Are crack cocaine and “regular” cocaine the same thing?

You see this claim all the time: “crack and cocaine are the same chemical, one is just criminalized harder because blacks use it.” Crack cocaine and “regular” cocaine (cocaine hydrochloride) are not effectively the same thing, however.

A great meta-analysis on this comes from Hatsukami and Fischman (1996).

Hatsukami DK, Fischman MW. Crack Cocaine and Cocaine Hydrochloride: Are the Differences Myth or Reality? JAMA. 1996;276(19):1580–1588. doi:10.1001/jama.1996.03540190052029

The conclusions read:

Cocaine hydrochloride is readily converted to base prior to use. The physiological and psychoactive effects of cocaine are similar regardless of whether it is in the form of cocaine hydrochloride or crack cocaine (cocaine base). However, evidence exists showing a greater abuse liability, greater propensity for dependence, and more severe consequences when cocaine is smoked (cocainebase) or injected intravenously (cocaine hydrochloride) compared with intranasal use (cocaine hydrochloride). The crucial 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 hydrochloride used intranasally may be a gateway drug or behavior to using crack cocaine. Based on these findings, the federal sentencing guidelines allowing possession of 100 times more cocaine hydrochloride than crack cocaine to trigger mandatory minimum penalties is deemed excessive. Although crack cocaine has been linked with crime to a greater extent than cocaine hydrochloride, many of these crimes are associated with the addiction to cocaine. Therefore, those addicted individuals who are incarcerated for the sale or possession of cocaine are better served by treatment than prison.

This is a reasonable take on the matter. Another study from the journal Psychopharmacology:

Chen, C.-Y., & Anthony, J. C. (2004). Epidemiological estimates of risk in the process of becoming dependent upon cocaine: Cocaine hydrochloride powder versus crack cocaine. Psychopharmacology, 172(1), 78–86. https://doi.org/10.1007/s00213-003-1624-6

Results:

Among persons who had recently started to use cocaine HCl powder but not crack cocaine, about 5–12% experienced clinical features of cocaine dependence. Most clinical features occurred 2–3 times more often among crack smoking users as compared to those using powder only, even with statistical adjustment for frequency of cocaine use (P<0.01). This crack-associated excess risk is more prominent for several clinical features of cocaine dependence, including tolerance associated with cocaine use and narrowed behavioral repertoire attributed to cocaine use.

This study is of potential interest:

Stewart, M. J., Fulton, H. G., & Barrett, S. P. (2014). Powder and Crack Cocaine Use Among Opioid Users: Is All Cocaine the Same? Journal of Addiction Medicine, 8(4), 264–270. https://doi.org/10.1097/ADM.0000000000000047

One of the results:

Polysubstance use was prevalent for both forms of lifetime cocaine use, with 86.6% (n = 58/67) of powder cocaine and 87% (n = 60/69) of crack cocaine users reporting coadministration of other substances.

Additionally, crack cocaine is far cheaper and lasts for a substantially shorter amount of time, making it more of a health threat overall. This is not to say that they should be treated as differently as they were in the 1980’s, simply that they are different post-consumption and should be treated accordingly.

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