Patricia Casey: 'Cocaine use now is higher than ever before - but we're not taking the threat seriously'
Cocaine according to the late Robin Williams was: "God's way of telling you you've got too much" (wealth). He might have reason to believe there was some divine seal of approval, given the accolade of Pope Leo XIII in the 19th century to the manufacturers of this "tonic", which he carried in a hip-flask.
It has always been regarded as a drug of the rich and powerful. From the 1920s onwards, it had an air of wealth and chic about it that other drugs like opium did not. Sigmund Freud, the psychoanalyst, used and promoted it as a cure for psychiatric ailments. The writer F Scott Fitzgerald glamorised it in his best-known novel, 'The Great Gatsby'. There are some iconic 1920s prints of women holding sleek cigarettes in diamond-encrusted holders in one hand and small gold boxes of cocaine in the other.
It was banned in the US in 1922 but emerged again during the 1960s sexual revolution, as the fashionable drug of writers and entertainers and otherwise "beautiful people". It has been the drug of choice for a galaxy of celebrities.
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Having hit Ireland in the Celtic Tiger years, cocaine abuse is now at levels even higher than in that period. It is rightfully cast as a scourge in Ireland. Garda sources say it is available to all age groups, in every socio-economic group and across the length and breadth of the country.
According to Europol, the Irish market for cocaine is saturated and this is one of the factors causing the current gangland killings as the major suppliers vie for territorial control in a very crowded market. The European drugs market overall is valued at €30bn or more, and cocaine itself is worth at least €9bn. This is an increase of more than 60pc compared with the value three years ago. The cocaine market now exceeds that for heroin.
The Global Drug Survey 2018 prices cocaine in Ireland at more than €80 per gram, making it one of the most expensive countries in Europe in which to purchase cocaine. But this does not deter Irish users from having the fourth highest consumption rate internationally, ahead of the US, although behind Scotland. The trading in cocaine has now extended to small towns and rural villages. As things get leaner for traders in the fully subscribed market in Ireland, some of the Irish gangs are reported to be turning to Australia, where the market is less saturated and where cocaine can command a price five times higher than in Ireland.
The high cost of cocaine is not just financial but emotional also. According to the Health Research Board, the number seeking treatment has climbed from 1,503 in 2017 to 2,254 in 2018. Cocaine is now rivalling cannabis as the second most common drug for which people present for treatment. The image of cocaine as a luxury for elite urbanites has now evaporated as the typical cocaine user may now be a taxi driver, farmer, teacher or somebody from any walk of life.
According to the Road Safety Authority, more than one-third of motorists screening positive for drugs were also positive for cocaine. It is also one of the causes of heart attacks in men under 40.
What is surprising is that there seems to be so little concern about the saturation of our culture in cocaine. There have been debates, position papers and strategies in respect of heroin and cannabis over the years. On the other hand, there has been absolutely no discussion about cocaine and how to respond to the scourge now facing Ireland and Europe.
Perhaps its history of association with wealth and glamour rather than with opium dens and cheap roll-your-owns is part of the explanation. Another is that it does not cause any major public health concerns in the same way that opiates cause. The response to the public health worries around opiates led to methadone clinics, the availability of clean needles and, in some countries, injecting rooms.
Cannabis has mainly been discussed with regard to decriminalisation. Abuse of cocaine has been largely ignored in public discourse, possibly because it is not seen as dangerous to the public at large.
Meanwhile the gangs themselves seem to be aware of the likely changing market if governments proceed with injecting rooms and decriminalisation. They seem to be on top of their game and devoting their energies to expanding the cocaine market.
Cocaine does not easily lend itself to a public health response so there is no suggestion from any quarter that cocaine should be decriminalised; it is, after all, a Schedule 2 controlled substance under the Misuse of Drugs Act (2015) and it can lead to profound depression during withdrawal or harm to others when it triggers violence or psychosis.
Cutting off the supply, which comes principally from Colombia, has been problematic. A 2016 deal with the Farc rebels, who had ties to cocaine production, has not had the desired effect because hundreds of thousands of poor farmers rely on cocoa for survival.
The debate to be had about cocaine should focus, ab initio, on why we are not discussing and waking up to the dangers of this deadly substance. Have we given up on it? Do we not realise how dangerous it is? Is it that we have no idea on how to tackle it? Or do we just not care any more?
Patricia Casey is a consultant psychiatrist in the Mater Hospital Dublin and Professor Emeritus of Psychiatry at UCD