Cocaine Legitimate use cocaine in medicine.

[jspun]

The above poster has a good point. It stops bleeding because bleeding can often obscure the source so when packing doesn't work, they ask patient to blow out clots, suction, get q tip in 4% cocaine and stop the bleeding caterize the source of bleeding or intervene other wise, replace blood if blood loss too great. A small number of people do die from nosebleeds or bleeding regarding that area as anyone who shaves and cuts themsel ves can attest.

N-gesicIts use is virtually limited to ophthalmology, where it occasionally has some benefits over other locals...

and

I've heard that cocaine is occasionally used for numbing pinpoint areas during eye surgery

The above claim is plausible, though, if your talking about realy pinpoint areas.

It is contraindicated for opthalmic use from my research. A british study said lidocaine gel, bupivicaine, and one more as agents of choice. The wiki ardical has a bottle of us pharm cocaine that has "not for opthalmic use on its label." Author of british study mentioned periorbital necrosis a one of the drawbacks. Remember reding the corneal ulcers or something like this limited use- unfortunately it is a vasocontrictor in an area that needs lots of blood. I'm not staying its not done, bou couldn't find evidence. Did google us, "use of cocaine in opthamalogy" Please provide evidence, even ancedotal because I am interested. Ultimately, I am curious to see if anyone fely a high- max dose is 200 mg but on don't know the average- seems like one can get a decent high off this type of anesthesia.

With the Coca in Coca-cola and new coke failing. I have had real nondecocanized coca tea. I brewed a bunch of bags in a teapot until it had a slight syrupy consistancy ( and numbed mouth alittle. Tastes awsome with honey. Regular 1-2 teabag tastes like green tea with a distinctive, pleasant smell. Couldn't see the connection to coca-cola's special taste. When I drank the concentrated batch- good sweet, sweet green-teachish taste like green southern sweet tea. When I belched- I got a definite cola like aftertaste in my throat thats reminded me of coca-cola big time. Somenody on BL noticed that phenomena and called that "coca throwback". FYI- the big bull gourmet cola has coca extract in it, I think it imparts a sharp, refreshing, almost carmaley-lemoney taste to the drink. I know those tastes are contradictory but I remeber big coke was missing something huge and noticible.

 

[jspun]

Contraindication of cocaine in opthamology

Got this from an article from 12 0ct, 2009 issue of clinical opthamaology discusion the evolution occular anesthesia since the days of Koller:

Introduction
Local anesthesia for ophthalmic surgery was first introduced by Koller in 1884.1
With the help of newly discovered topical cocaine, ophthalmic procedures could
be performed more skillfully and more safely than with the conventional adjuncts
of general anesthesia, hypnosis, or no anesthesia at all. Within weeks of Koller’s
discovery of the topical efficacy of cocaine, other practitioners began to experiment
with intraorbital injections of the drug. Surgeons soon realized that retrobulbar cocaine
afforded unprecedented ability to produce total anesthesia and akinesia of the globe,
and a wave of ophthalmic surgical advances ensued.2
Cocaine was lauded for its potent vasoconstrictive activity and its rapid blockade
of sensory and motor nerves. The excitement over its retrobulbar use was tempered,
however, by early reports of blindness, respiratory depression, and death with injection
near the orbital apex.3
With the subsequent discovery of epinephrine and other pharmacologic advances,
ophthalmic anesthesia became safer and more refined throughout the 20th century In the 1930s, procaine and lidocaine were found to be
cheaper and more stable than cocaine. In 1949, Atkinson
reported that the addition of hyaluronidase could facilitate
safe, long-lasting, large-volume retrobulbar nerve blockade.4
Variations on this technique continued to dominate anesthesia
for intraocular surgery through the 1970s and 1980s....Drawbacks to topical drops
include incomplete anesthesia of the conjunctiva and sclera
with a single application, potential toxicity to the corneal
epithelium,...ect...

anybody wanting more info can get the rest of the article but lidocaine gel is the anesthetic of choice in used to day for eye surgery.

