THE STIMULANT and euphoriant extracted from the leaves of the coca plant is becoming one of the most prized, if not most often used, of pleasure-giving drugs. Reports of the arrest of drug smugglers more and more often mention cocaine as their cargo. It is being sniffed or injected more and more openly and frequently by those who can afford it as well as those who have to beg, borrow, steal, or deal to obtain it. Movies and poplar songs have celebrated it or condemned it or done both at once. Articles in national magazines have described its pleasures and warned about its dangers, producing the usual combination of attitudes toward newly popular drugs in which interest predominates over fear. Cocaine has begun to reach the college campuses, where, notoriously, the merely fashionable is admitted into the company of the Zeitgeist.
In spite of the growing interest in the drug and its long history in both South America and the United States, ignorance and misapprehensions about it are substantial on both the popular and the scientific levels. Some people confuse the coca leaf with the cacao bean and assume vaguely that cocaine is related to chocolate; others confuse the coca plant with the coconut. A more serious misconception identifies cocaine with opiates; this confusion has been enshrined in laws that are only now first being challenged in the courts. There are also those who still believe that cocaine is a variant of heroin or similar to heroin in its effects, although in actuality the characteristic pleasures and dangers of cocaine and those of morphine or heroin are quite different. On the scientific level information is also surprisingly limited, and very little of it is recent. The most extensive work on the botany, ethnography, and medicinal uses of the coca leaf was published in 1901; the most important medical and psychiatric studies of cocaine abuse were made in the 1920s; most of the work on the effects of coca-leaf chewing on mood and behavior was done in the 1940s. The clinical literature on the effects of cocaine in man remains comparatively sparse, and most of it is over 50 years old. Controlled experimental studies on human beings are almost entirely lacking. The National Institute on Drug Abuse is funding several research projects, and in a few years considerably more will be known. Meanwhile we have to piece together information and conclusions from old case histories, animal experimentation, interviews, literary descriptions, and analogies with the effects of other drugs, especially the much more extensively studied amphetamines.
There are many reasons for taking an interest in cocaine, and no book can satisfy all the different kinds of concerns equally. One is a trivial but harmless curiosity on the level of gossip: a desire to know about the secret practices of the rich, or entertainers, or racial minorities, or adolescents. This can be disguised by or converted to a sociological interest in who takes the drug, when, why, how, and how much, and its connections with other social practices and conditions. Another kind of curiosity is the desire to find out what a drug might do for or to oneself. A false impersonality or objectivity, a pretense of addressing only students who are interested in a problem that is located at a respectable distance from their own lives, may conceal the fact that readers are using a book in this way. On the other hand, many studies openly choose potential drug 'users or those who .are trying to cope with the consequences of drug abuse as their main audience and aim largely to promote or prevent the use of a given drug. Most of the works in the literature on cocaine are of this kind—perhaps unfortunately, since certain facts are selectively overemphasized for polemical purposes. All these matters are secondary to us, although we have included information that is relevant to them.
This book is divided into three parts. The first is a historical and sociological sketch of the use of the coca leaf and cocaine; the second is a description of what is known of the source, pharmacology, and physiological and psychological effects of the drug, including its medical uses; the third is a more general discussion of the problem of drug abuse and the roots of contemporary confusion about psychoactive drugs, with specific reference to the lessons that can be learned from the history of coca and cocaine. We are interested in cocaine primarily as a case study in the cultural definitions of psychoactive drug use. Since cocaine becomes more a subject of open controversy as it becomes more popular, the implications of this case for public policy are important. In its long history as a medicine, stimulant, and intoxicant, cocaine has been classified in many different ways by different societies and in different eras. This history provides suggestions about the meaning of drug use in several different social contexts: primitive and archaic ritual and medicine, the labor of the poor in colonial empires and underdeveloped countries, and industrial society in a period when attitudes toward drugs and drug technology were undergoing a revolutionary change. The nineteenth-century developments that fixed our present established attitudes toward cocaine are especially interesting. By examining them we can suggest some reasons why nonmedical use of psychoactive drugs generates such strong passions and controversial public policies in our society. Present attitudes ' toward cocaine as well as other drugs that affect the mind may change as the historical conditions that created them disappear.
Our interest in the historical aspect of public policy on cocaine is inseparable from a concern about what that policy should be in the future, and more generally about the intellectual and moral basis of all public controls on psychoactive drugs. Therefore we have restated the general problem of drug dependence and drug abuse as applied to the particular case of cocaine. Cocaine is sometimes referred to as a drug problem or even as part of "the drug problem." Although the concern these phrases express is admirable, they are misleading. They tend to make us overemphasize the question of what we should do about "it" (the drug) or, worse, about "them" (the drug users), with unpleasant overtones of condescension, envy, or scapegoating. Instead we should be asking what to do about ourselves and our society. Although that question may seem too general to be meaningful, it saves us from the kind of premature definition and classification of problems that has been so disastrous in our treatment of the use of psychoactive substances. A redefinition of our ideas about these drugs has begun in recent years, first among the general public and now among physicians; it has produced more careful differentiations and at the same time more flexibility and tolerance of ambiguity. We hope this study of cocaine will contribute to that process. Although the use of drugs ' in general and cocaine in particular may not be in itself as important a social issue as the attention devoted to it sometimes suggests, the amount and quality of the interest in this subject is significant as a symptom of present social conditions and an indication for the future. By lifting some of the fog surrounding the cocaine issue, and especially by clarifying its historical aspects and its relation to general problems of drug dependence and drug abuse, we hope to promote the kind of rational public decision that has been rare where psychoactive drugs are concerned. The emotional obstacles to considering these substances calmly and in a large enough context are great, but the effort is worth making. For the questions discussed (almost always inadequately and with the wrong focus) under the rubric of drug problems involve, at their broadest extent, the kind of society and the kind of humanity we want and are capable of creating.