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Cocaine & Crack

  1. (Cocaine Use and Trends Among Youth in the US) "From 1976 to 1979, cocaine (Figure 5-4h) exhibited a substantial increase in popularity among 12th graders, with annual prevalence doubling in just three years from 6.0% in 1976 to 12.0% in 1979. Then from 1979 to 1984, little or no further change was observed in any of the cocaine prevalence statistics for 12th graders, at least in the overall national statistics. (Subgroup differences in trends are discussed subsequently.) In 1985, we reported statistically significant increases in annual and monthly use of cocaine, then another leveling in 1986. Between 1986 and 1992, however, both annual and monthly use dropped by three quarters or more: from 12.7% to 3.1% for annual use and from 6.2% to 1.3% for monthly use among 12th graders. (Reasons for this steep decline in cocaine use — in particular the role of perceived risk — are discussed in chapter 8.) Annual prevalence of cocaine then rebounded along with annual prevalence of most other drugs during the relapse period of the drug epidemic; in fact, prior-year use of cocaine among 12th graders exactly doubled, jumping from 3.1% in 1992 to 6.2% in 1999, as did 30-day prevalence, from 1.3% to 2.6%. Finally, in 2000, the first significant decline in cocaine use in several years was observed; annual prevalence among 12th graders dropped to 5.0% and then leveled at about that level through 2007, before declining again and reaching 2.6% by 2013."

    Source: 
    Johnston, L. D., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E. & Miech, R. A. (2014). Monitoring the Future national survey results on drug use, 1975–2013: Volume I, Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan, pp. 154-155.
    http://www.monitoringthefuture.org/pubs/monographs/mtf-vol1_2013.pdf

  2. (Cocaine and Crack Users in the US by Race/Ethnicity, 2012)

    Prevalence of Cocaine and Crack Use in the US, 2012, by Demographic Characteristics
    Numbers in Thousands
    Demographic Characteristic Cocaine (Total) Crack
    Lifetime Past Year Past Month Lifetime Past Year Past Month
    Total 37,688 4,671 1,650 9,015 921 443
    Age
      12-17 265 180 30 34 19 *
      18-25 4,267 1,600 398 34 19 *
      26 or Older 33,156 2,890 1,222 8,327 762 405
    Gender
      Male 22,757 3,298 1,231 6,214 699 329
    Hispanic Origin and Race
    Not Hispanic or Latino 33,030 4,005 1,481 8,070 888 428
      White 28,583 3,160 1,009 6,306 579 231
      Black or African-American 2,978 552 336 1,417 252 157
      American Indian or Alaska Native 286 37 24 52 7 *
      Native Hawaiian or Other Pacific Islander 71 * 2 18 * *
      Asian 507 98 58 68 17 17
      Two or More Races 605 123 52 209 34 24
    Hispanic or Latino 4,658 666 169 945 33 15

    *: Low precision; no estimate reported.

    Source: 
    Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013, Tables 1.29A and 1.34A.
    http://www.samhsa.gov/data/NSDUH/2012SummNatFindDetTables/Index.aspx
    http://www.samhsa.gov/data/NSDUH/2012SummNatFindDetTables/DetTabs/NSDUH-...
    http://www.samhsa.gov/data/NSDUH/2012SummNatFindDetTables/DetTabs/NSDUH-...

  3. (Community Epidemiology Working Group Assessment of Cocaine Use in the US, 2012) "While cocaine continued to be the predominant illicit drug based on treatment and seizure data in most CEWG areas, five area representatives reported a continuing decline in cocaine indicators as a key finding in their areas—Atlanta, Boston, Cincinnati, Phoenix, and St. Louis. All five areas experienced decreases in cocaine reports among drug items seized and analyzed by NFLIS laboratories. Primary treatment admissions for cocaine declined in 2012 from 2011 in Atlanta, Boston, and St. Louis. Cocaine-related deaths declined from previous reporting periods in Atlanta, Boston, and St. Louis. In Cincinnati and Phoenix, calls to poison control centers related to cocaine declined in 2012 from 2011. Cocaine-related hospital admissions fell in this reporting period in Phoenix, and arrests declined from 2011 to 2012 in Boston."

    Source: 
    "Epidemiologic Trends in Drug Abuse: Proceedings of the Community Epidemiology Work Group, Advance Report, June 2013" (Bethesda, MD: National Institute on Drug Abuse, December 2013), p. 4.
    http://www.drugabuse.gov/sites/default/files/files/AdvanceReport2013.pdf

  4. (Cocaine & Crack Use and Perceived Risk Among Youth) "According to the 2009 Monitoring the Future survey—a national survey of 8th-, 10th-, and 12th-graders—there were continuing declines reported in the use of powder cocaine, with past-year** usage levels reaching their lowest point since the early 1990s. Significant declines in use were measured from 2008 to 2009 among 12th-graders across all three survey categories: lifetime use decreased from 7.2 percent to 6.0 percent; past-year use dropped from 4.4 percent to 3.4 percent; and past-month use dropped from 1.9 percent to 1.3 percent. Survey measures showed other positive findings among 12th-graders as well; their perceived risk of harm associated with powder cocaine use increased significantly during the same period. Additionally, survey participants in the 10th grade reported significant changes, with past-month use falling from 1.2 percent in 2008 to 0.9 percent in 2009."

