions of South America. Chewing coca leaves is part of the people's religious tradition as well. The leaves can also be made into tea. Coca leaves are not smoked because the temperature needed to burn them destroys the cocaine alkaloid before it can be inhaled.

coca paste is a psychoactive drug that produces a rush followed by a high in those who smoke it. (Psychoactive drugs alter the user's mental state or change behavior.) To make the paste, lime water, kerosene (a type of fuel), and sulfuric acid are added to coca leaves. After the bulky leaf matter is removed, an unpleasant-smelling residue remains. This residue, called coca paste, is usually added to tobacco or marijuana cigarettes and smoked.

With additional processing, coca paste can be converted into powder cocaine (cocaine hydrochloride), which can be more than a hundred times more powerful than coca leaves. This powder is diluted with fillers before it is sold on the street in the United States. Common fillers include cheaper drugs such as amphetamines or sugars such as lactose. Average street powder cocaine is about 60 percent pure.

The most common way to use powder is to snort it into the nose, but it can also be dissolved in water and injected into the veins. Powder cocaine cannot be smoked, but it can be turned into another substance called freebase, which is smokable. Powder cocaine is addictive regardless of the way it is taken.

There are three freebase forms of cocaine, and all of them are highly addictive. The first, coca paste, has already been mentioned. It is made directly from coca leaves and is usually mixed with tobacco or marijuana before being smoked. The second form, simply called freebase, was developed in the mid-1970s. In this process, powder cocaine is converted into freebase by using water, ammonia, and a liquid anesthetic called ether.

Freebasing is a dangerous process because the chemicals are highly explosive and may ignite. Comedian Richard Pryor was badly burned while freebasing. The third and by far the most common form of freebase is crack. Crack forms when cocaine, water, and sodium bicarbonate are combined.

Crack Cocaine: The Drug of the Eighties

Crack is a form of freebase cocaine made from powder cocaine combined with water and sodium bicarbonate. After the resulting mixture is allowed to dry, it is cut into "rocks" weighing between one-tenth and one-half a gram. These rocks resemble human teeth in size, shape, and color. Ten grams of powder cocaine will convert to 8.9 grams of nearly pure crack.

A rock of crack is smoked in a glass pipe. As the crack heats up, the vapors are released and inhaled through the pipe. Sodium bicarbonate is the ingredient that gave crack its name, since it makes a crackling sound when lit. Because crack is inexpensive and delivers large amounts of cocaine to the lungs, it became the most popular form of cocaine shortly after its creation in the 1980s. Although all forms of cocaine are addictive, crack is known as the most highly addictive.

How Is It Taken?

The speed at which cocaine reaches the brain depends on how it is taken. The faster and more intense the high produced in the user, the greater the risk of addiction. Drug researchers have determined patterns in cocaine use. Cocaine abusers are more likely to take the drug at night rather than earlier in the day. They also tend to use up whatever supply they have in one sitting, snorting or injecting the drug over several hours until all of it is gone.

Cocaine is taken in one of four ways. The leaves of the coca plant, combined with lime or plant ash, are chewed, releasing small amounts of cocaine alkaloid in the process. Some of the cocaine is absorbed by the mucous membranes of the mouth and the intestines absorb some of the juice as it is swallowed. The small amount of cocaine entering the bloodstream numbs the mouth, decreases the feeling of hunger, and has a stimulant effect. Rather than feeling a high, users report feelings of well-being that can last one to two hours.

Snorted, Injected, or Smoked—They Are All Addicting

Powder cocaine is snorted through the nose in 20 to 30 milligram doses called "lines." Lines of powder cocaine, about the width of a straw, are placed on a smooth surface and inhaled through one

nostril at a time. In less than a minute, the cocaine travels through the network of blood vessels in the nasal cavity and reaches the brain. The high obtained from snorting powder cocaine is the least intense of all methods of ingestion. The drug causes the blood vessels in the nose to constrict, or tighten up. Thus, the high that is produced is milder, but longer lasting than the high achieved by the remaining two ingestion methods: injecting and smoking.

