Cocaine is the most potent stimulant of natural origin.
It can be snorted, smoked, or injected. When snorted, cocaine powder is inhaled through the nose where it is absorbed into the bloodstream through the nasal tissues. When injected, the user uses a needle to release the drug directly into the bloodstream. Smoking involves inhaling cocaine vapor or smoke into the lungs where absorption into the bloodstream is as rapid as by injection (Offi ce of National Drug Control Policy, n.d.).
Crack is cocaine base that has not been neutralized by an acid to make hydrochloride salt. This form of cocaine comes in a rock crystal that is heated to produce vapors, which are smoked. The term “crack” refers to the crackling sound produced by the rock as it is heated (Offi ce of National Drug Control Policy, n.d).
General Consumption Patterns
The National Survey on Drug Use and Health (NSDUH) provides national and state-level estimates of alcohol, tobacco, and other drug use (Substance Abuse and Mental Health Services Administration, Offi ce of Applied Studies, n.d.). According to 2007 data, the most recent estimates available, 114,000 Hoosiers ages 12 and older used cocaine in the past year, representing 2.19%
(95% Confi dence Interval [CI]: 1.69–2.85) of Indiana’s population. This rate is comparable to the nation’s (2.39%). Past-year cocaine use was highest among Hoosiers ages 18 to 25, at 6.37% (95% CI: 4.96–8.16);
the rate for U.S. residents in that age group was similar (6.63%) (see Figure 6.1).
Figure 6.1 Percentage of Indiana and U.S. Population (12 Years and Older) Reporting Cocaine Use in the Past Year, by Age Group (National Survey on Drug Use and Health, 2007)
Source: Substance Abuse and Mental Health Services Administration, Offi ce of Applied Studies, n.d.
2001 2002 2003 2004 2005 2006 2007 Indiana 1.46% 2.55% 2.57% 2.37% 2.33% 2.24% 2.19%
U.S. 1.70% 2.51% 2.50% 2.42% 2.31% 2.37% 2.39%
0%
1%
2%
3%
4%
5%
NSDUH data from 2001 through 2007 show that past-year cocaine use remained stable in Indiana from 1.46% (95% CI: 1.06–1.96) in 2001 to 2.19% (95% CI:
1.69–2.85) in 2007, mirroring national rates (see Figure 6.2).
Lifetime use was reported by 562,000 Hoosiers, or 11.1% (U.S.: 14.3%), and current (past-month) use was
reported by 33,000 Hoosiers, or 0.7% (U.S.: 1.0%).1 Publicly available NSDUH data currently do not include gender or race comparisons at the state level (Substance Abuse and Mental Health Services Administration, Offi ce of Applied Studies, n.d.).
1The most recent estimates of lifetime and current (past-month) cocaine use from the National Survey on Drug Use and Health are based on annual averages from 2002 to 2004. The confi dence intervals (CI) for these rates were not provided.
Figure 6.2 Percentage of Indiana and U.S. Population (12 Years and Older) Reporting Cocaine Use in the Past Year (National Survey on Drug Use and Health, 2001–2007)
Source: Substance Abuse and Mental Health Services Administration, Offi ce of Applied Studies, n.d.
Adult Consumption Patterns
According to 2007 NSDUH estimates, past-year
prevalence rates for cocaine use were highest among 18- to 25-year-olds; 6.37% (95% CI: 4.96–8.16) of Hoosiers in that age group have used cocaine in the past year.
The rate for Indiana residents ages 26 and older was signifi cantly lower (1.57%; 95% CI: 1.07–2.30) (see Figure
6.1). Indiana and U.S. rates were statistically the same.
The 2007 Treatment Episode Data Set (TEDS) shows that cocaine use was reported in 23.9% of treatment episodes in Indiana; the U.S. percentage was signifi cantly higher with 30.5% (P < 0.001) (see Figure 6.3) (Substance Abuse and Mental Health Data Archive, 2008).
2000 2001 2002 2003 2004 2005 2006 2007 Indiana 25.5% 22.3% 22.0% 22.7% 22.8% 23.8% 25.0% 23.9%
U.S. 31.2% 30.2% 30.1% 30.9% 30.9% 31.2% 31.7% 30.5%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Gender, age, and race differences in the Indiana treatment population were signifi cant (P < 0.001). More women (29.7%) than men (21.0%) reported cocaine use; blacks displayed drastically higher rates (42.6%) than whites (20.3%) and other races (23.0%); and the percentage of 35- to 44-year-olds (32.4%) using cocaine was greater than any other age group (see Table 6.1).
