Historia natural del consumo de la cocaína: el caso de ciudad Juárez, Chihuahua

SUMMARY Starting in the 1980’s, the consumption of cocaine in Mexico is considered a public health problem due to its increment in traditionally problematic geographical areas, such as the northern border and tourist zones of Mexico, and the emergence of new ways of use, such as crack speedball, as well as different administration routes (inhaled, smoked or intravenous), mainly in young people. All those events have lead to a quicker evolution from its use to its abuse, and even to its dependence, which is reflected in the increment of treatment demand due to the complications that its brings about, which represent a new challenge for the medical care services. New treatment options based on empirical and theoretical knowledge are necessary to give the appropriate response to face this problem. Information used for decision making requires a better understanding of the natural history of drug use and the magnitude and trends of cocaine consumption in order to create appropriate interventions to prevent its use, abuse and dependence. Objective: To describe the natural history of cocaine addiction according to characteristics of initiation, frequency, patterns of consumption and social environment. Material and methods: Two hundred and twenty five cocaine users over 14 years old were interviewed during April to November, 2000. They were residents of Ciudad Juarez in the State of Chihuahua, during the last six months. Of the total number of participants, 150 were selected by a non-probability quota sampling in rehabilitation centers; the rest was included by using snow-ball sampling techniques in high risk areas. Sociodemographic data, use of any drug before cocaine, and characteristics of consumption evolution were also collected. Results: Of all the sample studied, 19.2% of the participants were women, with a clear predominance of males; the mean age was 28.9 years (S.D. +8.6). One important fact was that the highest level of education in 50% of the sample was only elementary school and 47.7% of them were unemployed. One half of the participants were single and the most common religion was Christianity (45.3%). Almost all of the subjects studied (99%) had a previous consumption history which started with another type of drug, mainly tobacco, alcohol and marijuana. The age of onset for drugs consumption was 12.5 years (S.D. +3.3). Of them more than half (61%) started using cocaine as their fifth drug; 21 years was reported as the mean beginning age of consumption (S.D. +7.4). Their first use was mainly associated with their circle of friends, parties and idleness. The main route of administration was inhaled and more than 80% developed dependence to cocaine. Three patterns of cocaine consumption were identified according to the age of initiation: mild, moderate and severe, with no significant differences among their sociodemographic characteristics. Conclusions: Although cocaine was not their first drug of choice, and most of them had a previous history using drugs, users who began with alcohol and tobacco incorporated cocaine faster compared to those who started with marijuana as their first drug of choice. Also relevant was that 88% of the participants wound up using it following a severe pattern. The fact that the beginning of drug consumption on the whole and cocaine in particular is at early ages (12.5 and 21 years respectively), when biological, physiologic and psychological changes associated with puberty and adolescence take place, has important health implications in this reproductive ages. It involves also negative consequences in their education and labor environment. Our results show that the immense majority are excluded from social and economical sectors because of their drug use and specially when the pattern acquired becomes severe. Therefore, prevention strategies of will have to take into account all the characteristics that this and other studies have shown, such as peer and friend’s pressure in parties and idleness, as risk factors for cocaine consumption. The organized social response to this population sectors should not come only from the health system but from policies of social and economic equity that integrate all those factors.