The Problem of the Chewing of the Coca Leaf in Peru

Abstract

It has been demonstrated historically and archaeologically that coquéo, cocaísmo or the habit of chewing coca leaves existed in a very restricted form in ancient Peru.13 The use of coca was allowed only to the upper classes of society on the occasion of special ceremonies. Coca was regarded as a divine plant and was one of the most important accessories of religion.

Details

Author: Vicente ZAPATA ORTIZ
Pages: 26 to 33
Creation Date: 1952/01/01

PUBLIC MARKET IN QUIQUIJANA Photo: Martín Chambi

Full size image: 36 kB, PUBLIC MARKET IN QUIQUIJANA Photo: Martín Chambi

The Problem of the Chewing of the Coca Leaf in Peru

Professof of Pharmacology in the Faculty of Medicine at LimaDr. Vicente Zapata Ortiz

It has been demonstrated historically and archaeologically that coquéo, cocaísmo or the habit of chewing coca leaves existed in a very restricted form in ancient Peru.13 The use of coca was allowed only to the upper classes of society on the occasion of special ceremonies. Coca was regarded as a divine plant and was one of the most important accessories of religion.

The increase in the production and consumption of coca started with the Conquest; and more than 8,500 tons are now produced in Peru every year. This enormous quantity of coca contains over 42,500 kilogrammes of cocaine, of which at least 35,000 are consumed in the process of chewing.

Chewing became general immediately after the Conquest under the influence of various factors, the chief of which are the following: (1) the considerable decline in the production of foodstuffs, (2) the institution of forced labour, (3) the large profits derived from the trade in coca, and (4) the feeling of contentment and artificial well-being which the chewing of the coca leaf produces, and which helped to relieve the hardships of the Conquest and subjugation.

The consumption of coca is not at a uniform level throughout Peru. In the southern sierra over 5,000 tons are consumed annually, in the northern sierra from 2,000 to 2,500 tons, and in the coastal and forest areas only from 1,000 to 1,500 tons.

The quantity of coca chewed daily by the addicts varies between 20 and 60 grammes, with isolated cases of a consumption of more than 200 grammes. Research at the Instituto de Farmacología y Terapéutica of the Lima Faculty of Medicine has shown that during chewing an average of 86 per cent of the alkaloids contained in the coca leaves are ingested, the remaining 14 per cent being left in the residue of mastication, which the coca addicts throw away because they derive no stimulus from chewing it. Since these persons divide the daily dose of coca into three or four portions, they ingest between 60 and 80 milligrammes of cocaine each time, or between 160 and 200 milligrammes every twenty-four hours.[3] [4] [5]

The coca addicts usually masticate the coca leaf with the addition of alkaline substances, sometimes quicklime and sometimes the ashes of various vegetable products prepared in the form of pellets or small cakes containing potassium, sodium, calcium, magnesium, phosphorus and traces of iron and antimony. The pH content of the solutions of these alkalins varies between 10.6 and 11.4.[6] These substances are used because alkalinity helps extraction of the alkaloids, facilitates their absorption by the digestive tract and strengthens their stimulating effect on the nerves.

ABSORPTION AND ELIMINATION OF COCA ALKALOIDS

During chewing, the cocaine is ingested in its basic form and is transformed in the stomach into the hydrochloride. The alkaline substances which are ingested at the same time hinder this transformation by neutralizing the hydrochloric acid in the stomach, thus enabling more of the alkaloids to be absorbed at the level of the intestinal tract. This is shown by the rapid appearance of physiological changes in cases where chewing is practised with the addition of alkalins, as compared with the retarded or feeble change or the absence of change which is characteristic when alkalins are not employed, or when, on the contrary, acid substances are used. [4] [8] [23]

It is still not known what happens within the organism to the cocaine absorbed during chewing, although its presence has been observed in the blood. It is thought that the cocaine is largely hydrolyzed in the liver and transformed into ecgonine, an alkaloid which also has toxic effects. In any case, the excretion of part of the cocaine in the urine is observable even forty-eight hours after chewing, an interval in which from 24.7 to 98.4 per cent of the total alkaloids ingested are eliminated.[5] The elimination of cocaine alone is not so great, varying between 6.7 and 20.8 of the amount ingested, probably because it has been partly transformed into ecgonine and eliminated in that form.

