MOST OF THE INCREASED USE OF COCAINE IS RELATED TO CRACK

3 Keys To Epidemic: Lower Cost, Ease Of Ingestion, Rapid Effects

Cocaine once served as one of the main ingredients in throat lozenges,
tonics and other products such as Coca-Cola.

In 1914, concerns about instances of addiction, psychotic behavior,
convulsion and death finally resulted in outlawing the use of cocaine and
opiates in over-the-counter products. It now is available legally only as a
prescription for controlling pain after eye, nose and throat surgery.

Cocaine is a central nervous system stimulant, the most powerful found in
nature. Most often seen in the form of a white crystalline powder, it is
extracted from the leaves of a coca plant found in the Andes Mountains of
South America.

The Incas used coca leaves as a part of their religious rites thousands of
years ago. Individuals chewed coca leaves or brewed tea from them to
relieve mountain sickness, reduce hunger and fight fatigue and for refreshment.

Substantial declines in recreational cocaine use were recorded in the late
1980s and early '90s. By the mid-'90s, however, there was evidence of
increasing use, particularly among adolescents. Most of the increased use
was and continues to be related to crack.

What is crack? Crack is a rapidly acting form of cocaine that is smoked. It
usually appears as off-white chips, rocks or chunks. There are many
theories about the origin of crack. It is probable that cocaine
traffickers, seeking a broader market for an existing glut of cocaine,
developed crack to expand the user base. Creating crack allows small
amounts to be sold at low prices.

Smoking crack is easier than snorting the powdered form of cocaine -- and
carries less social stigma than injection. Chips or chunks are usually
placed in a pipe, often made of glass, or a similar vessel and heated with
a match or cigarette lighter. The user inhales the fumes.

Three factors have contributed to making crack usage epidemic in nature:

. The drug is cheap and affordable, making it more available to poor and
young users.

. It is easy to ingest.

. Its effects are rapid and intense.

Smoking crack brings users to a high twice as fast as snorting. Because of
this rapid high, crack is more quickly addicting. The fast high has made
crack an extremely marketable product.

One must also remember, though, that what goes up fast also comes down
fast, if not faster. This contributes to the violence associated with
crack. In order to function, the user has to have more of the drug and will
do anything, including prostitution, robbery and occasionally murder, to
get it.

Cocaine and crack are toxic, addictive, psychoactive substances that have
significant medical consequences for users. Perhaps even more significant
and unfortunate are the negative effects cocaine and crack users have on
their families, communities, workplaces and society.

Domestic and random violence are often fueled by cocaine or crack. Children
are often the victims of cocaine-or crack-using parents and suffer from
prenatal exposure or parental abuse. The unsettling thing is that
adolescents are using the drug more and more.

Dr. Van Stitt Jr. is vice president and chief medical officer at Gaston
Memorial Hospital.