DRUGS

The Straight Facts

Cocaine
DRUGS The Straight Facts

Alcohol
Cocaine
Hallucinogens
Heroin
Marijuana
Nicotine
 DRUGS
The Straight Facts

Cocaine

Heather Lehr Wagner

Consulting Editor
David J. Triggle
University Professor
School of Pharmacy and Pharmaceutical Sciences
State University of New York at Buffalo
Cocaine

Copyright © 2003 by Infobase Publishing

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Library of Congress Cataloging-in-Publication Data

Wagner, Heather Lehr.

Cocaine / Heather Lehr Wagner.
v. cm.—(Drugs, the straight facts)
Contents: Thinking about cocaine—A brief history of cocaine—How cocaine
affects your body—The business of cocaine—Who is really using cocaine?—
A look at addiction—Where to go for help.
ISBN 0-7910-7260-6
1. Cocaine habit—Juvenile literature. [1. Cocaine habit. 2. Drug abuse.]
I. Title. II. Series.
HV5810.W23 2003
362.29'8—dc21 2002155984

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 Table of Contents
The Use and Abuse of Drugs
David J. Triggle 6

1. Thinking About Cocaine 8

2. A Brief History of Cocaine 18

3. The Health Effects of Cocaine 36

4. The Business of Cocaine 48

5. Teenage Trends and Attitudes 60

6. Cocaine Addiction 72

7. Exploring Additional Resources 84

Appendix 90

Bibliography 92

Further Reading 94

Index 95
The Use and Abuse of Drugs
The issues associated with drug use and abuse in contemporary
society are vexing subjects, fraught with political agendas
and ideals that often obscure essential information that teens
need to know to have intelligent discussions about how to
best deal with the problems associated with drug use and
abuse. Drugs: The Straight Facts aims to provide this essential
information through straightforward explanations of how an
individual drug or group of drugs works in both therapeutic
and non-therapeutic conditions; with historical information
about the use and abuse of specific drugs; with discussion of
drug policies in the United States; and with an ample list of
further reading.
From the start, the series uses the word “drug” to describe
psychoactive substances that are used for medicinal or non-
medicinal purposes. Included in this broad category are
substances that are legal or illegal. It is worth noting that
humans have used many of these substances for hundreds, if
not thousands of years. For example, traces of marijuana and
cocaine have been found in Egyptian mummies; the use of
peyote and Amanita fungi has long been a component of
religious ceremonies worldwide; and alcohol production and
consumption have been an integral part of many human
cultures’ social and religious ceremonies. One can speculate
about why early human societies chose to use such drugs.
Perhaps, anything that could provide relief from the harshness
of life—anything that could make the poor conditions and
fatigue associated with hard work easier to bear—was consid-
ered a welcome tonic. Life was likely to be, according to the
seventeenth century English philosopher Thomas Hobbes,
“poor, nasty, brutish and short.” One can also speculate about
modern human societies’ continued use and abuse of drugs.
Whatever the reasons, the consequences of sustained drug use
are not insignificant—addiction, overdose, incarceration, and
drug wars—and must be dealt with by an informed citizenry.
The problem that faces our society today is how to break

6
the connection between our demand for drugs and the will-
ingness of largely outside countries to supply this highly
profitable trade. This is the same problem we have faced
since narcotics and cocaine were outlawed by the Harrison
Narcotic Act of 1914, and we have yet to defeat it despite
current expenditures of approximately $20 billion per year on
“the war on drugs.” The first step in meeting any challenge
is always an intelligent and informed citizenry. The purpose
of this series is to educate our readers so that they can
make informed decisions about issues related to drugs and
drug abuse.

SUGGESTED ADDITIONAL READING

David T. Courtwright, Forces of Habit. Drugs and the making of

the modern world. Cambridge, Mass.: Harvard University
Press, 2001. David Courtwright is Professor of History at
the University of North Florida.

Richard Davenport-Hines, The Pursuit of Oblivion. A global

history of narcotics. New York: Norton, 2002. The author
is a professional historian and a member of the Royal
Historical Society.

Aldous Huxley, Brave New World. New York: Harper & Row,
1932. Huxley’s book, written in 1932, paints a picture of a
cloned society devoted to the pursuit only of happiness.

David J. Triggle
University Professor
School of Pharmacy and Pharmaceutical Sciences
State University of New York at Buffalo

7
1
Thinking
About Cocaine
Cocaine is a very addictive drug. Cocaine is a stimulant—it directly
affects your brain. Cocaine stimulates certain nerve cells in the brain,
producing feelings of intense pleasure. Users talk about feeling care-
free, or relaxed, or utterly in control. But this artificial stimulation
comes with a price tag. The “high” from cocaine lasts only from five
to 20 minutes, and you will need more and more cocaine each time
you try to match the feelings of that first, initial experience. Cocaine
causes severe mood swings and irritability.
As soon as cocaine enters your bloodstream it goes to work,
increasing your heart rate and raising your blood pressure. It
increases your body’s temperature and causes the pupils of your eyes
to dilate. Repeated sniffing of cocaine powder causes your nose to
become irritated and frequently runny. The cocaine can even eat
away at the cartilage in your nose, producing holes.
No one starts out saying, “I want to be an addict.” Cocaine is
one of the most addictive drugs there is—both psychologically and
physically. Once you use cocaine, even just one time, you cannot
predict how much or how often you will continue to use it.

WHAT IS COCAINE?
Cocaine is a substance produced in the leaves of a shrubby bush
that grows mainly in Peru and Bolivia. This bush , known as
Erythoxylum coca, grows wild in parts of South America and is
cultivated in others.

8
Cocaine is manufactured by heating a paste produced from the leaves
of the coca bush with hydrochloric acid. The resulting white powder is
often separated into fine lines and inhaled or snorted into the nose.

Cocaine is not a new drug. It is thought that the Incas were

most likely the first to use cocaine, chewing the leaves of the
coca bush more than a thousand years ago. The practice was
originally reserved for priests in ceremonies and for soldiers
and workers who relied on the simulating effects of the plant to

9
10 COCAINE

increase their endurance. To this day, residents of the Andes

Mountains where the coca bush grows still chew the leaves of
the coca plant with little or no addictive effect. The amount of
cocaine in the leaves, when chewed, is quite small, and the
effect is similar to drinking several strong cups of coffee.
The absence of addiction among coca leaf chewers is
supported by firsthand reports from researchers and biolo-
gists like Andrew Weil, M.D., who wrote in the Journal of
Ethnopharmacology:

I have lived among coca-using Indians of the Andes and

the Amazon basin in Columbia and Peru and have not
seen any signs of physical deterioration attributable to the
leaf. I have never seen an instance of coca toxicity. Nor
have I observed physiological or psychological depend-
ence on coca. Even life-long chewers seem able to get the
effect they want from the same dose over time; there is no
development of tolerance and certainly no withdrawal
syndrome upon sudden discontinuance of use.

However, this research does not imply that cocaine use is

safe. The size of the coca leaf quid that can be chewed com-
fortably releases only a small amount of cocaine, much less
than what is present in the powdered or crystallized form
common to modern recreational use.
Cocaine as it is known today—in a synthesized form—
was first isolated from the coca plant in 1855 by a German
chemist named Albert Niemann. A paste is made from the
leaves of the plant. Then this paste is heated with hydrochloric
acid to produce cocaine hydrochloride. This is the most
common form of cocaine: the white powder that is separated
into fine lines, a few inches long, and then inhaled into the
nose. When it is found in powder form, its purity can be
anywhere from zero to 90 percent pure. In the form known as
crack or “rock,” it is generally 25 percent to 40 percent pure.
This element of uncertainty about cocaine’s purity adds to
 Thinking About Cocaine 11

the risks inherent in using cocaine. You can never be certain

exactly what is in that powder that you are inhaling. The dealer
who supplied it will most likely have cut it with another substance
to increase his or her profits. Cocaine may be cut with sugar,
laxatives, cornstarch, talcum powder, or even amphetamines.

achel never planned to use cocaine. It just happened.

R Her family moved and she was in a new school. Some
kids invited her to a party, and once the party started, she
saw the lines of white powder on the shiny mirror. She wanted
to fit in; she hated being the “new girl.” She wanted these
people to like her. So she tried it.
One of the boys must have known that she had never
tried it before. He handed her a rolled-up ten-dollar bill. He
told her to rub a bit of the powder on her gums, and then
showed her how to inhale it.
At first, Rachel did not feel anything. But when it came, it
was the most incredible feeling she had ever experienced. She
felt completely comfortable and at ease, suddenly confident
that she belonged. She felt energetic, capable of doing anything.
All of her insecurities and anxieties disappeared.
She tried it several more times since that first party, and
now she could hardly wait for the next opportunity. It was all
she thought about. Regular life seemed boring and flat. It
was simply the time that came before and after cocaine.

What Rachel may not know about cocaine is how it affects

her brain. The confidence and energy she feels are caused
by cocaine and its effect on the concentration of chemical
messengers in her brain. She will quickly become accustomed
to the neuronal imbalance that results in her confidence and
energy, and she will need more and more cocaine to produce
the same feelings.
12 COCAINE

This white powder may look clean and pure, but it is not.
The once natural “high” the plant’s leaves offered has become
big business, and opportunities are used to cut corners and
increase profits well before the cocaine reaches the dealer.
When the coca leaves are first harvested, they are thrown
into pits, pounded or chopped, and then mixed with kerosene
or gasoline as well as other chemicals. This process removes
the cocaine from the leaves. This is the freebase form of
cocaine, but it cannot stay in this form for long or it begins to
lose its strength. In order to transport the cocaine, it is mixed
with chemicals and converted into a kind of salt, which is less
fragile and more easily transported.

HOW DOES IT AFFECT YOU?

Cocaine affects structures deep in the brain. Among these is the
neural system located in the region of the brain known as the
ventral tegmental area (VTA). This is one of the regions of
the brain that, when stimulated, produces the sensation of
pleasure. Nerve cells that begin in the VTA stretch down to the
region of the brain known as the nucleus accumbens, which is
one of the brain’s key centers for creating feelings of pleasure.
When you are doing something that gives you pleasure,
large amounts of dopamine—a neurotransmitter (chemical
messenger) associated with creating these feelings of pleasure—
are released in the nucleus accumbens by neurons that begin in
the VTA. When your brain is functioning normally, a neuron
releases this dopamine into the small gap between two neurons
(known as the synapse). This dopamine then binds with
specialized proteins, known as dopamine receptors, on the
nearest neuron. When this happens, the dopamine sends a
signal to that neuron, a signal that something pleasant is
happening.
This is what happens when the brain is functioning
normally, when you are doing something that makes you
feel happy. When you use cocaine, though, it interferes with
 Thinking About Cocaine 13

This farmer in Peru harvests coca leaves, the base ingredient

in cocaine. Cocaine production has a negative effect on the
environment: 5.7 million acres of rainforest have been cleared
to grow coca over the last 30 years in Peru alone, and
14,800 tons of toxic chemicals used in the production of
cocaine paste have been dumped into the Amazon jungle.

this normal process. Research has shown that cocaine works

by blocking dopamine from leaving the synapse. The result?
A build-up of dopamine and an ongoing stimulation of the
receiving neurons.
So what’s so bad about that? What’s wrong with feeling
intense pleasure, even if it is an artificial feeling?
14 COCAINE

The reward pathway is a key concept in understanding the effects

of drugs like cocaine on the brain. The reward pathway involves
several parts of the brain, including the ventral tegmental area (VTA),
the nucleus accumbens, and the prefrontal cortex. When activated
by a rewarding stimulus like cocaine, a neurotransmitter called
dopamine is released in the nucleus accumbens by neurons that
begin in the VTA and then travels to the prefrontal cortex. The
prefrontal cortex is a complex structure that influences cognitive
processes like attention span, critical thinking, and expression
of emotions.

When dopamine leaves the synapse, the signal that pleasure

is taking place gradually disappears, and the process of nerve
communication continues. When dopamine accumulates, for
example with cocaine use, your brain grows accustomed to
higher and higher levels of dopamine being present—not when
something pleasant is going on, but simply as the brain’s
normal state. That means that you need to take more and
more cocaine, and take it more and more often, to copy
the “high” that you got the first time you used cocaine. It
 Thinking About Cocaine 15

also means that when the dopamine is not present, your brain
no longer feels as if it is in a normal state of functioning—it feels
deprived. It requires the cocaine not simply to achieve a state of
pleasure, but to make it seem as if everything is normal.

HOW COCAINE AFFECTS YOU

The pleasure cocaine brings doesn’t last long. When snorted,
the “high” lasts only about five to 20 minutes. The effects on
your body last longer, and the long-term dangers of continued
cocaine abuse are frightening.
In the short-term, cocaine increases your blood pressure
and heart rate. It constricts your blood vessels, dilates your
bronchioles (the tubes you use for breathing), and increases
your blood sugar. That is only in the short-term.

COCAINE AND TEENS:

The Numbers
The 2001 Monitoring the Future study analyzed drug use
among American teens and young adults. Here are some of
the statistics researchers discovered when interviewing teens
about their cocaine use:
• Among eighth graders, 4.3 percent report trying cocaine at
least once.
• Among tenth graders, 5.7 percent report using cocaine at
least once.
• Among twelfth graders, 8.2 percent say that they have tried
cocaine at least once.

The number of students saying that they have tried cocaine in

the last month was much lower. Only two percent of all twelfth
graders and a little more than one percent of eighth or tenth
graders say that they have used cocaine within the past month.

[Source: whitehousedrugpolicy.gov]
16 COCAINE

In the long-term, cocaine damages many different parts of

your body. It damages your heart, leading to disturbances in
your normal heart rhythm—disturbances that can cause a heart
attack. It damages your respiratory system, leading to chest
pain or even respiratory failure. It damages your neurological
system, leading to headaches or even seizures or strokes. It causes
problems with your gastrointestinal system (the system that
handles digestion), leading to nausea or abdominal pain.
Finally, cocaine damages you psychologically as well as
physically. It can trigger depression, anxiety, sleep problems, or
irritability. It can lead to paranoia or even convulsions. You
may begin to hallucinate and gradually slip away from reality
into a nightmare world.

ark needed extra money. His cocaine habit was getting

M expensive. At first, he had only used it occasionally
with friends. They had snorted it. Then one of his friends
had introduced him to smoking it, and he quickly found it
harder and harder to wait for the next time. He was doing
it by himself now, and even though smoking it was less
expensive, he was using more and more.
He had used up the savings from his summer job. Now
he was taking money from his parents and his sister. It wasn’t
really stealing, he told himself. He would pay them back when
he could. So he took a bit from his dad’s wallet, a bit from his
mother’s purse, and a bit more from the allowance money his
sister kept in an envelope in her dresser.

