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  • Writer's pictureThe Paladins

How should we fight the cocaine epidemic?

Psychiatry and drug addiction

Our short answer is that the criminal law has an important role to play in suppressing a global social evil; possession and dealing in cocaine, a particularly addictive and psychologically unpleasant recreational narcotic, should remain criminalised. But there should be amendments to the structure of the global legal regimes by which criminalisation is enshrined.

Our principal goal in this article is to approach the subject matter and the question the title poses logically, calmly, patiently, consistently with such limited scientific evidence relevant to the question as exists, and in a way both consistent with common social outrage as to the damage this particularly unusual recreational narcotic causes to both consumer and the broader society; and sympathetically to the individual users of cocaine that we identify as patients or as victims.

This article is the latest in a series that relates to the Belgrade Drug Policy Clinic. It will adopt an entirely different approach to the Paladins Organisation study of whether MDMA (Ecstasy) ought to be legalised, because cocaine is an entirely different and substantially more personally toxic and socially damaging narcotic than is MDMA.

Hence we will proceed as always. We will define our terms, and introduce the reader to cocaine. We will study why people take this drug, and the benefits they perceive from doing so as well as the known harms it does. We will reach the conclusion that the world would be unequivocally a better place, the less cocaine that is consumed. Then we will turn to socio-economic factors that seek to explain why, notwithstanding, cocaine usage is ever-increasing.

Finally we will turn to the public policy arguments that consider what measures governments, acting individually or collectively, can undertake to try to suppress cocaine usage. Finally we will draw conclusions about the most effective legal regime to suppress cocaine usage.

What is cocaine?


Cocaine is a stimulant drug obtained from the leaves of two Coca species native to South America, Erythroxylum coca and Erythroxylum novogranatense. After extraction from coca leaves and further processing into cocaine hydrochloride (powdered cocaine), the drug may be snorted, heated until sublimated and then inhaled, or dissolved and injected into a vein.

Cocaine stimulates the reward pathway in the brain. Mental effects may include an intense feeling of happiness, sexual arousal, loss of contact with reality, or agitation. Physical effects may include a fast heart rate, sweating, and dilated pupils. High doses can result in high blood pressure or high body temperature. Effects begin within seconds to minutes of use and last between five and ninety minutes. As cocaine also has numbing and blood vessel constriction properties, it is occasionally used during surgery on the throat or inside of the nose to control pain, bleeding, and vocal cord spasm.


Cocaine hydrochloride is typically dissolved in paraffin to create hard white brick blocks, for transport around the world to consumers. Then pieces are chipped off the block, cut up with a sharp bladed tool, and usually cut with some other substance before ultimately being sold 'by the gram' in bags and wraps of paper in cities all over the world.

Global quantities of cocaine production and use are climbing steeply. It is believed that approximately 0.5 per cent of the global population (approximately 35 million people) is a cocaine user at any given time. Despite significant under-reporting of use in surveys due to dominant illegality and stigma, on a mean global basis it is one of the most widespread illegal narcotics in the world.

Global cocaine consumption

It is not entirely clear why rates of cocaine production and ergo consumption are going up so rapidly. An economist's market explanation that cocaine is becoming cheaper and easier to produce would not be correct. Cocaine has always been very cheap and easy to produce (in South America) and that has not changed. A better explanation may be that in times of geopolitical uncertainty in which ever fewer people have certainty about security of tenure in their work and their abilities to cater for their own and for their families' needs, cocaine is increasingly used as a form of self-medication to alleviate mental anguish.

The vast majority of cocaine is snorted; we will consider the principal exception, crack cocaine, separately below. By snorting it the drug reaches the brain as quickly as possible.

The typical cocaine user is aged between 25 and 40. Rates drop off below this age due to expense; and above this age probably due to greater emotional and personal stability removing the principal cause of cocaine use, namely mental anguish, as we will discuss below.

Beneficial effects

Every cocaine user starts from the same set of principles. They are suffering from some degree of mental anguish. Cocaine, with a combination of anaesthetic and elatory effects, relieves their anguish and makes them feel that they can cope. It causes them high pleasure for a limited period and it seems harmless and fun. It is exciting so they try it again. And thus begins the path to addiction.

