Crack and Cocaine
Cocaine is a powerfully addictive stimulant drug. The
powdered, hydrochloride salt form of cocaine can be snorted or dissolved
in water and injected. Crack is cocaine that has not been neutralized
by an acid to make the hydrochloride salt. This form of cocaine comes
in a rock crystal that can be heated and its vapors smoked. The term
“crack” refers to the crackling sound heard when it is heated.*
Regardless of how cocaine is used or how frequently,
a user can experience acute cardiovascular or cerebrovascular emergencies,
such as a heart attack or stroke, which could result in sudden death.
Cocaine-related deaths are often a result of cardiac arrest or seizure
followed by respiratory arrest.
Cocaine is a strong central nervous system stimulant that interferes
with the reabsorption process of dopamine, a chemical messenger associated
with pleasure and movement. The buildup of dopamine causes continuous
stimulation of “receiving” neurons, which is associated with the euphoria
commonly reported by cocaine abusers.
Physical effects of cocaine use include constricted
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 time a user feels high and increases
the risk of addiction.
Some users of cocaine report feelings of restlessness,
irritability, and anxiety. A tolerance to the “high” may develop—many
addicts report that they seek but fail to achieve as much pleasure as
they did from their first exposure. Some users will increase their doses
to intensify and prolong the euphoric effects. While tolerance to the
high can occur, users can also become more sensitive to cocaine’s anesthetic
and convulsant effects without increasing the dose taken. This increased
sensitivity may explain some deaths occurring after apparently low doses
Use of cocaine in a binge, during which the drug is
taken repeatedly and at increasingly high doses, may lead to a state
of increasing irritability, restlessness, and paranoia. This can result
in a period of full-blown paranoid psychosis, in which the user loses
touch with reality and experiences auditory hallucinations.
Other complications associated with cocaine use include
disturbances in heart rhythm and heart attacks, chest pain and respiratory
failure, strokes, seizures and headaches, and gastrointestinal complications
such as abdominal pain and nausea. Because cocaine has a tendency to
decrease appetite, many chronic users can become malnourished.
Different means of taking cocaine can produce different
adverse effects. Regularly snorting cocaine, for example, can lead to
loss of sense of smell, nosebleeds, problems with swallowing, hoarseness,
and a chronically runny nose. Ingesting cocaine can cause severe bowel
gangrene due to reduced blood flow. People who inject cocaine can experience
severe allergic reactions and, as with any injecting drug user, are
at increased risk for contracting HIV and other bloodborne diseases.
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 potentially increasing the risk of sudden death.
The widespread abuse of cocaine has stimulated extensive
efforts to develop TREATMENT
PROGRAMs for this type of drug abuse.
One of NIDA’s top research priorities 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 for their safety and efficacy in treating cocaine
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
and services for each individual is critical to successful outcomes.
Extent of Use
Monitoring the Future Study (MTF)**
MTF assesses the extent and perceptions of drug use
among 8th, 10th, and 12th grade students nationwide. Crack cocaine use
decreased among 10th-graders for the lifetime, annual, and 30-day use
categories.*** This was the only statistically significant change affecting
cocaine in any form. These significant decreases were from 3.6 percent
in 2002 to 2.7 percent in 2003 for lifetime use; 2.3 percent in 2002
to 1.6 percent in 2003 for annual use; and 1.0 percent in 2002 to 0.7
percent in 2003 for 30-day use.
Overall annual cocaine use increased in each grade from
the early 1990s until 1998 or 1999 and has subsequently stabilized or
declined somewhat. Among 12th-graders, the rate increased from 3.1 percent
in 1992 to 6.2 percent in 1999, declined significantly to 5.0 percent
in 2000, and remained stable through 2003 at 4.8 percent. Among 10th-graders,
the rate increased from 1.9 percent in 1992 to 4.9 percent in 1999.
In 2003, 3.3 percent of 10th-graders reported annual cocaine use, significantly
below the peak in 1999, though year-to-year changes were not significant.
Among 8th-graders, 1.1 percent reported annual cocaine use in 1991,
a figure that increased to 3.0 percent in 1996, hovered around that
point for several years, then dropped to 2.2 percent in 2003—significantly
below the 1996 high point.
Community Epidemiology Work Group (CEWG)****
Cocaine/crack was endemic in almost all 21 CEWG areas
in 2002. Rates of emergency department (ED) mentions were higher for
cocaine than for any other drug in 17 CEWG areas. ED rates increased
significantly between 2001 and 2002 in Baltimore, and were highest in
Chicago, Philadelphia, Atlanta, Baltimore, Miami, Newark, Detroit, and
Cocaine-related death mentions in 2001 were particularly
high in Chicago, Baltimore, Dallas, Newark, San Antonio, Atlanta, Boston,
Denver, San Francisco, and New York, as measured by one Federal data
source. Reports from local medical examiner data named Detroit, Philadelphia,
Miami, and Phoenix as sites with the highest rates of cocaine-related
deaths from 2000 through 2002.
Primary cocaine TREATMENT
admissions were high in 9 of the 21 CEWG areas reporting TREATMENT
data in 2002 (Atlanta, Miami, New Orleans, St. Louis, Washington, DC,
Philadelphia, Texas, Detroit, and Illinois). Nearly half of adult male
arrestees in Atlanta, New York, and Chicago tested positive for cocaine
Nationwide, 61,594 kilograms of cocaine were seized
by the DEA in 2002, 3.6 percent more than in 2001 and 35.9 percent more
than in 1995.
National Survey on Drug Use and Health (NSDUH)*****
In 2002, 33.9 million Americans age 12 and over reported
lifetime use of cocaine, and 8.4 million of these reported using crack.
About 5.9 million reported annual use of cocaine, and 1.6 million of
these reported using crack. About 2 million reported 30-day use of cocaine,
and 567,000 of these reported using crack.
The percentage of youth ages 12 to 17 reporting lifetime
use of cocaine increased from 2.3 percent in 2001 to 2.7 percent in
2002. Among young adults ages 18 to 25, the rate increased from 14.9
percent in 2001 to 15.4 percent in 2002.
* 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 use of a needle to release the drug
directly into the bloodstream; any needle use increases a user’s risk
of contracting HIV and other blood-borne infections. Smoking involves
inhaling cocaine vapor or smoke into the lungs, where absorption into
the bloodstream is as rapid as by injection.
** These data are from the 2003 Monitoring the Future
survey, funded by the National Institute on Drug Abuse, National Institutes
of Health, DHHS, and conducted annually by the University of Michigan’s
Institute for Social Research. The survey has tracked 12th-graders’
illicit drug use and related attitudes since 1975; in 1991, 8th- and
10th-graders were added to the study. The latest data are online at
***“Lifetime” refers to use at least once during a respondent’s
lifetime. “Annual” refers to use at least once during the year preceding
an individual’s response to the survey. “30-day” refers to use at least
once during the 30 days preceding an individual’s response to the survey.
**** CEWG is a NIDA-sponsored network of researchers
from 21 major U.S. metropolitan areas and selected foreign countries
who meet semiannually to discuss the latest epidemiology of drug abuse.
CEWG’s most recent reports are available at http://www.drugabuse.gov/about/organization/cewg/pubs.html.
***** NSDUH (formerly known as the National Household
Survey on Drug Abuse) is an annual survey conducted by the Substance
Abuse and Mental Health Services Administration. Findings from the latest
survey are available at www.samhsa.gov.
Find this information and more at www.drugabuse.gov