In contrast, intranasal cocaine is more delayed with plasma levels and ratings of “High” peaking around 30-40 minutes and lasting for an hour or longer ( Cone, 1995 Javaid et al., 1978). Specifically, smoked cocaine achieves peak venous plasma concentrations within 4-5 minutes and subjective ratings of “High” within as little as 1 minute ( Evans et al., 1996), and lasts only about 15 minutes ( Cone et al., 1995 Foltin and Fischman, 1991 Evans et al., 1996). In the case of cocaine, route of administration is directly related to the onset of action and the reinforcing efficacy. It has been well established that drugs with a rapid onset of action can enhance the reinforcing effects or have greater abuse liability than drugs with delayed onsets (e.g., Abreu et al., 2001 Balster and Schuster, 1973 see reviews by Hatsukami and Fischman, 1996 and Lile, 2006). One often-ignored factor that can influence potential treatment outcome is the route of cocaine being used by individuals. Based on a recent Treatment Episode Data Set (TEDS), primary cocaine admissions represented 7% of all admissions for substance abuse treatment in 2012, with 69% of those admissions for smoked cocaine ( SAMHSA, 2014b).

The number of initiates to cocaine use, the number who report using cocaine and the number who are dependent on cocaine has not decreased over the past 4 years ( SAMHSA, 2014a). Although illicit drugs such as marijuana and non-medical use of prescription-type psychotherapeutics (primarily pain relievers) now exceed the use cocaine, cocaine continues to remain a persistent public health problem in the United States ( Substance Abuse and Mental Health Services Administration (SAMHSA), 2014a).

Lust for adventure 2.5.5