COCAINE

OFFICIAL NAMES: Powder cocaine, crack cocaine

STREET NAMES: Base, Bernice, blow, "C", coke, dream, dust, flakes, nose candy, Peruvian marching powder, powder, rock, stardust, snow, sugar, the devil's dandruff, white lady

DRUG CLASSIFICATIONS: Schedule II, stimulant

OVERVIEW

South Americans in the Andes Mountains legally and liberally chew coca leaves. By adding a little lime or plant ash, the naturally occurring cocaine alkaloid is released and absorbed into the cheek. This has a mild stimulating effect similar to drinking several cups of strong coffee. In this way, the mountain people have combated heat, cold, hunger, and fatigue for over 4,000 years. The leaves are used medicinally to alleviate problems of the digestive system, altitude sickness, and psychological ills. Used in the whole-leaf form, cocaine does not produce a "high" and is not addictive.

Coca leaves were not used in Europe or the United States because coca leaves do not travel well. But in 1860, a German chemist, Albert Niemann, separated cocaine from the leaf. In doing so, he unleashed the most powerful naturally occurring stimulant. In the salt form (cocaine hydrochloride), which is commonly known as powder cocaine, it travels very well. Soon, large quantities were being consumed abroad.

Initially, cocaine was thought to be a "cure-all," and, like the whole-leaf form, powder cocaine was believed to be non-addictive. Due to this misinformation, from the 1860s until the early 1900s, the use of cocaine was unregulated. It was used widely in Europe and in the United States. People could buy anything from cocaine-laced beverages, such as Vin Mariani coca wine and Coca-Cola, to 99.9% pure powder cocaine. Vin Mariani was a wine and cocaine concoction endorsed by Pope Leo XVIII and by over 7,000 physicians. In the 1880s, John Pemberton created Coca-Cola—the non-alcoholic "health drink" containing 60 mg of cocaine. (It should be noted that Coca-Cola no longer uses cocaine in its products.) Cocaine was believed to remedy many conditions, including fatigue, toothache, hay fever, asthma, seasickness, and vomiting during pregnancy. No prescription was necessary, and cocaine could easily be purchased at grocery stores, drug stores, and through mail-order catalogues.

Bona fide scientific and medical research lagged behind the commercial marketing of cocaine. It was not until the 1880s that cocaine was seriously studied. A German physician did a study on the effects of cocaine on the Bavarian army. He wrote a paper on the endurance enhancing qualities of cocaine. This paper was read by Dr. Sigmund Freud, who then experimented on himself. Freud discovered that cocaine affects the heart and produces a powerful "high." He later prescribed cocaine for heart disease, psychiatry, and morphine addiction. He wrote his own paper, "On Coca," extolling the virtues of the drug, which he claimed was non-addictive. In 1884, Karl Koller started using cocaine as a topical anesthetic for eye surgery and it was soon used in dentistry. In 1885, cocaine was used as a spinal anesthetic for dogs. William S. Halsted, considered to be the father of modern surgery, discovered that cocaine injected under the skin makes an effective local anesthetic for surgery.

It was not until the 1890s that public opinion began to shift against cocaine use. By then, reports of nasal damage, addiction, and cocaine-related deaths had begun to circulate. The toxic and addictive nature of cocaine became public knowledge. By the time the government stepped in to ban cocaine in 1914, most people were already shunning it.

In the 1970s there was a resurgence of powder cocaine use. This preceded the epidemic of crack cocaine in the 1980s. 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 and this increase was publicized in the media. In response to public concern, the Anti-Drug Abuse Act of 1986 and 1988 was passed. Known sometimes as the 100:1 law, this federal law includes mandatory minimum sentences for first-time offenders. The penalties are much harsher for possession of crack cocaine than powder cocaine.

In a 2001 study entitled Global Illicit Drug Trends conducted by the United Nations Office for Drug Control and Crime Prevention (ODCCP), it was estimated that 14 million people used cocaine worldwide. Though cocaine use has leveled off in the United States, it still leads the world in cocaine abuse. In 1999, cocaine use was stable in the United States, but increased in Western Europe and in several South American countries. Because of the addictive and destructive nature of cocaine, there is a concerted worldwide effort to reduce the production and illicit use of cocaine.

