Once considered a harmless source of pleasure and therapeutic benefit, today the drug cocaine is vilified as the cause of great misery and suffering for many who have succumbed to its euphoric effects. Yet, by nearly all acounts, cocaine is here to stay, despite the billions of dollars that government agencies around the world spend each year to eliminate it.

From the streets of cities as large as Los Angeles, New York, and Chicago, to small rural towns, Americans consume more cocaine than does any other citizenry in the world. An estimated 80 percent of all South American cocaine — approximately one thousand tons annually — finds its way to America’s consumers. The size of the market for cocaine is staggering by any measure. An estimated 40 million Americans admit to having tried cocaine, either in powdered form or as crack. Moreover, between 2 and 4 million people admit to regular use of or addiction to cocaine. Faced with such numbers, American political and spiritual leaders have labeled cocaine use an epidemic.

Cocaine use swept across America during the 1970s, glamorized by rock stars, Hollywood personalities, and heroes of professional sports. Their widely publicized use of the drug brought it to the attention of many Americans for the first time and gave it unprecedented status. More and more Americans began to explore the drug’s euphoric effects, but cocaine’s dark side began to emerge after a decade of use by people who first saw it as a fun and harmless drug. Addiction rates among young people and deaths from overdoses began to make headlines in newspapers and television news programs across the nation.

By the mid-1980s, what was already an epidemic was termed a crisis as a new, cheap form of cocaine called “crack” appeared on the streets. The low cost of crack made it the drug of choice among America’s inner-city poor. Street gangs warred over the control of the sale and distribution of crack. This violence, on top of the crime committed by addicts to support their habits and hundreds of fatal overdoses annually, added to the misery and hopelessness of life in urban ghettos. This desperate situation became worse when hospitals began reporting an apparent increase in the number of babies born to crack-addicted mothers. These babies, who seem to share their mothers’ addiction, were dubbed “crack babies” by the media.

A Costly Scourge

In addition to the human cost, the cocaine epidemic demands enormous amounts of money. Annually Americans are consuming roughly one thousand tons of cocaine at an estimated street cost of $90 billion — half of the value of all of America’s agricultural products combined. On top of the amount of money spent purchasing cocaine, enormous sums of tax money are spent confiscating cocaine, prosecuting and incarcerating traffickers, and helping addicts to overcome their drug habits.

How much the cocaine and crack epidemic costs taxpayers is difficult to estimate because of the numbers of people involved, but some of that cost is clear enough. The U.S. government annually spends $2 billion in foreign aid to cocaine-producing countries to help them eliminate the drug at its source. In addition, the Drug Enforcement Administration (DEA) has an annual budget of $19 billion to intercept illegal drugs — cocaine among them — before they enter the country. Therapy for cocaine and crack addicts costs the taxpayers another $3 billion per year. On top of these known amounts are unknown sums spent by many branches of the military and local law enforcement agencies to intercept, arrest, prosecute, and incarcerate cocaine and crack traffickers and users.

Despite the costs, America’s appetite for cocaine in its various forms seems insatiable. Political and civic leaders have organized to try to free America from the grip of the cocaine epidemic, but are divided on how best to do this. One faction proposes that America support a war on the coca fields in South America on the assumption that by destroying them, the supply of cocaine will dry up. Another faction proposes that America can stop cocaine trafficking only by providing more money for law enforcement, health practitioners, and social service workers to deal with the demand for the drug at home.

Neither of these two approaches has won the war on cocaine, however. Although use of cocaine in powder form has declined since 1985, crack use has increased. Both drugs, moreover, remain a major health and social problem and both continue to thrive on the streets of America regardless of the billions of dollars annually spent trying to stamp them out.

At the beginning of the twentieth century, the medicine cabinets and pantries in many American homes held a variety of pills and foods containing cocaine as an ingredient. At the time, cocaine was considered to offer considerable benefits as an energy booster and as a topical remedy to relieve minor pain such as toothache. For example, in 1900, Sears, Roebuck, and Company advertised a product called Coca Wine. The advertisement for the wine boasted that it “sustains and refreshes both the body and brain… It may be taken at any time with perfect safety … it has been effectually proven that in the same space of time more than double the amount of work could be undergone when Peruvian Wine of Coca was used, and positively no fatigue experienced.”

At the turn of the last century, both the medical profession and the pharmaceutical industry believed the claims that cocaine was useful and safe as an energy booster and for pain relief. Doses of the ingredient in foods and medicines were quite small, and most consumers did not experience problems from occasional use of such products. The few people who studied and wrote about cocaine during this era also believed that it had the potential to become a panacea — a wonder drug for the new century.

