Episode 35
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Is cocaine dangerous?
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What is the difference between cocaine and crack?
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How popular are cocaine and crack?
Cocaine used to be the drug of the 80’s. Business people and movie stars living large. Cocaine is making a comeback all over the world. In this episode we’ll be talking about cocaine and crack. Tune in to this week’s episode of All Things Substance.
Helpful Links
The Neurobiology of Cocaine Addiction
Cocaine Bear: Elizabeth Banks Movie True Story Inspiration – Rolling Stone
Cocaine: What is the Crack? A Brief History of the Use of Cocaine as an Anesthetic
What is the historical background of cocaine use, abuse and toxicity?
The Buyers – A Social History Of America’s Most Popular Drugs | Drug Wars | FRONTLINE | PBS
Cocaine DrugFacts | National Institute on Drug Abuse (NIDA)
What is Cocaine? | National Institute on Drug Abuse (NIDA)
Enjoying the high life—drugs in history and culture – The Lancet
How Fentanyl Is Contaminating America’s Cocaine Supply – Rolling Stone
HIV-1 infection and Cocaine Go hand in HAND
Five-Factor Model personality profiles of drug users | BMC Psychiatry | Full Text
The Severely-Distressed African American Family in the Crack Era: Empowerment is not Enough
Crack Cocaine Use and its Relationship with Violence and Hiv
A severe complication of crack cocaine use. – Abstract – Europe PMC
IDHS: Facts You Should Know about Crack – IDHS 4706
Basic Facts About Cocaine and Crack
Cocaine and Crack Addiction: Symptoms, Signs, Side Effects & Treatment
Man arrested in Port Arthur for making crack cocaine with baking soda, microwave | 12newsnow.com
Manufacturing Crack Cocaine – How Crack Cocaine Works | HowStuffWorks
Mentholated Crack Cocaine – HGExperts.com
Can We Make Crack Cocaine Smoking Safer?
Cocaine and Hollywood – The New York Times
Cocaine | Effects of Cocaine | FRANK
Cocaine Toxicity: Practice Essentials, Background, Pathophysiology
Crack in the Body – How Crack Cocaine Works | HowStuffWorks
What are some ways that cocaine changes the brain? | National Institute on Drug Abuse (NIDA)
Free Treatment Tool https://betsybyler.com/treatment-tool/
Transcript
You’re listening to the All Things Substance podcast, the place for therapists to hear about substance abuse from a mental health perspective. I’m your host, Betsy Byler and I’m a licensed therapist, clinical supervisor, and a substance abuse counselor. It is my mission to help my fellow therapists gain the skills and competence needed to add substance use to their scope of practice. So join me each week as we talk about All Things Substance.
Welcome back to the All Things Substance podcast. This is episode 35. Today we’re going to be answering “What is the difference between cocaine and crack?” As well as all the other things you need to know.
Cocaine has always seemed like one of the big drugs to me. I grew up in Chicago land, leaving the area in 1995. During that time, cocaine was extremely popular. The images that come to mind for me are of young people who were successful, single, no children, partying and staying out all night. As usual, we’re going to take a step back to take a look at where cocaine comes from.
Cocaine: The history
Cocaine is a stimulant drug that’s made from the leaves of a South American coca plant. We’re aware of its existence at least to 2000 BC. Indigenous people of the Amazon rainforest and the Andes mountains have chewed Coca leaves to get an energetic high.
European scientists first isolated cocaine from the Coca leaves in the 1850s. It was once known as a medical wonder drug. Coca plant is one of the oldest cultivated plants in South America. Botanists think that its cultivation may have started in the Amazon rainforest and then spread to the Andes mountains. Coca leaves were also said to be used in Inca cultural and religious ceremonies.
In 1551, the Catholic church in colonial South America saw the use of the Coca leaf as undermining the spread of Christianity. The bishops at the time urged the Peruvian government to prohibit the use of coca. Ultimately it wasn’t banned, but there were restrictions on how much land could be used to produce Coca plants.