Some users take powder cocaine, dissolve it in water, and inject the solution directly into their bloodstream through veins. The intravenous, or iv, method of taking cocaine is considered the most dangerous method because it involves the use of needles. In a matter of seconds, the injected cocaine reaches the brain, resulting in an almost immediate rush. IV cocaine use is highly addictive because the rush generally lasts only a few minutes, and the remaining high drops off quickly. To maintain the high, users inject another dose after about fifteen minutes.

Cocaine is also smoked. Users change the cocaine powder into paste or rock form in order to smoke it. If inhaled deeply into the lungs, cocaine vapors will enter the bloodstream in just three seconds. The immediate brain rush occurs slightly faster than the injection method and is achieved without the use of needles. Smoking cocaine is highly addictive because it creates the fastest and most intense rush and subsequent high.

Are There Any Medical Reasons for Taking This Substance?

The age-old tradition of chewing coca leaves continues to be part of the daily culture of South American Indians. This practice has often been compared to the American coffee break. Coca leaves are chewed to increase energy and reduce feelings of nausea in users.

After 1860, cocaine was being processed into powder and shipped to the United States and Europe. When mixed with water and taken by mouth in its liquid form, it was considered a common nonprescription remedy for hay fever, children's toothaches, asthma, and nausea. Snorting and injecting cocaine were somewhat less popular methods of ingestion through the early 1900s.

Only Acceptable Use Is as an Anesthetic

As more and more people used cocaine, it became increasingly obvious that the drug was harmful. Users were getting addicted. In 1914, the Harrison Narcotic Act banned the use of cocaine in the United States, except when used by a physician as a local anesthetic.

Cocaine was the first local, or topically applied, anesthetic ever used. In 1884, physician Carl Koller (1857–1944) started using the drug as a topical anesthetic for eye surgery. Soon it was being used by dentists and veterinarians to deaden pain at the site of surgical incisions. But it was William S. Halsted, the father of modern surgery, who found that cocaine injected under the skin (rather than just rubbed on top of the skin) made an even more effective local anesthetic for surgery. When used in this way, cocaine numbs the site of application almost immediately and lessens bleeding.

Did You Know?

How much do you know about cocaine? Did you know that:

• In 2003, an estimated 2.3 million Americans were current cocaine users. That is nearly 1 percent of the U.S. population. One out of every four of those 2.3 million users was considered "hooked" or dependent on cocaine.
• Research reveals that the coca plant produces cocaine to kill insects that prey on it.
• Cocaine is the second most commonly used illicit drug in the United States, according to Heather Lehr Wagner's 2003 book Cocaine. About 10 percent of Americans over the age of 12 have tried cocaine at least once in their lifetimes. About 2 percent have tried crack. And nearly 1 percent of all Americans are currently using cocaine.

Typically, a 1–4 percent cocaine solution is used for surgical purposes. This highly diluted solution does not have a psychoactive or changing effect on the brain. While cocaine is still used for ear, nose, and throat surgery, another drug called lidocaine has replaced it as the most widely used local anesthetic of modern times.

Usage Trends

When cocaine became popular in the late 1870s, it was thought to be a non-addictive "cure-all." The drug was routinely found in family medicine cabinets, and its use was completely legal. Cocaine use was accepted among factory workers to boost energy and ensure peak efficiency. But by the 1890s, cocaine had become an increasingly abused recreational drug, taken purely for the high it produced in users. During this time of widespread use, medical journals began to report on the toxic and addictive properties of cocaine.

The Era of Prohibition

Public support turned against cocaine around the same time that efforts were being made to ban alcohol in the United States. From 1920 to 1933, a nationwide ban existed on the manufacture and sale of all alcoholic beverages. This was known as the era of prohibition. At that time, alcohol was viewed as a destructive force in society. Crime, poverty, gambling, prostitution, and declining family values were blamed on excessive alcohol use. Even before this great push for Prohibition, however, the Harrison Act of 1914 was passed. This act classified cocaine as a narcotic and prohibited its use in the United States except as a local anesthetic. Tough drug laws were passed between the 1930s and the 1960s, and cocaine use dropped dramatically.