CHEMICAL/ORGANIC COMPOSITION

Cocaine is the most potent naturally occurring stimulant. It is found as an alkaloid (nitrogen-containing organic base) in the leaves of the Erythroxylon coca trees in the Andes Mountains. Coca leaves contain0.5–1.8% cocaine (benzoylmethylecgonine or BZ) that can be refined to nearly 100% purity. Research indicates that the plant produces cocaine to kill insects that prey on it. In humans, it is a central nervous system (CNS) stimulant.

TYPES OF COCAINE

Anesthetic

Cocaine was the first local anesthetic to be discovered and this is its only legal use in the United States. Cocaine is particularly effective as a local anesthetic because it numbs the site of application almost immediately and it minimizes bleeding. Typically a 1–4% solution is used clinically. 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, Lidocaine, a synthetic derivative of cocaine, is the most widely used local anesthetic.

Coca leaves

Cocaine is ingested in its mildest form by chewing coca leaves. Alkalines such as lime or ash are added to the leaves to release the cocaine alkaloid. In addition to cocaine, the leaves contain protein, minerals, vitamins, and over 14 alkaloids. Instead of experiencing a "rush"

or a "high," chewers first notice numbness of the mouth followed by alertness and a sense of well-being. The stimulant effect is about as potent as the caffeine in several cups of strong coffee. Regular coffee breaks in the United States is the social equivalent of regular coca leaf breaks in the mountains of South America. Chewing coca leaves is also part of the religious tradition. In addition to chewing coca leaves, the people also make the leaves into tea. Coca leaves are not smoked because the temperature needed to burn the leaves destroys the cocaine alkaloid before it can be inhaled.

Coca paste

Sometimes called "bazooka," coca paste is an impure free-base form of cocaine that is smoked. It contains 20–90% cocaine and it is psychoactive. Smokers experience a "rush" or a "spike" similar to the effects of smoking crack or injecting powder cocaine. This is followed by a "high." Coca paste is highly addictive. To make the paste, lime water, kerosene, and sulfuric acid are added to coca leaves. By removing the bulky leaf matter, 250 lbs (114 kg) of coca leaves are converted into 22 lbs (10 kg) of coca paste. Solvent residues give the paste an unpleasant taste and odor. It is usually added to tobacco or marijuana cigarettes. Use of coca paste is restricted mainly to South America as it is bulky and difficult to ship. With additional processing, coca paste can be converted into powder cocaine, which is easier to smuggle and is much more profitable for South American cartels.

Powder cocaine

Powder cocaine (cocaine hydrochloride) can be over 100 times more potent than coca leaves. By adding acids and purifying agents, 22 lbs (10 kg) of coca paste can be refined to 2.2 lbs (1 kg) of powder. This powder approaches 100% purity, but it is diluted with fillers before it is sold on the streets in the United States. Common fillers are cheaper drugs such as amphetamines or sugars such as lactose or inositol. Average street powder purity is 60%. 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. Powder cocaine is addictive when snorted and highly addictive when injected.

Free base

Free base is a form of cocaine that can be smoked. There are three free-base forms of cocaine: coca paste, free base, and crack. Coca paste is made directly from coca leaves with solvents and acids. It is not available in the United States. Another form called "free base" was developed in the mid-1970s. In this process, powder cocaine is changed into free base by using water, ammonia, and highly flammable ether. It is a dangerous process because the volatile chemicals sometimes explode or ignite. Comedian Richard Pryor was badly burned while "freebasing." By far, the most common free base is crack. In a very stable process, cocaine and sodium bicarbonate are combined. The precipitate, crack, is nearly 100% pure cocaine. All three forms of free base are highly addictive.

