Cohen, Peter (1990), Cocaine and Cannabis. An identical policy for different drugs?. In: Peter Cohen (1990), Drugs as a social construct. Dissertation. Amsterdam, Universiteit van Amsterdam. pp. 15-31.
© Copyright 1990 Peter Cohen. All rights reserved.

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III. Cocaine and Cannabis. An identical policy for different drugs?[1]

Peter Cohen

Table of contents

III.1 Introduction

Many policy makers are continuously influenced by incidental drug observations and haphazard media coverage relating to drugs. But, in order to reflect about possible guide-lines for the development of a governmental policy which is specially directed towards the use of illegal drugs, some background information is necessary.

This text focuses on the use of cocaine but does not contain all the possible background information about this psychotropic substance. It does however discuss the question of which attitude a government should have toward the use of cocaine within the present legal constraints, both from pharmacological and social scientific perspectives. I will eventually plead for a highly restrained government involvement in this area.

The text has four parts. First some brief remarks are made about the history of cocaine use and some methods of ingestion. The second part is dedicated to user descriptions of subjective experiences after the use of cocaine. In this part also some attention will be given to social reactions to cocaine use in the United States of America at the beginning of this century. These reactions are compared to some of the most important social reactions in the U.S. to the use of cannabis products. The purpose of this part is to show how crucial the constructed association between drugs and identified user groups is for judging the effects of a drug, both by the general public and by so called drug experts.

The third part continues the comparison between cannabis and cocaine, introducing at various points a comparison with alcohol. The final fourth part contains some general recommendations for a government policy in the field of cocaine.

III.2 A short history of cocaine use

Most material in this part is taken from the fine study Ashley1 published in 1975.

The use of cocaine was unknown in Europe until the Spaniards conquered the South American continent. Indians living in and around the Andes mountains have chewed the coca leaf since time immemorial. Spanish church authorities initially banned the use of coca leaf because they were convinced the effects of the leaf resulted from a pact between the devil and the Indians. However, the low quality of labour Indians presented in the many mines where they were put to work without coca chewing led the Church to stop forbidding the old custom. She then initiated a tax of 10% on the price of coca leaf.

A 19th century visitor to Peru gave witness of having used coca leaf himself, stating it gave him a pleasant soothing experience. It enabled him to "endure long abstinence from food with less inconvenience than I should otherwise have felt, and it enabled me to ascend precipitous mountain sides with a feeling of lightness and elasticity and without loosing breath". He recommended its use to members of alpine clubs.2

In the second half of the nineteenth century the prime alkaloid from the coca leaf, cocaine, was isolated in chemically pure form. An Italian, Mariani, applied the alkaloid immediately in a drink, Vin Mariani. This drink would become famous and remain so into the early 20th century.

Scientific circles started to show some interest after Freuds study "Über Coca" (1884) and after the application of cocaine as a local anaesthetic in eye surgery (1884). Confusion about the effects of cocaine -- is it a narcotic (cf Kollers way of using it) or a stimulant (cf Freuds way of using it) -- has raised considerable attention.

Cocaine may be ingested in several ways. Indians chew the leaf together with a small amount of calcium. The calcium serves to make the cocaine more available to the saliva of the chewer. An Indian will chew during one day several small bundles of leaf, ingesting the cocaine via the mucous membranes of mouth and throat. Typical use of an Indian chewer is estimated to be around 60 grams of leaf or ca 400 milligrams of cocaine per day.

Chemically produced cocaine hydrochloride from the coca leaf was used in Vin Mariani, but also in many other popular drinks, of which Coca Cola is the most well known. At the beginning of the 20th century these so called coca tonics were forbidden.

Presently cocaine is mostly used as a powder, snorted intranasally in dosages of 10 to 30 mg (so called lines) or injected intravenously by some users in dosages between 50 and 500 mg.3

Modern use of cocaine occurs most frequently by snorting. By snorting, cocaine hydrochloride is being conveyed into the blood stream via the mucous membranes of the nose and throat in which it dissolves. Several patterns of snorting are known. One can snort a few times a year in certain social groups, one can use every weekend and some use cocaine daily, sometimes repeatedly. Which frequency of use is chosen depends on taste, availability, financial means, fashions in ones social circles, etc. An individual use pattern is a complicated mixture of frequency and social rules of use. Use patterns are not static. A person may be abstinent for a couple of months then turn to frequent daily use until a certain work or task is finished, be abstinent again until the next occasion, and so on.

