Market Barriers to the Development of Pharmacotherapies for the Treatment of Cocaine Abuse and Addiction: Final Report. Estimate of Cocaine Users in the U.S.


There are more than 2 million addicted or "heavy" cocaine users. Of these, as many as 800,000 to 900,000 may enter treatment at least once in a given year. On any given day, roughly 250,000 cocaine abusers are enrolled in treatment (i.e., who are at a residential facility or have been served at an ambulatory treatment center within the previous 30 days). Thus, of all heavy cocaine users, slightly more than 10 percent are enrolled in treatment on any given day.

Of the estimated 250,000 cocaine abusers, about 150,000 are primary cocaine abusers and about 100,000 are secondary cocaine abusers, i.e., who abuse cocaine secondarily to alcohol or opiates. A national survey data set (Treatment Episode Data Set 1992-1995), indicates that as many as 170,000 daily patients enrolled in treatment are secondary cocaine users. However, because cocaine abuse may be the third or fourth drug problem for many of these patients, a more conservative estimate of 100,000 secondary cocaine abusers is used. This brings the combined estimate of primary and secondary cocaine abusers to 250,000, which is more consistent with other recent estimates of between 200,000 and 250,000 daily cocaine patients in treatment. Indeed, estimates derived from the Drug Services Research Surveys for 1990 indicated there were 210,000 daily cocaine abusers in treatment, only a third of which were primary cocaine abusers.

It is estimated that there are approximately 11,500 centers providing treatment for cocaine abuse. Total spending on treatment exceeds $2 billion, and spending on treatment for cocaine abuse averages about $23.00 per patient enrollment day (including inpatients and outpatients), with spending of $9.00 per day for non-intensive outpatients.

Substance abuse treatment generally emphasizes a psychosocial, rather than medical, model. The most recent surveys that have examined staffing patterns confirm that the substance abuse treatment system involves little or no physician time in the treatment of patients. Even when on staff, physicians are often addressing primary health care needs or other mental disorders, rather than delivering specialized substance abuse treatment services.

Involvement of private practice physicians in treating cocaine addiction is virtually negligible. Of national expenditures for all specialized substance abuse services, including alcoholism, less than 1 percent are for psychiatrist visits. Of all national expenditures for substance abuse services excluding alcoholism, 2 to 3 percent are for visits to physicians of any type.