Keep the stories comming though, the responses have been awsome. Capt H...did you friend with the mostly severed nose, did he notice a high or was he in too much shock?

 

[Captain.Heroin]

Capt H...did you friend with the mostly severed nose, did he notice a high or was he in too much shock?

I imagine he was in a lot of shock and didn't feel high at all. I'd have to ask him, and I haven't seen him in a while. He might have had some absorption, but merely thinking about that makes me shudder!

You ambulance/ICU workers do a great job on people hanging on to their body parts by a thread! I'm really surprised what quick treatment, modern drugs and plastic surgery can fix. I nearly didn't believe him when he told me this (I'd figure, how could you have that re-attached and look 99%-100% normal? and then I saw the scar).

If I ever get around to talking to my good friend I'll ask him.

 

[largeamount]

good luck infiltrating it

will you help i dont think i can do it on my own

 

[KnowBudz]

Did you feel any kind of high, or just the localized numbness of your eyes?

No numbness or any sort of pleasurable effect at all....just an almost instantaneous removal of the pain. I don't think it is commonly stocked by store pharmacies or used outside of hospitals and doctor's offices. I used to hear tales about "ripping off pharmacies and carrying off safes stuffed full of cocaine"....all was pure bullshit. What they had at the surgeon's office (and what I saw that had been stolen) were solutions in little 3ml eye-drop vials.

 

[jspun]

[QUOTEYou ambulance/ICU workers do a great job on people hanging on to their body parts by a thread! ][/QUOTE

The real credit goes to the paramedics/EMT. These guys are the true heros, yjey usually walk into a situation with little or no background and their acting fast saves lives and limbs. By the time they get through trauma service and/or the ER there is already more info, progress notes, a history and physical so we have a clearer picture of the patient if their condition deteriorates and they begin circling the drain. With real sick patients, though, their lives are hanging by a string and you have to be vigilante for any changes of conditions. In some case they have one infusion that supports the bp (like levophed "leave them dead") or dopamine and another that is an antihypotensive like dobutamine drips. Our job is to titrate them (The drips) so you reach the optimum BP/ cardic output/MAP-for patients whose lives are lieterally hanging by threads. The drs provide parameters but your on your own. What the public at large doesn't understand is how much autonomy a critical care RN and an RN period has. The doctors at most places with the exceptions teaching hospitals were residents are always around the RNs are often mentoring the residents to make sure they don't make a mistake or so look good infront of the attending- arent around except for the 5 minutes they see the patient and 20 minutes they look at their chart. The rest of the time they rely on us to let them know how the patient is the rest of the time. If there is a change in condition a computer doesn't tell us. If a patient is on a heart monitor and there is a change of rhytm it is up to us to determine if it is benign, a new condition but not worrysome, something to call the dr and interupt their valuable golf time or whatever else they are doing if it might be the precursor of something bad- some assholes will show their irritation. and be able to recognize ominous and lethal rhythms and in most cases act under standing orders or sometimes excercize your own judgement- sometimes an MD will take 10-30 minutes in an emergency, even though it has been evolving all morning, so without the autonomy ESOs or wink wink common good practice afords, you'd have lots of dead patients. If the public at large new the extent that RNs run the hospital, they might be surprised.

Anyway, I'm taking a break from critical care. My team lead once sowed a sailors finger on in a foreign port. They keys is to think fast, put the limb on ice, and keep it as clean as possible- otherwise, its not that much of a big deal.

