Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

186 III. SUBSTANCES OF ABUSEmales (34%), followed by black females (25%), white males (18%), and whitefemales (14%).Consistent with NHSDA data, both DAWN ED and TEDS data indicatethat the average age of cocaine users is increasing. DAWN data show significantincreases between 2000 and 2001 in ED cocaine mentions for patients age35 and older and for patients age 55 and older. TEDS data further indicate thatin 1999, most cocaine-related treatment admissions were in the 35–39 age category,whereas in 1998, most cocaine-related treatment admissions were in the30–34 age category.The number of Drug Enforcement Administration (DEA) arrests involvingcocaine dropped from 15,767 in 2000 to 12,847 in 2001, and data from theU.S. Sentencing Commission (USSC) show that the percentages of federaldrug sentences involving powder and crack cocaine were nearly unchangedfrom 2000 to 2001. Data from the Arrestee Drug Abuse Monitoring (ADAM;U.S. Department of Justice, 2001) program demonstrated that a median of29.1% of adult male arrestees and 30.7% of adult female arrestees tested positivefor cocaine at arrest in 2001. A median of 18.9% of adult male arresteesand 28.5% of adult female arrestees reported using crack cocaine at least oncein the year before being arrested. ADAM data indicate that powder cocaine inadult male arrestees decreased from 13.4% in 2000 to 12.5% in 2001, whilecrack cocaine in adult male arrestees increased from 17.5% in 2000 to 18.9% in2001. However, National Drug Threat Survey (U.S. Department of Justice,2003) data show that 33.1% of state and local law enforcement agenciesnationwide identify cocaine as their greatest drug threat; 8.2% identify powdercocaine as their greatest drug threat, while 24.9% identify crack cocaine astheir greatest drug threat. In both major urban areas, including Philadelphiaand New York City, and rural areas (i.e., St. John Parish, Louisiana), between31 and 40% of homicide victims tested positive for antemortem cocaine use(Clark, 1996; McGonigal et al., 1993; Tardiff et al., 1994).PREPARATION AND ROUTES OF ADMINISTRATIONCocaine is the most potent stimulant of natural origin. It is a benzoylmethylecgonine,an ester of benzoic acid and a nitrogen-containing base.Cocaine occurs naturally in the leaves of Erythroxylon coca and other species ofErythroxylon indigenous to Peru, Bolivia, Java, and Columbia. There are severalbasic routes to cocaine administration: chewing the leaves, cocaine sulfate(paste), cocaine hydrochloride, freebase cocaine, and crack cocaine. SouthAmerican natives who chew coca leaves experience diminished hunger andfatigue, and an improved sense of well-being without evidence of chronic toxicityand dependence. However, other preparations and routes of administrationof cocaine have a more rapid onset of action and are more problematic.