Stimulant Summit: Cocaine`s destructive power no longer in doubt

The opening keynote talk Monday at the National Cocaine, Meth & Stimulant Summit offered a rich history of changed thinking regarding cocaine, once labeled “the champagne of drugs” and now statistically the second deadliest illegal substance.

Famed addiction researcher Mark S. Gold, MD, traced a history of his own research, including an early 1980s paper on psychostimulants and memory that was published at a time when there still was no field-wide consensus that cocaine was addictive.

“Cocaine changed the definition of addiction,” said Gold, professor at the Washington University School of Medicine, from a definition based on drug withdrawal to one based on self-administration. “Process addictions wouldn't exist without this [shift],” Gold said.

As did other speakers on the first day of the inaugural Stimulant Summit in the Fort Lauderdale, Fla., area, Gold emphasized the overlap in drug use trends that now results in most overdose deaths involving more than one drug. Fentanyl is increasingly found in supplies of both cocaine and methamphetamine, Gold said, with isolated reports of even marijuana now being adulterated with the deadly opioid. About half of all cocaine-related deaths in Florida involve fentanyl, he said.

Gold said that with no approved medication treatments for cocaine dependence, behavioral treatments with a focus on psychiatric comorbidities have to be emphasized. He reminded the audience that not all overdoses are accidental, citing a statistic that about 30% are considered suicide attempts.

As a precursor to the focus on treatment, “The number one thing people can do is prevent overdose,” Gold said. A smattering of hands went up when he asked the audience of professionals if any of them routinely carried naloxone; the encouraging response earned applause from Gold.