2 COCAINE: AN OVERVIEW
What is cocaine?
6. Cocaine is a class A stimulant drug, produced
from the leaves of the coca plant which is indigenous to certain
regions of South America. Cocaine comes in two main forms: cocaine
hydrochloride (HCI), a powder which is snorted, and 'crack' cocaine,
a free base which is smoked. Both cocaine HCI and 'crack' can
be prepared for injection. Common names for cocaine powder include:
blow, C, Charlie, coke, farmer, henry, sniff, snow, ticket, white
lady, white; crack cocaine is sometimes known as base, crack,
freebase, rock, C, wash and white.
7. A line of cocaine powder typically contains between
50mg and 200mg.[3] In 2009
a gram of cocaine cost between £30 and £50 on the street
in London. On the average price of £40 a gram,[4]
a line of cocaine powder cost between £2 and £8 depending
on its size. A 0.2g 'rock' of crack cocaine cost around £15
in June 2009.[5]
Physical effects
8. Cocaine is a stimulant which raises the body's
temperature and makes the heart beat faster. The effects of snorted
cocaine last around 20-30 minutes, whilst the effects of crack
cocaine are immediate and more intense, peaking for about 2 minutes
and lasting for about 10 minutes.[6]
Users report that taking cocaine makes them feel wide-awake, energetic
and confident. DrugScope described the effects of cocaine:
Cocaine has powerful stimulant properties. Its
use produces physiological arousal accompanied by exhilaration,
feelings of well-being, decreased hunger, indifference to pain
and fatigue, and feelings of great physical strength and mental
capacity. Sometimes these desired effects are replaced by anxiety
or panic.[7]
Lord Mancroft, Vice Chair of the Commons All Party
Parliamentary Group on Drug Misuse and Founder of the Addiction
Recovery Foundation told us:
Cocaine makes people feel as if they can rule
the world, they feel very energetic, over-excited, but the more
of it you take the more of it you have to take, and the high is
quite a short time in terms of time, so you are taking more and
more.[8]
Health risks
9. A powerful stimulant, cocaine causes heart disease,
including heart failure, respiratory disease, destroys internal
cavities (particularly the nose), and makes users vulnerable to
psychiatric disorders and brain damage. There was a large increase
in non-fatal hospital admissions for cocaine poisoning from 262
in 2000/01 to 807 in 2006/07,[9]
and there were 235 cocaine-related deaths in England and Wales
in 2008, an increase of 20% compared with 2007.
10. Cocaine causes changes in brain function which
can cause mood swings, anxiety and paranoia. Medical research
has shown that long-term use of cocaine causes irreversible brain
damage, in particular to those areas which control judgment and
planning. This is one of the reasons why cocaine addiction is
hard to treat—the potential success of cognitive treatments
is lessened by chronic cocaine use as the parts of the brain able
to respond to rational cognitive therapies are irretrievably damaged.
It can also aggravate existing mental health problems. Professor
Nutt, then Chair of the Advisory Council on the Misuse of Drugs,
explained that:
No-one is quite sure whether [the cognitive changes
caused by cocaine] are reversible. You can do brain imaging studies
of cocaine users and find quite marked abnormalities particularly
of what we call executive function—those functions in the
brain that allow people to make the right kind of judgments about
what they are doing with their life. Those get impaired by cocaine
because it targets the frontal part of the brain, which is where
those decisions are made. That is why is can be very difficult
to engage heavy cocaine and crack users in treatment because they
have lost that capacity for planning behaviour in a way to maximise
the benefits of treatment.[10]
11. Whilst the physical effects of crack cocaine
are similar to those of cocaine powder, they are more rapid and
pronounced. Professor Strang explained that "the slower effect
of snorting the drug versus either injecting it or smoking it
would have fewer psychiatric complications and fewer cardiovascular
complications".[11]
Injection of crack cocaine also carries risks associated with
any injected drug, namely HIV and hepatitis C.[12]
12. A recent study of sudden deaths in south-west
Spain[13] (where prevalence
of cocaine use is the highest in Europe), showed that 3% of sudden
deaths were cocaine related.[14]
Some 62% of these deaths were caused by cardiac disease, and all
of the deaths were in men aged between 21 and 45—younger
than those who characteristically develop cardiac disease.