For anyone considering the job, it is thankless. Docs get irritated when they call them- a patient has a headache and insist that we get an order for advil- can't wait 3 hour for the doc- doc yells at you for doing your job.You the MD the family wan't an update from the doc, they ignore calling the family because they are a pain in the ass and you get yelled at by the family- that you've had to deal with all day but they leave to go to lunch the half hour the doc arives, you get calls from the social worker, skin nurse specialist, discharge planner, pharmacist questioning order (they can page the doc, they are at a desk, but they call you trying to explain their rationale- time elapsed same as if they paged doc- they just don't like getting yelled at by abusive docs.) Doc is short with family, family worships docand is scarred to challenge them, so they take it out on you ( having no clue what a prominent role you have in their loved ones care.) Pt A's is experiencing shortness of breath, chest pain (new onset), low urine output, wet breath sounds/coarse crackles. Doc not returning page- patient needs 12 lead ekg, lassix, CXR or CT of the chest, echocardiogram, cardiac enzymes stat with a basic metabolic panel if not recent, stat, ect... Irate family member for pt B at desk- why- because grandmas pillows havent been fluffed up and she hasn't gotten a backrub since she came into the hospital- as if family members can't do this. This person keeps bugging and calling even after you have explained the situation. CNA sent in- spends 1/2 an hour in there- not to their satisfaction. Complaint filed against hospital for poor care. Meanwhile patient begins to get septic because family members lack of adequate care led to a pressure ulcer pre admission, which got infected, becomes septic but because we were able to start antibiotics in time, grandma lives. Complaint against hospital filed for lack of attentiveness and poor care. Favorite- patient in severe respiratory distress, ashen, family member comes out complaining that patient hasn't been shaved in 2 days.
Sorry- needed to rant.

 

[DiverDave]

Severe sinus infection

I went to the ENT guy and he pulled out the 10% solution and stuffed some cotten in it and shoved it up my nose, he left the remander and left for awhile, so I drank what was left...he didnt say a word, but he sure stuck a big needle in my nose and into the sinus and douched my head, but good.
The color of the stuff that came out was BLACK, and he really put alot of water (saline solution) up there.
And No, I didnt get a buzz, I was too busy almost throwing up what with all the water coming out.

I was pretty sick before that and that procedure did the trick.

 

[PillPoppingAnimal]

my moms a pharmacist and when i was younger i went to work with her one day, and they have a locked narcotics closet/safe there. She had to open it for something and inside there was a jar of cocaine. Luckily i wasnt into drugs yet or that couldve gotten bad. Anyway i asked about it and she said they use it during surgery to stop bleeding or if somebody comes in with a severed artery or things like that.

thats fucking awesome [if you took it] lol. ive heard of very simular stories, but of people who work there saw a vile of cocaine... if u took it tho that would be bad news...

IF a pharmacy even has cocaine, they are extremely old...

but to anybody who comes across some vialed medically graded cocaine, PM me, u could come over and we can chill. ILL BE YOUR FRIEND!!

 

[IVXLCDM]

Eye and nose surgery primarily like every else said. The Migraine clinic I went to listed it as a possible treatment. It aroused my interest, but they say they only use it for S-E-V-E-R-E headaches too (like cluster-headaches, or if potent opioids fail). I dunno if it's injection or topical though.

 

[hexxx]

but they say they only use it for S-E-V-E-R-E headaches too (like cluster-headaches, or if potent opioids fail).

^ LSD and other ergot derivatives (as well as various psychedelics and hallucinogens) are also effective treatments for cluster headaches. But since their other name is "suicide headache", I think I'd prefer to not be needing treatment, nevermind the attractive sounding treatments.

Must be the vasoconstrictive properties of cocaine that makes it an attractive abortitive measure. I find it to be a bit of a paradox in a way, vasoconstriction = high BP = worse headache. But then again cluster headaches are obviously something different and not completely related to the headaches you get from high BP. I used to get migraines that weren't responsive to codeine or APAP for about 2 months and found (could have been coincidence) that sub recreational doses of LSD seemed to get rid of them.

More OT: A paramedic I know claimed they kept cocaine vials in each ambulance. Before reading this thread I always wondered why kept it, I knew it was used in surgery but now I realize it was probably used to stabalize low BPs or possibly prevent someone from bleeding out.

 

[jspun]

Introduction and History
Cocaine is an alkaloid derived from the leaves of the coca plant (Erythroxylon coca). It is the only naturally occurring local anesthetic in medical use today. Indigenous to the Andes Mountains, West Indies, and Java, its use was touted over the centuries as a method of reducing fatigue and promoting a sense of well-being.