South American Origins

Although Americans in the early twentieth century saw cocaine as a modern miracle, Indian tribes living in the Andes ranges of South America had known about this drug for five thousand years. People living at high altitudes where the air is thin discovered that chewing the leaves of the indigenous coca plant increased their energy levels. This plant, known to modern-day botanists as Erythroxylon coca, not only boosted energy but seemed to impart a sense of well-being.

Unbeknownst to the Indians, the boost in energy they experienced came from a chemical agent in the leaves called cocaine alkaloid. This chemical also contributes to the coca plant’s abundance — it acts as an insecticide, killing insects that try to feed on the plant.

Cocaine alkaloid occurs in low concentrations in the coca leaf, between .01 and .08 percent. As a result, chewing the leaves delivers a relatively low dose of the drug. At these low doses, people could partake of cocaine and still function normally. Furthermore, because the drug was never ingested in large quantities, its addictive qualities were less pronounced.

Indians noticed other beneficial effects besides the energy boost and euphoria. They discovered that chewing the coca leaf reduced the pain of tooth decay. They also found that chewing coca leaves relieved the physical discomfort that was part of long journeys on foot in the Andes. In fact, the use of coca was so common among mountain travelers that they measured the length of a journey by the number of wads of coca leaves chewed rather than by time or distance.

Introduction to Europe and America

Medical Applications

Commercial Value

Beneficial though cocaine seemed to the medical profession, its real growth was among people who were simply looking for an antidote to fatigue. Since no one in the medical profession had raised any serious reservations about possible harmful effects of cocaine, it appeared to be ideal as an energy booster. The earliest and most popular use of cocaine in a commercial product was the drink Vin Mariani, a mixture of wine and cocaine introduced in England in 1863. The beverage’s popularity was widespread, perhaps due to the fact that Vin Mariani claimed it was endorsed by such luminaries as the American inventor Thomas Edison, British writer Sir Arthur Conan Doyle, England’s Queen Victoria, and even the pope.

Following the success of Vin Mariani, the Coca-Cola Company, in 1886, added 60 milligrams of cocaine to each bottle of its product and advertised it as a beverage that would invigorate the drinker. At about this same time, drug companies also saw the commercial value of cocaine and added it to products designed to relieve sore throats and toothaches.

By 1910 commercialization of products with cocaine was rampant as elixirs sold as magical potions guaranteed to make people happier and more energetic. Claims that these potions could cure everything from backaches to heart problems to difficulties in a person’s love life caused congressional leaders to become alarmed at the widespread and uncontrolled use of cocaine in the nation’s food and drugs.

The elevated moods and energy surges that cocaine induced in its users became widely known. Its effects on the body, however, remained a mystery. Although no ill effects had been observed, many doctors called for research to determine exactly what effects cocaine had on the body and whether any of these effects might have long-term adverse consequences.

Short-Term Physiological Effects

Long-Term Physiological Effects

Is Cocaine Addictive?

The use of coca changed somewhat when the Spanish conquistadors first came to South America during the mid-sixteenth century. After the Spanish conquered the mountain tribes they forcibly converted them to Catholicism; Catholic priests, wishing to stamp out what they saw as a pagan practice, forbade the chewing of coca leaves. The Spanish, however, also forced the Indians to labor in the mines and fields and quickly observed that the workers tired more quickly when deprived of their coca leaves. To remedy this situation, the Spanish overseers distributed leaves to workers three to four times a day to increase their energy levels and productivity. The overseers began chewing the leaves as well and noted the same pleasant effects that the Indians experienced.

The Spanish sent shipments of the leaves back to Europe, where they became quite popular among the wealthy. The chewing of coca leaves did not, however, become widespread because shipping large quantities of leaves was not economically feasible and attempts to grow coca in Europe failed because the climate there was not suitable.

For nearly two hundred years, interest in coca leaves and their effect on the mind and body languished; for the most part the coca plant was merely a curiosity, of concern only to botanists such as Sir William Hooker, who in 1835 made the first accurate drawing of Erythroxylon coca for the magazine Companion to the Botanical Magazine. Cocaine’s potential for medical use remained known to a few doctors, however, and in 1850 small amounts of diluted cocaine were used experimentally for the first time as an anesthetic during throat surgery. By 1855, scientists had accomplished a major breakthrough when they learned how to extract pure cocaine from the coca leaves in large volumes.

Although the medical community in Europe was just beginning to investigate the medical benefits of cocaine, soldiers had the most direct experience with the drug. Military leaders, learning of cocaine’s effectiveness both as a painkiller and as an energy booster, tested cocaine on troops and found that these soldiers were able to endure longer marches and to fight more vigorously than soldiers who did not take the drug. Tests also indicated a distinct increase in soldiers’ willingness to engage in fierce battles under the drug.

