Some over-the-counter (OTC) and prescription cough and cold medicines contain active ingredients that are psychoactive (mind-altering) at higher-than-recommended dosages and are frequently abused for this purpose. These products may also contain other drugs, such as expectorants and antihistamines, which are dangerous at high doses and compound the dangers of abuse.
Two commonly abused cough and cold medicines are:
Dextromethorphan (DXM), a cough suppressant and expectorant found in many OTC cold medicines. It may produce euphoria and dissociative effects or even hallucinations when taken in quantities greater than the recommended therapeutic dose.
Promethazine-codeine cough syrup, a medication that contains codeine, an opioid that acts as a cough suppressant and can also produce relaxation and euphoria when consumed at a higher-than-prescribed dose. It also contains promethazine HCl, an antihistamine that additionally acts as a sedative. Although only available by prescription, promethazine-codeine cough syrup is sometimes diverted for abuse.
How Are Cough and Cold Medicines Abused?
Cough and cold medicines are usually consumed orally in tablet, capsule, or syrup form. They may be mixed with soda for flavor and are often abused in combination with other drugs, such as alcohol or marijuana.
Abusing DXM can cause impaired motor function, numbness, nausea or vomiting, increased heart rate and blood pressure,
Because they are easily purchased in drugstores without a prescription, cough syrups, pills, and gel capsules containing DXM—particularly “extra strength” forms—are frequently abused by young people (who refer to the practice as “robo-tripping” or “skittling”). To avoid nausea produced by high doses of the expectorant guaifenesin commonly found in DXM-containing syrups, young people may instead abuse Coricidin® HBP Cough & Cold capsules (street name C-C-C or triple-C), which contain DXM but lack guaifenesin.
Drinking promethazine-codeine cough syrup mixed with soda (a combination called syrup, sizzurp, purple drank, barre, or lean) was referenced frequently in some popular music beginning in the late 1990s and has become increasingly popular among youth in several areas of the country. A variation of “purple drank” is promethazine-codeine cough syrup mixed with alcohol. Users may also flavor the mixture with the addition of hard candies.
How Does Abusing Cough and Cold Medicines Affect the Brain?
When taken as intended, cough and cold medicines safely treat symptoms of lower and upper respiratory congestion and discomfort caused by colds and flu. But when taken in higher quantities or when such symptoms aren’t present, they may affect the brain in ways very similar to illegal drugs.
When taken in high doses, DXM acts on the same cell receptors as dissociative hallucinogenic drugs like PCP or ketamine. Users describe effects ranging from mild stimulation to alcohol- or marijuana-like intoxication, and at high doses, sensations of physical distortion and hallucinations.
Codeine attaches to the same cell receptors targeted by illegal opioids like heroin. Consuming more than the daily recommended therapeutic dose of promethazine-codeine cough syrup can produce euphoria similar to that produced by other opioid drugs; people addicted to codeine may consume several times the recommended, safe amount. Also, both codeine and promethazine HCl act as depressants of the central nervous system, producing sedating or calming effects.
When abused, both codeine and DXM directly or indirectly cause a pleasurable increase in the amount of dopamine in the brain’s reward pathway. Repeatedly seeking to experience that feeling can lead to addiction—a chronic relapsing brain disease characterized by inability to stop using a drug despite damaging consequences to a person’s life and health.
What Are the Other Health Effects of Abusing Cough and Cold Medicines?
Abusing DXM can cause impaired motor function, numbness, nausea or vomiting, increased heart rate and blood pressure, and at high doses, extreme agitation, increased body temperature, and a buildup of excess acid in body fluids. High doses of acetaminophen, a pain reliever commonly found with DXM, can cause liver damage. On rare occasions, hypoxic brain damage—caused by severe respiratory depression and a lack of oxygen to the brain—has occurred as a result of the combination of DXM with decongestants often found in the medication.
When abused, promethazine-codeine cough syrup presents a high risk of fatal overdose due to its effect of depressing the central nervous system, which can slow or stop the heart and lungs. Mixing with alcohol greatly increases this risk. Promethazine-codeine cough syrup has been linked to the overdose deaths of a few prominent musicians.
