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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
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
|Used in Past Year
|Used in Past Month
- 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
- 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
- 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
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
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.
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.