Chapter 35. Cocaine

The chief active ingredient in coca leaves, the alkaloid cocaine, was isolated in pure form in 1844. Little use was made of it in Europe, however, until 1883, when a German army physician, Dr. Theodor Aschenbrandt, secured a supply of pure cocaine from the pharmaceutical firm of Merck and issued it to Bavarian soldiers during their autumn maneuvers. He reported beneficial effects on their ability to endure fatigue.

Among those who read Dr. Aschenbrandt's account with fascination was a poverty-stricken twenty-eight-year-old Viennese neurologist, Dr. Sigmund Freud (whose subsequent ordeal with nicotine was recounted in Chapter 24). Young Freud at the time was suffering from depression, chronic fatigue, and other neurotic symptoms. "I have been reading about cocaine, the essential constituent of coca leaves, which some Indian tribes chew to enable them to resist privations and hardships," Freud wrote to his fiancée, Martha Bernays, on April 21, 1884. "I am procuring some myself and will try it with cases of heart disease and also of nervous exhaustion. . . ." The account of Freud's experiences which follows is drawn largely from the three-volume  Life and Work of Sigmund Freud, by Ernest Jones.

Freud "tried the effect of a twentieth of a gram [50 milligrams] and found it turned the bad mood he was in into cheerfulness, giving him the feeling of having dined well 'so that there is nothing at all one need bother about,' but without robbing him of any energy for exercise or work."

In addition to taking cocaine himself, Freud offered some to his friend and associate, Dr. Ernst von Fleischl-Marxow, who was suffering from an exceedingly painful disease of the nervous system (which was later to prove fatal), and who was addicted to morphine. Freud also prescribed cocaine for a patient with gastric catarrh. The initial results in all three cases were favorable. Freud decided cocaine was "a magical drug," and he wrote his fiancee, Martha:

If it goes well I will write an essay on it and I expect it will win its place in therapeutics by the side of morphium and superior to it. I have other hopes and intentions about it. I take very small doses of it regularly against depression and against indigestion, and with the most brilliant success.... In short it is only now that I feel I am a doctor, since I have helped one patient and hope to help more. If things go on in this way we need have no concern about being able to come together and to stay in Vienna.

Freud even sent some of his precious cocaine to Martha, "to make her strong and give her cheeks a red color." Indeed, Dr. Jones writes, "he pressed it on his friends and colleagues, both for themselves and their patients; he gave it to his sisters. In short, looked at from the vantage point of our present knowledge, he was rapidly becoming a public menace."

In a subsequent letter to Martha, Freud wrote more on his personal experience with cocaine:

Woe to you, my Princess, when I come. I will kiss you quite red and feed you till you are plump. And if you are froward you shall see who is the stronger, a gentle little girl who doesn't eat enough or a big wild man who has cocaine in his body. [Italics in original.] In my last severe depression I took coca again and a small dose lifted me to the heights in a wonderful fashion. I am just now busy collecting the literature for a song of praise to this magical substance.

Freud's haste in publishing his findings may astonish twentieth-century readers. On April 21, 1884, he was still only planning to secure some cocaine. On June 18, his essay was completed; and the "Song of Praise" to cocaine was published in the July 1884 issue of the  Centralblatt fur die gesammte Therapie.

This essay, Dr. Jones writes, had "a tone that never recurred in Freud's writings, a remarkable combination of objectivity with a personal warmth as if he were in love with the content itself. He used expressions uncommon in a scientific paper such as 'the most gorgeous excitement' that animals display after an injection of cocaine, and administering an 'offering' of it rather than a 'dose'; he heatedly rebuffed the 'slander' that had been published about this precious drug. This artistic presentation must have contributed much to the interest the essay aroused in Viennese and other medical circles. . . . He even gave an account of the religious observances connected with its use, and mentioned the mythical saga of how Manco Capac, the Royal Son of the Sun-God, had sent it as 'a gift from the gods to satisfy the hungry, fortify the weary, and make the unfortunate forget their sorrows.' "

More to the point, Freud described in detail the effects of small doses of cocaine on his own depression. These included "exhilaration. and lasting euphoria, which in no way differs from the normal euphoria of the healthy person. . . . You perceive an increase of self-control and possess more vitality and capacity for work. . . . In other words, you are simply normal, and it is soon hard to believe that you are under the influence of any drug.... Long intensive mental or physical work is performed without any fatigue.... This result is enjoyed without any of the unpleasant after-effects that follow exhilaration brought about by alcohol. . . . Absolutely no craving for the further use of cocaine appears after the first, or even after repeated taking of the drug; one feels rather a certain curious aversion to it." Cocaine, Freud concluded, was useful for "those functional states comprised under the name neurasthenia" "–– Freud at this time had diagnosed his own depressions as neurasthenic–– as well as for indigestion and for the withdrawal of morphine.

