Cocaine is a powerfully addictive stimulant that directly affects the brain. Cocaine was labeled the drug of the 1980s and 1990s because of its extensive popularity and use during that period. However, cocaine is not a new drug. In fact, it is one of the oldest known psychoactive substances. Coca leaves, the source of cocaine, have been chewed and ingested for thousands of years, and the purified chemical, cocaine hydrochloride, has been an abused substance for more than 100 years. In the early 1900s, for example, purified cocaine was the main active ingredient in most of the tonics and elixirs that were developed to treat a wide variety of illnesses.

Pure cocaine was originally extracted from the leaf of the Erythroxylon coca bush, which grew primarily in Peru and Bolivia. After the 1990s, and following crop reduction efforts in those countries, Colombia became the nation with the largest cultivated coca crop. Today, cocaine is a Schedule II drug, which means that it has high potential for abuse but can be administered by a doctor for legitimate medical uses, such as local anesthesia for some eye, ear, and throat surgeries.

Cocaine is generally sold on the street as a fine, white, crystalline powder and is also known as “coke,” “C,” “snow,” “flake,” or “blow.” Street dealers generally dilute it with inert substances such as cornstarch, talcum powder, or sugar, or with active drugs such as procaine (a chemically related local anesthetic) or amphetamine (another stimulant). Some users combine cocaine with heroin—in what is termed a “speedball.”

There are two chemical forms of cocaine that are abused: the water-soluble hydrochloride salt and the water-insoluble cocaine base (or freebase). When abused, the hydrochloride salt, or powdered form of cocaine, can be injected or snorted. The base form of cocaine has been processed with ammonia or sodium bicarbonate (baking soda) and water, and then heated to remove the hydrochloride to produce a smokable substance. The term “crack,” which is the street name given to freebase cocaine, refers to the crackling sound heard when the mixture is smoked.

What Is the Scope of Cocaine Use in the United States?

The National Survey on Drug Use and Health (NSDUH) estimates that in 2007 there were 2.1 million current (past-month) cocaine users, of which approximately 610,000 were current crack users. Adults aged 18 to 25 years have a higher rate of current cocaine use than any other age group, with 1.7 percent of young adults reporting past month cocaine use. Overall, men report higher rates of current cocaine use than women. Ethnic/ racial differences also occur—with the highest rates in those reporting two or more races (1.1 percent), followed by Hispanics (1.0 percent), Whites (0.9 percent), and African-Americans (0.8 percent).

The 2008 Monitoring the Future survey, which annually surveys teen attitudes and drug use, reports that while there has been a significant decline in the 30-day prevalence of powder cocaine use among 8th-, 10th-, and 12th-graders from its peak use in the late 1990s, there was no significant change in current cocaine use from 2001 to 2008; however, crack use declined significantly during this timeframe among 8th- and 12th-graders.

Repeated cocaine use can produce addiction and other adverse health consequences. In 2007, according to the NSDUH, nearly 1.6 million Americans met Diagnostic and Statistical Manual of Mental Disorders criteria for dependence or abuse of cocaine (in any form) in the past 12 months. Further, data from the 2005 Drug Abuse Warning Network (DAWN) report showed that cocaine was involved in 448,481 of the total 1,449,154 visits to emergency departments for drug misuse or abuse. This translates to almost one in three drug misuse or abuse emergency department visits (31 percent) that involved cocaine.