Trends In Cocaine Use Research Articles

Trends in cocaine use among United States females of reproductive age, 2005-2019.

The prevalence of cocaine use has increased in the United States, with an estimated 5.5 million people have used it at least once in 2019. We report trends in cocaine use for reproductive age females who participated in the National Survey on Drug Use and Health (NSDUH, 2005-2019). Interviewers for NSDUH recruited and assessed a representative sample of the US noninstitutionalized population. The prevalence of cocaine use was estimated annually for females (15-44 years; n = 295,751). Joinpoint regression was then used to test for significant changes in trends. Approximately 2.4% of females (n = 8136) reported past 12-month cocaine use. Joinpoint regression revealed an initial decline in cocaine use prevalence between 2005 and 2011, followed by a robust increase (2011-2019 annual percent change = 5.2; 95% confidence interval = 2.6, 7.8%). This nonlinear trend was observed for all subgroups, except for adolescent and pregnant females for whom a decrease in cocaine use prevalence was observed. Although the prevalence of cocaine use remains scarce among US females, the uptake in use after a period of initial decline is concerning, highlighting the need for continued public health awareness and action. Cocaine use among females of reproductive age is particularly concerning given the increased likelihood of transitioning to disordered use and the risk of use during pregnancy. Previous studies have not reported cocaine use estimates specific to reproductive age females or only reported co-drug use patterns, without detail of specific cocaine use trends.

Trends of Cocaine Use and Manifestations in Hospitalized Patients: A Cross-Sectional Study.

ObjectiveAbout 41 million people aged ≥18 years reported lifetime use of cocaine, and 5.4 million people reported having used cocaine in 2019. We aim to identify trends of cocaine use, manifestations, concomitant drug use, and financial burden on health care among hospitalized patients.MethodsWe utilized National Inpatient Sample from years 2006-2018. Patients with age ≥18 years, admitted to the hospital with a diagnosis of cocaine abuse, dependence, poisoning, or unspecified cocaine use were included in the study. We used ICD-9 Clinical Modification (CM) and ICD-10-CM codes to retrieve patient samples and comorbid conditions. The primary outcome was the trend in cocaine use among hospitalized patients from the year 2006 to 2018. Cochran-Mantel-Haenszel test was used to assess the significance of trends.ResultsIn the year 2006, the prevalence of cocaine abuse among hospitalized patients was 10,751 per million with an initial decline to 7,451 per million in 2012 and a subsequent increase to 11,891 per million hospitalized patients in 2018 with p =0.01. The majority of patients admitted were older than 50 years (43.27%), and a greater percentage of patients were males. All ethnicities showed a rising trend in the use of cocaine except for Native Americans. Cardiovascular effects, neuropsychiatric and infectious manifestations in hospitalized patients with cocaine abuse showed a consistent increase from year 2006 to 2018 with p <0.001.ConclusionsThere is a recent uptrend in cocaine use among hospital admissions in the US from 2006 to 2018 with an increased rate of systemic manifestations. This highlights the impact of cocaine use on the health system and the dire need to address this growing problem.

Trends in cocaine use, markets and harms in Australia, 2003-2019.

This paper aims to describe cocaine use, markets and harms in Australia from 2003 to 2019. Outcome indicators comprised prevalence of use from triennial household surveys; patterns of use from annual surveys of sentinel samples who use stimulants; and cocaine-related seizures, arrests, hospitalisations, deaths and treatment episodes. Bayesian autoregressive time-series analyses were conducted to estimate trend over time: Model 1, no change; Model 2, constant rate of change; and Model 3, change over time differing in rate after one change point. Past-year population prevalence of use increased over time. The percentage reporting recent use in sentinel samples increased by 6.1% (95% credible interval [CrI95% ] 1.2%,16.9%; Model 3) per year from around 2017 (48%) until the end of the series (2019: 67%). There was a constant annual increase in number of seizures (count ratio: 1.1, CrI95% 1.1,1.2) and arrests (1.2, CrI95% 1.1,1.2), and percentage reporting cocaine as easy to obtain in the sentinel samples (percent increase 1.2%, CrI95% 0.5%,1.8%; Model 2). Cocaine-related hospitalisation rate increased from 5.1 to 15.6 per 100 000 people from around 2011-2012 to 2017-2018: an annual increase of 1.3 per 100 000 people (CrI95% 0.8,1.8; Model 3). While the death rate was low (0.23 cocaine-related deaths per 100 000 people in 2018; Model 2), treatment episodes increased from 3.2 to 5.9 per 100 000 people from around 2016-2017 to 2017-2018: an annual increase of 2.9 per 100 000 people (CrI95% 1.6,3.7; Model 3). Cocaine use, availability and harm have increased, concentrated in recent years, and accompanied by increased treatment engagement.

