Coping With Cocaine

Cocaine is highly addictive, highly toxic, and increasingly abundant. We are fighting cocaine abuse the wrong way.


EVERY DAY 5,000 AMERicans try cocaine for the first time—a total of 22 million so far—according to estimates by the National Institute on Drug Abuse. About five million people are believed to be using the drug at least once a month, and they are administering it to themselves in increasingly destructive ways.

The damage caused by cocaine is palpable, and much of it has been done in less than a decade. The number of people with cocaine-related problems seeking admission to federally funded drug clinics climbed by 600 percent from 1976 to 1981—the most recent period for which such a figure is available. The surge in admissions to private clinics has undoubtedly been at least as great. For example, the Benjamin Rush Center, a private psychiatric hospital in Syracuse, New York, seldom admitted cocaine abusers during the 1970s; today 40 percent of the hospital’s beds are set aside for them.

There are four ways to make cocaine less available to confirmed and potential users. We can “go to the source" and try to inhibit the cultivation of coca in foreign lands. We can try to prevent the importation of the drug—“interdiction.”Once it is on our shores, we can try to disrupt or destroy the dealing and money-laundering operations that make the trade profitable. And, finally, we can punish those who use cocaine, do what we can to break their habits, and try to persuade everyone else not to use it in the first place.

The Reagan Administration, early in the President’s first term of office, proclaimed a war on drug trafficking. and from the outset the war has been waged primarily at the nation’s borders. It has been a war, in other words, largely of interdiction. The war effort has been substantial. In 1981 the Administration endorsed successful amendments to the Posse Comitatus Act (passed as a sop to the South after the Civil War), which prohibits soldiers from policing civilians. Military personnel and equipment may now be deployed in the fight against drugs. In the spring of 1982 the Reagan Administration launched the South Florida Task Force, under the authority of Vice-President George Bush, to coordinate the activities of nine federal crime-fighting agencies. (They are the United States Attorney’s Office, the Drug Enforcement Administration [DEA], the Federal Bureau of Investigation, the Customs Service, the Bureau of Alcohol, Tobacco, and Firearms, the Internal Revenue Service, the Coast Guard, the Border Patrol, and the United States Marshals.) Hundreds of federal agents poured into Miami and its environs, long known to hav e been the entry point of choice for illegal narcotics. Local police went into high gear.

At least on the surface Washington’s efforts appear to have paid a big dividend. In November of 1982, scarcely six months after the task force got under way, Ronald Reagan came to south Florida. Speaking amid tons of seized marijuana, kilos of captured cocaine, and a small armory of impounded Uzi and Mac-10 machine guns, the President proclaimed the South Florida Task Force a “brilliant example of working federalism.”During the first year of taskforce activity the United States Attorney’s Office in south Florida prosecuted some 664 drug-related cases—64 percent more than in the preceding year. The task force confiscated $19 million in cash and property from drug offenders—half again what had been confiscated in south Florida the year before—and interdicted enormous quantities of drugs. The quantities have increased in the years since.

From the first, the south Florida effort has been a source of pride to the Administration. But the statistics, which in themselves may seem impressive, in context tell a depressing story. For one thing, experts are convinced that the warehouses of captured contraband represent only a small fraction of the drugs being smuggled into the country. For another, the flow of imported drugs has been shifting, with cocaine occupying an increasingly important place. In 1983 government agents in south Florida seized some six tons of cocaine and 850 tons of marijuana (which tends to come in by the boatload). In 1985 the figures were twenty-five and 750 tons respectively. In other words, seizures of cocaine, a potentially lethal drug, have quadrupled while seizures of marijuana, a substance that looks benign in comparison, have fallen off. It is generally believed that the amounts of drugs seized reflect the amounts coming in. Thus, almost certainly, more cocaine is being imported now than ever before. More is also probably being consumed. The DEA has estimated that in 1981, before the South Florida Task Force existed, Americans used between thirty-six and sixty-six tons of cocaine. For 1984 it increased its estimate to between sixty-one and eighty-four tons. Cocaine’s price history also suggests that the supply is growing. When the task force began, dealers in Florida were paying roughly $60,000 for a kilogram of cocaine. Today they pay some 40 percent less.

Why the sudden abundance of cocaine? The government’s strategy in the war on drugs may be partly to blame. The heightened risk of interdiction has prompted smugglers to favor drugs that are compact and expensive, like cocaine, over drugs that are bulky and relatively cheap, like marijuana.

During the past half decade the availability and the use of cocaine have risen sharply. The trend is disturbing—all the more so if government policies are helping to foster it. Cocaine abuse has become a public-health problem of major proportions. And, unfortunately, doctors, lawyers, and politicians disagree profoundly as to how we should attack it.

COCAINE WAS ISOLATED IN THE LABORATORY MORE than a hundred years ago. It is an alkaloid—a member of the chemical family that includes nicotine, caffeine, and morphine—extracted from the coca plant, which grows chiefly in Latin America. When the extract is heated with hydrochloric acid, cocaine hydrochloride is created. This salt (together with various adulterants) is the stock-in-trade of most dealers, because, being w ater soluble, it can be taken in several different ways.