Also, with i.v. users several patterns are known. Persons who mainly inject can have sudden periods of very frequent injecting (so called binge use). Cocaine injections may be mixed with heroin to make "speedballs" although in the U.S. the injection of cocaine only is reported to be most frequent among injectors.4 It is assumed that in the Netherlands this is not different.

It will be clear that a completely reliable report on the quantity a user uses per week or month is not possible. This is not only due to the large differences a user may show in use patterns, but also to the unknown purity of cocaine on the illegal market.

A relatively rare way of ingesting cocaine is by smoking it free based. Cocaine hydrochloride, the substance available on the black market, is made basic in order to recreate the original free base alkaloid of cocaine. Cocaine free base is volatile which makes it fit for smoking. Untreated street cocaine (hydrochloride) would simply burn, for instance when smoked with tobacco. The effect of cocaine free base smoking is reported to be immediate and strong, comparable to the 'flash' effect of an injection. The mild and subtle effects of cocaine, which can only be learned through experience, are said to be not comparable to the effects of smoking free base.

III.3 Subjective and societal effects of cocaine use

III.3.1 Subjective effects

In a survey Ashley performed among eighty American cocaine users the most praised effects of cocaine are described as marked mood improvements, increase of energy for performing ongoing tasks, disappearance of feelings of tiredness and appetite for food and an increase in sexual stimulation.5

Large quantity use is experienced as unpleasant, but defining a large quantity is difficult. "Some persons can consume several grams a day and experience no notable ill effects, while others experience them when they exceed a quarter of a gram".6
Somebody taking more than the dosage level appropriate to him will experience a kind of 'hangover' feeling. Other effects of an overdose of cocaine can be: anxiety, a level of aggressiveness not proportionate to the actual situation, sleeplessness, sweating, impotence and a heavy feeling in the limbs. Very heavy users of cocaine may report strong feelings of paranoia "as if the police were on the point of breaking into the house".7,8,[2] The learning period of recognizing the unpleasant effects of too much cocaine is relatively long.

Lethal dosages of cocaine are said to be around 1200 mg, but according to several researchers such high dosages do not occur in the social use of cocaine.[3]

III.3.2 Societal effects of cocaine use

In the more than hundred years that cocaine has been used in the Western world a vast and broadly dispersed knowledge about this drug has been generated. This knowledge can be found in encyclopedias, medical handbooks, stories and media coverage. Most of this knowledge however is partial, unprecise and sometimes downright wrong. This concerns especially the dangerous characteristics ascribed to cocaine. This drug allegedly is heavily addictive, a source of violent and criminal behaviour, induces severe depression in its users and may even lead to permanent moral degeneration.9,10

Understanding this description of cocaine as an extremely dangerous drug is impossible if the role ascribed to cocaine as a cause of all sorts of social disturbance and deviance is not taken into account. The following examples will illustrate this role.

Cocaine has become popular since the end of the last century, at a time when in England11,12 as well as in the United States of America13,14,15 much concern had developed about alcohol and opiate use, especially in the lower classes of society. Both countries showed the emergence of a powerful popular movement against the use of drugs. In America this movement even succeeded in conquering a total ban on alcohol (Volstead Act 1919).

Because the image of cocaine as a very dangerous drug has its roots in the U.S.A. I will use mostly American material for the social history of cocaine.

Between 1880 and 1900 relatively little concern had been generated about cocaine. For as far as it was recognized at all, the drug was considered as "attractive to sensitive and intelligent people seeking to maintain energy in order to work harder at socially acceptable tasks".16

In medical circles the social use of cocaine seems to have been propagated. Cocaine was then still used as a substance in the famous coca tonics and many other "therapeutic" drug store products of the time.

