DDRESS

BY

C, EVERETT KOOP, M,D,
  SURGE~W GENERAL
U.S, PUBLIC HEALTH SERVICE

        AND

DEPUTY ASSISTANT SECRETARY FOR HEALTH
US, DEPARTMENT OF HEALTH AND HUMAN SERVICES

PRESENTED TO THE SYMPOSIUM ON COCAINE
    MILWAUKEE, WISCONSIN
      APRIL 18, 1985


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(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETCJ

   I WANT TO CONGRATULATE THE PEOPLE WHO PLANNED AND ORGANIZED THIS
MEETING, THE WISCONSIN INSTITUTE ON DRUG ABUSE AND THE NATIONAL
INSTITUTE ON DRUG ABUSE, I DON'T KNOW IF THIS IS TECHNICALLY THE
FIRST BIG CONFERENCE HELD ON THE NATURE -- AND THE DANGER -- OF
COCAINE, BUT IT IS CLEARLY A CONFERENCE WITH REPRESENTATION FROM ALL
THOSE GROUPS WHO ARE DEEPLY CONCERNED ABOUT THE PRESENCE OF A COCAINE
PROBLEM IN OUR SOCIETY,

  I'M PARTICULARLY PLEASED TO OBSERVE THE LEADERSHIP BEING PLAYED
AT THIS CONFERENCE BY DIFFERENT GROUPS WITHIN THE MEDICAL PROFESSION
-- PHYSICIANS, PHARMACISTS, AND PSYCHIATRISTS -- WORKING ALONGSIDE
THEIR COLLEAGUES FROM THE SOCIAL SERVICES, FROM GOVERNMENT, FROM
INDUSTRY, AND FROM THE PRIVATE, NONPROFIT VOLUNTARY SECTOR,


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  THE PROBLEMS RAISED BY COCAINE IN OUR SOCIETY CANNOT BE FULLY
UNDERSTOOD, MUCH LESS EFFECTIVELY ADDRESSED, BY ANY SINGLE GROUP OF
INDIVIDUALS, NO MATTER HOW EXCELLENT THEIR TRAINING OR HOW SINCERE
THEIR COMMITMENT,

  THAT'S A LESSON WE OUGHT TO HAVE LEARNED BY NOW,  I THINK IT HAS
BEEN ONE OF THOSE SELF-MADE BARRIERS TO PROGRESS IN THIS COUNTRY, IN
THE PAST, AMERICANS HAVE SOMETIMES BEEN GUILTY OF OVERSIMPLIFYING
SERIOUS PROBLEMS OF PUBLIC HEALTH AND PUBLIC SAFETY AND CASUALLY
LEAVING THEIR SOLUTIONS TO ONE OR ANOTHER INTEREST GROUP,, USUALLY THE
ONE WHO HAS YELLED THE LOUDEST,

  THEN, AFTER A FEW YEARS OF IMPATIENTLY WAITING FOR NEWS OF A
BREAKTHROUGH, WE FINALLY COME AROUND TO DOING WHAT WE SHOULD HAVE DONE
IN THE FIRST PLACE: BRING TOGETHER ALL THOSE PARTIES AND INTERESTS
THAT WANT TO HELP AND GIVE THEM ALL A PUBLIC CHARGE TO DO SO,


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  FOR MANY YEARS THAT'S HOW WE HANDLED THE BROAD ISSUE OF CHILD
HEALTH IN THIS COUNTRY, WE LEFT IT TO THE PEDIATRICIANS, BUT FINALLY
WE GOT GOVERNMENT, PARENTS, THE SCHOOL SYSTEM, AND A BROAD SPECTRUM OF
MEDICAL AND NURSING PROFESSIONALS TO FOCUS ON IMMUNIZATION AND
NUTRITION AND I THINK WE'RE MAKING MUCH BETTER PROGRESS FOR OUR YOUNG
PEOPLE AS A RESULT,

  AND THAT'S CERTAINLY WHAT HAPPENED WITH THE PROBLEM OF SMOKING
AND HEALTH, WE FIGURED THAT THE PUBLIC HEALTH PEOPLE COULD HANDLE IT
WELL ENOUGH FOR THE REST OF US, BUT THAT WASN'T SO, SMOKING IS THE
KIND OF PROBLEM THAT REQUIRES THE COMBINED TALENTS AND ENERGIES OF
PSYCHOLOGISTS AND EPIDEMIOLOGISTS AND EDUCATORS AND BIOMEDICAL
RESEARCHERS AND THE MASS MEDIA,