Freud also sought to inject cocaine directly into the area of a nerve to block intractable pain. In this he failed, but others succeeded; * and until better agents became available, cocaine was often used as local anesthesia for surgery.

* Among those who succeeded, as noted in Chapter 5, was the young American surgeon, Dr. W. S. Halsted.

Some of Freud's findings on cocaine as a psychoactive drug were amply confirmed by subsequent research. "The subjective effects of cocaine include an elevation of mood that often reaches proportions of euphoric excitement," Dr. Jaffe reported in Goodman and Gilman's textbook (1965). "It produces a marked decrease in hunger, an indifference to pain, and is reputed to be the most potent antifatigue agent known. The user enjoys a feeling of great muscular strength and increased mental capacity and greatly overestimates his capabilities. The euphoria is accompanied by generalized sympathetic stimulation. As is the case with amphetamine, a disturbed personality is not a prerequisite for cocaine-induced euphoria, and the drug is quite effective in relatively normal personalities."

Freud's experience, however, proved to be only part of the story. In July 1885, a German authority on morphine addiction named Erlenmeyer launched the first of a series of attacks on cocaine as an addicting drug. In January 1886 Freud's friend Obersteiner, who had at first favored cocaine, reported that it produced severe mental disturbances similar to those seen in delirium tremens. Other attacks soon followed; and Freud himself was subjected to "grave reproaches." Freud continued to praise cocaine as late as July 1887, when he published a final defense of the drug. But soon thereafter he discontinued all use of it both personally and professionally. Despite the fact that he had been taking cocaine periodically over a three-year span, he appears to have had no difficulty in stopping. His abandonment of cocaine was no doubt influenced in large part by the experience of Dr. von Fleischl-Marxow, the patient with whom Freud had shared his initial gram of cocaine.

Fleischl suffered from multiple tumors of various peripheral nerves–– neuromata–– which gave him excruciating pain. He took morphine for this pain. At first Freud's cocaine proved a –– welcome substitute for the morphine–– but Fleischl found it necessary to escalate his cocaine dose.

After a year on cocaine he was taking a full gram of it daily–– twenty times the dose Freud himself took from time to time. Indeed, Freud noted, Fleischl bad spent $428 for a three-month supply of cocaine, an enormous sum in Vienna in those days. On June 8, 1885, Dr. Jones adds, "Freud wrote that the frightful doses had harmed Fleischl greatly and, although he kept sending Martha cocaine, he warned her against acquiring the habit." Thereafter Fleischl developed a full-fledged cocaine psychosis, "with white snakes creeping over his skin." Freud and other physician friends nursed Fleischl faithfully, often throughout the long nights, but to little avail. In June 1885 Freud estimated that Fleischl could live six more months at most; he actually survived for six more painwracked years.

Nor was Fleischl's experience unique; subsequent observations were to reveal that repeated use of large doses of cocaine produces a characteristic paranoid psychosis in all or almost all users, and that the tendency to overuse is widespread. A peculiar characteristic of this psychosis is "formication"–– the hallucination that ants, or insects, or (as in Fleischl's case) snakes, are crawling along the skin or under it.

Why was Freud, unlike his friend Fleischl, able to use modest doses of cocaine–– 30 to 50 milligrams injected under the skin–– from time to time for three years without developing either a craving for the drug or a need to escalate the dose? At least three alternative explanations are available. Dr. Jones, a psychoanalyst, believed that it requires an "addictive personality" to establish an addiction; Tricking an addictive personality, he declares, Freud did not become a cocaine addict. (He did, however, become addicted to cigars, as described in Chapter 24.) The other two explanations are pharmacological.

One holds that there must be some biochemical difference–– perhaps a difference in enzymes–– between people like Freud who can take a particular addicting drug without becoming addicted and people like Fleischl who escalate the dose and become addicted. This hypothetical difference in enzymes may (or may not) be hereditary. The third explanation relates the addiction (or lack of it) to dosages and frequency of use. Because Freud took cocaine only occasionally, according to this theory, be had no need to escalate his dose. And because lie did not escalate the dose, he did not become addicted. Some other explanation, of course, may ultimately prove true.

