Cocaine and Crack Cocaine Health Article

COCAINE AND CRACK COCAINE

Cocaine, extracted from the leaves of the coca plant (Erythroxylon coca), is the most potent naturally occurring central nervous system stimulant. Cocaine is classified as a Schedule II drug due to its high potential for abuse (U.S. Controlled Substance Act 21 U.S.C., Section 802 [1996]), but it can be administered by a doctor for legitimate medical reasons, such as a local anesthetic for some eye, ear, and throat surgeries. There are two primary forms of chemical cocaine: the hydrochloride salt form, a powdered form of cocaine that is approximately 99 percent pure cocaine, and the "freebase" form. Hydrochloride salt dissolves in water and can be taken intravenously or intranasally. The freebase form of cocaine has not been neutralized by an acid to make a hydrochloride salt and can be smoked. It is processed with ammonia or sodium bicarbonate (baking soda) and water, and heated to remove the hydrochloride.

Crack cocaine, or simply "crack," is essentially the same end product as freebase cocaine, but the result of a cheaper and safer chemical method of preparing a smokable form of cocaine. The term "crack" refers to the crackling sound heard when the mixture is heated or smoked.

DISTRIBUTION AND EFFECTS

Illicit cocaine is generally distributed on the street as a fine, white, crystalline powder or as an off-white chunky material. Street dealers most often dilute it with inert substances such as sugar, cornstarch, and/or talcum powder; or with other active drugs, including local anesthetics such as lidocaine or procaine, or other stimulants such as amphetamines. The primary routes of cocaine administration are oral, intranasal, intravenous, and inhalation. However, there is no safe way to use cocaine, and any route of administration can lead to absorption of toxic amounts of cocaine, resulting in acute cardiovascular or cerebrovascular emergencies that sometimes result in death. Cocaine-related deaths are commonly the result of cardiac arrest or seizures followed by respiratory arrest.

Small amounts of cocaine may make the user feel euphoric, energetic, talkative, and mentally alert, especially to sensations of sight, sound, and touch. The duration of these effects depends upon the route of administration. The faster the absorption, the more intense the high—but the shorter the duration of action. Short-term physiological effects of cocaine include constricted blood vessels, dilated pupils, and increased heart rate, blood pressure, and body temperature. Longer-term effects of cocaine use include tolerance and addiction, irritability and mood disorders, restlessness, paranoia, and auditory hallucinations. The most frequent medical consequences of cocaine use are cardiovascular effects, including disturbed heart rhythms and heart attacks; respiratory effects, including chest pain and respiratory failures; neurological effects, such as strokes, seizures, and headaches; and gastrointestinal complications, including abdominal pain and nausea.

The combination of cocaine and alcohol is especially potent and dangerous. When taken in combination, the body converts the two into cocaethylene, which has a longer duration of action in the brain and is more toxic than either drug alone. The combination of alcohol and cocaine is the most common two-drug combination that results in drug-related deaths.

COCAINE USE

The United States witnessed a dramatic increase in cocaine use during the 1980s when, due to its high cost, it was glamorized as a symbol of status and material success by celebrities, the entertainment industry, and the media. The problem was further complicated when crack cocaine was introduced in 1985. A smokable and cheaper form of the drug, crack extended the problems of cocaine dependence to urban ghettos and to members of society who might not have been able to afford cocaine itself. Cocaine use in the United States peaked between 1982 and 1985, at which time between 5.7 and 10.4 million Americans (3 to 5.6 percent of the population) reported cocaine use. Since then, it has decreased, but remains a significant problem. According to the 1999 National Household Survey on Drug Abuse (NHSDA), there were 14.8 million illicit drug users in the United States in 1998. Of these 14.8 million, approximately 1.5 million people were using cocaine (0.7 percent of the household population over twelve years of age), and 413,000 people were using crack. According to the Office of National Drug Control Policy, by including data from additional sources that take into account users underrepresented by the NHSDA, the number of chronic cocaine users has recently been estimated at 3.6 million. The annual number of new users of any form of cocaine increased from 1994 to 1998, and data from both the NHSDA and the 1999 Monitoring the Future survey indicated increases in the rate of cocaine initiation among youths ages twelve to seventeen in particular.

Information about cocaine use outside the United States is less readily available, although the United Nations Drug Control Program estimates that approximately 13 million people worldwide abuse cocaine. Abuse remains highest in the United States, despite declines since the mid-1980s peak and increased levels of both cocaine and "bazuco" (coca paste) abuse in Latin American countries. Cocaine, along with other coca-derived substances, is the second most widely abused illicit drug in the Americas, and accounts for a majority of the demand for treatment. Data from the Report of the International Narcotics Control Board for 1999 showed increased cocaine seizures in Europe, largely in Spain and the Netherlands. While an upward trend is apparent across nearly all of Europe, it is especially pronounced in Spain, Ireland, and the United Kingdom.