For more information on abuse of DXM, see
http://www.deadiversion.usdoj.gov/drug_chem_info/dextro_m.pdf (PDF, 37KB)
For more information on abuse of promethazine-codeine cough syrup, see
Members of the armed forces are not immune to the substance use problems that affect the rest of society. Although illicit drug use is lower among U.S. military personnel than among civilians, heavy alcohol and tobacco use, and especially prescription drug abuse, are much more prevalent and are on the rise.
The stresses of deployment during wartime and the unique culture of the military account for some of these differences. Zero-tolerance policies and stigma pose difficulties in identifying and treating substance use problems in military personnel, as does lack of confidentiality that deters many who need treatment from seeking it.
Those with multiple deployments and combat exposure are at greatest risk of developing substance use problems. They are more apt to engage in new-onset heavy weekly drinking and binge drinking, to suffer alcohol- and other drug-related problems, and to have greater prescribed use of behavioral health medications. They are also more likely to start smoking or relapse to smoking.
Illicit and Prescription Drugs
According to the 2008 Department of Defense (DoD) Survey of Health Related Behaviors among Active Duty Military Personnel, just 2.3 percent of military personnel were past-month users of an illicit drug, compared with 12 percent of civilians. Among those age 18–25 (who are most likely to use drugs), the rate among military personnel was 3.9 percent, compared with 17.2 percent among civilians.
A policy of zero tolerance for drug use among DoD personnel is likely one reason why illicit drug use has remained at a low level in the military for 2 decades. The policy was instituted in 1982 and is currently enforced by frequent random drug testing; service members face dishonorable discharge and even criminal prosecution for a positive drug test.
However, in spite of the low level of illicit drug use, abuse of prescription drugs is higher among service members than among civilians and is on the increase. In 2008, 11 percent of service members reported misusing prescription drugs, up from 2 percent in 2002 and 4 percent in 2005. Most of the prescription drugs misused by service members are opioid pain medications.
Mental Health Problems in Returning Veterans
Service members may carry the psychological and physical wounds of their military experience with them into subsequent civilian life. In one study, one in four veterans returning from Iraq and Afghanistan reported symptoms of a mental or cognitive disorder; one in six reported symp-toms of post-traumatic stress disor-der (PTSD). These disorders are strongly associated with substance abuse and dependence, as are other problems experienced by returning military personnel, including sleep disturbances, traumatic brain injury, and violence in relationships.
Young adult veterans are particularly likely to have substance use or other mental health problems. According to a report of veterans in 2004-2006, a quarter of 18- to 25-year-old veterans met criteria for a past-year substance use disorder, which is more than double the rate of veterans aged 26-54 and five times the rate of veterans 55 or older.
The greater availability of these medications and increases in prescriptions for them may contribute to their growing misuse by service members. Pain reliever prescriptions written by military physicians quadrupled between 2001 and 2009—to almost 3.8 million. Combat-related injuries and the strains from carrying heavy equipment during multiple deployments likely play a role in this trend.
Drinking and Smoking
Alcohol use is also higher among men and women in military service than among civilians. Almost half of active duty service members (47 percent) reported binge drinking in 2008—up from 35 percent in 1998. In 2008, 20 percent of military personnel reported binge drinking every week in the past month; the rate was considerably higher—27 percent—among those with high combat exposure.
In 2008, 30 percent of all service members were current cigarette smokers—comparable to the rate for civilians (29 percent). However, as with alcohol use, smoking rates are significantly higher among personnel who have been exposed to combat.
Suicides and Substance Use
Suicide rates in the military were traditionally lower than among civilians in the same age range, but in 2004 the suicide rate in the U.S. Army began to climb, surpassing the civilian rate in 2008. Substance use is involved in many of these suicides. The 2010 report of the Army Suicide Prevention Task Force found that 29 percent of active duty Army suicides from fiscal year (FY) 2005 to FY 2009 involved alcohol or drug use; and in 2009, prescription drugs were involved in almost one third of them.
Addressing the Problem
A 2012 report prepared for the DoD by the Institute of Medicine (IOM Report) recommended ways of addressing the problem of substance use in the military, including increasing the use of evidence-based prevention and treatment interventions and expanding access to care. The report recommends broadening insurance coverage to include effective outpatient treatments and better equipping healthcare providers to recognize and screen for substance use problems so they can refer patients to appropriate, evidence-based treatment when needed. It also recommends measures like limiting access to alcohol on bases.