National Trends of Tobacco, Alcohol, and Drug Use in Patients Admitted With Acute Myocardial Infarction

BackgroundAcute myocardial infarction (AMI) is a significant health and economic burden in the US. Tobacco, alcohol, and drug use are established risk factors. We sought to evaluate the national trend of use of each substance in patients admitted with AMI. MethodsWe used the National Inpatient Sample between 2005 and 2017. We included adult patients hospitalized with AMI. International Classification of Diseases, Ninth and Tenth Revisions codes were used to define tobacco, alcohol, cocaine, opioid, cannabis and other drug use. Trends of each substance use were assessed using multivariable Poisson regression, and were expressed as annual percent change (APC) with their 95% confidence intervals (CIs). ResultsA total of 10,796,844 hospitalizations with AMI were included. Among all substances used, tobacco was the most common (32.7%), followed by alcohol (3.2%). Between 2005 and 2017, the prevalence ratio of tobacco use increased from 21.5% to 44.5% with an APC +6.2% (95%CI 6.2%–6.2%). Tobacco users had more percutaneous coronary intervention (41%vs25%) and coronary artery bypass surgery (6.9%vs4.9%), p < 0.001. Further, there were positive trends in alcohol (APC +3.1%; 95%CI 3.0%–3.2%), opioid (APC +9.0%; 95%CI 8.7%–9.2%), cannabis (APC + 7.2; 95% CI 7%–7.4%), and combined all drug use (+7.1%; 95%CI 7%–7.2%). Meanwhile, there was a slight negative trend in cocaine use. ConclusionsThis analysis outlines the national trends of substance use in patients admitted with AMI and reveals an increasing prevalence of tobacco use, alcohol and drug use. More effective cessation measures are necessary to reduce the risk for AMI and its burden on the healthcare system and economy.

Cocaine use is declining among emerging adults in the United States: Trends by college enrollment

BackgroundThe difference in cocaine use between student and non-student emerging adults is not well understood, despite the longstanding assumption that college is protective against use. ObjectiveTo describe trends in cocaine use among emerging adults by college enrollment. MethodsUsing cross-sectional, nationally-representative data from the National Survey on Drug Use and Health (2002–2016), we estimated the prevalence of four cocaine use indicators by year among emerging adults (ages 18–22) and stratified by college enrollment. We tested for linear and quadratic trends over time. ResultsFrom 2002 to 2016, 11.7% reported lifetime cocaine use, 5.8% reported past 12-month use, 1.7% reported past 30-day use, and 1% had a use disorder in the past 12-months. We observed significant linear decreases in all four use indicators over time (Lifetime: β = −0.20, Past 12-months: β = −0.17, Past 30-days: β = −0.22, Past 12-months disorder: β = −0.37). Students had lower rates of cocaine use than non-students, although prevalence estimates were more similar between groups for past 12-month (Students:5.3%, 95% CI:5.0–5.5; Non-students:6.3%, 95% CI:6.1–6.5) and past 30-day use (Students:1.6%, 95% CI:1.4–1.7; Non-students:1.8%, 95% CI:1.7–1.9) than for lifetime use (Students:9.4%, 95% CI:9.1–9.7; Non-students:13.8%, 95% CI:13.5–14.1). ConclusionsCocaine use has declined among emerging adults since the early 2000s. The college environment appears compensate for early life differences in cocaine use risk between students and non-students, closing the gap between groups for recent indicators of cocaine use. Given the severe health consequences associated with cocaine use, more public health attention to this issue is needed.