It was not until the 1970s that cocaine use began to rise once more. The drug became part of the disco scene, an era well known for its glittery nightlife, brightly lit dance clubs, outrageous outfits, and distinctive music. Cocaine gave clubbers the energy to dance the night away. Powder cocaine was quite expensive, though, and by the 1980s a new and cheaper form of the drug was being manufactured. It was called crack cocaine, and it was inexpensive enough to appeal to middle- and lower-income buyers. Crack can be smoked, it delivers a more intense high than powder cocaine, and it costs about one-tenth the price. Drug dealers had opened up a whole new market, and hundreds of thousands of new users became hooked on crack.

Cocaine use peaked in 1985 when the number of Americans who had ever used cocaine soared to 25 million. In response to the increase in cocaine-related hospital emergency visits, crack gained

a reputation as the most destructive and addictive drug of the 1980s. The Anti-Drug Abuse Act of 1986 and 1988 was passed, making possession of crack a far more serious offense than possession of powder cocaine.

By the time the law was passed, cocaine use was already on its way down. It declined steeply until 1992, when the trend once again reversed. According to the U.S. Department of Health and Human Services, the cocaine-using population had crept back up to about 3 million people by 1993. The gradual increase continued. By 1999, reported cocaine use hit 3.7 million or 1.7 percent of Americans.

Four years later, the 2003 National Survey on Drug Use and Health (NSDUH), conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), showed a downward trend in cocaine use among Americans. About 2.3 million persons were classified as "current cocaine users" that year, and 604,000 of those users smoked crack. Rates of use were highest among people age eighteen to twenty-five, with 2.2 percent of that age group using powder cocaine.

User Characteristics

The typical cocaine user comes from a large metropolitan area rather than a small town, but these metropolitan areas span the entire country. In other words, cocaine is abused widely throughout the big cities of the United States, with no concentration of use showing up in any specific state or section of the country.

According to "Pulse Check," a report available on the Office of National Drug Control Policy Web site, as of January 2004, the characteristics of powder cocaine users had not changed. The crack-using population, however, was aging considerably. Only in Cleveland, Ohio, and St. Louis, Missouri, were there reports of new use among young people. The results of the Monitoring the Future (MTF) survey, a joint effort of the University of Michigan and the National Institute on Drug Abuse (NIDA), seemed to back up these results. Annual use of powder cocaine among tenth and twelfth graders rose about one-half of 1 percent between 2003 and 2004. However, increases in crack cocaine use were reported to be much lower.

No single risk factor predicts cocaine use, but a person's willingness to take risks is often a factor in his or her decision to try it for the first time. Young people who smoke cigarettes are ten times as likely to use an illegal drug than their nonsmoking peers. In the past, students who used cocaine had to be willing to be very different from the norm. The trend of acceptance began changing in the 1990s, however. According to the 2004 MTF study, the perceived risk and disapproval of powder cocaine and crack use decreased among eighth, tenth, and twelfth graders.

Effects on the Body

When smoked or injected, cocaine quickly brings on an intense rush in the user, followed by a high. Snorting the drug does not produce the rush, and the high is slightly delayed because constricted blood vessels release the cocaine into the system at a slower rate.

Small doses of cocaine can cause users to feel self-confident, uninhibited, talkative, clever, and in control. Users have reported that they feel as if they can take on and accomplish just about any task. Their energy levels increase, and their appetites decrease. Larger doses and heavy use can cause the opposite effects. Heavy users often have difficulty expressing themselves verbally. They just cannot seem to find the right words to say what they want to say. They may also suffer memory problems, become extremely confused, and show signs of aggression, antisocial behavior, and paranoia.

The pleasurable feelings from cocaine use last only twenty to thirty minutes if it is snorted and only five to ten minutes if it is smoked or injected into the veins. When the high is over, the user feels tired, sluggish, and low. This cycle can trigger a dangerous pattern of repeated cocaine use as the user tries to recapture the first high. As the user "takes more of the drug," explained Elaine Landau in Cocaine, "he or she develops a tolerance for it. The same amount of cocaine will no longer make that person feel as good as it once did. Higher cocaine doses and increasingly frequent use of the drug become necessary. Many cocaine users say that in time they [need] significant amounts of the drug just to feel normal."