Mark is learning that cocaine will make you do things you never
thought possible, like stealing from your family. When someone
like Mark is addicted to a drug like cocaine, he or she will
continue to seek drugs in spite of the negative consequences
of his or her drug use.
 Thinking About Cocaine 17

MAKING WISE CHOICES

It is important to learn about any drug—what it is, where it
comes from, and how it affects your body—before deciding to
use it. Cocaine, whether snorted, smoked, or injected, is an
illegal drug. Cocaine is highly addictive. It is expensive. It
impairs your judgment. It interferes with your brain’s under-
standing of what creates pleasure, causing you to lose interest
in all of the other areas of your life—your friends, your family,
sports, and school.
In this book, you will read about teens making decisions
about cocaine. You will learn more about how cocaine affects
your body. You will learn about the legal issues surrounding
cocaine and how laws governing cocaine have changed over
the years. You will find out some surprising statistics about
cocaine and learn more about the people most likely to use
and abuse it. Finally, you will learn about how to deal with
cocaine addiction, how to prevent problems, how to ask for
help if you need it, and what to do if you suspect that a friend
or family member is abusing cocaine.
This information will help you make wise choices when
you are thinking about cocaine. Perhaps you have already tried
cocaine or been at a party where it was offered to you. Maybe
you have a friend or family member whom you suspect may be
addicted. Through the stories of the teens in this book and
the facts contained in each chapter, you will learn more about
cocaine and begin to understand how it can affect you.
2
A Brief History
of Cocaine
For the Incas who cultivated the coca bush in ancient Peru, the plant
they were growing and harvesting was a critical part of religious
ceremonies. Records show that the coca bush was grown in parts
of South America as far back as 1000 A.D. and was viewed by
those who tended it as a sacred symbol of endurance, strength, and
even fertility. Its use was reserved for the most important members
of Incan society: royalty and certain nobles.
In these early ceremonies, the leaves of the coca bush were
chewed. The result was a mild stimulant, similar to drinking a few
cups of strong coffee. Addiction was seldom a problem since each
leaf contained only a very small amount of the drug.
Those who chewed the leaves experienced greater alertness
and became less sensitive to hunger or cold. Eventually, small
supplies of coca leaves were placed in storehouses along impor-
tant routes so that they might be used by the kingdom’s warriors
or messengers.
In 1532, Pizarro’s conquest of the Incas marked a new chapter in
the use of the coca bush. Once reserved only for important ceremonies
or for the use of select groups, the coca bush became a form of
currency. The Spanish conquerors used coca plants as a kind of pay-
ment for the natives to ensure their cooperation and to keep them
energized for the backbreaking labor they were required to perform.
Soon, missionaries from the Catholic Church became con-
cerned by the effects of more widespread use and availability of

18
 Pizarro’s conquest of the Incas in the sixteenth century forever
changed the use of coca leaves in Peru. Once reserved for Incan
priests and soldiers, chewing coca leaves became widespread
when Spanish conquerors used coca leaves as payments for
Incan laborers. Eventually, the Spanish took over coca production
and cultivation completely from the Incas.

the coca leaves, both for the natives and their conquerors.
The coca leaves were symbolic of the Incan religion, and
their use seemed to support a kind of worship the Catholic

19
20 COCAINE

Church wished to stamp out. In 1560, laws were passed to

attempt to eliminate this new system of currency, but they
proved short-lived. Soon, the new government set up by Spanish
conquistadors took over the coca production and established a
monopoly both on its cultivation and on its use as currency.
Spaniards carried the plant back to Europe, where it
failed to generate much interst, most likely because the coca
leaves had lost their potency during the long voyage from
Peru. Centuries later, a German chemist named Albert
Niemann from the University of Gottingen experimented
with attempts to isolate the drug from the plant’s leaf. In
1858, he succeeded.
Niemann’s success would lead to the first widespread
cocaine epidemic. Since the full extent of the drug’s addictive-
ness was not known, cocaine soon gained use as a local
anesthetic. Peru became the site of a network of German-owned
plantations and factories, all attempting to cultivate the new
“miracle drug.” The Dutch also soon entered the competition,
cultivating their own cocaine plants in Java—a variety that
many felt was far superior to the German version.
Its use as a replacement for snuff (a powdered form of
tobacco) resulted in cocaine being not only injected intra-
venously, but also inhaled into the nose. Its addictiveness was not
yet widely understood, but this ignorance would not last long.

FREUD AND COCAINE

By the mid-1880s, commercial production of purified cocaine
was a full-fledged industry. While many real and imagined uses
for the drug were proclaimed, its most extensive medical use
was as a local anesthetic in eye surgery.
In those early days of medicine, a rather horrifying
prospect faced the patient needing the skills of an ophthalmol-
ogist (a doctor specializing in the structure, function, and
diseases of the eye). When eye surgery was required, it was often
necessary for the patient to be able to move his or her eye
 A Brief History of Cocaine 21

as the surgeon instructed—without pulling away or flinching!

An Austrian ophthalmologist named Karl Koller was the first
to discover that when cocaine was used as a local anesthetic,
the patients were able to handle this grueling process and the
surgery could be successfully completed.
Word of Koller’s experiments soon spread. Other
European physicians were proving equally resourceful at
discovering new uses for cocaine. In 1883, a German doctor
named Theodor Aschenbrandt discovered a new use for
cocaine, this time a military one. Aschenbrandt prescribed
cocaine to Bavarian soldiers during training and discovered
that it helped them cope with fatigue and exhaustion
during maneuvers.
The results of Aschenbrandt’s military use for cocaine
were published in a German medical journal, a journal
that was read by a neurologist named Sigmund Freud. It
would be Freud who would serve as one of cocaine’s most
prominent spokespersons. In July 1884, Freud published his
own study of cocaine, titled Uber Coca [On Cocaine]. Citing
the exhilaration and euphoria the drug induced, Freud
came to the misleading conclusion that cocaine could be
taken without any risk of addiction. He cited its potential
medical uses as a mental stimulant, as an aphrodisiac, as a
local anesthetic, and even as a treatment for everything
from digestive disorders and asthma to a cure for morphine
and alcohol addiction.
It did, of course, cure many addicts of their addiction to
morphine or alcohol—they instead quickly became addicted to
cocaine. Freud had advocated that cocaine be taken orally, a
method that would have enabled some of the cocaine to be
broken down in the liver before it reached the brain, resulting in
a less intense experience of euphoria. But in the 1880s the use of
the syringe was perfected, and soon hypodermic needles were
more widely available. Morphine addicts quickly began injecting
themselves with cocaine or cocaine mixed with morphine. It
22 COCAINE

would be some time before Freud would be forced to admit

that it was not hypodermic needles that caused cocaine to
prove addictive, but the drug itself. By then cocaine was being
used not only in wealthy European circles, but also among
lower- and middle-class Europeans and even in America.

THE FIRST COCA-COLA

The idea of marketing a drink containing cocaine originated
in France. A Corsican chemist created Vin Mariani, a wine
containing small amounts of cocaine.
The success of Vin Mariani inspired American John
Pemberton to create what he described as his version of the
“French Wine of Coca, the Ideal Tonic.” In 1886 Pemberton
began to market his syrupy beverage, which consisted of a
blend of coca leaves and African kola nuts—a drink that he
labeled “Coca-Cola.” Initially designed as a kind of medicinal
beverage, Coca-Cola was sold in drugstores. Soon, soda foun-
tains opened in drugstores across Georgia to offer customers a
convenient place to purchase and consume the beverage. The
new drink, and the soda fountain where it was dispensed,
would quickly spread across the United States.
That same year, 1886, cocaine gained another important
military endorsement, this one from Dr. William Alexander
Hammond, the Surgeon General of the U.S. Army. At a meeting
of the New York Neurological Society, he advocated the use of
cocaine for medical purposes.
It would be several more years before the danger of cocaine
and its addictiveness were fully recognized. In the early part of
the twentieth century, many so-called “tonics” or medicinal
beverages were sold to customers unaware of the danger they
posed for addiction. These tonics, unregulated by any govern-
mental agency, promised a wide range of miracle cures based
on the ingredients they contained—cocaine and opium.
Americans would soon discover that there was little of
the miraculous about these tonics. By 1902, estimates show that
 A Brief History of Cocaine 23

A Corsican chemist created Vin Mariani, a wine containing small

amounts of cocaine, in the late nineteenth century. The popularity of
this drink prompted American John Pemberton to create Coca-Cola,
a blend of coca leaves and African Kola nuts. Soda fountains
dispensing this drink opened in Georgia and soon spread across
the United States.

there were some 200,000 people addicted to cocaine in the

United States. By 1903, responding to public concern, Pemberton
agreed to remove cocaine from his Coca-Cola.

THE HARRISON NARCOTIC ACT

As concern about the growing numbers of people addicted
to various drugs grew, and as a prohibitionist movement to
ban alcohol gained popularity in various quarters throughout
the United States, the government began to recognize the need
for greater control and regulation of the distribution of these
substances. In December 1914, the United States Senate approved
24 COCAINE

the passage of the Harrison Narcotic Act under the urging of

then Secretary of State William Jennings Bryan.
The bill was labeled an “act to provide for the registration
of, with collectors of internal revenue, and to impose a special
tax upon all persons who produce, import, manufacture,
compound, deal in, dispense, sell, distribute, or give away
opium or coca leaves, their salts, derivatives, or preparations.”
Rather than making opium or cocaine illegal, the Harrison Act
instead allowed doctors and pharmacists to continue to
prescribe narcotics, and manufacturers and importers to
continue to meet this demand, provided that they registered
with the internal revenue office and paid the fee of one dollar
per year. (At the time cocaine was incorrectly labeled as
a “narcotic.”)
The law further said that government officials who were
“lawfully engaged in making purchases” of these drugs were
exempt from paying the tax. The manufacturers of tonics
and potions containing small amounts of cocaine were also
exempt, provided that the narcotic content of their products
did not exceed a certain fixed amount.
The opportunity the Harrison Act offered to those
seeking to stamp out the spread of addiction was contained
in one small phrase. A doctor or a dentist was permitted to
continue to prescribe cocaine and other narcotics, provided
that it was done “in the course of his professional practice
only.” In other words, cocaine could be prescribed as part
of a recommended course of medical treatment but not
merely to help someone who was addicted to the drug avoid
the symptoms of withdrawal or continue with their drug
use. Doctors found to be writing prescriptions without
some medical backup for the prescription could be and
were arrested.
As a result, addicts who had previously had little
problem obtaining their next fix legally and under medical
supervision soon found that their supply had dried up.
 A Brief History of Cocaine 25

Doctors were reluctant to write out prescriptions for these

drugs for fear that they would be questioned by law enforce-
ment officials and have their medical practices damaged by the
ensuing publicity.
Rather than stamping out drug abuse, the Harrison Act
prompted the gradual growth of an underground, illegal
industry for supplying drugs. The Harrison Act did not stop
people from using cocaine and other drugs; it simply forced
them to look elsewhere for their supply. About three years
after the Harrison Act was passed into law, a governmental
committee was formed to look into its effects. They discovered
that the illegal (or “underground”) trade in drugs now was
approximately equal to the legitimate sale; that smuggling
routes had been set up at access points to the United States,
particularly at the border with Canada; and that, based on
reports from several American cities, drug use had actually
increased since the Harrison Act had been passed.
It would not be the last time that the government and
law enforcement authorities were forced to confront a
burgeoning drug problem in the United States. The same
questions that plagued leaders in the early part of the twen-
tieth century continue to trouble lawmakers today. What
effect has criminal legislation had on the drug problem?
How can addicts be encouraged to seek help and ultimately
recover from their addictions? How can the United States
secure its borders against the smuggling of illegal substances?

A BRIEF LULL
Gradually, greater power was given to local law enforcement
authorities to regulate drug trafficking in their communities.
Public awareness of the dangers cocaine posed grew, and many
of its earlier advocates were forced to acknowledge their own
addictions. By the middle of the twentieth century, cocaine use
had declined, and the period from the 1940s through the 1960s
saw little mention of cocaine or concern about its abuse.
26 COCAINE

In the late 1960s, however, the climate had changed in the

United States. Recreational drug use became more acceptable
among young Americans. Popular culture soon celebrated a freer
lifestyle, one linked with drug use. Drugs became a symbol of a
new generation, a generation that rebelled against the values and
power structures its parents and grandparents had embraced.

COCAINE IN AMERICA:
A Timeline
1886: John Pemberton markets syrupy beverage consisting
of a blend of coca leaves and African kola nuts,
called “Coca-Cola.” U.S. Army Surgeon General
William Alexander Hammond advocates the use
of cocaine for medical purposes.
1902: Statistics show 200,000 Americans addicted
to cocaine.
1903: Pemberton agrees to remove cocaine from Coca-Cola.
1914: Harrison Narcotic Act passed.
1970: Controlled Substances Act passed.
1973: Drug Enforcement Agency created.
1981: Medellin cartel consolidates power.
1985: Crack epidemic in New York City draws media
attention.
1986: Len Bias dies of a cocaine overdose.
1990: Panama leader Noriega is captured and taken
to Florida.
1993: Pablo Escobar is killed.
1995: Cali cartel leaders arrested.
2000: President Bill Clinton approves $1.3 billion aid pack-
age to Colombia for combating drug trafficking.
[Source: www.pbs.org/wgbh/pages/frontline/shows/drugs/]
 A Brief History of Cocaine 27

Drug use was no longer stigmatized. The drugs of choice

in the 1960s were marijuana, LSD, and heroin. To help offer
a more effective governmental response to the rise in drug
use, President Lyndon Johnson created a new division of the
Justice Department, the Bureau of Narcotics and Dangerous
Drugs (BNDD). The BNDD was designed to consolidate
responsibility for drug enforcement into a single agency,
rather than the previously scattered system spreading enforce-
ment duties among customs officials, law enforcement
agencies, and other national agencies.
In October 1970, Congress passed the Comprehensive
Drug Abuse Prevention and Control Act, a law designed to
consolidate all previous drug laws regulating the manu-
facture and distribution of drugs. It gave law enforcement
officials the right to conduct “no-knock” searches for drugs.
The law is particularly significant for the fact that it contains
the Controlled Substances Act which places all substances
regulated under federal law into one of five categories. The
categories are chosen based on the drug’s medicinal value,
harmfulness, and potential for abuse or addiction. Drugs
placed in Schedule I are considered to be the most danger-
ous, with no recognized medical use. Drugs in Schedule V
are considered to be the least dangerous.
Cocaine is listed as a Schedule II drug. This means that it
is considered to have a high potential for abuse, and that
abuse of cocaine may lead to severe psychological or physical
dependence. However, its placement in this category indicates
that it has a “currently accepted medical use in treatment in
the United States or a currently accepted medical use with
severe restrictions.”
In 1971, President Richard Nixon declared that drug abuse
was a public enemy and launched a governmental war on
drugs. However, the approach under Nixon was significant and
unique—the focus was on drug abuse prevention, with most
funding going towards treatment rather than enforcement of
28 COCAINE

drug laws. Two years later, President Nixon would announce

the creation of a new agency to handle all aspects of the
nation’s drug problem: the Drug Enforcement Agency (DEA).

A NEW COCAINE PROBLEM

In November 1975, Colombian police seized a small plane at an
airport in Cali, Colombia, after receiving a tip that it contained
drugs. On board they found 600 kilos (1,323 pounds) of cocaine.
It was the largest cocaine seizure that had ever been made up to
that time. It also signaled to drug enforcement authorities, both
in Colombia and in the United States, that the illegal trade in
cocaine was much larger than they had previously suspected.
The loss of this shipment did not go without a response.
The cocaine traffickers launched a brutal retaliation, in
part to attempt to seek out whoever had tipped off police
and to signal the full extent of their power. Over a single
weekend, 40 people were brutally killed in the Colombian
city of Medellin, an event that would become known as the
“Medellin Massacre.”
A subtle shift was underway. Cocaine, which had pre-
viously seemed to pose less of a threat than other drugs, was
suddenly back. By 1977, it was visible at certain society parties
and glamorous settings throughout the United States. Its
high price tag gave cocaine a certain, supposed cachet—not
everybody could afford it. Its presence, like expensive cars
and designer clothes, became linked to a certain lifestyle, a
lifestyle that was quickly popularized in the media.