As the amount and availability of cocaine increased in Europe, some of it got into the hands of the public, which quickly discovered its ability to boost a person’s energy level. Office workers found that cocaine seemed to make their day pass more swiftly, and athletes soon recognized that cocaine might have value in sports that required endurance. Several English long-distance runners, for example, attributed their success to chewing the coca leaves during races.

In the decades since research began, doctors have come to recognize that of the body’s many systems, the cardiovascular system experiences the most noticeable short-term effects of cocaine use. The first of these is a rapid increase in the user’s heart rate, which results in the heart pumping a greater volume of blood through the body. This is essentially the same effect that results from strenuous physical activity except that when cocaine is the cause, blood vessels narrow, forcing the heart to work not just faster but harder. Occasionally, cocaine also causes temporary rapid or erratic heart rhythms, increased blood pressure, and increased body temperature.

The central nervous system also experiences temporary physiological changes. As the cocaine carried by the bloodstream enters the brain, the electrical activity of the brain is temporarily altered as the cocaine is absorbed by cells called neurons. The absorption of cocaine alters the chemistry of the brain to increase production of the chemical dopamine. This change in brain chemistry is responsible for the sense of euphoria, sometimes referred to as a “rush” that is usually described in pleasurable terms as a sudden sense of excitement.

In most healthy people, most of these symptoms disappear within thirty to sixty minutes as the liver chemically decomposes the cocaine, which is then removed from the system by the kidneys.

Dopamine Research

Although the neurotransmitter dopamine has been linked to the euphoric effects of cocaine for several years, recent research suggests that dopamine may only be part of the puzzle, and researchers now suspect that other neurotransmitters may also play a role.

In 1999 researchers at the University of North Carolina at Chapel Hill wrote a summary of dopamine research titled “Breakthrough? Study Finds Dopamine Cannot Be Source of Pleasure in Brain.” University researchers implanted a tiny carbon fiber electrode in laboratory rats to stimulate the animals’ brains’ pleasure centers in the same way cocaine does. According to Dr. R. Mark Wightman, “We discovered that when we applied the electric shock to a pleasure sensor in the brain of untrained rats, we clearly saw dopamine, but when the animals themselves applied the shock, little or no dopamine appeared.”

Wightman and his staff conclude that although dopamine may be involved in initial learning or anticipation of reward, it clearly is not responsible for continuous pleasure. Wightman suspects that cocaine stimulates production of other neurotransmitters such as serotonin, and that these may be responsible for continued pleasure.

Researchers found little, if any, lingering effects from occasional use of cocaine. The long-term physiological effects for persistent cocaine use over many years are dramatic, however. Although the kidneys filter out cocaine after each use, the cumulative effect of hundreds of cocaine doses eventually alters the body’s physiology and leads to physical damage. The organ that suffers the most damage is the brain. The more frequently cocaine users ingest the drug, the more frequently the blood vessels in the brain are narrowed and fail to adequately provide needed oxygen. Deprived of oxygen, brain cells die, so frequent cocaine use eventually compromises the brain’s function. Furthermore, as the blood pressure in the millions of tiny constricted blood vessels and capillaries that supply the brain builds, they gradually break, causing hemorrhage. Dr. Thomas Kosten described this phenomenon during congressional testimony in 1999:

If these vessels are blocked for even a few minutes, brain cells die and thinking, feeling, moving and life itself can cease. Cocaine blocks these blood vessels by constricting them and filling them with abnormal clotting cells called platelets. A large blockage like this leads to strokes in some cocaine abusers, and in most abusers the blockages are smaller, but occur in multiple places in the brain. These multiple blockages leave the cocaine abuser’s brain shrunken, discolored and often poorly functioning.

The restriction of blood supply to the brains of long-term cocaine users appears to be permanent. Scientists have recently been able to observe the restricted blood flow in the brains of such individuals. Using an imaging technique called positron emission tomography (PET), scientists can document the flow of blood in the brain tissue. When the researchers compared PET scans of long-term cocaine abusers with PET scans of normal non-cocaine abusers, they found that the abusers had less blood flow in several areas of the brain. When the researchers performed PET scans again ten days after cocaine use had been discontinued, the blood flow deficits remained even though the subjects in the study had stopped using cocaine.

Not only does the cocaine-related brain damage appear permanent, but the constricted arteries are vulnerable to strokes, which in turn can cause paralysis of parts of the body, the complete loss of speech, loss of memory, and even death. The overall effect is similar to greatly accelerating the aging process. Dr. R. I. Herning, a researcher working on the effects of long-term cocaine use, says, “Our data suggest that cocaine abusers in their thirties have arteries that are as constricted as those of normal subjects in their sixties.”

