Is Cocaine Making a Comeback Amidst the Opiate Crisis?

Is Cocaine Making a Comeback Amidst the Opiate Crisis?


Right now the opiate crisis is getting all of the press, and rightfully so–opiate overdoses are now the leading cause of death in this country for people under the age of 50. Shocking and upsetting as that may be, other substances are still a viable threat.

The NY Times says that “…opioids are not America’s only significant drug problem. Among illicit drugs, cocaine is the No. 2 killer and claims the lives of more African-Americans than heroin does. ”

You may be wondering exactly how the two substances differ. Cocaine is a stimulant and it essentially opens a doorway in the brain that allows dopamine to become more efficient. Opiates actually have molecules that target the opiate receptors in the brain in order to produce euphoria.

When the opiate molecules flood the brain they cause it to care less about the pain signals that the brain may be receiving from the body. The pain is still there and the pain signals are still being sent, but the opiate drug is like a rag in a ringing alarm clock–it simply dampens the brain’s awareness of that pain.

The problem with the current drug crisis is that it is a very complicated and expensive problem to try to fix. There is no easy answer, and there is no inexpensive answer. Furthermore, even if we throw a great deal of money at the problem it will not necessarily solve it or even make much of an impact. In other words, we need to do the right things and we also need to be willing to invest heavily in doing those things well.

So what are those solutions, and what do they look like? For one thing, we can attempt to step up our prevention efforts, though no one is really sure if that will have the kind of downstream effect that we are hoping for. Traditionally, prevention efforts of the past have not done much to prevent the current crisis, so it is questionable if doubling down on prevention would have the effect that we want. But it might be better than not trying at all.

Second, we could pour more money and funding into treatment programs for existing addicts. So one of the things that is sorely needed in the battle against addiction is a much more intense focus on inpatient treatment.

While there are a variety of possible options for a struggling drug addict–ranging from AA meetings to IOP to counseling to sober living to inpatient rehab–it could be argued that the most effective starting point for a struggling addict is to go to a 28 day inpatient program.

One of the problems with this is that treatment of that kind is not cheap, and most addicts are not exactly flush with cash, resources, and great health insurance. Instead, the typical addict may have lost all of their money as well as the job that was needed to get them decent health insurance that would have possibly covered inpatient treatment. But because they tend to lose their job as a result of their addiction, the typical addict often has no money or health insurance to be able to get the help that they need.

Some people argue against this solution because the success rate of traditional treatment programs is typically fairly low. If you take 100 addicts and put them through a 28 day inpatient program, how many of them are still clean and sober a year later? Unfortunately, the answer seems to be “very few of them,” with statistics generally reporting around 20 percent “making it” at best. However, no matter what the actual success rate is, we know that it is higher than zero, and essentially zero is what we are getting when we do not attempt any sort of solution at all.

One of the other problems with inpatient treatment as the solution has to do with the stigma that is attached to it. So part of the long term solution, if that solution is to include a push for more treatment services, is going to have to include some sort of effort to reduce the perceived stigma that our society has towards the treatment process. If we want to push more and more people to get help then we may need to rearrange how we view treatment in general, and what our overall opinions are of.

Another shift that may be happening over the next few years may come in the form of MAT, or “medication assisted treatment.” This is what you used to know as the “methadone maintenance program” but today is becoming more and more sophisticated as we develop new and safer drugs to treat addiction with. For example, in the world of opiate abuse we are now using Suboxone as a safer and less addictive alternative to methadone. Also, there are new medications on the horizon that can be used to reduce cravings for cocaine, and there are already a few medications that exist to treat alcoholism. While it may not be a total solution just yet, the future of drug and alcohol addiction treatment may very well be a new wave of medications that reduce cravings and block the euphoric effects of recreational drugs. These new medications may even be semi permanent implants that, once taken, simply do their job to help us regulate our addictions. Nobody knows for sure how this medical technology will evolve or to what extent it will impact the face of recovery, but it could have quite a large impact based on the last few years of research.

The reason that MAT may become the focal point of treatment is based on the generational differences that we are seeing unfold. The “old way” of treatment involved going to rehab and following that up with devout AA attendance, sponsorship, reading literature, and step work. Are younger people today going to embrace the path of “hard work in recovery” over something as easy as getting an “anti craving implant?” It seems unlikely. Of course, what we really care about is the fact that we need a treatment plan that works and actually helps people to reduce the overall damages and cost to society. For every addict we can “save” today, we prevent a considerable amount of cost and damages in the future.