Cocaine was introduced into Europe in the 1800s. Sigmund Freud used cocaine on his patients and became addicted through self-experimentation. Niemann first isolated and purified cocaine in 1859. In the latter half of the 1800s, widespread interest in cocaine developed among the medical community, and, during this period, many of the pharmacologic actions and adverse effects were elucidated.

In the 1880s, Koller introduced cocaine into the practice of ophthalmology and Hall introduced it to dentistry.




Chemical structure of cocaine.
[ CLOSE WINDOW ]Chemical structure of cocaine.




Cocaine was widely available at the outset of the 20th century, and Coca-Cola contained approximately 4.5 mg/180 mL. With widespread use, the problems of abuse and addiction became apparent, and the Harrison Narcotics Act of 1914 essentially banned distribution of cocaine in the United States, except by prescription.

Today, cocaine continues to be used for recreational and medical purposes. Medical use is confined primarily to operative procedures of the nose and throat and treatment for dermal lacerations in children.


Mechanism of Action
Cocaine produces anesthesia by inhibiting excitation of nerve endings or by blocking conduction in peripheral nerves. This is achieved by reversibly binding to and inactivating sodium channels. Sodium influx through these channels is necessary for the depolarization of nerve cell membranes and subsequent propagation of impulses along the course of the nerve. When a nerve loses its ability to propagate an impulse, the individual loses sensation in the area supplied by the nerve.

Cocaine also has a profound effect on the CNS. Cocaine blocks reuptake of dopamine in the midbrain region responsible for reward mediation. This leads to increased stimulation and a sense of euphoria and arousal. As the cocaine level decreases, so does the dopamine level in this region, resulting in depression and a craving for the drug.

Cocaine also blocks the reuptake of norepinephrine in the sympathetic portion of the autonomic nervous system and may stimulate the release of catecholamines from the adrenal gland, resulting in increased stimulation of the sympathetic nervous system. This results in the characteristic tachycardia, hypertension, diaphoresis, mydriasis, and tremors associated with cocaine use.

Cocaine is the only local anesthetic with vasoconstrictive properties. This is a result of its blockade of norepinephrine reuptake in the autonomic nervous system.


Absorption and Metabolism
Cocaine is absorbed rapidly through mucous membranes, and peak plasma levels (ie, 120-474 ng/mL) are reached within 15-60 minutes. Half-life in serum is 30-90 minutes.

Cocaine is metabolized in several ways. Hydrolysis by plasma pseudocholinesterases accomplishes most cocaine degradation to benzoylecgonine, cocaethylene, and several other metabolites.

Oxidative metabolism in the liver produces norcocaine, a toxic substance capable of causing severe hepatic damage. Up to 20% of absorbed cocaine is excreted in the urine unmetabolized.

Cocaine is detectable in the nasal mucosa for 3 hours following application. Serum and urine levels are measurable for approximately 6 hours following application.


Clinical Uses
Cocaine is used for topical anesthesia and vasoconstriction for surgery of the nose, throat, and oral cavity. Cocaine provides rapid and profound anesthesia in conjunction with vasoconstriction and decongestion of swollen mucosa.

Cocaine hydrochloride is available commercially in the United States as flakes, crystals, 135-mg tablets, and solutions of various concentrations. The flakes and crystals are intended for application via moistened cotton swabs. The tablets are to be used in preparation of a topical solution. The premade topical solutions are available in strengths ranging from 2-10%, with a 4% solution most frequently referenced.

The safe maximum dosage is reported to be 200 mg or 2-3 mg/kg, but this is based on anecdotal observations rather than controlled studies. Even 200 mg can cause adverse reactions if rapidly absorbed. Spraying or painting cocaine on the intended surgery site causes more rapid absorption than application by patch or pledget. Clinical studies have shown that only approximately one third of a cocaine solution placed on pledgets is absorbed via the nasal mucosa, with serum levels continuing to rise for 5 minutes after removal. This provides an added margin of safety for the surgeon.