    Source: 
    National Institute on Drug Abuse DrugFacts: Cocaine (Rockville, MD: US Department of Health and Human Services, revised March 2010), last accessed Dec. 13, 2012.
    http://www.drugabuse.gov/publications/drugfacts/cocaine

  5. (Estimates of Coca Cultivation)
    The UN Office on Drugs and Crime estimated that in 2011, 149,200 hectares was devoted to coca cultivation, of which 62,000 hectares were in Colombia, 61,200 were in Peru, and 31,000 were in Bolivia. In 2001, an estimated 210,900 hectares were being cultivated, of which 144,800 hectares were in Colombia, 46,200 were in Peru, and 19,900 were in Bolivia.

    Source: 
    UNODC, World Drug Report 2012 (United Nations publication, Sales No. E.12.XI.1), p. 35, Table 12.
    https://www.unodc.org/documents/data-and-analysis/WDR2012/WDR_2012_web_s...

  6. (Worldwide Cocaine Seizures, 2010) "With 694 tons of cocaine of unknown purity seized in 2010, compared with 732 tons in 2009, global cocaine seizures have remained relatively stable in recent years (see figure 24). Comparing trends in cocaine seizures and manufacture, it can be noted that seizures increased significantly, at a much faster pace than cocaine manufacture, between 2001 and 2005, when drug control efforts were intensified, particularly in the vicinity of cocaine-manufacturing countries such as Colombia, which was then by far the world’s largest producer. During that period, South America and Central America accounted for more than two thirds of the increase in global cocaine seizures. After 2005, cocaine seizures decreased at a comparable rate to manufacture and drug control successes became increasingly difficult to achieve, as traffickers adapted their strategies and developed new methods. This could have contributed to the decrease in recent annual cocaine seizure totals, which failed to reach the peak level of 2005. While the total weight of seized cocaine remained rather stable from 2006 to 2010, the amount of pure cocaine removed from the illicit market was actually smaller because the purity of the cocaine on the market decreased. For example, the average purity of the cocaine seized in the United States fell from 85 per cent in 2006, the highest annual average in the period 2001-2010, to only 73 per cent in 2010, the lowest level in that period."

    Source: 
    UNODC, World Drug Report 2012 (United Nations publication, Sales No. E.12.XI.1), p. 36.
    https://www.unodc.org/documents/data-and-analysis/WDR2012/WDR_2012_web_s...

  7. (Seizure Statistics May Be Misleading) "Comparing absolute numbers of total cocaine seizures and manufacture could be misleading. To understand the relationship between the amount of annual seizures reported by States (694 tons cocaine of unknown purity in 2010) and the estimated level of manufacture (788-1,060 tons of cocaine of 100 per cent purity), it would be necessary to take into account several factors, and the associated calculations would depend on a level of detail in seizure data that is often unavailable. Making purity adjustments for bulk seizures, which contain impurities, cutting agents and moisture, to make them directly comparable with the cocaine manufacture estimates, which refer to a theoretical purity of 100 per cent, is difficult, as in most cases the purity of seized cocaine is not known and varies significantly from one consignment to another. The total amount of seized cocaine reported by States is also likely to be an overestimation. Large-scale maritime seizures, which account for a large part of the total amount of cocaine seized, often require the collaboration of several institutions in a country or even in several countries. 76 Therefore, double counting of reported seizures of cocaine cannot be excluded."

    Source: 
    UNODC, World Drug Report 2012 (United Nations publication, Sales No. E.12.XI.1), pp. 36-37.
    https://www.unodc.org/documents/data-and-analysis/WDR2012/WDR_2012_web_s...

  8. (Cocaine Supply Shortages) "Cocaine shortages have persisted in many U.S. drug markets since early 2007, primarily because of decreased cocaine production in Colombia but also because of increased worldwide demand for cocaine, especially in Europe; high cocaine seizure levels that continued through 2009; and enhanced GOM counterdrug efforts. These factors most likely resulted in decreased amounts of cocaine being transported from Colombia to the U.S.–Mexico border for subsequent smuggling into the United States."

    Source: 
    National Drug Intelligence Center, "National Drug Threat Assessment 2010," (Johnstown, PA: February 2010), p. 1.
    http://www.justice.gov/archive/ndic/pubs38/38661/38661p.pdf

