Use of Cocaine Levels Off but Fatalities Soar

Cocaine use has stabilized in the United States, but medical complications and deaths associated with the drug are on the rise, U.S. health officials said Thursday.

Cocaine-related deaths have nearly tripled since 1981 and emergency-room admissions for cocaine-induced problems have more than doubled since 1983, the officials said.

“This cocaine epidemic . . . may well have peaked in terms of rise in 1979-1980, and now we’re at a flat place,” said Dr. Donald Ian Macdonald, administrator of the Alcohol, Drug Abuse and Mental Health Administration. “But, in the flat place, we’re picking up the people who are falling off the cliff as they get more and more years into their habit.”

Cocaine consumption has leveled off among young people, often those most prone to drug abuse, according to the National Institute on Drug Abuse. For example, a survey of college students showed that cocaine use has remained near 17% since 1980. Other institute surveys show a leveling off of cocaine use among high school students at about 12% from 1979 to 1984, rising to 13% by 1985.

Macdonald said that many users do not begin to develop complications until three or four years after they began taking the drug. He attributed much of the rise in medical problems to an increase in “free-basing,” or smoking of cocaine. Free-basing is more dangerous than snorting because the inhaled drug reaches the brain within seconds, resulting in a sudden and intense high that produces strong cravings for more.

The danger of cocaine was highlighted by the recent deaths of University of Maryland basketball star Len Bias, who died apparently after free-basing, and Cleveland Browns football player Don Rogers, who died of a cocaine overdose.

How Cocaine Kills

Cocaine, whether snorted or smoked, can kill in various ways, Macdonald said. It stimulates the cerebral nervous system, causing convulsions that lead to respiratory collapse; increases blood pressure, resulting in strokes, and constricts coronary arteries that supply oxygen to the heart, causing heart attacks.

Macdonald said that a single dose of cocaine can kill a first-time user, depending on the physical condition of the person, the amount of stress he or she is under and the strength or impurities of the drug. “This is not simple stuff we’re playing with,” he said.

Charles R. Schuster, director of the National Institute on Drug Abuse, predicted that 13,000 cocaine users will enter emergency rooms this year because of drug complications, compared to 6,000 in 1983. In the first quarter of this year, New York, with 674 cocaine-related admissions, led the nation, followed by Los Angeles, with 363 admissions, and Detroit, with 348.

580 Dead in Year

Schuster said that more than 580 people died of cocaine-associated complications in 1984, compared with more than 195 in 1981. In 1985, with not all the cases counted, the number of deaths so far stands at 563. Those numbers do not include deaths in New York, for which accurate data could not be obtained, or drug-related deaths that may have been recorded as heart attacks.

Dr. Mitchell Rosenthal, director of Phoenix House, one of the largest residential drug treatment programs in the nation, said that most users see no danger in the drug until their use is already out of control. He said many continue using the drug even after they have begun to experience regular convulsions.

Health specialists were reassured by 1974-75 surveys of high school seniors that showed an increasing awareness of the drug’s danger, Macdonald said. But, despite the growing awareness, later surveys found that cocaine use was rising among young people. Macdonald said the researchers had failed to notice the significance of early survey results that found that most students believed the drug would not be harmful if used only two or three times.

“The message has to be: ‘Don’t do it once,’ ” Macdonald said.