Past 15-year trends in lifetime cocaine use among US high school students

BackgroundMost recent research on adolescent drug use has focused on alcohol, tobacco, and marijuana. Less is known about the recent epidemiology of adolescent cocaine use, which has serious health consequences. PurposeTo describe recent trends in cocaine use by U.S. high school students, and identify differences in lifetime and repeated use across sex and racial/ethnic groups. MethodsWe used data from the national Youth Risk Behavior Surveys (YRBS) from 1999 to 2015. We estimated the prevalence of lifetime cocaine use (LCU) and repeated lifetime cocaine use (RLCU) across years by race/ethnicity and sex and tested for linear and quadratic trends. ResultsThe prevalence of LCU decreased from 1999 to 2015 (9.54%–5.19%). RLCU also decreased (5.13%–2.84%). Despite the overall decline, LCU and RLCU both rose between 2009–2015 (LCU:2.78%–5.19%, RLCU:1.58%–2.84%). Boys had higher rates of LCU and RLCU than girls (LCU:6.42% vs 4.65%; RLCU:3.69% vs 2.18%). American Indian/Alaskan Native, Native Hawaiian/Pacific Islander, and Hispanic adolescents had the highest overall prevalence of LCU. Black adolescents’ LCU patterns differed from other racial/ethnic groups. The prevalence of LCU among Black boys increased over time, while the prevalence for Black girls remained consistently low. ConclusionsAdolescent cocaine use is less common today than in the 1990s. However, rates of adolescent cocaine use have risen across all racial/ethnic groups in the past few years. Public health efforts should address at risk groups with particularly high or rising rates of cocaine use.

The Recent Expansion in the Australian Cocaine Market: Who are the New Users and What are the Harms?

Cocaine supplies to and within Australia increased after 2006-07, and there is some evidence that cocaine demand may also have risen. However, the extent, nature and public health implications of any changes in cocaine demand remain unclear. Equally unclear, is whether such changes may have been fuelled by declines in two of Australia's other stimulant markets. We examined general population trends in cocaine use and harmful practices and use of related stimulants between 1998 and 2010, and conducted age-period-cohort analyses using five repeated cross-sections of Australia's National Drug Strategy Household Survey. The results indicate past year cocaine use prevalence has increased significantly since 2004, to its highest point in the past 12 years; 2.1% in 2010. But frequency of cocaine use has not increased. Moreover, most harmful practices (injecting, high-quantity use) have remained stable. Changes in the cocaine market appear related to changes in the Australian methamphetamine and ecstasy markets, including declining purity of ecstasy. For example, the cohorts of people most likely to exhibit recent cocaine use were also most likely to have used ecstasy and methamphetamine (those born from 1976 to 1984). The findings indicate that an increase in cocaine demand does not necessarily lead to substantial increases in public health harm: and indeed that the public health implications from the recent increase are likely to be negligible. Moreover, the findings suggest changes to either ecstasy or methamphetamine supply may lead to more shifts in demand for Australia's cocaine market.