Every cocaine addict started cocaine usage as a form of self-medication for one or the other species of mental anguish in respect of which they could find no relief through exercising, psychiatric medicines (typically because they had no access to adequate psychiatry) or other recreational narcotics such as alcohol.

Therefore it is essential to view cocaine users as patients with an underlying medical condition that cocaine is partially treating albeit at significant long-term expense (see next section).

So we may list the benefits of cocaine usage as:

  1. Temporary elation (onset within a minute if snorted; half life 15-30 minutes).

  2. Temporary anaesthesia of painful psychological experiences (same time period as elation).

  3. A feeling of confidence (very important where the underlying mental anguish has caused the patient to lose self-confidence).

  4. In some patients: weight loss (cocaine is an effective weight loss medication only where a patient wishes to use it as such; there are plenty of cocaine users who drink huge quantities of alcohol contemporaneously with using cocaine and they gain weight, not lose it).

  5. Management of negative feelings (many cocaine users feel calmer when intoxicated, rendering them less liable to violent or emotional actions).

  6. Increased sociability and conversation (important where the underlying mental anguish relates to being shy).

  7. If you are physically weak or unfit, cocaine usage can make you feel physically stronger (while you are using it).

  8. If you are socialising in an alcohol-dominated culture, cocaine usage can help you to 'keep up' with your drinking companions. (Of course this becomes very destructive when all your drinking companions are using cocaine as well.)

  9. Cocaine immediately cures virtually any sort of headache, in particular one associated with a hangover.

  10. Cocaine is often snorted by more than one person using the same toilet cubicle simultaneously in public premises. This can deliver a sense of common thrill and companionship.

  11. If a person is lonely, cocaine usage can give them the self:confidence to carry on in a situation in which they are on their own. Hence housewives have been known to take cocaine while at home doing the ironing.

  12. Cocaine usage can make you feel that you have the internal psychological strength to make difficult decisions of the kind that a lot of people procrastinate about and never make.

  13. Cocaine makes the user feel more relaxed in complex social situations, including anything from an evening out with colleagues or fellow professionals, or a busy nightclub.

  14. Cocaine use makes the user feel more able to express their own personal opinions in uninhibited terms, particularly where they otherwise may feel intimidated by the company they are in.

  15. Cocaine suppresses sleep in a positive way (i.e. you feel excited) as long as you keep taking it. But see the negatives below.

  16. Cocaine suppresses the bad temper, foul mouthed and unpleasant, angry opinions, aggression and violence associated with the consumption of alcohol.

  17. Cocaine use, during elation, generally increases one's attractiveness to the opposite sex through increased self-confidence.

Cocaine obviously has a lot of beneficial effects. Otherwise people would never spend so much money on it.

Harmful effects

Cocaine has a series of harmful effects virtually all of which are the same in that their onset is gradual with use of cocaine over time and few or none of them are observed at first.

There is no person who did not enjoy their first line of cocaine and indeed who had any adverse effects from it. The adverse effects all come later, after repeated use.

  1. Cocaine elation is accompanied by paranoia and anxiety which lasts after the short-term high.

  2. People in a state of cocaine elation typically talk rubbish.

  3. People coming down from cocaine elation can be brooding, miserable and negative, turning inwards.

  4. Cocaine use substantial reduces the capacity for concentration.

  5. Cocaine use is highly psychologically addictive due to its short onset time and half life; leading the consumer to want to 'take one more line'.

  6. Cocaine use at higher levels (or upon repetition of doses) can cause panic as the anaesthetic effects of the drug start to affect the body more comprehensively.

  7. Cocaine overdose, although difficult, in principle can cause immediate cardiac arrest and hence death, particularly in persons of poor health, obesity, weak coronary systems etcetera. Many pop stars and movie stars who died young were unhealthy and then took a cocaine overdose that, for them in their physical condition, proved lethal.

