The Cocaine Trade - Home Affairs Committee Contents


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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