Prevalent Cocaine Use and Myocardial Infarction

Studies have reported a possible link between cocaine use and risk for cardiovascular events. The aim of this study was to examine the association between self-reported cocaine use and physician-diagnosed myocardial infarction (MI) in the Third National Health and Nutrition Examination Survey (NHANES III), conducted from 1988 to 1994. Odds ratios (ORs) were estimated using logistic regression models adjusted for age and additionally for gender, race, and other MI risk factors, which accounted for the complex sampling design. In the group aged 18 to 59 years, there was no statistically significant association between any exposure to cocaine and MI (age-adjusted OR 1.56, 95% confidence interval [CI] 0.44 to 5.50, p = 0.48; multivariate-adjusted OR 1.06, 95% CI 0.30 to 3.73, p = 0.92). Participants who reported using cocaine >10 times had a nonsignificant higher prevalence of MI (age-adjusted OR 3.13, 95% CI 0.80 to 12.25, p = 0.10; multivariate-adjusted OR 1.84, 95% CI 0.46 to 7.29, p = 0.40). However, participants aged 18 to 45 years who reported >10 occasions of cocaine use had a significantly elevated prevalence of MI in age-adjusted models (OR 4.60, 95% CI 1.12 to 18.88, p = 0.035). The association was attenuated in multivariate-adjusted models (OR 3.84, 95% CI 0.98 to 15.07, p = 0.054). The lifetime prevalence of cocaine use increased from 14% in NHANES III to 19% in NHANES 2005-2006. In conclusion, these data support a substantial association between cocaine use and MI; the temporal trend in cocaine use may increase the occurrence of MI, particularly in younger populations.

Trends, motivations and settings of recreational cocaine use by adolescents and young adults in the Netherlands

Background In recent years the use of powder cocaine among socially integrated adolescents and young adults has normalised. It is no longer an extraordinary drug to use in trendy/innovative as well as mainstreams clubs. Not much research has been done on motivations for and settings in which this cocaine use takes place. Methods To gain insight in normalisation and trends in cocaine use, we used quantitative data from the National Prevalence Study on Substance Use (NPS) 1997, 2001 and 2005. To gain insight in social settings and motivations (initiation and continuation), and in the combined use of cocaine with alcohol and/or other drugs, we analysed mostly qualitative data from in-depth interviews with 55 adolescents and young adults who used cocaine in the past year. Results The NPS studies show a rising trend in lifetime cocaine use, a fall in incidence, and a fall in continuation rates. From the interviews we learn that cocaine has further normalised. Cocaine is – and stays – attractive because of the ritual of snorting (the route of administration). Initiation is often planned. Effects play a role in the continuation of use, not in initiation. Motivations for use are divided into three categories: physical, mental and social. Cocaine is used in nightlife and home settings, together with friends, and it is often combined with alcohol (on the same occasion), because of feeling mentally clear and being able to drink more. Conclusion About 5% of adolescents have used cocaine at least once in their lives. They feel it can be used in every setting, since it leaves a user in control. While acknowledging the negative side effects, young users try to regulate their cocaine use in order to regulate these effects. Although high frequent use is an exception in our sample, we cannot foretell how many might develop a pattern of problematic use.

Cocaine-related deaths: An enigma still under investigation

In recent years there has been an increase interest in cocaine-related death reflecting the rising trend in cocaine use in Europe. Nevertheless is still now very difficult to attribute a death to cocaine. We can affirm that cocaine can be responsible for the cause of death only when there is a reasonably complete understanding of the circumstances or facts surrounding the death. Isolated blood cocaine levels are not enough to assess lethality, should be always considered and evaluated in relation to concentrations of cocaine and benzoylecgonine concentrations in body tissue compartments, especially in brain and blood. We have reanalyzed all of our cocaine-related case from 1990 to 2005, applying the methodology used by Spielher and Reed over 30 years ago. Our aim was to try to validate this model and verify its applicability and effectiveness after 20 years.

Cocaine use and educational achievement: understanding a changing association over the past 2 decades.

Trends in cocaine use over the past 2 decades were compared across levels of education in a population-based US sample of adults. Significant inverse associations between educational achievement and cocaine use after 1990 were driven by dramatic decreases in persistent cocaine use among more highly educated adults, whereas persistent cocaine use remained relatively unchanged among those who did not finish high school. This emerging health disparity highlights the need for improved interventions that target persistent cocaine users with low educational achievement.