  8. Cocaine increases one's blood pressure both during onset and more generally; many people admitted to drug wards / clinics with cocaine addiction have bright red faces and this is typically due to raised blood pressure from prolonged cocaine use.

  9. For men, cocaine usage inhibits the ability to have sex during and after onset because it causes temporary impotence. (For this reason some men combine cocaine with Viagra, a most harmless combination compared to the cocaine alone but that can kill via a heart attack if the combination of the two raises one's blood pressure high enough).

  10. Cocaine induces in many people a desire to consume excessive alcohol, with all the separate downsides that has.

  11. Cocaine use typically inhibits the capacity to sleep, even after elatory effects have passed. This in turn may disrupt sleep patterns and cause nights of sleepless anxiety, depression and paranoia; this in turn may provoke a benzodiazepene addiction to offset the negative sedatory effects of cocaine.

  12. Use of cocaine may deteriorate the septum and the inner nasal passages more generally, causing the nose to leak liquid - in extreme cases that liquid will be red as blood vessels in the nose have been ruptured. These effects are seldom irreversible. (Note: this effect can be overstated. Police Officers and spies often look for runny noses in their targets but of course runny noses can be caused by a variety of things.)

  13. Cocaine may temporarily diminish the effectiveness of the auto-immune system, rendering a user more likely to infections.

  14. Cocaine usage may cause a user to neglect the importance of a balanced diet.

  15. In extreme cases prolonged cocaine usage may catalyse Bipolar II Dsiorder or aggravate Bipolar I Disorder. We cannot here set out the different causes and symptoms of these two psychiatric illnesses: all we would say for current purposes is that while cocaine is unlikely to be the sole cause of either such condition, it may be an aggravating factor in exacerbating such a condition. (We also remind the reader that these conditions may lead the patient to the mental anguish that causes them to initiate cocaine usage in the first place.)

  16. Cocaine is expensive in many countries.

  17. Cocaine is almost always illicitly cut with some other substance that may vary from sodium bicarbonate to amphetamine sulphate, pharmaceutical medicines of white powder form or ground lightbulb glass. In each case an experienced cocaine consumer can typically tell the difference by sight or insufflation; but the cutting agent will have all its own side effects that will typically be negative and these need to be factored in.

  18. In many countries there is a risk of police action against persons caught in possession of cocaine. In some countries these penalties are swingeing having regard to the fact that a cocaine user should be considered a patient or victim. In some countries blood tests may be taken and a prison term may follow a finding of cocaine in the blood.

  19. Cocaine distribution and sale is often associated with dangerous, violent people due to the high risk, high reward nature of the trade and it is inadvisable to get into their debt.

  20. Anyone caught selling distributing or trafficking cocaine will likely have their life ruined by an extensive period of incarceration. These offences are treated so harshly by criminal justice that there is generally no second chance.

  21. Cocaine use can promote risky and promiscuous sexual behaviour, particularly on the part of women, who may be induced to undertake sex acts in exchange for cocaine.

  22. Cocaine users are easily deluded into thinking that they don't have a problem; taking cocaine is the only time they feel normal and that their underlying mental anguish has been extinguished or ameliorated. Hence rationalising with a cocaine user with a view to encourage them to stop can be tiresome and circular.

  23. 'Cocaine hangovers' can be particularly unpleasant, in some cases lasting more than 24 hours. The body feels totally destroyed; the only thing that can renovate it is more cocaine.

  24. Although cocaine use per se does not cause loss of judgment outside the periods of elation and consequent anxiety / depression, it may encourage a user to believe that their emotional and rational reactions to their underlying mental trauma are justified. That is because they have found a means of summarily lifting the symptoms of the mental trauma through cocaine use. Hence cocaine use may undermine a person's capacity to come to terms with the facts and circumstances underlyong their state of mental distress.

  25. As users become increasingly addicted, vendors may surreptitiously put the price up by increasing the proportion of cutting agent.

It is obvious from the foregoing that the negative individual and social effects of cocaine usage so exceed its benefits that government and society more generally are under a public duty to take every measure to suppress its consumption.