Cocaine has been produced in quantity since the 1920s. Vet even now the drug’s activity is only partially understood. The cocaine molecule resembles the local anesthetics procaine (Novocain) and lidocaine (Xylocaine) in structure. All three consist of an amino group with a focal nitrogen atom and a six-carbon ring that facilitates solubility in fatty tissue (such as the tissue of the brain). Although cocaine is itself a local anesthetic, it is also a stimulant of the central nervous system—possibly the most potent in nature.

The “rush”—the sense of euphoric excitement—reported by users of the drug probably comes from the activation of nerve cells in the brain that release a chemical messenger, or neurotransmitter, called dopamine, which is associated with pleasure, alertness, and motor control. According to Mark Gold, a psychiatrist, who directs drug research at Fair Oaks Hospital, in Summit, New Jersey, cocaine tricks the brain into feeling as if it had been “totally supplied with food and sex.” It is a compelling sensation. A survey conducted by 1-800-COCAINK (a national hotline for counseling and referral, set up by Gold) revealed that 70 percent of respondents had on occasion used cocaine continuously over a twenty-four-hour period. Large proportions preferred the drug to food (71 percent), sex (50 percent), family (72 percent), and friends (69 percent).

Paradoxically, chronic cocaine use eventually leads to dysphoria—a depressed, low-energy state characterized by flattened emotions, a lack of interest in sex, and physical immobility. New research by Gold and his colleague Charles Dackis suggests that after cocaine has saturated the nerve synapses and receptor neurons with dopamine, it chemically blocks the “re-uptake" sites of the original dopamine projector cells. As a result, the neurotransmitter, when its job is done, cannot return to the places where it is usually stored. Instead it is metabolized and then flushed out of the system. The dopamine stocks of heavy cocaine users are depleted more rapidly than they can be replenished. These users may be incapable offeeling pleasure without the drug.

The absence of a sense of pleasure can become all the more Oppressive because cocaine hinders the brain’s production of serotonin, the neurotransmitter that is chiefly responsible for sleep. In order to blunt the dysphoria, or even just to fall asleep, users of cocaine frequently resort to other drugs—alcohol, marijuana, sedatives, heroin. Or they may simply take more cocaine, hoping to regain the high. Many users conclude from the unwelcome symptoms of dopamine depletion that the cocaine is out of their systems—and that it is therefore safe to use more. Of course, this is not the case.

The physical and psychological consequences of heavy cocaine use are numerous and negative. High-dosage users can experience hallucinations and delusions, and eventually may lapse into a state that mimics schizophrenia. Many of them experience formication, the sensation that their skin is crawling with bugs. Impaired judgment and feelings of persecution are common. (One patient at the Benjamin Rush Center once drove the New York Thruway convinced that an enemy was hiding in his trunk. He repeatedly fired a gun into it, fortunately missing the gas tank.) Many cocaine users lose considerable weight and suffer from malnutrition.

Each means of administering cocaine entails a discrete set of risks. Inhaling the drug—"snorting"—eventually will cause nasal membranes to crack and bleed, and may destroy the cartilage that separates the nostrils. Those who inject cocaine intravenously invite deterioration of arteries in the muscles, kidneys, and heart; in addition, they become candidates for blood poisoning and (if they share their needles) hepatitis and AIDS. Smoking cocaine in its relatively pure “freebase” form may be more dangerous than any other method, Freebase is the alkaloid—the chemical base—constituent of street cocaine. According to Richard Rawson, a clinical-research psychologist affiliated with the University of California at Los Angeles Medical School and the director of the Matrix Center, a cocaine-abuse clinic in Beverly Hills, freebase is so concentrated when it reaches the brain that it produces “an explosion at the synapse.” Freebase seems to be the most toxic form of cocaine and the most conducive to convulsions. Its production, which entails the use of a highly flammable solvent, such as ether, is also hazardous. It was while freebasing that the comedian Richard Pryor suffered near-fatal burns, in 1980.

Like other local anesthetics, cocaine in toxic doses will cause convulsions; these may result in a rapid series of grand mat seizures and ultimately in death. Cocaine can also trigger sometimes fatal cardiac arrhy thmia or respiratory paralysis. Tolerance for cocaine, like tolerance for alcohol, varies widely among individuals. The smallest lethal dose of cocaine was long held to be 1.2 grams ingested in a day. but clinicians have reported treating patients who have consumed ten times that amount and survived, and sending to the morgue others who had consumed only milligrams. Chronic users may experience “kindling,” in which a small amount of cocaine triggers unexpectedly severe reactions—notably seizures or psychotic behavior. Kindling may be the result of drug-provoked alterations in the brain’s physiology, such as, perhaps, the creation of new receptor sites that become fresh targets for neurotransmitters.

Cocaine is among the most “reinforcing” of drugs. In an experiment reported in the journal Psyrhopharmacologia in 1969, monkeys were allowed to self-administer intravenously a variety of chemical substances, including cocaine, caffeine, amphetamines, and nicotine. The monkeys went on binges with each of these substances, but only with cocaine did their use become so compulsive that they reached a lethal dose and died. Although there is some disagreement about whether cocaine produces psychological dependence or physical addiction, the dopamine-depletion model suggests that at least there is a physical component. And chronic users do experience w ithdrawal: craving, extreme irritability, fuzzy thinking, sluggishness, and heavy sleeping—symptoms lasting from days to weeks.