In 1960, cocaine was isolated from the cocoa plant in both Germany and France. In the late 1800’s cocaine was being used experimentally in cataract surgery. Apparently cataract surgery used to be performed without anesthesia. Can’t imagine that. They found that when they soak the eyeball in a cocaine solution, that the person’s eye no longer twitched when the scalpel touched it. Pharmaceutical companies soon began marketing cocaine. However enthusiasm for anesthetic cocaine dropped quite sharply because of accidental overdoses during surgery.
In our world I think a lot of us have heard that one of our forebears, Sigmund Freud, happened to love him some cocaine. Freud, an Austrian neurologist, credited with founding the field of psychoanalysis was reported to be fascinated with cocaine. In 1884 at the age of 28, he wrote a paper called Uber Coca. Which he described as “song of praise to this magical substance.”
I’ve seen some people over the years use that information to discredit Freud and the things that he gave to our field. I think we have to treat the fact that he was addicted to cocaine the same as we would someone who was addicted to alcohol. While it was part of his life and certainly something he struggled with. It doesn’t necessarily negate all the things that he said and the things he proposed. I happen to be somewhat psychodynamic in my orientation. I appreciate his work on the unconscious and the subconscious. I don’t know that I agree with everything that he proposed. The same way I don’t agree with everything that the founders of other schools of thought said either.
An American pharmacist founded Coca-Cola in 1886 with a beverage concoction of cocaine and sugary syrup. Coca-Cola was first sold at racially segregated soda fountains and became popular among white middle-class at the time. In 1899, 13 years later, Coca-Cola began selling its drink in bottles. This enabled others who were not in white middle class to access the beverage, containing the sugar syrup and cocaine. In 1903, cocaine was removed from the product.
The Harrison Narcotics Act of 1914 was one of the first forays into national drug policy. This act was introduced by a representative from New York, which outlawed the sale and use of Coca and opium products. From the beginning these laws were aimed at reducing use among minority populations. There was a lot of stigma and racist thought about cocaine and crack being used primarily in the African-American population. Research though doesn’t bear this out. What is true is that the number of people prosecuted for possession of crack or cocaine is primarily minority populations, but that isn’t the same as having the primary users be in the minority population. However, that stigma was presented in widespread media.
Cocaine use was in Hollywood circles in the thirties and into the forties. In 1934 Cole Porter’s Broadway musical, Anything Goes opened with the song. I get a kick out of you. In it audiences were told that some get kick from cocaine. In order for the song to be played on the radio there was an agreement that the singers would change the “objectionable” reference. The line that mere “alcohol doesn’t thrill me at all” apparently got no opposition.
Cocaine has also been used during war times. We have reports during World War one of cocaine being given to various groups of soldiers from Bavarian soldiers to United States soldiers. There was a tonic called Forced March that was supposed to handle hunger and tiredness and enable the troops to keep going. Cocaine was widely believed to quote, supply the place of food, make the coward brave, the silent eloquent, and render the sufferer insensitive to pain.
Cocaine use between 1940 and the late 1960s decreased dramatically. It wasn’t until the seventies that we started seeing the resurgence that would make the eighties super popular with cocaine.
During the seventies, cocaine came out as the fashionable new drug for entertainers and business people. It seemed to be the perfect companion of working long hours and being able to stay up. There’s some reports that at American universities that cocaine use increased 10-fold from 1970 to 1980. And what was responsible for this?
Cocaine: The Cartels
Well, in the late 1970s Colombian drug traffickers set up shop and some really successful drug cartels. The most infamous cartel is the Medellin cartel and the head of that cartel Pablo Escobar. Some of you may have seen a series on Netflix called Narcos. This is the story of Pablo Escobar and his empire.
The Medellin cartel was said to be an empire of stunning sweep and unimaginable violence. It was estimated that they were earning $4 billion a year in the early 1980s. The amount of cocaine that was running through this organization accounted for 80% of all of the cocaine being brought into the United States.
The thing about the cartel that’s interesting is they were more like a wholesaler. They brought the cocaine in, got their price and let other people figure out what they were going to charge for it. The way that the cartel was created, it was incredibly successful. It was run like a business except more violent.