The remaining question is how to achieve that using the policy tools typically at the disposal of government. But before we consider those, there are a number of side issues we need to analyse.

Overcoming cocaine addiction

This is an area of this essay in which we can thankfully say some positive things.

  1. Overcoming cocaine addiction can take place very quickly in the right sort of environment (what we call 'benign but mandatory'). The period of detoxification can be as little as 48 hours if the appropriate form of supervision is available.

  2. Cocaine is not physically addictive, principally because through its anaesthetic effects it is a necrotic.

  3. To prevent a person who has dried out from returning to cocaine use one needs to remove the underlying cause of cocaine usage, which is always a mental anguish. This is usually the most difficult part of the rehabilitation process and it has nothing to do with the qualities of cocaine. Without elimination of the underlying mental anguish, cocaine users will exhibit recidivism.

  4. Weight loss or gain during cocaine usage is easily reversed and there are seldom any long-term physical effects of cocaine usage at all, once a successful pattern of withdrawal is established.

  5. Even using amateur methods, a cocaine user can be persuaded by loving friends and/or family to cut down and stop gradually, in particular by cross-subatirution into other less harmful narcotics and also by alleviating the underlying mental anguish.

  6. Virtually all cocaine users do at some point stop - when their mental anguish levels have subsided.

Crack cocaine

Crack cocaine is cocaine hydrochloride boiled up with sodium bicarbonate (baking soda), an easily available kitchen product on every country. This yields an off white - yellowish crystalline substance that is either chopped up and snorted or smoked and inhaled (e.g. in a 'crack pipe').

Crack cocaine crystals

Cocaine addiction recovery

A lot of cocaine is cut with bicarbonate of soda for ease of dealers. If the consumer wants cocaine, it is pre-cut with bicarbonate of soda (that makes one sneeze as they insufflate it); if the consumer wants crack cocaine you just heat up the mix and the crack cocaine crystals will be formed.

Crack cocaine typically attracts a premium led gram over cocaine, at street prices, for reasons not entirely clear (undoubtedly some cocaine is wasted during the boiling process) but probably because the high from crack cocaine is more intense. The margin in Europe is about +USD20 per gram (see below).

Crack cocaine is much more addictive than cocaine; indeed it is one of the most addictive substances in the world. That is because it produces a quicker, more intense cocaine-like high that also lasts less time. Hence the desire to take more crack cocaine quickly is amplified.

Crack cocaine is associated with physically addictive symptoms, unlike cocaine. This makes the task of overcoming addiction all the harder and it requires amplified medical supervision and attendance.

Crack cocaine can become addictive within just a few 'puffs'. It is so addictive that no sane person should try it even once, even for experimental purposes.

Crack cocaine possession typically carries higher criminal penalties than cocaine. Trafficking crack cocaine is not prosecuted, as process of conversion of cocaine into crack cocaine typically takes place domestically in the country of sale.

Crack cocaine causes near-immediatre psychosis, paranoia, and belief-based hallucinations (i.e. believing things that are obviously false).

Persona addicted to crack cocaine often desist from eating and malnutrition is the major killer for crack cocaine users. Use of this narcotic may kill in as little as six weeks for this reason.

Crack cocaine usage is known to be a particularly fast route into coerced prostitution, as the user needs to pay urgently for their habit which needs to be constantly satisfied lest the physical and psychological withdrawal symptoms become overwhelming. Crack cocaine addicts become thin and lose weight over the course of their addictions, as they fail to eat properly.

Hence 'crack whores' are thin female crack cocaine addicts and prostitutes, usually managed by a male pimp who supplies them with the crack cocaine, who perform sex acts for relatively small amounts of money in order to feed their ultimately fatal addictions.

Any 'crack den' (i.e. an establishment arranged on such operating principles) should become a police priority both due to the high risk of sexual exploitation and the danger of death of the crack addicts.

Comparison with amphetamines

In Europe cocaine is often cut with amphetamine sulphate so beware of this if purchasing what is sold as cocaine (which you should not as both substances are very bad for your health).