  9. (Crack & Powder Cocaine Use Among Hispanic Youth)
    "• Hispanics now have the highest annual prevalence rates for crack and cocaine in all three grade levels. The rate of cocaine use by Hispanic students has tended to be high compared to the other two racial/ethnic groups, particularly in the lower grades. It bears repeating that Hispanics have a considerably higher dropout rate than Whites or African Americans, based on Census Bureau statistics, which would tend to diminish any such differences by 12th grade.
    "• An examination of racial/ethnic comparisons at lower grade levels shows Hispanics having higher rates of use of many of the substances on which they have the highest prevalence of use in 12th grade, as well as for several other drugs For example, other cocaine (i.e., powder cocaine) has a lifetime prevalence in 8th grade for Hispanics, Whites, and African Americans of 3.4%, 1.4%, and 1.0%, respectively. In fact, in 8th grade — before most dropping out occurs — Hispanics have the highest rates of use of almost all substances, whereas by 12th grade Whites have the highest rates of use of most. Certainly the considerably higher dropout rate among Hispanics could explain this shift, and it may be the most plausible explanation. Another explanation worth consideration is that Hispanics may tend to start using drugs at a younger age, but Whites overtake them at older ages. These explanations are not mutually exclusive, of course, and to some degree both explanations may hold true.41"

    Source: 
    Johnston, L. D., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E. & Miech, R. A. (2014). Monitoring the Future national survey results on drug use, 1975–2013: Volume I, Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan, p. 106.
    http://www.monitoringthefuture.org/pubs/monographs/mtf-vol1_2013.pdf

  10. (Coca Cultivation, 2007) "In 2007, the total area under coca cultivation in Bolivia, Colombia and Peru rose to its highest level since 2001. The 16% year-on-year increase brought the total area under cultivation to 181,600 ha. The increase itself was led by a 27% increase in the area under cultivation in Colombia, followed by smaller increases of 5% and 4% in Bolivia and Peru respectively. Despite these recent increases, the global area under coca cultivation continues to be lower than in the 1990s and 18% below the level recorded in 2000 (221,300 ha).
    "Fifty-five per cent of coca bush was cultivated in Colombia, followed by Peru (30%) and Bolivia (16%). In 2007, Colombia remained the world’s largest coca cultivating country with 99,000 ha of coca bush, an increase of 27%, or 21,000 ha, over 2006."

    Source: 
    United Nations Office on Drugs and Crime (UNODC), World Drug Report 2008 (Vienna, Austria: UNODC, 2008), p. 67.
    http://viewer.zmags.com/showmag.php?preview=1&mid=wtddth&_x=1#/page0/

  11. (Initiation of Cocaine or Crack Use in the US, 2013)
    "• In 2013, there were 601,000 persons aged 12 or older who had used cocaine for the first time within the past 12 months; this averages to approximately 1,600 initiates per day. This estimate was similar to the number in 2008 to 2012 (ranging from 623,000 to 724,000). The annual number of cocaine initiates in 2013 was lower than the estimates from 2002 through 2007 (ranging from 0.9 million to 1.0 million).
    "• The number of initiates of crack cocaine ranged from 209,000 to 353,000 in 2002 to 2008 and declined to 95,000 in 2009. The number of initiates of crack cocaine has been similar each year since 2009 (e.g., 58,000 in 2013).
    "• In 2013, most (81.9 percent) of the 0.6 million recent cocaine initiates were aged 18 or older when they first used. The average age at first use among recent initiates aged 12 to 49 was 20.4 years. The average age estimates have remained fairly stable since 2002."

    Source: 
    Substance Abuse and Mental Health Services Administration, Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014, p. 62.
    http://www.samhsa.gov/data/NSDUH/2013SummNatFindDetTables/Index.aspx
    http://www.samhsa.gov/data/NSDUH/2013SummNatFindDetTables/NationalFindin...

  12. (Cocaine Production, 2007) "Despite the large increase in area under coca cultivation recorded in Colombia, low yields seemed to limit production, keeping the global potential production of cocaine fairly stable. In 2007, global potential production of cocaine reached 994 mt, slightly above the 984 mt recorded for 2006. Of this total, 600 mt were produced in Colombia, 290 mt in Peru and 104 mt in Bolivia."

    Source: 
    United Nations Office on Drugs and Crime, "World Drug Report 2006" (UNODC: Vienna, Austria, 2008), p. 67.
    http://www.unodc.org/documents/wdr/WDR_2008/WDR_2008_eng_web.pdf

  13. (Cocaine Toxicity or Overdose) "An overdose may cause severe anxiety, panic, agitation, aggression, sleeplessness, hallucinations, paranoid delusions, impaired judgment, tremors, seizures, and delirium. Mydriasis and diaphoresis are apparent, and heart rate and BP are increased. Death may result from MI or arrhythmias.
    "Severe overdose causes a syndrome of acute psychosis (eg, schizophrenic-like symptoms), hypertension, hyperthermia, rhabdomyolysis, coagulopathy, renal failure, and seizures. Patients with extreme clinical toxicity may, on a genetic basis, have decreased (atypical) serum cholinesterase, an enzyme needed for clearance of cocaine.
    "The concurrent use of cocaine and alcohol produces a condensation product, cocaethylene, which has stimulant properties and may contribute to toxicity."

    Source: 
    "Cocaine," The Merck Manual for Health Care Professionals, Special Subjects, Drug Use and Dependence, Cocaine (Merck & Co. Inc.: July 2008), last accessed Dec. 13, 2012.
    http://www.merckmanuals.com/professional/special_subjects/drug_use_and_d...