Richard Rawson considers cocaine to be addictive and says that the probability of getting hooked is different for different people. “If two people walk into a room with plutonium in it. only one may get cancer, because of differences in their immune systems,” he says. “ There is a genetic factor involved. Similarly, the propensity for cocaineaddiction may involve an underlying neurophysiological vulnerability.”

That vulnerability may run in families. About 80 percent of those being treated for cocaine addiction at the Benjamin Rush Center and the Matrix Center have families in which alcoholism has been a problem. Studies have long shown that children of alcoholics are far more likely than others to develop a problem with alcohol or other drugs; children of alcoholics who are raised by non-alcoholic foster parents are just as likely to become alcoholics as if they had remained with their biological parents. The evidence points persuasively to the existence of a genetic risk factor in addiction to any substance, including cocaine.

THE RISK TO THE USER OF BECOMING ADDICTED TO cocaine seems to be linked most closely with how the user administers the drug and how much of it he consumes. Smoking freebase carries the greatest risk. The least risk is posed by the method of consumption that was used exclusively for nearly 5,000 years; chewing on coca leaves. According to Ronald Siegel, a psychopharmacologist at UCLAwho is a consultant to President Reagan’s Commission on Organized Crime, until ways of ingesting more concentrated doses were found, “there was no cocaine problem.” Siegel has studied Peruvian Indians, who chew coca for the mild stimulation it provides as well as for its appetite-suppressing effect. They do so without apparent damage to their health. A one-hundred-gram sample of coca leaves, Siegel points out, contains more than 300 calories and significant quantities of vitamins A and B2. The Indians, who traffic in coca, know that cocaine is snorted and taken intravenously by others, and they deem these practices repulsive.

According to Siegel, cocaine did not become a health hazard until 1860, when European scientists succeeded in extracting the cocaine alkaloid from the coca leaf. The drug thus became available in a pure and puissant form, and its many useful qualities were hailed by physicians. Because it works simultaneously as a pain-killer and a vasoconstrictor, cocaine became a popular anesthetic for procedures (such as eye and throat surgery) in which clearing away blood was difficult. Because it anesthetizes the body but keeps the mind sharp, doctors prescribed it for the terminally ill. Cocaine was used in cough medicines, hemorrhoid balms, nasal sprays, and wines (one of which bore the endorsements of President William McKinley. Thomas Edison, and Pope Leo XIII), And, of course, the drug was once an ingredient in Coca-Cola.

The darker side of cocaine was exposed within decades: many people became habitual users of the drug, which commonly they administered with a hypodermic needle, or of products that contained it; some experienced toxic reactions; a few died of overdoses. Cocaine represented a greater threat to society than either opium or morphine. By the 1880s some states had outlawed it for other than medicinal purposes. Interstate shipment of cocaine was prohibited by the Pure Food and Drug Act of 1906. The Harrison Narcotics Act of 1914 imposed a nationwide ban on the use of both cocaine and heroin (except, again, for medicinal purposes). International agreements in 1925 and 1931 outlawed trade in cocaine. Because the principal sources of coca at the time, including Peru and Bolivia, lacked the capacity to refine coca leaves, and because the leaves themselves were too bulky to smuggle, the prohibition was not difficult to enforce. In the 1930s amphetamines were first used clinically and quickly captured much of the underground market for stimulants. By the onset of the Second World War cocaine was no longer a menace.

Cocaine reappeared as a significant recreational drug in the late 1960s and early 1970s. It did so at least in part because of a successful crackdown by police on amphetamine laboratories and the trafficking networks sustaining them, which created a place in the market for a new stimulant. But cocaine was given a better press than amphetamines, probably because it was far more expensive and thus kept better company.

Snorting cocaine predominated over intravenous injection when the drug made its comeback. That preference helped to keep the problems associated with cocaine to a minimum. Contrary to popular belief, the nose is not a short route to the brain. After being snorted, cocaine sustains a threeor four-minute passage through the circulatory system before arriving at the receptors. It is being diluted all the while. Two other circumstances also gave users some protection against the drug’s ill effects. In 1979 Robert Byck, who with Craig Van Dyke was in the midst of a six-year study of cocaine at the Yale University School of Medicine, testified before Congress that cocaine posed a severe threat to public health but one mitigated by the drug’s “adulteration" and “exceedingly high price.”When Byck spoke, an adulterated gram of cocaine could sell for $100 or more.

The conditions identified by Byck no longer obtain. In the past five years, as more and more cocaine has entered the United States and the price has dropped, purity has increased. Much of the cocaine now sold is at least twice as pure as the cocaine sold a decade ago. Meanwhile, the price of cocaine has plummeted. Today a gram can often be had for $50, making it less expensive than an ounce of marijuana. Cocaine is within reach of the suburban middle class and, increasingly, the urban poor. Indeed, users can now procure cocaine in such large amounts that the tins coke spoon — the principal item of paraphernalia in the 1970s—is an object of nostalgia.

