National Surveillance of Cocaine Use and Related Health Consequences

A recent report on extensive surveillance of cocaine use and related health consequences compiled by the National Institute on Drug Abuse (NIDA) of the U.S. Public Health Service is discussed below.

An initial report from the early 1970s stated that little cost to society attributed to cocaine use had been verified in the United States (1). This pattern of low cost was believed to reflect the route of administration most commonly used, i.e., sniffing or "snorting," and an estimated low prevalence of chronic use. However, use of cocaine has increased substantially in the United States since that time. A more recent report indicates that almost 10 million people over the age of 11 years reported having used cocaine during the year preceding the survey, and almost half of these had used cocaine during the month before the survey (2). Two-thirds of these self-reported cocaine users were between the ages of 18 and 25 years. Overall, the number of people in the United States reporting cocaine use in 1979 was more than double that in 1977 (3). Additional survey data from 1975 through 1981 show a similar trend for graduating high school seniors (4). There was a substantial increase in the number of these students who reported having used cocaine both during the year and the month preceding the survey, i.e., from 5.6% to 12.4% and from 1.9% to 5.8%, respectively.

The recent marked increase in the prevalence of cocaine use is also reflected in health consequences associated with use. Figure 1 shows data on morbidity and mortality associated with cocaine use reported to the Drug Abuse Warning Network (DAWN)* (5) and the rate of treatment-program admissions for problems related to cocaine use reported to the Client-Oriented Data Acquisition Process (CODAP)** (6). As the figure shows, there was a more than 3-fold increase in the rate of cocaine-related emergencies/10,000 emergencies (from 0.7 to 2.3) and the rate of cocaine-related deaths/10,000 medical-examiner reports (from 4.5 to 19.1) between 1976 and 1980-1981. At the same time, the percentage of cocaine-related treatment-program admissions increased more than 6-fold in the period 1975-1981.

Males associated with reported non-fatal cocaine-related emergencies outnumber females by more than 2 to 1 (Table 1), a ratio that is consistent with prevalence estimates for current use of cocaine. The prevalence ratio for cocaine use is 7 to 1 for whites compared with all other races; the emergency cases for which race/ethnicity is recorded are about equally distributed between whites and others (Table 2). Clear age differences exist, however, in both sex and race categories, with females being younger than males and whites being younger than blacks.

Despite regional variability in cocaine-related morbidity rates, almost all metropolitan areas reporting to DAWN have shown substantial increases in the period 1976-1981 (Table 3). Although a portion of the increase may have resulted from improved reporting-- which may reflect a greater awareness among emergency-room staff of the potential implications of cocaine use--much of the increase is due to actual increased prevalence, including use of cocaine in combination with other substances. For example, 64% of all cocaine-related emergencies reported to DAWN in 1980 were reported in combination with the use of other substances, including alcohol.

Data on treatment support the conclusion that changes have occurred in patterns of cocaine use. Table 4 shows changes indicating increases in smoking and intravenous use in the period 1977-1980. Both these routes of administration result in more immediate and direct absorption of the drug and produce a quicker and more intense euphoria, while, at the same time, substantially increasing the possibility of acute toxic reaction. Reported by NJ Kozel, MS, RA Crider, PhD, EH Adams, MS, Div of Data and Information Development, National Institute on Drug Abuse, US Public Health Svc, Dept of Health and Human Svcs.

Editorial Note

Editorial Note: Cocaine is an alkaloid derived from the leaves of the coca shrub (Erythroxylon Coca). The U.S. Pharmacopeia compound consists of white, odorless crystals or crystalline powder having a purity of 100% (plus or minus 1). Its current medical application is limited to topical use for anesthesia of the ear, nose, and throat, and for bronchoscopy.

Illegally distributed cocaine is often adulterated with a variety of substances including procaine, lidocaine, and amphetamines, as well as sugars, such as mannitol and lactose. The dangers involved in cocaine use include consequences of both acute and chronic use. Acute toxicity, similar to that caused by amphetamines, is characterized by nervousness, dizziness, blurred vision, and tremors, and may lead to convulsions, cardiac arrhythmias, and respiratory arrest. Chronic use is associated with ulceration and perforation of the nasal septum, weight loss, insomnia, anxiety, paranoia, formication, and hallucination.

The increased prevalence of cocaine use and of the health consequences associated with that use may be based on increasing availability and changes in the patterns of use. The U.S. Department of Justice estimated that between 40 and 48 metric tons of cocaine hydrochloride were imported into the United States in 1980, an increase of more than 50% over the previous year (7). In addition, changes in the route of administration of the drug from inhaling or "snorting" to freebasing (processing the cocaine into a pure form by removing the hydrochloride base and then smoking the freebase) and to intravenous use may be causing adverse health consequences.

References

1. Marihuana and Drug Abuse Commission. Drug use in America: problem in perspective, second report of the National Commission on Marihuana and Drug Abuse. Washington, D.C.: National Institute on Drug Abuse, March 1973. Public Health Service.

2. Fishburne PM. National survey on drug abuse: main findings 1979. Rockville, Md.: Office of Medical and Professional Affairs, National Institute on Drug Abuse, 1980, Public Health Service.

3. Abelson, HI. National survey on drug abuse, 1977: a nationwide study--youth, young adults and older people. Washington, D.C.: National Institute on Drug Abuse, 1979. Alcohol, Drug Abuse, and Mental Health Administration, Public Health Service.

4. Johnston LD, Bachman JG, O'Malley TM. Student drug use in America, 1975-1981. Washington, D.C.: National Institute on Drug Abuse, 1981. Alcohol, Drug Abuse, and Mental Health Adminisitration, Public Health Service.

5. Drug Abuse Warning Network. 1976-1981 data (tape-SRVCD 48). Washington, D.C.: National Institute on Drug Abuse, December 1981. Public Health Service.

6. Division of Scientific and Program Information. Client-oriented data acquisition process. Rockville, Md.: National Institute on Drug Abuse, 1980. Alcohol, Drug Abuse, and Mental Health Administration, Public Health Service.

7. National Narcotics Intelligence Consumers Committee. The supply of drugs to the U.S. illicit market from foreign and domestic sources in 1981 (with projections through 1984). Washington, D.C.: 1982. Drug Enforcement Administration, Department of Justice. *DAWN is a morbidity- and mortality-information system, funded by NIDA, in which data are collected from a non-random sample of more than 800 hospitals located in 26 major metropolitan areas in the continental United States and in a national panel of hospitals outside these areas, and from medical examiners/coroners located in the 26 major metropolitan areas. **CODAP was a drug-abuse treatment-program information system, operated by NIDA, through 1981, in which data were collected for persons admitted to all federally funded treatment programs in the United States.

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