Cocaine use is associated with several adverse health consequences such as increased risk of cardiovascular complications, HIV, hepatitis B and C, and higher mortality. Between 2016 and 2018, for example, cocaine-related fatal poisonings in Michigan increased 52.9% (MDHHS, 2019). Trends explicating the incidence of cocaine use and transition to a cocaine use disorder (CUD) for sub-groups of cocaine users might help to inform policy and to tailor a suitable public health response to cocaine-related morbidity and mortality.Building from pre-clinical animal experiments, clinical research on cocaine has mainly focused on understanding the effect of cocaine on human experiences. However, there has been little research on variations in estimates of cocaine dependence over time. This dissertation fills this gap by estimating a 15-year epidemiological trend in the proportion of the population transitioning from cocaine initiation to dependence within 12 months. The data are from the Online Restricted Data Analysis System of the United States National Survey on Drug Use and Health (RDAS), 2002-2016. The novel discovery from study 1 (Aim1) is that roughly one-in-five (22%) of the powder-then-crack subgroup of initiates developed cocaine dependence within 1-12 months after powder-onset versus a powder-only attack rate of roughly one-in-20 (5%) - a fourfold variation. Study 2 (Aim 2) accounts for within-person statistical interdependence of cocaine-related side effect problem experience (SEPE) responses during formation of cocaine dependence syndromes through use of Generalized Estimating Equations (GEE) modeling. It provides novel evidence on the occurrence of cocaine-related SEPEs among a crack + powder group contrasted with a powder-only group. The data are the National Surveys on Drug Use and Health 2011-2017, (n0303 55,000/year). I first estimated analysis-weighted incidence proportions for cocaine powder-only users (n=2364) and crack + powder users (n=231). Subsequently, I estimated odds ratios for 21 individual SEPEs reflecting crack/powder-only contrasts, year-by-year with corresponding Taylor series 95% confidence intervals. A fixed effects meta-analysis approach yielded summary estimates for each SEPE. Strong crack-associated excess odds were observed for inability to keep limits; aOR=9.5 (5.9, 15.4) and use despite emotional problems aOR=10.5 (6.7, 16.5). This work provides a novel and broadened view of experiences during early phases of what might become cocaine use disorders. This evidence suggests that treatment modalities for different subgroups of cocaine users might need to be tailored based on the route of administration of the drug. The third study (Aim 3) shifts focus from the epidemiological rubric of 'Quantity' to the rubric of 'Prevention and Control'(Anthony,1998) . The main aim is to analyze oral cocaine use as a potential adaptation to the Medication Assisted Treatment (MAT) program in a County jail to address the issue of comorbid OUD and CUD. Results show that oral cocaine agonist treatments like coca tea, which have been used for more than 4,000 years in Peru and Bolivia with little evidence of harm might offer a potentially viable treatment modality for CUD. However, larger trials recruiting specific subpopulations of users are needed to build the evidence base for the efficacy of this approach.
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