There is some evidence that more and more people are choosing to inject a cocaine solution directly into their bloodstreams (a fifteen-second route to the brain) or to smoke freebase (a seven-second route). One source is the reports of federally funded drug-treatment programs to the National Institute of Drug Abuse (NIDA), a division of the Department of Health and Human Services. These show that 25 percent of cocaine users admitted for treatment in 1977 were shooting up or smoking freebase, whereas 41 percent were in 1984. Another source of evidence is the 1 -800-COCAINK hotline. In 1983 among 500 callers surveyed at random 39 percent were shooting up or smoking freebase. The 1985 figure is 48 percent. One might expect problem users to favor the most potent ways of taking cocaine. But these statistics are not the only indication that a change is occurring. There are also death statistics.

Alcohol contributes to as many as 200,000 deaths annually in the United States; tobacco contributes to another 350,000. There is no comparable figure on the long-term lethal effect of cocaine abuse, but some comparative data does exist on “crisis deaths.”The NIDA maintains a Drug Abuse Warning Network (DAWN), which collects information on drug overdoses from emergency rooms and medical examiners in twenty-six metropolitan areas. Sketchy as the DAWN data are, they are perhaps the best indication we have of the relative dangerousness of various drugs. In 1984 cocaine (implicated in 604 deaths) was third on the list, behind heroin and morphine (1,072 deaths) and alcohol used in combination with other drugs (1,131 deaths). More alarming than the number of cocaine-related deaths is the rate at which the number may have been increasing. In the first half of this decade the number of deaths reported to DAWN in which cocaine was implicated increased by 324 percent—considerably faster than the reported number of deaths involving alcohol or other drugs.

A poll limited to southern California, which the Matrix Center conducted last year, showed that 58 percent of callers to the center chose smoking freebase over any other method. Users in California can now buy $10 chunks of freebase (thus avoiding the danger of preparing it themselves) at places called rock houses. This has helped to create a market for cocaine among the very poor. As Rawson explains, “A person may get a two-hundred-dollar welfare check and think he’ll spend twenty dollars on freebase and use the rest for groceries. But he ends up going back to the rock house again and again until he uses up the whole two hundred. Once started into a freebase episode, people will use it until they drop. It generates a type of drug-seeking behavior previously unseen. It’s more compelling than heroin.” In California the rock houses seem to be controlled largely by street gangs. Law-enforcement officials worry that the rock-house phenomenon, like other trends in the drug culture, will move from West to East. According to Raw son, there have been unconfirmed reports of rock houses operating in Arizona.

THE PROBLEM OF COCAINE HAS ATTRACTED A SUBstantial amount of professional attention in recent years. There have been clinical surveys. There has been laboratory research. There have been articles in lawjournals, hearings on Capitol Hill, and commissions and task forces too numerous to cite. We know more today than we did a decade ago about cocaine specifically, about addiction generally, and about the baffling complexities of law enforcement. We know enough, perhaps, to agree that cocaine is a social ill that can be managed but one that cannot be easily cured. Enough evidence has accumulated to suggest where efforts to manage the problem are likely to go awry and where they may do some good.

The focus of the showpiece South Florida Task Force— interdiction—is extremely popular with legislators. Interdiction is “cleaner" than undercover work at home, and it is easier than trying to wean foreign economies from their dependence on sales of coca. Also, it makes use of alluring (albeit expensive) technology: radar aircraft, helicopters, and custom-built pursuit craft. Interdiction is highly visible, inspiring confidence that, yes, a war on drugs really is in progress. But Edward Jurith, staff counsel for the House Select Committee on Narcotics Abuse and Control, says, “The truth is, we’re getting clobbered.”

One clear consequence of interdiction has been simple diversion: smugglers alter their routes and landing spots to avoid areas that are “hot.” In recent years, as security around south Florida began to tighten, much of the drug traffic shifted to the north and west. As Stev en Wisotsky, a professor at the Nova Law Center, in Fort Lauderdale, puts it, “We’ve simply taken our garbage and dumped it in our neighbors’ back yards.” (The governors of Alabama, Louisiana, Mississippi, Florida, and Texas held an emergency meeting early last year to discuss the problem.) Federal and state law-enforcement officials say that at the very least diversion disrupts established smuggling routes and distribution networks, leaving drug traffickers vulnerable. But the DEA’s estimate that the quantity of cocaine finding its way into the United States has doubled since 1981 does not support that contention. Worldwide coca production is up. Brazil, Venezuela, and Ecuador have joined Peru, Colombia, and Bolivia as producers.

In order to understand interdiction’s effect on the cocaine business, one should consider what has happened to the marijuana business. Before the interdiction effort marijuana typically traveled in bales aboard slow, rusting freighters, called mother ships, or on lumbering, vintage aircraft. A ton of marijuana had the same market value as a kilogram of cocaine, but one was the size of a car, the other no bigger than a two-pound bag of sugar. Marijuana presented the easier target to law-enforcement officers. As a result, domestically grown marijuana, which had been much more expensive than imports, mainly because of higher labor costs, suddenly became competitive.

Today marijuana is probably the largest cash crop in the United States after corn; according to the National Organization for the Reform of Marijuana Laws, growing it is a $16.6 billion-a-year industry. Yet the market for marijuana seems to have remained stable. If, as this suggests, less marijuana is coming into the country, what has become of marijuana smugglers? In August of 1983 Frank Chellino, then a spokesman for the DEA and now the supervisor of DEA intelligence for Florida and the Caribbean, told a reporter for the Miami Herald that “we know that a number of individuals who were heavily involved in the growth of marijuana have severely curtailed their activities—probably because of the task force—and have now switched to cocaine.” Florida has the same mandatory prison sentence for trafficking in either marijuana or cocaine. A smuggler turned DEA informant, Luis Garcia, told me recently, “If you are going to get fifteen years for doing one and fifteen years for doing the other, you’re going to go for the coke. It’s easier to handle, easier to fly, and easier to hide.”