  14. (Legal Uses of Cocaine) "Once the cocaine has been legally produced from the coca leaf, it is exported to various countries for medicinal use, basically as a topical anesthetic (applied to the surface, not injected, only treating a particular area). In the United States the crystalline powder is imported to pharmaceutical companies who process and package teh cocaine for medical use. Merck Pharmaceutical Company and Mallinckrodt Chemical Works distribute cocaine in crystalline form (hydrochloride salt) in dark colored glass bottles to pharmacies and hospitals throughout the United States. Cocaine, in the alkaloid form (base drug containing no additives such as hydrochloride in the crystalline form) is rarely used for medicinal purposes. Cocaine hydrochloride crystals or flakes come in 1/8, 1/4 and 1 oz bottles from teh manufacturer and has a wholesale price of approximately $20-$25/oz (100% pure).
    "Cocaine is still a drug of choice among many physicians as a topical local anesthetic because the drug has vasoconstrictive qualities as it stops the flow of blood oozing. And although synthetic local anesthetics such as novacaine and xylocaine (lidocaine) have been discovered and are used extensively as local anesthetics, they do not have the same vasoconstrictive effects as cocaine."

    Source: 
    Frye, Enno, and Levy, Joseph, "Pharmacology and Abuse of Cocaine, Amphetamines, Ecstasy and Related Designer Drugs: A Comprehensive Review on Their Mode of Action, Treatment of Abuse and Intoxication" (Springer, 2009), p. 33.
    http://books.google.com/books?id=OTAlolM3XlwC&printsec=frontcover#v=onep...

  15. (Legal Coca Production) "Coca is regarded as a sacred leaf by some of the indigenous American communities of the Andes and Amazon basin, where it has been used for a variety of purposes for thousands of years (Mortimer, 1974). As a consequence, the legal status of coca is sometimes ambiguous in South America, complicating efforts to control cocaine production. Bolivian and Peruvian laws allow the growing of some coca in order to supply long-standing, licit, local consumer markets for coca leaves (‘chewing’) and derived products, mostly coca tea, in both countries. The International Narcotics Control Board (INCB) has recently called for the suppression of these legal coca markets under Article 49, 2e, of the 1961 Single Convention on Narcotic Drugs, which requires the elimination of coca consumption ‘within twenty-five years of the coming into force of this convention’ (INCB, 2008a). Additionally, some coca is grown legally in Peru and Bolivia for processing into decocainised flavouring agents that are sold to international manufacturers of soft drinks under Article 27 of the 1961 Single Convention. Finally, the ‘chewing’ of coca leaves and the drinking of coca tea appears to be tolerated for some communities or in some regions in a number of South American countries, including Argentina, Brazil, Chile, Colombia and Ecuador."

    Source: 
    EMCDDA and Europol, "Cocaine: A European Union perspective in the global context" (Luxembourg: Publications Office of the European Union, 2010), pp. 9-10.
    http://www.emcdda.europa.eu/attachements.cfm/att_101612_EN_TDAN09002ENC....

  16. (History of Coca) "Modern archaeology suggests that descendants of nomadic Siberian people may have established communities in the Andes Mountains as early as 10,000 B.C.E.37 Aymara-speaking tribes migrated to the Bolivian altiplano38 around 700 B.C.E, and sometime after 700 B.C.E, Andean people began growing coca in the altiplano.39 Before the Spanish conquest, Indians of eastern Bolivia grew coca for tea, chewing, and ritual use."

    Source: 
    Freisinger, Will, "The Unintended Revolution: U.S. Anti-drug Policy and the Socialist Movement in Bolivia," California Western International Law Journal (San Diego, CA: California Western School of Law, Spring 2009) Volume 39, Number 2,
    http://www.accionandina.org/documentos/Wonders-of-the-Coca-Leaf.pdf

  17. (History of Coca) "Archaeological evidence has confirmed that the coca leaf has been cultivated and used by the indigenous people of the Andes region for at least 4,000-5,000 years while other estimates put this as far back as 20,000 years. By the time of the Spanish colonial conquest, coca use extended all the way from what is today Costa Rica and Venezuela, through the Brazilian Amazon (coca’s place of origin) and on down to Paraguay, northern Argentina and Chile."

    Source: 
    Forsberg, Alan, "The Wonders of the Coca Leaf," Accion Andina (Cochabamba, Bolivia: January 2011), p. 1.
    http://www.accionandina.org/documentos/Wonders-of-the-Coca-Leaf.pdf

  18. (History of Crack) "Most Americans first learned about crack cocaine through media stories, which usually disclosed tragic details of public figures’ addictions. Coverage of the dangers associated with the use of all forms of cocaine intensified in 1979 with the emergence of the practice of smoking cocaine, colloquially referred to as 'freebasing.'63 Rolling Stone magazine focused on smokeable forms of cocaine, calling it the 'top-of-the-line model of the Cadillac of drugs,' yet cautioned that 'freebasing seemed to be much more dangerous than snorting.'64 In 1980, when comedian Richard Pryor sustained third-degree burns after reportedly using a butane torch to light cocaine freebase, newspapers capitalized on the incident.65 Outlets including The Philadelphia Inquirer, Chicago Tribune, and The Boston Globe ran stories about the new trend of freebasing cocaine.66
    "In 1985, The New York Times became the first major media outlet to use the term 'crack cocaine,'67 and a follow-up article appeared on the front page less than two weeks later, detailing crack cocaine and its intensely addictive quality.68 By 1986, major news outlets had declared crack cocaine usage to be in 'epidemic proportions.'69"

