(From the book: Cocaine the Legend by Jorge Hurtado)

Colombia and especially Peru confront cocaine base’s problems for some years before Bolivia did. Their tried treatments have been based of antidepressants. Nor have been missing amphetamines and the whole battery of minor tranquilizers. There have been desperate cures such as “the dream cure”, which consists in introducing lethargy for many days. This treatment, of course, had no success, as to be effective it would be necessary to have the patient sleep for years. Electroshock, almost abandon today or reserved for deep or rebellious psychosis, has been revived once more with categorical failures.

In Peru doctors’ extreme cure of addiction has been the interruption of the pleasure channels, by means of neurosurgery. I know of other therapeutic attempts in specialized clinics of Argentina, Brazil, Chile and United States. In the great majority of cases the results are discouraging, specially in those where use of the drug has been too prolonged. The limits being quite variable, depends on the individual. It can be affirm that the longer time of use the more difficult to abandon it. The chronic patients take longer to be out of the hospital than to get back into the habit. I have seen people that were released from hospital with no depressive clinical symptoms, quite the contrary, they were optimistic, sure and confident to abandon pasta definitely, to see them coming back few days or weeks later, unable to explain what had happened to them, how they had relapsed.

Similar experience were confronted in Bolivia. It was thought that once the original depression or rebound was overcome, the need for anti-depressants (pasta in this case) should have disappeared, but in the majority of cases such thing did not happen.

From the biochemical stand point of view the phenomena could be explained because there is an extra wear of neurotransmitters, for which not even the imipramine type drugs work. Under this concept, the administration of L-Dopa, a precursor of norepinephrine or the raw material to manufacture neurotransmitters was tried. I am attending a case who after been treated in USA, comeback with this novelty. Now, on top of antidepressants and L-Dopa, he consumes pasta. Moreover, he tells me that he is in better conditions than before to continue using the drug, because L-Dopa lessens the rigidity and tremors of exaggerated usage. Relapses continue same as at the beginning. I know other individuals that have become habituated to L-Dopa which is yet more dangerous than pasta itself, it quickly causes mental disorders.

It was believed that relapses presented themselves before imipramine type drugs had time to act. But, if that would be the case, it could be resolved with prolonged hospital confinements. In some cases there has been a positive reaction to this scheme (of course with psychotherapy help). But the majority, even those where the antidepressants had acted quite well and removed almost for entire the depression, once released from the clinic they tend relapsed again.

Some habitual users, when unable to find pasta in their countries, they found themselves forced to turn to amphetamines with very confusing results. I know the affects of amphetamines through young women that fell into the, so much advertised today, diet pill trap. This drug further to create strong addiction, causes very serious emotional and mental unbalances. That is why, sometimes I have referred to amphetamines as “second class pasta”.

On matters of measures taken on the environmental type, the only thing that appears to give results is the isolation from the drug; generally long periods of time in hospitals or a kind of police control from the family’s side. But here we incursion into the socio-economical side, as confinement can last as long as nine months or more. That means money, a generally scarce commodity, we have seen already that socio-economic maladjustment is the rule in these cases. The habitual pasta user becomes, from the treatment point of view, a very expensive invalid. The National Budget for treatment and rehabilitation has been relegated to emphasize police and interdiction aspects.

Especial situations that allow a prolonged withdrawal of the drug are not always possible, nor are within everybody’s economic means. As Jose’s case that resorted to a voluntary isolation in the country side, in an hacienda with no land access. A change of residence supposes not only extra money, but also change of jobs and the stress resulting from it.

The habitual pasta user, when finally recognizes that he has a problem and that he needs help to get out of it, which generally takes a lot of time even years, and gets to see a doctor he finds that very little can be done for him. Desperate measures are then tried on, expensive trips abroad searching for “experts”, job changes, divorces, seclusion whether voluntary or forced, religious conversions, etc.. Meanwhile, pasta is thrown many times into toilet seats, followed by futile withdrawal promises. Callawayas (respected medicine native individuals) sorceress, naturists, miracle workers, fruitlessly parade which finishes with the last hope of salvation. Frustrated doctors, friends and relatives abandon the sick and he abandons himself too. That is how he ends wondering through the city confused with beggars, until in a conscious or involuntary act an overdose paralyzes the respiratory and cardiac center, putting an end to it all.