Interdiction has led law-enforcement officials into an unwitting symbiotic relationship with drug traffickers. The smugglers understand Washington’s need to see a steadily rising number of arrests and confiscations. As a result, a smuggler sends into the country not less cocaine but more—divided among several boats, one of which the smuggler considers expendable. If the police capture the decoy, they get some cocaine, a boat, a crew, statistics, and arrests. These may or may not lead to convictions or information, however. Most captures at sea involve not the drug trade’s linchpins but its lowliest laborers, who are generally too ignorant and fearful of reprisals to be of use. In any case, the other boats get through. Both sides are reasonably content, but only the smuggler has accomplished his purpose.

Even if interdiction did keep substantially more cocaine out of the country, no great change would occur in the market for it—which is ultimately what counts. Looking into this matter, Peter Reuter, an economist at the Rand Corporation, generously credited the current interdiction effort with stopping 20 percent of the cocaine headed for U.S. shores. He then calculated how the retail price of cocaine would change if 40 percent of the incoming drug were somehow seized. He concluded that the price for a kilogram would rise by a scant 3.4 percent—hardly enough to drive down demand. The reason the increase would be so modest has to do with cocaine’s price structure. In addition to the costs incurred in transportation and distribution, middlemen and dealers take a huge profit. U.S. importers pay their suppliers roughly $50,000 for a kilogram of Colombian cocaine, which they in turn retail for upwards of $625,000. (The street value of a shipment of cocaine is the total that would have been paid to dealers if the shipment had been sold off by the gram.) It seizures really were running at 20 percent, as Reuter assumed for his model, an importer would have to buy 125 kilos from Colombia in order to get 100 kilos into the country. If seizures ran instead at 40 percent, the importer would have to bus 167 kilos. The additional 42 kilos would cost the importer $2.1 million, or just 3.4 percent of the retail value—not much of a difference.

Last July a spokesman for the Reagan Administration conceded that too much attention may have been focused on enforcement, at the expense of other drug-control efforts. Speaking before a Senate committee considering his nomination as head of the DEA, John C. Lawn, a former FBI agent and the DEA’s acting administrator, testified that when he joined the DEA, in 1982, he believed that “with sufficient resources the drug problem could be addressed and solved with law enforcement alone.”He had come to understand, however, that “the problem is greater than law enforcement is able to cope with.” And Law n regretted that Washington had focused on the supply side of the drug business. The real problem, he concluded, is demand.

DEMAND LIES AT THE HEART OF THE ARGUMENT for the decriminalization of cocaine. The most articulate reasoning in support of that argument is found in a 120-page article by Steven W isotsky, the Nova Law Center professor: “Exposing the War on Cocaine: The Futility and Destructiveness of Prohibition.”Wisconsin Law Review published the article in 1983. Most people with an interest in the interdiction and control of cocaine are familiar with Wisotsky’s work. His research is often praised even by those who are profoundly skeptical of the conclusions drawn from it.

The case that Wisotsky builds turns on the proposition that a “strongly inelastic demand always will support the black market.” He points out that the demand for cocaine has been dominated by a core group of very heavy users. According to the National Narcotics Intelligence Consumers Commission, consisting of representatives of eleven federal agencies, as of 1981 about six percent of the nation’s cocaine users were consuming about 60 percent of all of the cocaine entering the United States. ‘These hard-core users were experiencing, on average, some 234 “abuse sessions” a year. They wanted cocaine badly, and they were willing to pay for it.

A gram of legal cocaine, pharmaceutically pure, costs less than two dollars, Wisotsky points out. Black-market cocaine, diluted with adulterants, costs as much as seventy dollars a gram. It is this markup that draws smugglers, dealers, and other criminal elements into the cocaine trade. With them comes violence, corruption, tax evasion, property inflation, and the usual ugly manifestations of widespread social decay. As long as cocaine remains a black-market commodity, and as long as demand remains inelastic, traffic in the drug will be too profitable for some to resist.

The problem, Wisotsky writes, is not merely a domestic one. He worries about how the billions in profits from cocaine are being spent and what the implications might be for national security. The cocaine business has made multimillionaires of hundreds of criminals in Latin America and the Caribbean. In league with assorted guerrilla movements, or simply by throwing money around, many of these people have become sources of instability in their own countries. Some are virtual warlords. Reportedly, the M-19 Communist insurgents in Colombia and the Maoist Sendero Luminoso guerrillas in Peru are financed in part by the cocaine trade, as is the right-wing Cuban-exile group Omega-7. The bureaucracies and even the cabinets of some small island regimes are riddled with people involved in the drug trade.

Wisotsky worries that efforts by law-enforcement agencies and the military to crack down on cocaine and cocaine dealers might contribute to an erosion of American civil liberties: a more casual approach to wiretapping, search and seizure, the exclusionary rule, and the basic rights of defendants. Although Wisotsky does not take the dangers of cocaine abuse lightly, he wonders whether our present policies might not prove ultimately to be even more pernicious. If cocaine were decriminalized, he argues, the black market in the drug, and the crime associated with it, would immediately disappear. The threats to national security and to the integrity of the Constitution would recede.