But after 1900 cocaine started to become extremely well known. The media started to report the use of cocaine by the black population in the southern states of the U.S.A. The end of the century had seen many lynchings of black persons, and many apartheid laws were made including the curbing of voting rights. The white majority thus had many reasons to expect black opposition. Although white violence against the black population will have been many times larger than vice versa, black violence against white Americans (mainly manslaughter and rape) has received enormous attention in the media. All black violence was said to have its cause in the use of cocaine.

"The drug produces several other conditions that make the 'fiend' a peculiarly dangerous criminal. One of these conditions is a temporary immunity to shock - a resistance to the 'knock down' effects of fatal wounds. Bullets, fired into vital parts, that would drop a sane man in his tracks, fail to check the 'fiend' - fail to stop his rush or weaken his attack." "A recent experience of Chief of Police Lyerly of Asheville N. C., illustrates this particular phase of cocainism. The Chief was informed that a hitherto inoffensive negro was 'running amuck' in a cocaine frenz... Knowing that he must kill the man or be killed himself, the Chief drew his revolver [a heavy army model... large enough to kill any game in America], placed the muzzle over the negroe's heart and fired - 'intending to kill him right quick'- but the shot did not even stagger the man. And a second shot that pierced the arm and entered he chest had just as little effect in stopping the negroe or checking his attack."
In the Report International Opium, written by Hamilton Wright M.D. for the American Congress, cocaine was mentioned as a drug about which "it has been authoritatively stated that cocaine is often the direct incentive to the crime of rape by the Negroes of the South and other sections of the country".19

A certain Colonel Watson from Georgia reported already in 1903 in the New York Tribune that "many of the horrible crimes committed in the Southern States by the coloured people can be traced directly to the cocaine habit".20

At the beginning of this century emerging organizations of pharmacists participated in creating the cocaine myths. In the same year Colonel Watson made his report, the American Pharmaceutical Association made it known that cocaine was attractive to "negroes, the lower and immoral classes".21

The Philadelphia Pharmaceutical Board explained in 1910, that "a great many of the southern rape cases have been traced to cocaine".22

We see cocaine depicted as a drug that not only causes sexual assault and murder, but also as one that enables its user superhuman energy. Or, like Everybody's Magazine wrote in 1914 about cocaine using Blacks: "Ordinary shootin' don't kill him.".23>/a>

The fear that was raised in those times about cocaine has found its way to both national and international legislation. In the U.S.A. cocaine was seen as by far the most dangerous drug.24 This point of view, that was shared by medical and pharmacological authorities, has recreated itself via a long chain of citations (of cited citations) until the present times. The Dutch pharmacologist van Rossum writes in 1979:

"Logically regular use of cocaine creates a moral decay in the addict who intends nothing else but acquiring his euphoric stimulus and who becomes insensitive for social interactions. This causes a lack of duty and will power, egocentrism, wild associations and sometimes psychotic states. His extreme obsession with action, coupled to paranoia can make the addict under the influence of cocaine into a dangerous individual; homicidal behaviour occurs. The cocainist under influence of cocaine is more dangerous than the morfinist under influence of heroin. Moral decay with chronic use however is with both cases identical."25
It is reasonable to assume that the very negative connotation of cocaine in the U.S.A. emerged as a side effect or a side function of a much larger complex of social change and upheaval. But because of the creation of international Drug Treaties, in the process of which the U.S.A. were a strong and dominating force26, cocaine has remained petrified as a dangerous drug since the first Convention of The Hague in 1911.

III.3.3 Societal reactions to the use of cannabis type drugs

The early history of cannabis has many similarities to the history of cocaine. Use of cannabis was known, but the Harrison Act of 1914 had no rules about cannabis use. In view of the very strong attitudes against all drugs during this period the omission of cannabis from the Harrison Act may be seen as a proof of the lack of concern cannabis use created. The first Convention of The Hague (1911) advised about cannabis that its use be studied statistically and scientifically.27

This peaceful attitude would make way for a similar mythology as we have seen emerge for cocaine. Since the early Twenties Mexican immigration into the U.S.A. had increased considerably, above all to the States bordering on Mexico.

Although Mexicans already had the reputation to be violent people their cheap labour was sought in order to develop large agriculture in the South. The discussions in this era about curbing immigration also concerned the Mexicans.

