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Progress Watch

Cocaine use: Will the factors behind its steady decline continue?

The US government released more good news this month about impeding entry of cocaine into the country. Still, opinions vary when it comes to interpreting the overall cocaine-use decline and the possible reasons for it.

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Some experts attribute the recent drop in US consumption largely to rising prices and shifts in the market (with an increasing share of cocaine going to Europe and emerging markets around the globe). In January 2007, the average price per pure gram was $98; between 2008 and 2012, it ranged from $175 to $195, according to national Drug Enforcement Administration data reported by Ms. Maxwell.

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Higher prices, combined with a decline in purity of the cocaine available in the US (which leads to less-intense effects), have led many cocaine users to shift to other drugs, Maxwell says. In Texas, for instance, it appears some are turning to methamphetamines coming out of Mexico. Maxwell also worries there will be more injuries related to cocaine users injecting “bath salts,” a new wave of synthetic drugs, to intensify their highs.

Another line of explanation is that drugs go in and out of style over the years and “it probably has very little to do with successes or failures with interdiction and source control,” says Ethan Nadelmann, executive director of the Drug Policy Alliance in New York City, which advocates reforming drug-control policies.

After the peak of the crack cocaine crisis in the early 1990s, crack became “uncool” even among drug users, Mr. Nadelmann says. Anecdotally, he’s heard recently that cocaine is regaining popularity in artsy crowds.

As the economy rebounds, more Americans may turn again to cocaine, often considered “the champagne of street drugs,” says James Hall, an epidemiologist at the Center for Applied Research on Substance Use and Health Disparities at Nova Southeastern University in Davie, Fla., and a member of the NIDA tracking group.

Unlike most other regions, southern Florida has seen cocaine-related emergency-room visits rise sharply in the past several years – perhaps an indicator that cocaine will soon be on the rise again nationwide, Mr. Hall says. In the 1970s, Miami was a harbinger of the original cocaine epidemic.

Despite a decline in cocaine use, there’s a great deal of cause for concern about other trends in drug use, Hall and others say.

“What has emerged in prescription drug abuse, particularly prescription opioids, is the most dangerous, the most addictive, and the most deadly drug problem of our lifetime,” Hall says. Even though the number of illegal prescription drug users has declined in the past few years, he says, the problems are severe.

Whatever the drug, “the real front line in these epidemics is treatment,” Hall says.

In his budget request for fiscal year 2014, President Obama asked for $1.4 billion more for treatment than was enacted in FY 2012. It’s the largest requested increase in at least two decades, says Rafael Lemaitre, ONDCP spokesman.

Overall progress in the fight against drugs is visible, Mr. Lemaitre says, if one looks back to the peak of 1979, when roughly 14 percent of Americans reported using illicit drugs. The survey methodologies have changed slightly since then, so it is difficult to compare numbers precisely, but today, the figure is just under 9 percent.

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