There are a number of objections to Wisotsky’s position, the first of which he himself has raised: “It has no chance. Society isn’t ready for it.” Indeed, to mention the subject of drugs in a state legislature today is to invite a new round of repressive legislation. Not even the legalization of marijuana has a sizable political constituency. For this reason. Wisotsky now argues, in a book to be published this year, rather than change the laws governing cocaine we should simply enforce them more selectively.

Second, there is a precedent for decriminalization, and it is discouraging. The British have since the 1920s prescribed heroin for confessed addicts. This approach worked well enough as long as the number of heroin addicts remained small, but during the 1960s. when the number of addicts increased, it not only failed to deter the growth of a black market but led to notorious abuses. Some patients with prescriptions, it was learned, were selling their legal heroin to junkies. Others were supplementing their prescribed doses with heroin obtained on the black market. Today Britain has all but eliminated heroinby-prescription.

Charles Rangel, a Democratic congressman from New York and the chairman of the House Select Committee on Narcotics Abuse and Control, dismisses the British experiment out of hand as “a remarkable failure.”He believes that any attempt by the government to decriminalize and regulate the distribution of cocaine would raise practical questions that no one could answer. Should the drug be available to people under the age of eighteen? If not, wouldn’t they perpetuate the need for a black market? In what concentration should the drug be av ailable? And in what form? Freebase and injectable solution, as well as pow der? The problem, Rangel says, is that the black market will always offer choices that the larger society will not. And besides, he adds, there is the matter of principle: “It’s pathetic when a great civilization and democracy reaches the point that it makes its citizens federally subsidized zombies.”

From a legal standpoint, the decriminalization of cocaine would not be easy to achieve. No individual state can decriminalize the drug, because federal prohibitions exist, and they supersede state laws. Congress, in turn, cannot decriminalize it, because the United States is a party to the United Nations Single Convention on Narcotic Drugs. This is a treaty, and treaties supersede federal law. Under the Single Convention, adopted in 1961, signatory nations must regard the non-medical use of marijuana, cocaine, and opium derivatives as illegal. In order to decriminalize cocaine, the United States would have to withdraw from a treaty that it worked hard to bring about.

The most compelling argument against decriminalization is that it would almost certainly broaden the population of cocaine users. Significantly, the most-abused psychoactive substances in America today—alcohol, tobacco, and mood-altering drugs available over the counter (sleep inducers, for example) or by prescription—are all legal, though regulated to various degrees. If cocaine became legal, the crime and violence associated with it would probably decline. But deaths from overdoses would increase, as would seizures and other forms of physical trauma, automobile accidents, family troubles, and difficulties on the job. Carlton Turner, the President’s adviser on drug-related issues, estimates that as many as 60 million Americans would become cocaine users if the drug were decriminalized. If 10 to 20 percent of these users became addicts (Mark Gold estimates that one in four would), then cocaine abuse would be a national scourge on the scale that alcoholism now is.

Short of decriminalizing cocaine, we might explore ways to blunt its negative physical effects. One is to create a replacement drug. To date an alcohol substitute has been the primary goal of researchers thinking along such lines. In small doses, alcohol relieves anxiety better than any other substance, but it also is addictive and highly corrosive to the user’s system. Consequently, a “safe” alcohol or alcohol-like substance—one that retains alcohol’s healthful qualities but lacks its dangerous ones—would be welcome. Theoretically, it might be possible to create a safe drug that somehow matched cocaine’s performance in enhancing alertness, self-esteem, and sociability, without impairing judgment. In laboratory settings cocaine users have already shown that they can be fooled under certain circumstances by the local anesthetic lidocaine. Bur even if the development of a replacement for cocaine were socially desirable, which is by no means clear, it is not imminent. Nor is the history of replacement drugs encouraging. In the nineteenth century cocaine itself was recommended—by Sigmund Freud and others—as a non-habit-forming substitute for morphine.

A less problematical alternative to a replacement for cocaine is a drug to ease withdrawal. Research on one such drug has been conducted by Charles Dackis, of Fair Oaks Hospital. Theorizing that a lack of dopamine causes heavy users to crave cocaine, Dackis gave forty such users a prescription drug called bromocriptine, which does the work of dopamine in the brain without imitating dopamine’s euphoric effects. (The drug is commercially available as a treatment for the symptoms of Parkinson’s disease.) Subjects reported that their craving decreased sharply, and that they also experienced the other usual symptoms of withdrawal less intensely. Animal studies indicate that bromocriptine is not habit-forming. Dackis expects to make a full report later this year.

ONE HOPE FOR DIMINISHING THE DEMAND FOR COcaine lies in education. Both in and out of school, drug-prevention programs aimed at young people are increasingly common across the country.

Educating children and teenagers about drugs is a wellintentioned idea, but no one really knows how workable it is. During Prohibition every state had educational programs designed to foster awareness of the dangers of alcohol. Yet alcohol remained popular. It’s possible that drug education only stimulates curiosity rather than promotes self-control. Moreover, it may be difficult for teachers to commend permanent abstinence with respect to some psychoactive substances when their students know that society permits adults to engage in the use of others.

