Today the Mexican Cartel supplies 70% of cocaine, fentanyl, heroin, marijuana, and methamphetamine in the United States, an industry that has been responsible for the deaths of 150,000 people from 2006-2012. (Beittel, Mexico: Organized crime and drug trafficking organizations). The economic impact of violence in Mexico has been approximated to 135 Billion USD (Davis, A short history of Mexican drug cartels); with the US and Mexican governments spending billions to combat this problem, to no avail. But how did Mexico reach this point of immense bloodshed and governmental fiasco? The story begins in the early 1990s.

Background of the problem at hand

While small-scale drug trade has existed in Mexico since the early 1900s, this small-scale trade became a global industry with the collapse of the Medellin and Cali Cartel of Colombia. US’s victory in terminating the Colombian Cartels was short-lived: “Colombian drug manufacturers turned to new and safer transit routes through Mexico where enforcement policy was practically non-existent.” (Waters, Inside Mexico’s Drug Wars).

This led to the rise of the Mexican Cartels, primarily the Gulf, Sinaloa, and Juarez Cartels. These Cartels saw a rapid rise to power using corruption and violence to carve their path to absolute power. Their economic successes in supplying the largest drug consumers in the world – The United States – gave them the ability to pay off judges, officers, and politicians. “They also coerce officials into cooperating; assassinations of journalists and public servants by the cartels are relatively common”. (CFR.org Editors, Mexico’s Long War: Drugs, crime, and the cartels)

The Mexican government’s failure to protect its people has contributed to the cartel’s gaining “ideological power”, leading to a large proportion of Mexican youth joining the Cartels and a much larger Mexican population conforming to its rules. This has made the Cartels the “alternate government” or the “illegitimate power source”. The consequence of this – a full-fledged civil war between the government and the cartels (Pointer, The ideological power of the Mexican cartels escalates violence)

Effect on the Mexican civilian

Over the past 20 years, Mexico has been in a constant state of chaos, battle, and suffering: the burden of which is most strongly felt by innocent civilians who have become the collateral damage of this war. The 2011 Human Rights Watch report found that human rights complaints increased sevenfold from 2003-2010, with complaints of torture tripling in the same time period. The shocking fact is that law enforcement plays a large part in conducting these human rights violations, namely a number of counts of forced disappearances and extrajudicial killings.

With the Mexican military busy on the battlefield, there is no one to ensure basic public safety – adding to the perils of the civilians – contributing to this human rights crisis. Additionally, the flawed nature of the Mexican Judicial system makes it so that a mere one of two hundred crimes end in conviction. The flaws of the judicial system don’t end there: “only eight of Mexico’s thirty-two states have laws against forced disappearances and only sixteen have formally criminalized torture”. Quite apparently, this war has disrupted the livelihood of millions.

Mexican Government’s approach to combating the problem

President Felipe Calderón’s (2006-2012) primary method of combatting the problem was the breakdown of the Cartels by hunting major drug kingpins. By deploying the Mexican Military, reinforced by US assistance, Calderón was able to eliminate 25 of the top 37 drug kingpins in Mexico. This created a power struggle for the leadership of the cartels, leading to a lot of internal violence and overall instability in the region. The consequence? Creation of a dozen stronger, more violent drug gangs and 120,000 homicides during his term. (CFR.org Editors, Mexico’s Long War: Drugs, crime, and the cartels)

The next president, Enrique Peña Nieto (2012-2018) followed his predecessor’s footsteps, dumping more and more money into the national forces and military. Once again, this lead to more cartel fragmentation but unfortunately also an increase in homicides – a product of territorial cartel violence.

Andrés Manuel López Obrador launched the “Abrazos, no balazos” scheme, which translates to hugs not bullets. Under this scheme, Obrador reduced military pressure on the cartels and instead worked towards strengthening the socioeconomic standing of the country through job creation. In theory, this would eliminate the prevalence of organized crime by solving the problem at its beginning stage. The program launched an anticorruption drive to disrupt cartel finances, proposed decriminalizing all illegal drugs, and even offered amnesty to cartel members.

Contrary to its intentions, this program caused a large-scale increase in violence and cartel activity, a product of no judicial retribution. “This allowed all but the smallest cartels to act with near impunity, effectively replacing the Mexican government as the de facto power in many provinces, erecting roadblocks, enforcing taxes, and policing entire regions.”

