Some things never really change


Salon recently posted a history of cocaine. Has PHARMA changed at all?

For serious cocaine consumers, other products were also available in the late nineteenth century. Large drug companies such as Parke-Davis in Detroit also got into the cocaine game. They developed processes for the mass production of easily crystallizable and soluble salts like hydrochloride, which could be accurately measured and dispensed. Finely powdered “lines” of cocaine could easily be “snorted” through a cut straw or rolled up banknote and would enter the well-vascularized mucous membranes in the nose and move from there into the blood and then the brain relatively quickly. Naturally, the most efficient way of taking cocaine, just like morphine, was to inject it intravenously. To satisfy this portion of the cocaine market, drug companies like Parke-Davis also came up with drug-taking paraphernalia such as nifty little boxes that contained syringes, needles, and supplies of cocaine all packaged together as a fashion accessory for the smart set. According to Parke-Davis’ own ads, cocaine “could make the coward brave, the silent eloquent, and render the sufferer insensitive to pain.” As we have seen with other powerful and potentially dangerous drugs, the end of the nineteenth and the beginning of the twentieth century was a time when these things were generally available and not illegal. In fact, cocaine could be purchased over the counter in the United States until 1916.

via A brief history of cocaine –

If it wasn’t rational, cont’d

English: Cocaine user "tweaking" or ...
English: Cocaine user “tweaking” or withdrawing from cocaine searches ground for small bits of lost or overlooked crack cocaine, while standing beneath an anti-cocaine graffitum. (Photo credit: Wikipedia)

Yesterday I posted about a recent NY Times column arguing for a rational model of addictive drug use:

“When they were given an alternative to crack, they made rational economic decisions.”

When methamphetamine replaced crack as the great drug scourge in the United States, Dr. Hart brought meth addicts into his laboratory for similar experiments — and the results showed similarly rational decisions.

“If you’re living in a poor neighborhood deprived of options, there’s a certain rationality to keep taking a drug that will give you some temporary pleasure,”

I was thinking about it a little more and several people have spoken with me about it.

I have two thoughts that I’d add to yesterday’s post.

First, it might be rational if the person’s life is hopeless. This premise worth thinking deeply about.

nihilism by Brett Jordan
nihilism by Brett Jordan

Second, several people have commented on the ethics of his studies:

Dr. Hart recruited addicts by advertising in The Village Voice, offering them a chance to make $950 while smoking crack made from pharmaceutical-grade cocaine.

Um, yeah.  There is that. It never ceases to amaze me that a human subjects review board would approve this kind of study.

What happened to the “crack babies”?

English: An intubated female premature infant ...
English: An intubated female premature infant born prematurely 26 weeks 6 days gestation, 990 grams. Photo taken at approximately 24 hours after birth. (Photo credit: Wikipedia)



Dirk Hansen reports the good news about “crack babies”:


In a paper authored by Hurt, Laura M Betancourt, and others, the investigators write: “It is now well established that gestational cocaine exposure has not produced the profound deficits anticipated in the 1980s and 1990s, with children described variably as joyless, microcephalic, or unmanageable.” The authors do not rule out “subtle deficits,” but do not find evidence for them in functional outcomes like school or transition to adulthood.


And, the bad news:


As FitzGerald writes: “The years of tracking kids have led Hurt to a conclusion she didn’t see coming. ‘Poverty is a more powerful influence on the outcome of inner-city children than gestational exposure to cocaine,'” Hurt said.


He asks, “How did this urban legend get started?”


In the 1980s, during the Reagan-Bush years, Americans were confronted with yet another drug “epidemic.” The resulting media fixation on crack provided a fascinating look at what has been called “drug education abuse.” This new drug war took off in earnest after Congress and the media discovered that an inexpensive, smokable form of cocaine was appearing in prodigious quantities in some of America’s larger cities. Crack was a refinement to freebasing, and a drug dealer’s dream. The “rush” from smoking crack was more potent, but even more transient, than the short-lived high from nasal ingestion.




24 month outcomes


surprise result road by dougtone
surprise result road by dougtone

Another study supports the effects of twelve step participation over 24 months. (I know the abstract says “self help”, but the pay-walled article makes it clear that they were looking at twelve step participation.)


The goal was to identify factors that predicted sustained cocaine abstinence and transitions from cocaine use to abstinence over 24 months. Data from baseline assessments and multiple follow-ups were obtained from three studies of continuing care for patients in intensive outpatient programs (IOPs). In the combined sample, remaining cocaine abstinent and transitioning into abstinence at the next follow-up were predicted by older age, less education, and less cocaine and alcohol use at baseline, and by higher self-efficacy, commitment to abstinence, better social support, lower depression, and lower scores on other problem severity measures assessed during the follow-up. In addition, higher self-help participation, self-help beliefs, readiness to change, and coping assessed during the follow-up predicted transitions from cocaine use to abstinence. These results were stable over 24 months. Commitment to abstinence, self-help behaviors and beliefs, and self-efficacy contributed independently to the prediction of cocaine use transitions. Implications for treatment are discussed.

It’s worth noting that some of these factors predicting abstinence are enhanced by twelve step participation:

These models represented fairly stringent tests of the predictive power of the time varying variables, as they controlled for both baseline (i.e., early treatment) cocaine use and cocaine use status at the time the predictor variables were assessed. In analyses that included multiple time-varying predictors and baseline cocaine use, the variables that contributed independently to the prediction of transitions in cocaine use states were self-efficacy, self-help participation (for those who were currently using cocaine), commitment to abstinence, and self-help beliefs. Three of these four variables assessed self-help group related factors, which highlights the important role that self-help involvement and beliefs play in sustained recoveries in this population.