A report released in 1984 by the Rand Corporation suggests that anti-drug education will have the best chance of success if it employs techniques borrowed from anti-smoking campaigns for adolescents that are knowm to have worked. According to the report, these campaigns typically stress not the long-term health effects, which are likely to “seem uncertain and far in the future,” but rather the short-term effects of smoking, “such as bad breath, discolored teeth, or increased carbon monoxide in the blood.” The Rand analysts concluded, “Future efforts against adolescent drug use should give greater emphasis to prevention, and not continue to pin hopes largely on law enforcement.” Their implicit conviction that adolescent experimentation with drugs cannot be stopped absolutely suggests that teachers should convey accurate information about which drugs and which methods of administration are most dangerous.

The Reagan Administration rhetorically favors drug education, but it has yet to devote much money to the effort. Indeed, the Department of Education’s budget for programs to combat drug abuse has declined, from $14 million in 1981 to a paltry $2.9 million in 1985. Nevertheless, the Administration has managed to maintain a high profile when it comes to the perils of illegal drugs. For example, Nancy Reagan has made drug abuse her chief topic of concern; she served as the host of a television series. Chemical People, that was intended to help promote an antidrug atmosphere in the schools. And a year ago the Administration announced that it would be sponsoring anti-drug seminars featuring prominent athletes in 200 American cities. “Sports people are heroes to our young people,” said William H. Webster, the director of the FBI. “I can’t think of anyone better to get their attention.” What impact such awareness campaigns have actually had is impossible to say. But the psychiatrist Robert Byck, among other researchers, has warned that using well-known personalities as “point men,” particularly where cocaine is concerned, may serve subtly to glamorize the use of drugs. The cocaine scandals that have bedeviled baseball since last summer show that holding up athletes as models can easily backfire.

Prevention is the best approach to any public-health problem. But prevention cannot help the many hundreds of thousands who are already dependent on cocaine. These people constitute the core of the cocaine market. It is they who keep the producers, smugglers, and dealers in business, and it is they who thereby do the most damage to their communities, their families, and themselves.

One aspect of the drug wars on which Steven Wisotsky, who wrote the article advocating decriminalization, and Carlton Turner, the White House’s adviser on drugs, might agree is the importance of the private sector in providing treatment for those who cannot cope with cocaine. Wisotsky considers the program of screening and follow-up care proposed for professional baseball players by Commissioner Peter Ueberroth a better solution than jail. Turner praises a number of corporations, including Greyhound, General Motors, U.S. Tobacco, Union Pacific, and Alcoa, that have set up treatment programs enabling drug users to get help but also keep their jobs. It may be that when professional intervention is required, cocaine users have it slightly better than people with other drug habits. Cocaine abuse is far more a middleand upper-class problem than heroin addiction ever was or will be. That simple fact creates a variety of financial incentives that result in superior care. “A heroin counselor is often an unlicensed, untrained ex-addict trying to help someone get a job,” the psychiatrist Richard Rawson says. “Cocaine therapists typically are M.A.s or Ph.D.s who have a higher set of skills.”

Rawson contends that after the initial trauma of withdrawal—usually about two weeks—85 to 90 percent of cocaine users can be treated on an outpatient basis. It often happens that patients, after passing through withdrawal, experience a “honeymoon” period of relief at being free of the drug. Afterward, however, they hit what Rawson calls a “wall of anhedonia.” Still, those who continue with treatment through this stage generally manage to remain abstinent. Their chances improve if after detoxification they shun not only the drug but the life-style and acquaintances associated with it. Cocaine Anonymous and Narcotics Anonymous, therapeutic groups patterned after Alcoholics Anonymous, now have active chapters throughout the country.

Even when treatment does not succeed in keeping a patient permanently clean, it has an overall beneficial effect. “We have a definite indication that treatment does reduce cocaine use,” Rawson says, “although we can’t be sure yet whether the reduction is permanent.” The majority of people with cocaine problems, unfortunately, never seek treatment. Many do not want to (and cannot be forced to). Many others do not know that treatment may be available. And many who want help can’t find it. Federal subsidies for treatment programs, though never the prime source of funding for local drug-rehabilitation efforts, have been cut back in recent years; the cutbacks have taken their toll. The cocaine users who exist beyond the reach of therapy are to be found disproportionately among the ranks of the poor. Not everyone can afford a private clinic. Not everyone works for Alcoa or, for that matter, even has a job.

Public opinion seems to be united on the question of how society should deal with the vast army of the untreated and the untreatable. People are fed up with the crime and the urban squalor bred by drugs. They want users and dealers off the streets. “We have to start focusing on the users and make them pay the price, and we ought to have the death penalty for drug dealers,” Carlton Turner told me recently. Last spring an editorial in The New Republic asserted that society had to choose between adopting “severe” mandatory penalties for drug possession and legalizing what are now controlled substances. In reality, the American public lacks the will, and their government the resources, to catch, try, and lock up any more than a tiny fraction of drug users.