Under pressure of both the Mexican government and the large farmers Mexicans were not included in quota regulations.28 Opposition against on-going Mexican immigration was increasing however, lead by patriotic organizations (like the American Legion) small farmers and labour Unions.29 A passionate and racist campaign started against Mexicans in the U.S.A.. Early reports about violence of Mexicans under the influence of marijuana can be found in a 1917 document of the Department of Agriculture. In this respect a 1925 American document about problems with the Panama Canal has also been influential. This document described countless conflicts between police and violent marijuana using Mexicans.30

In the Thirties reports about extremely violent crimes committed by marijuana using Mexicans increased so much that political pressure emerged to outlaw cannabis type drugs on the federal level in the U.S.A.. The orthodoxy in relation to drugs, the Federal Bureau of Narcotics under Harry Anslinger opposed such legislation initially. Later it supported and co authored the necessary Tax Act.31

In 1929 the Michigan Municipal Review reported: "Marahuana, the Mexican dope known as Indian hemp or Loco, is being sold in large quantities around high schools in many localities." "This affords a peculiar thrill and is followed up until another addict to drugs is made and the helpless chap joins this gruesome procession that has only one end. This social drug is known as the murder weed".32

The Police Chief in Los Angeles reported in the early thirties that "marihuana is probably the most dangerous of all our narcotic drugs." "In the past we have had officers of this department shot and killed by marihuana addicts and have traced the act of murder directly to the influence of marihuana,with no other motive".33

During the hearings about the Marijuana Tax Act the physician Treadway maintained that marijuana produces "a delirium with a frenzy which might result in violence: but this is also true of alcohol."34

Such a delirium has also been documented in a 1931 report about Crime and Foreigners. After showing that marijuana use is quite frequent among Mexicans the document states that "if continued, the drug develops a delirious rage, causing smokers to commit atrocious crimes."35

The objective level of violence between Mexicans among themselves or towards other groups is quite irrelevant, although Helmer has tried to give some quantitative data.36 What is important is that a causality is constructed between the use of marijuana and a consequent committing of the most hideous crimes. This is why marijuana got a name it would keep until into the Sixties, i.e. Killer Weed.

The habit of Mexicans to smoke marijuana was quickly forgotten after the Marijuana Tax Act had passed Congress in 1937. The plant emerged again in the Sixties when a fast growing cultural youth movement more or less adopted the plant as its symbol. The original association of cannabis with violence, reached by coupling the behaviour of a deviant subgroup with marijuana, could not be used in this new period. But another behaviour of the mostly well to do cannabis users struck the onlookers, their 'dropping out'. This was the root of the then constructed most prominent 'effect' of marijuana, the so called amotivational syndrome.

In 1967 a Superior Court Judge in the U.S.A. wrote: "Many succumb to the drug as a handy means of withdrawing from the inevitable stresses and legitimate demands of society. The evasion of problems and escape from reality seem to be among the desired effects of the use of marijuana."37

And a member of the New York State Council on Drug Addiction witnessed during Congress hearings in 1968, comparing LSD to marijuana, that "even marijuana in heavy doses can, after repeated use, produce the same loss of ambition, rejection of previously established goals, and retreat into a solipsistic, drug oriented cocoon."38

And during the hearings one year later a Harvard expert said: "But I am very much concerned about what has come to be called the ' amotivational syndrome'. I am certain as can be ..... that when an individual becomes dependent on marijuana .... he becomes preoccupied with it. His attitude changes toward endorsement of values which he had not before".39

The essence of this short excursion into the social histories of cocaine and cannabis is to show that the effects of a drug are to a high degree constructed by associating a drug with conspicuous behaviours of deviance in the drug using group. It is not really clear if such constructions emerge as popular images, to be shared later by so called experts who in their turn will reinforce the original images. It is clear however, that so called experts will in the cases of illegal drugs judge the effects of these drugs in a way that fits the above mentioned association and that these experts will only rarely rely on balanced empirical research.

