CRACK COCAINE AND COCAINE HYDROCHLORIDE - ARE THE DIFFERENCES MYTH ORREALITY

Objective.-To review and discuss the differences and similarities betw een the use of crack cocaine and cocaine hydrochloride; and to determi ne how these findings might affect policies on the imprisonment and tr eatment of cocaine users. Data Sources.-English-language publications were identified through a computerized search (using MEDLINE) between 1976 and 1996 using the search terms ''smoked cocaine,'' ''crack cocai ne,'' ''freebase,'' and ''cocaine-base.'' In addition, manual searches were conducted on references cited in original research articles, rev iews, and an annotated bibliography, and on selected journals. Study S election.-Only those articles that compared various routes of cocaine administration or types of cocaine (cocaine base or crack cocaine vs c ocaine hydrochloride) were examined. Data Extraction.-Studies were rev iewed to obtain information on the composition of the 2 forms of cocai ne, and the prevalence, pharmacokinetics and pharmacodynamics, abuse l iability, pattern of use, and consequences across the various routes o f cocaine administration and forms of cocaine. Conclusion.-Cocaine hyd rochloride is readily converted to base prior to use. The physiologica l and psychoactive effects of cocaine are similar regardless of whethe r it is in the form of cocaine hydrochloride or crack cocaine (cocaine base). However, evidence exists showing a greater abuse liability, gr eater propensity for dependence, and more severe consequences when coc aine is smoked (cocaine-base) or injected intravenously (cocaine hydro chloride) compared with intranasal use (cocaine hydrochloride). The cr ucial variables appear to be the immediacy, duration, and magnitude of cocaine's effect, as well as the frequency and amount of cocaine used rather than the form of the cocaine. Furthermore, cocaine hydrochlori de used intranasally may be a gateway drug or behavior to using crack cocaine, Based on these findings, the federal sentencing guidelines al lowing possession of 100 times more cocaine hydrochloride than crack c ocaine to trigger mandatory minimum penalties is deemed excessive, Alt hough crack cocaine has been linked with crime to a greater extent tha n cocaine hydrochloride, many of these crimes are associated with the addiction to cocaine. Therefore, those addicted individuals who are in carcerated for the sale or possession of cocaine are better served by treatment than prison.