    Source: 
    Beaver, Alyssa L., "Getting a Fix on Cocaine Sentencing Policy: Reforming the Sentencing Scheme of the Anti-Drug Abuse Act of 1986," Fordham Law Review (New York, NY: Fordham University School of Law, April 2010) Vol. 78, No. 5, p. 2539.
    http://fordhamlawreview.org/assets/pdfs/Vol_78/Beaver_April_2010.pdf

  19. (History of Cocaine's Use as Anaesthetic) "One of the main properties of the coca leaf, which has been and continues to be used industrially, is its medical potential as an anaesthetic and analgesic. This characteristic of cocaine, which was part of ancestral practices and knowledge in the Andean-Amazon region, came to light in the 1880s and led to a revolution in medical science, particularly in surgery. As a local anaesthetic, it offered an alternative for operations that had previously been painful and hazardous. These properties were used to ease childbirth pains and dental treatments, among other things, taking the coca leaf and cocaine rapidly to the pinnacle of pharmacology and medicine.
    "In 1923, Richard Willstatter of the University of Munich synthesised the cocaine molecule for the first time, basing his work on the molecule found in the coca leaf and maintaining its anaesthetic and energizing effects, which later found a series of applications. Unlike natural cocaine isolated from the coca leaf, the synthetic version lacks vaso-constrictive properties. This was useful for some applications, but not for others. A long list of pharmaceuticals (benzocaine, novocaine/procaine, lidocaine, etc.) was soon included in the anaesthetist’s vade mecum."

    Source: 
    "Coca yes, cocaine, no? Legal options for the coca leaf," Transnational Institute (Amsterdam, The Netherlands: May 2006), p. 16.
    http://www.tni.org/sites/www.tni.org/files/download/debate13.pdf

  20. (Cocaine Powder, Freebase, and Crack) "Cocaine is derived from the coca plant, which, upon consumption, anesthetizes and stimulates the central nervous system.75 The coca plant can be chewed to induce a high and is difficult to obtain in the United States, as cocaine is usually exported from South America in powder form.76
    "The chemical name for powder cocaine is cocaine hydrochloride, which is created through a complex process of heating and cooling coca leaves.77 After pulverizing coca leaves into a coarse powder, alcohol is added and distilled off in order to extract the most pure form of cocaine alkaloid.78 Powder cocaine is ingested intranasally, through snorting, and takes effect within five to fifteen minutes; the euphoria lasts up to two hours.79
    "Cocaine freebase, first created in the 1970s, is smokeable. To create cocaine freebase, cocaine hydrochloride must be heated and then mixed with ammonia and ether.80 The substance cools and yields smokeable cocaine crystals after drying.81 Ether, an extremely flammable substance, renders the process of smoking cocaine freebase quite dangerous.82 After inhalation, cocaine reaches the brain within ten seconds, and the high lasts for up to five minutes.83
    "In the 1980s, a less dangerous form of cocaine freebase was invented: crack cocaine.84 When cocaine powder is mixed with baking soda to form a paste and heated, the substance hardens into rocks.85 This product was given the street name 'crack,' for the crackling sound it makes when smoked.86"

    Source: 
    Beaver, Alyssa L., "Getting a Fix on Cocaine Sentencing Policy: Reforming the Sentencing Scheme of the Anti-Drug Abuse Act of 1986," Fordham Law Review (New York, NY: Fordham University School of Law, April 2010) Vol. 78, No. 5, p. 2540.
    http://fordhamlawreview.org/assets/pdfs/Vol_78/Beaver_April_2010.pdf

  21. Physiological and Psychological Effects

    (Overview of Effects) "Cocaine is a sympathomimetic drug with CNS stimulant and euphoriant properties. High doses can cause panic, schizophrenic-like symptoms, seizures, hyperthermia, hypertension, arrhythmias, stroke, aortic dissection, intestinal ischemia, and MI. Toxicity is managed with supportive care, including IV benzodiazepines (for agitation, hypertension, and seizures) and cooling techniques (for hyperthermia). Withdrawal manifests primarily as depression, difficulty concentrating, and somnolence (cocaine washout syndrome).
    "Most cocaine users are episodic recreational users. However, about 25% (or more) of users meet criteria for abuse or dependence. Use among adolescents has declined recently. Availability of highly biologically active forms, such as crack cocaine, has worsened the problem of cocaine dependence. Most cocaine in the US is about 50 to 60% pure; it may contain a wide array of fillers, adulterants, and contaminants.
    "Most cocaine in the US is volatilized and inhaled, but it may be snorted, or injected IV. For inhalation, the powdered hydrochloride salt is converted to a more volatile form, usually by adding NaHCO3, water, and heat. The resultant precipitate (crack cocaine) is volatilized by heating (it is not burned) and inhaled. Onset of effect is quick, and intensity of the high rivals IV injection. Tolerance to cocaine occurs, and withdrawal from heavy use is characterized by somnolence, difficulty concentrating, increased appetite, and depression. The tendency to continue taking the drug is strong after a period of withdrawal."