The IOM Report also notes that addressing substance use in the military will require increasing confidentiality and shifting a cultural climate in which drug problems are stigmatized and evoke fear in people suffering from them.
Branches of the military have already taken steps to curb prescription drug abuse. The Army, for example, has implemented changes that include limiting the duration of prescriptions for opioid pain relievers to 6 months and having a pharmacist monitor a soldier’s medications when multiple prescriptions are being used.
NIDA and other government agencies are currently funding research to better understand the causes of drug abuse and other mental health problems among military personnel, veterans, and their families and how best to prevent and treat them.
National Institute on Drug Abuse. Substance Abuse in the Military Retrieved from http://www.drugabuse.gov/publications/drugfacts/substance-abuse-in-military on May 23, 2015
2014’s Monitoring the Future survey of drug use and attitudes among American 8th, 10th, and 12th graders continued to show encouraging news about youth drug use, including decreasing use of alcohol, cigarettes, and prescription pain relievers; no increase in use of marijuana; decreasing use of inhalants and synthetic drugs, including K2/Spice and bath salts; and a general decline over the last two decades in the use of illicit drugs. However, the survey highlighted growing concerns over the high rate of e-cigarette use and softening of attitudes around some types of drug use, particularly decreases in perceived harm and disapproval of marijuana use.
Alcohol 2014 The survey showed continued declines in alcohol use by all grades. Nine percent of 8th graders, 23.5 percent of 10th graders, and 37.4 percent of 12th graders reported past-month use of alcohol, which was significantly lower than in 2009, when rates were 14.9 percent, 30.4 percent, and 43.5 percent, respectively. There was also a significant five-year drop in binge drinking (five or more drinks in a row in the previous 2 weeks) by seniors: 19.4 percent reported binge drinking in 2014, whereas 31.5 percent had reported the practice at its peak in 1998.
Cigarette smoking-Cigarettes by youth continues to drop and is at its lowest rate in the survey’s history. Only 1.4 percent of 8th graders reported smoking every day in 2014, compared to 2.7 percent in 2009; 3.2 percent of 10th graders reported smoking daily, compared to 4.4 percent in 2013 and 6.3 percent in 2009; and 6.7 percent of high school seniors reported smoking daily in 2014, down from 8.5 percent in 2013 and 11.2 percent in 2009. In 1997, at its peak, nearly a quarter of seniors were daily smokers.
However, other forms of tobacco remain popular. In 2014, past-year hookah use continued to increase among12th graders to 22.9 percent—the highest rate since 2010, when the survey started capturing this type of tobacco use.
Also popular among teens is the use of e- cigarettes, which was measured for the first time in 2014. Use of e-cigarettes in the past 30 days was reported by 8.7 percent of 8th graders, 16.2 percent of 10th graders, and 17.1 percent of 12th graders. Only 14.2 percent of 12th graders view regular e-cigarette use as harmful. The nicotine in e-cigarettes is vaporized and inhaled (not smoked), but the health impact of e-cigarette use is not yet clear, nor do we know if e-cigarette use makes it more likely for people to use conventional cigarettes or other tobacco products. Survey findings show that while most e-cigarette users have also smoked conventional tobacco products, approximately 2.9 percent of 8th graders, 4.5 percent of 10th graders, and 3.8 percent of 12th graders who report past month use of e-cigarettes deny ever using tobacco cigarettes or smokeless tobacco.
Use Illicit of Drugs any illicit drug has generally declined over the past two decades. Past- year use of illicit drugs for all grades combined was 27.2 percent in 2014, down from its peak at 34.1 percent in 1997. The MTF survey also shows a decline in the perceived availability of most substance over the past few years, including alcohol, cigarettes, marijuana, powder cocaine, crystal methamphetamine, and prescription painkillers.
Marijuana use remained stable in 2014, even though the percentage of youth perceiving the drug as harmful went down. Past-month use of marijuana remained steady among 8th graders at 6.5 percent, among 10th graders at 16.6 percent, and among 12th graders at 21.2 percent. Close to 6 percent of 12th graders report daily use of marijuana (similar to 2013), and 81 percent of them said the drug is easy to get. Among 8th graders, there was a drop in perceived availability in 2014, with 36.9 percent saying it is easy to get marijuana, compared to 39.1 percent in 2013.