One of the things that the cartel had going for it was what’s described as fierce, almost irrational loyalty to its leaders, especially Escobar. He was reportedly very charismatic, very powerful and very demanding. He’s been described as the Robin Hood of Columbia. He rallied support from some of the poorest citizens in Columbia by stepping in where the government couldn’t or wouldn’t..
There is an apartment complex in the town of Medellin that still bears his name. He reportedly paid to build hundreds of homes in the impoverished area that had largely been a garbage dump. Even today, you can hear people talk about what he did for their community.
When loyalty didn’t work well, violence was the next step. Merger and acquisition being the name of the game. The cartel member in charge of training the men hired British and Israeli mercenaries to train them. This was not some ragtag bunch of criminals committing violent acts. These were soldiers that were trained by other soldiers and acted as an army in and of itself.
If violence didn’t work or wasn’t the right call, then bribery was the next step. There was an incredible amount of money each year coming in that provided the ability to pay bribes to local officials and anyone who needed to look the other way.
Up until the late seventies cocaine was coming into the United States, mainly in small quantities, stuffed into suitcase linings on commercial flights or smuggled in by boats and fishing trawlers. But as it became the disco era’s drug of choice and Wall Street’s drug of power larger quantities were required to meet the nearly insatiable demand.
Cocaine was coming in, mainly through the Caribbean and from their flights into South Florida and The Bahamas. In 1982 joint forces came together and were able to crack down on the massive amounts of cocaine coming through South Florida. Didn’t stop it though. They just switched the route. They took legitimate cargo shipments and did things like replace the insulation and refrigerators and TV sets with cocaine.
The profits were said to be so big that pilots made one way trips to the Florida coast, dropping sacks of cocaine and ditching their planes in the sea and then swimming to waiting ships.
So when we put it in perspective, a kilo of cocaine might cost $1000 to refine and up to $4,000 to smuggle to Miami. But that same kilo could sell for $50,000 to $70,000. There were an estimated five to seven flights per day into the U S Mexico or the Caribbean, each carrying some 500 kilos of cocaine.
If there’s five to seven flights, each carrying 500 or so kilos of cocaine every day, and one kilo of cocaine could have sold for 50 to $70,000. Just do the math for a second on the massive amount of money that we’re talking about here. And all that money goes to pay mercenaries, soldiers, bribe officials, purchase planes, get people to process, all sorts of things.
Pablo Escobar was all but untouchable. He had fierce loyalty from the community who would protect him because he had given them what the government couldn’t or wouldn’t at the time. He had those who were willing to commit violence for him. It was an incredibly large and powerful organization.
Within the U S cocaine was the party drug for the rich and famous and fueling the success of Wall Street. There are many places you can watch different interactions about cocaine, like in the movie, the Wolf of Wall Street.
So you got to wonder why cocaine was so popular and the answer marketing. Successful people, movie stars, people in Hollywood were known to be using cocaine. It looked fun and it looked like it was for powerful people. What we know from having influencers today is that average folks want to try what those people are doing and cocaine because of its nature is going to reinforce its use.
Cocaine: What it is and how its used
Cocaine is a fine white crystal. Like we said earlier, it’s processed from the leaves of the Coca plant. On the street cocaine often gets cut with other things. Sometimes it can be mixed with things like cornstarch or talcum powder or even flour to increase profits. Today cocaine is a Schedule 2 drug, which means that it has a high potential for abuse, but can be administered by a doctor for legitimate medical uses such as local anesthesia or some eye, ear and throat surgeries.
Just want to take it a second to think about the fact that marijuana is currently a Schedule one drug. Cocaine is currently a Schedule 2 drug. So marijuana being on the list with heroin as Schedule 1 and cocaine as Schedule 2. Something isn’t right about that. Now, if you’ve listened to my episodes on marijuana, you know that I’m not necessarily a fan. What I’m saying is we do need to look at our laws. Saying that cocaine is somehow more useful and less deserving of a Schedule one rank than cocaine. That’s something else.
Typically, when we think of cocaine, we think of people snorting it, and yeah, that’s typically how people do it. Sometimes they’ll stick it in their mouth and rub it on their gums because it’ll get into the bloodstream pretty quickly. It does cross the blood-brain barrier so it’s able to get into the brain pretty easily. There are some people who will dissolve the powder and inject it into their bloodstream. If you’ve ever heard of a speed ball, that’s the combination of cocaine and heroin.
