The negative effects of amphetamines, which became the street substitute for cocaine in the 1930s, and the somewhat permissive attitudes toward drug use during the Vietnam War era allowed cocaine to make a resurgence in the late 1960s to early 1970s: "Cocaine, the truly American drug: first used by the Andean Indians, now with its resurgence restating the Yankee energy and vitality of free enterprise... even incorporated into our leisure hours ('Coke-time')... it is inevitable that cocaine, perhaps the most rapturously euphoric drug known to man, would be rediscovered by the dark experimenters of the Snorting Seventies" (Gay et al., 1973, p. 426; see also Das, 1993; Gold, 1992). Cocaine was again viewed as a "safe" high. The drug was initially used by methadone patients seeking the euphoria not offered by methadone (Spotts and Shontz, 1980), but it soon became the drug of choice for middle- and upper-class individuals (Gold, 1992). In large part, use by these groups resulted from the publicity given cocaine by persons in the public spotlight, which in turn led to a perception that cocaine was not dangerous--the hard-learned lessons from earlier decades concerning the dangers of cocaine having been by this time forgotten ( Kleber, 1988 ; Musto, 1992). Risks from this "Champagne of pharmaceuticals" were seen as minimal (Gold, 1992). Even the 1980 edition of the Comprehensive Textbook of Psychiatry stated that cocaine was safe if used only two or three times per week (Grinspoon and Bakalar, 1980). Individual drug use averaged 1 to 4 grams per month, and the high cost of the drug limited its acceptability (Das, 1993).

The current wave of cocaine use began in the late 1960s to early 1970s, initially among middle-class or well-to-do users. Later, during the late 1970s and early 1980s, it became popular among the inner-city poor. During the period 1972-1982 the lifetime prevalence of cocaine abuse in the general population increased from 1.6% to 8.5% for older adults and from 9.1% to 28.3% among younger adults (Abelson and Miller, 1985). After reaching a peak in 1985, a decline occurred in cocaine abuse (Substance Abuse and Mental Health Services Administration [SAMHSA], 1991). During this period increasingly fewer young adults appear to have been initiated into cocaine use (that is, have ever tried cocaine; SAMHSA, 1991). Data from the Drug Abuse Warning Network (DAWN) about cocaine-related emergency room episodes appear to confirm this finding. Between 1989 and 1992, the only increases found in emergency room visits for cocaine use were among those between the ages of 35 and 64 (SAMHSA, 1994a). Preliminary data for 1993 (SAMHSA, 1994c) indicated that between 1990 and 1993, cocaine-related episodes per 100,000 population increased by 49%, from 36 to 54, with most of this increase occurring between 1990 and 1992. Similarly, cocaine-related episodes per 100,000 emergency department visits rose 41% between 1990 to 1993, from 98 to 137. Data from the Drug Use Forecasting system (DUF) also indicated that cocaine remained the most pervasive drug among adult male arrestees, and the rate of use remained largely unchanged (National Institute of Justice, 1994a). In 1993 the rate of testing positive for cocaine ranged from 19% to 66% in various precincts, compared with 16% to 63% in 1992, with the median percentage dropping slightly from 45% to 43%. Similarly, among juvenile arrestees, levels of cocaine use were largely unchanged from 1992 to 1993 (National Institute of Justice, 1994b). Cocaine remains a drug of cities. . .