COCA LEAF CHEWING TREATMENT

The old coca chewers that had tried COCAINE pasta for any reason, specially curiosity, did not like it. From that point onwards I started to prescribe the leaf as a medium to control the desire for pasta, with good results within that population. Later, when I tried to introduce the system in the city, another problem appeared, the difficulty of the chewing technique, the smell and unpleasant taste for many and specifically the green coloration of the mouth, all these show themselves as serious obstacles. This did not happen with foreigners that I attended to, the majority of them accepted my proposal to chew the leaf as something interesting and they exert themselves in learning the technique. The group of “pico verdes” (green mouths), as someone has called them, grows slowly with failures and successes that necessarily go along in anything new.

Surely due to the difficulty of the coca chewing technique, a percentage of this group has found in cocaine crystal the easy solution to get out of pasta. For sure potency and easiness of administration has a lot to do with this choice. But, as we already saw, these qualities are precisely the ones that the empiric use does not recommend, as they allow abuse and overdose. It’s use could be accepted as a minor evil in circumstances such as the case of Fleischl-Marxow, Freud’s friend, where cocaine crystal certainly due to it’s potency, is an indispensable element to fight the physical abstinence syndrome of morphine. Nevertheless, that example demonstrate to us the dangers of overdose inherent in that modality. If we should use cocaine crystal at any time, (only in case that coca leaves may not be available), it must be administered under medical supervision. In Bolivia where the use of the leave is legal and easily available and specifically due to it’s quality in regulating the dosage, it would be a mistake not to use it.

Problems concerning the administration of the coca leaf as a quick action antidepressant were already seen in the Industrialization Project of the Coca Leaf with Pharmaceutical Goals. In it, I suggested the manufacturing of full leaf’s extracts with a minimum of chemical preparation, with the object to facilitate it’s administration.

GENERAL CONCLUSIONS

The coca leaf is a true energizer. It has a number of vitamins, minerals and proteins. It is a very effective antidepressant or stimulant. Mayor ethnic groups such as the Aymaras and Quechuas have used it by generations through the centuries. It allows a social-economic adaptation beyond what is humanly possible, such was the case of the mita’s infra-human work (forced native labor for the Spaniards) during the Spanish colonization and of the present Bolivian miner.

The cocaine chlorhydrate or cocaine crystals is one of the leaf’s chemically extracted alkaloids. It is an efficient local anesthetic and a potent stimulant. But is this potency which precisely makes it inadvisable for a pleasurable use or as an empiric self-treatment for depression. The abuse and overdose are the rule with subsequent emotional unbalance. It is little known and used in Bolivia. It can produce socioeconomic maladjustment.

The cocaine sulfate or pasta, is a violent drug and its modality of obligated administration: through smoking conditions compulsive drug-search behavior, something very difficult to resolve. This in turn, causes overdosing. These abuses destroy the emotional and mental balance. It is known in Bolivia from the beginning of the 80’s and it’s growing usage threatens to become into a serious medico-social problem. Socioeconomic maladjustment is the norm.

We can conclude that, in the first place, it is urgent to look for a solution for this last problem: the pasta, that can be applied, secondarily, to cocaine crystal abuse. In the second place, we have a century proved element: the coca leaf, whose properties could be taken advantage of as a therapeutic element in the context of the situation.

Especially cases such as Bolivia’s, where medical hospitalarian assistance is very difficult because of money and infrastructure shortage. The following statistical analysis are the result of this situation. Forced by the absence of resources I have recommended the chewing of the coca leaf, between 100 to 200 gr of coca leaf per week, as an ambulatory treatment since 1984.

In 1992 I was invited to work in a Therapeutic Community Center for drug dependence, created by Dr. Carlos Jordan. There, we proved the importance and efficiency of the psychological factor in he treatment of drug dependency, when done within a controlled environment.