The cardiovascular system can also suffer damage from long-term cocaine use. The heart, in response to blood vessel constrictions, pumps faster and with greater force in order to meet the oxygen requirements of the body. When the heart is forced to sustain these elevated rates and pressures, it is vulnerable to serious, even deadly problems. For example, the heart can begin to beat erratically, which is called ventricular fibrillation. During an attack of fibrillation, little blood is pumped and without immediate treatment, the victim can die. The heart can also race at rates three to four times normal, a condition called tachycardia. Persistent tachycardia can lead to death.

Medical researchers have proven that long-term cocaine use can cause permanent and massive damage to the brain and heart. Understanding the physical damage inflicted on the body by cocaine, however, has been far easier for researchers than understanding the psychological effects of cocaine. Central to this understanding is the question of whether cocaine is addictive or not.

The immediate psychological effect of cocaine ingestion is euphoria. The intensity of this effect depends on how fast the drug reaches the brain; that is, the faster cocaine reaches the brain, the more intense the euphoria. For the first few minutes after inhaling powdered cocaine, or the first few seconds after injecting it, the user experiences the onset of the euphoria, known as a rush. Users describe such feelings as a heightened state of pleasure, a profound sense of mastery over their personal affairs, a sense of cleverness, and an unquestioned confidence in their ability to achieve their goals. Many users claim that the drug helps them perform many physical and intellectual tasks more quickly. As one youth describes it, cocaine made him feel “as if I was going up in a flying machine” or “as if I was a millionaire and could do anything I pleased.” In addition to the sense of euphoria, many users describe being more energetic, talkative, and more acutely aware of the sensations of sound, taste, color, and touch. Officer Gordon James Knowles of the Pearl Harbor Police Narcotics Division questioned a cocaine user and dealer named Carl, whose description of the initial rush also explains its value as an escape from reality:

I feel high like you wouldn’t believe… It’s hard to explain how you feel… I feel like I’m floating on air… On one hand … I feel like an idiot for doing what I’m doing and that is absolutely nothing except getting high, but on the other hand, I love it because I’m getting high as much as I want, when I want … and that makes up for everything else. You see people who live on the streets, 99 percent of them snort coke because it’s a way for them to forget about life … forget about the things you wanted in life … this is like a replacement.

New pharmacological research supports a widely held theory that cocaine-induced euphoria is tied to a chemical messenger in the brain called dopamine.

Dopamine is a special chemical, called a neurotransmitter, that has the job of transmitting electrical messages from one nerve cell, or neuron, to the next. Researchers, who have identified more than fifty different neurotransmitters, believe that dopamine is the one responsible for interacting, or binding, with the psychoactive chemicals found in cocaine. Dopamine is called the “pleasure neurotransmitter” because the impulses it transmits impart a pleasurable sensation.

Dopamine flows from neurons into the synapses, the tiny spaces between neurons, to form a temporary bridge that carries the signal across the synapse. Normally, after a neuron has transmitted its signal to the next neuron, the dopamine leaves these spaces, returning to the same neuron that released it in a recycling process called re-uptake.

If cocaine is present in the brain while an electrical signal is taking place, scientists believe it blocks the re-uptake process, resulting in a buildup of dopamine in the synapses which creates an abnormally acute sense of pleasure. As the buildup of the dopamine neurotransmitter continues, it causes the euphoria commonly reported as the pleasurable rush.

Exactly why this pleasurable sensation occurs is still largely a mystery. However, Dr. Donald W. Landry, associate professor of medicine at Columbia University, speculates that the answer lies in the limbocortical region deep in the center of the brain. Cocaine, he suspects,

stimulates a neural “reward pathway” that evolved in the ancestors of mammals more than 100 million years ago. This pathway activates the so-called limbocortical region of the brain, which controls the most basic emotions and behaviors … [that] undoubtedly conferred a survival advantage. The same structures persist today and provide a physiological basis for our subjective perception of pleasure. When natural brain chemicals known as neurotransmitters stimulate these circuits, a person feels “good.”

When all the cocaine has reacted however, the re-uptake process begins and the dopamine levels drop, causing the euphoria to disappear as fast as it first appeared. The absence of euphoria is experienced as depression. The user also experiences irritability, fatigue, and an intense craving for more of the drug to escape the depression.

It is worth noting that this view of how dopamine causes its pleasurable effects is still theoretical, as Dr. Solomon Snyder of Johns Hopkins University indicates: “Again, we do not know for certain exactly how the brain regulates specific behaviors, but we can formulate some educated guesses and … we can use these guesses as the basis for the next important advances in understanding.”

For those who have experienced the cocaine cycle of “rush-to-crash” many times, the psychological effects have long-term consequences that become a constant part of the habitual user’s life.