  1. Both are white powders but cocaine (if tending towards pure) is more crystalline. Cocaine cut with amphetamine looks like amphetamine sulphate: a loose white powder.

  2. Amphetamine sulphate (and other amphetamine narcotics) are mostly made in people's bathrooms. It may carry an odour of the industrial solvent used to prepare it (e.g. acetone), although pure amphetamine sulphate is odourless.

  3. Amphetamine sulphate is bitter on the tongue but you may not notice this if you snort it.

  4. The time of action of amphetamine sulphate is a few minutes when taken per nasum - so slower than cocaine - although its effects last longer, typically 30-60 minutes.

  5. Amphetamine sulphate is very cheap, e.g. USD5-10 per gram, hence distinguishing it from cocaine.

  6. Amphetamine sulphate causes much more serious anxiety, depression, paranoia and insomnia than cocaine. It is also physically addictive so your body will exhibit shaking and withdrawal symptoms if you try to stop. All things considered, if you can afford it then a cocaine addiction is better mutatis mutandis than an amphetamine addiction.

  7. Amphetamines permanently damage skin texture (particularly in young women but not exclusively so) as they cause unnatural drying out.

  8. Amphetamines are virtually never fatal per se (although their consumption may lead users to do fatal things such as driving cars intoxicated).

  9. You can be addicted to cocaine and amphetamine simultaneously, particularly where the former is cut with the latter.

  10. Amphetamine psychosis is far more common than cocaine psychosis, in large part due to the excessive sleep deprivation amphetamines cause.

  11. If you have a cocaine addiction, do not try to cross-substitute with amphetamines. It will get you nowhere except having an addiction to two substances not one.

  12. Amphetamine usage can cause dramatic weight loss.

  13. Amphetamines render a person's character increasingly intense. It can make them volatile or aggressive, whereas this is not so commonly indicated with cocaine.

  14. Drying out amphetamine addicts is a substantially more complicated process than drying out cocaine addicts.

Cocaine and MDMA

MDMA is a particularly effective cross-substitute for those seeking relief from cocaine addiction because the presence of active MDMA in the bloodstream eliminates virtually all the elatory and other positive effects of cocaine. Hence MDMA is a good ad hoc 'antidote'.

Cross-substitution of cocaine with psychedelic narcotics (e.g. LSD; psilocybin (magic mushrooms) has not been studied to the best of our knowledge but we welcome any information about this subject.

Price theory and cocaine

Unsurprisingly for a mid-range luxury commodity, cocaine exhibits high price elasticity of demand: the more expensive it is, the less the demand. This, ultimately, will prove to be the reason why cocaine should not be legalised. Criminalisation keeps prices high and hence usage rates lower than they should be.

Given that there is no valuable cross-substitution (cocaine usage does not suppress consumption for even more dangerous or for that matter less dangerous drugs), the natural governmental policy imperative is simply to apply whatever measures exist at the government's disposal to suppress supply and hence keep prix high and demand lower.

One of the distinctive economic qualities of cocaine is its price variability in different global regions. The reason for this is that cocaine is virtually exclusively produced in South America (due to climate) and price differentials reflect the variable costs in the extraordinarily risky movement of pure cocaine (typically dissolved in paraffin and travelling in sold white blocks) around the world.

Because cocaine trafficking across borders is illegal everywhere, and the criminal penalties for doing this are so swingeing, price ends up reflecting the inbuilt danger in illicitly moving the substance trans-globally outside regular commodity movement infrastructure subject to institutional inspection.

In fact cocaine pricing exhibits fairly solidly the exponential pricing model for exports that exists for consumer goods: the price goes up exponentially with distance from source. The reason is not so much the cost of shipping but the legal risks of transporting the cargo, most of which is moved by sea, submarines or light aircraft, usually across the Atlantic from South America and then beyond. The US market is separate and may involve transfer across the US-Mexican border (porous in some remote and dangerous places to cross) or by ship to remote US ports.

Here are some street price examples (all figures USD per gramme 2020; cocaine prices do not tend to vary with inflation or over time, for reasons we will come to explore.)