One alternative to jail that has been proposed by various specialists in drug abuse, including Mark Gold, is the involuntary civil commitment of addicts to treatment facilities. All states make some provision for the involuntary commitment of people who exhibit psychotic behavior and who pose an immediate lifethreatening danger to themselves or others. The third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual, whose taxonomy of psychiatric afflictions is used almost universally in commitment proceedings, makes reference to a number of drugrelated disorders. Nevertheless, involuntary commitment on the grounds of drug dependency is rare. Many families and law-enforcement officials are unaware that this remedy exists. And as the laws are currently written, it could be prescribed unfairly. Yet involuntary commitment does seem to work for one group of substance abusers—alcoholics. Over the past two decades, as the concept of alcoholism as a disease has gained acceptance, the national trend has been away from jailing alcoholics for an offense like public drunkenness. Most states now provide for the involuntary commitment of alcoholics, if only for the purpose of detoxification. There is evidence to suggest that treatment even against a patient’s will can be effective in the fight against alcoholism. The same seems to hold true for cocaine abuse.

In a landmark 1962 decision, Robinson v. California, the Supreme Court ruled that a person’s status as a drug addict could not in itself be defined as a crime under the Constitution. However, the court upheld compulsory treatment for drug addicts on the grounds that treatment programs would advance legitimate state interests. A handful of states have enacted statutes that provide specifically for the involuntary commitment of addicts. Massachusetts had such a law until 1969, when it quietly expired. California has an addict-commitment law, but it is used strictly as a means of diverting people charged with or convicted of crimes out of the clogged criminal-justice system. Connecticut has a law allowing for the commitment of drug-dependent people who have not been charged with crimes. Poorly drafted, it has essentially gone unused.

Until recently Texas had a little-used law similar to the one in Connecticut. Last year, however, the state tightened up its statute. The principal architect of the new bill was Judge Patrick W. Ferchill, of Fort Worth. The motivation for the revision came not from cocaine, though more and more of it is being seen in Texas, but from legal substances called inhalants.

ABOUT A DHCADE AGO THERE WAS A FLURRY OF NAtional concern over juvenile glue-sniffing. In the Southwest the practice has never died out. Rather, it expanded to include spray paint, cleaning solvents, motor-fuel products, and a variety of other highly toxic substances. Thousands of youngsters, primarily poor Hispanics, have become addicted to inhalants. “Many of these people are married to their spray cans,” Judge Ferchill says. “It’s a hideous problem. The brain damage often is massive and permanent. They lose control of their speech, muscles, and kidneys. Some have to be diapered.”

The amended law was passed last spring by the Texas legislature and took effect in September. It provides for the involuntary commitment of persons dependent on drugs or inhalants. Before a person can be committed, he must be given a jury trial (unless he waives this right); two psychiatrists must testify that his dependency requires treatment for his own welfare or the safety of others. The addict is given the benefit of legal counsel at every stage of the proceedings. “We don’t want lay-down lawyers in this system,” Ferchill says. “We want a fair, vigorous defense.” If a person is committed, his term of involuntary treatment may not exceed six months. The judge or jury may find that treatment can be undertaken on an outpatient basis. If a person is hospitalized, it may be in either a public or a private institution, and the goal is to make the transition to outpatient care as quick as possible. The Texas statute applies only to those who have no criminal charges pending against them.

Two things make this approach appealing as a way of handling cocaine abusers. First, safeguards are built into the system to protect the rights both of the individual (to due process) and of society (to public safety). Second, the commitment option provides an alternative to involving the police. Mark Gold says, “We get a lot of calls at 1-800COCAINE from people who say their son or husband weighs a hundred pounds, has lost his job, and is having seizures and automobile accidents. They don’t know what to do.” People are generally reluctant to initiate criminal proceedings against a relative, a friend, or a co-worker. They might be more willing to testify at civil commitment hearings—provided that the treatment itself is genuine, the term of treatment no longer than necessary, and the place of treatment humane. It is essential, too, that laws sanctioning involuntary commitment be painstakingly crafted.

To Steven Wisotsky, involuntary commitment smacks of “the Soviet asylum approach.” He invokes the psychiatrist Thomas Szasz, who has objected to involuntary commitment for any reason on civil-liberties grounds. But a cocaine habit is not freedom; and when it has a destructive impact on the family, community, or workplace, attempting to cure it is in the spirit of civil liberties. John Stuart Mill, whose philosophy has helped to give that spirit definition, wrote, “The only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others.” Surely the control of drug addiction is such a purpose.

AMERICANS DO NOT EXPECT LAW-ENFORCEMENT agencies to eradicate crime but merely hope that they will limit it as much as possible. No public official would ever promise to end rape, robbery, theft, or homicide. Yet politicians routinely vow to stop drugs cold, to sweep them from the streets and keep them from our children. In reality, law enforcement per se may have less control over drug trafficking than it has over other forms of crime. This is especially true in the case of cocaine trafficking. The drug is produced in remote regions of foreign countries where even local governments have little influence. It then enters the United States, in whose free society it is consumed more often than not by otherwise law - abiding people.

Because the traffic in cocaine is one of the most corrupting and corrosive forces in American society, Washington has an obligation to fight it. The Reagan Administration has tried to, mainly by jawboning the public and by attempting to intercept the drug before it hits the beach or the landing strip. But meanwhile, the government has virtually ignored the demand side of the cocaine traffic—the side that is somewhat more susceptible to government influence. It has invested a great deal of money in supplyside enforcement, and that, unfortunately, may very well have made the problem worse.