Cocaine epidemic

Minkler, M., Roe, K.M. and Price, M. (1992) The physical and emotional health of grandmothers raising grandchildren in the crack cocaine epidemic. Gerontological Society of America 32, 6, 752-761. 

Roe, K.M., Minkler, M., Barnwell, R.-S. and Jendrek, P.M. (1994) The assumption of caregiving grandmothers raising the children of the crack cocaine epidemic. Qualitative Health Research 4, 3, 281-303. 

The highest proportions related to cocaine abuse over the first two quarters of 2006 (excluding alcohol) were reported for people in treatment in Port Elisabeth (36%) and in East London (28%), followed by Gauteng (21%). Cape Town was the first city to develop a cocaine epidemic in South Africa in the 1990s. In this city, however, methamphetamine has largely replaced cocaine as the drug of choice in recent years so that cocaine now accounts for 9 per cent of treatment demand. Data for the third and fourth quarters of 2006 show that the overall upward trend for cocaine continued. 

So why is there a disparity in the federal sentencing guidelines In the 1980s, as the powder cocaine epidemic was drawing to a close, a new epidemic was emerging—crack cocaine. Crack sold for as cheaply as three to five dollars per rock. Suddenly, the market exploded and crack use spread to the young and the poor. Though cocaine powder is powerfully addictive, crack seems to be even more so. 

The Coca Leaf Early Use of Cocaine The Amphetamines Cocaine Epidemic II The Return of Meth Pharmacokinetics of Stimulants Mechanism of Stimulant Action Acute Effects at Low and Moderate Doses... 

Niemann s success would lead to the first widespread cocaine epidemic. Since the full extent of the drug s addictiveness 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. 

Abuse of phencyclidine hydrochloride (PCP) is a national problem that has reached epidemic proportions in urban areas of the United States. The drug is inexpensive, readily obtainable, and is usually used in combination with other drugs such as marijuana, heroin, cocaine, and alcohol (Golden et al. 1982). The routes of PCP use include inhalation, ingestion and parenteral administration. 

In the epidemiological tracking of agitated delirium victims in Metropolitan Dade County, men with preterminal delirium comprised approximately 10% of the annual number of cocaine overdose deaths. The demographic trends show that the proportion of these cases remains consistent throughout the epidemic of cocaine abuse and tends to track the annual frequency of cocaine-related sudden deaths. This observation suggests that a certain percentage of cocaine addicts may be at risk for cocaine delirium with chronic abuse. 

Angrist, B. M. Cocaine in the context of prior central nervous system stimulant epidemics. In Cocaine in the Brain (Mind in Medicine Series), Volkow, N. and Swann, A.C., Eds. Rutgers University Press, New Brunswick, NJ, 1990, 7. 

In contrast, some drugs of abnse prodnce intense craving and are highly addictive bnt do not prodnce physical dependence. The absence of physical dependence indicates the relative lack of physiological withdrawal. This is not synonymous with meaning that discontinuation of these componnds may not be psychologically nncomfortable. Two examples are marijnana and cocaine. One need only look to the recent crack epidemic to see evidence of the way these substances can destroy lives, bnt they do not produce tolerance or risk of withdrawal to the same extent as alcohol or heroin. As a result, we would say that the daily crack or marijuana user meets the dehnition of substance dependence bnt does not exhibit true physical (or physiological) dependence. 

By the 18th century in Europe, distilled spirits such as gin had become a devastating new problem, particularly among the poor in cities such as London. Gin was cheap, produced a quick high, and proved highly addictive to people seeking to escape the misery of poverty. Gin houses advertised that one could get drunk for a penny and dead drunk for two pence. The problem was made worse by employers who paid their employees in gin instead of cash. The British government tried to control the gin epidemic with laws such as the Gin Act of 1736. One could say that gin was the crack cocaine of its time. 

Desipramine is a tricyclic antidepressant that has been tested in several double-blind trials among cocaine addicts. Like cocaine, desipramine inhibits monoamine neurotransmitter reuptake, but its principal effects are on norepinephrine reuptake. It was hypothesized that desipramine could relieve some of the withdrawal symptoms of cocaine dependence and reduce the desire for cocaine during the vulnerable period following cessation of cocaine. This drug showed efficacy early in the epidemic in a group of patients who were primarily white collar intranasal cocaine users. The majority of subsequent studies of desipramine-using, more severely ill cocaine addicts have been negative. 

In the 1970s there was a resurgence of powder cocaine use. This preceded the epidemic of crack cocaine in the 1980s. Because crack cocaine is cheaper than powder, it became more readily available to the young and the poor. Crack addiction and crime began to increase rapidly and this increase was publicized in the media. In response to public concern, the Anti-Drug Abuse Act of 1986 and 1988 was passed. Known sometimes as the 100 1 law, this federal law includes mandatory minimum sentences for first-time offenders. The penalties are much harsher for possession of crack cocaine than powder cocaine. 

While laws continued to be passed over the next seven decades, none proved to be as controversial as the Anti-Drug Abuse Act of 1986 and 1988. Like the Harrison Act, this law arose during an epidemic of cocaine use. 

This time, it was the 1980s epidemic fueled by crack. In 1986, the death of two promising young athletes, Len Bias and Don Rogers, added to public outrage. The new laws differentiated between powder cocaine and crack and were much harsher on the latter. These laws require 100 times as much powder cocaine possession as crack to trigger an identical minimum mandatory prison sentence. Ongoing controversy surrounds this law. Several bills have been introduced to reduce the disparity, but none have been passed into law as of early 2002. 

See David T. Courtwright, The Hidden Epidemic Opiate Addiction and Cocaine Use in the South, 1860-1920, Journal of Southern History 49 (1983) 57-72. 

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