The How and Who Behind Cocaine Use

Coca-Cola, Sigmund Freud, Scarface ““ cocaine has made its mark on American culture, but knowledge of the mechanisms of and risks associated with this popular recreational drug remains elusive. Last week, we talked about heroin, and today, we’ll do the same to cocaine.

How is cocaine produced?

Cocaine (benzoylmethylecgonine) is a stimulant derived from the a chemical in the leaves of the coca plant. The coca plant, Erythroxylum coca, is native to South America and plays a significant role in many Andean cultures. The indigenous use of coca leaves continues to be widespread, but ever since cocaine was synthesized in the lab, other uses of the drug have grown.

Richard Willstatter in all his glory. Photo found on Wikipedia.

The synthesis and chemical formula of cocaine was first described by Richard Willstatter in 1894. That was his PhD work, y’all, describing the chemistry of cocaine. Willstatter was no slouch ““ he spent his life researching the chemistry of plant pigments, which resulted in him winning a Nobel Prize.  A brilliant scientist, he worked in Germany for much of his career, but resigned in 1924, at the (young for an academic) age of 53, citing the increasing anti-Semitism as the reasons for his resignation.

Cocaine was initially used as an anesthetic and antidepressant, but due to cocaine’s addictive nature, the drug is now highly restricted and the only legal uses for  are very specific anesthetic reasons or the use of coca leaf by members of indigenous cultures.

Cocaine in the United States generally comes in two forms: powder and crack. Crack cocaine is always smoked, the rock crystal being heated in a pipe and the vapors inhaled. The word “crack” apparently comes from the sound the rock makes when it is being heated in a crack pipe. Cocaine is brought to the United States in powder form and is converted to crack by dealers, generally mixing baking soda and distilled water to form the rocks. Crack is safer to produce than freebase cocaine, which requires the use of ammonia.  Both crack and powder cocaine can be cut with substances like baking powder or sugar to increase the bulk. They can also be mixed with other drugs, such as heroin (speedball).

What does cocaine do short term?

Short term, cocaine makes people feel really, really great. For about 15-30 minutes (snorting) or 5-10 minutes (smoking) after taking the drug, people feel awesome. There’s a sense of euphoria, a feeling of alertness, confidence, sexuality, and power. People have a lot of energy on cocaine. Some people will  have a bad reaction and feel anxious or paranoid while high on cocaine, however.

The good feelings come from how cocaine acts in the brain. Shortly after smoking or injecting, or a little longer after snorting, cocaine gets into the blood stream and up to the brain. There, it camps out and prevents dopamine, one of the brain chemicals associated with feeling good and reward (and generally tied to things like eating, sex, and winning a hockey game), from being taken up by transporter proteins. Normally, dopamine is released, hangs out for a bit in the gap between two neurons, hits dopamine receptors, makes you feel good, and then gets taken up by one of those transporter proteins. When those proteins are blocked, the dopamine builds up in the game, which makes the dopamine receptors get hit a lot, which makes you feel REALLY good.

A 1995 World Health Organization report, which was not officially published (and was possibly suppressed), suggests that unlike chronic use or abuse, experimental or occasional use of cocaine has no significant negative physical or social effects. While people can die from overdoses on their first go from cardiac problems, generally speaking, occasional users do not have the severe, significant health effects that long-term users experience.

Data from the Lancet about the 20 most popular recreational drugs, looking at their likelihood to cause dependence and physical harm. Created by wiki-user Apartmento2.

Last week, I was able to give specific information about how addictive heroin is, however, I was unable to find any concrete discussion of exactly how addictive cocaine is and how realistic it is to expect a person to just occasionally use the drug. The National Institute on Drug Abuse claims that cocaine is a powerfully addictive drug, and the Lancet, a weekly peer-reviewed medical journal, provided data about 20 popular recreational drugs that suggests that cocaine is both the second most addictive and  the second most harmful popular recreational drug behind heroin. The World Health Organization’s 1995 report suggests that cocaine use should be kept in perspective, while admitting that some parts of North America (specifically the United States) are seeing an increase in cocaine-related health problems. Of the 19 countries in the report, the United States was second in the number of adults who have ever used cocaine, behind only Peru, which reported over a quarter of its population has chewed coca leaves.

What does cocaine do long term?

Chronic use of cocaine can lead to increased tolerance of the drug, as well as long-term changes in brain chemistry. These long-term changes in brain chemistry are generally a result of the dopamine receptors being lost or turned off, permanently. This can result in depression or even suicidal ideations in long-term cocaine users. The body starts to depend on the drug to feel good, and many addicts report never being able to replicate that first high. In addition to changing the brain’s wiring, long-term cocaine abuse can lead to anxiety, restlessness, teeth-grinding, increases in body temperature, increases in blood pressure, full-blown paranoid episodes, strokes, heart problems, heart attacks, and death.

Those long-term consequences are the same for people who use cocaine heavily regardless of how the cocaine is ingested. Injecting, snorting, and smoking (generally associated with crack cocaine) each come with their own health risks. People who inject cocaine face all the health risks that other intravenous drug users face, such as increased risk of contracting blood borne diseases like hepatitis or HIV/AIDS.