    Source: 
    "Cocaine," The Merck Manual for Health Care Professionals, Special Subjects, Drug Use and Dependence, Cocaine (Merck & Co. Inc.: July 2008), last accessed Dec. 13, 2012.
    http://www.merckmanuals.com/professional/special_subjects/drug_use_and_d...

  22. (How Cocaine Affects the Brain) "Cocaine is a strong central nervous system stimulant that increases levels of dopamine, a brain chemical (or neurotransmitter) associated with pleasure and movement, in the brain’s reward circuit. Certain brain cells, or neurons, use dopamine to communicate. Normally, dopamine is released by a neuron in response to a pleasurable signal (e.g., the smell of good food), and then recycled back into the cell that released it, thus shutting off the signal between neurons. Cocaine acts by preventing the dopamine from being recycled, causing excessive amounts of the neurotransmitter to build up, amplifying the message to and response of the receiving neuron, and ultimately disrupting normal communication. It is this excess of dopamine that is responsible for cocaine’s euphoric effects. With repeated use, cocaine can cause long-term changes in the brain’s reward system and in other brain systems as well, which may eventually lead to addiction. With repeated use, tolerance to the cocaine high also often develops. Many cocaine abusers report that they seek but fail to achieve as much pleasure as they did from their first exposure. Some users will increase their dose in an attempt to intensify and prolong the euphoria, but this can also increase the risk of adverse psychological or physiological effects."

    Source: 
    National Institute on Drug Abuse DrugFacts: Cocaine (Rockville, MD: US Department of Health and Human Services, revised March 2010), last accessed Dec. 13, 2012.
    http://www.drugabuse.gov/publications/drugfacts/cocaine

  23. (Treatment for Cocaine Toxicity) " Treatment of mild cocaine intoxication is generally unnecessary because the drug is extremely short-acting. Benzodiazepines are the preferred initial treatment for most toxic effects, including CNS excitation and seizures, tachycardia, and hypertension. Lorazepam 2 to 3 mg IV q 5 min titrated to effect may be used. High doses and a continuous infusion may be required. Propofol infusion, with mechanical ventilation, may be used for resistant cases. Hypertension that does not respond to benzodiazepines is treated with IV nitrates (eg, nitroprusside) or phentolamine; β-blockers are not recommended because they allow continued α-adrenergic stimulation. Hyperthermia can be life threatening and should be managed aggressively with sedation plus evaporative cooling, ice packs, and maintenance of intravascular volume and urine flow with IV normal saline solution. Phenothiazines lower seizure threshold, and their anticholinergic effects can interfere with cooling; thus, they are not preferred for sedation. Occasionally, severely agitated patients must be pharmacologically paralyzed and mechanically ventilated to ameliorate acidosis, rhabdomyolysis, or multisystem dysfunction.
    "Cocaine-related chest pain is evaluated as for any other patient with potential myocardial ischemia or aortic dissection, with chest x-ray, serial ECG, and serum cardiac markers. As discussed, β-blockers are contraindicated, and benzodiazepines are a first-line drug. If coronary vasodilation is required after benzodiazepines are given, nitrates are used, or phentolamine 1 to 5 mg IV given slowly can be considered."

    Source: 
    "Cocaine," The Merck Manual for Health Care Professionals, Special Subjects, Drug Use and Dependence, Cocaine (Merck & Co. Inc.: July 2008), last accessed Dec. 13, 2012.
    http://www.merckmanuals.com/professional/special_subjects/drug_use_and_d...

  24. (Black Cocaine) "Black cocaine is created by a chemical process used by drug traffickers to evade detection by drug sniffing dogs and chemical tests. The traffickers add charcoal and other chemicals to cocaine, which transforms it into a black substance that has no smell and does not react when subjected to the usual chemical tests."

    Source: 
    United States General Accounting Office, "Drug Control: Narcotics Threat from Colombia Continues to Grow" (Washington, DC: USGPO, 1999), p. 5.
    http://www.gao.gov/archive/1999/ns99136.pdf

  25. (Price of Cocaine) In 2010, a kilogram of cocaine base in Colombia typically sold for $1,474.50 and a kilogram of cocaine typically sold for $2,438.80. In Peru in 2008, a kilogram of cocaine base typically sold for $850 and a kilogram of cocaine typically sold for $1,250. In Mexico in 2010, a kilogram of cocaine typically sold for $12,500. In the United States in 2010, the cost of a kilogram of cocaine typically ranged from $11,500-$50,000, and the cost of a kilogram of crack ranged from $14,000-$45,000.

    Source: 
    UN Office on Drugs and Crime, World Drug Report 2012 (United Nations publication, Sales No. E.12.XI.1), Cocaine-type Retail and wholesale prices and purity levels, by drug, region and country or territory (prices expressed in US$)
    http://www.unodc.org/unodc/en/data-and-analysis/WDR-2012.html
    http://www.unodc.org/documents/data-and-analysis/statistics/WDR2012/Pric...