Harm to the Brain

In 1999, two NIDA-funded studies confirmed that heavy cocaine use could cause long-lasting brain impairment. Because cocaine reduces blood flow to the brain, some abusers develop problems with their attention span, memory, and problem-solving skills. Even a month after their last use, heavy users still found it difficult to perform tasks involving planning and reasoning. Users can become psychologically dependent on cocaine, using the drug to take the place of real-life experiences and problem-solving strategies. People who become dependent and then quit using cocaine often experience an intense craving for the drug long after the last use.

It has been known for years that cocaine use narrows blood vessels, raises blood pressure and body temperature, and increases the user's heart rate. These changes put a user at a high risk for life-threatening events. Sudden death can result from heart failure, respiratory failure, seizures, and strokes. In 2003, even more evidence came to light about cocaine's negative effects on the heart and circulatory system. Patrick Zickler reported in NIDA Notes that heavy users of cocaine also seem to "have elevated levels of … a blood protein that increases in concentration" among people at risk for a heart attack.

Cocaine Bugs

Heavy users of cocaine can experience paranoia, mood disturbances, and hallucinations (visions or perceptions of things that are not really there) of all sorts. A tactile hallucination (one involving the sense of touch) called "cocaine bugs" causes users to feel imaginary bugs or even snakes crawling under their skin. Users frequently scratch themselves until they bleed—using tweezers or a knife—to try to remove the imagined "bugs" from their bodies.

The Dopamine Connection

Drug researchers found out long ago that cocaine interferes with the regulation of the brain's dopamine levels. Dopamine is a neuro-transmitter and acts on the part of the brain responsible for filtering incoming information, making choices, judging behavior, and deciding when and how to act. Dopamine levels are associated with movement, emotional response, and the ability to experience pleasure.

Cocaine blocks the normal flow of dopamine, allowing greater-than-normal amounts of the chemical to build up in the spaces between the neurons. Too much dopamine in the brain produces negative effects: dopamine receptors become over-stimulated, and this can cause the brain to lose the ability to produce feelings of pleasure on its own. Although a cocaine-induced high typically lasts from fifteen to thirty minutes, the low can last from one to two days. Scientists suspect that continued use of cocaine actually reduces both the amount of dopamine and the number of dopamine receptors in the brain. So, once the cocaine-induced high is over, the user can fall into a period of deep and lasting depression. "In the same way that [the] brain will interpret the presence of cocaine as one of the most pleasurable experiences," wrote Heather Lehr Wagner in Cocaine, "it will interpret the absence of cocaine as one of the most painful."

The Myth of Nonaddiction

As late as the 1980s, there was a myth that cocaine was not addictive. Addiction occurs when drug use is no longer a voluntary choice but an uncontrollable compulsion. Some crack users report addiction after just one use.

When a person addicted to a substance stops taking that substance, he or she experiences unpleasant withdrawal symptoms. Cocaine withdrawal symptoms include an intense and irresistible craving for the drug, along with depression, irritability, exhaustion, extreme hunger, and sometimes paranoia. It is now known that cocaine is extremely addictive. In fact, it is one of the easiest drugs to get animals to take willingly. Animal research indicates that after repeated ingestion of cocaine, nearly 100 percent of monkeys and rats tested will continue to self-administer the drug whenever they are given the chance.

The most serious effect of using cocaine is the possibility of sudden death. It can happen after the first use or anytime thereafter. Sudden death can occur with cocaine use alone, but is more common when combined with alcohol or other drugs. Other side effects include irreversible damage to the heart and liver, along with damage inflicted by strokes and seizures.

And There Is More.…

The point of ingestion determines the specific side effects cocaine will cause in a user. For instance, snorting powder cocaine over time will damage the septum and ulcerate the mucous membrane of the nose. Users who snort cocaine are prone to nosebleeds.

The bleeding may occur without warning and could cause considerable disruption if it happens in public. For instance, schools are required to evacuate and thoroughly clean areas where human blood has spilled. This precaution must be taken to decrease the risk of transmitting blood-borne viruses such as HIV (the human immunodeficiency virus), which causes AIDS (acquired immunodeficiency syndrome).

Smoking crack cocaine can cause lung trauma and bleeding. Injecting cocaine into the veins often causes inflammation and infections. It also carries a greater risk for contracting HIV/AIDS and hepatitis because users sometimes share needles. Cocaine also has a reputation for lowering users' inhibitions. Users may take unusual risks that can lead to long-term consequences. These risks can range from unsafe sexual encounters to automobile crashes caused by poor judgment or aggression.