Crack cocaine

Crack is free-base cocaine extracted from powder cocaine using water and sodium bicarbonate. The resulting precipitate is dried and cut into "rocks" weighing between one-tenth to one-half a gram. Ten grams of powder cocaine will convert to 8.9 grams of nearly pure crack. A rock is placed into a glass pipe, heated, and the vapors are inhaled. It is called "crack" because when it is heated, the sodium bicarbonate makes a crackling sound. Because crack is inexpensive and delivers large amounts of cocaine to the lungs, it has become the most popular form of cocaine. Crack is highly addictive.

INGESTION METHODS

The way cocaine is ingested greatly determines the intensity of the effect it will have on the brain and the body. As ingestion methods increase the speed at which cocaine reaches the brain, it also increases the "high" and the risk of addiction.

Mouth and stomach

South American natives chew coca leaves mixed with lime or plant ash to gradually release small amounts of cocaine alkaloid. 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 similar to drinking several cups of strong coffee. It does not cause a "high," but the feeling of wellbeing can last one to two hours.

Snorting

Typically, a line of 20–30 mg of powder cocaine is placed on a mirror or glass and is snuffed into the nose. In less than one minute, this blood-vessel-rich nasal area transports the cocaine to the brain, resulting in a "high" or "euphoria." Because of the constricting effect cocaine has on the blood vessels, absorption is slower than when cocaine is smoked or used intravenously. The "high" from snorting is less intense, but it lasts longer. Snorting cocaine is addictive.

Injecting

Powder cocaine can be dissolved in water and injected into the veins. In less than 16 seconds, the cocaine is mixed with the blood, sent to the lungs, returned to the heart and received by the brain. The intense euphoria is greater than a "high" and is referred to as a "rush." The "rush" generally lasts only a few minutes and the remaining "high" drops off quickly. This is the least socially acceptable way to ingest cocaine. Injecting cocaine is highly addictive.

Smoking

Powder cocaine and coca leaves cannot be smoked. The heat required to smoke these forms of cocaine destroys its psychoactive properties. In order to smoke cocaine, it must be changed to a free-base form. In South America, the most common free base is coca paste. In the West, people smoke crack, and to a much lesser extent, free base made with ether. The free base or crack is put into a glass pipe, heated, and the vapors are inhaled.

If it is inhaled deeply into the lungs, the vapors will come in contact with over 300 million alveolar sacs representing 171 yd² (143 m²) of surface area. Within three seconds, cocaine is absorbed into the blood and pumped directly to the brain. This immediate brain "rush" or "spike" is slightly faster than the injection method and is achieved without the use of needles. Smoking cocaine by inhaling free-base vapors creates the fastest and most intense "rush" and subsequent "high." This is highly addictive.

THERAPEUTIC USE

The medicinal and ceremonial uses of cocaine via coca leaves can be traced back over 4,000 years to pre- Columbian times. It continues to be used legally and is part of the daily culture of South American Indians. Coca leaves are chewed to combat fatigue and to ward off hunger. They are also used to alleviate problems of the larynx, digestive system, metabolism of carbohydrates, vertigo, altitude sickness, and for psychological ills.

After 1860, cocaine was being processed into powder and shipped to the United States and Europe. As described, in the 1880s, people could buy 99.9% pure powder cocaine at the grocery store and in mail-order catalogs, and could drink cocaine-laced "health" drinks. It was a common nonprescription remedy for hay fever, children's toothaches, asthma, mountain sickness, seasickness, vomiting during pregnancy, and cramps. Snorting also became popular and some people began injecting cocaine. One company, Parke-Davis, not only sold cocaine—it offered needle and syringe kits.

As use proliferated, the toxic effects of cocaine became apparent. People were getting addicted. In 1914, the Harrison Narcotic Act banned cocaine in the United States. Only use as a local anesthetic was legally retained. It is still used today in nasal, mouth, and throat surgery. Anesthetic solutions contain 1–4% cocaine.

A need was seen for a synthetic and less toxic anesthetic. In 1905, Procaine was synthesized and became the prototype for synthesized anesthetics for the next 50 years. In 1948, Lidocaine was developed and is now the most commonly used local anesthetic. Other synthesized local anesthetics include bupivacaine and tetracaine.

