Crack Cocaine

09/28/2008

Psychopathology due to crack cocaine

In the Manschreck et al. study mentioned above, which showed considerable psychosis in the crack abusers, they found that 55 per cent of the addicts with crack-induced psychosis had been involved in some type of violent behavior.

Of the crack addicts who were non-psychotic but suffered from depression and anxiety, 35 per cent had been involved in violent behavior. This study validates the clinical impression that psychopathology due to crack cocaine is associated with violent behavior. In fact, with the possible exceptions of amphetamines and phencyclidine (PCP), crack has a greater violence-stimulating potential than other abused drugs. One can understand the chaos in Washington DC, where crack cocaine often is used with PCP (‘space basing’), which produces an extreme potential for violence.

The Agent

The agent is crack cocaine. The form of cocaine, and the route of its administration, are absolutely critical for any discussion of the drug to have meaning. The emphasis in this book has been on crack cocaine, although much of the information applies equally to well to injecting intravenous cocaine hydrochloride or to smoking coca paste in cigarettes (basuco), which is now becoming available on the world market. The freebase form of cocaine (crack) passes quickly through the lipid membranes of the brain into the central nervous system. As described in Chapter 1, the psychic and addictive effects of cocaine depend on how fast the blood level rises, so here we consider crack as a prototype of those forms of cocaine which cause a very rapid rise, with extreme consequences, including addiction.

Even as the AIDS virus attacks the immune system in such a way as to reduce its capacity to resist infection, crack acts on brain physiology in a way that reduces the ability of the user to resist more cocaine. The user both wants more pleasure, and, when the dysphoric (unpleasant) phase of abuse appears, the user also wants relief. Thus there is both a push and a pull to use more crack.

The Environment.

The environment is another critical element in crack use and abuse. The most important single environmental force is the availability of the drug. Use will be non-existent or limited if the drug is not available or is very expensive. For many, whether they start crack use at all will be determined by whether or not it is available and affordable; if it is not, they may either use no drugs or turn to alternatives.

There is no doubt that the cost of cocaine has dropped considerably over the last few years in terms of the cost per hit or per effective high. This is due to a drop in the cost per unit weight of street cocaine, to an increase in the purity of the drug (so that less is required for a good hit), and to the switch from snorting powder to inhaling crack. The latter gives more pleasurable effect per weight than does snorting, so less is needed per hit. By clever marketing, a powerful hit is now available in the US for $5-$10.

The external pressures to buy crack, to participate in trafficking, and to avoid fighting against the pushers in order to be safe, are greater than for any previous illicit drug. The crack sales force is far more extensive and decentralized than for most other drugs, which means that modern marketing methods are going beyond the product to the sales organization as well. It takes a massive and dependable supply system to provide over $100 billion of powdered cocaine per year just to the United States, so that the providers, the wholesalers, and the retailers all can make a good profit from the drug.

The fear of AIDS from needles is another factor in the environment that is encouraging users to switch from intravenous drugs, including heroin and cocaine, to crack. This is ironic, because in the United States at least, frequently crack abusers will begin prostitution to obtain money for the drug, and this produces a direct increase in the risk of AIDS. Also, prostitution increases the chances of various sexually transmitted diseases which, in turn, increase the chance of acquiring AIDS through sexual intercourse, because the virus of AIDS can more readily enter the body through mucous membranes that have ulcers or are inflames from sexually transmitted disease.

Source: Crack The Broken Promise
by David F. Allen and James F. Jekel

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