Cocaine use: disturbing signs.

A form of cocaine use in which "coco paste" is smoked has recently made its way to the United States, according to a just-released monograph published by the National Institute on Drug Abuse in Rockville, Md. Because coca paste is highly concentrated and relatively inexpensive compared with other forms of cocaine, "it may maximize all the [cocaine-related] problems we've seen in the past," says the report's author, psychiatrist Ronald K. Siegel of the University of California at Los Angeles.

Cocaine is usually "snorted" and absorbed through the mucous membranes of the nose. In recent years, its chemical conversion to a more concentrated form known as "freebase," which is usually smoked, has greatly increased. Coca paste is also smoked, often in a tobacco or marijuana cigarette, but has traditionally been avaiable only in South American countries, where it is processed into "street cocaine" for worldwide distribution.

"Coca paste is probably stronger than freebase," says Siegel. There is an epidemic of coca paste use in South American countries, he says, which has led to numerous psychiatric hospital admissions. These patients suffer from symptoms such as paranoia, excitability, hallucinations and delusions that in severe cases make up what is known as "cocaine psychosis."

Laboratories that process coca paste have sprung up in the United States, and several coca paste seizures by law enforcement officials have occurred over the last few years. Siegel located 45 coca paste users in three states and reports that most are either involved in drug trafficking or are undocumented alines from South America. Coca paste use is currently limited to this segment of the population, "but this [overall pattern] is the same way freebase use started out in the 1970s," says Siegel.

Coca paste is easier and less expensive to make and distribute than "street cocaine," he adds; thus, it may reach a wider audience of users.

Another disturbing development, he points out, is a parttern of cocaine bingeing that has emerged in the United States since 1982. Rather than using the drug daily, some individuals take an entire week's supply during one or two binges lasting from 4 to 48 hours. When combined with the more concentrated cocaine doses now available, bingeing increases the risk of adverse reactions.

Concludes Siegel, "The history of coca and cocaine [use] has been a history of increasing doses, increasingly effective routes of administration and an increasing incidence of dependence and toxicity."