Further experience with the syndromes produced by coca paste smoking

Cocaine base or white coca paste was smoked heavily by 188 patients who came to four hospitals of Lima, Peru. The length of hospitalization varied from two days to six months. All patients were admitted because coca paste smoking had become a serious problem for their health or for social adjustment. Coca paste was smoked mixed with tobacco or marihuana. The main symptoms were anxiety mingled with euphoria and a rapidly developing compulsion to continue smoking. Frequently the patients developed irritability, illusions, hallucinations. When the use of the drug was heavy and continued for many hours or several days, the patients developed successively four stages of psychological reaction: euphoria, dysphoria, hallucinosis, and acute paranoid psychosis. The main symptoms and signs of all of these phases are discussed.