(Reeves & Callum, The impact of Mexico’s “Hugs not bullets” campaign)

Situation today

On 6^th January 2023 Ovidio Guzmán – the son of El Chapo, the world-famous drug lord and former leader of Sinaloa Cartel – was arrested by Mexican authorities. The arrest took place in Culiacán, Sinaloa – the result of a lengthy operation involving 200 special force officers. The aftermath was bloody, with 10 military personnel and 19 gang members losing their lives in the violent clashes taking place in Northern Mexican state. Guzmán was to be extradited to the US immediately, following the same fate as his father, but a Mexican federal judge halted the extradition due to “formalities of the law”. Reporters however believe this postponement of extradition is a precautionary response to the outright bloodshed committed by the Sinaloa cartel. (Plaza et al., Extradition of ‘el chapo’ son to the US halted after 29 killed in arrest operation)

The arrest took place only a few days before US president Joe Biden and Canadian President Justin Trudeau were to visit Mexico city for the North American Leaders Summit. This could have been a way for Obrador to show America that Mexico is in control of the situation, and is actively working to destroy its drug empire.

While this could be perceived as a victory for the Mexican government, the fact is that this will just create more cartel fragmentation – meaning more bloodshed for the country of Mexico, more suffering for its civilians, more damage to its economy, and the continued prevalence of alternate governments.

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Illegal drug use is dangerous. When you use street drugs you are taking a lot of risks, because there is usually no way to know how strong they are or what else may be in them. It’s even more unsafe to use them along with other substances like alcohol and marijuana.

Here’s a rundown of common street drugs and the health threats they can pose.

Bath Salts

These designer drugs came on the scene fairly recently and became popular fast. That may be because they were easy to get and used to be hard to detect in drug tests.

They’re highly addictive, and they come in a crystalline powder that users swallow, inhale, or inject.

Despite their name, bath salts have nothing in common with products you can use for a soak in the tub.

What else they’re called: Plant Food, Bloom, Cloud Nine, Ivory Wave, Lunar Wave, Scarface, Vanilla Sky, or White Lightning.

What type of drug is it? Bath salts contain manmade stimulants called cathinones, which are similar to amphetamines.

What are the effects? These stimulants increase levels of dopamine, a brain chemical that can create feelings of euphoria.

Some say the effects are similar to cocaine or methamphetamines. But they’re even more likely to cause serious health effects, including:

• Violence
• Paranoia
• Agitation
• Hallucinations
• Psychosis
• Racing heart
• High blood pressure
• Chest pain
• Panic attacks
• Dehydration
• Kidney failure
• Death

Cocaine

This drug comes in different forms. A user can snort the powder type through their nose or inject it into their bloodstream. Crack is a crystal form of the drug that’s smoked and absorbed into the bloodstream through the lungs.

What else it’s called: Blow, Bump, C, Candy, Charlie, Coke, Crack, Flake, Rock, Snow, or Toot.

What type of drug is it? Cocaine is a highly addictive stimulant made from the coca plant. Crack cocaine is even more addictive.

What are the effects? It triggers your brain to release dopamine and creates a euphoric feeling. The high is intense but short-lived, which leads people to use it repeatedly to try to keep the feeling going.

The risks are:

• Increased heart rate
• High blood pressure
• Increased body temperature
• Stomach pain, nausea
• Loss of appetite, malnourishment
• Heart damage and heart attack
• Stroke
• Death
• Loss of smell, nosebleeds, and problems swallowing
• Higher risk of HIV and hepatitis C due to sharing needles or other drug equipment
• When used during pregnancy it can cause spontaneous abortion, low birth weight, birth defects, and a baby born addicted to the drug

Ecstasy

Users often take this drug by mouth in pill or tablet form. You can also snort it or inject it into a vein.

What else it’s called: MDMA or Molly.

What type of drug is it? This is a man-made stimulant and hallucinogen.

What are the effects? Ecstasy increases levels of several chemicals in the brain, including serotonin, dopamine, and norepinephrine. It alters your mood and makes you feel closer and more connected to others. Users get a sense of euphoria and a boost in energy.

When the drug wears off, though, it can lead to confusion, depression, anxiety, and sleep problems.

The physical effects that it has on the body can be very similar to other stimulants like cocaine and amphetamines. Those effects include:

• Increased heart rate
• Increased blood pressure
• Tense muscles
• Nausea
• Blurred vision
• Dizziness
• Sweating or chills

Flakka

This designer drug is similar to bath salts. It is a pale-hued crystal that users eat, snort, inject, or vaporize using an e-cigarette device.