This process of associating drugs with subgroups is not only used in a negative way. This becomes apparent when looking at the costly advertisement campaigns of producers of drugs like tobacco or alcohol, in which their products are strongly associated with certain behaviours of certain (high) status groups.

III.4 Cannabis and cocaine

In the Netherlands the association of cannabis type drugs with large groups of young people who did not or rarely distinguish themselves by dangerous forms of deviance, and the complete lack of a history of negative associations probably explains much of the sceptical attitude of a number of (mostly self appointed) Dutch drug experts when confronted with reports about the 'effects' of cannabis. This had a lot of influence on the report of the Baan Commission on Narcotic Drugs, presented in 1972 to the Dutch Government who had not only created the Commission but also asked it to write a report on future drug policies.

The recommendations from this report led to the present de facto undisturbed access to cannabis type drugs for every Dutch person who feels the need. Contrary to the recommendations of the Baan Commission no research has ever been done into the effects of this state of affairs on public health. But, just as valid is the remark that the need for this research has never arisen. Politicians in the Netherlands have never been pressed into researching this subject. Taking into account the large variety of political ideologies represented in Parliament, which include intolerance against the use of alcohol and other drugs, one can expect that bad experiences with the easy access to cannabis type drugs would have resulted in at least strong requests for investigations. Hospitals, individual physicians or Drug Treatment Institutions show a conspicuous lack of reports on the use of cannabis type drugs resulting in problems of one kind or another.

Although all this is not enough to definitively conclude that cannabis use never results in any form of problem behaviour, the absence of concern about the use of this drug is in itself an interesting and important phenomenon. The factors that cause this lack of concern may be the relative inoccuousness of cannabis when used socially, the lack of criminalisation of individual users, etc. Research into this matter would be of international relevance.

But, after more than 20 years of cannabis use by a small minority of the Dutch population we can certainly make two important observations:

  1. In the Netherlands the prevalence of cannabis use is very probably not higher than in countries where this use is still vehemently prosecuted and punished 40. The prevalence of cannabis use in the Netherlands even seems to decline, in spite of the absence of any form of public pressure or policies that intend such a decline.
  2. Apparently cannabis has found its place in the Dutch variety of socially integrated drugs. We can assume that rules and techniques have been generated in relatively easy going atmospheres that help regulate and control use.
Use of cannabis that could be associated with problem behaviour of any quantitative importance has remained outside the attention of the public and as far as we know, even outside the attention of professional drug treatment institutions. Marginalisation of users is unknown. Although all of these remarks require assessment by research, such research is simply not available. For the time being however we may legitimately observe that Dutch cannabis policy, characterized by a lack of state involvement in individual cannabis use, has been succesful.

Could we draw from this the conclusion that a possible cocaine policy in the Netherlands should use the cannabis policy as its model? Let us see.

III.5 A closer comparison of cannabis and cocaine

Just like cannabis cocaine does not result in physical dependence. For those who do not want to be without the effects of cocaine and proceed to daily use this does not result in tolerance for the desired effects. This means stable doses can be taken for long periods without loss of effects.41,42 Long term use of very high doses results both with cannabis and with cocaine in unpleasant and undesired mental reactions for some users (cf 2.1.).

Because of the price of illegal cocaine frequent use can cause financial problems, but this is not an effect of the drug itself.

A very important difference between cocaine and cannabis is that the former can be lethal.[4]In this respect cocaine is similar to alcohol and other legally available psychotropic substances. But in integrated social use of cocaine the doses that are necessary for lethal intoxication do not occur. A snorter will very rarely ingest more than 150 mg per session, an intravenous user rarely more than 500 mg per injection. In daily practice the probability of taking a lethal dose of cocaine is negligible, although more so than with cannabis.

A similarity between between cannabis and cocaine in the present situation of illegality for both is the unclarity of the purity of street market substances. Cocaine and cannabis (e.g. marijuana) can both be cut, although it is far easier with cocaine. A user never really knows how strong the product is he takes after purchasing it. Fortunately, both drugs are most often taken in ways that allow fast adjustment of dosage to perceived purity: cocaine is snorted and cannabis usually smoked. Only when eating a cannabis product or injecting cocaine is adjustment not possible if the substance is unusually strong (pure).