USAGE TRENDS

Americans' attitude toward cocaine has run the gamut from acceptance to ambivalence to outrage. In the late 1870s, soon after cocaine was first introduced as a non-addictive "cure-all," the drug was found in family medicine cabinets for dozens of applications. Also, in keeping with the spirit of the American Industrial Revolution, cocaine was touted as a tonic to energize workers and ensure peak efficiency. By the 1890s, cocaine had gone beyond medical application and began to contribute to the pleasure-centered Gay Nineties. During this time of widespread use, medical journals began to report on the toxic and addictive properties of cocaine.

Public support turned against cocaine and it became a focal point of the temperance crusade in 1903. The Harrison Act of 1914 classified cocaine as a narcotic and prohibited its use in the United States except as a local anesthetic. During that same year, all 48 states passed similar laws. The 1930s through the 1960s became a time of intolerance as exemplified by the tough drug laws that were passed. Then ambivalence set in. People forgot the reason for the outrage. In the 1960s, few people personally knew a cocaine user or addict.

By the 1970s, another epidemic of cocaine use was underway. Cocaine became part of the disco scene with bright lights, glittery clothes, and the energy to dance the night away. Cocaine, generally snorted, gained a reputation as being a drug for the affluent. In the 1980s, a new form of cocaine known as crack became available. Crack could be smoked, delivered a more intense high, and cost about one-tenth as much as powdered cocaine. Cocaine use peaked in 1985 when the number of Americans who had ever used cocaine soared to 25 million.

As cocaine-related hospital emergency visits increased and negative media stories began to proliferate, public opinion once again moved against recreational cocaine use. Crack especially was singled out as being extremely addictive and destructive. Amid this outcry, the Anti-Drug Abuse Act of 1986 was passed and crack possession now carried much heavier penalties than its counterpart, 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 National Household Survey on Drug Abuse (NHSDA), the cocaine-using population had crept back up to about three million people by 1993. The gradual increase continued. By 1999, the NHSDA reported cocaine use by3.7 million or 1.7% of Americans. The Community Epidemiology Work Group (CEWG), which follows drug abuse trends in 21 major U.S. metropolitan areas showed a slight downward trend in crack/cocaine use in their 2000 report.

Scope and severity

The fact that less than 2% of the American population uses cocaine is not cause to minimize its scope and severity. These three million or so Americans consume about 50% of the world's cocaine production. According to the Drug Abuse Warning Network (DAWN) for 2000, cocaine was the second most frequently mentioned drug that caused people to be admitted to hospital emergency rooms. Also, of the 32,288 suspects referred to federal prosecutors for drug charges during 1999, 43% were charged with offenses relating to powder cocaine or crack. The Office of National Drug Control Policy (ONDCP) reports in the November 2001 Pulse Check,

that over half the Pulse Check communities listed crack as the drug with the most severe or second-most severe consequences, whether medically, legally, or otherwise. The same report listed powder cocaine as widely available in 85% of the 21 Pulse Check cities. Crack was listed as widely available by 75% of the Pulse Check sources.

As of 2002, about 14 million people worldwide use cocaine. According to the ONDCP, the United States leads the world in cocaine abuse. While U.S. cocaine use has remained relatively stable over the last decade, the United Nations Commission on Narcotic Drugs reported in March 2000 that 34 countries out of 112 reported an increase in cocaine use from 1997 to 1998. In the European Union, the increase in cocaine use was mainly in the group of people aged 16 to 29 years.

Age, ethnic, and gender trends

In 2000, according to the NHSDA, cocaine use dropped over the course of the year from 0.2% to 0.1% in youths aged 12 and 13. Youths aged 14 and 15 had no change for the same time period with 0.5% using cocaine. Cocaine use increased in youths aged 16 and 17, from 0.9% to 1.1%. Crack use declined in young adults aged 18 to 25 and went from 0.3% to 0.1%. Adults aged 26 and older had no change in cocaine use, but there was a decline in crack use for adults 26 to 34 years. This study also indicated that 43% of cocaine users were under the age of 26. The ONDCP reports in November 2001 that nine Pulse Check cities considered young adults (18–30 years) to be the primary crack user group, while eight cities cited adults older than 30 years.