The alkaline substances which are absorbed during chewing play an important part in the elimination of coca alkaloids in the urine. It has been shown in the case of persons who are not addicts that when alkalies are not used from 10 to 20 per cent of the alkaloids are eliminated through the urine in the first six hours following chewing, as compared with from 21 to 34 per cent when chewing is performed with the addition of alkaline substances.[7]

It has also been shown that the excretion of cocaine through the urine is greater in the case of non-addicts in the coastal districts. The probability is that in cocaleaf addicts more of the cocaine molecules are disintegrated. In both non-addicts and addicts, however, the maximum elimination of cocaine takes place during the first hour following chewing.

The great variations from person to person in the proportion of coca alkaloids eliminated through the urine are the result of individual variations in clearance, plasma concentration, indices of histo-plasmatic concentration, capacity for hepatic detoxification, absorptive capacity of the digestive tract and size of the doses ingested.

The elimination of cocaine and other coca alkaloids through the urine shows that they are absorbed by the digestive tract and justifies the inference that they are present in the blood. In this connexion, it is well to explain that although the presence of cocaine in the blood is a point of some importance, it is not the immediate factor in inducing a toxic condition, for such a condition is determined by impregnation of the tissues, particularly of the nervous system, the liver and other organs. The part played by the alkaline substances at this histic stage has still not been determined, although it is thought that such substances increase the stimulating effect of cocaine on the nerves, a view which is supported by the following facts: (1) cocaine in its basic form is most soluble in fats, and the nervous system is largely composed of fats; (2) basic cocaine is charged with positive electricity, its micelles or ions being absorbed by the negative charges in the nervous system; (3) the potassium salts contained in the alkaline substances employed with chewing facilitate the penetration of basic cocaine into the nervous tissue by increasing the permeability of the lipoid layer to water; and (4) the alkaline substances, in producing a non-acid pH, prevent the hydrolysis of the cocaine and facilitate its action.[4] [23]

FORMATION OF THE COCA HABIT

Coca addicts usually begin to form the habit after leaving school, between the ages of 12 and 14.

It should be said that in spite of the marked differences between the coca-chewing habit and cocaine addiction, they have nevertheless certain points in common. In both cases cocaine is responsible for the principal effects.

It has been shown that the ease and intensity with which addiction to a drug is established largely depends on the method of administration adopted, the intravenous method being most effective, with the subcutaneous and oral methods coming next in order. In coca-leaf chewers, the cocaine penetrates the organism by this last means and in doses smaller than those used by cocaine addicts. It is for this reason that coca chewing is not accompanied by the startling toxic features so frequent among those addicted to cocaine, and that its effects are much slower and essentially chronic. The symptoms of addiction to cocaine are therefore relatively weak, a circumstance which enables the individual concerned to give up the drug with ease.

Difficulties are encountered and moderate abstinence symptoms appear only in the case of coca addicts who consume more than 100 or 200 grammes of coca a day.

The cocaine habit starts much more easily, as has been experimentally demonstrated with dogs. The first to produce experimental addiction to cocaine were Tatum and Seevers.[24] Somewhat later Gutiérrez Noriega and his collaborators confirmed and extended the knowledge of this phenomenon.[12] The craving for the drug is so marked in habituated dogs that even when they have not been fed for a long time they refuse food in order to obtain an injection of cocaine, and can endure painful electric shocks provided they obtain the drug. It has also been shown in the case of these animals that cocaine does not induce tolerance, but, on the contrary, phenomena of increased sensitivity. Thus, during a course of treatment with cocaine, it is almost impossible to increase the initial dose; and on the contrary, as the experiment proceeds, the reactions produced by the same dose of cocaine become stronger until the day arrives when marked toxic phenomena are displayed and may result in the animal's death. We have called this phenomenon increased sensitivity as opposed to tolerance, which is a characteristic of morphine, a drug the doses of which must be increased in order to obtain effects equal to those produced by the small initial dose. Tolerance of cocaine does not occur in human beings either, and most coca addicts take practically the same dose of coca throughout their lives.

EFFECTS OF COCA

The effects of coca on the individual are various, but among them may be distinguished physiological and psychological effect's, both acute and chronic.