Apart from a pharmacological comparison of cocaine and cannabis both drugs should also be compared on their social characteristics. Cocaine is comparable with cannabis in the sixties as far as the association with dangerous deviance is concerned. Like cannabis in those years cocaine is now taken by a very polymorphous public. An association of cocaine with dangerous deviant groups has not yet appeared, in spite of the fact that it is known that 'junky-type' opiate users have reported highly adverse reactions to free base cocaine during its introduction in 1983.43 This means that cocaine use by some heroin junkies has not at all damaged the slightly elitist image of cocaine. This is why no association exists between 'dangerous' groups and cocaine, so that depicting cocaine as dangerous is not seen as legitimate at the moment. This creates the chance for a more objective judgement about cocaine. I would like to present such a judgement, along the lines of an idea the Baan Commission published in 1972: "Usually a distinction is made when discussing drugs and drug use between so called hard and soft drugs. One actually designs a kind of danger scale for e.g. heroin,morphine, codeine, etc. By drawing a line somewhere along this scale a categorization of hard and soft drugs may be reached. In some cases the rank a substance takes in the order of the scale is open for dispute."44

We now know that the rank order in such a scale is more or less historically determined. The present number 1 (heroin) has taken its place from earlier numbers 1, cocaine and cannabis. But a discussion on rank order in a danger scale of drugs is not impossible and I repeat that we can reasonably search for a place for cocaine on the "Scale of Baan".

When I say 'reasonably' I mean a way of reasoning in which one does not focus on ways of using a drug that are either very rare or depicted in an extremely ugly way.

Ashley very aptly wrote: "Where illicit drugs are concerned the prevailing practice is to accept the most adverse reports and then to elevate them to generalities applicable to all users."45

Examples of this are described in 2.2 and 2.3. "Just saying no" to the above-mentioned illegitimate generalizations is an enormously important step toward a reasonable searching process for the position of a drug on the Scale of Baan. And for this process we could use another recommendation of the Baan Commission, which is that the risks of a drug, and not only the pharmacological risks, should be the fundament of a drug policy.46

So, in my attempt to give cocaine a position in the Scale of Baan I will use evaluations of both pharmacological and social risks of this drug.

In order to really make an objective scale construction one would first have to find agreement among experts how to define or operationalise the different social and pharmacological risks. Also agreement would have to be reached about which drugs belong on such a scale. And what patterns of use will be taken as reference? Are we making a scale for drugs only for patterns where they are consumed very sparingly in well integrated social situations, or do we allow forms of excessive use? All these questions can not be answered, even assuming that agreement among experts could be reached. To be able to proceed with the building of the Scale of Baan I have chosen to use our relation to a widely known drug as a model. This drug is alcohol. This drug is mostly used quite modestly in socially integrated ways[5]. Regular excessive use in a person is the border of what is usually accepted socially. Strong negative reaction occurs from the moment where excessive use becomes the rule and where the capacity of the user to maintain an adequate level of social and economic contacts is clearly damaged. My reference pattern will therefore be: daily low dosage use, once in a while excessive use, always within socially accepted frameworks.

I will try to compare similar cocaine and cannabis use patterns with this reference  pattern for alcohol use. To find a place for cocaine on a scale which includes all known psychotropic substances or even all known socially used drugs would be far beyond the boundaries of this article.

Table III.1 Some medical/pharmacological risk factors of alcohol, cannabis and cocaine when used daily in social situations with occasional high level use.

Comparing the above mentioned medical/pharmacological risks we see that cocaine and cannabis both score "no" 2 times, compared with zero for alcohol. If we just take the safest ways of ingesting the three drugs (drinking a known dosage of alcohol, eating a known dosage of cannabis and snorting a known dosage of cocaine) the scores change slightly. Cannabis and cocaine would score "no" 4 times. Alcohol would score 1 "no" because in daily practice the purity of alcohol is almost always known and extreme lethal dosages do not or very rarely occur.

We see on this selection of severe medical/pharmacological risks that cannabis and cocaine score about the same, but better than alcohol.[6]

For an evaluation of the risk factors involved in taking a certain drug it is not sufficient to look at the medical/pharmacological ones. Social risks are vital for a complete comparison.

