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SCOTTISH ADVISORY COMMITTEE ON DRUG MISUSE: Psychostimulant Working Group Report

ANNEX D: COCA UPDATES

Printed by kind permission of COCA UK

COCA UPDATE - COCAINE ACID AND ALKALOID FORMS:

There are basically two different states of cocaine:

When cocaine is first produced it is in its base form and is therefore an alkaloid. Hydrochloric acid is then used in a process to turn it into a salt form which is now cocaine hydrochloride.

When ammonia, ether or bicarbonate of soda are used in the preparation of freebase or crack the cocaine is being returned to its base form (alkaloid). In its alkaloid state it is far easier to smoke as the melting point has been reduced hence the process before smoking.

Preparation for injection:

Crack cocaine or freebase cocaine in its alkaloid state does not return back to a hydrochloride state when it has been prepared for injection using vinegar, citric acid or vit C.

When acids are used to convert cocaine into an injectable form the cocaine is being converted into an acid form (salt). But the form of the cocaine is dependent on the type of acid used.

Cocaine hydrochloride is in an acid salt form so does not need to have an acid added to it as with crack and will dissolve in water alone.

Information from:

• Yale School of Medicine, Department of Epidemiology and Public Health

• National Institute of Drug Addiction, USA

COCA UPDATE - BLOOD BORNE VIRUSES:

The issue of blood borne viruses in connection with crack and cocaine use has to a large extent been ignored unless the route of use is injecting and even then important elements are not being addressed. There is a need to challenge this and disseminate information to users who are at risk.

HIV:

The main transmission route for HIV amongst crack and cocaine users is either through sharing contaminated needles or risky sexual behaviour. There is a tendency generally for risk taking behaviour to increase when taking cocaine, which in itself could increase the likelihood of the above transmission routes.

Recent research from the University of California has discovered that cocaine not only influences risk taking behaviour and consequent possible transmission but it also affects the AIDS viral load in the blood. Cocaine affects HIV in two ways:

The above combination can obviously have a dramatic affect upon the health of an individual who is HIV positive and taking cocaine, whether it is on a recreational basis or dependent use.

HCV:

The dangers of contracting Hepatitis C are again not confined to intravenous drug use. If Hep C positive cocaine use itself can exert strain upon the liver, let alone if alcohol is also used and the immune system can be impaired.

Injecting:
As mentioned above cocaine use can increase risk taking behaviour and anecdotal information suggests that injecting users of cocaine who are fully aware of safer injecting behaviour can ignore this when caught up in the chaos and compulsion of using. This can increase the risks of either accidental or risk taking transmission.

Smoking:
The use of crack can seriously dehydrate the body leading to lips becoming chapped. These can often be picked producing open wounds and the virus transmitted by pipe sharing. Some pipes can also cut the mouth when smoking, again increasing the risk. Open sores or wounds can also occur through burns received from pipes and lighters in the process of smoking.

Snorting:
When cocaine is snorted on a regular basis damage to nasal mucus membranes can occur causing the nose to bleed. The practice of sharing straws to 'snort' is quite common leading to the possibility of blood to blood transmission via the straw.

Harm minimisation:

• Users need to be informed of the above risks to enable them to make informed decisions and use safely.

• Advise users that no drug using equipment should be shared.

• Extra strong condoms/lubricants should be given to crack and cocaine users.

COCA UPDATE - RECYCLING COCAINE FROM CRACK PIPES

After a pipe has been used for a period of time residues of cocaine build up on the insides of the pipe. Some users recycle this so that it can be smoked through the pipe again. There are several ways to do this:
scraping the cocaine residue off the insides of a pipe with a razor;
dissolving the cocaine residues with nail varnish remover (acetone main ingredient);
dissolving the cocaine residues with acetone (C3H6O).

Methods using acetone:

Once a pipe has built up enough cocaine residues the holes are sealed up and a small amount of acetone or nail varnish remover is poured into the bottle and given a good shake. This process dissolves the cocaine residues into the acetone and allows it to be removed from the bottle.

The acetone is then poured onto a large mirror and set alight (it can also be left to evaporate). If not too much acetone is used then it should burn itself out in about 20 seconds. The cocaine residue is now on the mirror and is allowed to dry. When dry this can be scraped off with a razor (hence the need for the mirror) and smoked.

Some users report that the high that they get from recycled cocaine is better than a normal 'rock', but with crack purity being normally high there may be some other explanation for this other than increasing the purity.

