Cocaine and Other Commonly Abused Drugs: Introduction

Cocaine and other psychostimulant drug abuse remains a major public health problem in the United States and throughout the world; its prevalence appears to be increasing in some metropolitan areas for both college students and adults ages 19 to 40. Drug abuse by women continues to parallel abuse of cocaine and other psychostimulant drugs by men; psychostimulant abuse among youth in the United States is a special concern.

The initiation and persistence of drug abuse are determined by a complex interaction of the pharmacologic properties and relative availability of each drug, the personality and expectations of the user, and the environmental context in which the drug is used. Polydrug abuse, the concurrent use of several drugs with different pharmacologic effects, is increasingly common among individuals from all socioeconomic strata. Particularly dangerous forms of polydrug abuse, such as the combined use of heroin and cocaine intravenously, remain a major problem in hospital emergency room settings. Drug abusers may attempt to attenuate one drug effect with another, as when heroin or alcohol is used to modulate the cocaine high. Sometimes one drug is used to enhance the effects of another, as with benzodiazepines and methadone, or cocaine plus heroin in methadone-maintained patients.

Chronic cocaine and psychostimulant abuse may cause a number of adverse health consequences, ranging from pulmonary disease to reproductive dysfunction. Preexisting disorders such as hypertension and cardiac disease may be exacerbated by drug abuse, and the combined use of two or more drugs may accentuate medical complications associated with abuse of one of them.

Drug abuse increases the risk of exposure to HIV. Cocaine and psychostimulant abuse contribute to the risk for HIV infection in part by suppression of immune function. In addition, concurrent use of cocaine and opiates (the "speedball") is frequently associated with needle-sharing by intravenous drug users. Intravenous drug abusers continue to represent the largest single group of persons with HIV infection in several major metropolitan areas in the United States as well as in urban areas in Scotland, Italy, Spain, Thailand, and China.