It might also be referred to as Gravel, because of the way it looks.

What type of drug is it? Like bath salts, it also contains synthetic cathinone.

What are the effects? The drug has a stimulant-like effect but can cause paranoia, hallucinations, and can lead to violence or self-harm. It’s been linked to deaths due to heart attack, suicide, and kidney damage or kidney failure.

Heroin

Heroin comes as a white or tan powder, or a black sticky substance, known as “black tar heroin.” Users can inject, inhale or smoke it.

What else it’s called: Brown Sugar, China White, Dope, H, Horse, Junk, Skag, Skunk, Smack, and White Horse

What type of drug is it? It’s an opioid derived from the opium poppy flower. It’s rapidly absorbed into the brain, which makes it highly addictive.

What are the effects? A rush of euphoria followed by dry mouth, a heaviness sensation in the arms and legs, and a fuzzy mind.

Heroin use can be deadly. Risk factors for overdose include, simultaneous use of sedatives or alcohol, use of prescription pain pills, and recent abstinence with relapse.

It can also lead to:

• Collapsed veins
• Skin Infections
• Gastrointestinal problems (especially constipation)
• Kidney disease
• Suppressed breathing, which is which is leading cause of coma, brain damage, and death
• Risk of catching HIV and hepatitis C through sharing needles and other drug equipment
• When used during pregnancy it can cause spontaneous abortion, low birth weight, birth defects, and a baby born addicted to the drug

Krokodil

This drug isn’t common in the U.S., but it’s used widely in Russia, especially among young adults as a cheaper alternative to heroin. It’s a man-made form of morphine and about 10 times stronger.

It’s a combination of several harmful chemicals including codeine, iodine, gasoline, paint thinner, lighter fluid and others.

Users inject it into the bloodstream, and it has a rapid and brief effect. It’s also sometimes spelled Crocodil.

What type of drug is it? Opioid.

What are the effects? Krokodil is named for the crocodile-like appearance it creates on the skin. Over time, it damages blood vessels and causes the skin to become green and scaly. The tissue damage can lead to gangrene and result in amputation or death.

LSD

This drug became popular in the 1960s and is still commonly used today. It’s made from an acid found in a fungus that grows on rye and other grains.

What else it’s called: Acid, Blotter, Doses, Hits, Microdots, Sugar Cubes, Trips, Tabs, and Window Panes.

What type of drug is it? Hallucinogen.

What are the effects? It causes someone to see, hear, and feel things that seem real, but aren’t. These hallucinations, called “trips,” can last as long as 12 hours.

LSD can cause physical effects such as dilated pupils, increased heart rate and blood pressure, sweating, less appetite, dry mouth, and shakiness.

Marijuana

It’s still the most-used illegal drug in the U.S., despite it recently earning legal status for medical purposes in many states.

Marijuana refers to the dried leaves, flowers, stems, and seeds of the hemp (Cannabis sativa) plant. Most people smoke marijuana, but it can also be added to foods and eaten.

What else it’s called: Blunt, Bud, Dope, Ganja, Grass, Green, Herb, Joint, Mary Jane, Pot, Reefer, Skunk, Smoke, Trees, Weed, Ashish, Boom, Hash, and Hemp.

What type of drug is it? It can act as both a stimulant and a depressant, and even a hallucinogen.

What are the effects? Marijuana contains the chemical THC, which acts on different parts of the brain to create the “high” that users experience, such as changes in sensations, mood, body movements, thinking, and memory.

When used regularly, marijuana can affect brain development and lead to cognitive problems. It can become addictive for some people, and also cause serious health problems such as breathing issues, increased heart rate, and higher risk of heart attacks, depression, anxiety, and suicidal thoughts for some people. Among young people, heavy MJ use has been associated with cognitive impairment and mental illness, like schizophrenia. However, in adults, chronic use has not been associated with serious medical conditions.

Methamphetamines

Meth is a white powder that users swallow, smoke, snort, or inject. It’s made from a combination of pseudoephedrine, a common ingredient in cold medications, along with other toxic chemicals.

What else it’s called: Crystal meth, Chalk, Crank, and Ice.

What type of drug is it? Stimulant.