Though crack and powder cocaine are different forms of the same drug, clearly divided ethnic preferences exist. The NHSDA reported in 2000, African Americans are the predominant users of crack, whereas whites are the predominant users of powder cocaine. Socioeconomic status may contribute to this trend. The Hispanic population uses more powder cocaine than crack, but figures overall remain low.

Regarding gender differences, again the NHSDA separates the statistics for powder cocaine and crack. Males are more likely than females to use powder cocaine. However, males and females are equally likely to use crack in many surveyed cities. Studies indicate that female crack use has been increasing over the past five years.

No single risk factor predicts cocaine use. However, because cocaine use is approved of and practiced by such a small percentage of the population, a person's willingness to take risks is often a factor. Other factors include a person's level of impulsiveness, other available sources of attaining pleasure, the availability of cocaine, and the relationship of adolescents with their parents. Because recreational cocaine use is against the law, how people view breaking the law is also a factor. It is noteworthy that young people who illegally smoke are ten times as likely to use an illegal drug than their non-smoking peers.

Students who use cocaine must be willing to deviate greatly from the norm. However, the trend of acceptance is changing. According to the "Monitoring the Future" study, in the decade of the 1990s, perceived risk and dis-approval of powder cocaine and crack decreased in eighth, tenth, and twelfth grades.

MENTAL EFFECTS

Small doses of cocaine can cause users to feel both mentally and sexually excited, self-confident, uninhibited, talkative, clever, and in control. Larger doses and heavy use can cause the opposite effects. Heavy users can become confused mentally, uninterested in sex, paranoid (feeling everyone is against them), antisocial, aggressive, and are subject to cocaine psychosis (a mental illness whose symptoms include paranoia, disorientation, and severe depression).

The pleasurable feelings from cocaine use last only 15–30 minutes if it is snorted and only five to 10 minutes if cocaine is smoked or injected into the veins. When the "high" is over, the user feels tired, sluggish, and "low."

This cycle can precipitate repeated cocaine use to try to recapture the first high. Oddly, the more often cocaine is used, the less intense the pleasure. This is called tolerance. If use continues to the point of addiction, users take cocaine just to feel "normal."

Heavy users and binge users can experience visual and auditory hallucinations. A tactile hallucination (a hallucination involving the sense of touch) called "cocaine bugs" causes users to feel imaginary bugs crawling under their skin. Users can scratch or use a knife to try to remove the "bugs" in reaction to this sensation. In 1999, two NIDA-funded studies confirmed that heavy cocaine use can cause long-lasting brain impairment. In one study, it was found that the user's problem-solving skills and cognitive skills lagged behind that of moderate or non-users. In a second study, a month after last use, heavy users performed much worse than moderate or non-users in 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.

PHYSIOLOGICAL EFFECTS

Cocaine is a central nervous system (CNS) stimulant that causes a significant increase in heart rate, respiration, blood pressure, and body temperature. According to DAWN, one in thirteen cocaine users go to the hospital to be treated for severe reactions that could be life threatening. Sudden death can result from heart failure, respiratory failure, seizures, strokes, and cerebral hemorrhage. There is no antidote for cocaine overdose. Even if the adverse reactions do not result in death, they can do permanent damage to the body.

For years, scientists have known that cocaine interferes with the brain's dopamine system. Dopamine is a neurotransmitter—a chemical that passes nerve impulses from one nerve cell to another, and dopamine is associated with movement, emotional response, and the ability to experience pleasure. Research indicates that serotonin transporters are also inactivated with cocaine use. Serotonin is another neurotransmitter, and adequate levels are associated with well-being. Low levels of serotonin in the brain have been linked to depression. Inactivation of dopamine and serotonin transporters leads to receptor over-stimulation and the "high." Continued use of cocaine can result in long-term changes in the brain chemistry as receptors decrease in number. These changes can be persistent and even irreversible, and may be responsible for the feeling of depression that lasts long after withdrawal.