By 1890, the addicting and psychosis-producing nature of cocaine was well understood in medical circles; yet for another twenty years it does not appear to have occurred to many people to demand a  law against the drug. * In the United States, cocaine was widely used not only in Coca-Cola but also in "tonics" and other patent medicines, including very popular "catarrh cures"–– for, like the amphetamines, cocaine has the effect of reducing mucous membrane swelling and thus enlarging the nasal and bronchial passages. This property no doubt first gave users the idea of  sniffing cocaine, a common form of cocaine use even today. "Most of the cases of the cocaine habit have been admittedly created by the so-called catarrh cures," Dr. Charles B. Towns wrote in  Century Magazine in 1912, "and these contain only two to four percent of cocaine. ** In the end, the snuffer of catarrh powders comes to demand undiluted cocaine."

* Dr. Charles B. Towns wrote (1912): "When in overseer in the South will deliberately put cocaine into the rations of his Negro laborers in order to get more work out of them to meet a sudden emergency, it is time to have some policy of accounting for the sale of a drug like cocaine."

** "Street cocaine" sold on the New York black market in 1970 was reported to contain about 6 percent pure cocaine.

Cocaine addiction differs from opiate addiction, and from alcohol and barbiturate addiction, in at least two respects. A cocaine user, even after prolonged use of large doses, does not, if deprived of his drug, suffer from a dramatic withdrawal crisis like alcoholic delirium tremens or like the opiate withdrawal syndrome. The physical effects of cocaine withdrawal are minor. This has led many authorities, mistakenly, to classify cocaine as a nonaddicting drug. However, cocaine withdrawal is characterized by a profound psychological manifestation–– depression–– for which cocaine itself appears to the user to be the only remedy; cocaine addiction in this respect resembles tobacco addiction more closely than it resembles opiate addiction or alcoholism. The compulsion to resume cocaine is very strong.

Moreover, cocaine addiction can lead to a severe psychosis  while the user is still on the drug. This is in contradistinction to the opiate withdrawal syndrome and to the delirium tremens of alcoholism or barbiturate addiction, which set in hours or days  after the drug is withdrawn.

Decades ago, cocaine users discovered that a mixture of cocaine and morphine or heroin relieves the excess agitation and tension produced by large doses of pure cocaine. The users of morphine and heroin similarly discovered that the mixture increases both the "bang" or "rush" or "flash" and the mood elevation produced by their favorite drug. The combination came to be known as the "speedball," and it has long been popular among some addicts in Britain, the United States, and elsewhere.

Since 1914, the possession, sale, and giving away of cocaine have been subject to the same dire federal penalties as those governing morphine and heroin; and most state laws similarly identify cocaine as a "narcotic."

During the 1940s, 1950s, and most of the 1960s, the smuggling of cocaine into the United States was curtailed and the black market in cocaine was relatively small. The reduced use of cocaine, however, can hardly be attributed, even in part, to law-enforcement efforts. Neither was it the result of pharmacological research. Cocaine was replaced by a new group of synthetic drugs, the amphetamines, which were available far more cheaply than cocaine after 1932, and which had certain other advantages over the natural imported product. Late in the 1960s, when narcotics law-enforcement agencies began cracking down heavily on the amphetamine black market, cocaine smuggling and cocaine use enjoyed a renaissance.

Footnotes
Chapter 35

1.  Remington's Pharmaceutical Sciences, 4th ed. (Easton, Pa.: Mack Publishing Co., 1970), p. 1067.

2. Theodor Aschenbrandt, "Die physiologische Wirkung und die Bedeutung des Cocains,"  Deutsche medizinische Wochenschrift (December 12, 1883); cited by Ernest Jones,  The Life and Work of Sigmund Freud, Volume I (1856-1900) (New York: Basic Books, 1953), p. 80.

3, Ernest Jones,  Life and Work of Sigmund Freud, 1, 80.

4. Ibid.

5. Ibid., p. 81

6, Ibid.

7. Ibid., p. 84.

8. Ibid., p. 82,

9. Ibid., pp. 82-83.

10. Ibid., p. 83.

11. Jerome H. Jaffe in  Goodman and Gilman, 3rd ed. (1965), pp. 298-299.

12. Ernest Jones,  Life and Work of Sigmund Freud, 1, 94.

13. Ibid., p. 91.

14. Charles B. Towns, "The Peril of the Drug Habit,"  Century Magazine, 84 (1912): 586.

15. Ibid., p. 583.