When epinephrine is added to the solution to promote further vasoconstriction, systemic absorption decreases; however, according to published series, the decrease is inconsistent. Late absorption of cocaine has also been reported when cocaine is administered with epinephrine. Therefore, the use of epinephrine cannot be assumed to protect from systemic cocaine absorption. The addition of epinephrine has also been reported to enhance the sympathomimetic action of cocaine, causing hypertension and tachyarrhythmias.

To use cocaine in the nasal cavity, cotton pledgets are soaked in the cocaine solution. After being wrung out, the pledgets are introduced into the operative field with bayonet forceps. Pay particular attention to placing the pledgets in contact with the mucosal surface.

After the pledgets have been in place for at least 10-15 minutes, they may be removed from the side to be approached first. Infiltration of submucosal lidocaine with epinephrine may then be performed. This is best performed with a small syringe and 25-gauge or smaller needle. Proper placement creates blanching of the mucosa. Rarely is more than 1.5 mL required for each side. After allowing several minutes for the injected solution to take effect, inspect the mucosa for the anticipated vasoconstriction. If the patient reports pain at this time or further along in the operative course, pledgets may be loosely reapplied.

Cocaine has also been used as a topical spray for analgesia during transnasal fiberoptic laryngoscopy and awake nasotracheal intubation. Superiority over topical analgesics that do not contain cocaine has not been established.

Another more recently developed use of cocaine is in combination with tetracaine and adrenaline (TAC), composed of 0.5% tetracaine, epinephrine 1:200,000, and 11.8% cocaine. This combination has been used in the pediatric population for suturing lacerations less than 10 cm long in the emergency department. It has been found to be most effective in the head, neck, and scalp; less effective in the trunk; and ineffective in the extremities.

A few drops of the solution may be placed directly on the wound, or, preferably, a moistened cotton ball soaked in the solution may be applied to the wound. Constant gentle pressure is then applied to the cotton balls for 10-20 minutes. After testing the adequacy of anesthesia, the wound may be irrigated, cleansed, and sutured. Inadequacy of anesthesia is remedied by injection of local anesthetic. It should not be used on mucous membranes, large abrasions, or burn areas due to the risk of rapid absorption and systemic toxicity.

Monitor the patient with pulse oximetry and telemetry during use of TAC. In addition, observe the patient for any signs or symptoms of systemic toxicity. Following application and suturing, observe the patient for an additional 60 minutes to ensure that no untoward effects of cocaine absorption occur.

The benefits of TAC include ease of application, patient comfort during application, and avoidance of wound distortion from the injection of local anesthetic solution. This technique has been proven safe and effective in numerous published studies and has gained wide popularity among emergency departments. More recent studies suggest that alternative cocaine-free topical anesthetics are equally effective, with the benefit of decreased risk and cost.


Toxicity and Adverse Reactions
Although adverse reactions to cocaine seldom occur in the medical field, those that do may be rapid, unexpected, and severe. Other good alternatives for anesthesia are available, and many surgeons have ceased using cocaine because of its unpredictable effects and the risk of having such a highly addictive drug in the office.

Cocaine toxicity may have profound adrenergic effects on the CNS, cardiovascular system, and respiratory system. Sympathetic stimulation of the cardiovascular system may lead to hypertension, tachycardia, ventricular fibrillation, and cardiac arrest. Other serious complications include direct cardiotoxicity, angina, myocardial infarction, cerebrovascular accident, transient ischemic attack, pulmonary edema, hepatotoxicity, intestinal ischemia, seizures, and CNS depression.

Cocaine readily passes into breast milk and across the placenta, an important consideration in patients who are pregnant or nursing. Stillbirth, preterm labor, and abruptio placentae may occur. Intrauterine growth is also restricted. These often-profound effects on the fetus may continue after birth. Developmental delay is common in children born to mothers with cocaine in their system.


