Crack and Cocaine

Cocaine is a powerfully addictive drug of abuse. Once having tried cocaine, an individual cannot
predict or control the extent to which he or she will continue to use the drug.

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 nose 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 inhaling cocaine
vapor or smoke into the lungs where absorption into the bloodstream is as rapid as by injection.

"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.

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 snorted. 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 are shared.

Health 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 hyper-stimulation, 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.

Treatment

The widespread abuse of cocaine has stimulated extensive efforts to develop treatment programs
for this type of drug abuse.

NIDA's top research priority is to find a medication to block or greatly reduce the effects of
cocaine, to be used as one part of a comprehensive treatment program. NIDA-funded researchers
are also looking at medications that help alleviate the severe craving that people in treatment for
cocaine addiction often experience. Several medications are currently being investigated to test their safety and efficacy in treating cocaine addiction.

In addition to treatment medications, behavioral interventions, particularly cognitive behavioral
therapy, can be 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.

Extent of Use

Monitoring the Future Study (MTF)*

The MTF assesses the extent of drug use among adolescents and young adults across the country.

The proportion of high school seniors who have used cocaine at least once in their lifetimes has
increased from a low of 5.9 percent in 1994 to 9.8 percent in 1999. However, this is lower than its
peak of 17.3 percent in 1985. Current (past month) use of cocaine by seniors decreased from a
high of 6.7 percent in 1985 to 2.6 percent in 1999. Also in 1999, 7.7 percent of 10th-graders had
tried cocaine at least once, up from a low of 3.3 percent in 1992. The percentage of 8th-graders
who had ever tried cocaine has increased from a low of 2.3 percent in 1991 to 4.7 percent in 1999.

Of college students 1 to 4 years beyond high school, in 1995, 3.6 percent had used cocaine within
the past year, and 0.7 percent had used cocaine in the past month.

Cocaine Use by Students, 1999:
Monitoring the Future Study

Community Epidemiology Work Group (CEWG)**

Although demographic data continue to show most cocaine users as older, inner-city crack addicts,
isolated field reports indicate new groups of users: teenagers smoking crack with marijuana in some
cities; Hispanic crack users in Texas; and in the Atlanta area, middle-class suburban users of
cocaine hydrochloride and female crack users in their thirties with no prior drug history.

National Household Survey on Drug Abuse (NHSDA)***

In 1998, about 1.7 million Americans were current (at least once per month) cocaine users. This is
about 0.8 percent of the population age 12 and older; about 437,000 of these used crack. The rate
of current cocaine use in 1998 was highest among Americans ages 18 to 25 (2.0 percent). The rate
of use for this age group was significantly higher in 1998 than in 1997, when it was 1.2 percent.



* MTF is an annual survey on drug use and related attitudes of America's adolescents that began
in 1975. The survey is conducted by the University of Michigan's Institute for Social Research
and is funded by NIDA. Copies of the latest survey are available from the National
Clearinghouse for Alcohol and Drug Information at 1-800-729-6686

** CEWG is a NIDA-sponsored network of researchers from 20 major U.S. metropolitan areas
and selected foreign countries who meet semiannually to discuss the current epidemiology of
drug abuse.

*** NHSDA is an annual survey conducted by the Substance Abuse and Mental Health Services
Administration. Copies of the latest survey are available from the National Clearinghouse for
Alcohol and Drug Information at 1-800-729-6686.

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