COCAINE WARS
In 1979, a Colombian named Carlos Lehder purchased 165
acres of land on the island of Norman’s Cay in the Bahamas.
Lehder would use this strategic location as a way to transform
the smuggling of drugs into the United States. Lehder master-
minded an operation that relied on using small planes and
landing them at Norman’s Cay for refueling on the journey
 A Brief History of Cocaine 29

Carlos Lehder, shown here in a 1987 mug shot, and a group

known as the Medellin cartel revolutionized the manufacture,
smuggling, and distribution of cocaine in the United States.
Estimates claim that the Medellin cartel was responsible for
smuggling over 70 percent of the cocaine used in the United
States in the early 1980s.
30 COCAINE

from Colombia to the United States. Lehder used bribes and

intimidation to cement his position on Norman’s Cay.
By 1981, Lehder and a group of other Colombians,
including Pablo Escobar, Jose Gonzalo Rodrigues Gacha,
and members of the Ochoa family, had united their drug
operations into a single, powerful entity labeled the Medellin
cartel. The cartel consolidated the various stages — manufac-
turing, distribution, and marketing of cocaine — and allowed
its members to exercise even greater control and pose a
more significant threat to law enforcement officials and
local governments.
When the U.S. government was ultimately able to
pressure Bahamian authorities to crack down on the Norman’s
Cay drug operation in 1982, the Medellin cartel formed a
new alliance — this time with the leader of Panama, General
Manuel Noriega. Noriega agreed to allow cocaine to be
moved through Panama from Colombia, en route to the
United States, in exchange for a payment of $100,000 per
load. The deal had been negotiated by Noriega and Pablo
Escobar. Escobar would further demonstrate his power that
same year by being elected to Colombia’s Congress. Escobar
was elected on a platform that focused on bringing greater
opportunity to the poor — he traveled through the slums of
Medellin, accompanied by Catholic priests, and handed out
money to poverty-stricken residents there. He would remain
in office for only one year before being forced out by a
reform-minded government.
Evidence of the increased trafficking in cocaine and
the growing power of the Colombians became clear on
March 9, 1982, when nearly 4,000 pounds (1,814 kilos) of
cocaine were seized at Miami International Airport. The large
size of the shipment — valued at more than $100 million —
made it clear to U.S. drug enforcement officials how exten-
sive the Colombian drug operation had become.
For much of the 1980s, cocaine became the drug of
 A Brief History of Cocaine 31

choice of many wealthy and well-known Americans. Efforts to

crack down on imports from Colombia would meet with
minor victories and then new setbacks. As soon as one
point of entry was eliminated, another would spring up. In the
mid-1980s, drug enforcement officials based in Florida began
to concentrate their efforts on shipments coming through
Miami. The South Florida Drug Task Force’s successes forced a
major shift in the cocaine smuggling route—it was transferred
to the 2000-mile border between the United States and Mexico.
By the middle of the 1980s, most cocaine entering the United
States would do so over this border.
Pressure was increased on the Colombian government to
extradite known drug traffickers to the United States to stand
trial. When Colombian officials finally agreed to begin this
extradition process, they became a target. In 1985, a Colombian
Superior Court judge was assassinated, other judges were
routinely threatened, and the Colombian Palace of Justice
was attacked, resulting in the deaths of 95 people including
11 Supreme Court justices. All paperwork concerning pending
extradition cases was set on fire and destroyed.

A NEW EPIDEMIC
By 1985, it was clear that a new form of cocaine was causing
an epidemic, particularly in New York City. In the early 1980s,
the smokeable form of cocaine known as crack was developed
and quickly spread. Its low cost and strong potential for
addiction meant that cocaine no longer could be considered
a drug for the wealthy. In the form of crack, cocaine was
hooking an entirely new population — one that was often
younger and poorer than previous groups of cocaine addicts.
Gradually, the image of cocaine began to grow tarnished.
The death of Len Bias in 1986 dramatically illustrated the
dangers of cocaine. Bias was a talented basketball player for
the University of Maryland who had been selected as the
second-round draft pick by the Boston Celtics. A mere two
32 COCAINE

days after the triumph of the draft selection, Bias died from
a cocaine overdose.
Previous media coverage had focused on cocaine as a
glamour drug. With the death of Len Bias and the spread of
crack, the coverage began to shift to the dangers of cocaine,
the health hazards to people who used it, and its potential
for addiction.
The U.S. government’s efforts also began to shift—from
targeting smugglers to placing equally forceful pressure on
world leaders who enabled the smugglers to access the United
States. In 1988, a new president, Carlos Salinas de Gortari, was
elected in Mexico. U.S. president-elect George Bush made it
clear in a meeting with Salinas that he expected the new
president to do everything in his power to cooperate in U.S.
efforts to fight drug smuggling.

or Bob, the best part of high school had been playing

F varsity football. He had been good, but then came a
stupid injury his junior year, leaving him unable to play. It
was during that year, when he was sidelined from football
and worrying about whether or not he would make the team
his senior year, that he first tried cocaine at a party. For the
first time away from the football field, Bob felt powerful and
confident. He felt the same thrill that he used to get on the
brightly lit field Friday nights, when the announcer would call
out his name over the loudspeaker and cheers would echo
from the bleachers. It used to be playing football that made
him feel good about himself. Now it was cocaine.

What Bob may not know yet is that cocaine is not an adequate
replacement for the excitement and sense of accomplishment
he misses in his life. It may help him recapture the feelings
he had on the football field for a time, but eventually even
those feelings will fade as his tolerance to cocaine increases.
 A Brief History of Cocaine 33

That same year, a U.S. federal grand jury issued an indict-

ment against the Panamanian leader Manuel Noriega. Noriega,
it was charged, had cooperated with drug traffickers, allowing
them to use his country to launder money as well as to build
laboratories to process cocaine in Panama. On December 20,
1989, U.S. forces invaded Panama. Noriega avoided capture
for more than three weeks by seeking asylum in the Vatican
embassy. Ultimately, under pressure from drug enforcement
officials, he was forced to surrender. He was flown to Miami
to stand trial. On July 10, 1992, he was convicted of drug traf-
ficking, racketeering, and money laundering and sentenced to
40 years in prison.
Throughout the 1990s, other drug kingpins would be
hunted down. In December 1993, Pablo Escobar, one of the
leaders of the Medellin cartel, was killed during a raid by
Colombian police. In 1995, five leaders of the Cali cartel were
captured. Other arrests would follow—in Mexico, in Ecuador,
in Colombia, and in Venezuela—all designed to eliminate
cocaine production facilities, close down potential money
laundering operations, seize cartel leaders, and block potential
smuggling routes.

THE WAR CONTINUES

Billions of dollars have been spent in the past decade in the war
against drugs. The creation of new agencies to combat drug
smuggling, the naming of new drug “czars” to direct the drug
enforcement efforts, and the tougher sentencing for drug users
and dealers have all underscored the seriousness with which
this problem is viewed by leaders.
Yet cocaine is still available. According to the U.S. Drug
Enforcement Agency, cocaine is the second most commonly used
illicit drug in the United States. About ten percent of Americans
over the age of 12 have tried cocaine at least once in their
lifetime. About two percent have tried crack. And nearly one
percent of all Americans are currently using cocaine.
34 COCAINE

The worldwide supply of cocaine is still controlled by

organized crime groups, most of them based in Colombia. The
U.S. border with Mexico remains the primary point of entry
for cocaine shipments smuggled into America.

ARE YOU CARRYING

COCAINE IN YOUR WALLET?
Drug trafficking generates a lot of money for drug dealers, and the
United States spends close to $20 billion battling drug suppliers
and educating the general public about the health problems
associated with drug use in an effort to reduce demand. Cocaine
and money are related in an even more direct way.
Studies in recent years estimate that a large percentage of
U.S. currency, up to 80 percent, bears traces of cocaine. However,
this does not mean that every contaminated bill has been
used to snort cocaine or has come in direct contact with the
drug. It only takes one cocaine-tainted bill to contaminate
an entire cash register full of money. Considering the millions
of automated teller machines, money sorting and counting
machines, and cash registers in the United States, it is easy
to see how quickly much of the country’s currency would
become contaminated with cocaine.
However, this contamination does not mean that the average
American will get high or fail a drug test simply by handling
contaminated cash. A study by the Argonne National Laboratory
in 1997 revealed that the average amount of cocaine on a
contaminated bill measures about 16 micrograms, or one-sixteen
millionth of a gram. (As a comparison, the average recreational
user snorts more than 3,000 times that amount to get high).
The contamination does call into question the validity
of police searches and asset forfeiture based solely on trace
amounts of cocaine on currency. U.S. courts are increasingly
rejecting cocaine-tainted paper money as evidence that the
owner of that money was involved in drug activity.
 A Brief History of Cocaine 35

As discouraging as these facts are to those engaged in

combating drug smuggling, there are some signs that law
enforcement officials are encountering some small success in
stemming the flow of cocaine into the United States. The Drug
Enforcement Agency points to the declining purity of cocaine
samples being seized from smugglers and dealers as an indica-
tion that the available supply of cocaine is decreasing. The
purity level of cocaine in these seized samples declined from 86
percent in 1998 to 78 percent in 2001.
It is a small victory. As long as cocaine continues to bring
prices ranging from $12,000 to $35,000 per kilogram and as
long as there are people willing to buy, the war will continue.
3
The Health
Effects of Cocaine
Let us begin with the basics. Cocaine is a stimulant — a stimulant
that affects the central nervous system. Cocaine stimulates sections
of the brain that produce feelings of energy and a sense of well-
being. Users of cocaine report feeling more in control of themselves
and the world around them, and more competent at whatever they
are doing.
But these feelings are short-lived. They will last no more than
an hour, and more typically anywhere from five to 20 minutes. This
combination—powerful good feelings that only last a short while—
helps make cocaine so addictive.
It is important to remember that drugs do not affect all people
in precisely the same way. Cocaine will not even affect the same
person in the same way each time he or she uses it. Cocaine will
produce different effects depending on the environment in which it
is taken, how it is taken (snorted, smoked, injected), how much is
taken, how frequently it is used, etc. This is, of course, separate from
the fact that cocaine may be cut with different substances that
can produce very different effects.
Let us take a closer look at the different forms of cocaine to
better understand how it affects the body.

HOW IT ENTERS THE BODY

As learned in previous chapters, cocaine is derived from leaves
of the coca bush. The coca leaf contains about one percent cocaine.

36
This is the chemical structure of cocaine, C17H21NO4, the most
common form of the drug smuggled into and used in the United
States. Cocaine in its natural state is an alkaloid, which is not
easily dissolved. When it is converted to cocaine hydrochloride,
it is easier to snort or inject.

In the most ancient and basic form of cocaine use, South

American natives chewed the leaves of the coca bush to obtain
a very mild effect, something similar to drinking a few cups
of coffee. It also was a time-consuming stimulant, taking about
15 minutes before any effect was felt.
Beginning in the mid-1800s, researchers determined how
to further refine this material into a substance that was nearly
100 percent pure powder. Cocaine begins in its natural state as
an alkaloid. It cannot easily be dissolved, making it difficult to
snort or inject. So hydrochloric acid is added, producing a sub-
stance—cocaine hydrochloride—that is highly water-soluble.

37
38 COCAINE

The majority of cocaine that is smuggled into the United States

is in the form of cocaine hydrochloride.
Because of cocaine’s composition, it cannot be taken in
pill form like certain other drugs. The acids in the stomach do
not degrade it, and it cannot be digested. The effects would
not be quickly felt — there would be no sudden changed
mood or increased energy.
Instead, cocaine is frequently taken by snorting through
the nose. This route ensures a relatively short time between
taking the drug and feeling its effects —approximately three to
four minutes from nose to brain. The cocaine first penetrates the
mucous membrane of the nose. From there, it travels into the
veins and on to the right side of the heart. It is then pumped
through the lungs, traveling on to the left side of the heart. From
there, it proceeds to the brain, as well as the rest of the body.
The process is slightly different when cocaine is injected.
Someone using cocaine might inject it into the arm using a
hypodermic syringe. The cocaine would penetrate into the
veins, then travel to the right side of the heart, through the
lungs, and proceed on to the left side of the heart. From
there, it would go on to the brain, a process taking approxi-
mately 14 seconds.

CRACK COCAINE
A separate form of cocaine is known as crack, or “rock.” Crack
is not injected or snorted; it is smoked through a pipe or other,
similar device. This results in a much faster and more powerful
high. When using crack, cocaine vapors are inhaled into the
lungs. The cocaine avoids the right side of the heart and lungs
and goes directly to the left side of heart and on to the brain, a
process that takes no more than eight seconds.
The “high” produced by crack is much more intense than
the high produced by cocaine, but its low is also much lower.
Because the drug’s effects are felt so quickly, and disappear so
quickly, it is extremely addictive.
 The Health Effects of Cocaine 39

What is the difference between cocaine that is snorted or

injected and crack? The powder or crystal form of cocaine—
cocaine hydrochloride — cannot easily be converted into a
gassy vapor. This would require extremely high tempera-
tures—around 359°F (182°C)—temperatures high enough to
destroy much of the expensive drug. To avoid wasting the
cocaine in this way, an alternative route is to convert the
cocaine hydrochloride back to its original alkaloid form, a

ATTITUDES AND BELIEFS:

High School Seniors
How do most twelfth graders feel about cocaine and crack use?
The U.S. Department of Health and Human Services’ National
Institute on Drug Abuse carried out a study of attitudes toward
drug use among secondary school students. Some of what
they learned:
• 84 percent of twelfth graders disapprove of people
experimenting with cocaine.
• 88 percent of twelfth graders disapprove of people
experimenting with crack.
• More than 64 percent of twelfth graders feel that people
risk harming themselves if they try cocaine occasionally.
• 65 percent of twelfth graders feel that people risk harming
themselves if they use crack occasionally.
• 90 percent of twelfth graders believed that their friends
would disapprove of their experimentation with cocaine.
• 95 percent of twelfth graders felt that their friends would
disapprove of their experimentation with crack.

[Source: Johnston, L.D., O’Malley, P.M. and Bachman, J.G. (2001)

“Monitoring the Future: National Survey Results on Drug Use,
1975 – 2000.” Vol. 1: Secondary School Students. (NIH Publication
O. 01-4924) Bethesda, MD: National Institute on Drug Abuse]
40 COCAINE

form at which it will vaporize at a lower temperature, 209°F

(98°C). The term “crack” is thought to come from the sound
that the cocaine makes when it is heated as it breaks down
from a solid form into a gas that can be inhaled—a crackling
sound that is actually burning bicarbonate.
Earlier attempts to break down the cocaine into a gas
involved the use of ether and heat. Ether is highly flammable
and heavier than air, and is used to free cocaine from
impurities before it is heated and inhaled— a process known
as “freebasing.” However, ether is not easy to ventilate out of a
room. Comedian Richard Pryor suffered a serious accident
when attempting to light a freebase pipe while ether fumes
were still in the room. Following reports of serious
accidents involving the use of ether to freebase cocaine, the
federal government began enacting stricter controls over its
sale and distribution.
Crack is generally inhaled using either a water pipe
containing liquid, in cigarettes, or in a straight, heat-resistant
tube. This tube is particularly hazardous as it shoots unfiltered
gas directly into the throat and lungs, neither of which is
capable of tolerating heat that intense. Lung diseases like
emphysema, normally seen in much older adults, can soon
result from chronic use of crack cocaine.
There is no predictable amount of cocaine or particu-
lar form of its use that can be described as “safe.” Cocaine,
even in small amounts, even the first time you use it, can
prove fatal. Some people have extremely violent reactions
to cocaine the very first time they use it, and some even
die. Your tolerance to the drug can change from one time
to the next.
You may not know what is in the drug you are taking.
Dealers use different techniques to increase the weight
of the drug they are selling, thereby increasing their
profits. Drain cleaner has been added to crack. The
powder form of cocaine may contain PCP, amphetamines,
 The Health Effects of Cocaine 41

caffeine, or simply some kind of white powder that looks

like cocaine.