Management of Toxicity
The cornerstone of treatment for cocaine toxicity is early recognition and action. The treating physician must curtail the operative procedure and remove any remaining pledgets. Immediately activate advanced cardiac life support protocols, including intubation and defibrillation if indicated.

Above all, seek help immediately. In a hospital setting, assistance is readily available. In the office surgery setting, call emergency services (ie, dial 911 in the United States) immediately. The surgeon must direct resuscitation until assistance arrives. This requires that any surgeon using cocaine in the office be familiar with advanced cardiac life support protocols and have the proper equipment on hand should an emergency situation arise.

Cocaine toxicity has no known antidote. Aggressive resuscitation is the only treatment. In addition to intubation and defibrillation, administering drugs such as propranolol, nitrates, calcium channel blockers, and alpha-adrenergic blockers may be necessary in an attempt to improve coronary blood flow and restore normal sinus rhythm. Control seizure activity with diazepam (Valium), and aggressively treat hyperthermia with cooling blankets.

Contoversies
Controversy still exists over the use of cocaine in otolaryngology. Criticisms include the risks, cost, problems with storage and dispensing, or combinations of these problems. Much of the literature references a survey done in 1977 regarding cocaine use by otolaryngologists. This survey preceded the epidemic of recreational cocaine use and the first reported case of cocaine-induced myocardial infarction. A more recent survey in 2004 showed that physicians in practice less than 10 years were less likely to have used cocaine than those in practice more than 10 years.1 Compared with the 1977 survey, fewer physicians reported ever using cocaine in their practice, and a greater number of adverse reactions were reported.

Recent studies suggest that safer alternatives for topical anesthesia with equal effectiveness are available. The treating physician must be aware of potential interactions between cocaine and other medications, and to consider an alternative if concern about the cardiac status of the patient exists

http://emedicine.medscape.com/article/874104-overview

Little paragraph about preping someone for septoplasty

Prior to injection, the nose should be packed loosely with cocaine-soaked pledgets to maximize the decongestive effect. Using bayonet forceps, place one pledget along the roof and one along the floor of the nasal cavity.

Maximum dose for cocaine is 2-3 mg/kg. A single 5-cm3 vial of 4% cocaine typically is used to soak all 4 pledgets for an adult patient.

Inject approximately 5 cm3 of 1% lidocaine with 1:100,000 parts epinephrine into the subperichondrial and subperiosteal planes throughout the septum to look for blanching of the mucosa, which indicates that the proper plane has been entered. Injections are performed with a long 25- or 27-gauge needle.

Maximum dose of lidocaine with epinephrine is 7 mg/kg.

Somewhere they mention a max dose of 200 mg- that would have to get some prety gacked.

 

[ugly_pickle]

I went to a ear, nose and throat doctor and he put cocaine hcl in my nose cause he took a thing that looked like a nail with a light on it and was prodding around my sinus to take a cyst out. Look at my avatar picture...thats what the bottle looked like...my nose was numb afterwords but not really and high.

 

[LSDMDMA&AMP]

Cocaine's only proper medical use is with local anaestesia. I havent heard of it being used much, but i havent been to the hospital much. Anything else (weight loss, etc.) can be achieved safer via use of amphetamine/methamphetamine or other longer acting stimulants.

 

[jspun]

Cocaine is used because it combines local anethsthetic effect eefect plus vasocontrictioon, the nose and throat are really vascularized so it allows one to do surgery without too much blood obscuring the procedure. It also decreases nasal condition in the short turn. I think that it might still be used because of nostalgia given the price and other alternatives (afrin, xlocaine, epi). They still use ephedirne of all drugs to antagonize hypotension in post op anethesthetized agent. Why this one when there are better probably out there God only knows.