The acute physiological manifestations are not of great importance and are characterized by tachycardia, a slight increase in arterial pressure and body temperature, a somewhat accelerated respiratory movement, the intensification of tendinous reflexes, modification of the neuro-vegetal reflexes, increased basal metabolism and delayed reaction to auditory stimuli.[8] [14 ] [18] [26] In addition, coca and cocaine increase the resistance to fatigue.[11] This last point deserves special consideration, because it must not lead to the conclusion that coca has a beneficial effect on the output of human labour. The chronic effects of addiction to coca and malnutrition among the chewers lead to a general weakening of the system, and consequently the stimulating effect of coca hardly ever produces in the chewer an output of labour greater than that to be observed in persons not addicted to the drug but receiving proper food.

Studies now being conducted by Dr. Santiago Valdizan and to be published shortly in their entirety show that coca addicts, even when under the stimulating influence of coca, display, together with a reduced liabil ity to fatigue, a lower output of physical labour as compared with persons who are not habituated.

Dr. Valdizán used the "Whipple tapping test" which consists of ascertaining the number of taps which the person being tested can make with a punch on a metal plate within a given period of time. The number of taps is recorded by means of an electric register in periods of twenty seconds for a total duration of two minutes, and the total thus obtained constitutes the output of the person being tested. Comparison of the values obtained for the six periods of twenty seconds establishes the extent to which the person being tested is subject to fatigue.

Valdizán tested 500 coca addicts and 500 non-addicts and he found that the output of the latter (the non-coca addicts) was greater, the average varying between 127.6 for the first twenty seconds and 102.5 for the last twenty seconds; while in the case of the coca addicts these averages were no more than 108.6 and 94.7 respectively. As may be seen, the difference in output for the first and last periods of twenty seconds is 25.1 in the case of non-addicts and 13.9 in the case of the coca addicts. This indicates a lesser inclination to fatigue among the latter while they are under the stimulating influence of the drug

Observations made by the author in the Sierra with the Smedley dynamometer show that the average strength values of the coca addicts varied between 28 and 32 kilogrammetres, while similar experiments conducted with Lima medical students yielded average values of between 40 and 45 kilogrammetres. If we remember that in the case of the chewers the experiment was conducted while they were under the stimulating influence of coca and that they were persons who by reason of their occupation should have been better capable of muscular effort, we are surprised by the low indices obtained as compared with those for the group of students, who, apart from not being under the influence of any drug, were persons whose work was essentially intellectual. As we shall see, the difference is due principally to the fact that the student group was well nourished while the chewers lived on diets deficient both as to quality and quantity.

So far as concerns the chronic physiopathological manifestations (including not only those acquired during the individual's lifetime but also inherited ones), it is very difficult to say exactly to what extent they are the exclusive result of coca chewing. The difficulty of defining them is increased by the effects of alcoholism, under-nourishment and the generally unsatisfactory health conditions under which the coca addicts lived. In any case, the ill-health of the chewers is an easily demonstrable fact, for many of them have chronic diseases, and some show signs of degeneration.[14]

Everything points to the conclusion that the constant toxic condition produced by coca results in acceptance of the most wretched living conditions, which are the chief cause of the chewers' deficiencies; and coca is therefore regarded as primarily responsible.

No less important than the physiological changes are the psychological modifications which coca produces. The acute effects on mental activity are various. Large doses of coca produce changes in thinking, effectiveness, perception, etc. The chronic psychological changes are those which are of greatest interest and to which particular attention has been devoted. Under the able direction of the late Professor Carlos Gutiérrez Noriega, we made a comprehensive study of this subject, which embraces the intelligence, powers of attention and personality of the chewers.[19]

The intelligence rating as determinated by the Binet-Simon test shows very low indices not exceeding 90 per cent. In most cases the indices are between 50 and 70 per cent.

In order to eliminate possible errors arising from any misunderstanding of the questions which might be caused by the fact that many of the cocaine addicts have an insufficient knowledge of Spanish, an interpreter was always available. For the same reason, use was made of the "non-language multimental test of Terman, McCall and Lorge", and the Porteus labyrinth test, because these are tests in which words are not employed. The results obtained from the Terman test were discouraging and apparently contradictory. The intelligence coefficients were much lower than those obtained from the Binet-Simon test. We attribute these results to the fact that the Terman test consists of series of shapes the selection of which requires the exercise of abstract thought more often than in the case of the other tests. In this kind of mental ability the coca addicts display a marked deficiency. Though still sub-normal, the results yielded by the Porteus labyrinth test were somewhat better than those obtained from the Binet-Simon test. In addition, use was made of the Rorschach test which confirmed the results obtained from the other tests.