COCAINE IN THE BRAIN

A closer look at precisely how cocaine affects the brain is critical
both to understanding how cocaine affects the central nervous
system and why it is so addictive. Cocaine does not simply affect
your brain; it actually changes your brain. How does this happen?
As we have learned, depending on the method through
which cocaine is introduced into your body (either snorted,
injected, or inhaled), the drug travels a quick route to its
ultimate goal: your brain. In the brain, cocaine ultimately
undergoes a critical transformation: from a source of
pleasure to a desperate craving or need.
Your brain is constantly sending information and signals
to your body, often without you even realizing it. For example,
when you type on a computer keyboard, the signal for your
finger to push the right key travels from your brain through
your brain stem, down your spinal cord, and then through
your hand to your finger. You are not aware that these signals
are happening, but they involve a complex series of nerve
impulses, traveling first as electrical signals, then chemical
signals, and finally back as electrical signals.
These signals, or nerve impulses, are carried on part of
their journey by substances called neurotransmitters, named
for their ability to transmit information from one neuron to
another. There are dozens of these neurotransmitters in your
nervous system, each specifically developed to carry signals to
certain cells called receptors. How does this work?
Think of your brain as a kind of elaborate message center.
A message comes into your brain and is picked up by the
dendrites. These branch-like parts of your brain gather up
information coming in from sensory organs or even other
neurons. Next, this information travels on to the axons,
designed to relay messages from one neuron on to the next.
42 COCAINE

Dendrites on a neuron receive messages from other neurons,

which are converted to electrical signals that travel toward the
cell body. When the cell body receives enough electrical
signals to excite it, a large electrical impulse is generated
and travels down the axon toward the terminal. In the terminal
area, chemical messengers called neurotransmitters are
released from the neuron in response to the arrival of the
electrical impulse. These neurotransmitters travel across the
synapse to the next neuron, and the process repeats.

This message system does not work like a relay race, with
one part of the system brushing up against another and then
handing off the message. The pieces are not seamlessly
attached, with messages traveling a straight path. Instead, there
is actually a narrow gap between neurons—a gap so narrow
that it is no more than one-millionth of an inch wide. This
 The Health Effects of Cocaine 43

gap, called a synapse, poses an obstacle for the messenger

attempting to get a message from one neuron to the next. The
gap must be crossed. But how?
This is where the neurotransmitters enter the picture. The
neurotransmitters are actually chemical substances, created
and stored by the neurons until they are needed. Once the
neuron receives the signal to carry a message on, the neurotrans-
mitters are released. They jump across the synapse gap — or,
more accurately, squirt across — and attach themselves to
specially designated receptors on the other side. Each neuro-
transmitter has its own particular receptor. Some trigger an
action response; others send a signal inhibiting a response.

THE PLEASURE PRINCIPLE

Neurotransmitters are the triggers for a number of bodily
responses. Are you feeling sad? Sleepy? Anxious? Calm? These
feelings are all triggered by neurotransmitters. There are many
neurotransmitters at work in your body triggering certain
feelings and sensations—everything from pain to pleasure.
Scientists have currently identified about 75 neurotransmitters
in the human body, and most believe that there are many more
still to be identified.
Certain neurotransmitters are particularly sensitive to the
presence of drugs in the body. Doctors frequently attempt to
treat illnesses like chronic, severe depression with medication
designed to trigger particular neurotransmitters.
When cocaine enters your brain, its target is the neurons
containing the neurotransmitters known as dopamine. At least
four major clusters of cells in the brain produce dopamine.
What makes dopamine so critical to understanding cocaine?
Dopamine is normally released by your brain when you
are doing something you enjoy—playing with a pet, eating a
delicious dessert, spending time with someone you care about,
or walking on a beach.
Some drugs—like nicotine—work by triggering the release
44 COCAINE

of dopamine. Cocaine operates differently. Cocaine acts to

block the dopamine transporter, the physiological mechanism
by which dopamine (and many other neurotransmitters) are
removed from the synapse to avoid prolonged action.
Blockade of the dopamine transporter increases the con-
centration of dopamine in the synapse. This build-up of
dopamine in the synapse results in an ongoing stimulation
of the receiving neurons.
While this is a somewhat simplistic explanation of what is

evin was in the emergency room of the hospital. Two

K friends had dropped him off and then left him there.
They were afraid — afraid of the strange way that Kevin was
acting, and afraid that they would get into trouble. They
had all been at a party, and some of the kids were using
cocaine. Kevin had been one of them.
The next thing they knew, he was hunched over in a
corner, rubbing his arms constantly, and acting as if he
were seeing things that weren’t there. He kept talking about
flashing lights. He was sweating, and his skin was a strange
red color.
They took him to the hospital because they were afraid of
what was wrong with him. They left him there, alone, because
they were even more afraid of what would happen when the
doctors found out exactly what was wrong with him.

Kevin and his friends are learning that cocaine use can be
costly. Some first-time cocaine users feel a rush of energy,
confidence, and euphoria while others, like Kevin, have
violent reactions. People vary in their ability to tolerate
cocaine, and for some, even small amounts can prove harmful
or even fatal. Experiencing the positive effects of cocaine
once does not guarantee a similar experience in the future
since tolerance to the drug can change over time.
 The Health Effects of Cocaine 45

a highly complicated process, it may help you to better under-

stand cocaine’s effects and its addictiveness. Cocaine’s ability
to block dopamine transporters results in an increased concen-
tration of dopamine in the spaces between neurons. Your brain
will quickly adapt to the increased amount of dopamine present
in it. With regular cocaine use, the increased concentration of
dopamine will become “normal.” This means that you will need
more and more cocaine to mimic the euphoric effects of those
earliest experiments with the drug. In the same way that your
brain will interpret the presence of cocaine as one of the most
pleasurable experiences you can have, it will interpret the
absence of cocaine as one of the most painful.
Recently, research carried out at Brookhaven National
Laboratory in New York by Dr. Nora Volkow has demonstrated
that there is a direct relationship between how intense and
long-lasting a “high” from cocaine is and how extensively it
blocks one of the key mechanisms that controls how much
dopamine is in the brain. Because cocaine blocks dopamine’s
transporter sites, preventing the dopamine from completing its
normal cycle and returning to the brain cells that released
it, higher concentrations of dopamine remain in the brain.
They stay there longer than they normally would. These high
levels of dopamine make the cocaine user feel powerful and
capable of doing just about anything.
So what is so bad about feeling good? Cocaine will cause
your pupils to dilate, your blood vessels to narrow, your heart
rate and blood pressure to increase, and your appetite to
decrease. These physical symptoms all pose particular risks
that we will discuss in greater detail later. For now, let us
concentrate on what happens when cocaine blocks critical
neurotransmitters from their preordained tasks.
Certain neurotransmitters are critical to your main-
taining a normal state of mental health, i.e., what lies in
between a “good mood” and a “bad mood.” Frequent use of
cocaine can make this “normal” state impossible to achieve.
46 COCAINE

Cocaine creates a “high” by increasing the effective concentration

of dopamine in the brain. It does so by targeting the neurons
containing the neurotransmitter, dopamine. By blocking these
transporter sites, cocaine causes the dopamine to remain in
the brain for longer than usual, making the user feel euphoric,
confident, and energetic.

When neurotransmitters are depleted by cocaine, you will

feel intense anxiety and a chemically caused depression. Your
body is signaling that the cocaine, which had artificially
created your intense feelings of pleasure, has now disappeared,
and there is nothing left to take its place. The extra dopamine
manufactured to replace that which cocaine had blocked has
now depleted your supply.
People who regularly abuse cocaine can so alter their
brains that they no longer have the capacity to manufacture
these critical neurotransmitters. They lose the ability to
produce them naturally—they can only do it when cocaine
triggers it. There is no more “normal” brain functioning:
no more production of neurotransmitters to produce a good
 The Health Effects of Cocaine 47

mood naturally. There is only intense craving for cocaine and

the temporary relief that comes when the drug is once more
present in the brain.

WHAT HAPPENS WHEN YOU QUIT COCAINE?

If cocaine alters the way your brain functions, changing the
brain’s ability to manufacture certain transmitters, what
happens when you stop using cocaine? Can your brain change
back to the way it was before you started abusing the drug?
The answer to this question offers both good news and bad
news. Most experts in brain functioning believe that the
changes created by lengthy cocaine abuse will alter the brain in
certain basic ways. These changes may be permanent.
Research at the Brain Institute at the University of Florida
has shown that, even months after cocaine use has stopped, there
continue to be changes in the amount of dopamine receptors
and transporters in the cocaine user’s brain and how these
receptors and transporters are functioning. However, because
there will be certain parts of the brain unaffected by the cocaine,
recovering addicts can hope to achieve sufficient brain function-
ing—provided that they give up cocaine permanently.
4
The Business
of Cocaine
The business of cocaine begins in conditions of deep and lasting
poverty, on remote farms in Colombia, Bolivia, and Peru. Along
various points of the Andes Mountains, cocaine is transformed
from a simple crop — the coca bush — into a highly profitable
commodity. Those at the beginning of this transformation, the
coca farmers, see little wealth from their crop. It is simply that
cocaine has proved more profitable than some of the other crops
they might produce, things like bananas or coffee.
Cocaine powder begins in Peru, where coca leaves, coca paste,
and cocaine base are all produced. Along the eastern portion of the
Andes Mountains, in the dense jungle of the Upper Huallaga Valley,
one can find the largest single source of coca leaf in the world. Most
estimates show that about 60,000 farmers depend on producing coca
for their livelihood. The coca bushes can produce four harvests every
year and thrive in an inhospitable climate and terrain that make
growing other crops much more difficult. The farmers’ hard work
earns them a mere fraction of one percent of the retail value of the
crop they harvest.
To increase their profits, many farmers have expanded their
operations to include the producton of cocaine paste. The process
is less than glamorous; the farmers take the coca leaves and stomp
on them in their bare feet, then soak them in bleach or kerosene to
yield the coca paste.
United States drug enforcement officials, working with the

48
Peruvian government, have attempted to address drug produc-
tion at this initial source by offering farmers incentives to plant
other crops. Their efforts have been largely unsuccessful. The
presence of the Sendero Luminoso, a guerilla group known as

ike first tried cocaine when one of the seniors on his

M basketball team offered it to him at a party at the end
of the season. This senior was one of the best players on the
team; if he was using it, Mike decided, there couldn’t be
anything too bad about cocaine. Mike loved the way cocaine
made him feel; it made anything seem possible. He soon
came to hate the way he felt when he wasn’t high.
Mike began spending a lot of money on cocaine. He was
using up all of the money from his after-school job, plus a lot
of what he had saved to buy a car. Soon the friend who was
selling him cocaine suggested that Mike might try selling some,
too. It seemed like the perfect solution, plus a way to get his
hands on more cocaine than he could afford to buy on his own.
It quickly became hard for Mike to control himself. The
more cocaine he had, the harder it was to focus on anything but
using it. He found ways to dilute the supply he was selling to
other kids so that he could keep more for himself. Sometimes
he cut the coke with baby powder or condensed milk, but it
didn’t really matter what he used as long as it was white.

Cocaine trafficking is big business, but unlike products sold by

other businesses, drug dealers and the quality of the drugs they
sell are not regulated. There is no guarantee that the cocaine
bought from someone like Mike is pure or safe, or even cocaine.
By the time cocaine reaches the average buyer, it has passed
through the hands of numerous dealers. In order for each dealer
in this chain to make a profit, they must cut the cocaine with
another substance, thereby increasing the amount of the drug
they are able to sell.

49
50 COCAINE

This Peruvian farmer pours gasoline over coca leaves, part of the
process of making coca paste, which will eventually be converted
into crystallized cocaine for sale in the United States, Europe, and
elsewhere. Estimates show that close to 60,000 farmers in the Andes
Mountains depend on coca cultivation for their livelihood.

the Shining Path, has added to the complicated politics of

the region. This terrorist group has taken over much of
the territory where coca bushes are cultivated, demanding
payments from the peasant farmers in the region. Govern-
ment officials sent in to find and destroy coca bushes are
attacked and killed.
Bolivia is another important source of cocaine. While
Bolivian cocaine production is somewhat smaller than that
 The Business of Cocaine 51

of Peru, the industry is more firmly entrenched in Bolivia,

with connections to the military and upper class that date
back to the late 1970s. The coca plants grown here are found
mainly in the central part of Bolivia near the mountainous
region of Chapare.
In Bolivia, cocaine production began to grow in the final
quarter of the twentieth century, when landowners who
had previously focused on farming soybeans and sugar or
grazing cattle on their land instead turned their attention to
the harvesting of coca plants. Control soon concentrated
in the hands of a few powerful “families,” who used coca
produced locally, as well as paste imported from Peru, and
transformed it into the 90 percent pure cocaine base that is
then exported, principally to Colombia.
Government efforts to eliminate, or at least curtail, the
drug trade have proved largely ineffective. Both Bolivia and
Peru suffer from economic problems that have made it difficult
for their governments to present farmers with an enticing
alternative to the coca crop. While a small amount of money
does go to the coca farmer, little of the profits generated from
the finished cocaine make their way back to their country of
origin. The wealth generated by cocaine is most often spent
outside of Peru and Bolivia, deposited into foreign banks, or
spent on investments. Some is used to bribe politicians and
make local authorities look the other way.
The cocaine industry further cripples the economy
because of the higher pay it offers farmers. Many decide
to grow coca bushes rather than traditional foods, thus
causing the prices of these crops to go up since fewer and
fewer of them are readily available.
Beyond the farmers who grow the coca plants, the cocaine
industry does offer other job opportunities. There is a demand
for workers to produce the cocaine paste or refine it into
powder. The labs where the cocaine is processed must be built
and landing strips must be constructed to facilitate easy access
52 COCAINE

to the hidden sources of the drug. The trails that lead from
farm to lab to airfield must be guarded, which offers another
potential source of employment for guards.
It is easy to see why the business of cocaine is more
complicated than a buyer and a seller somewhere in America.
In poorer countries, cocaine provides employment where it is
badly wanted and money where it is desperately needed.