Although marijuana use has remained relatively stable over the past few years, there continues to be a shifting of teens’ attitudes about its perceived risks. The majority of high school seniors do not think occasional marijuana smoking is harmful, with only 36.1 percent saying that regular use puts the user at great risk, compared to 39.5 percent in 2013 and 52.4 percent in 2009. However, 56.7 percent of seniors say they disapprove of adults who smoke it occasionally, and 73.4 percent say they disapprove of adults smoking marijuana regularly.
Marijuana use continues to exceed cigarette use in all three grade levels. In 2014, 21.2 percent of high school seniors had used marijuana in the past 30 days, whereas only 13.6 percent had smoked cigarettes.
Prescription and Over-the-Counter
Misuse Drugs and abuse (or “non-medical use”) of prescription and over-the-counter drugs continues to decline among the nation’s youth. Past-year use of the opioid pain reliever Vicodin has dropped significantly over the past 5 years; 4.8 percent of 12th graders used Vicodin for non-medical reasons in 2014, compared to 9.7 percent in 2009. Past-year use of narcotics other than heroin (which includes all opioid pain relievers) among high school seniors dropped from 7.1 percent in 2013 to 6.1 percent in 2014; 9.5 percent of seniors had reported past- year use of these drugs in 2004. Past-year non-medical use of the stimulants Adderall and Ritalin (often prescribed for ADHD) remained relatively steady in 2014, at 6.8 percent and 1.8 percent respectively for high school seniors. The survey continues to show that most teens get these medicines from friends or relatives; a smaller percentage misuse or abuse pills that had been prescribed for them for a medical problem. Although teens did not misuse or abuse prescription stimulants at higher rates than in past years, there has been a decline in teens’ perceptions the risks of doing so. In 2014, 55.1 percent of seniors saw regularly taking prescription amphetamines as harmful, down from 69.0 percent in 2009.
In 2014, there was also a significant drop in the past-year use of cough/cold medicines containing dextromethorphan (DXM) among 8th graders, with only 2.0 percent using them for non-medical reasons, down from 2.9 percent in 2013 and 3.8 percent in 2009.
Other Illicit Use
Past year use of MDMA (also known as ecstasy or “Molly”) saw a significant decline among 10th graders to 2.3 percent in 2014, from 3.6 percent in 2013 and 6.2 percent in 2001, when it peaked. Past-year use of heroin remained very low in all three grades despite increased use among adults over 26 years of age in 2013.1
There has been a considerable decline in past-year use of synthetic cannabinoids (“K2/Spice,” sometimes misleadingly called “synthetic marijuana”) in the two years the survey has been tracking their use. Only 5.8 percent of 12th graders reported using K2/Spice in 2014, compared to 7.9 percent in 2013 and 11.3 percent in 2012. This was associated with an increase in the perceived risk of taking synthetic marijuana once or twice among 12th graders. Use of the hallucinogen salvia also dropped significantly among 12th graders in 2014 to 1.8 percent, from 3.4 percent in 2013.
Another harmful synthetic drug, bath salts (synthetic stimulants), was added to the survey in 2012; past-year use of bath salts remained low in 2014, and dropped considerably among 8th graders, to 0.5 percent, compared to 1 percent.
1 Substance Abuse and Mental Health Services Administration. Results from the 2013 National Survey on Drug Use and Health: Summary of national findings. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2014. HHS Publication No. (SMA) 14-4887. NSDUH Series H-49.
Current, past-year, and lifetime use
of among 10th and 12th graders is at its lowest levels in the history of the survey. Rates of inhalant use are traditionally highest among the youngest adolescents (unlike most other drugs); in 2014, 5.3 percent of 8th graders reported using inhalants in the past year, down from 8.1 percent in 2009 and 12.8 percent in 1995, when use peaked.
Complete MTF survey results are available at www.monitoringthefuture.org.
For more information on the survey and its findings, also visit www.drugabuse.gov/related- topics/trends-statistics/monitoring- future.
About the Survey
Other sources of information on drug use trends among youth are available:
The annual National Survey on Drug Use and Health, conducted by the Substance Abuse and Mental Health Services Administration, gathers detailed data on drug, alcohol, and tobacco use by all age groups. It is a comprehensive source of information on substance use and dependence among Americans aged 12 and older. Data and reports can be found at www.samhsa.gov/data/population- data-nsduh.
