National-level prevalence studies indicate that after a period of recent decline, cocaine use may be rising again, especially among adults. Importantly, cocaine use has recently begun to increase again, with 0.9 million new users in 2000. Data from the 2001 National Household Survey on Drug Abuse (NHSDA; Substance Abuse and Mental Health Services Administration, 2001b) indicate that 1.7 million Americans, or 0.7% of the population age 12 and older, are current cocaine users, and that past year use increased significantly for both powder cocaine (1.5-1.9%) and crack cocaine (0.3-0.5%). Users were more likely to be young adults ages 18-25 (1.9%) than youth ages 12-17 (0.4%) or adults 26 years and older (0.6%). NHSDA data show that current cocaine use among young adults (ages 18-25) grew significantly, from 1.4% in 2000 to 1.9% in 2001, with significant increases in past year use from 4.4 to 5.7% for powder cocaine and 0.7 to 0.9% for crack. For adults age 26 and older, current use was relatively stable (0.4% in 2000 and 0.6% in 2001). However, past year use for adults ages 26-34 rose slightly for both powder cocaine (2.1-2.7%) and crack (0.4-0.6%). A similar 2000 to 2001 trend was found for current use in adults age 35 and older, with powder cocaine use increasing from 0.7 to 0.9% and crack use increasing from 0.2 to 0.3%. Current cocaine use also increased significantly among men (0.7% in 2000 to 1.0% in 2001), while women's use rates stayed approximately the same (0.4-0.5%). In addition, current cocaine use in 2001 was inversely correlated with educational status and was higher among the unemployed (3.6%) than among the employed (1.8%). Because socioeconomically disadvantaged persons are still a minority population, cocaine users are more often white, employed, and high school graduates (Johanson & Schuster, 1995).
Unlike adult levels of use, national-level prevalence studies indicate that adolescent (ages 12-17) levels of cocaine use appear stable and may be declining. According to NHSDA data, adolescents reported that past year cocaine use dropped from 1.7% in 2000 to 1.5 % in 2001, while past year crack use remained the same (0.4%). In 2001, the past year prevalence of cocaine use among youth ages 12-17 years was higher among Hispanic males (0.9%) and white females (0.6%) and males (0.4%) than among blacks (0.1%) and female Hispanics (.1%). The Monitoring the Future study (MTF; Johnston, O'Malley, & Bachman, 2003) demonstrated that past year rates for powder cocaine appear similar (1.9% in 2001 and 1.8% in 2002) for eighth graders, 10th graders (3.0% in 2001 and 3.4% in 2002), and 12th graders (4.4% in 2001 and 2002). Crack cocaine use appeared stable for eighth (1.7% in 2001 and 1.6% in 2002) and 12th graders (2.1% in 2001 to 2.3% in 2002), but increased significantly for 10th graders (1.8% in 2001 to 2.3% in 2002).
Consistent with overall growth in cocaine use, the Drug Abuse Warning Network (DAWN; Substance Abuse and Mental Health Services Administration, 2001a) reports that cocaine continues to be the most frequently mentioned illicit substance reported by hospital emergency departments (EDs) nationwide. The most recent data available regarding the consequences of cocaine use reveal rising ED mentions and declining treatment admissions. Data from DAWN show that the estimated number of cocaine-related ED mentions increased significantly, from 174,881 in 2000 to 193,034 in 2001. In fact, reports of cocaine were present in 30% of the ED drug episodes during 2001 and part of 2002. ED cocaine mentions in 2001 increased 10% from 2000. In a large study conducted in New York City, the rate of overdose deaths for cocaine increased from 1993 to 1998, with cocaine being involved in 69.5% of fatal overdoses. The majority of overdose death rates were attributed to drug combinations of opiates, cocaine, and alcohol. Accidental overdose deaths varied by racial and ethnic group, with overdose deaths among blacks due primarily to cocaine, and overdose deaths among Latinos and whites due to opiates with cocaine (Coffin et al., 2003).
Treatment Episode Data Set (TEDS; Substance Abuse and Mental Health Services Administration, 2002) data also reveal the use of cocaine in combination with other illegal drugs. Marijuana, methamphetamine, and heroin were the secondary drugs of abuse most often mentioned in 1999 TEDS admissions for which cocaine was identified as the primary substance of abuse. Admissions for cocaine taken by routes other than smoking were more likely to be white males (29%), followed by black males (23%), white females (18%), and black females (12%). Admissions for smoked cocaine were more likely to be black males (34%), followed by black females (25%), white males (18%), and white females (14%).
Consistent with NHSDA data, both DAWN ED and TEDS data indicate that the average age of cocaine users is increasing. DAWN data show significant increases between 2000 and 2001 in ED cocaine mentions for patients age 35 and older and for patients age 55 and older. TEDS data further indicate that in 1999, most cocaine-related treatment admissions were in the 35-39 age category, whereas in 1998, most cocaine-related treatment admissions were in the 30-34 age category.
The number of Drug Enforcement Administration (DEA) arrests involving cocaine dropped from 15,767 in 2000 to 12,847 in 2001, and data from the U.S. Sentencing Commission (USSC) show that the percentages of federal drug sentences involving powder and crack cocaine were nearly unchanged from 2000 to 2001. Data from the Arrestee Drug Abuse Monitoring (ADAM; U.S. Department of Justice, 2001) program demonstrated that a median of 29.1% of adult male arrestees and 30.7% of adult female arrestees tested positive for cocaine at arrest in 2001. A median of 18.9% of adult male arrestees and 28.5% of adult female arrestees reported using crack cocaine at least once in the year before being arrested. ADAM data indicate that powder cocaine in adult male arrestees decreased from 13.4% in 2000 to 12.5% in 2001, while crack cocaine in adult male arrestees increased from 17.5% in 2000 to 18.9% in 2001. However, National Drug Threat Survey (U.S. Department of Justice, 2003) data show that 33.1% of state and local law enforcement agencies nationwide identify cocaine as their greatest drug threat; 8.2% identify powder cocaine as their greatest drug threat, while 24.9% identify crack cocaine as their greatest drug threat. In both major urban areas, including Philadelphia and New York City, and rural areas (i.e., St. John Parish, Louisiana), between 31 and 40% of homicide victims tested positive for antemortem cocaine use (Clark, 1996; McGonigal et al., 1993; Tardiff et al., 1994).
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