A very interesting and revealing phenomenon is disclosed by an examination of intelligence coefficients and the length of addiction to coca. There is a close relation between these factors, the duration of addiction being in direct ratio to the mental age and vice versa, a circumstance which clearly shows the important part played by coca in the process of mental deterioration displayed by coca addicts. Mental deficiencies begin as soon as addiction to coca starts, and increase as addiction continues. According to information supplied by schoolmasters in the sierra, the mental development of children who are addicted to coca shows a backwardness which can almost be made good when the chewing habit is overcome.

It is undeniable that other factors may have an adverse effect on mental development, such as education, language, geographic and social isolation, economic hardship, heredity, alcoholism, nutritional deficiencies, etc. In a previous publication we studied in detail the part played by each of these factors in the coca addict's mental backwardness, and we believe that those factors are of secondary importance.[15] The relation between the duration of addiction to the drug and mental deterioration shows that coca is the chief cause of the deficiencies encountered. It is probably true to say that coca is in turn responsible for some of the factors mentioned above, and that in this way it acts on the intelligence both directly and indirectly.

Also revealing are the relations between the duration of addiction to coca on the one hand, and illiteracy and resistance to learning Spanish on the other hand. Thus, persons who have been addicted to coca for many years are almost all illiterate and the language they speak is predominantly the vernacular. In the departments of the southern sierra, where the consumption of coca is greatest, the percentage of illiteracy is high, and Quechua and Aymara are the prevailing languages.

Coca also has an adverse effect on the power of concentration. As determined by the Hamburgo test, the power of concentration among coca addicts bears a relationship to the duration of addiction to coca, the power of concentration being less among inveterate coca addicts than among those who have been addicted for only a short time.

The personality of coca addicts was studied by means of the Rorschach test, and it was found that the neutral type predominated at any rate amongst inveterate chewers. Such addicts are apathetic, hypo-affective, indolent, deficient in higher mental activity and subjective life.[19] They are aimless, indifferent and maladjusted. Next in numbers come the egocentric, extratensive types, and in the third place, and forming only a small minority, the introvert types, who significantly have the highest intelligence coefficients and the lowest duration of addiction. It is not claimed, however, that the results obtained from the Rorschach test are the consequence of the coca habit alone. They might be racial in nature or the result of other factors. In any case, coca is not the only drug capable of changing the personality and affecting the results obtained by the Rorschach test.

It has been shown that extroversion is prevalent among the less serious cases of chronic alcoholism, whereas among the most extreme cases the degree of extroversion is reduced.[12] The particulars we have mentioned suggest that chronic alcoholism produces modifications in the personality and in the results obtained by the Rorschach test. From the theoretical point of view there is no objection to accepting the thesis that a change in personality also takes place in coca-leaf chewers owing to the chronically toxic effects which coca produces.

COCA ADDICTION AND NUTRITION

This is the most important aspect of the problem we are studying.

The elimination of the sensation of hunger is one of the characteristic effects of addiction to coca and the most important reason why the inhabitants of the Andes contract the habit.

There is a manifest relation of antagonism between addiction to coca and nutrition. Historical data show that in ancient Peru there was an abundance of food, particularly in the Andean area, which is today the poorest and most badly supplied. The drug, which is used today to counter the effects of hunger and stimulate organisms weakened by undernourishment, then had no purpose to fulfil, and, as has already been said, its use was confined to particular social classes and special occasions. In an extremely interesting study,[17] Gutiérrez Noriega showed that in those parts of Peru where nutrition is most unsatisfactory the consumption of coca is greatest. In the southern sierra where chewing is prevalent and where the average annual consumption of coca per head (including non-chewers) is between two and four kilogrammes, the daily food ration is about 767 grammes. In the northern sierra, where between one and two kilogrammes of coca are consumed annually per head, the food supply is better, although it amounts to only 904 grammes a day. In other areas, where the consumption of coca amounts to only 100 grammes per head annually, the food supply is 1,096 grammes a day.