Long-term cocaine users who snort their cocaine can lose their sense of smell, get nosebleeds, have problems swallowing, and experience a nose that just won’t stop running. More disturbingly, the powder cocaine can erode away at the cartilage in the nose, leading to the entire thing collapsing one day. Most disturbingly, ingesting cocaine can lead to gangrene in the bowels, due to lack of blood flow.

People who smoke crack cocaine tend to develop addictions more quickly than people who snort it, possibly due to the increased speed with which the body feels the high. Crack cocaine users are at risk of experiencing lung trauma and bleeding, shortness of breath, and other respiratory problems. Crack is considered more harmful than powder cocaine. Crack cocaine is seen as causing aggressive and paranoid behavior, however, whether these behaviors are seen more often in crack cocaine users than powder cocaine users while controlling for socio-economic background, race, and other factors which influence public perception and stereotyping is unclear.

Botanical drawing of the Coca plant by Franz Eugen Köhler, for Köhler's Medizinal-Pflanzen.

One last note ““ cocaine is especially dangerous when taken in conjunction with other drugs. Cocaine and heroin (speedball) is a particularly potent combination, which effectively masks the symptoms of an overdose and is believed to have been responsible for the deaths of Chris Farley and Mitch Hedburg, among others. A less potent, but still potentially harmful, combination is cocaine and alcohol. When cocaine and alcohol meet in the liver, the liver produces a chemical called cocaethylene. Cocaethylene amplifies the euphoria felt with cocaine and is associated with a greater risk of sudden death than cocaine by itself.

Who uses cocaine?

Cocaine was not a commonly used drug until the 1970s, and the introduction of crack cocaine made cocaine one of the most popular recreational drugs in the United States. While current usage trails the peak (in 2007, the number of Americans who admitted to using cocaine in the past month was 1.6 million, compared to the 1985 number of  5.7 million Americans), cocaine is still a very popular drug with 7% of high school seniors admitting to using cocaine at least once in their lives and 16.1% of all Americans admitting the same.

I am not sure why the Substance Abuse and Mental Health Services Administration, a part of the Department of Health and Human Services, does not provide statistics for powdered versus crack cocaine, but they do not. The numbers I have for cocaine users include all cocaine users, including those who use crack. The numbers I have for crack cocaine users are just for the people who use crack cocaine. That’s all the data I have access to, so with that caveat out of the way, let’s get on to what the average cocaine user looks like.

The average cocaine and crack cocaine user is a young (not too young since the average cocaine user will not try cocaine until they are 18 or older), white male. Men are almost twice as likely as women to use cocaine, which may be associated with risky or thrill-seeking behavior, both of which are seen more often in men than in women.

According to a 2003 SAMSA study, out of the 34,243,000 people who admitted to using cocaine in their lifetimes, 26,381,000 self-identified as white. While proportionally, more people who self-identified as American Indian and Native Alaskan use cocaine or crack cocaine (21.6% compared to 17.5%), looking just at the numbers, white people are the predominant users of cocaine and crack cocaine. Only 7,792,000 people reported using crack cocaine, and again, white people make up the majority of the users with 5,345,000 crack cocaine users self-identifying as white. Proportionally speaking, a larger percentage of the total population people who self-identify as two or more races (7.1%), Native Hawaiian or Other Pacific Islander (5.1%), American Indian or Alaska Native (6.1%), and Black or African American (5.5%) admit to crack cocaine use than people who self-identify as white (3.5%). Use of cocaine and crack cocaine are likely to be especially large problems in communities of color, but the most likely user of cocaine and crack cocaine is a white guy.

This is not borne out in drug arrests: people of color are disproportionately arrested for crimes related to cocaine and crack cocaine. According to the Drug Enforcement Administration as reported by the White House’s Drug Policy webpage, in 2004, only 695 white people were arrested by the DEA for crack cocaine, while 3,161 black people were, a startling number considering that the SAMSA 2003 survey found 703,000 white people and 402,000 black people reported using crack cocaine in the past year.

Powdered cocaine showed just as little equity in arrests. In 2004, 4,648 white people, 2,273 black people, and 3,943 Hispanic people were arrested for offenses related to powdered cocaine. The SAMSA 2003 survey found that 3,802,000 white people, 646,000 black people, and 806,000 Hispanic people reported using cocaine or crack cocaine in the past year.

While these arrests were not divided into discrete crimes, such as possession, possession with intent to distribute, trafficking, etc., and as such, the use numbers I cite may not speak directly to these crimes, the huge disparities in the racial backgrounds of the individuals arrested for drug crimes paints a troubling picture of how cocaine and crack cocaine use is being policed.  The Human Rights Watch released a report in 2009 that found that African American adults were arrested on drug charges at 2.8 to 5.5 times the rate of white adults, even though both groups commit drug offenses at comparable rates.  The Fair Sentencing Act of 2010 reduced the disparities in how crack and powder cocaine were treated by the judicial system (prominent among which was the change in the former 100:1 ratio of amount of powdered cocaine needed to trigger the same sentence as would be given for crack cocaine to 18:1), however, systemic inequalities remain.

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