Crack

• ALSO KNOWN AS: Rock; crack cocaine

• STATUS: Illegal in the United States, Canada, and Europe
• CLASSIFICATION: Schedule II drug in the United States because of its high abuse potential; has medicinal purposes (as an anesthetic). Crack and cocaine are considered the same drug. Canada classifies crack as a Schedule I drug. Since 1961, the United Nations has identified cocaine as a Schedule I drug. In the United Kingdom, crack is a Class A drug, and in the Netherlands, it is a List 1 drug under that country’s opium law.
• SOURCE: A chemically altered form of cocaine, which is derived from the leaves of the coca plant, commonly found in South America. Cocaine can also be biosynthesized in a laboratory.
• TRANSMISSION ROUTE: Inhalation; intravenous (of the liquid form of crack, also called freebase)

DEFINITION: Crack is a solid form of cocaine made by dissolving powdered cocaine in a mixture of baking soda or ammonia with water. The mixture is boiled into a solid form and then broken into chunks. Crack is a powerful stimulant that reaches the brain in about eight seconds and produces an intense high that lasts between five and ten minutes.

History of Use

Crack first appeared in the US cities of Los Angeles, San Diego, and Houston in the early 1980s, reportedly as a means of moving a large amount of cocaine that was available in the United States in the 1970s. The major crack epidemic, as it came to be called, took place between 1984 and 1990, mostly in low-income, urban areas in the United States. By 2002, the United Kingdom reported a crack epidemic, and today, crack is used worldwide.

Since about 2000, the use of crack has decreased substantially, though it has not disappeared. Young adults (at levels as high as 65 percent) report having tried crack at least once; however, repeat-use percentages are significantly lower. Arrest rates for crack possession are also dramatically lower than those of the 1980s and 1990s, with some cities showing crack-arrest percentages in the single digits. In 2010, the National Institute on Drug Abuse reported that, according to the National Survey on Drug Use and Health, an estimated 359,000 Americans used crack cocaine in 2008. While crack use continued to decline in later years, it still remained a problem. According to the American Addiction Centers, in 2021, over one million Americans over age twelve had used crack in the previous year.

There are several explanations for these lowered rates, including higher prices for cocaine and changes in how the law handles charges for crack possession. However, the most significant cause for the decrease in the use of crack is the dramatic rise in the use of other drugs, such as methamphetamine and fentanyl. Methamphetamine and fentanyl both have low costs, are easily available, and are extremely addictive, making both choices more popular among individuals with substance use disorders.

Effects of Use

Crack is a stimulant that artificially increases the levels of dopamine released from the brain. Also, crack prevents dopamine from being “recycled” by the body, leading to an excess of dopamine with repeated use. This excess causes an overamplification of the dopamine-receptor neurons and leads to a disruption of normal neural communications. For example, the brain loses the ability to properly respond to pleasurable stimuli, which causes the person to seek more drugs to feel any pleasure. While the initial response of the brain to this massive dopamine buildup is a drug-induced euphoria, an increase in self-confidence, and increased energy, these effects become harder and harder to attain as the dopamine system becomes damaged, leading to addiction and tolerance.

Risks of Use

Crack affects not just the brain but also almost every system in the body. One of the most strongly affected is the pulmonary system. Because crack is inhaled using high temperatures (90 degrees Celsius, or 194 degrees Fahrenheit), those who inhale crack often sustain burned lips, tongue, and airways. Another common side effect of crack use is a cough with black sputum, which is caused by the butane torches used to heat the smoking pipes. Other crack-related respiratory illnesses include pulmonary edema (also known as crack lung), asthma, and adult respiratory distress syndrome.

Sudden death from cardiac arrest is another danger for people who use crack, especially those who also drink alcohol. (Any polydrug use increases the risk of sudden cardiac arrest.) Psychiatric trauma is also common and may include severe paranoia, violent behavior, and hallucinations (including delusional parasitosis, or Ekbom’s syndrome, the belief that one is infested with parasites; this can cause a person to violently scratch themselves).

Those who use crack are especially at risk for infections with the human immunodeficiency virus and hepatitis. Shared needles are one source; the other source is the exchange of sex for drugs. This often places women at an especially high risk. Another danger is tuberculosis and other saliva-borne diseases, which are passed by sharing a common crack pipe.

During the 1980s and 1990s, the term "crack baby" began being used to describe babies born addicted to crack and facing insurmountable developmental issues and an inability to bond. However, research later debunked the idea that prenatal cocaine exposure causes catastrophic outcomes. The reality is more complicated. Through changes in brain function and structure occur, and emotional regulation may be altered, with proper care, these impacts are significantly less than once believed. Independent of other issues, such as alcohol and tobacco abuse and poor physical environment, many of these babies can live typical lives.

Further research shows that the area of the body most affected in these children is the dopamine system that develops early in the fetal cycle; the system may show long-term effects of crack and cocaine exposure. A child also may have a mild behavioral disorder or a subtler developmental phenotype that resembles attention-deficit hyperactivity disorder. Cognitive and attention systems may be affected, and these children may require help from a special-needs program.

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