13. When mixed with alcohol, the effects of cocaine
are even more potent. Cocaine and alcohol combine in the body
to produce a toxic chemical called cocaethylene. The number of
cocaine-related deaths in the UK in 2008 where alcohol was taken
alongside cocaine is almost as many as those where cocaine alone
was present: 75 to 86.[15]
The European Heart Journal Editorial noted that:
Cocaine users often ingest ethanol or other illicit
drugs concurrently. In fact, among drug abusers seeking help in
emergency departments, a combination of cocaine and ethanol is
the most common finding. Such a combination is popular, since
ethanol enhances the euphoria of cocaine and minimizes the dysphoria
that often occurs during its withdrawal. Previous studies have
shown that a combination of cocaine and ethanol is more cardiotoxic
than either substance alone.[16]
The editorial concluded "the notion that recreational
cocaine use is 'safe' should be dispelled, since even small amounts
may have catastrophic consequences, including sudden death".[17]
Cutting agents
14. Cocaine is cut (in effect diluted) with a plethora
of other substances, the precise nature of which have varied over
time. Although some cocaine is cut with more innocuous sugars,
such as mannitol, increasingly the preferred cutting agents are
other pharmaceutical drugs which mimic the mildly analgesic effects
of cocaine. These include benzocaine, which Harry Shapiro of DrugScope
described as "a mild analogue of cocaine where you would
get the same kind of numbing feeling in your nose and tongue which
would give you the impression that you were getting the real deal".[18]
Witnesses agreed that, despite popular perception, substances
such as rat poison or bleach were not being used as cutting agents.[19]
15. Analysis from the Forensic Science Service of
cocaine seizures in the UK, shows that the most common agents
at in 2009 were:
- Phenacetin: a painkiller, currently
banned in the UK for its potentially carcinogenic effects;
- Benzocaine: a local anaesthetic, often used in
sore throat lozenges and some teething products; and
- Lydocaine (also known as lignocaine): an animal
worming agent.
Phenacetin is commonly found in cocaine seized at
importation, whereas benzocaine and lydocaine are found in UK
seizures, suggesting that they are added in the UK.[20]
The law
16. Cocaine is a class A controlled drug under the
Misuse of Drugs Act 1971. Importation or exportation, dealing
and possession are all illegal, attracting penalties of up to
life imprisonment, up to life imprisonment and an unlimited fine,
and up to 7 years in prison, respectively.
Decriminalisation
17. Several witnesses argued that the supply of and
demand for cocaine could not be effectively tackled whilst it
remained an illegal drug, but one which for which there was demand.
Steve Rolles of Transform Drug Policy told us that:
When prohibition of something collides with huge
demand for it you just create an economic opportunity and illegal
criminal entrepreneurs will inevitably exploit the opportunity
that it creates.[21]
Lord Mancroft agreed:
We have controlled drugs in this country but
you only have to walk within a mile of this palace to realise
that the controls do not work, because anywhere on the streets
of London you can buy any of these drugs… The way forward
is a range somewhere from the way we control alcohol or indeed
the most dangerous object in our everyday lives, the motorcar.
If you go outside in the street and step in front of a moving
motorcar you will find out how dangerous it is, so what do we
do? We do not prohibit it. We license the vehicle, we license
the users, we made them pass a test, we make them have insurance
so if they damage anybody they have to pay up, we tell them how
fast they can use it, on which side of the road. That is control.[22]
18. However, others told us that there was little
evidence that decriminalisation would affect demand, and that
in fact it would be likely to increase it. For instance, Professor
Strang of the National Addiction Centre told us:
There is no question that the illegality of a
substance is a major deterrent to its use…one would have
to presume that if legal constraints were taken away the level
of use would almost certainly increase.[23]
Professor Nutt also said he would be "surprised
if making drugs legal would actually reduce use".[24]
He argued that the, at least partial, success of controlling drugs
could be seen in the rise in popularity of 'legal highs' being
bought over the internet:
People are buying drugs over the Internet which
are currently legal, presumably because there is a deterrent to
getting illegal drugs…The law must influence people to some
extent.[25]
19. Professor Nutt told us that cocaine was correctly
classed as 'A' and should remain so:
Cocaine is undoubtedly a class A drug—I
do not think there is any doubt about that. Cocaine powder is
less harmful than crack cocaine; within the scale of drugs in
class A crack and heroin are at the top… 'A' is the right
place for cocaine, given the number of deaths and the degree of
dependency it produces, and the difficulty of getting off cocaine.
It is considerably more addictive than some other drugs of class
A like MDMA, Ecstasy, like the psychedelics.[26]
There is no doubt that the arguments set out by Transform
Drug Policy and Lord Mancroft will continue to be debated.
20. Some witnesses suggested there was a need for
a cost/benefit analysis of the Misuse of Drugs Act 1971, to assess
the evidence of whether the Government's drugs policy offered
value for money. Steve Rolles called specifically for a value
for money impact assessment of the 1971 legislation, and told
us that the Act had "never been subject to that kind of scrutiny
and it is time that it was".[27]
Professor Nutt supported an impact assessment, saying "I
think my Council would be quite comfortable if people wanted to
review the Act".[28]
21. On 21 January 2010 the Home Office published
an evaluation completed in June 2007 by an academic at the University
of York entitled Drugs Value for Money Review, which Transform
had been campaigning for three years to have released under a
Freedom of Information request. The review as published made two
key conclusions. Firstly, that there was a real lack of data collected
by Government to enable an assessment of how effective its drugs
policy had been, particularly on the supply side. It stated:
Policies to reduce the availability of drugs
produced the greatest analytical challenge. The absence of robust
and recognised measures of success, combined with a limited base
of research evidence, makes it particularly difficult to draw
conclusions about supply-side policy.[29]
Secondly, it concluded that Government spending on
drugs had not been properly evaluated, making it hard to draw
conclusions about whether resources were appropriately allocated:
There is no single, comprehensive, agreed overview
of cross-government expenditure. Evaluations of effectiveness
are patchy and incomplete, making it difficult to assess value
for money and to decide how to best allocate resources in the
future.[30]
There was a similar indictment in analysis carried
out by the UK Drug Policy Commission—a grouping of expert
drug treatment and medical practitioners—in April 2007,
which concluded that it was "difficult to estimate government
expenditure on drug policy, as it is not transparently reported"
and that "the UK invests remarkably little in independent
evaluation of the impact of drug policies, especially enforcement.