The Youth Risk Behavior Survey is a school-based survey conducted every other year by the Centers for Disease Control and Prevention. It gathers data on a wide variety of health-related risk behaviors, including drug abuse, from students in grades 9 through 12. More information is available at www.cdc.gov/nccdphp/dash/yrbs/inde x.htm.
“Anabolic steroids” is the familiar name for synthetic variants of the male sex hormone testosterone. The proper term for these compounds is anabolic-androgenic steroids (abbreviated AAS)—“anabolic” referring to muscle-building and “androgenic” referring to increased male sexual characteristics.
Anabolic steroids can be legally prescribed to treat conditions resulting from steroid hormone deficiency, such as delayed puberty, as well as diseases that result in loss of lean muscle mass, such as cancer and AIDS. But some athletes, bodybuilders, and others abuse these drugs in an attempt to enhance performance and/or improve their physical appearance.
How Are Anabolic Steroids Abused?
Anabolic steroids are usually either taken orally or injected into the muscles, although some are applied to the skin as a cream or gel. Doses taken by abusers may be 10 to 100 times higher than doses prescribed to treat medical conditions.
Steroids are typically taken intermittently rather than continuously, both to avert unwanted side effects and to give the body’s hormonal system a periodic chance to recuperate. Continuous use of steroids can decrease the body’s responsiveness to the drugs (tolerance) as well as cause the body to stop producing its own testosterone; breaks in steroid use are believed to redress these issues. “Cycling” thus refers to a pattern of use in which steroids are taken for periods of weeks or months, after which use is stopped for a period of time and then restarted.
In addition, users often combine several different types of steroids and/or incorporate other steroidal or non-steroidal supplements in an attempt to maximize their effectiveness, a practice referred to as “stacking.”
How Do Anabolic Steroids Affect the Brain?
Anabolic steroids work very differently from other drugs of abuse, and they do not have the same acute effects on the brain. The most important difference is that steroids do not trigger rapid increases in the neurotransmitter dopamine, which is responsible for the rewarding “high” that drives the abuse of other substances.
However, long-term steroid use can affect some of the same brain pathways and chemicals—including dopamine, serotonin, and opioid systems—that are affected by other drugs, and thereby may have a significant impact on mood and behavior.
Abuse of anabolic steroids may lead to aggression and other psychiatric problems, for example. Although many users report feeling good about themselves while on steroids, extreme mood swings can also occur, including manic-like symptoms and anger (“roid rage”) that may lead to violence. Researchers have also observed that users may suffer from paranoid jealousy, extreme irritability, delusions, and impaired judgment stemming from feelings of invincibility.
Are Steroids Addictive?
Even though anabolic steroids do not cause the same high as other drugs, steroids are reinforcing and can lead to addiction. Studies have shown that animals will self-administer steroids when given the opportunity, just as they do with other addictive drugs. People may persist in abusing steroids despite physical problems and nega-tive effects on social relationships, reflecting these drugs’ addictive potential. Also, steroid abusers typically spend large amounts of time and money obtaining the drug—another indication of addiction.
Individuals who abuse steroids can experience withdrawal symptoms when they stop taking them—including mood swings, fatigue, rest-lessness, loss of appetite, insomnia, reduced sex drive, and steroid cravings, all of which may contribute to continued abuse. One of the most dangerous withdrawal symptoms is depression—when persistent, it can sometimes lead to suicide attempts. Research has found that some steroid abusers turn to other drugs such as opioids to counteract the negative effects of steroids.
What Are the Other Health Effects of Anabolic Steroids?
Steroid abuse may lead to serious, even irreversible, health problems. Some of the most dangerous consequences that have been linked to steroid abuse include kidney impairment or failure; damage to the liver; and cardiovascular problems including enlargement of the heart, high blood pressure, and changes in blood cholesterol leading to an increased risk of stroke and heart attack (even in young people).
Steroid use commonly causes severe acne and fluid retention, as well as several effects that are gender- and age-specific:
For men—shrinkage of the testicles (testicular atrophy), reduced sperm count or infertility, baldness, development of breasts (gynecomastia), increased risk for prostate cancer
For women—growth of facial hair, male-pattern baldness, changes in or cessation of the menstrual cycle, enlargement of the clitoris, deepened voice
For adolescents—stunted growth due to premature skeletal maturation and accelerated puberty changes, and risk of not reaching expected height if steroid use precedes the typical adolescent growth spurt
In addition, people who inject steroids run the added risk of contracting or transmitting HIV/AIDS or hepatitis.