 

[disasterline]

i was given cocaine during a nose surgery, before, during, and after the surgery.

other than a numb feeling i got know other effects, most likely because they had just broken my nose and i was in a ton of pain to even worry about feeling anything

 

[LSDMDMA&AMP]

ephedrine and phenylephrine are used in very dilute amounts though, same with cocaine (medically)

 

[jspun]

Hitler's treatment with medical cocaine

Hitler, tweaker extrordinaire ( depending on who you believe). In this insane megolomaniac with an inferiority complex, the injection of meth/vitamin and the doses of pervitin in between helped to erode his sociopathic judgement and it would appear contributed to the irrational decisions he made- thus hastening the end of the war. He also took heavy sedatives to sleep. In fact, according to the excellent book cocaine: an unauthorized biography it would appear that the German response to D-Day was delayed because Hitler couldn't be awaken easily. This book reveals some other information which is interesting. This information comes from Dr. Edwin Giesing, the ENT that treated Hitler. His addictive behavior and response to the treatment is something many of us can relate to- he displays stereotypical dope fiend logic.

To treat him for injuries sustained in the failed bomb assasination plot

Giesling...dosed Hitler with cocaine in 10 % solutions when he complained of sore throats. Nothing unremarkable about this despite apart from the fact that Giesing records in his notes that Hitler enjoyed the treatment so much that that he asked for it to be continued even after his throat problems were gone. In fact, Hitler asked for cocaine so much that Giesing specifically had to warn him away from it lest he become addicted. Giesing eventually refused point-blank to dose Hitler with cocaine any more often. Ok, said Hitler, the same number of doses. But what about increasing the strength of the cocaine solution.

Got to appreciate the dramatic irony- the clasic use of dope fiend logic. Actually acording to this book, alot of cocaine was being used by the aristocratic elite and command structure of the third reich.

Another interesting bit of historical information that was brought up, during the 20s, the US was experimenting with the prohibition of alcohol. Before this cocaine among other "narcotics" was outlawed by the Harrison Act. As it turned out, before the US entered the war, Canadian soldiers on R&R introduced British soldiers to the joys of cocaine use. Apparentally alot of that was going on before and after the war. Driary of a Drug Fiend is an excellent period piece, though a work of fiction. In the 20s prohibition agents through out Europe had their hands tied with cocaine and other drugs (atleast those that had ratified international treaties. World War I had left Germany with alot of debts, unemployment, and war reparations. At the time it was the worlds largest pharm producer of cocaine. It did what Japanese firms did with philipon after World War II: It dumped coke on a demoralized population. In the 20s, and pre nazi 30s there was a roaring bohemian/hip scene going on around coke and Jazz in Berlin. The Nazi elite, destroyed the art, freedom, and hippness, but kept coke, albeit on a smaller scale and more discrete among influential party members. For the middleclass, Pervertin was handed out in great numbers (used during the Blitzkreig).

The brits, french, italians, ect... all had coke scenes in the 20s. In Greece had a scene among bohemian immigrants (Rebetes) although hash and to a lesser extent opium and heroin were a part of it. The way all this coke was getting to Europe involved 2 major schemes. The Swiss hadn't ratified anti narc treaties and appear to be the first to exploit analogues to get around laws. They would convert cocaine or heroin to legal compounds that could easily be converted to illegal drugs in the destination countries. Holland was slow to ratify the treaty so Rotterdam remained a major port of cocaine import for 10 years (up until early 30s).

In the East, India had a big coke scene. China was a huge market for coke as well as opiates as the Japanese were to find out. The military, in the 30s, to fund there expansion, and the expansion of the japanese empire turned to selling coke in China. They started plantation in Taiwan and Peru, sd well as quitely buying coca plantations in Dutch controlled Indonesia. Further, they grew the crop on Japanese soil in Okinawa and Iwo Jima. Coke refineries were even established on the Chinese mainland according to this book to fuel the huge market for the drug in the country of China that was undergoing a civil war (and this was intended to protect Japanese interests in China especially in manchuria, part of which was later anexed.

Lesson for today: If a gang like the Triads in Australia were smart enough to realize it, they could start coca plantations in places like Papua New Guinea or other parts of Asia that can support coca and replace the huge market in Australia for substandard coke with large amounts of better quality stuff.