  WE DID THE SAME THING WITH NARCOTICS AND MARIJUANA, FOR MANY
YEARS WE LEFT THE PROBLEMS OF DRUG ADDICTION AND DRUG TRAFFIC TO LAW
ENFORCEMENT AND THE COURTS, FINALLY, WE ENERGIZED OUR MEDICAL AND
PUBLIC HEALTH PEOPLE AND OUR EDUCATORS TO STEP IN AND ASSUME THEIR
SHARE OF RESPONSIBILITY, ALSO, FOR AMELIORATING THE PROBLEM, IF NOT
ACTUALLY SOLVING IT,


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  BUT I THINK WE'RE IN BETTER SHAPE NOWmWE'RE COMMITTED TO A

COMMUNITY-WIDE, INTERDISCIPLINARY APPROACH TO THE BATTLE AGAINST
COCAINEwAND I BELIEVE THAT, AS A RESULT, WE'RE GOING TO BE MORE
SUCCESSFUL,

   WITH COCAINE, HOWEVER, WE'VE GOT SOME UNKNOWNS WE NEED TO KEEP IN

MIND, TO MY KNOWLEDGE COCAINE IS THE FIRST DRUG THAT HAS, AS ITS CORE
USER-GROUP, THE PEOPLE WHO ORDINARILY DO NOT RISK THEIR FUTURES QUITE
SO CASUALLY, ACCORDING TO THE 1982 SURVEY ON DRUG ABUSE, CONDUCTED BY
N,I,D,A,, THE AVERAGE COCAINE USER -- BY A MARGIN OF 2-TO-1 -- WAS A
WHITE MALE BETWEEN THE AGES OF 18 AND 34 WITH A STEADY JOB, AND WE
LEARNED THAT HALF THESE COCAINE USERS EARN MORE THAN 820,000 A YEAR,

   WE'VE ALSO DISCOVERED SOMETHING ELSE ABOUT THE DEMOGRAPHY OF
COCAINE, THERE WERE, FOR EXAMPLE, 8,000 COCAINE-RELATED HOSPITAL
EMERGENCIES AND 476 COCAINE-RELATED DEATHS REPORTED FOR THE 12 MONTHS
THAT ENDED LAST OCTOBER 1984, THESE VICTIMS WERE NOT CLUSTERED IN ANY
ONE GEOGRAPHICAL AREA, THEY SHOWED UP ALL ACROSS OUR COUNTRY, IN ONE
MAJOR METROPOLITAN AREA AFTER ANOTHER,


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  WHAT DOES THIS TELL YOU? I THINK IT TELLS YOU THAT COCAINE IS
EVERYBODY'S PROBLEM,, #EVERYWHERE,  IT TELLS YOU THAT A PROGRAM TO
FIGHT THE INVASION OF THIS DRUG IN AMERICAN SOCIETY MUST BE A PROGRAM
THAT DRAWS UPON A BROAD SPECTRUM OF SOCIAL, MEDICAL, AND PUBLIC HEALTH
RESOURCES,  IT MAY BEGIN AS A REGIONAL PROGRAM, BUT IT WON'T STAY THAT
WAY BECAUSE THIS IS A NATIONAL PROBLEM,

   I'M EMPHASIZING THIS POINT BECAUSE I AM HERE TODAY NOT ONLY AS
YOUR FRIEND AND SUPPORTER,  I AM HERE AS THE SURGEON GENERAL OF THE
AMERICAN PEOPLE, WHAT YOU DO HERE IN WISCONSIN THIS WEEK -- AND THIS
YEAR -- TO FIGHT THE SPREAD OF COCAINE IS OF VITAL IMPORTANCE TO THE
REST OF OUR COUNTRY, THE LEADERSHIP YOU ARE DEMONSTRATING HERE CAN BE
-- AND MUST BE -- REPLICATED ALL ACROSS THE UNITED STATES,

AND I BELIEVE IT IS MY BUSINESS TO HELP THAT PROCESS ALONG,


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  DO YOU HAVE ENOUGH INFORMATION TO GET THE JOB DONE? PROBABLY NOT
AS MUCH AS WE'D LIKE, WE COULD USE MORE DATA, I'M SUREwAND A
PORTION OF YOUR AGENDA IS DEVOTED TO INTRODUCING SOME OF THIS NEW
KNOWLEDGE,

BUT WE ALREADY KNOW ENOUGH TO ACT,

  TODAY WE KNOW THAT COCAINE IS POWERFULLY ADDICTIVEwTHAT SOMEONE
"HOOKED" ON IT HAS A COMPULSIVE NEED TO REPEAT AND ENLARGE THE DOSE
AGAIN AND AGAIN, AS THESE DOSES BUILD UP, SO DOES COCAINE TOXICITY,
THIS ESCALATING CYCLE BRINGS ON THE SYMPTOMS OF THE COCAINE USER:

BLURRED VISION,,,PANIC ATTACKSmCRUSHING HEADACHES,,,
DEBILITATING NAUSEA,,,PARANOIA,,,CONVULSIONS,,,DEPRESSION,,,
HALLUCINATIONS,,,RESPIRATORY ARRESTmCARDIAC ARREST,,,
AND DEATH,


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  DRUG ADDICTION HAS TORN A GREAT AND GAPING HOLE IN THE SOCIAL
FABRIC OF OUR COUNTRY, EVEN IF IT WERE STOPPED RIGHT NOW, WE WOULD
STILL HAVE TO SPEND MANY DECADES AND BILLIONS OF DOLLARS TO ELIMINATE
THE CHAOS THAT DRUGS HAVE CAUSED IN OUR FAMILIES, OUR SCHOOLS, AND OUR
COMMUNITIES,

  WE HEAR REPORTS THAT ILLICIT DRUG USE MAY BE LEVELLING OFF OR
EVEN TURNING DOWNWARD AND WE MUST BE THANKFUL FOR THAT INFORMATION, IF
IT IS INDEED TRUE,

  BUT THE EXCEPTION SEEMS TO BE THE USE OF COCAINE,  IT IS
INCREASING, ESPECIALLY AMONG YOUNG MEN AND WOMEN AND IN THEIR LATE 20s
AND 30s AND AMONG HIGH SCHOOL SENIORS, THAT'S ~ GENUINELY ALARMING,


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  REPORTS FROM AROUND THE COUNTRY INDICATE THAT COCAINE IS BECOMING
MORE AVAILABLE TO OUR CHILDREN, AND DEALERS AND PUSHERS ARE INTRODUC-
ING THEM TO MORE POWERFUL AND, HENCE, MORE DANGEROUS CONCENTRATIONS,
SUCH AS "COCAINE FREEBASE,"  MAKE NO MISTAKE ABOUT IT, THIS IS A
MURDEROUS UNDERGROUND INDUSTRY AND IT MUST BE STOPPED,

HOW CAN WE DO THAT?

  I HAVE NO MAGIC PRESCRIPTIONS, I WISH I HAD, BUT I DON'T,
INSTEAD, I -- LIKE EVERY OTHER CONCERNED AMERICAN -- MUST APPEAL TO
THE PEOPLE AT THIS SYMPOSIUM, WE ASK YOU TO HELP US,,,TO GIVE US THE
KIND OF REALISTIC GUIDANCE WE NEED,

  IN THAT EFFORT, GOVERNMENT IS A PARTNER AND AN ALLY, WE'VE BEEN
DOING SOME THINGS,,,AND WE INTEND TO DO MORE IN OUR FIGHT AGAINST THIS
DANGEROUS DRUG, LET ME BRIEFLY SUMMARIZE THEM FOR YOU,


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  FIRST, WE ARE COMMITTED TO AN EXTENSIVE PROGRAM OF NATIONAL AND
INTERNATIONAL LAW ENFORCEMENT TO STOP THE COCAINE TRAFFIC AND REDUCE
THE SUPPLY OF COCAINE COMING INTO THIS COUNTRY,

  WE ARE WORKING WITH FOREIGN GOVERNMENTS TO HELP THEM ERADICATE
THE COCA FIELDS AND REPLACE THEM WITH OTHER CASH CROPS, ,,CROPS THAT
PROMOTE RATHER THAN DESTROY HUMAN LIFE AND HEALTH,

  WE ARE ALSO WORKING WITH THE WORLD HEALTH ORGANIZATION TO DRAW UP
A DRUG ABUSE ACTION PLAN FOR ALL MEMBER NATIONS OF W,H,O, WE ARE
WORRIED -- FIRST AND FOREMOST -- ABOUT OUR OWN CITIZENS, BUT WE MUST
REMEMBER THAT THE UNITED STATES IS NOT THE ONLY COUNTRY TO SUFFER FROM
THE PLAGUE OF DRUG ABUSE, OTHER COUNTRIES SUFFER AS WELL, TOGETHER,
WE CAN FIGHT BACK WITH MUCH GREATER EFFECT,