From the point of view of quality there is the same relation between addiction to coca and nutrition, the diets of poorest quality being found in areas where chewing is most widespread. In general, the average number of calories provided by the amounts of foodstuffs noted is below the normal in all the areas surveyed, but the shortage is most marked in the Southern Andes, which is the area where most coca is consumed and where the diet, besides being almost completely lacking in proteins (meat, milk, eggs) and in fruits and sugar, is very poor in fats, legumes and green vegetables, and consists chiefly of farinaceous foods (wheat, barley, maize, quinoa, potatoes, etc.). The 767 grammes of food which the inhabitant of that area receives daily yield no more than about 2,000 calories, a figure which is very much below the minimum needed by a working man. Since coca is absolutely lacking in nutritive or energy-supplying properties, and since there is a large consumption of alcohol in the areas where addiction to coca is most widespread, it is probable that part of the physiological minimum of calories is in some cases supplied by alcohol. This substance is not a food, either, and since it is as toxic and dangerous as cocaine, its toxic effects are added to those of that alkaloid.

The relation between the extent of cocaism and dietary deficiencies is very revealing, and we believe that shortage of food is the main reason for the existence of coca addiction, and that any campaign for the suppression of this pernicious habit must be accompanied in the first place by an improvement in the nutrition of the coca-chewing populations. In this connexion we have conducted experiments which, though of brief duration, yielded very significant results. At Huancayo a group of coca addicts were kept under strict observation for a number of days. They were provided with good food, and it was found that they voluntarily gave up coca-chewing as the experiment proceeded and their state of nutrition improved As has already been said, it has been established as a historical fact that the causes determining the spread of addiction to coca in the Andean area are related to the considerable decline in the production of foodstuffs which occurred immediately after the Conquest.

GENERAL CONSIDERATIONS ON THE SUBJECT OF COCA ADDICTION

The problem of the chewing of coca leaves has long been a subject of interest to many students. The general opinion of those who have worked on the subject directly is that coca produces a number of unfavourable effects. There are, however, people who regard coca as of great value to the Indian and who advocate the unrestricted continuation of its use. Let us consider some of the views of those who are of that opinion:

In the first place, it is said that coca is indispensable for the acclimatation of man to great heights, and that if coca leaves are not chewed in many countries in South America it is because those countries do not contain the high altitudes which are to be found in the Peruvian Andes. While it is true that the greatest heights are to be found in Peru and Bolivia, it is also true that other American countries contain population centres situated at high altitudes, and that the coca habit is completely unknown in them. We shall mention a few examples supplied to us by the Department of Geography of the University of Wisconsin (United States of America). In Ecuador there are population centres situated at heights of over 4,000 metres, such as Chuquipoquio to the north-east of Riobamba and the villages of Antisana to the south-east of Quito. In Colombia there are settlements between 3,500 and 4,000 metres above sea level, such as La Argentina to the north-east of the town of Ibague, La Leona (3,640 metres) near the town of Manizales, and Bucaracica to the west of the town of Cúcuta. In Venezuela, on the transandine highway, there is the settlement of Casa de Gobierno north-east of the town of Mérida at an altitude of approximately 4,000 metres, and the village of La Culata at an altitude of 4,487 metres about 20 kilometres to the north of the same town of Mérida. In Mexico, approximately 100 kilometres north of the capital in the central part of the country, there are many villages between 3,000 and 3,300 metres high (San Joaquín, Yonder?, La Purísima, Palizada, Pundereje, etc.). It is true that the places referred to do not have large populations, but it is undeniable that these references demonstrate the possibility of living at heights of 4,000 metres or more without using coca. Why do the indigenous inhabitants of Peru need coca at altitudes of 3,000 or 4,000 metres when the inhabitants of other countries do not? Furthermore, not all the inhabitants of the Peruvian Andes consume coca. It is generally known that the inhabitants of the coastal areas easily adapt themselves to life on the high plateau without the need for coca, and that the same is true of persons with other countries of origin, many of them Europeans or North Americans, who have established themselves with their families near the highest mines and in the highest cities of Peru, where they live and procreate children without the least difficulty and consequently without the need for coca to help them to adjust themselves. And even in the Andean native villages themselves, the consumption of coca among women is insignificant.

