Cocaine: 1977, 13
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COCAINE: 1977 EDITORS: Robert C. Petersen, Ph.D. Richard C. Stillman, M.D. NIDA Research Monograph #13 May 1977 DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE Alcohol, Drug Abuse, and Mental Health Administration 5600 Fishers Lane Rockville, Maryland 20852 For sale by the Superintendent of Documents, U.S. Government Printing Office Washington, D.C. 20402 - Price $3 (paper cover) Stock No. 017-024-00592-4 The NIDA Research Monograph series is prepared by the Division of Research of the National Institute on Drug Abuse. Its primary objective is to provide critical reviews of research problem areas and techniques, the content of state-of-the-art conferences, integrative research reviews and significant original research. Its dual publication emphasis is rapid and targeted dissemination to the scientific and professional community. EDITORIAL ADVISORY BOARD Avram Goldstein, M.D. Addiction Research Foundation Palo Alto, California Jerome Jaffe, M.D. College of Physicians and Surgeons Columbia University, New York Langley Porter Neuropsychiatric Institute Reese T. Jones, M.D. University of California San Fransisco, California William McGlothlln, Ph.D. Department of Psychology, UCLA Los Angeles,California Alcohol and Drug Abuse Research Center Jack Mendelson, M.D. Harvard Medical School McLean Hospital Belmont, Massachusetts Helen Nowlis, Ph.D. Office of Drug Education, DHEW Washington, D.C. Lee Robins, Ph.D. Washington University School of Medicine St. Louis, Missouri NIDA RESEARCH MONOGRAPH series Robert DuPont, M.D. DIRECTOR, NIDA William Pollin, M.D. DIRECTOR, DIVISION OF RESEARCH, NIDA Robert C. Petersen, Ph.D. EDITOR-IN-CHIEF Eunice L. Corfman, M.A. EDITOR Rockwall Building 11400 Rockville Pike Rockville, Maryland, 20852 COCAINE: 1977 ACKNOWLEDGMENT Support services for the development of this monograph were provided by Koba Associates, Inc. under NIDA Contract No. 271-76-3332. Other publications on cocaine are available in the NIDA Division of Research Research Issues series. Numbers and titles are: 8 A COCAINE BIBLIOGRAPHY -- NONANNOTATED 15 COCAINE -- SUMMARIES OF PSYCHOSOCIAL RESEARCH 16 THE LIFESTYLES OF NINE AMERICAN COCAINE USERS DHEW publication number (ADM) 77-471 Library of Congress catalog card number 77-77787 Publications in the NIDA Research Monograph series are indexed in Index Medicus. FOREWORD Increasing chemical sophistication has brought a bewildering array of drugs that produce feelings people like. Despite this increase in the number of abusable psychoactive drugs, a few plant substances have been the dominant psychochemical influence in many cultures over millennia. One of these is the coca bush. Unlike tobacco, marihuana, and opium, it has been geographically restricted -- primarily to the Andes mountains of South America, where its leaves continue to be chewed by millions of Indians on a daily basis. For most Americans, it comes as a surprise to realize that much traditional drug use around the world has been and continues to be work-related, rather than recreational. Contrary to expectations based on modern pharmacology, this is true of such drugs as canna- bis, opium, tobacco, and it is even more characteristic of the coca leaf. In fact, the most compelling analogy to Andean coca chewing is American coffee drinking as a work adjunct. In most cultures over most of history, use of such substances as coca, cannabis and opium has existed in a cultural context which tended to moderate and restrict use. During the last century, traditional patterns of drug use have been increasingly, often profoundly, modified. The availability of the concentrated psychoactive ingredients of traditional drug sub- stances in purified form together with such new routes of admin- istration as intravenous injection has markedly altered the drug picture. Simultaneously with these pharmacological developments, traditional cultures all over the world have been losing their power. In addition, the numbers of people exposed to each psycho- active substance have grown dramatically. Cocaine, the principal psychoactive ingredient of the coca plant, has been a part of this trend. The purified drug was isolated a little more than a hundred years ago. The leaves of the coca plant are typically chewed or used for a tea in traditional settings of use. By contrast, their psychoactive ingredients, from fifty to a hundred times more concentrated, may be "snorted" (like snuff), injected or smoked. The traditional customs that have governed coca use in South America’s mountains are largely absent with respect to cocaine. Despite the spurt of scientific interest in cocaine when it was first isolated and despite the drug’s limited medical use as a local anesthetic, our knowledge of cocaine as a psychoactive substance is modest. For most of the last half century, use was restricted to a comparative few. The amount of research that was conducted using modern pharmacological