Cocaine is one of the most powerfully addictive drugs of abuse. Most clinicians estimate that approximately 10 percent of people who begin to use the drug "recreationally" will go on to serious, heavy use. Once having tried cocaine, an individual cannot predict or control the extent to which he or she will continue to use the drug.

Extent of Use
Monitoring the Future Study

The Monitoring the Future Study assesses the extent of drug use among adolescents and young adults across the country.

• Data show that cocaine use among high school seniors had been on a downward trend since its peak in 1985, but it remained level from 1992 to 1995. The proportion of seniors who have used cocaine at least once in their lifetimes dropped from 17.3 percent in 1985 to 6.0 percent in 1995. Current use of cocaine decreased from 6.7 percent in 1985 to 1.8Êpercent in 1995. Also in 1995, 5.0 percent of 10th-graders had tried cocaine at least once, up from 4.3 percent in 1994. The percentage of 8th-graders who had ever tried cocaine rose significantly from 2.3 percent in 1991 to 3.6 percent in 1994 then to 4.2 percent in 1995. Cocaine Use By Students, 1995

  	8th Grade	10th Grade	12th Grade
  Ever Used	4.2%	5.0%	6.0%
  Used in Past Year	2.6	3.5	4.0
  Used in Past Month	1.2	1.7	1.8
  Daily Use	0.1	0.1	0.2

• Of college students 1 to 4 years beyond high school, in 1993, 2.7 percent had used cocaine within the past year, and 0.7 percent had used cocaine in the past month - a decrease from 6.9 percent in 1985.
• In 1993, 4.6 percent of young adults 1 to 4 years beyond high school but not in college had used cocaine within the past year, and 1.5 percent had used cocaine in the past 30 days.

National Household Survey

• In 1994, almost 22 million Americans age 12 and older had tried cocaine at least once in their lifetimes; about 3.7 million had used cocaine during the past year; and more than 1.3 million had used cocaine in the past month. These were significant decreases in cocaine use from its peak in 1985.
• Use of crack cocaine declined from 1991 to 1992 but has risen again to exceed 1991 levels. In 1994, about 4 million people had used crack cocaine at least once in their lives, and about 1.2 million people had used crack within the past year.

Drug Abuse Warning Network

The Drug Abuse Warning Network (DAWN) collects data on drug abuse morbidity and mortality through reports from hospital emergency rooms and a selected sample of medical examiners in 21 metropolitan areas. Data from the DAWN system continue to show increases in adverse health consequences associated with the use of cocaine.

• The estimated number of cocaine-related emergency room episodes has fluctuated since 1988 when it totaled 101,578. That number increased to 110,013 in 1989 and then decreased significantly to 80,355 in 1990. However, in 1991 the number of cocaine-related ER incidents began an increasing trend that reached an estimated 142,410 in 1994.
• The number of cocaine-related ER incidents was highest for persons aged 26 to 34 years. The number for males (95,974) was almost twice that for females. Blacks accounted for 77,815 mentions, significantly more than the 40,102 for whites and 13,043 for Hispanics.

Methods of Use
Cocaine use ranges from episodic or occasional use to repeated or compulsive use, with a variety of patterns between these extremes. The major routes of administration of cocaine are sniffing or snorting, injecting, and smoking (including free-base and crack cocaine). Snorting is the process of inhaling cocaine powder through the nostrils where it is absorbed into the bloodstream through the nasal tissues. Injecting is the act of using a needle to release the drug directly into the bloodstream. Smoking involves the inhalation of cocaine vapor or smoke into the lungs where absorption into the bloodstream is as rapid as by injection.

There is great risk whether cocaine is ingested by inhalation (snorting), injection, or smoking. It appears that compulsive cocaine use may develop even more rapidly if the substance is smoked rather than taken intranasally. Smoking allows extremely high doses of cocaine to reach the brain very quickly and brings an intense and immediate high. The injecting drug user is at risk for transmitting or acquiring HIV infection/AIDS if needles or other injection equipment is shared.

"Crack" is the street name given to cocaine that has been processed from cocaine hydrochloride to a free base for smoking. Rather than requiring the more volatile method of processing cocaine using ether, crack cocaine is processed with ammonia or sodium bicarbonate (baking soda) and water and heated to remove the hydrochloride, thus producing a form of cocaine that can be smoked. The term "crack" refers to the crackling sound heard when the mixture is smoked (heated), presumably from the sodium bicarbonate.