New information released by NIDA in 2004 revealed that cocaine might negatively affect a user's immune system. "Cocaine itself has a direct biological effect that may decrease an abuser's ability to fight off infections," wrote Patrick Zickler in NIDA Notes. This information, reported by a team of doctors at Harvard Medical School and the McLean Hospital Alcohol and Drug Abuse Research Center, could help explain why drug abusers have such a high incidence of infections.

Other research findings published in NIDA Notes show that cocaine has a definite negative effect on unborn babies. Children born to mothers who took cocaine when they were pregnant usually have lower-than-average birth weights, small heads, and the potential for more behavioral problems than other children. "At age two," wrote Robert Mathias, "cocaine-exposed children did significantly poorer in mental development than children" who were not exposed to cocaine.

These findings suggest that cocaine-exposed children may require extra assistance to overcome learning difficulties. Experts such as Dr. Lynn Singer of Case Western Reserve University believe that early educational programs can help these youths develop the skills they will need to succeed in school.

Reactions with Other Drugs or Substances

Cocaine is almost always used with other drugs, including alcohol, heroin, amphetamines, and marijuana. Combining drugs increases the chances of overdosing or experiencing serious side effects. The most common drug to be combined with cocaine is alcohol. Alcoholic beverages prolong the cocaine high and tend to reduce drug-induced paranoia. This combination creates a new substance, cocaethylene. Cocaethylene is as powerful as cocaine, and its effects last longer. However, it can be more toxic to the heart. NIDA statistics indicate that the combination of cocaine and alcohol results in more deaths than any other illegal drug combination.

The combination of cocaine and heroin is called a "speedball." It is especially dangerous because cocaine speeds up the respiratory system, while heroin depresses it, or slows it down. At very high doses, however, cocaine can begin to depress the respiratory system as well. In speedballing, cocaine and heroin are typically ingested at the same time, but some users ingest the drugs alternately to feel either more energetic or more relaxed. This combination can be more toxic than using either drug alone. Comedian John Belushi died from speedballing in 1982.

Amphetamines are often combined with cocaine to extend the high. Cocaine creates a rush but it is short-lived. Adding amphetamines extends the high for up to ten hours. Using these drugs together increases the chances of an overdose and increases toxic effects.

Treatment for Habitual Users

In an article for the New York Times, Linda Carroll reported that certain people are more likely to become addicted to cocaine than others. The reason for this seems to be some sort of inborn flaw in the brain's wiring. "The leading suspect," noted Carroll, "is a defect in the dopamine system." Studies conducted on monkeys seem to back up this theory. Five monkeys involved in a Wake Forest University medical school experiment were allowed to take cocaine whenever they wanted for a whole year. At the end of the year, the "addicted monkeys ended up with a 15 percent to 20 percent decrease in dopamine receptors," wrote Carroll. The five monkeys were reexamined nine months after the conclusion of the experiment. The brains of three of them had returned to normal, but the brains of the other two still had lower-than-normal amounts of dopamine receptors in them.

Addicts and Addiction

Some people believe that drug addiction is a voluntary behavior—that addicts simply choose to use drugs again and again. However, with continued use over a period of weeks or months, a person can go from being a voluntary drug user to being a compulsive, out-of-control drug user. Addictive drugs can actually change the brain in ways that result in more and more drug use.

Drug use is a very hard habit to break, even for the most determined individuals. It really does not matter which drug a person is abusing. In general, many drugs of abuse have similar effects on the brain. Such effects are discussed in Alan I. Leshner's article "Exploring Myths about Drug Abuse" on the NIDA Web site. Among the effects are:

• changes in the chemical makeup of brain cells
• a shift in mood
• transformation in memory processes
• alteration of motor skills needed to walk and talk.

These changes greatly impact the addict's behavior. The user's biggest motivation in life becomes obtaining and using the drug. Such behavior is not the result of a weak will or a character flaw. Rather, the drug use has caused major changes in the structure and the functioning of the user's brain—changes that are beyond the user's control.

