Hatsukami D K, Fischman M W
Department of Psychiatry, Division of Neurosciences, University of Minnesota, Minneapolis 55455, USA.
JAMA. 1996 Nov 20;276(19):1580-8.
To review and discuss the differences and similarities between the use of crack cocaine and cocaine hydrochloride; and to determine how these findings might affect policies on the imprisonment and treatment of cocaine users.
English-language publications were identified through a computerized search (using MEDLINE) between 1976 and 1996 using the search terms "smoked cocaine," "crack cocaine," "freebase," and "cocaine-base." In addition, manual searches were conducted on references cited in original research articles, reviews, and an annotated bibliography, and on selected journals.
Only those articles that compared various routes of cocaine administration or types of cocaine (cocaine base or crack cocaine vs cocaine hydrochloride) were examined.
Studies were reviewed to obtain information on the composition of the 2 forms of cocaine, and the prevalence, pharmacokinetics and pharmacodynamics, abuse liability, pattern of use, and consequences across the various routes of cocaine administration and forms of cocaine.
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 (cocaine-base) 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.
回顾并讨论游离可卡因与盐酸可卡因使用方面的异同；确定这些研究结果如何影响针对可卡因使用者的监禁和治疗政策。
通过计算机检索（使用MEDLINE），在1976年至1996年间以“吸食可卡因”“游离可卡因”“快克可卡因”“古柯碱”和“可卡因碱”为检索词，识别英文出版物。此外，对原始研究文章、综述和带注释的文献目录中引用的参考文献以及选定的期刊进行了手工检索。
仅审查那些比较可卡因不同给药途径或可卡因类型（可卡因碱或快克可卡因与盐酸可卡因）的文章。
对研究进行综述，以获取关于两种可卡因形式的成分、不同可卡因给药途径和形式的流行率、药代动力学和药效学、滥用倾向、使用模式及后果的信息。
盐酸可卡因在使用前很容易转化为碱。无论可卡因是以盐酸可卡因还是快克可卡因（可卡因碱）的形式存在，其生理和精神活性作用都是相似的。然而，有证据表明，与经鼻使用（盐酸可卡因）相比，吸食（可卡因碱）或静脉注射（盐酸可卡因）可卡因时，滥用倾向更大、成瘾可能性更高且后果更严重。关键变量似乎是可卡因作用的即时性、持续时间和强度，以及可卡因的使用频率和用量，而非可卡因的形式。此外，经鼻使用的盐酸可卡因可能是使用快克可卡因的入门药物或行为。基于这些研究结果，联邦量刑指南规定持有盐酸可卡因的量比快克可卡因多100倍才触发强制性最低刑罚，这被认为过高。尽管快克可卡因与犯罪的关联程度比盐酸可卡因更大，但其中许多犯罪与可卡因成瘾有关。因此，那些因贩卖或持有可卡因而被监禁的成瘾者，接受治疗比监禁更有益。