THE COLOMBIAN CONNECTION

While only a tiny percentage of the revenue from cocaine
finds its way back to Peru and Bolivia, in Colombia the
profit cocaine generates is more clearly felt. Colombia has
maintained tight control over the later stage of the cocaine
industry — the business of exporting cocaine powder.
Within Colombia itself, even tighter control over the
cocaine business is maintained. At one time, a group of
less than 10 organizations, known as cartels, regulated
the cocaine industry — dictating supply and pricing and
controlling approximately 90 percent of the world’s cocaine
business. Among the best known of these are the Medellin
and the Cali cartels, each named after the city where they
were based.
It is at this final part of cocaine’s production that the
greatest revenues are generated. Once the cocaine paste has
been processed into powder, it follows a twisting network of
routes (via road, boat, and air) to avoid law enforcement
authorities. With profits to invest, smugglers are able to use
top-of-the-line boats and airplanes — many with highly
sophisticated navigation equipment.
At one time, southern Florida was the main entry point
into the United States for cocaine arriving from South
America. New York was the second port of choice for
smugglers. More recently, the majority of cocaine entering
the United States does so by crossing the Mexican border.
From these entry points, the cocaine is then distributed to
 The Business of Cocaine 53

This gunman from the Medellin cartel poses in Colombia in

2000. By maintaining tight control over the export of cocaine
to countries like the United States, Columbian cartels dictated
the supply and pricing, and reaped huge profits, from the
cocaine business.
54 COCAINE

the U.S. cities where the majority of the cocaine business

is based: New York, Los Angeles, San Francisco, Chicago,
Houston, New Orleans, and Dallas.

OTHER COUNTRIES, OTHER CONNECTIONS

While much of the cocaine industry, from production to
distribution, has been based in Peru, Bolivia, and Colombia,
other nations have become involved in the distribution of
cocaine. Smugglers transporting drugs from South America
have targeted fuel stopover points in Panama, Nicaragua,
Honduras, Jamaica, the Bahamas, Haiti, Cuba, and Mexico
prior to entry into North America. Brazil, bordering on the
three major cocaine-producing countries, has become a
point of distribution in the drug trade. Brazil has also
become a coca-producing nation. Coca farms in northwest-
ern Brazil can easily transport their crops along the Amazon
River and on to Colombia.
The industry has also spread to other South American
nations, offering new points of transit from Colombia to North
America and Europe. As drug enforcement efforts have
attempted to crack down on shipments coming in from
Colombia, smugglers have turned to Argentina and Venezuela,
both for processing and export.
In fact, producers have been skillful at taking advantage
of weak governments, officials susceptible to bribery, and
remote locations with airfields somewhere between North
and South America to further extend the network distribut-
ing cocaine. The industry is more than simply production
and export. A key element of the profitability of cocaine lies
in what happens to cocaine once it crosses over the borders
of the United States.
For years, the island of Norman’s Cay in the Bahamas was
a center of drug smuggling activity for the head of the Medellin
cartel, Carlos Lehder, as we have discussed earlier in this
book. Located approximately 210 miles (338 kilometers) from
 The Business of Cocaine 55

This map shows the main entry points through which cocaine enters
the United States. Because the DEA has concentrated its efforts on
stopping the influx of cocaine through Florida and the major cities on
the East Coast, the majority of cocaine now entering the United States
crosses over the Mexican border.

Florida, Norman’s Cay was ideally situated for smuggling.

Lehder was successfully able to use money and threats to
dominate the island. The prime minister of the Bahamas,
Norman Pindling, was believed to have accepted bribes in
order to ignore Lehder’s illegal activities. From 1978 to
1982, Lehder bought up extensive property on the island,
building an airstrip, a home, and a hotel. Soon, small
aircraft were frequently landing and taking off from the
56 COCAINE

Cocaine enters the United States in bricks, which are then cut up
among dealers. This shipment of 515 pounds was seized in July 2001
from an oil tanker in San Francisco Bay and had an estimated street
value of $4.5 million.

island under the protective eyes of armed guards on the

beaches. It was several years before American authorities
were able to put a stop to the flow of drugs from this
nearby Bahamian point by increasing pressure on the local
authorities and Bahamian government.
In recent years, U.S. drug enforcement authorities have
concentrated their efforts on the smuggling routes that had
carried cocaine from South America into the United States
 The Business of Cocaine 57

along the main entry points of the East Coast, principally

southern Florida and New York City. As a result, new routes
have been created by smugglers who carry cocaine from
South America into the United States via Mexico. The
Mexican border has now become the primary access point
for cocaine entering the United States. Estimates show that
nearly 65 percent of all cocaine entering the United States
does so by crossing this southwestern border.

THE COCAINE MARKETPLACE

As it passes from locale to locale, the price of cocaine steadily
rises. In Colombia, processed cocaine is available for an esti-
mated $1500 per kilo. Once the drug enters the United States, its
potential for profit skyrockets. A kilo of cocaine, for example,
may fetch as much as $66,000 once it reaches American soil!
The drug frequently enters the United States bundled in
packs containing 100-200 kilos (220-441 pounds). Dealers over-
seeing large markets buy these bundles, and then cut both the
bundles and the cocaine itself to reduce the size of the packages
and increase their potential profits by reducing the purity
of the drug. The packs are sold to regional dealers—groups
(sometimes gangs) who control specific parts of the country.
From there, the cocaine is again repackaged and re-cut for
sale to local dealers. By now, the drug has passed through
several successive handlers and has been re-cut to reduce its
purity at nearly every stage. The local dealers often reduce the
purity themselves before selling it to users. By the time it
reaches the user, the end product often bears little resemblance
to the highly concentrated cocaine powder that first crossed the
U.S. border.

MONEY LAUNDERING
The vast profits of the illegal drug trade result in a problem for
the drug industry: how to handle the money (generally cash)
that cocaine generates?
58 COCAINE

The network that operates so efficiently in moving cocaine

from the border to the street is equally efficient in moving
money. Cash is collected from the local dealers and then trans-
ferred to a central collection point (the biggest are in southern

DRUGS AND TEENS:

In the United States and Abroad
In early 2001, an international study was published comparing the
use of tobacco, alcohol, and illegal drugs by teens. The study covered
31 countries, including the United States, and surveyed 15- and
16-year-olds. The results included some of the following facts:

• Fewer American tenth graders smoke cigarettes than European

tenth graders (26 percent compared to 37 percent said
that they had smoked a cigarette in the past month).

• Fewer American tenth graders drink alcohol than their

counterparts in Europe (40 percent compared to 61 percent
said that they had consumed alcohol in the past month).

• However, more American 15- to 16-year-olds admitted

to smoking marijuana at least once in their lifetimes
(41 percent of American tenth graders compared to an
average of 17 percent for European students).

• The numbers are also higher for cocaine use. Eight percent
of U.S. tenth graders say that they have used cocaine at
least once, compared to one percent in Europe.

• Four percent of U.S. tenth graders say that they have tried
crack at least once. The rate of crack use among all European
tenth graders was found to be two percent or less.

[Source: “Monitoring the Future: National Survey Results on Drug

Use, 1975-2000.” Illicit drug data from European School Survey
Project on Alcohol and Drugs posted on www.monitoringthefuture.org,
maintained by the University of Michigan Institute for Social Research]
 The Business of Cocaine 59

Florida and New York City on the East Coast, Houston and Los
Angeles on the West Coast). The cash is then “laundered”—
disguising its source by converting it into legitimate revenue.
Cash can be used to purchase money orders or cashier’s checks,
payable to a person who then deposits them in a bank account.
From this account, the money is then transferred to another
bank, either American or foreign. Businesses may be set up as
“fronts” and drug money added to the businesses’ own profits
to disguise the source of the money and then enable it to be
transferred elsewhere.
The cash most often ends up in “safe haven” countries,
i.e., countries where banking laws protect depositors and enable
them to avoid detection or having their financial activities
reported. The Cayman Islands, located approximately 150 miles
(240 kilometers) south of Cuba in the Caribbean Sea, are a
favorite choice because of their bank secrecy laws.
5
Teenage Trends
and Attitudes
According to the Centers for Disease Control (CDC), the use of
cocaine is once again increasing among young Americans. Each
year, the CDC surveys more than 13,000 high school students from
around the country to determine their use of illegal substances.
The most recent study, surveying students for the year 2001,
shows that the number of teens who said that they had tried cocaine
in their lifetime increased to 9.4 percent. This shows a substantial
increase over the high school students surveyed ten years earlier;
in 1991, only 5.9 percent said that they had tried cocaine in
their lifetimes.
The number of high school students reporting recent use of
cocaine also is increasing. In 2001, 4.2 percent of high school
students said that they had used cocaine in the past month,
compared with 1.7 percent in 1991.
The U.S. Department of Health and Human Services also
performs an annual survey of high school students to determine
trends in their use of illegal substances. These annual results are
published in a volume entitled Monitoring the Future. According to
the most recent Monitoring the Future data, eight percent of all
American tenth grade students say that they have used cocaine,
and four percent say that they have tried crack.
These figures disturb public health officials, who are con-
cerned that these increases reflect an ignorance of the health
risks and the potential for addiction cocaine and crack pose. A

60
This graph from the 2001 National Household Survey on Drug
Abuse shows the rate at which various drugs, including cocaine,
were used among 14- to 15-year-olds over the past month for the
years 1999, 2000, and 2001. The data from this survey, as well
as surveys from the CDC and Monitoring the Future, all show
similar trends: cocaine use continues among teens despite
warnings about its negative health effects.

quick glance at the trends in cocaine use over the past few
decades show that its popularity and the number of teens
abusing the drug rose and fell depending on perceptions of
the drug.
Results from surveys of high school seniors in previous
Monitoring the Future studies show that cocaine use among
seniors substantially increased from 1976 to 1979. In 1976, six
percent of all high school seniors said that they had used
cocaine. By 1979, that number had doubled to 12 percent. This
figure remained relatively stable for the next five years,
increased slightly in 1985, and then leveled again in 1986.

61
62 COCAINE

As we have learned in previous chapters, the mid-1980s

brought a shift in public perception of cocaine, as well as
how it was portrayed in the media. Greater awareness of the
hazards of cocaine use produced a drop in the numbers of
high school seniors using cocaine. From 1986 to 1992, the
number of high school seniors who said that they had used
cocaine at least once in the previous year decreased from
12.7 percent to 3.1 percent. The number who said that they
had used cocaine in the previous month decreased from
6.2 percent to 1.3 percent.
The numbers then rose again in the late 1990s — in fact,
they doubled. By 1999, 6.2 percent of high school seniors
said that they had used cocaine in the past year; 2.6 percent
said that they had used it in the previous month. Researchers
had found some hope in the fact that 2000 figures showed a
decline to five percent, but one year later the figures were
once more rising.

CRACK: The Numbers

The data on crack use and abuse among high school seniors
dates back to the mid-1980s, when references to crack were
generally available only as part of a larger, comprehensive
picture of cocaine use. However, rather than referring to crack
specifically by name, information about its abuse was more
commonly reflected in questions about smoking cocaine.
Between 1983 and 1986, the number of high school seniors
who reported that they had smoked cocaine in the past year
more than doubled—from 2.4 percent to 5.7 percent. An
increase was also clear in the number who said that they had
tried to stop using cocaine in the past year and been unable to
stop, as well as in those who reported active daily use of
cocaine. These numbers are all thought to reflect the spread of
crack in the mid-1980s.
By 1987, surveys contained specific questions about crack.
By this time, the media had also painted graphic portraits of
 Teenage Trends and Attitudes 63

Smoking the crack form of cocaine delivers the drug to the brain
more quickly than does snorting. Snorting requires that the
cocaine travel from the blood vessels in the nose to the heart
(blue arrow), where it gets pumped to the lungs (blue arrow) to
be oxygenated. The oxygenated blood (red arrows) carrying the
cocaine then travels back to the heart where it is pumped out to
the organs of the body, including the brain. Smoking bypasses
much of this process — the cocaine goes from the lungs directly
to the heart and up to the brain. The faster an addictive drug
reaches the brain, the more likely it will be abused.

crack abuse — showing the ravages of crack on whole com-

munities from the addicts to their babies, born premature
and addicted. Tougher drug sentencing also contributed to a
different attitude toward crack and cocaine.
In studies measuring drug use among high school seniors,
the period from 1986 to 1991 shows a sharp decline in crack
use, from 4.1 percent to 1.5 percent. The prevalence of crack
use then stayed level for several years before once more rising
between 1993 and 1999 (an increase from 1.5 percent to
64 COCAINE

2.7 percent). A decline to 2.2 percent in 2000 has since been

offset by increasing figures reported in 2002.
While it is helpful to see how the number of high school
students who say that they have used cocaine or crack have
increased and declined over the years, these figures offer an
incomplete picture of exactly who is using cocaine. They are, in
the end, only numbers. A more complete picture includes real
people who have made choices that have impacted real lives.

PORTRAIT OF A COCAINE USER

Teens decide to use cocaine for a variety of reasons. It is
rare to find a teen who snorted, smoked, or injected cocaine
with the hope of becoming addicted. They use cocaine
because they want to feel better about themselves, and
cocaine offers a quick fix, an instant “high.” They try it
because they want to fit in with a particular group. They try
it because they have heard rumors of the drug’s benefits:
it will help them feel more confident, lose weight, or have
more energy.
For some teens, cocaine can be a gesture of independence,
a way to signal that no adult can take away their right to make
their own decisions. It may be a way to “break the rules.”
Teens may be influenced to use cocaine in subtle ways. It
may be a scene in a movie, a story in a magazine, or an image
on television. Even though cocaine is illegal, many movies
depict popular actors and actresses using the drug in a way
that makes it seem acceptable, conveying a sense that people
who use cocaine are somehow more sophisticated, more
glamorous, or “edgier” than those who don’t.
There are other factors that may mark a teen’s likelihood
to use drugs. Teens with poor grades and low self-esteem are
more likely than their peers to use drugs. Teens from single-
parent families are more likely than their peers to abuse
cocaine and other illegal substances. Teens who have suffered
abuse, who have grown up in a violent household, or in a
 Teenage Trends and Attitudes 65

household where a family member suffered from mental

illness or substance abuse problems or had been jailed, are
more likely to become substance abusers themselves. Few
teens who do use cocaine are unaware of the risks. They
like the way cocaine makes them feel and they view its
hazards as something that could happen when they are older
or if they use the drug for many years. They believe that they
will easily be able to stop before they reach the point where
cocaine will seriously damage their health. They believe
that they can easily stop before they become addicted. They
are wrong.

raci’s friends called it snowball or blow. Her boyfriend

T called it nose candy. Traci didn’t worry about names. Her
boyfriend had brought some to her house a few weeks ago so
that she and her friends could try it. It was the greatest thing
Traci had ever experienced, and she couldn’t wait to do it
again. She and her friends had pooled together some money
so that her boyfriend could buy more, and they had had
another party over the weekend. Every time Traci thought
about the party, every time she talked to her friends, she
remembered the feeling the cocaine had given her. She
wanted to feel that way again. It was as if there were a tiny
voice in the back of her mind, whispering to her, nagging at
her, reminding her of how much better she could be feeling.

According to the CDC, Traci’s pattern of cocaine use is

becoming more and more common among teens. In 2002,
9.4 percent of teens admitted to trying cocaine in their
lifetime, compared to only 5.9 percent in 1991. Regular
use of cocaine is on the rise as well, with 4.2 percent of
teens admitting they had used cocaine in the past month
in 2001, compared to 1.7 percent in 1991.
66 COCAINE

The prevalence of negative images of cocaine and crack use in the media,
such as this picture of police raiding a crack house in Washington, D.C.,
have done little to affect the overall trends of cocaine use among teens.
Peer influence and reinforcement from the positive effects of the drug
itself seem to overshadow scare tactics and education.