The biggest challenge to cocaine treatment and rehabilitation is preventing relapse (the return to using drugs) caused by a persistent and intense craving for cocaine. Although cocaine addiction can be treated successfully, there is no single program that is effective for

everyone. NIDA recommends a dual approach to treatment, healing both the body and the mind. It suggests behavioral therapies, medications, rehabilitation, and social services. The idea is to treat the whole person.

Regarding medication, NIDA research reports that medications that act on dopamine receptors might reduce the intense craving and depression in former cocaine users. Behavioral therapies can include group and/or individual counseling, popular twelve-step programs, and chemical dependency inpatient and outpatient programs.

A Simple but Promising New Treatment Approach

On January 5, 2005, the National Institutes of Health (NIH) announced that peer counseling actually helped reduce cocaine and heroin abuse. The study was conducted by doctors at Boston University Schools of Medicine and Public Health and involved 1,175 male and female drug abusers. The process took only twenty minutes and consisted of "a motivational interview with a substance abuse outreach worker who also was a recovering addict," according to the NIH press release.

Members of the study were also given referrals to drug abuse treatment programs and a list of different types of treatment methods. In addition, they received a phone call ten days later to check on their progress. These simple interventions motivated a significantly higher percentage of abusers to stay away from drugs over a six-month period.

Consequences

When cocaine use progresses to a point of dependence, it can be devastating. At this stage, drug seeking often becomes the user's first priority. Suddenly, values such as love of family and friends and commitment to work can take second place to finding, buying, and using cocaine. "Cocaine addiction almost always interferes with social and economic functioning," stated Weil and Rosen. Addicts may end up spending "phenomenal amounts of money on their habits ($15,000 a year and more)," the authors explained. "They become paranoid, isolated, and depressed, unable to stop thinking about their next dose."

Habitual users often find themselves trapped in a web of deception and criminal behavior. Users desperate for more drugs may turn to robbery or prostitution in order to finance their habit. NIDA Notes stated that "cocaine use in 'crack' exchanges also contribute[s] to transmission of HIV/AIDS." Conviction of an illegal drug offense can trigger minimum mandatory prison sentences. Also, students convicted of cocaine possession can be disqualified from obtaining federal college grants and loans. In addition, NIDA-funded research shows that drug abusers cost employers about twice as much in medical and workers' compensation claims than drug-free workers. As a result, more and more businesses are requiring drug screening for employees.

The Law

Under the U.S. Controlled Substance Act of 1970, cocaine is a Schedule II drug. This means that cocaine has a high potential for abuse and that abuse may lead to severe physical and psychological dependence. It also means that cocaine has accepted medical uses with severe restrictions. The only legal use of cocaine in the United States is as a local anesthetic.

The Anti-Drug Abuse Act of 1986 and 1988 established mandatory minimum drug sentencing guidelines for cocaine use and possession. Federal law carries a much harsher penalty for crack cocaine than for powder cocaine. Because more African Americans tend to use crack than powder, this law continues to result in harsher prison terms for blacks. Possession of 5 grams of crack or 500 grams of powder carries a first-offense penalty of not less than five years in prison. Despite the severity of this penalty, according to Landau, about "85 percent of those imprisoned for drug abuse" will continue to "use cocaine or other drugs after leaving prison."

In the United Kingdom, cocaine and crack are considered Class A drugs under the 1971 Misuse of Drugs Act. Possession of the drugs can result in a fine and a prison term of up to seven years. Supplying, or selling, either form of cocaine can lead to a lifetime prison sentence.

For More Information

Books

Brecher, Edward M., and others. The Consumers Union Report on Licit and Illicit Drugs. Boston: Little Brown & Co., 1972.

Gahlinger, Paul M. Illegal Drugs: A Complete Guide to Their History, Chemistry, Use, and Abuse. Las Vegas, NV: Sagebrush Press, 2001.

Landau, Elaine. Cocaine. New York: Franklin Watts, 2003.

Robbins, Paul R. Crack and Cocaine Drug Dangers. Berkeley Heights, NJ: Enslow Publishers, Inc., 1999.

Wagner, Heather Lehr. Cocaine. Philadelphia: Chelsea House, 2003.

Weil, Andrew, and Winifred Rosen. From Chocolate to Morphine. New York: Houghton Mifflin, 1993, rev. 2004.