We might multiply examples contradicting the contention of those who maintain that coca is necessary for life at high altitudes, but we shall confine ourselves to mentioning one or two more. Angel Giménez[10] observes that in the copper mine in the central Navarro area (Mendoza, Argentina), 4,500 metres above sea level, the workers do hard manual labour and are perfectly adjusted to the height without the need for coca or other toxic drugs, but that they are well fed. In Brazil, addiction to coca also exists, particularly among the Huitotos of the Amazon region[21] less than 300 metres above sea level. In the great uplands of Tibet, which are much higher than the Peruvian Andes, neither coca nor any similar drug is consumed. In India on the other hand there were some coca addicts almost at sea level and more than a million consumers of cocaine.[9]

In our opinion, the consumption of coca is not necessary to life at high altitudes, and as we have already shown, it is closely related to general conditions of life and nutrition and to the individual's facilities for obtaining the drug. A clear example of this is provided by the Peruvian army, which consists of a high percentage of natives of the Andes, who give up coca immediately on commencing their military service; and this is true not only of those soldiers who go down to the coast to do their service, but also of those who remain in quarters on the high plateau. The reason is obvious. They give up coca with the greatest of ease (which proves that it is not necessary), because in the army they get proper food and living conditions. In many estates on the north coast of Peru, on the other hand, where living conditions and nutrition are inadequate, the Andean workers keep on consuming coca.

It is affirmed that the inhabitant of the Andes is a distinct being, physically and chemically; that he forms a whole with the environment in which he lives and to which he is perfectly adapted; that he constitutes a climatic and physiological variety of the human race, etc., and that while other races do not need coca, to the Andean it is indispensable.[20] On this subject we shall merely quote the opinion of Professor Gutiérrez Noriega [16] who says: "It is maintained that the acclimatized Andeans are a true 'climato-physiological racial variety'. This means that the process of adaptation has reached such an extreme of perfection that it transforms the human being into a new race. In these circumstances it is clearly illogical to require the assistance of an alkaloid in order to achieve acclimatization. Is the subject of discussion, therefore, a race which has become adapted to the climate, or a pharmacological process which results in adaptation to the climate? If the inhabitant is so well acclimatized that he has become racially transformed by acclimatation, drugs to assist adaptation should not be necessary. The inconsistency is even greater if we recall that the Spanish white race and other races which have adapted themselves to the climate of the Andes in recent years do not use coca for the purposes of acclimatization. Hence it seems to me absurd to assert that the 'climato-physiological race', whose inhabitation of the Andes goes back for thousands of years, requires coca alkaloids to enable it to live at great heights, while races which are of much more recent settlement and which should theoretically be less well adapted do not need the drug."

Another argument in support of coca is based on its allegedly stimulating effect on muscular labour. In this connexion reference is made to experiments carried out at great heights on persons who, when under the effects of coca, have exerted a muscular effort greater than that of the inhabitants of the plains. In this connexion it is enough to recall that the effect of cocaine on the output of labour and the ability of cocaine to strengthen certain humoral reactions which tend to raise that output are perfectly well-established facts; and although it is true that the chewing of coca leaf diminishes fatigue and by exerting a stimulating effect may increase the output of work within the short period of a particular experiment, this result in no way shows that coca addicts are capable of doing more work and achieving a greater output over the protracted period required for their customary tasks, and much less that they have a greater capacity for labour than persons who do not consume coca and who receive proper nourishment.

As an example to show that coca improves the output of labour, reference is made to the ancient Peruvians' monumental achievements in stone and it is affirmed that their execution was possible only owing to the invigorating effect of coca. But in that case, it may well be asked why the Indian does not produce works on anything like so vast a scale today, when the consumption of coca is much greater.

It is also asserted that the concentrations of cocaine in the blood of addicts are very small and do not exceed half a microgramme per cubic centimetre, and that such insignificant quantities of the drug are not capable of producing toxic effects. How can it be stated, however, that a concentration of half a microgramme or any other amount has no toxic effects if the concentrations which are really toxic, and which must be known if a comparison is to be made, have not been established? In this respect it should be recalled that the most recent publications of M. H. Seevers and his group[25] in the Department of Pharmacology of the University of Michigan show among other conclusions that in the blood of dogs which were injected with cocaine, concentrations of only 3.3 to 6.9 microgrammes per cubic centimetre were found at the time when convulsions occurred; that cocaine has a greater affinity for the tissues than for the blood; and that the central nervous system, particularly the cortex of the brain, shows the greatest concentrations of the drug.

