Unsafe at Any Speed

Cocaine Papers by Sigmund Freud

edited and with an introduction by Robert Byck MD, notes by Anna Freud
New American Library/Meridian, 402 pp., $4.95 (paper)

Cocaine: Its History, Uses and Effects

by Richard Ashley
St. Martin’s, 232 pp., $7.95

The Speed Culture: Amphetamine Use and Abuse in America

by Lester Grinspoon MD, by Peter Hedblom
Harvard University Press, 340 pp., $15.00

It is refreshing to have three new books which demonstrate, in their separate ways, how much we have yet to learn about drugs. The millions of words published about cocaine and amphetamines during the last twelve years suggest that most people, including health professionals, cling to familiar myths and stereotypes that cover up the contradictory facts.

The books under review show that doctors and medical societies alike have failed the public by being frightened of cocaine because of a few extreme cases, while being sanguine about the more dangerous amphetamines because of their popularity. Ashley as well as Grinspoon and Hedblom document the irresponsible or ignorant misuse of these drugs by modern doctors, while Byck’s collection of Freud’s papers suggests that the self-serving pettiness of the medical profession when faced with psychoactive substances goes back at least a century.

Both cocaine and amphetamines are stimulants of the central nervous system. The leaves of the coca plant have been chewed for thousands of years by the Indians of Central and South America. The plant appears to be a complex substance containing several alkaloids, vitamins B and C, and other elements. Its principal alkaloid, cocaine, was isolated in the 1850s. Coca users seem to tolerate their habits well and feel few, if any, noticeable side-effects. Some pharmacologists explain this by saying that the various elements of coca may oppose or activate one another. The effects of coca are quite different from those of the more powerful alkaloid, for the natural plant contains only from 0.5 to 1.5 percent cocaine. (One should no more equate the potencies of coca and cocaine than one should equate the potency of marijuana with that of pure delta-9 tetrahydrocannabinol [THC], marijuana’s most active ingredient.)

But even in its pure—that is, chemical—form, cocaine (when snorted) produces a relatively brief effect on the user. In most cases, a rush of euphoric feeling is followed in minutes by a half-hour high, with some effects lingering on for as long as two hours. The cocaine high can be so subtle that many users feel no particular response at all, apart from some numbing of the nose and mouth, and a general feeling of well-being. Freud wrote that one-twentieth of a gram of cocaine cured a bad mood and gave him the impression of “having dined ‘well so that there is nothing at all one need bother about,’ but without robbing [me] of any energy for exercise or work.” Except for those who take extremely large doses, most people who snort cocaine develop no tolerance for the drug, can fairly easily stop using it, experience little metabolic change, and are not subject to toxic responses or to psychoses.

Still, as Ashley points out, “if cocaine is not the addictive, dependence-producing, dangerous drug it has been made out to be, it nevertheless can create serious toxic or adverse reactions” for those who abuse it. Each user, he observes, has a limit—and this varies widely—beyond …

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Letters

No Cause for Optimism January 22, 1976