WHAT TEENS REALLY THINK ABOUT COCAINE

Despite new information about the risks of cocaine use and
greater data about precisely how cocaine affects the body, teens
continue to try cocaine. Technology has made it possible for
 Teenage Trends and Attitudes 67

scientists to observe the changes that happen in the brain

when someone uses cocaine. They can see the way the brain is
affected by each stage: the initial “rush,” the “high” and then the
absence of the drug that sparks a craving for more. Scientists
are even able to identify the parts of the brain that become
active when a cocaine addict see or hears something that
sparks their craving for cocaine.
Even with all of this information available, cocaine remains
a serious problem. According to the National Institute on
Drug Abuse, more than a million Americans over the age of
11 are chronic cocaine users.
You may already have your own ideas about cocaine,
based on information you’ve read in this book, learned
from other sources, or even heard from friends or family
members. What do other teens think about cocaine?
The National Center on Addiction and Substance Abuse
(CASA), based at Columbia University in New York, surveyed
2,000 teens and 1,000 parents. The results of this survey offer
a comprehensive picture of what teens think about drugs and
how substance abuse has impacted their lives.
According to CASA, 60 percent of all teens are at moder-
ate or high risk of substance abuse. That’s 14 million teens
aged 12 to 17!
What places a teen at risk for abusing drugs? The CASA
study placed in this category any teen who had friends who
used marijuana or friends who drank regularly, had a class-
mate or friend who used cocaine or heroin, felt that they
could buy marijuana quickly, or answered that they expected
to use an illegal drug in the future.
Where do teens rank cocaine? According to CASA’s
survey, cocaine is the third most often used drug by high
school students (following marijuana and LSD/acid).
Middle school students ranked it as the second most often
used drug after marijuana. Nearly all teens surveyed agreed
that cocaine use generally followed marijuana use — teens
68 COCAINE

who smoked marijuana were more likely to go on to use

cocaine than those who didn’t.
There were other results from the CASA survey that show
that teens admit that drugs pose a problem, both inside and
outside school. If it sometimes feels to you as if everybody is
using drugs, take a look at these results:

• 60 percent of teens said that they did not expect to use

any drug in the future.

• 44 percent of teens said that they attended a drug-free

school.

• 40 percent of teens said that the drug situation in school

is getting worse (a decrease from the 55 percent who felt
this way one year earlier).

THE STRAIGHT FACTS

Cocaine is an addictive stimulant that directly affects your
brain. It interrupts the neurotransmitter balance in your
central nervous system. This may give you a temporary
feeling of increased confidence, greater energy, and a feel-
ing of intense pleasure, but this will not last. Cocaine raises
your blood pressure, increases your heart rate, causes your
muscles to tense and your breathing to become more
rapid. Use it regularly, and you will become paranoid,
anxious, and confused. You may experience hallucinations.
You may have trouble sleeping, easily become agitated, or
become depressed.
It is as if cocaine is leaving a bill behind, and it is an
expensive one. The cost of those initial feelings of confi-
dence, satisfaction, energy, and well-being come after the
cocaine leaves your system. Use cocaine as many people do —
in a binge lasting a night or a few nights — and your body
will ultimately crash. Sleep off the results, and you will soon
face a body demanding more cocaine. Cocaine is highly
 Teenage Trends and Attitudes 69

In addition to activating the brain’s reward circuitry, cocaine affects the overall
level of brain activity in the user. Scientists can observe cocaine’s effect on
brain functions using such sophisticated brain imaging technologies as positron
emission tomography scanning (PET). PET scans allow scientists to see
which areas of the brain are active by measuring the amount of glucose,
the brain’s main energy source, that is used by different brain regions.
The left scan is taken from a normal, awake person. The red color shows the
highest level of glucose utilization (yellow represents less utilization and blue
indicates the least). The right scan is taken from someone using cocaine. The
loss of red areas in the right scan compared to the left (normal) scan indicates
that the brain is using less glucose and therefore is less active. This reduction
in activity results in a disruption of normal brain functions.

addictive — you can become addicted very quickly after your

very first cocaine experience. Cocaine use leads to nosebleeds,
a constantly irritated nose, feelings of fear and paranoia, and
an empty wallet.
70 COCAINE

The numbers show that many teens are making wise

choices. They are choosing not to use cocaine—in fact, more
than 90 percent of all teens have never tried it.
There are some basic steps you can take to stay drug-
free. First and most important is remembering to make
your own decisions, to worry less about what other people
think of you and more about how you want to think of
yourself. You can choose to surround yourself with people
who are not using drugs. The friends who are around you
can support your choices or make them harder. If you

WHAT TEENS SAY ABOUT COCAINE

According to the U.S. Department of Health and Human Services’
Monitoring the Future survey of high school students, teens
have strong opinions about cocaine:

• Between 85 and 90 percent of all high school seniors say

that regular use of cocaine and crack poses a serious risk
to the user.

• More than half of all high school seniors say that trying
cocaine or crack once or twice is very risky.

• A survey of tenth graders shows that the majority view

cocaine and crack as very dangerous.

• 84 percent of all high school seniors say that they

disapprove of people experimenting with cocaine.

• 88 percent of all high school seniors say that they

disapprove of people experimenting with crack.

[Source: Johnston, L.D., O’Malley, P.M., and Bachman, J.G. (2001).

“Monitoring the Future: National Survey Results on Drug Use,
1975–2000.” Volume 1: Secondary School Students. NIH Publication
No. 01-4924. Bethesda, MD: National Institute on Drug Abuse]
 Teenage Trends and Attitudes 71

spend a lot of time just hanging out with your friends and
feeling bored, find an after-school activity that you enjoy, a
sport or a club, or volunteer at a shelter or food bank in
your area. Find someone you trust and can talk to — a
parent, a teacher or counselor, a pastor or friend — and
share your questions and concerns.
At the back of this book, you will find resources, web
sites, and organizations that can supply you with additional
information about cocaine.
6
Cocaine
Addiction
Addiction can be defined as a state in which you have given your-
self over to something, made yourself dependent on this object or
substance. Depending on who you are talking to, and what you are
discussing, addiction can be viewed quite differently and thought
to mean very different things.
There is a physical element to addiction, and this is the one we
often think of first when discussing drugs and addiction. When
speaking of a physical addiction to drugs, you will most often
mean the body’s dependence on a particular drug like cocaine.
The body has built up a certain tolerance to the continued
presence of a drug, and its absence causes intense physical suffering.
The body may suffer symptoms of withdrawal — physical signs
that the body is in distress because of the absence of a particular
drug. This is the body’s way of sending a clue that it has come
to expect certain quantities of a drug at certain times, and the
absence of the drug is now creating problems for proper function-
ing of your body’s systems.
There is also a psychological aspect to addiction. This is
where phrases like “learned behavior” are often used. Someone
who is addicted to drugs has developed a certain set of behaviors
in response to particular situations. For many, drugs are a
coping mechanism for certain emotional states like depression,
loneliness, stress, or even fatigue. When an addict develops a
particular pattern of behavior in response to these feelings ,

72
Cocaine is a powerfully addictive drug. Addiction can be physical and
cause the user to experience withdrawal symptoms when he or she does
not use the drug. Addiction can also be psychological, and used in a
pattern of behavior that helps the user cope with difficult emotions. An
often overlooked aspect of cocaine addiction is its social aspect — that
is, the user may associate certain friends and situations with drug use.

in other words, when he or she feels stressed or depressed,

he or she takes drugs. The earliest stages of those feelings
trigger a desire to use the drug to cope with that uncom-
fortable emotion.
There is even a social aspect to addiction. If you regularly

73
74 COCAINE

take drugs with a particular group of friends, or in a particular

setting — after a football game on Friday nights, when
you are hanging out after school, etc. — simply being in that
setting or with certain people can trigger a desire for the
drug. This is why people battling addictions must often
completely separate themselves from their old friends and
drastically change their patterns of behavior. They need to
avoid the settings and people who remind them of drugs.

COCAINE AND ADDICTION

Cocaine is thought to be one of the most powerfully addictive
of all drugs. Its effects are long-lasting, and cocaine addiction
involves physical, physiological, and social aspects.
For many years, the full scope of cocaine’s addictiveness
was not understood. The body’s clues that it has become
addicted — the symptoms of withdrawal from cocaine — are
not as obvious as in other addictive drugs. Things like
trouble sleeping, changes in energy levels, and increased
depression are not always clear and can be explained by a
variety of other factors.
It is important to remember that addiction involves a
change in behavior — a change in which things that used to
be important are forced to take a back seat to one particular
behavior. What does this mean? In the case of cocaine, an
addict will begin to give cocaine a higher priority than other
things: higher than work or school, higher than sports and
activities, higher than friends and family.
One theory states that there are seven factors that will
indicate whether or not someone is dependent, or addicted,
to a drug. They are:

1. Becoming aware that you need to take a drug, generally

as a result of trying to stop

2. Wanting to stop taking drugs

 Cocaine Addiction 75

3. Having a clear and specific pattern of drug-taking

behavior

4. Experiencing symptoms of tolerance and withdrawal

5. Using the drug to avoid symptoms of withdrawal

6. Getting the drug becoming more important than

anything else

7. Staying away from the drug for a brief period of time,

only to quickly slip back into taking it again

COCAINE: The Warning Signs

If you think that cocaine is somehow safer than other drugs or
are feeling curious about trying it, take a look at what people who
regularly use cocaine say:

• “I need to use cocaine in order to feel okay.”

• “I can’t really predict whether or not I’m going to get high.”

• “I need more cocaine than I used to in order get high.”

• “Cocaine is the only way I can deal with stress.”

• “Cocaine is the only way I can get through a day.”

• “I used to use cocaine with friends, but now I only want to be

alone when I get high.”

• “I am having trouble at school and at home.”

• “I promise myself I won’t use any more, but I can’t stop.”

• “I feel alone.”

• “I feel miserable.”

• “I feel scared.”

[Source: www.pbs.org.wnet/closetohome/]
76 COCAINE

These two graphs from the 2001 National Household Survey

on Drug Abuse illustrate current rates of addiction among
teen drug users. The pie graph reports the estimated numbers
of past-year drug users, aged 12 and older, who report an
addiction to alcohol, an illicit drug (like cocaine), or alcohol
and an illicit drug together. The bar graph shows the
percentages of past-year drug users reporting an addiction
to a specific drug; 24.9 percent of past-year drug users
reported an addiction to cocaine.
 Cocaine Addiction 77

Other experts explain the signs of addiction as the

“Three Cs”:

• Continuing to use cocaine, even though you know it is

harming you

• Feeling a Compulsion to take cocaine

• Feeling that your cocaine use is out of Control

DO YOU HAVE A PROBLEM WITH COCAINE?

The National Council on Alcoholism and Drug Dependence has
developed a test to help you determine whether or not you may
have a problem with drugs. Portions of this self-test have been
adapted here to help you honestly assess whether or not you
may need help with your use of cocaine. Remember that only a
professional—a doctor or trained specialist—can diagnose
addiction. This list of possible risk factors for cocaine addiction
is not designed to do that. Instead, it is designed to help you hon-
estly examine your use of cocaine and better understand your
risk factors for becoming dependent on cocaine.

Possible Risk Factors for Cocaine Dependency

• You use cocaine to build self-confidence

• You ever get high immediately after you have a problem at

home, work, or school

• You ever miss school or work due to cocaine

• It bothers you if someone says that you use too much

cocaine

• You started hanging out with a crowd that regularly

uses drugs

• Cocaine is affecting your reputation

• You feel guilty after using cocaine

78 COCAINE

• You feel more comfortable or at ease at parties or on dates

if you are using cocaine
• You have gotten into trouble at home, school, or work for
using cocaine
• You borrow money or give up other things to buy cocaine
• You feel a sense of power when you use cocaine
• You lost friends since you started using cocaine
• Your friends use less cocaine than you do
• You use cocaine until your supply is all gone
• You wake up and wonder what happened the night before
• You have ever been arrested or hospitalized due to cocaine use
• You avoid lectures or speeches about cocaine use
• You have tried to quit or to cut back using cocaine
• Someone in your family has an alcohol or drug problem
• You think you might have a problem with cocaine

The National Council on Alcoholism and Drug Depen-

dence suggests that identifying with three of these risk factors
indicates that you may be at risk for developing a dependence
on cocaine. If you identify with five or more of these risk
factors, you should immediately seek professional help. Talk
to a counselor, a nurse, or doctor. There are also organizations
listed in the Yellow Pages of your phone book that can refer
you to trained professionals who specialize in dealing with
cocaine addiction and drug dependence.

DEPENDENCE VERSUS ABUSE

Is there a difference between abusing cocaine and being
dependent on it? Most experts feel that there is. The American
Psychiatric Association publishes a guide to mental health
that contains specific guidelines to help its members properly
 Cocaine Addiction 79

diagnose cocaine abuse and dependence. This guide, known

as the Diagnostic and Statistical Manual of Mental Disorders
(DSM), describes cocaine abuse as happening when the user:
(1) continues to use cocaine in spite of the adverse conse-
quences; and (2) continues to use the drug in situations
where it poses a physical danger. According to the DSM,
cocaine abuse exists if at least one of these two factors applies
to the user and if the user does not qualify as dependent
on cocaine.

ony would never admit it to any of his friends, but when

T he was alone, he felt afraid. The first couple of times he
had used cocaine had been great — the most unbelievable
feeling he had ever known. But after those first few times,
it had never felt quite as intense. Still, he kept using and
hoping that he would feel that way again.
But now it seemed that the cocaine didn’t make him feel
great — it just made him feel okay. It was as if being high had
become normal. He kept thinking about cocaine — the smallest
things would trigger this sense that he had to have more. He
had used up all the money from his after-school job, he had
even taken money from his mom’s purse, and it wasn’t enough.
And now he felt worried and afraid. Did his mom know that
he had taken the money? Did his coach suspect that he was
high at practice? What would happen when they found out?
Most of all, he worried about the terrible way he felt. He was
only 17 years old — he couldn’t be an addict. Could he?

The fear that Tony feels is a combination of his realization that

he may be addicted to cocaine, and the psychological and
physical effects of cocaine itself. Heavy, regular use of cocaine
is known to cause restlessness, anxiety, paranoia, and irritability,
as well as insomnia and weight loss.
80 COCAINE

So what is cocaine dependence? The same DSM describes

cocaine dependence as occurring when: (1) the user takes more
cocaine than he or she intended to; (2) the user cannot reduce
his or her drug use despite trying to; (3) the user spends a lot
of time buying, using, and withdrawing from cocaine; (4) when
being high or withdrawing from cocaine is interfering with daily
life; (5) when activities involving cocaine are taking the place
of all other social, school-related, and work-related activities;
(6) the user continues to take cocaine in spite of the negative
consequences; (7) the user needs to take more cocaine to get
the same effects; (8) the user experiences withdrawal symptoms;
(9) the user takes cocaine to self-medicate or to fight off the
symptoms of withdrawal. You are considered to be dependent
on cocaine if at least three of these nine factors apply.