People who use cocaine tend to use it in binges, where they use it multiple times over a short period of time. And this is because the high doesn’t last very long. You can imagine that injecting it increases the danger of it pretty significantly.
When snorted cocaine gets into your system pretty quickly, usually around five minutes. The initial high from cocaine, like I said, doesn’t last very long, probably 20 to 30 minutes at the outside. It does depend on the purity of the cocaine and the person’s tolerance. There is a significant downside to cocaine where the come down from it makes you feel really low, inspiring you to use more right away.
The effects of cocaine are said to be increased energy, happiness, feeling excited, wide awake, confident on top of your game and hypersensitivity to sight, sound and touch. There can be some irritability and some paranoia due to the increased activity of the nervous system. Some people who use cocaine may experience tactile hallucinations. A common example is feeling bugs crawling on the skin.
Physically cocaine constricts, blood vessels, dilate pupils. There is nausea associated with it as well as raised body temperature and blood pressure, fast or irregular heartbeat, tremors and muscle twitches or restlessness.
Cocaine is also said to increase sexual desires . Use of cocaine is often correlated with increased sexual activity. Because of the invincibility, that all of that’s not going to be protected and be done in a safer manner.
Cocaine is risky in general. It’s also risky specifically for people who have high blood pressure or heart conditions. In the 1980s college basketball star, Len Bias died the first time he tried cocaine due to an undiagnosed heart condition.
You can overdose from cocaine. The risk of overdose increases exponentially if you mixed cocaine with other drugs and especially alcohol. Over time, snorting damages the lining of your nose, as you can imagine. And this can happen to the point that someone could lose the cartilage between their nostrils and end up with one large nostril. Cocaine use while pregnant causes issues in utero including low birth weight, premature labor, miscarriage among other issues.
Regular use of cocaine can leave people feeling depressed, run down, anxious and paranoid. Cocaine gets cut with a lot of things depending on the market and how much pure cocaine is available. Pretty much nobody is doing pure cocaine. It’s generally going to be cut with something else. A popular method is to use benzocaine, which is a local anesthetic that produces a numbing effect similar to cocaine, but without the cocaine high.
Cocaine: Possibly the most addictive substance
Cocaine is said to be one of the most addictive substances on earth and part of that is because of the way that it handles dopamine. Cocaine acts to release more dopamine, like most drugs, but it also prevents the reuptake of dopamine. Imagine a sink faucet set on high and the sink plug being put in so that it keeps filling up with dopamine.
Scientists believe that cocaine causes significant changes in the brain. This makes it especially difficult for people who are trying to recover from cocaine because their cravings can last for quite a while. It could be several months before they start feeling those cravings subside. Right now, we don’t have an effective medication to treat cocaine dependence the way we do with heroin and opiates.
There are research studies talking about that cocaine can make changes in gene expression. Now we’re not talking about changing the gene itself. If it’s a liver gene, then it’s always a liver gene. If it’s a brain gene is always a brain gene, but the way that it expresses itself can change.
Cocaine affects the expression of numerous genes within the nucleus accumbens. Including some that influenced the important neurotransmitter chemical glutamate and the brain’s natural opioid like compounds.
Cocaine gives you the highest amount of dopamine or bang for your buck other than meth. Meth is the only thing that gives you a higher spike of dopamine. And we’ll talk about that in a couple of weeks when we cover meth in more detail. The average price for cocaine is about 300 to 350 per gram. That’s a $50 increase per gram than meth.
The most common chemicals that are used along with cocaine are alcohol and nicotine. The current data indicates that using alcohol along with cocaine increases mortality from cardiovascular complications. In 74% of cocaine related fatalities, another drug, usually alcohol has been ingested at the same time. The addition of alcohol increases the risk of sudden death by 25 fold. The reason is that the alcohol forms a third active compound called Cocaethylene.