What are the effects? Meth creates an immediate high that quickly fades. As a result, users often take it repeatedly, making it extremely addictive. The physical effects are very similar to other stimulants like cocaine and amphetamines. Those effects can include:

• Increased breathing
• Rapid heart rate
• High blood pressure
• Increased body temperature

With repeated long-term use, meth can lead to extreme weight loss, skin sores, and severe dental issues. Chronic abusers often suffer from anxiety, confusion, insomnia, hallucinations and delusions, and paranoia. Injecting the drug can raise the risk of getting HIV or hepatitis when sharing needles and other drug equipment.

When used during pregnancy it can cause spontaneous abortion, low birth weight, birth defects, and a baby born addicted to the drug.

Mushrooms

Psilocybin and peyote mushrooms are eaten, brewed in a tea, or added to foods to get a high. Though cravings may occur, physical dependence isn’t usually present with hallucinogens.  

What else they’re called: Boomers, Little Smoke, Magic Mushrooms, and Shrooms.

What type of drug is it? The active ingredient is psilocybin, which is a hallucinogen found in certain types of mushrooms.

What are the effects? The effects start within about 20 minutes and last as long as 6 hours. Similar to LSD, mushrooms can cause hallucinations, an altered perception of time, and an inability to tell the difference between what’s real and what’s not.

Taking high doses or using them for a long time can cause panic, psychosis, or flashbacks. They can also cause extreme pupil dilation, nausea, and vomiting.

Salvia

This drug is an herb in the mint family that’s native to parts of Mexico. Users chew or smoke its leaves.

What else it’s called: Maria Pastora, Sage of the Seers, Diviner’s Sage, Sally-D, and Magic Mint.

What type of drug is it? Hallucinogen.

What are the effects? The drug creates intense but short-lived effects, which start within 5 to 10 minutes and last about 30 minutes. The hallucinogenic effects include changes in vision, mood, emotions, and body sensations.

Little is known about the health effects of salvia, though animal studies show it may have an impact on learning and memory. The Drug Enforcement Administration doesn’t consider salvia an illegal drug, but several states have passed laws to regulate its use.

Spice

This is a mixture of different herbs and chemicals that looks similar to potpourri. Users either smoke it like marijuana or make it into an herbal tea-like drink.

What else it’s called: Black Mamba, Bliss, Bombay Blue, Fake weed, Fire, Genie, K2, Moon Rocks, Skunk, Smacked, Yucatan, or Zohai.

What type of drug is it? Synthetic cannabinoid.

What are the effects? Compounds in Spice act on the same parts in the brain as THC, the psychoactive ingredient in marijuana. As a result, the effects are very similar, such as feeling happier and more relaxed. But the compounds in Spice can lead to a stronger effect.

Users also report severe anxiety, paranoia, and hallucinations.

Other effects of Spice can include:

• Rapid heart rate
• Vomiting
• Confusion
• Seizures
• Increased blood pressure
• Heart attack (rarely)

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Cocaine (C₁₇H₂₁NO₄) is a powerfully addictive, psychoactive, stimulant drug. On the street it is usually sold as a fine, white crystal powder. The powdered, hydrochloride salt form can be snorted or dissolved in water and injected. Use in any form is illegal in the U.S. when used as recreational drug.

Freebase is cocaine hydrochloride that is processed to remove the hydrochloride salt. This ‘freebase’ form is not water-soluble; the powder can be heated and its vapors smoked due to the lower melting point. Diethyl ether is used to process freebase and is highly flammable and volatile, often leading to lab explosions and bodily injury such as burns. It produces a much more intense “rush” than snorting the drug and can be extremely addictive due to the quick high and repeated use.

Crack cocaine (“crack”) is another form that is processed into a rock form using baking soda and may contain a high percentage of impurities. The term “crack” refers to the crackling sound heard when it is heated prior to smoking. Crack abuse in the U.S. rose in the mid-1980’s and is considered the most addictive form of the drug. Crack looks like small, irregularly shaped chunks (or “rocks”) of a whitish solid.

People who use cocaine in any form may “binge” — taking the drug repeatedly within a short time and at increasingly higher doses — to maintain their high.

Where does cocaine come from?

Cocaine originates from coca leaves, and has been used for centuries in a variety of cultural applications. The pure drug is extracted from the Erythroxylon coca bush, found primarily in the South American countries of Peru, Bolivia, and Colombia. Coca-leaf infusions or teas have been used to combat altitude sickness and boost energy in many native tribes of South America.