In view of the fact that dogs are animals much more resistant than man to the effects of cocaine and many other drugs; that Seevers' experiments are occasional and not of equal duration with chronic addiction to coca; and that nevertheless concentrations of 3.3 microgrammes of cocaine per cubic centimetre are enough to produce convulsions, can the concentrations of 0.5 microgrammes of cocaine per cubic centimetre which it is affirmed that coca addicts display, be regarded as harmless and insignificant, especially if it is borne in mind that these concentrations are repeated several times a day throughout life?

It is also affirmed that the effects of addiction to coca do not altogether fit in with the definition of drug addiction given by the World Health Organization.[22]

If before the existence of addiction and the pernicious effects of the use of a particular drug could be recognized, it were necessary to establish the characteristics of compulsion, progressive increase in dose and mental and physiological dependence on the drug's effects, there would be no reason to combat cocaine addiction; for in the first place it has been experimentally demonstrated that cocaine (the most important alkaloid in the coca leaves consumed by the inhabitants of the Andes) does not produce tolerance, but the very opposite, increased sensitivity;12 24 secondly, there are no cocaine addicts who can appreciably increase the dose of cocaine with which they started; and lastly, such addicts do not display physiological dependence on the drug and can give it up at any time without exhibiting such abstinence symptoms. In spite of these facts, no one attempts to deny the harmful effects of cocaine. Why should coca addiction be required to fulfil conditions that are not satisfied in the case of cocaine addiction? We do not say that all persons who chew coca are drug addicts, but we have observed many such persons who cannot be described otherwise. In this connexion it should be recalled (W. W. Adams, Drug Addiction, Oxford University Press, 1937) that addictions to drugs display a great variety of symptomatic manifestations and that between the addict who is perfectly adapted to society and whose state passes unnoticed and the addict who has to be shut up by force in an asylum there are all conceivable intermediate stages.

In the case of addiction to coca, what is really important are the effects which it produces, whether it be a typical case of addiction to drugs or not, and if people insist on regarding it as a habit, it should at any rate be made clear that it is a harmful habit.

Economic arguments have also been advanced and it has been urged that the revenue produced by the cultivation of and trade in coca is so great that their suppression would upset the national economy. That is by no means certain, however, as may be seen from the data supplied by the Ministry of Finance and Commerce to the United Nations Commission which came to Peru and Bolivia to study that problem. Those data showed that the revenue from taxes on coca which it was expected to obtain in 1950 amounted to only 0.23 per cent of the general budget estimates for the Republic.[22]

We are convinced that the suppression of the coca plantations would enable the land now used for the growing of coca to be exploited for crops which are economically more productive and of benefit to the public. In this connexion it has been demonstrated that this land would produce very good crops of maize,fruit, yuccas, sweet potatoes, tea, cocoa and many other foodstuffs.

Rough estimates indicate that in Peru there are at least 17,000 hectares of land used exclusively ,for the cultivation of coca and not more than 21,000 hectares used for growing vegetables. The area used for the production of coca is probably greater, since there are plantations whose situation in the mountains makes inspection very difficult and sometimes impossible.[17]

And even if it were true that the economic benefits to the State contributed by coca were considerable; it32 would still be unreasonable to tolerate addiction to coca, which impairs the physical and mental health of the people

Lastly, we have shown that the cocaine contained in the coca leaves is absorbed during chewing. Proof of that is to be found in the portion eliminated through the urine. The effects of addiction to coca are due principally to the effects of cocaine. As we said at the beginning, official data show that more than 8,500 tons of coca leaves are consumed annually in Peru, and that these leaves contain more than 42,500 kilogrammes of cocaine, of which at least 35,000 kilogrammes are consumed during chewing. It is not necessary to be an expert in drug addiction to understand the enormous harm caused by the ingestion of such gigantic quantities of a drug which is both toxic and dangerous.

BIBLIOGRAPHY

001p030

O Billing and D. J Sullivan: Prognostic data in chronic alcoholism, Rorschach Res. Exch. v. 6, p 117, 1942.

002p030

O Billing and D. J Sullivan: Personality structure and prognosis of alcohol addiction: a Rorschach study, Quart. Journ of Studies of Alcohol, v. 3, p 554, 1943.