How can acetone affect health?

If people are exposed to acetone, it goes into your blood which then carries it to all the organs in your body. If it is a small amount, the liver breaks it down to chemicals that are not harmful and uses these chemicals to make energy for normal body functions. Breathing moderate- to-high levels of acetone for short periods of time, however, can cause nose, throat, lung, and eye irritation; headaches; light-headedness; confusion; increased pulse rate; effects on blood; nausea; vomiting; unconsciousness, possible coma; and shortening of the menstrual cycle in women. Skin contact can result in irritation and damage to your skin.

Health effects from long-term exposure are known mostly from animal studies. Kidney, liver, and nerve damage, increased birth defects, and lowered ability to reproduce (males only) occurred in animals exposed long-term. It is not known if people would have these same effects.*

* Agency for Toxic Substances and Disease Registry, Atlanta, USA

Harm minimisation:

The best form of harm minimisation is to avoid, however the reality is that most users do it, so please advise them to:
have good ventilation in the room where the acetone is being used.
don't scrape plastic bottle as you can scrape off pieces of plastic as well.
be aware of the potential for accidental fire (especially if concentration is low due to lack of sleep).

Indicators:
The respiratory irritation or burning eyes that occur from moderate levels of exposure are good warning signs that they are exposing themselves too much and should not continue. If in doubt they should seek primary medical treatment as soon as possible.

COCA UPDATES - GUIDELINES FOR PRISON WORKERS ( in England and Wales)

Although national statistics are showing an increase in the amount of crime related to this drug it doesn't necessarily follow that there will be a corresponding increase in the amount of cocaine used within the prison system. Many prisoners will not use cocaine throughout their sentence as availability/price make it difficult to maintain their previous habit and a drug that makes you more aware of your surroundings/increase paranoia is often in compatible with the prison setting. The issue of drugs within the prison system is very important although when talking about the issue of crack and cocaine in the prison system this raises issues that need to be specifically addressed:

• Many prisoners may not be forthcoming about their crack or cocaine use on arrest, or throughout their sentence, leading to no targeting for education, health etc.

• Cravings will, in most cases disappear, which in turn can lead a prisoner into a belief that they have not got a problem. Craving will usually reappear again on or just before release.

• Low levels of both dopamine and serotonin can lead to a chemical depression as well as the normal reactive depression. These feelings of depression could increase the likelihood of suicidal thoughts or attempts at suicide.

• Anxiety issues may be compounded due to the prison environment and also paranoia felt at the initial intake. Some cocaine users may have long term anxiety problems.

• Good health check ups need to be offered as health problems are often ignored when in the chaos of using. Attention needs to be paid to heart, lungs (especially T.B.), liver and dangers of particular routes of use.

• Because cocaine is a strong stimulant, hidden dependence to other substances such as alcohol, benzodiazepines and heroin may not be apparent to the prisoner until initial intake.

• Cocaine can act as a form of self medication with psychiatric conditions such as schizophrenia and ADHD. A worsening of these illnesses may occur some weeks after initial intake. Cocaine use can also figure strongly in conditions such as Bi-polar.

• The use of educational groups/individual sessions can work very well once the prisoner has settled into the prison routine. They can also be used as an opportunity to explain how cocaine works, triggers and cravings etc.

• Attention needs to be paid to pre and post release plans so that the issue of cravings/setting themselves up to use can be addressed and the chances of relapse reduced if the prisoner is looking at continuing abstinence from the drug.

• Prisons may want to look at the issue of harm minimisation in relation to release plans considering the nature of cocaine cravings. Special attention needs to be paid to injecting users and also the transmission of BBV's.

• The prison system can offer a good basic recovery package in the initial stages as lots of sleep and food is often the best method for primary cocaine use.

• Work looking at the connection between crime and cocaine use (fight and flight response/cravings) can be successfully done in the prison setting and can increase the prisoners' awareness into their own patterns of use.

• There is often a large amount of energy in cocaine users once they have recovered from the initial chaos of using. This energy needs to be directed whilst in the prison setting and also on release.

• Prisons, where the intake is from a high crack or cocaine using area, may want to look at designating a CARAT worker as crack/cocaine specific (as in the case of H.M.P.'s Wormwood Scrubs, Holloway, Brixton and Wandsworth) to help maximise prisoner response to services.

PRISON AWARENESS TIMELINE

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