(For county-level information, see Appendix 6A, page 105.)
Table 6.1 Percentage of Treatment Episodes in Indiana with Cocaine Use Reported at Treatment Admission (Treatment Episode Data Set, 2007)
Source: Substance Abuse and Mental Health Data Archive, 2008
Cocaine Use
Gender Male 21.0%
Female 29.7%
Race White 20.3%
Black 42.6%
Other 23.0%
Age Group Under 18 3.8%
18-24 14.8%
25-34 24.7%
35-44 32.4%
45-54 31.6%
55 and over 17.9%
Total 23.9%
Figure 6.3 Percentage of Treatment Episodes in Indiana and the United States with Cocaine Use Reported at Treatment Admission (Treatment Episode Data Set, 2000–2007)
Source: Substance Abuse and Mental Health Data Archive, 2008
Youth Consumption Patterns
Findings from the 2007 NSDUH survey show that 1.41%
(95% CI: 0.97–2.06) of 12- to 17-year-old Hoosiers used cocaine in the past year (see Figure 6.1). The national rate is similar, at 1.57% (Substance Abuse and Mental Health Services Administration, Offi ce of Applied Studies, n.d.).
According to the 2007 Youth Risk Behavior Survey System (YRBSS), 8.0% (95% CI: 6.5–9.8) of Indiana high school students (grades 9 through 12) reported that they had used any form of cocaine, including powder, crack, or freebase, once or more during their life, and 3.8% (95% CI: 2.7–5.3) stated that they currently use cocaine (Centers for Disease Control and Prevention, 2008). National rates for lifetime use and current use were slightly lower, at 7.2% (95% CI: 6.2–8.2) and 3.3% (95%
CI: 2.8–4.8), respectively. The rate differences between Indiana and the United States were statistically not signifi cant (see Table 6.2).
In Indiana, 8.7% (95% CI: 6.3–11.8) of males and 5.8% (95% CI: 3.4–8.2) of females reported lifetime use, and 4.2% (95% CI: 2.7–6.7) of males and 2.8%
(95% CI: 2.0–3.9) of females reported current use of the substance. National rates were comparable. Neither the differences between the genders nor between Indiana and the United States were statistically signifi cant (see Table 6.2).
In Indiana, Hispanic students reported the highest rate of cocaine use, with 12.4% (95% CI: 7.9–18.9) reporting lifetime use and 8.0% (95% CI: 3.5–17.3) reporting current use. The prevalence for white students seemed lower, at 8.0% (95% CI: 6.5–9.9) for lifetime use and 3.2% (95% CI: 2.3–4.5) for current use, but the differences were statistically not signifi cant. Black students had the lowest rates of cocaine use, with 2.4%
(95% CI: 0.7–7.8) reporting lifetime use and 2.4% (95%
CI: 0.7–7.8) reporting current use (see Table 6.2).
The lowest rate of cocaine use in Indiana high school students was found among 9th graders, of whom 4.4% (95% CI: 2.5–7.5) reported lifetime use and 2.7%
(95% CI: 1.4–5.3) reported current use. Rates tended to increase with age. High school seniors displayed the highest rates, with 10.4% (95% CI: 5.8–18.1) reporting
Table 6.2 Percentage of Indiana and U.S. High School Students (Grades 9 through 12) Reporting Lifetime and Current Cocaine Use (Youth Risk Behavior Surveillance System, 2007)
Source: Centers for Disease Control and Prevention, 2008
Lifetime Use Current Use
Indiana Gender Male 8.7% 4.2%
Female 6.8% 2.8%
Race/Ethnicity White 8.0% 3.2%
Black 2.4% 2.4%
Other Race 9.9% 7.1%
Hispanic 12.4% 8.0%
Grade 9 4.4% 2.7%
10 8.7% 3.3%
11 8.6% 3.2%
12 10.4% 5.4%
Total 8.0% 3.8%
U.S. Gender Male 7.8% 4.0%
Female 6.5% 2.5%
Race/Ethnicity White 7.4% 3.0%
Black 1.8% 1.1%
Other Race 6.5% 4.0%
Hispanic 10.9% 5.3%
Grade 9 4.8% 2.7%
10 7.2% 3.2%
11 7.7% 2.9%
12 9.5% 4.4%
Total 7.2% 3.3%
lifetime use and 5.4% (95% CI: 2.5–11.4) reporting current use. However, rates for lifetime and current cocaine use between Indiana and the United States were statistically the same, as were rates among individual grades (9 through 12) (see Table 6.2).