1. Bolivia: 2

2. Colombia: 3

3. Argentina: 10

4. Mexico: 15

5. USA: 60

6. Europe: 80

7. Middle East: 250

8. East Asia. 300

9. Australasia 450

Cocaine is a strikingly good example of the principle that export commodity prices increase exponentially with distance from source.

Is there a case for legalisation?

The usual case for legalisation might be made: you can tax and regulate, thereby not reducing the price and ergo not increasing demand; but providing health warnings and testing to prevent dirty products.

The reason why the argument to legalise cocaine but to tax it to ensure prices do not drop is specious is because this would inevitably open a secondary unregulated and informal market for cheaper cocaine. Hence street prices would fall and accordingly, due to cocaine's high price elasticity of demand, demand and hence usage would go up.

Given that cocaine usage is so unequivocally bad a thing both for the individual and for society (it involves a horrendous waste of money that could be spent on economically productive activities) any measure that might stimulate demand for cocaine must be suppressed.

Hence there can be no argument for the legalisation of cocaine.

The benefits of a criminal ban

A criminal ban works because it associates the activities in transport trafficking and supply of cocaine with extreme risk. People engaged in this trade are liable to spend much to all of the rest of their lives in prison.

To be compensated for this risk, cocaine prices must be very high. That suppresses demand.

It also makes a few successful criminals extremely wealthy. But most cocaine dealers or traffickers get caught in the end, and at that point their funds are confiscated and transferred to government treasuries for economically productive purposes.

The efforts made to capture cocaine gang criminals by domestic and international law enforcement authorities are substantial but nowhere near as high in cost terms as the value of the assets and cashflow streams seized thereby.


Decriminalisation is an informal policy of the Police overlooking cocaine users while continuing to pursue and prosecute cocaine suppliers and traffickers.

It is a humane policy, if one treats cocaine users as patients or victims which is what modern society ought to be doing.

It is also a rational policy given the disproportionate resources that domestic police forces could spend arresting trying and punishing cocaine consumers, all for no social reward and a lot of social destruction and upheaval (families being wrenched apart; persons in custody being removed from the labour market, etcetera).

Also criminalisation of usage inhibits the seeking of psychiatric assistance, which is what those with acute drug addictions need. They are afraid to create a medical record that incriminates them.

Hence decriminalisation of cocaine possession (not trafficking or supply) is rational policy.

The importance of investing in acute psychiatry

Because cocaine use is a form of self-medication for mental anguish and psychiatric illness, a key plank of any governmnent's cocaine policy should be to make available acute psychiatrists that patients can visit rather than self-medicating with cocaine.

Very few countries invest sufficiently in publicly funded psychiatry. As a result a stigma builds up around seeing a psychiatrist for mental anguish, principally because it is so difficult / expensive.

General practitioners within the medical profession have nowhere near the necessary levels of training or expertise to address drug addiction.

Also, psychiatrists are often trained to be judgemental of persons with drug problems, which likewise deters usage of such services. This should change; drug addiction is just another branch of psychiatric medicine and arguably its most common one (or it should be). Drug addiction is so rampant across so many societies that a wholesale change in attitudes is required on the part of the psychiatry profession and the public purse if we are to fight the world's most common psychiatric problem (drug addiction) successfully.


  1. Cocaine is an extremely harmful drug and to maintain high prices and hence lower use its transport distribution and sale should remain criminalised with heavy penalties.

  2. Particularly heavy penalties should be imposed where cocaine is mixed with another toxic or damaging substance for street sale.

  3. However there is a compelling argument for decriminalisation of usage.

  4. Cross-substitution into MDMA, and possibly other narcotics, ought to be considered by way of medical trials.

  5. A radical change in perspective both towards professional psychiatry for drug addicts and public funding of psychiatry is essential to fight this scourge.

  6. Improvements in public psychiatry should be coordinated with public information campaigns to help relieve economically inefficient stigmas preventing people from seeking medical help to what ought to be considered as primarily a medical problem.


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