Crack cocaine and cocaine hydrochloride. Are the differences myth or reality?
D. K. Hatsukami and M. W. Fischman
Department of Psychiatry, Division of Neurosciences, University of Minnesota, Minneapolis 55455, USA.
OBJECTIVE: To review and discuss the differences and similarities between
the use of crack cocaine and cocaine hydrochloride; and to determine how
these findings might affect policies on the imprisonment and treatment of
cocaine users. DATA SOURCES: English-language publications were identified
through a computerized search (using MEDLINE) between 1976 and 1996 using
the search terms "smoked cocaine," "crack cocaine," "freebase," and
"cocaine-base." In addition, manual searches were conducted on references
cited in original research articles, reviews, and an annotated
bibliography, and on selected journals. STUDY SELECTION: Only those
articles that compared various routes of cocaine administration or types of
cocaine (cocaine base or crack cocaine vs cocaine hydrochloride) were
examined. DATA EXTRACTION: Studies were reviewed to obtain information on
the composition of the 2 forms of cocaine, and the prevalence,
pharmacokinetics and pharmacodynamics, abuse liability, pattern of use, and
consequences across the various routes of cocaine administration and forms
of cocaine. CONCLUSION: Cocaine hydrochloride is readily converted to base
prior to use. The physiological and psychoactive effects of cocaine are
similar regardless of whether it is in the form of cocaine hydrochloride or
crack cocaine (cocaine base). However, evidence exists showing a greater
abuse liability, greater propensity for dependence, and more severe
consequences when cocaine is smoked (cocaine-base) or injected
intravenously (cocaine hydrochloride) compared with intranasal use (cocaine
hydrochloride). The crucial variables appear to be the immediacy, duration,
and magnitude of cocaine's effect, as well as the frequency and amount of
cocaine used rather than the form of the cocaine. Furthermore, cocaine
hydrochloride used intranasally may be a gateway drug or behavior to using
crack cocaine. Based on these findings, the federal sentencing guidelines
allowing possession of 100 times more cocaine hydrochloride than crack
cocaine to trigger mandatory minimum penalties is deemed excessive.
Although crack cocaine has been linked with crime to a greater extent than
cocaine hydrochloride, many of these crimes are associated with the
addiction to cocaine. Therefore, those addicted individuals who are
incarcerated for the sale or possession of cocaine are better served by
treatment than prison.
