July 16th, 2018

Increase Usage of Cocaine

Increase of cocaine positive test resultsAlthough I frequently get interview requests from the media to talk about the opioid epidemic, many years had passed since anyone has asked about cocaine. That changed recently when I spoke to a reporter from Caracol Television – a large Colombian news network. The trigger for the request was that the U.S. Office of National Drug Policy (ONDCP) had just announced that cocaine production in Colombia was at a record high for the second consecutive year. The reporters wanted to know the impact of this, if any, on an outpatient drug treatment program such as ours.

Cocaine-positive Test Results Increase

The first hint that I had of the resurgence of the cocaine problem was a report in May by Quest Diagnostics of a sharp increase in cocaine-positive urines taken at worksites around the country. Maryland was one of several states in which this increase was particularly striking. Fortunately, the overall percent of drug positives urines had not increased, and the number of prescription opioid positives had “declined dramatically.”

My answer to the reporter was that we have continued to see patients whose primary addiction is cocaine, but the numbers were dramatically lower than during the peak of the “cocaine epidemic” in the 1980’s. The news of a possible return of cocaine addiction was unwelcome because cocaine had been one of the substances for which we had the poorest treatment outcomes. Part of this, I believe, was because, unlike with alcohol and opioids, we never found any medication that was helpful in treating cocaine addiction, despite considerable research devoted to that effort. The diminution of cocaine as a major issue seems, in fact, to have led to a reduction in the focus on developing such medications.

Supply Side verses Demand Side  Intervention Strategy

Worse still, the predictable response of the administration to the news of increased production was to focus on increasing eradication efforts and criticizing Colombia for not doing enough in this regard. While law enforcement efforts need to be part of the intervention strategy, I fear a return to an emphasis on the “supply side war on drugs,” which has proven to be so expensive and less effective than a “demand side” emphasis on treatment, including medication.

Meanwhile, we will have to wait to see if cocaine addiction will actually return to its previously high levels and if we can improve our treatment outcomes this time around.

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