As late as the 1980s, there was a pervasive myth that cocaine is not addictive. This was because withdrawal symptoms were not thought to be physical. When a person addicted to a substance stops taking the substance, he or she experiences withdrawal symptoms. The withdrawal symptoms are unpleasant, and encourage the person to take the substance again in order to avoid the withdrawal. Cocaine withdrawal symptoms include an intense and irresistible craving for cocaine, depression or "crash," and sometimes paranoia. It is now known that cocaine is powerfully addictive. Research indicates that after repeated ingestion of cocaine, nearly 100% of monkeys and rats tested will self-administer the drug. Cocaine is one of the easiest drugs to get animals to take willingly.

Cocaine is metabolized very quickly by the body. Within minutes, enzymes in the blood and in the liver split the cocaine molecule into two halves, rendering it inactive. Cocaine and its metabolites are excreted in the urine. The body's efficient metabolism of cocaine causes the "high" to be relatively short-lived. This often causes cocaine users to take several doses of cocaine in a short time, which can increase the chances of an overdose.

Harmful side effects

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 it more commonly occurs when cocaine is combined with alcohol or other drugs. More common side effects include irreversible damage to the heart and liver, along with damage inflicted by strokes and seizures. Cocaine users are also at risk for addiction. Addiction is often viewed as a disease. It occurs when drug use is no longer a voluntary choice but an uncontrollable compulsion. Some crack users report addiction after just one use.

The point of ingestion determines the specific side effects. For instance, snorting powder cocaine over time will damage the septum and ulcerate the mucous membrane of the nose. Smoking crack cocaine can cause lung trauma and bleeding. Injecting cocaine into the veins often causes inflammation, infections, and carries a greater risk for contracting AIDS/HIV and hepatitis.

Cocaine use during pregnancy is especially dangerous. It can cause harm to both the mother and the baby. Cocaine causes spasms in the blood vessels, including those in the placenta. Sometimes placenta abruption (separation of the placenta from the wall of the uterus before the baby is born) and bleeding occurs, which can be fatal to the mother and baby. Children born to mothers who used cocaine during pregnancy are often termed "crack babies." These babies tend to be abnormally small. Because of their low birth weight, they are 20 times more likely to die in their first month of life than babies of normal weight. The babies have an increased risk of mental retardation, cerebral palsy, and vision and hearing disabilities. Cocaine-induced prenatal strokes can cause permanent brain damage. Another common abnormality of these babies is their unusually small head. While they seem to have normal intelligence, studies indicate more behavioral problems for exposed children than unexposed children.

Long-term health effects

Cocaine constricts blood vessels and decreases blood flow. Using imaging technology such as magnetic resonance angiography (MRA) and transcranial Doppler sonography (TDC), scientists can see both short-term and long-term blood flow deficits in the brains of cocaine users. Long-term cocaine use can also cause atherosclerosis, or thickening of the blood vessels. Because of this, cocaine abusers in their thirties can have arteries as constricted as non-abusers in their sixties. With reduced blood flow to the brain, some cocaine abusers have shown cognitive deficits in attention span, memory, and problem-solving. Other effects include serious damage to the heart, lungs, and liver.

Cocaine also has a reputation for being disinhibiting. Users may take unusual risks that can lead to long-term consequences. These risks can range from sexual encounters to automobile accidents caused by poor judgment or aggression.

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 overdose and serious side effects. The most common drug to be combined with cocaine is alcohol. Alcoholic beverages prolong the cocaine "high" and reduce drug-induced paranoia. This combination creates a new substance, cocaethylene. Cocaethylene is as potent as cocaine and lasts longer. However, it can be more toxic to the heart. The combination of cocaine and alcohol results in more deaths than any other illegal drug combination.

Combining cocaine with heroin is called a "speedball," "dynamite," or "whiz-bang." It is a very dangerous combination because cocaine speeds up the respiratory system while heroin depresses it. However, at high doses, cocaine can begin to depress the respiratory system, as well. In speedballing, cocaine and heroin are typically ingested at the same time. However, 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 using this combination 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.