IS SOMEONE YOU CARE

ABOUT ABUSING COCAINE?
Cocaine abuse is not selective — it does not only happen in
certain neighborhoods, in certain schools, or among a certain
class or category of people. Drug abuse happens everywhere.
And addicts can look very much like the people around
you. In fact, you may have picked up this book because you
are concerned about someone around you — a friend or
family member.
It can be quite difficult to tell if someone you care about
is using cocaine. There are certain clues, warning signs that
may indicate that cocaine or another illicit drug may be
causing a problem:
• A change in friends

• A change in eating habits

• A change in sleeping habits

• Red, bloodshot eyes

• A runny nose
 Cocaine Addiction 81

• Frequent sniffing

• A change in grades

• A change in behavior

• Acting tired or depressed

• Becoming careless about the way he or she looks

• No longer caring about family, school, or activities he or

she used to enjoy

• Frequently needing money

It is important to remember that these are merely clues

that cocaine or other drugs may be a problem. Only trained
professionals can accurately diagnose a drug problem.
You cannot force a friend or family member to admit that
they have a problem with cocaine or force them to stop—they
have to do that themselves. However, there are certain things
you can do to help someone you care about who is abusing
cocaine. The first thing you can do is talk to someone you can
trust about your friend’s problem—perhaps a counselor, a
teacher, a doctor, or a parent. Ask him or her to keep what you
are sharing confidential. You don’t even need to mention your
friend’s name. Adults can often provide you with additional
resources or information that may be helpful as you decide
what to do next.
If you decide to talk to the person you believe is abusing
cocaine, think carefully in advance about what you want to say
and when you want to say it. Pick a time when the person is not
high. Don’t use word like “addict” or blame him or her for
using drugs; instead, express your concern about the drug use.
Tell him or her how worried you feel, and what you’ve seen
when he or she has been using cocaine—specific things you’ve
seen him or her do or say that bothered you. Make it clear that
you are talking to him or her because you care.
Be prepared that your friend or family member may
82 COCAINE

Studies have shown that students who use drugs, cigarettes, or

alcohol are less likely to participate in extra-curricular activities.
This graph shows the results of a 2000 report by the National
Household Survey on Drug Abuse. Notice that students aged
12 –17 are less likely to participate in more than one activity
if they use or abuse drugs or alcohol.

become angry, make excuses, or deny what you are saying.

Stress that you are speaking because you are worried. Offer to
go with him or her to get help.

HELP IS AVAILABLE
At the end of this book we will talk about resources and
treatment options that are available for people who have
become addicted to cocaine. There are also certain groups and
 Cocaine Addiction 83

organizations that specialize in helping family members and

friends of addicts. These groups can offer you support and
advice. Your phone book will contain a list of local organiza-
tions that specialize in issues surrounding drug abuse. Your
school nurse and counselor will also have information about
support groups.
There are certain national organizations that may also
have chapters or groups that meet in your area or may be
able to provide you with information or even support. Some
groups specialize in helping teens.

POINTS TO REMEMBER
Cocaine is illegal. It affects your brain and your body. Cocaine
may make you feel carefree, relaxed, and in control, but that
feeling will last only a few minutes. Use it enough and you will
feel depressed and irritable. You will want more cocaine—and
you will need to take more each time you want to get high. You
won’t eat or sleep regularly. It will increase your blood pressure
and heart rate. It may cause convulsions or muscle spasms.
Snorting cocaine can permanently damage your nasal tissue. It
will also make you feel angry, hostile, paranoid, and anxious—
even when you’re not high.
Now take a look at crack. Crack may give you a quick
high and a complete sense of power and pleasure. It is almost
instantly addictive. It can lead to a fatal heart attack — even
if you’ve only used it once. It can cause insomnia, seizures,
hallucinations, and paranoia.
The highs from cocaine or crack last only a few minutes.
The consequences last much longer. Think about this: there are
more hospitalizations per year caused by crack and cocaine use
than any other illegal drug.
7
Exploring
Additional
Resources
In this book we have discussed how cocaine can affect your body.
We have learned a bit about the history of cocaine use, particularly
in the United States. We have examined the business of cocaine,
how the cocaine industry has grown, and how political efforts to
control the drug industry have evolved.
We have read about teens making decisions about cocaine
and learned more about who is likely to abuse cocaine and
why. We have discussed cocaine addiction and learned what
to do if you or a friend or family member needs help with a
cocaine problem.
There are many resources available if you need assistance,
support, or just more information about cocaine. Start with the
adults you know — a parent, a teacher, your school counselor, a
minister, or your doctor or nurse may be able to provide support
or suggestions for places where you will find the help you need.
There are also a number of organizations that specialize in deal-
ing with drug-related issues, offering support groups, counseling,
or helpful statistics and information. Many of these may have
local chapters in your area — you can check your phone book to
find one near you.

84
 he day started out like any other. Julie woke up from
T partying all night and decided to do a couple of lines to
get her day started. A couple turned into 5, then 6. By the
time she was ready to go to her dealer for another few grams,
it was raining and the roads were especially slick. But she had
driven high before, so she wasn’t worried.
As she drove across the bridge into the city, she lost
control. The car started bouncing across the lanes like a ping-
pong ball, hitting both cement medians over and over again.
She felt the strain of the seatbelt crushing her chest and the
impact of the airbag hit her in the face like a punch. Did the
car finally stop? . . . Was she dead? . . . She could feel the
blood running down her face and dripping onto her shirt.
Julie knew she had hit rock bottom as she sat in the
emergency room, sore and bruised, but alive. She needed
help. When the doctor offered to have a drug counselor speak to
her when she felt better, she accepted. She and her parents
met with the counselor and came up with a plan to help her
kick her cocaine habit. The counselor mentioned that there
were even support groups she could join where other teens
with drug problems met to share their stories and offer each
other support.

Julie is starting to realize that it is often difficult, or impossible,

to beat an addiction without help. Parents and teachers are
good places to start — and although they may be upset that
you are using drugs, they will be relieved that you are seeking
help. In addition, addiction counselors and organizations,
such as Cocaine Anonymous and others listed in this chapter,
can give cocaine addicts the support and direction they need
to recover.

85
86 COCAINE

African American Family Services

Telephone: 1-612-871-7878
www.aafs.net
Provides referral services for substance abuse issues, including
contacts for local treatment centers, support groups, family coun-
seling, prevention, and diagnosis.

American Council for Drug Education

www.acde.org and www.drughelp.org
The American Council for Drug Education sponsors DrugHelp, a
private, non-profit source of information and referral network.
DrugHelp provides information on specific drugs and treatment
options, and offers referrals to public and private treatment
programs, self-help groups, family support groups, and crisis
centers throughout the United States.

Cocaine Anonymous
Telephone: 1-800-347-8998 (for referrals to local meetings)
www.ca.org
An organization for cocaine addicts seeking to lead a life free from
cocaine abuse. Members support each other in their effort through
regular meetings held throughout the United States. Groups
follow a 12-Step Program. Web site offers links to local chapters.

Co-Anon Family Groups

Telephone: 1-800-898-9985
www.co-anon.org
An organization for friends and family members of cocaine
addicts. Offers information about addiction, support services and
links to local meetings.

Girls and Boys Town National Hotline

Tele phone: 1-800-448-3000
www.girlsandboystown.org
Offers tips, information, resources, and a chat room about family
relationships, depression, violence in the family, and substance
abuse. Trained counselors are on staff and can make referrals to
specialists in your area.
 Exploring Additional Resources 87

TREATMENT TRENDS

There were nearly 1.9 million admissions to publicly funded

substance abuse treatment programs in 1995:

• Nearly 46 percent of treatment admissions were for illicit

drug abuse treatment, and 54 percent were alcohol abuse
treatment.

• The largest number of illicit drug treatment admissions were

for cocaine (38.3 percent), followed by heroin (25.5 percent)
and marijuana (19.1 percent).

• Seventy percent of individuals in treatment were men, 30

percent were women.

[Source: National Association of State Alcohol and Drug Abuse

Directors (NASADAD)]

Hazelden Information Center

Telephone: 1-800-257-7800
www.hazelden.org
Provides information and resources for teens and adults dealing
with alcohol addiction and drug abuse. Also maintains treatment
centers for those struggling with addiction.

Narcotics Anonymous World Services Office

Telephone: 1-818-773-9999 (for meeting information)
www.wsoinc.com
Narcotics Anonymous is an organization for recovering addicts.
Members support and learn from each other in their efforts to
live a clean and sober life following the 12-Step Program.
Meetings are held throughout the United States and worldwide.
Web site offers information, free publications, and links to
local chapters.
88 COCAINE

National Clearinghouse for Drug and Alcohol Information

Telephone: 1-800-729-6686
www.health.org
Operated by the Federal Center for Substance Abuse Prevention,
this organization provides a wide range of free information and
resources on drug use and abuse, including material from the
National Institute on Drug Abuse, the National Institute of
Alcohol Abuse and Addiction, and more.

National Council on Alcoholism and Drug Dependence

Telephone: 1-800-NCA-CALL (1-800-622-2255)
www.ncadd.org
Provides public education and information on drug abuse and
alcoholism. Also offers referrals to local treatment services.

BEATING COCAINE ADDICTION:

A New Approach
Researchers at the Xenova Group, a biotechnology company in
England, are in the process of creating a vaccine that will help
cocaine addicts fight their addiction.
The euphoria associated with cocaine abuse occurs
because cocaine blocks dopamine uptake in the brain,
increasing the effective concentration of dopamine in
synapses between neurons. The vaccine, called TA-CD, is
designed to work by generating antibodies in the bloodstream
that prevent cocaine from crossing from the bloodstream into
the brain. In this way, the cocaine will not be able to block
dopamine uptake in the brain.
This vaccine would be a novel therapy for cocaine
addicts, who have had to rely on counseling, support groups,
and willpower to beat their addictions. Cocaine addicts may
benefit from TA-CD and its ability to inhibit them from feeling
“high,” and thus reinforcing their addiction, should they
relapse after stopping cocaine use. NIDA is supporting the
Xenova Group’s development of this drug, which is still in
early trial stages.
 Exploring Additional Resources 89

National Institute on Drug Abuse

Telephone: 1-301-443-1124
www.nida.nih.gov
The National Institute on Drug Abuse, a division of the U.S.
Department of Health and Human Services, provides information
on prevention and treatment of drug abuse. A special section for
students contains research information about the effects of drug
abuse on the brain and interactive activities to teach more about
various drugs and how they affect how your brain works. It also
features links to interesting information about the work that other
scientists at the National Institutes of Health are doing.

Substance Abuse Mental Health Services Administration

Telephone: 1-800-662-HELP (1-800-662-4357)
www.samhsa.gov
A division of the federal government that offers drug and alcohol
treatment referrals. Provides advice and information about local
drug and alcohol treatment services, as well as links for teens.
Appendix
The Economic Cost of Drug and Alcohol Abuse in the United States
The National Institute on Drug Abuse (NIDA) and the National Institute on
Alcohol Abuse and Alcoholism (NIAAA) released a study in 1998 that
estimated the total economic cost of drug and alcohol abuse to be $245.7 billion
for 1992, the most recent year for which sufficient data were available. This
estimate represents $965 for every man, woman, and child living in the
United States in 1992. Of this cost, $97.7 billion was due to drug abuse.
When considering the total cost of drugs and their impact on society, it is
necessary to consider more than just the money spent on the drugs them-
selves. The NIDA/NIAAA estimate includes substance abuse treatment and
prevention costs as well as other health care costs, costs associated with
reduced job productivity or lost earnings, and other costs to society such as
crime and social welfare. The study also determined that these costs are borne
primarily by governments (46 percent), followed by those who abuse drugs
and members of their households (44 percent).
The 1992 cost estimate has increased 50 percent over the cost estimate
from 1985 data. The four primary contributors to this increase were:

• The epidemic of heavy cocaine use

• The HIV epidemic (spread by intravenous drug use)

• An eightfold increase in state and federal incarcerations for

drug offenses

• A threefold increase in crimes attributed to drugs.

More than half of the estimated costs of drug abuse were associated with
drug-related crime. These costs included lost productivity of victims and
incarcerated perpetrators of drug-related crime (20.4 percent); lost legitimate
production due to drug-related crime careers (19.7 percent); and other
costs of drug-related crime, including federal drug traffic control, property
damage, and police, legal, and corrections services (18.4 percent). Most
of the remaining costs resulted from premature deaths (14.9 percent),
lost productivity due to drug-related illness (14.5 percent), and healthcare
expenditures (10.2 percent).
The White House Office of National Drug Control Policy (ONDCP)
conducted a study to determine how much money is spent on illegal drugs
that otherwise would support legitimate spending or savings by the user in
the overall economy. ONDCP found that, between 1988 and 1995, Americans
spent $57.3 billion on drugs, broken down as follows: $38 billion on cocaine,
$9.6 billion on heroin, $7 billion on marijuana, and $2.7 billion on other
illegal drugs and on the misuse of legal drugs.

90
91
Bibliography
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Blum, Richard H., ed. Society and Drugs. Vol. 1: Social and Cultural
Observations. San Francisco, CA: Jossey-Bass Inc., 1970.
Chatterjee, Sumana. “More young people using illegal drugs, survey finds,”
The Philadelphia Inquirer, September 6, 2002, p. A4.
Cooper, Mary H. The Business of Drugs. Washington, D.C.: Congressional
Quarterly, 1990.
Flynn, John C. Cocaine. New York: Birch Lane Press, 1991.
Johnston, L.D., P.M. O’Malley, and J.G. Bachman. Monitoring the Future:
National Survey Results on Drug Use, 1975 – 2000. Vol. 1: Secondary
School Students. Bethesda, MD: National Institute on Drug Abuse, 2001.
Karch, Steven B. A Brief History of Cocaine. Boca Raton, FL: CRC Press,
1998.
Kassin, Saul. Psychology. 3rd ed. Upper Saddle River, NJ: Prentice-Hall,
Inc., 2001.
Lee, Rensselaer W. The White Labyrinth: Cocaine and Political Power.
New Brunswick, NJ: Transaction Publishers, 1989.
Nahas, Gabriel G. Cocaine: The Great White Plague. Middlebury, VT:
Paul S. Eriksson, 1989.
National Institute on Drug Abuse. Cocaine and A Changing Brain: Meeting
Summary, October 25, 1997. Rockville, MD: National Institute of
Health, 1999.
Nuckols, Cardwell C. Cocaine: From Dependency to Recovery. 2nd ed. Blue
Ridge Summit, PA: Tab Books, 1989.
Platt, Jerome J. Cocaine Addiction: Theory, Research, and Treatment.
Cambridge, MA: Harvard University Press, 1997.
Schaffer, Howard J. and Stephanie B. Jones. Quitting Cocaine: The Struggle
Against Impulse. Lexington, MA: Lexington Books, 1989.
Weil, Andrew. “The Therapeutic Value of Coca in Contemporary Medicine.”
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Books, 1990.