Crack: What it is and how its used
So here’s where we need to talk about crack. Cocaine is the powdered form. Crack is the rock form and you can easily turn cocaine into crack. Production does not require the use of flammable solvents and so it is safer to make than freebase cocaine. There are lots of places online with recipes to turn cocaine into crack. Without getting into tons of specifics you have to dissolve the powder in hot water. You have to add sodium bicarbonate, otherwise known as baking soda. You boil it to separate out the salads and then cool the separated mixture and cut it up into the rock.
Crack rocks are white or tan in color and typically range from like 0.1 to 0.5 grams. Crack started appearing in big cities around the United States around 1985. Cocaine was really expensive. Crack was a lot cheaper. So here’s the thing about crack. You could buy a gram of pure cocaine. You could turn that into crack and sell it for much more than you paid for the gram of cocaine.
Because of this crack use was rampant in neighborhoods where incomes were lower. The sentencing for people possessing crack to cocaine were set up at about a 100:1. A low-level crack dealer could therefore be subject to harsher penalties than a high level cocaine dealer. .
Crack reaches the brain in less than eight seconds. And it produces a high, which peaks in the 10 to 15 seconds after. Typically it only lasts about 15 minutes. Because the crack tricks the brain into releasing chemicals that produce a false feeling of intense pleasure. The high is immediately followed by a very deep low. Lot of times this low is accompanied by sleeplessness, paranoia, irritability, restlessness. There are some reports of hallucinations and delusions. The side effects from crack tend to be a chronic sore throat, respiratory problems like bronchitis, weight loss, some brain seizures have been noted, sweating, high blood pressure, slow digestion, increased heart rate risk for heart attack and shortness of breath. The withdrawal effects tend to be nausea, paranoia, and an intense craving of the drug, including the physical problems that I listed just a second ago.
So remember that we talked about giant amounts of cocaine coming into the United States on a daily basis. In the mid eighties, people found a way to stretch this cocaine, even farther. The introduction of crack made a huge impact on the amount of cocaine being used and who it was being used by introducing communities to crack that wouldn’t previously have been using cocaine.
Crack is incredibly addictive. Now cocaine itself is said to be one of the most addictive substances on the planet. Well, crack takes that and puts it into a huge high with a huge low, and it’s really rapid and people would use it in succession over and over and over. . A hit of crack might cost $5, but when you have to use it multiple, multiple times and the low is really bad and you’re irritable and restless, you can see how the cycle goes.
So crack cocaine is baking soda and cocaine; where freebased cocaine is a crystal like powder and it’s less common. Freebase is made by adding ammonia and ether to a cocaine water solution. This is a more dangerous process as ether is highly flammable. But the resulting product is purer than crack cocaine.
Cocaine and Crack: Making a comeback
It might seem that we’re just looking at a history lesson here of the late seventies and eighties and the big cocaine crack problem that we had in the United States. Well, cocaine is making a comeback. A couple of years ago in my practice I started hearing about cocaine when I hadn’t heard about it pretty much at all. The first time I heard about it was , one of my younger clients who had been in a bar and had been snorting cocaine with some of the other bar patrons. As I’m listening to this, I’m thinking what?
I don’t live in a place that seems like it would be a haven for cocaine use. If cocaine made its way all the way up here to the small area in which I live, I’ve got to wonder what’s happening in big cities. Based on reports it’s not just the United States.
According to stats from the home office of the UK Border, for Scottish Government and Northern Ireland Police Service cocaine was the most seized stimulant in the UK, both in terms of number and quantity of those seizures. In another set of statistics released in 2016 for England and Wales, cocaine is one of the more commonly abused substances outside of marijuana.
Something that’s really important is that all over the United States and I’m assuming in other parts of the world, fentanyl has found its way into the cocaine supply. Now cocaine is a stimulant. People use it for its stimulant effects. Fentanyl the most powerful of the opiates is a downer. When combining heroin and cocaine, you get a speed ball, which as you can imagine is pretty dangerous. Now, remember fentanyl is a powder and not something that you’re going to be able to tell is in there. Fentanyl is getting into all sorts of different drugs from ecstasy to methamphetamine.