Cocaine is also frequently combined with marijuana. Called a "diablito" or "turbo," a cigar is filled with marijuana and crack and then smoked. This increases the risk to the cardiovascular system as both drugs speed up the heart and increase blood pressure.

Brompton's mixture

In the 1970s, a combination of cocaine, methadone, and alcohol was given to terminal cancer patients. The methadone and alcohol relieved the pain but induced a lethargic and clouded state for the patients. Cocaine was added to make patients more alert. New medications are more effective and cocaine is no longer used for cancer patients.

TREATMENT AND REHABILITATION

According to the 1997 National Association of State Alcohol and Drug Abuse Directors (NASADAD), excepting alcohol, the largest number of publicly funded drug treatment admissions were for cocaine. 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. To this end, after detoxification, which can take less than a week, treatment programs often include deconditioning. Deconditioning exposes abstinent users to cues that produce powerful and pleasurable memories of cocaine use. By keeping the patients from reinforcing the memories with cocaine use, the cues eventually lose their power to produce a craving.

While cocaine addiction can be treated successfully, there is no one program that is effective for everyone. Principles of Effective Drug Treatment, published by NIDA, recommends a multi-faceted approach to treatment. 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 both the dopamine and serotonin receptors might reduce the intense craving and depression. Behavior therapies can include group and/or individual counseling, popular 12-Step programs, therapeutic communities, and chemical dependency inpatient and outpatient programs. Rehabilitative treatment includes training focused on resolving problems related to jobs, home life, and the criminal justice system.

PERSONAL AND SOCIAL CONSEQUENCES

When cocaine use progresses to a point of dependence it can be devastating. At this stage, drug seeking often becomes the first priority. Suddenly, values such as love of family and commitment to work can take second place to finding, buying, and using cocaine.

Habitual users can lose the trust and respect of the people important to them. Lying, stealing, and isolating oneself all take a heavy toll on family, friends, and employment relationships.

Aside from theft, NIDA funded research shows that drug abusers cost employers about twice as much in medical and worker's compensation claims than drug-free workers. As a result, more and more businesses are requiring drug screening before hiring and are employing periodic drug-testing thereafter.

While a single dose of cocaine may cost as little as five or ten dollars, an addiction can cost hundreds of dollars a week. This can lead to financial ruin and often progresses to criminal activity. (Users desperate for more drugs may turn to illegal activity, including robbery or prostitution, in order to finance their habit.) 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.

Though less than 2% of Americans use cocaine, it has profound national consequences. Health and human services related to drug and alcohol abuse cost taxpayers more than $294 billion dollars annually. This cost rose 50% from 1985 to 1992. A NIDA-funded study showed that cocaine use was the primary factor contributing to this increase.

LEGAL CONSEQUENCES

Under the Controlled Substance Act, 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 federal mandatory minimum drug sentencing guidelines. The punishment exacted by the federal law is substantially greater than the punishment imposed by most state laws. For example, someone convicted of cocaine possession that receives a 12-year sentence in the state system may be liable for a mandatory life term if tried in the federal system. Also, most state laws do not differentiate between powder cocaine and crack cocaine. Federal law carries a much harsher penalty for crack than for powder. Possession of five grams of crack or 500 grams of powder carries a mandatory first-offense penalty of not less than five years in prison.

Legal history

Cocaine accessed by chewing coca leaves has been a legal and common tradition in South America for over 4,000 years. It continues to be legal.

Purified powder cocaine was legal in Europe and the United States from its introduction in the 1860s until1914. During that time, cocaine use reached epidemic proportions. Medical reports of addiction and sudden death caused public opinion to move against cocaine use. In 1906, the Pure Food and Drug Act mandated that cocaine be listed as an ingredient in all medicines whether they were sold by individuals or drug companies. President William Taft declared cocaine as Public Enemy No. 1, and in 1914 Congress passed the Harrison Narcotics Act. Cocaine thus became one of the first drugs to be banned in the United States. That same year, all 48 states had laws banning cocaine. The only legal use for cocaine was as a local anesthetic.