Health and Psychological Hazards
Cocaine is a strong central nervous system stimulant that interferes with the reabsorption process of dopamine, a chemical messenger associated with pleasure and movement. Dopamine is released as part of the brain's reward system and is involved in the high that characterizes cocaine consumption.

Physical effects of cocaine use include constricted peripheral blood vessels, dilated pupils, and increased temperature, heart rate, and blood pressure. The duration of cocaine's immediate euphoric effects, which include hyperstimulation, reduced fatigue, and mental clarity, depends on the route of administration. The faster the absorption, the more intense the high. On the other hand, the faster the absorption, the shorter the duration of action. The high from snorting may last 15 to 30 minutes, while that from smoking may last 5 to 10 minutes. Increased use can reduce the period of stimulation.

Some users of cocaine report feelings of restlessness, irritability, and anxiety. An appreciable tolerance to the high may be developed, and many addicts report that they seek but fail to achieve as much pleasure as they did from their first exposure. Scientific evidence suggests that the powerful neuropsychologic reinforcing property of cocaine is responsible for an individual's continued use, despite harmful physical and social consequences. In rare instances, sudden death can occur on the first use of cocaine or unexpectedly thereafter. However, there is no way to determine who is prone to sudden death.

High doses of cocaine and/or prolonged use can trigger paranoia. Smoking crack cocaine can produce a particularly aggressive paranoid behavior in users. When addicted individuals stop using cocaine, they often become depressed. This also may lead to further cocaine use to alleviate depression. Prolonged cocaine snorting can result in ulceration of the mucous membrane of the nose and can damage the nasal septum enough to cause it to collapse. Cocaine-related deaths are often a result of cardiac arrest or seizures followed by respiratory arrest.

Added Danger: Cocaethylene

When people mix cocaine and alcohol consumption, they are compounding the danger each drug poses and unknowingly forming a complex chemical experiment within their bodies. NIDA-funded researchers have found that the human liver combines cocaine and alcohol and manufactures a third substance, cocaethylene, that intensifies cocaine's euphoric effects, while possibly increasing the risk of sudden death.

Greater Risk for Women

Estimates on the extent of drug abuse by women vary. One NIDA study reported in 1994 that more than 220,000 women had used an illicit drug during their pregnancies. Of this group, more than one-fifth had used powdered cocaine or crack.

When a woman uses drugs, she and her unborn child are exposed to significant health risks. During pregnancy, almost all drugs cross the placenta and enter the bloodstream of the developing baby. The most serious possible adverse effects on the unborn child's health include premature delivery and low birthweight. Other possible problems include ectopic pregnancy, stillbirth, sudden infant death syndrome, and small gestational size. The woman who uses drugs is herself at increased risk of hemorrhage, spontaneous abortion, toxicity, sexually transmitted diseases, and nutritional deficiencies. In addition, drug use by women puts women and their children at risk for HIV/AIDS.

Treatment
The widespread abuse of cocaine has stimulated extensive efforts to develop treatment programs for this type of drug abuse. According to the State Alcohol and Drug Abuse Profile, in FY 1990, States reported 238,071 patients entering treatment with cocaine as the primary drug of abuse, representing almost 36 percent of treatment admissions. Another study, NIDA's Drug Services Research Survey, estimates that 31 percent of a sample of drug treatment clients had used cocaine or crack cocaine within 30 days prior to admission for treatment. Data from treatment programs using different therapeutic approaches indicate that outpatient cocaine treatment can be successful. One report suggests that from 30 percent to 90 percent of abusers remaining in outpatient treatment programs cease cocaine use.

NIDA has initiated a program with the purpose of discovering new medications that can be used in the treatment of cocaine abuse. Several medications are currently being investigated to test their safety and efficacy in treating cocaine addiction.

In addition to pharmacological treatments, behavioral interventions also have been developed that are effective in decreasing drug use by patients in treatment for cocaine abuse. Providing the optimal combination of treatment services for each individual is critical to successful treatment outcome.

Part of the NIDA Capsule Series - (C-82-02)

Information provided by NIH.