Cocaine e-cigarettes could help people struggling with addiction

Vaping cocaine might seem like something no scientist would recommend – but two European researchers want to make it a reality, and it could actually help people struggling with stimulant addiction.

In a recent article published in the journal Drug science, policy and law, toxicologist Fabian Steinmetz and addiction research professor Heino Stöver have conceptualized a cocaine e-cigarette. The authors say such a device could mitigate the harms of cocaine use by reducing the risk of overdose and death, and could potentially help people find treatment when and if they are ready. The design is similar to what a normal e-cigarette contains: a battery, an atomizer for heating the drug and a cartridge for the e-liquid – only in this case the cartridge would not contain nicotine, but cocaine.

Vaping certain drugs is obviously popular and is generally considered a less dangerous – but by no means risk-free – activity compared to inhaling smoke. But vaporizer technology has also been co-opted for ingesting illegal drugs, including the potent Psychedelic DMT, MDMA (also known as ecstasy), and yes, cocaine. So Steinmetz does not claim to have invented the idea of ​​a cocaine e-cigarette – or “crack penas some online called it – but he did the work to make this design a reality. The question is how much it can actually help and if people would actually use it to help alleviate their addiction.

“I’m definitely not the first person to think about this,” Steinmetz said. To discover. “It might be somewhere between crack and snorting cocaine, but if it helps half the people, then it helps half the people.”

Crack versus powder cocaine

Cocaine can be refined into a hydrochloride powder usually snorted. But in its freebase form, cocaine can also be smoked thanks to a lower boiling point. The crackling sound it makes when heated is where this variation gets the name “crack”. Both forms are essentially the same drug, but this has not always been reflected in legal distinctions: door crack harsher penalties than gunpowder, but crack is generally less expensive, so communities of color are often the first victims of these laws.

Since the route of administration is different when snorting or smoking, the high of cocaine powder compared to crack is also different. Crack gives a more intense rush it dissipates faster, so if someone is addicted to it, they can use it several times a day.

“The most harmful thing about stimulants is that people use them all the time,” Steinmetz says, noting that the result sleep deprivation may increase the risk of psychosis. Heated particles can also cause lung damage, sometimes referred to as “crack lungwhich is something a vaporizer would address. But it can also keep people alive in other ways.

“You can actually reduce the risk of overdose,” says Steinmetz. Additionally, Steinmetz argues, because his concept would be a prescribing model for people who tend to avoid the healthcare system (because their drug use is illegal), it can help them find treatment when they are loans. (Forcing people into drug rehab has been shown to be largely ineffective.)

But according to Steinmetz, one of the biggest benefits of a cocaine e-cigarette would be that it would remove the risk of bans. No more background stuff or cut substances with unknown chemicals. Steinmetz says that many scholars, when evaluating legalization and decriminalization, “always overlook the harm that prohibition directly or indirectly inflicts on people.”

Can we make illegal drugs safer?

The cocaine e-cig is an example of “secure supplya harm reduction concept that suggests that by replacing black market drugs with a pure version of the same substance, prescribed by a doctor, the risk of overdose and death can be reduced. A safe supply already exists in small forms in Europe and North America, usually involving opioids like hydromorphone.

Doctors in the UK, Switzerland, Canada and Germany can prescribe heroin so that users are not looking for an illicit version that might be tainted with other drugs. The data published in the Cochrane Database of Systematic Reviews suggests that so-called heroin-assisted treatments may actually reduce drug use, increase treatment graduates, and most importantly, reduce mortality.

For the past two years, Mark Tyndall, a professor of public health at the University of British Columbia, has led a safe supply program in Vancouver using vending machine, which is particularly useful during covid pandemic. He currently prescribes injectable hydromorphone, sold under the brand name Dilaudid, to about 70 patients, with plans to expand the program. The machines operate using a touch screen, biometric hand scanner, and participants can pick up the drugs several times a day.

The results are promising so far. Several patients have completed the program, while many others have reduced their drug use or stopped shopping on the street altogether.

But, notes Tyndall, “It’s a drop in the bucket when it comes to need.” More than 1,500 people died of overdoses in British Columbia between March 2020 and March 2021 — double the amount of the same period in 2019. “Obviously what we’re doing now, the incremental progress that we think we’re making, isn’t making enough of a difference.”

E-Cigs for Opioids and More

Tyndall floated the idea of ​​an opioid e-cigarette, but like the cocaine pen, it’s just an idea. Tyndall estimates that in British Columbia, about 30-40% of opioid users smoke heroin or fentanyl. But while smoking opioids is safer than injecting them, it can still cause health issues, and tools like e-cigarettes could make it less harmful.

At least in some countries, it’s actually not so far-fetched to imagine doctors prescribing a cocaine e-cigarette for problematic stimulant use. Yet secure sourcing is not yet a very popular idea. “In Germany, every doctor could prescribe [heroin], but there are still only 10 practices nationwide,” Steinmetz says.

Some Experts argued this secure supply led to the current opioid crisis, noting the high rate of prescription opioids that more than a decade ago fueled the first wave of the overdose crisis. But Tyndall and his colleagues argued that we are no longer in the first wave of this public health emergency – we are now in the fourth wave, fueled by synthetic opioids like fentanyl and isotonitazene. We need different strategies, whether it’s a safe supply in the form of cocaine vaporizers, supervised consumption sites or naloxone programs.

Whatever role a safe supply plays in the future of drug treatment, many global health experts argue that the ban is ineffective. “People stop using drugs when they find something better,” says Tyndall. “And we don’t offer people much better, we just keep punishing them.”

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