While laws continued to be passed over the next seven decades, none proved to be as controversial as the Anti-Drug Abuse Act of 1986 and 1988. Like the Harrison Act, this law arose during an epidemic of cocaine use. This time, it was the 1980s epidemic fueled by crack. In 1986, the death of two promising young athletes, Len Bias and Don Rogers, added to public outrage. The new laws differentiated between powder cocaine and crack and were much harsher on the latter. These laws require 100 times as much powder cocaine possession as crack to trigger an identical minimum mandatory prison sentence. Ongoing controversy surrounds this law. Several bills have been introduced to reduce the disparity, but none have been passed into law as of early 2002.

Drug trafficking organizations in Columbia control the world's cocaine supply. The United States is actively engaged in fighting Columbia-based drug cartels. The U.S. Drug Enforcement Administration Congressional testimony of March 2, 2001 stated that targeting organized crime groups in Columbia will continue to be a priority and a matter of national security.

Federal guidelines, regulations, and penalties

Federal Trafficking Penalties, which are outlined in the Anti-Drug Abuse Act of 1986 and 1988, make a significant distinction between powder cocaine and crack cocaine. A first-time offender convicted for possession of 5–49 grams of crack cocaine will receive a mandatory minimum sentence of five years and not more than 40 years. Fines for individuals can be up to $2 million. The federal mandatory minimum sentences for powder cocaine begin at 500–4,999 grams and trigger the same sentence. Penalties for convicted second-time offenders are a minimum mandatory sentence of 10 years to life, with fines up to $4 million. This law is often referred to as the 100:1 law and has been challenged and reviewed several times.

RESOURCES

Books

Berger, Gilda. Crack, The New Drug Epidemic. Franklin Watts,1987.

Carroll, Marilyn. Cocaine and Crack. Enslow Publishers Inc.,1994.

Friedman, David P., and Sue Rusche. False Messengers: How Addictive Drugs Change the Brain. Harwood Academic Publishers, 1999.

Goldstein, Avram. Addiction: From Biology to Drug Policy. Oxford University Press, 2001.

Other

Center for Education and Information on Drugs and Alcohol. NSW+Health. Cocaine<http://www.ceida.net.au/tools_for_workers/drugs/cocaine.html>.

National Institute on Drug Abuse. National Institutes of Health. "Cocaine Abuse May Lead to Strokes and Mental Deficits." NIDA Notes 13, no. 3 (July 1998). <http://www.nida.nih.gov/NIDA_Notes/NNVol12N3/Cocaine.html>.

National Institute on Drug Abuse. National Institutes of Health. "Oops: How Casual Drug Use Leads to Addiction." NIDA NOTES<http://www.nida.nih.gov/Published_Articles/Oops.html>.

United States Department of Justice. Drug Enforcement Administration. Cocaine. <http://usdoj.gov/dea/concern/cocaine.html>.

United States Office of National Drug Control Policy. "Crack: The Perception." Pulse Check: Trends in Drug Abuse (November2001). <http://www.whitehousedrugpolicy.gov/publications/drugfact/pulsechk/fall2001/crack.html>.

United States Office of National Drug Control Policy. "Powder Cocaine: The Perception." Pulse Check: Trends in Drug Abuse (November 2001). <http://www.whitehousedrugpolicy.gov/publications/drugfact/pulsechk/fall2001/powder.html>.

Organizations

Cocaine Anonymous World Services, P.O. Box 2000, Los Angeles, CA, USA, 90049-8000, (310) 559-5833, [email protected], <http://www.ca.org>.

Cocaine Helpline, 1-800-662-HELP.

National Institute on Drug Abuse (NIDA), National Institutes of Health, 6001 Executive Boulevard, Room 5213, Bethesda, MD, USA, 20892-9561, (301) 443-1124, (888) 644-6432, [email protected]/Inforfax/cocaine.html, <http://www.drugabuse.gov/Inforfax/cocaine.html>.

Patty Jo Sawvel