Cocaine Users May Be Leaning on 2nd Drug

A dramatic increase in the use of tranquilizers by cocaine abusers is worrying counselors nationwide who fear the doubly dangerous effects of dual addictions.

Tranquilizers such as Valium, used to ease the “crash” of a cocaine high by calming nerves and relieving paranoia, are becoming a second drug of choice among cocaine users, according to a study by the city’s Haight Ashbury Free Clinic.

But cocaine users, particularly those who smoke the potent form known as crack, take tranquilizers in such quantity that the effects are reversed and users often become more agitated, unpredictable and violent, said David Smith, the clinic’s founder and medical director.

The “dual-drug” phenomenon mirrors the “speed-balling” habits of heroin addicts 20 years ago who supplemented their barbiturates with amphetamines, Smith said.

Valium, Xanax

Valium and the tranquilizer Xanax, which overtook Valium last year as the most prescribed benzodiazepine tranquilizer in the country, are long-acting drugs that can produce seizures when taken at high doses. They can also lead to severe addictions that are hard to kick, Smith said.

“We believe we have identified a valid trend nationwide and other independent sources support it,” Smith said. The study surveyed 3,000 workers in more than 300 chemical dependency treatment programs nationwide on a variety of questions and found that many reported a growing dual-drug problem.

Data on hospital emergency room drug overdoses, addiction treatment admissions and law enforcement seizure statistics support the study results, Smith said. In San Francisco, emergency room overdoses have increased 77% this year compared to 1987.

“The emergency room data suggest not only were we correct, but it’s worse than we thought,” Smith said. “It’s clearly a trend and we’ve not peaked out yet.”

With long waiting lists for treatment programs, Smith said the widespread dual-drug phenomenon warrants expanded treatment centers, supply reduction efforts and education programs for drug users and physicians.

Alcohol Also Used

Although cocaine users also employ alcohol to take the edge off, Smith’s researchers are particularly fearful of the cocaine-tranquilizer combination.

“When you combine two drugs . . . it multiplies. Instead of one plus one equaling two, it’s three, four, five or six,” said Hal Linebarger, a chemical dependency therapist at Mills-Peninsula Hospitals Chemical Dependency Center in Burlingame, just south of San Francisco. “They cancel each other out, but it ends up being much more poisonous to the system.”

Tranquilizers can ease the “crash” period associated with a cocaine high, providing escape from the emotional and physical depression that accompanies the post-high experience, Linebarger explained.

A secondary dependence on tranquilizers can develop but go unnoticed by a cocaine addict, Smith said. Physicians may prescribe tranquilizers for patients who complain of feeling anxious and paranoid, not realizing the symptoms are a result of cocaine use, he said.

Prescription tranquilizers are also available on the street through wholesale diversions and international smuggling, he said.

Although the cocaine epidemic appeared to be leveling off in 1983, the introduction of crack cocaine in 1984 has produced record levels of dual-drug dependence, Smith said.

“Anytime you see an increase in an upper, you’ll see an increase in downers, and anytime you see an increase in downers, you’ll see an increase in uppers,” he said. “Smokable forms of cocaine are really the fuel for this.”

The study, which included responses from specialists in 339 treatment programs in the United States, was conducted by the Training and Education Section of the Haight Ashbury Free Clinic in conjunction with the Research Division of the Merritt-Peralta Chemical Dependency Recovery Hospital in Oakland.