The early use was not just limited to South American countries. In the U.S., it was found as an active ingredient in many elixirs and tonics used in the early 1900’s and was even found in Coca-Cola products at that time.

Is cocaine dangerous?

Yes, illicit cocaine use can be extremely dangerous and deadly. The immediate physical effects of cocaine use include constricted blood vessels, dilated pupils, nausea, restlessness and increased body temperature, heart rate, and blood pressure.

Health complications of cocaine include:

• disturbances in heart rhythm
• headaches
• chest pain
• respiratory (breathing) failure
• stroke
• stomach pain
• nausea
• heart attack
• seizures

The various means of using this illicit drug can produce different adverse reactions:

• Snorting the powder can lead to loss of the sense of smell, nosebleeds, problems with swallowing, hoarseness, nasal cavity erosion and a chronically runny nose.
• Ingesting the powder can cause severe bowel gangrene (tissue death) due to reduced blood flow.
• Injecting the drug can lead to severe allergic reactions and, as with all IV drug users, an increased risk for contracting HIV, viral hepatitis and other blood-borne diseases.
• Smoking crack can lead to lung disease like asthma and infections such as pneumonia

People who use illicit drugs, especially when injected, are at increased risk for diseases like HIV, hepatitis C, skin infections and vein collapse. Impairment of judgement can lead to risky behavior, as well. NIDA has found that use of cocaine can speed up HIV infection because the drug impairs immune function and promotes replication of the virus.

Long-term, cocaine use can lead to an increased risk for becoming malnourished due to loss of appetite. The occurrence of Parkinson’s disease has been reported as well.

Is cocaine addictive?

Yes, cocaine is a strongly addictive illicit drug. Long-term effects of use can lead to tolerance, high doses and the need for more frequent use to attain the same level of pleasure during the initial period of use.

The use of cocaine increases the neurotransmitter dopamine in the brain. This sends an amplified “reward” signal to the brain, resulting in the euphoria described by users. Cocaine prevents dopamine from being recycled in the cell, and large amounts accumulate. This reinforces the drug-taking behavior and lowers sensitivity to the drug. People then take larger and more frequent doses to attain the same high and feel relief from the “crash” or withdrawal. Withdrawal symptoms can include:

• depression
• fatigue
• hunger
• trouble sleeping
• trouble thinking

Eventually, a tolerance to the high develops. Many addicts report that they seek but fail to achieve as much pleasure as they did from their first exposure. Some users will increase their dose to intensify and prolong the euphoric effects. While tolerance to the high can occur, users can also become more sensitive to the anesthetic and convulsant effects without increasing the dose taken. This increased sensitivity may explain some deaths occurring after apparently low doses.

Use in a binge, during which the drug is taken repeatedly and at increasingly high doses, may lead to a state of increasing irritability, restlessness, and paranoia. This can result in a period of paranoid psychosis, in which the user loses touch with reality and experiences auditory (hearing) hallucinations.

Because it has a tendency to decrease appetite, many chronic users can become malnourished. If used in a binge fashion, with frequent, repeated use over a short period of time, panic and paranoia may set in, with psychosis and auditory hallucinations possible.

Can I overdose on cocaine?

Yes, cocaine abuse can lead to an overdose and serious or deadly side effects after your first use or anytime thereafter. There is no specific medication that can reverse a cocaine overdose.

Cocaine use or overdose can lead to:

• Acute cardiovascular (heart) or cerebrovascular (brain vessel) emergencies, such as an irregular heart rhythm, heart attack or stroke, which may result in sudden death.
• Deaths are often a result of cardiac arrest (heart attack) or seizure followed by respiratory arrest (breathing stopped).
• Other symptoms of cocaine use or overdose include difficulty breathing, high blood pressure, high body temperature, hallucinations, and extreme agitation or anxiety.
• Mixing cocaine with a heroin injection can be a deadly combination.

Is there a drug interaction between alcohol and cocaine?

A particularly concerning and common drug interaction between alcohol and cocaine has been reported.

• Research has shown that the human liver combines cocaine and alcohol and manufactures a third substance in the liver, cocaethylene, that intensifies the drugs euphoric effects but may increase the risk of sudden death.
• Cocaethylene may remain in the system up to 3 times longer than cocaine.
• According to the NIDA, this drug-drug interaction is the most common two-drug combination that results in drug-related deaths. Death can be due to due cardiovascular (heart) death, stroke, or other organ toxicity.
• Studies have also shown that the effect of cocaethylene on liver fibrosis (long-term liver disease) was significantly greater than that of cocaine or alcohol use alone.