003p030

Emilio Ciuffardi Dosis de alcaloides que ingieren los habituados a la coca, Revista de Farmacología y Medicina Experimental, T 1, pp 81 and 216, 1948.

004p030

Emilio Ciuffardi: Contribución a la química del cocaísmo, Revista de Farmacología y Medicina Experimental, T. 2, p. 18, 1949.

005p030

Emilio Ciuffardi Publicación en prensa en la Revista de la Sanidad de Pohc?a, A?o 11, No 67, 1951.

006p030

G Cruz Sánchez and Angel Guillén: Estudio químico de las substancias auxiliares al cocaísmo, Revista de Farmacología y Medicina Experimental, T. 1, p 209, 1948

007p030

G. Cruz Sánchez and Angel Guillén Eliminación de la. cocaína en sujetos no habituados, Revista de Farmacología y Medicina Experimental, T 2, p. 8, 1949.

008p030

N Chamochumbi Efectos de la coca sobre el metabolismo basal en sujetos no habituados, Revista de Farmacología y Medicina Experimental, T 2, p 94, 1949

009p030

Chopra and Chopra Indian Journal of Medical Research, v 18, p. 1013, 1913.

010p030

Angel Girn?nez: Sobre la represión del coqueo. Proyecto de Ley, La Semana Médica, 41, II, p. 1892, 1934.

011p030

C Gutiérrez Noriega Acción de la cocaina sobre la resistencia a la fatiga en el perro, Revista de Medicina Experimental, v. 3, p. 239, 1944

012p030

C Gutiérrez Noriega and V. Zapata Ortiz: Cocainismo experimental I Toxiología general, acostumbramiento y sibilización, Revista de Medicina Experimental, v. 3, p. 279, 1944.

013p030

C Gutiérrez Noriega: Datos históricos sobre la habituación a la coca en el Perú, Revista de Medicina Experimental, v. 3, p. 341, 1944.

014p030

C Gutiérrez Noriega and V. Zapata Ortiz: Observaciones Fisiológicas y Patológicas en sujetos habituados a la coca, Revista de Farmacología y Medicina Experitmental, T 1, p 1, 1948.

015p030

C. Gutiérrez Noriega and V Zapata Ortiz Estudio de la inteligencia en sujetos habituados a la coca, Revista de Farmacología y Medicna Experimental, T 1, p 32, 1948

016p030

C. Gutiérrez Noriega Errores sobre la interpretación del cocaísmo en las grandes alturas, Revista de Farmacología y Medicina Experimental, T 1, p 100, 1948

017p030

C. Gutiérrez Noriega E1 cocaísmo y la alimentación en el Perú, Anales de la Facultad de Medicina, v 29, p 1, 1948

018p030

C Gutiérrez Noriega and V Zapata Ortiz Estudio de los habituados a la coca en estado de abstinencia, Revista de Farmacología y Medicina Experimental, T 3, p 56, 1950

019p030

C Gutiérrez Noriega and V. Zapata Ortiz: La inteligencia y la personalidad en los habituados a la coca, Revista de Neuro-Psiquiatría, T XIII, p 22, 1950

020p030

C Monge El problema de la coca en el Perú, Anales de la Facultad de Medicina, T XXIX, p. 311, 1946

021p030

C P. Murdock Our, primitive contemporaries, Cap XV. New York, 1934

022p030

United Nations Economic and Social Council Twelfth session. Special Supplement No 1 Report of the Commission of Enquiry on the Coca Leaf New York, May 1950

023p030

P. Salomón B Potenciación del efecto neuroestimulante de la cocaína por substancias alcahnas, Revista de Farmacología y Medicina Experimental, T 2, p. 114, 1949.

024p030

A. L. Tatum and M H. Seevers Experimental cocaine addiction, Journal of Pharmacology and Experimental Therapeutics, v. 36, p. 401, 1929.

025p030

L. A. Woods, F G McMahon and M H. Seevers: Distribution and Metabolism of Cocaine m the dog and rabbit, Journal of Pharmacology and Experimental Therapeutics, v. 101, p 200, 1951

026p030

V. Zapata Ortiz Modificaciones psicológicas y fisiológicas producidas por la coca y la cocaína en los coqueros, Revista de Medicina Experimental, v 3, p 132, 1944.33