At least two kinds of social risks of a drug exist. The first and foremost is the risk of social marginalization. This may occur because use of a drug is so little accepted socially that the knowledge about somebody using the drug will cause panic and later expulsion from the micro-environments of the user. Marginalisation may also occur via strong criminalization of the drug user. Here police and prosecution procedures will be the roots of marginalisation. Often, however, one will find the two kinds of marginalisation combined.

A second social risk of the use of a drug is that its use does not result in socially integrated forms of control or self-regulation. The risk here is not that one uses a drug, but the way one consumes it is not compatible with broader rules of behaviour between persons who take part in a social situation.

Self-regulation of drug use emerges within the circles the drug is used, if rules are learned about which effects and which methods of consumption are tolerated in different situations and which behaviours apply when these rules are not followed.

Self-regulation is in this sense a collective product. This is why the exact form of self-regulation may vary from group to group.

The most important advantages of self-regulation are that users among themselves are able to deal with unexpected effects and that a user is so familiar with the effects that he can choose the dosage (or way of ingestion) that suits the occasion. An example will clarify this. Everybody knows how somebody behaves when intoxicated with alcohol. Somebody may behave disturbingly but the doctor will not be called in. But somebody using a high dosage of heroin outside his usual circle, quietly nodding off in a corner and barely reacting to questions or remarks, will easily elicit panic reactions. In the latter case bad self-regulation is evident. Neither the user nor his social environment are able to adjust their behaviour to the demands of the situation.

What can we say about the social risks of cannabis, cocaine and alcohol? The big problem is that social risks are not independent of each other. Strong criminalization will endanger or even block the emergence of broadly applicable forms of self-regulation and thereby increase the probability of marginalisation. The opposite process is also possible. Strong marginalisation may force public authority to criminalize users. In both cases the two social risks will reinforce each other.

Table III.2 Some social risk factors of alcohol, cannabis and cocaine when used daily in social situations with occasional high level use.

My impression is that the striking absence of problem-inducing forms of cannabis use in the Netherlands has to be associated with the Dutch policy of non-intervention. Social risks of cannabis use are not reported, at least not in the metropolitan areas where prevalence is highest.48

For cocaine the evaluation of potential social risks is extremely difficult. We know almost nothing about users or patterns of use. The only thing I am quite certain of is that the image of cocaine at the moment is such that public institutions may still influence the emergence, or not, of social risks.

The contribution of the State could be to not criminalize cocaine use and to supply information about it as objectively as possible. The latter would above all be the task of conspicuous politicians and state servants.

"Government affects behaviour chiefly by shaping the cognitions of large numbers of people in ambiguous situations. It helps create their beliefs about what is proper;their perceptions of what is fact;and their expectations of what is to be done"49
If the state would choose not to criminalize cocaine use and to give balanced information about cocaine as was done earlier for cannabis by the publication of the Baan report, a similar drug policy for cocaine is possible. Because of the similarity between user-groups of cannabis then and cocaine now, such a policy would not produce great political confrontation. Beyond this, it is official drug policy to "diminish risks".50>,51 Thus, a normalization/harm-reduction policy toward cocaine-use is a feasible option.

III.6 Recommendations

1 On the basis of observed similarities in the medical/pharmacological risk-levels of cannabis and cocaine, as well as in the social status of the dominant user groups, the Dutch cannabis policy may serve as a model for a future cocaine policy.

2 The myth, created in the beginning of this century in the U.S.A., that cocaine is an extremely dangerous drug has to be debunked. (This myth should not be replaced by a new one, i.e. that cocaine use produces "psychological dependence" because stopping its use creates severe forms of depression.)

3 The State initiates research into use-patterns of illegal drugs and their potential physical and social risks. Further, it should organise weekly analyses of "black market" drugs, conveying the results to public health institutions. Possible risks of adulterations can then be dealt with at the local level.