The role of cocaine in heroin-related deaths: Hypothesis on the interaction between heroin and cocaine

In recent years, there has been an increase in cocaine-related deaths at the Department of Legal Medicine and Public Health of Pavia, probably reflecting the rising trend in cocaine use in Western Europe. Deaths from cocaine alone have increased from 6 cases in 1979–1991 (1.5% of drug-of-abuse deaths) to 13 in 1992–2002 (3.2%) and comparing the same periods, heroin-related deaths (HRDs) involving cocaine more than doubled from 8 (1.9%) to 22 (5.4%). In an attempt to investigate the role of cocaine in HRDs, acute narcotic death cases testing positive for cocaine use (blood cocaine or metabolite concentration >0.01 mg/l, COC+) were examined. Only cases from 1997 to 2001 were considered as in this period all data were obtained using the same analytical procedures (free morphine and total morphine by DPC Coat-A-Count radioimmunoassay before and after enzymatic hydrolysis, cocaine and metabolites in blood by SPE, TMS derivatization and gas chromatography–mass spectrometry (GC–MS)). The median, minimum and maximum concentrations of free morphine in blood (FM) and total morphine in blood (TM), urine (UM) and bile (BM) in the COC+ group ( n = 9) were compared with those calculated in the group of “pure” HRDs (no other drugs detected in blood, COC−, n = 30). Differences among the medians in the two groups were statistically evaluated using the two-tailed Mann–Whitney U-Test. Statistical analysis was also carried out including in both groups cases with a blood alcohol concentration (BAC) > 20 mg/L (COC+, n = 19; COC−, n = 76). For the COC+ group, median TM was lower (0.32 mg/l versus 0.90 mg/l, P = 0.0214), median FM was lower, but not statistically significant (0.08 mg/l versus 0.28 mg/l, P = 0.1064), FM/TM ratio was similar (0.33 and 0.35), UM was also similar (21.0 mg/l and 18.0 mg/l), and BM was higher (90.0 mg/l versus 49.0 mg/l, P = 0.0268). Similar comparison results were obtained by repeating statistical analyses after including in the two groups cases with positive BAC. The picture observed for HRD cases involving cocaine is very different from what was previously observed for HRD cases involving ethanol [A. Polettini, A. Groppi, M. Montagna, The role of alcohol abuse in the etiology of heroin related deaths: evidence for pharmacokinetic interactions between heroin and alcohol, J. Anal. Toxicol. 23 (1999) 570–576], and updated with more recent data; in the high-ethanol (HE, BAC > 1000 mg/l) group, TM was lower than in the low-ethanol (LE, BAC ≤ 1000 mg/l) group (0.59 mg/l versus 0.90 mg/l, P = 0.0180), FM/TM ratio was higher (0.66 versus 0.43, P = 0.0038), FM was equal, UM was lower (0.21 mg/l versus 13.0 mg/l, P = 0.0001), as was BM (10.0 mg/l versus 26.5 mg/l, P = 0.0156). The observed lower TM in the COC+ group supports the hypothesis of an interaction of cocaine with heroin in the cause of death, as previously observed for the heroin–ethanol interaction. However, ethanol results suggested that a pharmacokinetic interaction is prevalent (inhibition of heroin metabolism, as suggested by the increased FM/TM ratio, resulting in reduced urinary and biliary excretion). In the case of cocaine, a pharmacodynamic interaction seems to prevail, as the FM/TM ratio remains unchanged and UM and BM are not lower in the COC+ group. The hypothesis of a pharmacodynamic interaction of cocaine with heroin could not be confirmed owing to the paucity of data and the many uncontrolled variables involved.

Homicide and Drugs

Recent declines in homicide rates in many U.S. cities have prompted a search for potential explanations. Changes in drug market activity, including reductions in crack cocaine use, have been offered as contributing factors to this decline. Combining data from structured interviews with policy makers and community representatives and from existing data programs (especially Drug Use Forecasting), the relationship of changing drug use and drug market patterns to homicide trends is extensively investigated in 6 cities. Findings include a low awareness of specific local drug use trends, strong perceptions of links between drugs (particularly crack) and violence, and a correlation between trends in cocaine use among arrestees and homicide rates. The latter finding may be at least partially explained by the larger evident risks, both individual and aggregate, associated with crack use and crack purchases.