National Institute on Drug Abuse. Anabolic Steroids Retrieved from http://www.drugabuse.gov/publications/drugfacts/anabolic-steroids on March 5, 2015
Cocaine is a powerfully addictive stimulant drug made from the leaves of the coca plant native to South America. It produces short-term euphoria, energy, and talkativeness in addition to potentially dangerous physical effects like raising heart rate and blood pressure.
How Is Cocaine Used?
The powdered form of cocaine is either inhaled through the nose (snorted), where it is absorbed through the nasal tissue, or dissolved in water and injected into the bloodstream.
Crack is a form of cocaine that has been processed to make a rock crystal (also called “freebase cocaine”) that can be smoked. The crystal is heated to produce vapors that are absorbed into the blood-stream through the lungs. (The term “crack” refers to the crackling sound produced by the rock as it is heated.)
The intensity and duration of cocaine’s pleasurable effects depend on the way it is administered. Injecting or smoking cocaine delivers the drug rapidly into the bloodstream and brain, producing a quicker and stronger but shorter-lasting high than snorting. The high from snorting cocaine may last 15 to 30 minutes; the high from smoking may last 5 to 10 minutes.
In order to sustain their high, people who use cocaine often use the drug in a binge pattern—taking the drug repeatedly within a relatively short period of time, at increasingly higher doses. This practice can easily lead to addiction, a chronic relapsing disease caused by changes in the brain and characterized by uncontrollable drug-seeking no matter the consequences.
How Does Cocaine Affect the Brain?
Cocaine is a strong central nervous system stimulant that increases levels of the neurotransmitter dopamine in brain circuits regulating pleasure and movement.
Normally, dopamine is released by neurons in these circuits in response to potential rewards (like the smell of good food) and then recycled back into the cell that released it, thus shutting off the signal between neurons. Cocaine prevents the dopamine from being recycled, causing excessive amounts to build up in the synapse, or junction between neurons. This amplifies the dopamine signal and ultimately disrupts normal brain communication. It is this flood of dopamine that causes cocaine’s characteristic high.
With repeated use, cocaine can cause long-term changes in the brain’s reward system as well as other brain systems, which may lead to addiction. With repeated use, tolerance to cocaine also often develops; many cocaine abusers report that they seek but fail to achieve as much pleasure as they did from their first exposure. Some users will increase their dose in an attempt to intensify and prolong their high, but this can also increase the risk of adverse psychological or physiological effects.
What Are the Other Health Effects of Cocaine?
Cocaine affects the body in a variety of ways. It constricts blood vessels, dilates pupils, and increases body temperature, heart rate, and blood pressure. It can also cause headaches and gastrointestinal complications such as abdominal pain and nausea. Because cocaine tends to decrease appetite, chronic users can become malnourished as well.
Most seriously, people who use cocaine can suffer heart attacks or strokes, which may cause sudden death. Cocaine-related deaths are often a result of the heart stopping (cardiac arrest) followed by an arrest of breathing.
People who use cocaine also put themselves at risk for contracting HIV, even if they do not share needles or other drug paraphernalia. This is because cocaine intoxication impairs judgment and can lead to risky sexual behavior.
Some effects of cocaine depend on the method of taking it. Regular snorting of cocaine, for example, can lead to loss of the sense of smell, nosebleeds, problems with swallowing, hoarseness, and a chronically runny nose. Ingesting cocaine by the mouth can cause severe bowel gangrene as a result of reduced blood flow. Injecting cocaine can bring about severe allergic reactions and increased risk for contracting HIV, hepatitis C, and other blood-borne diseases.
Binge-patterned cocaine use may lead to irritability, restlessness, and anxiety. Cocaine abusers can also experience severe paranoia—a temporary state of full-blown paranoid psychosis—in which they lose touch with reality and experience auditory hallucinations.
Cocaine is more dangerous when combined with other drugs or alcohol (poly-drug use). For example, the combination of cocaine and heroin (known as a “speedball”) carries a particularly high risk of fatal overdose.
National Institute on Drug Abuse. Cocaine Retrieved from http://www.drugabuse.gov/publications/drugfacts/cocaine on March 5, 2015