References chapter III

  1. Ashley, R.: Cocaine: Its History, Uses and Effects. N.Y. St. Martin's Press. 1975
  2. Ibid., p. 5
  3. Spotts, J. and Shontz, F.: Cocaine users: A representative case approach. N.Y. The Free Press, 1980, p. 461
  4. Ibid., p. 459
  5. Ashley 1975, p. 155
  6. Ibid., p. 165
  7. Spotts and Shontz, 1980, p. 329
  8. Ashley 1975, p. 164. Cf also Woods, J. and Downs, D: The psychopharmacology of cocaine, in: National Commission on Marihuana and Drug use, Drug use in America: problem in perspective, Washington 1973, Appendix I, p. 124. Cf also Van Dyke, C and Byck, R.: Cocaine: 1884-1974, in Ellinwood, E. and Kilby, M.: Cocaine and other stimulants, New York 1977
  9. Ashley 1975, p. 158-159
  10. Editorial British Med. Journal (1930) Quoted in Bean, Ph.: The social control of drugs, London 1974
  11. Berridge, V. and Edwards, G.: Opium and the people. Opiate use in Nineteenth-Century England. London 1981
  12. Johnson, B.: Righteousness before revenue: the forgotten moral crusade against the indo-chinese opium trade. Journal of Drug Issues, 1975, p. 304-326
  13. Musto, D. The American Disease. Origins of narcotic control. Yale -University, 1973
  14. Helmer, J.: Drugs and minority oppression, New York 1975
  15. Morgan, P.: The legislation of drug law: economic crises and social control. Journal of Drug Issues, 1978, p. 53-62
  16. Morgan, Wayne H.: Drugs in America. A social history 1800-1980. New York 1981, p 91
  17. Musto 1973, p. 7
  18. Williams, E. 1914, quoted in Ashley 1975, p. 71
  19. Wright 1910. Quoted in Musto 1973, p. 44
  20. Musto 1973, p. 254, footnote 15
  21. Quoted in Morgan, Wayne H. 1981, p. 92
  22. Ibid., p. 93
  23. Ibid.
  24. McLaughlin,: Cocaine, the history and regulation of a dangerous drug, Cornell Law Review, 1973. p. 568. Quoted in Austin, G.: Perspectives on the history of psychoactive substance use. Rockville, NIDA 1978
  25. Rossum, J. van: Cocaïne: psychofarmacologische en psychotoxische effecten. Tijdschrift voor Alcohol en Drugs, 1979. p. 61-66
  26. Musto 1973. p. 52
  27. Ibid., p. 51
  28. Helmer, 1975, p. 57
  29. Ibid., p. 58
  30. Himmelstein, J.: From killer weed to drop out drug: the changing ideology of marihuana. Contemporary Crises, 1983, p. 13-38
  31. Musto 1973, p. 222
  32. Morgan, Wayne H. 1981, p. 140
  33. Helmer 1975, p. 66
  34. Musto 1973, p. 226
  35. Himmelstein, 1983, p. 24
  36. Helmer 1975, p. 69
  37. Himmelstein, 1983, p. 28
  38. Ibid.
  39. Ibid.
  40. Sijlbing, G.: Het gebruik van drugs, alcohol en tabak. Amsterdam, Swoad 1984. cf Introduction
  41. Ashley 1975, p. 160. Cf also Spotts and Shontz, 1980.
  42. Ashley 1975 claims that cocaine does not create tolerance (p. 160 and p. 172.) Spotts and Shontz who also use subjective reports of long term users claim a diminished effect occurs if repeated doses are taken within one day. This would indicate very short term tolerance.
  43. personal communication of Ch. van Brussel, MD
  44. Commission on Narcotic Drugs, 1972, p. 64
  45. Ashley 1975, p. 154
  46. Commission on Narcotic Drugs, 1972, p. 65
  47. Ibid., p. 50
  48. Sijlbing 1984, p. 24
  49. Edelman, M.: Politics as symbolic action. Chicago 1971. Quoted in Gusfield, J.: The culture of public problems. Drinking driving and the symbolic order. Chicago 1981. p. 15
  50. Letter of the Secretary of Public Health to Parliament, Subcommission for Drugpolicy, The Hague, April 15th 1983
  51. Report on Drug maintenance, Municipality of Amsterdam, December 1984

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