  26. (Current Uses of Coca Leaf) "Coca has traditionally been used in one of two ways: either as a chew or in coca tea.45 Coca leaves contain many nutrients, including vitamins A and B, phosphorus, and iron.46 In high-altitude communities where green vegetables are scarce, the extra nutrients provided by coca leaves are often much needed.47 Coca is also widely used to diminish the effects of the decreased oxygen at high altitudes, as any visitor to an Andean city will discover.48 Much like coffee, coca is a mild stimulant and is the social drink of choice for many. Coca is also believed to be a panacea for numerous ailments and is even used as an aphrodisiac.49"

    Source: 
    Reisinger, Will, "The Unintended Revolution: U.S. Anti-drug Policy and the Socialist Movement in Bolivia," California Western International Law Journal (San Diego, CA: California Western School of Law, Spring 2009) Volume 39, Number 2, p. 248.
    http://www.cwsl.edu/content/journals/Reisinger.pdf

  27. (Uses of Coca Leaf) "Coca leaf consumption is an integral part of Andean cultural tradition and world view. The principle uses are:
    "• Energizer: provides an energy boost for working or for combating fatigue and cold. Although it reduces feelings of hunger, the coca leaf is not considered a food.
    "• Medicinal: in teas, syrups and plasters for diagnosing and treating a series of illnesses. It is used as a local anesthetic.
    "• Sacred: to communicate with the supernatural world and obtain its protection, especially with offerings to the Pachamama, the personification and spiritual form of the earth.
    "• Social: to maintain social cohesion and cooperation among members of the community, it is used in community ceremonies, as a 'payment' for labor exchange and a social relations instrument."

    Source: 
    "Coca yes, cocaine, no? Legal options for the coca leaf," Transnational Institute (Amsterdam, The Netherlands: May 2006), p. 6.
    http://www.tni.org/sites/www.tni.org/files/download/debate13.pdf

  28. Law and Policy

    (Federal Penalties)
    US Code violations for cocaine/crack cocaine and possible sentences:

    Title 21 - FOOD AND DRUGS
    CHAPTER 13 - DRUG ABUSE PREVENTION AND CONTROL
    SUBCHAPTER I - CONTROL AND ENFORCEMENT
    Part D - Offenses and Penalties

    "(b) Penalties
    Except as otherwise provided in section 849, 859, 860, or 861 of this title, any person who violates subsection (a) of this section shall be sentenced as follows:
    ...
    "(ii) 5 kilograms or more of a mixture or substance containing a detectable amount of—
    "(I) coca leaves, except coca leaves and extracts of coca leaves from which cocaine, ecgonine, and derivatives of ecgonine or their salts have been removed;
    "(II) cocaine, its salts, optical and geometric isomers, and salts of isomers;
    "(III) ecgonine, its derivatives, their salts, isomers, and salts of isomers; or
    "(IV) any compound, mixture, or preparation which contains any quantity of any of the substances referred to in subclauses (I) through (III);
    "(iii) 280 grams or more of a mixture or substance described in clause (ii) which contains cocaine base;
    ....
    "such person shall be sentenced to a term of imprisonment which may not be less than 10 years or more than life and if death or serious bodily injury results from the use of such substance shall be not less than 20 years or more than life, a fine not to exceed the greater of that authorized in accordance with the provisions of title 18 or $10,000,000 if the defendant is an individual or $50,000,000 if the defendant is other than an individual, or both."

    "(B) In the case of a violation of subsection (a) of this section involving—
    ...
    "(ii) 500 grams or more of a mixture or substance containing a detectable amount of—
    "(I) coca leaves, except coca leaves and extracts of coca leaves from which cocaine, ecgonine, and derivatives of ecgonine or their salts have been removed;
    "(II) cocaine, its salts, optical and geometric isomers, and salts of isomers;
    "(III) ecgonine, its derivatives, their salts, isomers, and salts of isomers; or
    "(IV) any compound, mixture, or preparation which contains any quantity of any of the substances referred to in subclauses (I) through (III);
    "(iii) 28 grams or more of a mixture or substance described in clause (ii) which contains cocaine base;
    ....
    "such person shall be sentenced to a term of imprisonment which may not be less than 5 years and not more than 40 years and if death or serious bodily injury results from the use of such substance shall be not less than 20 years or more than life, a fine not to exceed the greater of that authorized in accordance with the provisions of title 18 or $5,000,000 if the defendant is an individual or $25,000,000 if the defendant is other than an individual, or both."

    Source: 
    United States Code, 2011 Edition, Title 21 - FOOD AND DRUGS - CHAPTER 13 - DRUG ABUSE PREVENTION AND CONTROL SUBCHAPTER I - CONTROL AND ENFORCEMENT, Part D - Offenses and Penalties. From the U.S. Government Printing Office, www.gpo.gov, last accessed Dec. 13, 2012.
    http://www.gpo.gov/fdsys/pkg/USCODE-2011-title21/html/USCODE-2011-title2...