Prevalence of lifetime and current cocaine use among Indiana’s high school students remained stable from 2003 through 2007 (Centers for Disease Control and Prevention, 2008).
The annual Alcohol, Tobacco, and Other Drug Use by Indiana Children and Adolescents (ATOD) survey is based on a nonrandom sample and may not be representative of all Indiana students (Indiana Prevention Resource Center, 2009). However, the survey provides a
good estimate of substance use among Hoosier children in grades 6 through 12. The 2009 survey shows that lifetime, annual, and monthly cocaine and crack use in middle and high school students generally increases with age. Lowest rates of use are found among 6th graders, the youngest students surveyed.
Current cocaine and crack use among high school seniors has remained fairly stable in Indiana and the nation (see Figure 6.4) (Indiana Prevention Resource Center, 2009; Inter-university Consortium for Political and Social Research, University of Michigan, n.d.). For regional data, see Appendix 6B, parts 1 and 2, pages 106-107.
Figure 6.4 Percentage of Indiana and U.S. High School Seniors (Grade 12) Reporting Current Cocaine and Crack Use (Alcohol, Tobacco, and Other Drug Use by Indiana Children and Adolescents Survey, 2000–2009, and Monitoring the Future Survey, 2000–2008)
Note: Information for 2009 is not available yet at the national level.
Source: Indiana Prevention Resource Center, 2009; Inter-university Consortium for Political and Social Research, University of Michigan, n.d.
2000 2001 2002 2003 2004 2005 2006 2007 Indiana 13.6% 11.0% 10.8% 11.5% 11.6% 12.1% 12.6% 11.8%
U.S. 13.5% 12.9% 12.9% 13.6% 13.7% 13.9% 13.9% 12.9%
0%
2%
4%
6%
8%
10%
12%
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16%
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20%
CONSEQUENCES Health Consequences
Cocaine is an addictive drug and powerful stimulant. It can be taken orally or intranasally, rubbed onto mucous tissues, dissolved in water and injected intravenously, and smoked in its freebase form (known as crack) (National Institute on Drug Abuse, 2004).
The effects of cocaine depend on the amount of the drug taken and the route of administration. Taken in small amounts, it can make the user feel euphoric, energetic, talkative, and mentally alert; and it may temporarily decrease the need for food and sleep. Short-term physiological effects of cocaine include constricted blood vessels; dilated pupils; and increased temperature, heart rate, and blood pressure. Large amounts may lead to bizarre, erratic, and violent behavior. Users may experience tremors, vertigo, muscle twitches, and paranoia. With repeated doses, users may have a toxic reaction closely resembling amphetamine poisoning. Use of crack/cocaine may result in feelings of restlessness, irritability, and anxiety. A user may suffer sudden death with the fi rst use of cocaine or unexpectedly during any use thereafter. Long- term effects of cocaine use include dependence, irritability, mood disturbances, restlessness, paranoia, and auditory hallucinations (National Institute on Drug Abuse, 2004).
The medical consequences of cocaine abuse are primarily cardiovascular problems (such as disturbances in heart rhythm and heart attacks), respiratory diffi culties (such as chest pain and respiratory failure), neurological effects (such as strokes, seizures, and headaches), and gastrointestinal complications (such as abdominal pain and nausea). Babies born to mothers who abuse cocaine during pregnancy are often prematurely delivered, have low birth weights and smaller head circumferences, and are often shorter in length (National Institute on Drug Abuse, 2004). Additionally, users who inject cocaine intravenously are at higher risk for acquiring and/or transmitting sexually transmitted diseases if needles or other injection equipment are shared (Offi ce of National Drug Control Policy, n.d.).