Because cocaine often leads to a heart attack or stroke, first-responders or emergency personnel try to supply oxygen-rich blood to the affected organs. Seizure medicines may be given to help stop a seizure.

How is cocaine used medically?

In the U.S., prescription cocaine is classified as a Schedule II controlled substance, meaning it has a high potential for abuse but can be administered by a physician for legitimate medical uses. Brands names for FDA-approved topical nasal cocaine solution products include:

• Goprelto
• Numbrino

Cocaine is available in the U.S. as a prescription solution for local mucosal anesthesia, and for some eye, ear, and throat surgeries, but is rarely used because of safer alternatives have been developed.

A nasal solution is used for the induction of local anesthesia of the mucous membranes when performing diagnostic procedures and surgeries on or through the nasal cavities in adults. Topical cocaine may be administered by using cotton applicators or packs, installed into a cavity, or as a spray. Topical cocaine may also be applied to reduce bleeding of the mucous membranes.

How do people abuse cocaine?

Cocaine is most commonly abused by:

• snorting up the nose
• rubbing on gums
• smoking
• injection
• inhaled into lungs (from freebase “crack” form)

Cocaine hydrochloride (HCL) is water soluble due to the HCL salt and can be injected; it is also snorted in powder form. Mixing cocaine with heroin and injecting is called a “speedball” and can be especially lethal.

When purchased on the street, is usually ‘cut’ with adulterants such as cornstarch, baking soda, talcum powder, flour, lactose sugar, or other local anesthetics such as lidocaine or benzocaine. This increases the weight and allows the seller to make more profit on the street.

Other more dangerous adulterants, such as the stimulant amphetamine or synthetic opioids, including fentanyl, may also be used to cut the drug. Cutting cocaine with other illicit drugs can be especially harmful as the user is not aware of the added drug and an accidental overdose or death can occur.

Most often the powder is snorted, and the drug is laid out on a mirror, plate or other flat surface, separated into ‘lines’ and snorted nasally through a straw, rolled-up dollar bill or other inhaling device. The cocaine is absorbed into the bloodstream through the nasal tissues.

The effect, or ‘high’ with snorting may last 15 to 30 minutes, but does not occur as quickly as smoking or injecting it. Alternatively, smoking crack or injecting cocaine may have a rapid and more intense effect, but the “high” only lasts 5 to 10 minutes, often with an intense “crash”, which leads to repeated use to sustain the high (an action called “binging”).

How will cocaine make me feel?

The effect of cocaine is described as euphoric with increased energy, happiness, reduced fatigue, and heightened mental alertness. Users may be talkative, extraverted, and have a loss of appetite or need for sleep. They may be more sensitive to light, sounds or touch.

Some users report feelings of restlessness, irritability, and anxiety. The psychoactive and pleasurable effects are short-lived without continued administration. Continued use, or even a first-time use, can be dangerous and deadly.

Do employers test for cocaine?

Cocaine is a substance that is commonly tested for in pre-employment drug screening in the US.

• Cocaine is metabolized primarily in the liver, with less than 1% of the parent drug being excreted in the urine.
• The primary metabolite is benzoylecgonine.
• Benzoylecgonine can be detectable in the urine for up to eight days after consumption, but this can be variable based on the individual.

In Nov. 2020, the state of Oregon voted in Measure 110 to decriminalize use of all drugs, including drugs such as cocaine. The law does not legalize the drugs – it means that the state will remove criminal penalties and prison time for possession of small amounts of illegal drugs. Instead, penalty involves a $100 fine or a “health assessment” completed at an addiction recovery center, according to Vox. The sale of drugs such as heroin or cocaine will still be illegal.

Do teens use cocaine or crack?

The extent of cocaine use in youth is important to follow to see trends and changes in drug use — and drug choice — over time.

In the Monitoring the Future Study: 2021 Overview Key Findings on Adolescent Drug Use, the National Institute of Drug Abuse (NIDA) found these trends in 2021 in the prevalence of cocaine use for 8th, 10th, and 12th Graders in the past year:

• 0.2% for 8th graders
• 0.6% of 10th graders
• 1.2% of 12th graders.