  YOU'LL BE HEARING MORE ABOUT THIS LATER TODAY BY PERSONS MORE
KNOWLEDGEABLE THAN I,


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  SECOND, WE ARE COMMITTED TO A BROAD PROGRAM OF RESEARCH AND
PUBLIC AWARENESS, I PUT THESE TWO ACTIVITIES TOGETHER BECAUSE, THE
MORE GOOD SCIENCE WE HAVE ON THE DANGERS OF COCAINE, AND THE MORE WE
TRANSMIT THAT NEW INFORMATION TO THE PUBLIC, THE MORE LIKELY IT IS
THAT THE PUBLIC WILL DECIDE "NO, NO MORE COCAINE" AND PUT THE
SMUGGLERS AND THE PUSHERS OUT OF BUSINESS,

  THIS IS THE STRATEGY THAT SEEMS TO BE WORKING IN REGARD TO
CIGARETTE SMOKING, CIGARETTE CONSUMPTION IS LEVELLING OFF AND EVEN
DECREASING FOR MOST GROUPS -- YOUNG WORKING WOMEN ARE THE ONE

EXCEPTION -- BECAUSE THE PUBLIC HAS READ AND BELIEVES THE SCIENTIFIC
REPORTS THAT CLEARLY LINK CIGARETTES TO HEART DISEASE, CANCER, STROKE,
AND CHRONIC OBSTRUCTIVE LUNG DISEASE,

WE MUST DO THE SAME THING WITH COCAINE,


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  WE MUST GENERATE THE SCIENTIFIC DATA ABOUT THE LIFE-THREATENING
NATURE OF THIS DRUG,, ,

  WE MUST TRANSMIT THAT DATA TO THE PUBLIC THROUGH NATIONWIDE
INFORMATION AND PUBLIC EDUCATION CAMPAIGNS,

AND WE MUST ENCOURAGE THE PEOPLE TO TAKE IT FROM THERE,

  AND THIRD, WE'VE GOT TO DO FOR ALL AMERICANS WHAT YOU ARE DOING
FOR THE CITIZENS OF WISCONSIN, WE'VE GOT TO BRING TOGETHER INTO
EFFECTIVE, WORKING COALITIONS THOSE ORGANIZATIONS THAT REPRESENT THE
GREAT MAJORITY OF THE ANTI-DRUG PUBLIC -- AND THERE ARE MILLIONS OF
THEM -- ALONG WITH GROUPS REPRESENTING PARENTS, EDUCATORS, MEDICINE,
PUBLIC HEALTH, SOCIAL SERVICES, AND BUSINESS AND INDUSTRY,

  AND BY THE WAY, I DID NOT ADD "BUSINESS" AND "INDUSTRY" AS AN
AFTER-THOUGHT,


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  ABSOLUTELY NOT, LET ME BE JUST AS CLEAR ABOUT THIS AS I CAN
BE, THE FIGHT AGAINST COCAINE IS A FIGHT TO RESCUE THE GREAT
POTENTIAL THAT IS AMERICA,

WHEN THAT POTENTIAL IS COMPROMISED BY DRUG PUSHERS,,,

WHEN OUR YOUNG PEOPLE TURN AGAINST THEMSELVES WITH DANGEROUS DRUGS
SUCH AS COCAINE, a,

WHEN WE HAVE TO INVEST MORE OF OUR RESOURCES TO SALVAGE BROKEN
MINDS AND BODIES, RATHER THAN TO STRENGTHEN WHOLE, YOUNG LIVES,,,

  THAT'S WHEN YOU MIGHT AS WELL CLOSE DOWN YOUR SHOPS AND
FACTORIES, FOR THE HOPE AND THE PROMISE OF AMERICA COUNTRY WILL HAVE
LITERALLY GONE UP IN SMOKE,


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  THIS IS NOT A CHALLENGE RESERVED JUST FOR PROFESSIONALS IN
MEDICINE AND SOCIAL SERVICE AND THE LAW, THIS IS A CHALLENGE FOR US
ALL, IN THIS FIGHT, THERE ARE NO "SECTORS," PUBLIC OR PRIVATE,,,
PROFIT OR NON-PROFIT, THERE IS ONLY THE JOB WE'VE GOT TO DO,

   I KNOW I'M SPEAKING TO AN AUDIENCE AS COMMITTED TO THE ERADICA-
TION OF COCAINE AS I AM, I WANT YOU TO HAVE A SUCCESSFUL MEETING
HEREmAND THEN I WANT YOU TO GO OUT AND TELL THAT STORY TO EVERY

AMERICAN,

  TIME MAY NOT BE ON OUR SIDEvBUT IN THIS FIGHT, I BELIEVE THAT
HISTORY -I&

THANK YOU,

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