This needs redressing if policy makers are to be able to identify
and introduce effective measures in the future".[31]
22. The Home Office review was intended to inform
the Government's new Drugs Strategy 2008-2018.[32]
However, the publication of the strategy in February 2008, only
eight months after the review was completed, suggests it is extremely
unlikely that the serious criticisms voiced in the review about
the lack of an evidence base on which to assess the effectiveness
of expenditure on drugs could have been addressed in time.
23. Cocaine, even before it is cut, frequently
with other noxious substances, and even if only taken occasionally
or in small amounts is not a 'safe' drug. A significant number
of sudden deaths are associated with cocaine: 235 in the UK in
2008 alone—a whole third of the number of deaths from heroin/morphine
the same year. As a recent study in the European Medical Journal
concluded, "the notion that recreational cocaine use is 'safe'
should be dispelled, since even small amounts may have catastrophic
consequences, including sudden death". Medical understanding
of the precise nature of harms associated with regular cocaine
powder use is still developing: but a body of evidence is emerging
about the links to heart disease, the long-term erosion of cognitive
brain function, and of disturbing toxic effects when combined
with alcohol, when it forms a third substance, more dangerous
than either of the two ingredients. As Professor Nutt told us,
it rightly deserves its 'A' classification.
24. We were very interested to learn that a Government
review completed in 2007—the publication of which the Home
Office had fought for three years—concluded that the effectiveness
and value for money of the Government's drugs spending could not
be evaluated. It is at best careless that the Government nevertheless
pressed ahead and published its Drugs Strategy in February 2008
without publishing a proper value-for-money analysis of where
resources would be most effectively targeted. We therefore support
calls for an full and independent value-for-money assessment of
the Misuse of Drugs Act 1971 and related legislation and policy.
This assessment must also address the concerns about inadequate
data collection raised in the 2007 review.
3 Q 108 [Matthew Atha] Back
4
Q 35 [Harry Shapiro] Back
5
SOCA, The National Intelligence Requirement for Organised Crime
2009/10 (June 2009), p.33 Back
6
Talk to Frank website, A-Z of drugs, under 'cocaine': http://www.talktofrank.com/drugs.aspx?id=106
Back
7
Ev 108 [DrugScope] Back
8
Q 220 Back
9
Department of Health, United Kingdom 2007 National Report to the
EMCDDA by the Reitox National Focal Point (2007), p.99: http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_081645.pdf
Back
10
Q 311 Back
11
Q 6 Back
12
Q 9 Back
13
European Heart Journal (12 January 2010), Lucena, J. et al, Cocaine-related
sudden death: a prospective investigation in southwest Spain,
doi: 10.1093/eurheartj/ehp557, summarised and discussed in European
Heart Journal (12 January 2010), Lange, R.A., and Hillis, L.D.
Sudden Death in Cocaine Abusers, Editorial. Back
14
21 out of 668 in Seville between 2003 and 2006 Back
15
Office for National Statistics, Deaths relating to drug poisoning
In England and Wales 2008, (29 August 2009), Table 2: http://www.statistics.gov.uk/pdfdir/dgdths0809.pdf
Back
16
Lange, R.A., and Hillis, L.D. Sudden Death in Cocaine Abusers,
European Heart Journal Editorial (published 12 January 2010),
p.3 Back
17
Ibid., p.3 Back
18
Q 18 Back
19
For instance, Q 36 and Q 48 [Harry Shapiro, Drugscope], Ev 95
[ACPO] and Ev 144 [SOCA] Back
20
SOCA, The UK Threat Assessment of Organised Crime 2009/10, p.39 Back
21
Q 157 Back
22
Q 220 Back
23
Q 23 Back
24
Q 326 Back
25
Q 325 Back
26
Q 305 and Q 306 Back
27
Q 138 Back
28
Q 323 Back
29
Home Office, Drugs Value for Money Review, (June 2007,
published 21 January 2010), p.9 Back
30
Ibid., p.3 Back
31
UK Drug Policy Commission, An analysis of UK drug policy, (April
2007), p.1 & p.4: http://www.ukdpc.org.uk/docs/UKDPC%20drug%20policy%20review%20exec%20summary.pdf
Back
32
Ibid., p.2 Back
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