Monday, March 10, 2008

“A Scenario for Enlightened Drug Policy”

“A Scenario for Enlightened Drug Policy”
by Richard B. Karel, September 29, 1988,
U.S. Congress House Select Committee on Narcotics Abuse and Control, as regards to Coca and cocaine

Coca, in the form of leaves or simple extracts of leaves, has far more in common with coffee than it does with granular cocaine (16). There is a long history of use with coca and coca-containing beverages without concurrent social problems. It is fair to say that the habit forming potential of coca is similar to that of coffee and tea (16a). Even daily use of what we would consider extraordinary large quantities of leaves by South American Indians is not correlated with social dysfunction or ill health (16b).

A recent article in The New York Times (“Drug Researchers Try to Treat A Nearly Unbreakable Habit”) on the phenomenon of crack addiction drew a sharp distinction between crack, cocaine and coca. The euphoria induced by crack, and by intranasal use of cocaine, stems from the abnormal stimulation of a pleasure center in the base of the brain. However, the sense of euphoria demands not only on blood levels of cocaine, but also the rate at which blood levels rise. Hence the faster the increase the greater the euphoria. Dr. Herbert Kleber of Yale, an expert in the field, observed that the slow absorption of cocaine as occurs through the Indian habit of leaf chewing would create high blood levels but no euphoria. “It would have an effect like caffeine.” Kleber wrote (17) ">It would not be unreasonable to allow simple coca tea to be sold as tea now is in a supermarket. The effects and risks are comparable.""> Extracts containing more than a designated amount of leaves might be regulated like alcoholic beverages."" It would also make sense to allow limited cultivation of coca for personal use. In addition to the original Coca-Cola, the rather colorful history of coca records use of a beverage called "Mariani’s Coca Wine Vin Mariani. It contained two ounces of fresh coca leaves to a pint of wine. Testimonials for the wine were recorded from than president of the United States William McKinley, patriotic composer John Phillip Sousa, inventor Thomas Edison, and Pope Leo XIII (19), (19a). Despite the widespread use of coca containing beverages, there is little evidence that social or medical problems ensued 19b). The jump form coca to cocaine and from cocaine to crack is a difference in kind, not merely in potency. Although crack is by far more addicting and dangerous than granular cocaine, the latter is highly addicting to a small but significant number of cocaine users. Accordingly, the legal restrictions must reflect the medical and social problems associated with its use.

Crack poses unreasonable risks, and I find it extremely difficult to justify any degree of legalization. The question arises, then, of what to do with crack addicts who prefer smoking to other forms of administration. There is no easy answer, and researchers feel that addiction to the crack form of cocaine is the hardest to kick (20). It is worth considering the plausibility of providing a less dangerous form of cocaine to the crack addict. The availability of other forms of cocaine, and of other legal drugs would in my opinion, minimize a black market in crack even if that form of the drug remained illegal. It would not eliminate the crack cocaine problem, however. There are no panaceas, only hard choices.

Cocaine, although problematic, has a lower addiction potential than crack (21). I do not believe that making granular cocaine available to the public would be wise policy. I suggest, however, that cocaine be made available to the public in the form of a chewing gum similar to that now used to treat nicotine addiction. The nicotine gum has proven quite effective, and there is no reason to doubt that a cocaine gum would be equally so. (22). Some years back, Weil suggested consideration of a coca chewing gum. In order to minimize the excessive use of the gum, and in order to send a signal that restraint must be exercised, a limited distribution system would be employed for this form of the drug. The gum would be available in packages of 20, each piece containing a small amount – 1/20 to 1/30 of a gram – of pharmaceutical cocaine. It would be almost impossible to overdose form this form of the drug, and intake would be limited by the physical limitations inherent in mastication. To further regulate use, however, a MOST style rationing card would be used, limiting purchase to one pack every 48 to 72 hours. If a purchase was attempted more frequently, the card would indicate that not enough time had elapsed. Undoubtedly, people would sometimes circumvent the system by having friends purchase gum for them. This would certainly be better than having someone become involved with a criminal subculture and granular cocaine or crack, however. A pharmacist would do the actual dispensing. The card would simply be an electronic time log. Further compliance with the system could be ensured by requiring presentation of corroborating photo identification at time of purchase. The system would only monitor most recent purchases, and not invade privacy by keeping a long term log. The treatment of the addicted user, either or crack or granular cocaine, presents other problems. I would suggest that addicts be supplied with the cocaine gum under a clinical distribution system separate and apart from regular pharmacies. I would also allow physicians operating through the clinics to use other approaches as they deem fit. This could include judicious use of other forms of cocaine or treatment with other drugs, such as anti-depressants (23). I stress, however, that abstinence should not be forced on addicts who have not made the psychological leap of wanting to quit. Such efforts are doomed to failure. Administration of cocaine to addicts though a clinical system would undermine any remaining black market and keep the addict in touch with an environment where his addiction is treated as a medical problem and not a crime. I do not believe this would legitimize use of granular cocaine or crack, any more than use of methadone has legitimized heroin addiction (24) … … Regulation of raw coca and opium would also be handled by the USDA, although once the coca went into the marketplace, it would be regulated, like coffee or tea, by the Food and Drug Administration (FDA) as a foodstuff. You will recall, that more concentrated coca extract would be regulated like alcohol, in which case purity and content would fall under the jurisdiction of BATF… It is important to remember that some forms of substance not create impairment. No one, for example, believes that a pilot is a menace following his morning cup of coffee. The use of coca tea or beverages would have to be viewed in the same light.

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