Treating Drug Problems Volume 2 (1992) / Chapter Skim
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Repeating Cycles of Cocaine Use and Abuse
Repeating Cycles of Cocaine Use and Abuse
Pages 289-316
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From page 289... ...
Little else is known about Lincoln's pattern of Cocaine" use or its consequences, but the following week he started growing his famous beard and shortly thereafter became president of the United States. Although Lincoln may not have pursued the use of cocaine, the time of his purchase -- five years after the alkaloid was isolated from coca by Gaedecke and one year after Albert Nieman named it "cocaine'' -- signaled the beginning of a new cycle of coca and cocaine abuse.
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From page 290... ...
These promotions, lacking medical or scientific support, encouraged frequent use of escalating doses, a pattern that inevitably led to a new cycle of cocaine abuse. Recent analysis of these preparations reveals that changing dose regimens were inextricably tied to this abuse (Siegel, 1985a)
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From page 291... ...
French Wine Coca, the original name for Coca-Cola, was an imitation of these French coca wines and reportedly contained less than one-half ounce of coca leaves per gallon.2 Initially, physicians, pharmacists, and chemists recommended a pattern of use for drinking coca products that would have resulted in less daily intake of cocaine than from chewing the leaves but with the same stimulating properties. For example, in the first commercial book advertising coca and its products,3 Chevrier (1868)
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From page 292... ...
Daily dosages of cocaine ~addicts" sometimes reached more than 12 grams (Meyers, 1902) , doses almost impossible to achieve with coca products and ones that would not be seen again until the discovery of smoking cocaine free base in the 1970s.
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From page 293... ...
But most cocaine users treated themselves with "home curesn -- patent medicines taken at home. These "home cures" were gradually replaced by Sanitarium cures," which employed long periods of hospitalization.
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From page 294... ...
. These users were primarily motivated by curiosity about cocaine and a desire to experience the anticipated drug effects of euphoria, stimulation, and enhanced sexual motivation.
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From page 295... ...
Although the sample represented a specific geographical population, the users appeared highly similar to those sampled by smaller studies elsewhere (Grinspoon and Bakalar, 1976;
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From page 296... ...
Although hinging can be found within all groups of cocaine users, social-recreational users did not tend to binge during the period 1975-1978. When engaged in episodes of intensified use, 17 users reported binges that involved intake of an average of 0.5 grams (range, 0.25-1.25 grams)
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From page 297... ...
Treatment in the Third Cycle Because the social-recreational patterns of cocaine use during this cycle resulted in relatively few users seeking clinical attention, researchers and clinicians alike minimized the dangers of cocaine. Most efforts focused on treatment of acute toxic reactions in emergency rooms (Siegel, 1985b)
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From page 298... ...
Fourth, the smoking route became a preferred route of administration for many new users. Fifth, the perception of intranasal cocaine as a relatively safe pattern of drug use continued in the face of increasing negative publicity concerning cocaine smoking (Siegel, 1982~.
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From page 299... ...
The decline of the paraphernalia industry during this period resulted in a shortage of cocaine smoking accessories. Thus, the most common method of preparing cocaine free base became the baking soda method (Siegel, 1982)
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From page 300... ...
Furthermore, because crack was typically dispensed in small vials containing only one or two pellets, each weighing only 100 ma, users were forced to maintain high rates of purchase in order to maintain their daily dose regimens. Crack was generally prepared from cocaine hydrochloride using a baking soda extraction method that did not remove the adulterants, diluents, or baking soda usually removed by other methods of preparing cocaine free base (Hisayasu et al., 1982~.
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From page 301... ...
During the 1980s, the fictional cocaine outlaws frequently lost their battles in television episodes of Miami Vices or in the movies (e.g., Scarface in 1984~. But many real cocaine dealers armed themselves for the war with automatic weapons, ruthless tactics, and even detailed instruction manuals (e.g., Feral, 1984)
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From page 302... ...
, longer lasting preparations such as intranasal cocaine free base (Siegel, 1985a) , and cheaper and longer lasting substitute drugs such as methamphetamine.
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From page 303... ...
Although this represents a relatively high rate of attrition, it is important to recognize that the subjects in this longitudinal study were the first to manifest patterns of cocaine smoking in the United States, and their continued study enabled the prediction of the present epidemic of cocaine smoking. In addition, these users were among the first to display other new fashions in cocaine use including coca paste smoking and intranasal use of cocaine free base.
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From page 304... ...
SIEGEL Monthly Segment Subject 1 2 3 4 5 6 7 8 9 10 11 12 13 A + B C D E F G H J K L N o p ~+ + + + + + + + + + + + + + + + + + + + + ~+ + + + + + + + + + + + + + + periods of no use interrupted by periods of continuing use for one or more months. During periods of cocaine use, the quantitative RIAH levels for all social-recreational users were in the range of 5 to 20 nanograms (fig)
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From page 305... ...
All reported daily compulsive smoking of cocaine free base, with an average weekly intake of approximately 7 to 14 grams, and all satisfied the diagnostic criteria for a cocaine smoking disorder (Siegel, 1984c) , cocaine abuse, and severe cocaine dependence (DSM-III-R7~.
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From page 306... ...
found that the majority of cocaine users did not experience deleterious consequences, a finding undoubtedly related to the continued popularity of socialrecreational patterns and the relatively low numbers of compulsive users. However, treatment programs may not have been widely available to innercity crack users who, despite their low doses of cocaine, were engaged in high-risk patterns of use.
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From page 307... ...
Most importantly, however, the coca tea drinkers did not satisfy the diagnostic criteria for cocaine abuse, and their claims of controlled use seemed to be correct. Indeed, during this three-year period the National Addiction Foundation in San Francisco dispensed coca tea as part of their cocaine treatment program, and their patients reported that it was effective in curbing the craving for cocaine itself.
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From page 308... ...
In 1985 the introduction of crack changed the epidemiology of cocaine use in America by allowing individuals to purchase single doses of smokable cocaine free base. These vending practices brought cocaine free base within the budgetary reach of almost anyone; however, studies of crack users in Los Angeles suggested that they used impure preparations and consumed less cocaine than either cocaine free base smokers or intravenous cocaine users, and only slightly more than intranasal users.
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From page 309... ...
While nothing can be concluded from Siegel's two subjects who switched to methamphetamine, the growing number of methamphetamine labs and abusers surfacing throughout the western part of the United States (Methamphetamine labs, 1988; Methamphetamine on fast track, 1988) points to a potential methamphetamine epidemic that could attract many cocaine users.
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From page 310... ...
Therefore, it is important to recognize that behavior in the current fourth cycle includes several patterns of use associated with low doses and low toxicity, albeit large numbers of users (e.g., coca tea drinkers and some social intranasal users)
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From page 311... ...
6Compulsive cocaine smokers also showed significantly more cocaine trapped in the outside cuticle layer of hair (which absorbs ambient smoke) than did compulsive intranasal users.
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From page 312... ...
Evaluation of cocaine free base extraction kits and procedures. In R.K Siegel, Cocaine Smoking.
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From page 313... ...
Gawin (1984) Cocaine abuse: a review of current and experimental treatments.
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From page 314... ...
Schuyten-Resnick (1976) Clinical aspects of cocaine: assessment of cocaine abuse behavior in man.
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From page 315... ...
Shontz (1976) The Life Soles of Nine American Cocaine Users: Tops to the Land of Cockaigne.
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From page 316... ...
Community and Legal Responses to Doug Paraphemalia. National Institute on Drug Abuse Services Research Report.
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