techniques was correspondingly small. Four years ago, the awareness of increasing cocaine use and the realiza- tion of how little we know led the National Institute on Drug Abuse to launch the present high priority cocaine research effort. About a million dollars a year has been spent in the intervening period to support 40 research projects exploring aspects of cocaine from the chemistry of the substance to the characteristics of users. This volume summarizes our current understanding of cocaine. One of the most notable aspects of our knowledge is that so much is not yet known. We are still, to a large extent, ignorant of the actual and potential health hazards posed by this fascinating substance, even though it was used by about two million Americans this past year. Despite obvious knowledge limitations, we do know a few things that are important: We know, for example, that cocaine can kill -- not commonly but occasionally and perhaps not predictably. Despite the street lore to the contrary, death sometimes occurs even when the drug is snorted rather than injected. We also know that cocaine is among the most powerfully reinforcing of all abused drugs. Although not physically addictive in the sense that the opiates are, there is good evidence that the desire to continue use when available is remarkably strong. The relatively benign picture presented by occasional use of small quantities might be markedly altered were the single euphoric illicit dose now costing about $10 available at the licit cost of about ten cents. While the evidence accumulated thus far does not justify the claim that the American public is now suffering greatly as a consequence of cocaine use, it is evident that much more needs to be known before any actions are taken that might result in a wider avail- ability at lower cost. In the tradition of the Marihuana and Health Reports, we at NIDA are proud to publish our first major report describing what is known and not known about cocaine and its implications for health. We hope that this book will serve not only as a useful reference work for clinicians and scientists interested in the area, but also that it will become a useful document for those interested in applying modern scientific knowledge to the serious social policy questions associated with cocaine use in America today. Robert L. DuPont, M.D. Director National Institute on Drug Abuse CONTENTS Foreword v Robert L. DuPont, M.D. Introduction 1 Robert C. Petersen, Ph.D. and Richard C. Stillman, M.D., Editors Cocaine: An Overview 5 Robert C. Petersen, Ph.D. Chapter I History of Cocaine 17 Robert C. Petersen, Ph.D. Chapter II Coca: The Plant and Its Use 35 Eleanor Carroll, M.A. Chapter III Cocaine: The Material 47 Richard Hawks, Ph.D. Chapter IV Behavioral Effects of Cocaine in Animals 63 James Woods, Ph.D. Chapter V What are the Effects of Cocaine in Man? 97 Robert Byck, M.D. and Craig Van Dyke, M.D. Chapter VI Cocaine: Recreational Use and Intoxication 119 Ronald K. Siegel, Ph.D. Chapter VII Cocaine: Its Use for Central Nervous System Stimulation Including Recreational and Medical Uses 137 Donald R. Wesson, M.D. and David E. Smith, M.D. Chapter VIII The Forensic Toxicology of Cocaine 153 Bryan S. Finkle, Ph.D. and Kevin L. McCloskey, Ph.D. Chapter IX Cocaine in Clinical Medicine 193 Paul G. Barash, M.D. Chapter X Characteristics of Clients Admitted to Treatment for Cocaine Abuse 201 Eduardo Siguel, Ph.D. Author Index 211 Subject Index 215 List of Monographs 222 INTRODUCTION The marked rise in interest in the use of illicit drugs in the past decade has brought with it renewed interest in a drug with a long and romantic history. As with other "recreational" drugs, cocaine has elicited uncritical enthusiasm in some while others better ac- quainted with its earlier history have viewed it with alarm. Cocaine today is perceived by many users as being a physically and psychologically safe recreational drug. It is also an extremely well liked drug. In one recent survey of 100 drug-using college students (Stillman, pers. comn.), cocaine was the recreational drug of choice of all but 2 of the 29 students who had tried it. From their standpoint the only limitations on its use were its high cost and lack of availability. Yet if cocaine becomes cheaper and more readily available dosages will undoubtedly rise and the more un- pleasant and dangerous aspects of the drug may become more apparent. Although the data presented in this volume show that cocaine as typically used in the United States at present poses only a limited hazard, these same data also demonstrate that it can be physically dangerous in ways that marihuana, for example, is not. The present volume represents an attempt to summarize our admit- tedly limited knowledge of cocaine through a series of reports by leading workers in the cocaine area. They range from animal behaviorists conducting research at the preclinical level to clini- cians contending with the problems of the street user.