  29. (Crack/Powder Cocaine Sentencing Disparity)
    On August 3, 2010, President Barack Obama signed the Fair Sentencing Act of 2010. Per the Sentencing Project, "the minimum quantity of crack cocaine that triggers a 5-year mandatory minimum from 5 grams to 28 grams, and from 50 grams to 280 grams to trigger a 10-year mandatory minimum sentence. The amount of powder cocaine required to trigger the 5 and 10-year mandatory minimums remains the same, at 500 grams and 5 kilograms, respectively. The legislation also eliminates the mandatory minimum for simple possession of crack cocaine. The quantity disparity between crack and powder cocaine has moved from 100 to 1 to 18 to 1."

    Source: 
    The Sentencing Project, "Fair Sentencing Act Signed by President Obama," August 3, 2010, last accessed Dec. 13, 2012.
    http://www.sentencingproject.org/detail/news.cfm?news_id=984&id=164

  30. (Crack vs Powder Cocaine) "In July 1986, in the midst of a surge of articles regarding the crack 'epidemic'37 both the United States Senate and the House of Representatives held hearings on the perceived crisis.38 At these hearings, it was asserted that crack: (1) was more addictive than powder cocaine,39 (2) produced physiological effects that were different from and worse than those caused by powder cocaine,40 (3) attracted users who could not afford powder cocaine, especially young people,41 and (4) led to more crime than powder cocaine did.42"

    Source: 
    Graham, Kyle, "Sorry seems to be the hardest word: The Fair Sentencing Act of 2010, Crack, and Methamphetamine, "University of Richmond Law Review (Richmond, VA: Richmond School of Law, March 2011) Vol. 45, Issue 3, pp. 771-773.
    http://lawreview.richmond.edu/wp/wp-content/uploads/2011/04/Graham-453.p...

  31. Sociopolitical and Clinical Research

    (Crack Smoking and Risk of HIV) "Smoking of crack cocaine was found to be an independent risk factor for HIV seroconversion among people who were injection drug users. This finding points to the urgent need for evidence-based public health initiatives targeted at people who smoke crack cocaine. Innovative interventions that have the potential to reduce HIV transmission in this population, including the distribution of safer crack kits and medically supervised inhalation rooms, need to be evaluated."

    Source: 
    Kora DeBeck, Thomas Kerr, Kathy Li, Benedikt Fischer, Jane Buxton, Julio Montaner, and Evan Wood, "Smoking of crack cocaine as a risk factor for HIV infection among people who use injection drugs," Canadian Medical Association Journal, (October 2009), 181(9), p. 588.
    http://www.cmaj.ca/cgi/reprint/181/9/585.pdf

  32. ("Crack Baby" Myth) "In the final analysis, the notion of the 'crack baby' is a myth. So-called 'cocaine babies' and 'crack babies' are more likely suffering from their mothers’ multiple drug use (particularly alcohol), and/or are 'poverty babies' suffering from a lack of medical care and poor nutrition."

    Source: 
    Inciardi, James A., "The Irrational Politics of American Drug Policy: Implications for Criminal Law and the Management of Drug-Involved Offenders," Ohio State Journal of Criminal Law (Columbus, OH: Moritz College of Law, The Ohio State University, Fall 2003) Volume 1, Issue 1, p. 278.
    http://moritzlaw.osu.edu/osjcl/Articles/Volume1_1/Commentary/inciardi.pd...

  33. (Spraying Counterproductive) "Critics note that the spraying has not prevented the tripling of the area under coca cultivation since Pastrana's inauguration, and that the spraying simply destroys the means of livelihood of subsistence farmers and displaces the crops deeper into the jungle. The coca producers have also adapted by developing new varieties of the coca plant, such as the Tingo Maria, which produces three times as much coca as the traditional varieties."

    Source: 
    Rabasa, Angel & Peter Chalk, "Colombian Labyrinth: The Synergy of Drugs and Insurgency and Its Implications for Regional Instability" (Santa Monica, CA: RAND Corporation, 2001), Chapter 6, p. 66.
    http://www.rand.org/pubs/monograph_reports/MR1339.html
    http://www.rand.org/pubs/monograph_reports/MR1339/MR1339.ch6.pdf

  34. (Land Subjected To Crop Eradication in Colombia) "Between 1998 and 2009, the area subjected to manual eradication increased from 3,125 ha to 60,577 ha, while aerial spraying—using a formula known as Roundup® (a mixture of glyphosate and Cosmo-FluxTM)—rose by more than 58 percent, from 66,029 ha to 104,772 ha.3 Between 2003 and 2009, the Bogotá government invested $835 million to underwrite these programs, a figure that is expected to surge to $1.5 billion by 2013.4"

    Source: 
    Chalk, Peter, "The Latin American Drug Trade: Scope, Dimensions, Impact, and Response," RAND Corporation for the the United States Air Force (Santa Monica, CA: 2011), p. 60.
    http://www.rand.org/content/dam/rand/pubs/monographs/2011/RAND_MG1076.pd...