92
Web sites
The National Center on Addiction and Substance Abuse at Columbia University
www.casacolumbia.org
In Search of the Big Bang
www.cocaine.org.uk
The Council on Alcohol and Drugs Houston
www.council-houston.org
The Church of Scientology International
www.drugfreelife.org
Schaffer Library of Drug Policy
www.druglibrary.org/schaffer/history/e1910/harrisonact.htm
Drug Strategies
www.drugstrategies.org
Go Ask Alice
www.goaskalice.columbia.edu
PREVLINE: Prevention Online
www.health.org
Join Together Online
www.jointogether.org
Monitoring the Future
www.monitoringthefuture.org
National Institute on Drug Abuse
www.nida.nih.gov
National Criminal Justice Reference Service
www.ondcp
Frontline: Drug Wars
www.pbs.org/wgbh/pages/frontline/shows/drugs/
Teen Challenge
www.teenchallenge.com/main/drugs/
U.S. Drug Enforcement Administration
www.usdoj.gov/dea/
Office of National Drug Control Policy
www.whitehousedrugpolicy.gov/drugfact/cocaine

93
Further Reading
Books
Cooper, Mary H. The Business of Drugs. Washington, DC: Congressional
Quarterly, 1990.
Flynn, John C. Cocaine. New York: Birch Lane Press, 1991.
Johnston, L.D., P.M. O’Malley, and J.G. Bachman, Monitoring the Future:
National Survey Results on Drug Use, 1975-2000. Vol. 1: Secondary School
Students. Bethesda, MD: National Institute on Drug Abuse, 2001.
Lee, Rensselaer W. The White Labyrinth: Cocaine and Political Power. New
Brunswick, NJ: Transaction Publishers, 1989.
Nuckols, Cardwell C. Cocaine: From Dependency to Recovery. 2nd ed. Blue
Ridge Summit, PA: Tab Books, 1989.
Papa, Susan. Addiction. Farmington Hills, MI: Blackbirch Press, 2001.

Web sites
Cocaine Anonymous
www.ca.org
The National Center on Addiction and Substance Abuse at Columbia University
www.casa.columbia.org
Co-Anon Family Groups
www.co-anon.org
Freevibe.com
www.freevibe.com
PREVLINE: Prevention Online
www.health.org
National Institute on Drug Abuse
www.nida.nih.gov
Teen Challenge
www.teenchallenge.com
Office of National Drug Control Policy
www.whitehousedrugpolicy.gov

94
 Index
Administration, routes Business of cocaine, 48-59 Co-Anon Family Groups,
of injection, 17, 20, 36, and Bolivia, 8, 48, 50- 86
38, 41 51 Coca-Cola, 22-23
smoking, 17, 36, 38-41 and Brazil, 54 Cocaine abuse, 78-80
snorting, 8, 10, 17, 20, and cocaine wars, 28, See also Cocaine addic-
26, 38, 41, 69, 83 30-35 tion
and time for travel to and Colombia, 28, Cocaine addition, 8, 14-15,
brain, 38 29-30, 33, 35, 48, 52, 17, 32, 36, 67, 68-69,
African American Family 54-56 72-83
Services, 86 and employment and coca leaf chewers,
Alkaloid, cocaine as, 37, needs, 51-52 10, 18, 37
39-40, 48, 51 and farmers, 48-51, 54 and crack, 31, 32, 38, 83
American Council for and Florida, 30-31, 52, definition of, 72
Drug Education, 86 57 and dependence versus
Anesthetic, cocaine as, and growing coca abuse, 78-80
20-21 plant, 8, 48-50 and Freud, 21-22
Argentina, and drug and Harrison Act, 24-25 history of, 22-23
trade, 54 and Mexico, 31, 32, 35, lack of awareness of,
Aschenbrandt, Theodor, 52, 54, 57 21-22, 64, 65
21 and money laundering, and number of addicts,
57-59 22-23, 33
Bias, Len, 31-32 and New York, 52, 57, physical, 8, 27, 72
Blood pressure, and 59 and pleasure principle,
cocaine, 8, 15, 45, 68, 83 and Norman’s Cay 43-47
Blood sugar, and cocaine, (Bahamas), 28, 30, psychological, 8, 27,
15 54-56 72-73
Blood vessels, and and Panama, 30, 33, 54 self-test on risk factors
cocaine, 15, 45 and Peru, 8, 37, 48-50, for, 77-78
Body temperature, and 51 signs of, 74-75, 77,
cocaine, 8 and price of cocaine, 80-81
Bolivia, coca plant grown 35, 57 social aspect of, 73-74
in, 8, 48, 50-51 and purity of cocaine, in someone you care
Brain, effect of cocaine 10-12, 35, 37, 40-41, about, 80-83, 84,
on, 8, 12-15, 16, 17, 38, 57 86-89
41-47, 67, 68, 83 and repackaging, 57 and withdrawal, 72, 74
Brazil, and drug trade, See also Treatment, for
54 Catholic Church, and cocaine addictio
Bronchioles, and cocaine, Incas, 18-20 Cocaine Anonymous, 86
15 Cayman Islands, and Cocaine base, 48, 51
Brookhaven National money laundering, 59 Cocaine dependence,
Laboratory, 45 Centers for Disease 78-80
Bryan, William Jennings, Control, 60 See also Cocaine addic-
24 Chapare, Bolivia, 51 tion
Bureau of Narcotics and Chicago, and cocaine Cocaine hydrochloride,
Dangerous Drugs business, 54 10, 37-38, 39
(BNDD), 27 Cigarettes, crack inhaled See also Powder,
Bush, George, 32 with, 40 cocaine as

95
Cocaine paste, 10, 48, 51, Diagnostic and Statistical Group, and teens’ cocaine
52 Manual of Mental use, 64
Cocaine wars, 28, 30-35 Disorders (DSM),
See also Business of 79-80 Haiti, and drug trade, 54
cocaine Dopamine, 12-15, 43-46 Hammond, William
Coca leaves, 48 Drug Enforcement Agency Alexander, 22
chewing of, 9-10, 18, (DEA), 28, 33, 35 Harrison Narcotic Act,
37 Drug trade/smuggling. 23-25
cocaine made from, 8, See Business of Hazelden Information
10-12, 36 cocaine Center, 87
Coca plant, 8 Health effects of cocaine,
from Bolivia, 8, 48, Erythoxylum coca, 8 8, 15-16, 32, 36-47,
50-51 See also Coca plant 68-69
cocaine isolated from, Escobar, Pablo, 30, 33 and appetite, 45
10, 20, 37 Europe, cocaine in, 22 and blood pressure, 8,
and farmers, 8, 48-51, 54 Eye surgery, cocaine as 15, 45, 68, 83
and Incas, 9-10, 18-20 anesthetic in, 20-21 and blood sugar, 15
from Java, 20 and blood vessels, 15
from Peru, 8, 18, 20, Family and body temperature,
37, 48-50, 51 help for addiction in 8
Colombia, and drug trade, member of, 80-83, and brain, 8, 12-15, 16,
28, 29-30, 33, 35, 48, 86-89 17, 38, 41-47, 67, 68,
52, 54-56 and teens’ cocaine use, 83
Comprehensive Drug 64-65 and death, 31-32, 40
Abuse Prevention and Florida, and drug trade, and effects of cocaine,
Control Act, 27 30-31, 52, 57, 59 8, 12-16, 38, 43-47,
Controlled Substances Freebase form, of 83
Act, 27 cocaine, 12 and gastrointestinal
Crack cocaine, 10, 33, Freebasing, 40 system, 16
38-41 Freud, Sigmund, 21-22 and heart rate, 8, 15,
and addiction, 31, 32, Friend, help for cocaine 16, 45, 68, 83
38, 83 addiction in, 80-83, and nose irritation, 8,
and number of teens 86-89 69, 83
using, 62-64 Fronts, and money laun- and pleasure from
Cuba, and drug trade, dering, 59 cocaine, 8, 12-15, 17,
54 36, 38, 43-47, 64, 68,
Currency, coca plant as, Gacha, Jose Gonzalo 83
18, 19 Rodrigues, 30 psychological, 16, 68,
Gas, cocaine as, 39-40 69, 83
Dallas, and cocaine See also Crack cocaine and pupil dilation, 8,
business, 54 Gastrointestinal system, 45
Death from cocaine, and and cocaine, 16 and respiratory system,
famous people, 31-32, Germany, and medical 15, 16, 40
40 use of cocaine, 20 and risks, 10-11
Derivation, of cocaine, 8, Girls and Boys Town See also Cocaine
10-12, 36 National Hotline, 86 addiction

96
Heart rate, and cocaine, Judgment, and cocaine, National Center on Addic-
8, 15, 16, 45, 68, 83 17 tion and Substance
High, from cocaine, 8, Abuse survey, 67-68
12-15, 38, 43-47, 64, Koller, Karl, 21 National Clearinghouse
68, 83 for Drug and Alcohol
History of cocaine, 18-35 Legal issues Information, 88
and Coca-Cola, 22-23 and cocaine as illegal, National Council on
and Colombia, 28, 30- 17 Alcoholism and Drug
31 and Comprehensive Dependence, 77-78, 88
and first epidemic, 20 Drug Abuse Preven- National Institute on
and Freud, 21 tion and Control Act, Drug Abuse, 67, 89
and Harrison Narcotics 27 Neurotransmitters, 12,
Act, 23-25 and Controlled 41, 43, 68
and Incas, 9-10, 18-20, Substances Act, 27 and dopamine, 12-15,
37 and Harrison Narcotics 43-47
and introduction to Act, 23-25 New Orleans, and cocaine
Europe, 20 Lehder, Carlos, 28, 30, business, 54
and isolation from 54-56 New York
coca plant, 10, 20, 37 Los Angeles, and cocaine and cocaine business,
and Johnson, 27 business, 54, 59 52, 54, 57, 59
and late 1960s-1970s, crack in, 31
26-28 Manufacture, of cocaine, Nicaragua, and drug
and medical use, 20-21, 10-12, 37 trade, 54
22-23, 24, 27 and purity, 10-12, 35, Niemann, Albert, 10, 20
and 1980s, 31-33 37, 40-41, 57 Nixon, Richard, 27-28
and 1940s-1960s, 25 Marijuana, and cocaine Noriega, Manuel, 30, 33
and 1990s, 33 use, 67-68 Norman’s Cay (Bahamas),
and Nixon, 27-28 Medellin cartel, 30, 33, and drug trade, 28, 30,
See also Business of 54-56 54-56
cocaine Media, and teens’ cocaine Nose, cocaine snorted in,
Honduras, and drug use, 64 8, 10, 17, 20, 36, 38, 41,
trade, 54 Medical use, of cocaine, 69, 83
Houston, and cocaine 20-21, 22-23, 24, 27 Nucleus accumbens, 12
business, 54, 59 Mexico, and drug trade,
31, 32, 35, 52, 54, 57 Ochoa family, 30
Incas, 9-10, 18-20, 37 Military use, of cocaine,
Independence, and teens’ 21, 22 Panama, and drug trade,
cocaine use, 64 Money laundering, 57-59 30, 33, 54
Injection, of cocaine, 17, Mood swings, and Pemberton, John, 22-23
20, 36, 38, 41 cocaine, 8 Peru
Morphine addicts, and coca plant grown in, 8,
Jamaica, and drug trade, cocaine, 21 18, 20, 37, 48-50, 51
54 and Incas, 9-10, 18-20,
Java, cocaine grown in, Narcotics Anonymous 37
20 World Services Office, Physical addiction, to
Johnson, Lyndon, 27 87 cocaine, 8, 27, 72

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Pindling, Norman, 55 Schedule II drug, cocaine and likelihood of using
Pipes, crack inhaled with, as, 27 cocaine, 67
38, 40 Self-esteem, and teens’ and marijuana use,
Pizzaro, Francisco, 18 cocaine use, 64 67-68
Pleasure, from cocaine, 8, Self-test, on risk factors for and numbers using
12-15, 17, 36, 38, 43-47, cocaine dependency, cocaine, 60-64, 67,
64, 68, 83 77-78 68
Powder, cocaine as, 10-12, Shining Path (Sendero and reasons for using
37, 39, 48 Luminoso), 49-50 cocaine, 64-65
and drug trade. See Smoking, of cocaine, 17, and unawareness of
Business of cocaine 36, 38-41 risks, 64, 65
purity of, 10-12, 35, 37, Snorting, of cocaine, 8, Tonics, 22-23, 24
40-41, 57 10, 17, 20, 36, 38, 41, Transporting cocaine, 12
Prices for cocaine, 35, 57 69, 83 Treatment, for cocaine
Pryor, Richard, 40 Snuff, cocaine replacing, addiction
Psychological addiction, 20 and brain, 47
to cocaine, 8, 27, 72-73 Social aspect, to addic- and Nixon, 27-28
Psychological effects, of tion, 73-74 support for, 78, 80-83,
cocaine, 16, 68, 69, 83 Spanish conquerors, 84, 86-89
Pupils, dilation of, 8, 45 18-20 Tube, crack inhaled with,
Purity, of cocaine, 10-12, Stimulant, cocaine as, 8, 40
35, 37, 40-41, 57 36
Substance Abuse Mental U.S. Department of
Resources, on cocaine, 84, Health Services Health and Human
86-89 Administration, 89 Services, 60
Respiratory system, and Upper Huallaga Valley, 48
cocaine, 15, 16, 40 Teenage trends and
Rock. See Crack cocaine attitudes, 17, 60-71 Venezuela, and drug
and abstaining from trade, 54
Safe haven countries, and cocaine, 68, 70-71 Ventral tegmental area, 12
money laundering, 59 and benefits of cocaine, Vin Mariani, 22
Salinas de Gortari, 64 Volkow, Nora, 45
Carlos, 32 and crack use, 62-64
San Francisco, and and effects of cocaine, Weil, Andrew, 10
cocaine business, 54 68-69 Withdrawal, 72, 74

98
 Picture Credits
page:
13: Associated Press, AP 61: Courtesy National Household Survey on
14: Courtesy of National Institute Drug Abuse/SAMHSA
of Drug Abuse 63: Courtesy of Substance Abuse and Mental
19: © Bettmann/Corbis Health Services Administration/National
23: © Bettmann/Corbis Household Survey on Drug Abuse
29: © Bettmann/Corbis 66: © Catherine Karnow/Corbis
42: Courtesy of National Institute 69: Courtesy of National Institute
of Drug Abuse of Drug Abuse
46: Courtesy of National Institute 76: Courtesy of National Institute
of Drug Abuse of Drug Abuse
50: Associated Press, AP 82: Courtesy of Substance Abuse and Mental
53: © Reuters New Media Inc./Corbis Health Services Administration/National
55: Courtesy of Substance Abuse and Mental Household Survey on Drug Abuse
Health Services Administration/National 91: Courtesy of Substance Abuse and Mental
Household Survey on Drug Abuse Health Services Administration/National
56: Associated Press, AP Household Survey on Drug Abuse

99
About the Author
Heather Lehr Wagner is a writer and editor. She earned an M.A. from the
College of William and Mary and a B.A. from Duke University. She has
written several books for teens on global and family issues and is also the
author of Alcohol and Nicotine in the DRUGS: THE STRAIGHT FACTS series.
She lives with her husband and their three children in Pennsylvania.

About the Editor

David J. Triggle is a University Professor and a Distinguished Professor in
the School of Pharmacy and Pharmaceutical Sciences at the State University
of New York at Buffalo. He studied in the United Kingdom and earned his
B.Sc. degree in Chemistry from the University of Southampton and a Ph.D.
degree in Chemistry at the University of Hull. Following post-doctoral work
at the University of Ottawa in Canada and the University of London in the
United Kingdom, he assumed a position at the School of Pharmacy at Buffalo.
He served as Chairman of the Department of Biochemical Pharmacology
from 1971 to 1985 and as Dean of the School of Pharmacy from 1985 to 1995.
From 1995 to 2001, he served as the Dean of the Graduate School and as
the University Provost from 2000 to 2001. He is the author of several books
dealing with the chemical pharmacology of the autonomic nervous system
and drug-receptor interactions, roughly four hundred scientific publications,
and has delivered over one thousand lectures worldwide on his research.

100