Periodicals

Carroll, Linda. "Genetic Studies Promise a Path to Better Treatment of Addictions." New York Times (November 14, 2000).

Web Sites

"2003 National Survey on Drug Use and Health (NSDUH)." U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration.http://www.oas.samhsa.gov/nhsda.htm (accessed June 30, 2005).

"Brief Encounters Can Provide Motivation to Reduce or Stop Drug Abuse." National Institutes of Health: NIH News (press release). http://www.nih.gov/news/pr/jan2005/nida-05.htm (accessed June 30, 2005).

"Cocaine." bbc.co.uk, A to Z of Drugs. http://www.bbc.co.uk/crime/drugs/cocaine.shtml (accessed June 30, 2005).

"Cocaine." U.S. Department of Justice, Drug Enforcement Administration.http://www.usdoj.gov/dea/concern/cocaine.html (accessed June 30, 2005).

"Comparing Methamphetamine and Cocaine." National Institute on Drug Abuse, NIDA Notes.http://www.nida.nih.gov/NIDA_notes/NNVol13N1/Comparing.html (accessed June 30, 2005).

"Crack." bbc.co.uk, A to Z of Drugs.http://www.bbc.co.uk/crime/drugs/crack.shtml (accessed June 30, 2005).

"Crack and Cocaine." National Institute on Drug Abuse, NIDA Info Facts.http://www.nida.nih.gov/Infofax/cocaine.html (accessed June 30, 2005).

"Drugs and Chemicals of Concern: Cocaine." U.S. Department of Justice, Drug Enforcement Administration, Diversion Control Program.http://www.deadiversion.usdoj.gov/drugs_concern/cocaine/cocaine.htm (accessed June 30, 2005).

"Four Tonnes of Cocaine Seized in Joint Operation with UK, Spain, and Portugal." Tackling Drugs, Changing Lives: Drugs.gov.uk, January 7, 2005. http://www.drugs.gov.uk/News/1117623830 (accessed June 30, 2005).

Leshner, Alan I. "Exploring Myths about Drug Abuse." National Institute on Drug Abuse: The Science of Drug Abuse and Addiction.http://www.drugabuse.gov/published_articles/myths.html (accessed June 30, 2005).

Mathias, Robert. "Study Finds Significant Mental Deficits in Toddlers Exposed to Cocaine before Birth." National Institute on Drug Abuse, NIDA Notes.http://www.nida.nih.gov/NIDA_notes/NNVol17N5/Study.html (accessed June 30, 2005).

Monitoring the Future.http://www.monitoringthefuture.org/ and http://www.nida.nih.gov/Newsroom/04/2004MTFDrug.pdf (both accessed June 30, 2005).

National Institute on Drug Abuse.http://www.nida.nih.gov/ and http://www.drugabuse.gov (both accessed June 30, 2005).

"Pulse Check: Drug Markets and Chronic Users in 25 of America's Largest Cities." Executive Office of the President, Office of National Drug Control Policy.http://www.whitehousedrugpolicy.gov/publications/drugfact/pulsechk/january04/january2004.pdf (accessed June 30, 2005).

"Stimulants." NIDA for Teens: The Science behind Drug Abuse, Mind over Matter.http://www.teens.drugabuse.gov/mom/mom_stim1.asp (accessed June 30, 2005).

Swan, Neil. "Brain Scans Open Window to View Cocaine's Effects on the Brain." National Institute on Drug Abuse, NIDA Notes.http://www.nida.nih.gov/NIDA_notes/NNVol13N2/Brain.html (accessed June 30, 2005).

Zickler, Patrick. "Cocaine May Compromise Immune System, Increase Risk of Infection." National Institute on Drug Abuse, NIDA Notes.http://www.nida.nih.gov/NIDA_notes/NNVOL18N6/Cocaine.html (accessed June 30, 2005).

Zickler, Patrick. "Methamphetamine, Cocaine Abusers Have Different Patterns of Drug Use, Suffer Different Cognitive Impairments." National Institute on Drug Abuse, NIDA Notes.http://www.nida.nih.gov/NIDA_notes/NNVOL16N5/Meth_Coc.html (accessed June 30, 2005).

See also: Alcohol; Amphetamines; Heroin; Marijuana