This causes the risk of overdose to increase exponentially. Cocaine used to be something that I didn’t really think about very much until that day, a few years ago, when my client was talking about using cocaine. If cocaine can make it into a small country bar where a client who’s typically just an alcohol user, decided to try cocaine. I extrapolate on that and I have to think, wow, it’s really coming back.
Cocaine has a lot of risks to it. One of the big risks of course, is that it absolutely can kill you. It can kill you the first time. It can kill you the 50th time. And it’s going to be typically from some kind of cardiac event. It is an incredible stimulant.
The trouble with it is that it’s not just the stimulant it’s the fact that it stays with you after you’ve used it and causes cravings to be intense for quite some time. Now, not the first time you use it. It’s not like you’re going to use Coke. And all of a sudden you’re like a Coke fiend instantly. But remember that Coke is one of those things that people use often in a binge way where they’re using it multiple times during a short period of time due to the way that it functions. So you get high, the high lasts for 15 minutes, and then you have to do it again.
Now for talking crack. Then you gotta drop that down because the high peaks at about 15 seconds after it first registers in your bloodstream and remembering that the downside or the comedown is really harsh.
We also have the problem that the most commonly abused chemical along with cocaine is alcohol and because of the interaction, it creates this third compound which increases the risk of death greatly. I think people see cocaine as something that they just do once in a while and that’s a party drug. Well, I think that people underestimate its power.
Cocaine is supposed to give you a super intense rush. Like I said earlier, when talking about dopamine rushes there’s only one thing that can cause a greater rush than cocaine and that’s methamphetamine. So we have this resurgence of cocaine and I haven’t heard a ton about crack, but I’m certain that it’s out there too.
People being able to take cocaine and create crack themselves. It doesn’t take a lot of skill, the recipe and the ability to cook it to the right consistency makes it not difficult to reproduce.
Cocaine also causes long lasting damage. It can cause sinus infections and loss of smell, damaging tissues and the nose. Can damage the lungs causing what’s called a crack lung with severe chest pains and breathing problems and fever. Crack lung can absolutely be fatal.
When we’re talking about injections then we have a whole new level of risk in terms of HIV and various forms of hepatitis. We also have the fact that there’s an increased risk for sexually transmitted infections because of the correlation between having risky sex and use of cocaine and crack. The stimulant effect also attempts some people to use it to manage their hunger and to manage weight.
Cocaine is something that I think a lot of us aren’t used to thinking about. We either think about it as being a rich person’s drug, or we think about it being something from history. However, cocaine is on its way back. And it’s something that we should be paying attention to. When you’re doing a drug use history, be sure to ask specifically if they’ve ever tried cocaine. When people use something just a couple of times, a lot of times they won’t list it as something that they’ve ever tried.
Cocaine is incredibly addictive and the recovery from it’s actually really hard. It’s not that recovery in general isn’t the hard because of course it’s hard. It’s super difficult, but there are some specific things about cocaine and the changes that it makes in the brain, making it more difficult at times to recover from cocaine use. The physical craving usually goes away from other substances more quickly than it does for cocaine. Don’t really have any effective medications right now to help manage those cocaine cravings.
Next week. We’re going to be talking about benzodiazepines. This is something that intersects our mental health world all the time. Benzodiazepines are useful medications that when used properly can be an incredibly effective tool for managing panic. There was a time when benzodiazepines were being prescribed in a way that I feel like was over prescribing, but it seems that that has been curbed along with the prescription of opiates.
I’m sure that many of you have had certain clients of yours either taken off their benzodiazepines or people have refused to give them benzodiazepines because of over-prescribing in the past. Benzodiazepines are also readily available on the street.
Next week we’re going to talk about that and the different kinds of benzodiazepines, which ones are most commonly abused and how they work. I hope you’ll join me for that podcast. Until then have a great week.
Thank you for listening to the All Things Substance podcast. For show notes, links and downloads, please visit betsybyler.com/podcast. If you loved what you heard today, it’d be great if you would share those with your therapist friends and colleagues. If there are topics that you think would be useful and you’d like to hear me cover them, please let me know. Just send a message to podcast@betsybyler.com. I’ll see you on next week’s podcast. And until then have a great week.
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