Compare these 2021 numbers above to 2020 use in the past year:

• 0.5% of 8th graders
• 1.1% of 10th graders
• 2.9% of 12th graders.

Overall cocaine use in these groups declined in 2021 with cocaine showing a relative decline in annual prevalence for the three grades combined of 57% (p<.001). This results in an overall annual prevalence at 0.7%, down from 1.4% in 2020.

It is interesting to compare youth numbers of cocaine use with marijuana use, the most commonly abused substance. Past-year use of marijuana / hashish in 2021:

• 30.5% of 12th graders (a decline of 4.7% from 2020)
• 17.3% for 10th graders (a decline of 10.7% from 2020)
• 7.1% for 8th graders (a decline of 4.3% from 2020)

Marijuana showed a considerable decline in 2021 of 6.7 percentage points in annual prevalence, respectively, for the three grades combined. The COVID-19 pandemic is postulated to have affected the declines in drug use overall seen among youth.

Cocaine use in pregnancy

The full extent of the effects of cocaine use on the unborn or newborn child are difficult to predict. Multiple factors can play into this outcome, such as use of other illegal drugs, maternal sexually-transmitted diseases, extent of prenatal care, and socioeconomic factors, among others.

In the mother, cocaine use can lead to a serious high blood pressure and spontaneous miscarriage. Pregnant women who abuse this drug may have other addictive habits, such as nicotine and alcohol use. Pregnant women with substance abuse and addiction should receive immediate medical and psychological healthcare to minimize these adverse outcomes.

Studies have shown that infants born to women who use cocaine during pregnancy may be delivered prematurely, have low birth rates, may have smaller head circumference, and be shorter in length.

Longer-term research is finding that exposure in utero and environmental factors may also lead to deficits in cognitive abilities, information processing, memory, and ability to complete tasks in childhood. More research is needed to understand the childhood long-term effects of exposure in pregnancy.

How is cocaine addiction treated?

The extensive abuse of cocaine has lead to efforts to develop treatment programs for this type of drug abuse. The majority of abusers seeking treatment programs smoke crack, and are likely to abuse multiple drugs. Many people may need to stay in rehabilitation (rehab) center during treatment. Sessions with a therapist can help you to have successful treatment.

• Cognitive behavioral therapy teaches the ability to help someone recognize the situations in which they are most likely to use this drug, and avoid these situations. It is especially used to help prevent relapse.
• Contingency management (CM), also called motivational incentives, centers on a system of rewards for abstinence. It can be effective in decreasing drug use by patients in treatment for cocaine abuse.
• Community-based recovery groups like Cocaine Anonymous uses a 12-step program that can be helpful in maintaining abstinence from cocaine.

As of 2022, there are no FDA-approved medications to treat cocaine addiction. However, research is ongoing. One of the National Institute on Drug Abuse’s (NIDA) top research priorities is to find a medication to block or greatly reduce its effects, to be used as one part of a comprehensive treatment program. Research is focusing on dopamine, serotonin, gamma-aminobutyric acid (GABA), glutamate, and norepinephrine neurotransmitters involved in chemical messaging in the brain.

Several medications have been investigated for their safe use in treating cocaine addiction.

• Lorcaserin (Belviq, Belviq XR) – an FDA-approved weight loss medication that acts at serotonin receptors.
• Disulfiram (Antabuse) – an FDA-approved medication used to treat alcoholism, has shown promise.
• Cocaine vaccine – under research; it stimulates antibodies that bind to cocaine and prevent it from getting into the brain.

Providing the optimal combination of treatment and services for each individual is critical to successful outcomes. Ultimately, a combination of both treatments may be the most effective option.

• A 2020 review of a group of research studies (a meta-analysis) found that combined cognitive behavioral therapy and medication treatment (pharmacotherapy) for cocaine addiction treatment was associated with an increased benefit compared with usual care and pharmacotherapy.

Who should I contact for help?

Call SAMHSA’s National Helpline: 1-800-662-HELP (4357). For TTY, call 1-800-487-4889. This service is confidential, free, and open 24 hours-a-day, 365-days-a-year. Available in English and Spanish.

• An information service for people, and their families, facing mental and/or substance use disorders.
• You can receive a referral to local treatment facilities, support groups, and other organizations based in your local community.
• If you have no insurance or are underinsured, you will be referred to your state office which is responsible for state-funded treatment programs.

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