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WHO/UNICRI - The Natural History of Cocaine Abuse

Programme on Substance Abuse
World Health Organization - WHO/UNICRI
A case study endeavor
Volume I - International Report
September 1995

2. General characteristics of users

2.1 Coca-side products and methods of use

Coca leaf (Cochabamba)

The 44 interviewees making up this sub-sample are 'chewers ("acullicadores" [3]) of coca leaves. Most of them are aware that cocaine hydrochloride is a drug extracted from the leaves of the coca bush by means of a chemical process, but only a few have actually seen it. Approximately half of the interviewees know or have seen cocaine hydrochloride or coca paste users: "I've seen half-drugged people in the streets, out of their minds".

[3] "Acullicar" ('pijchar' in Quecha) is to hold the leaves in the bucal cavity. This is the traditional method of use in the Andean commuunities. It is not exact to refer to it as "mascado" (chewing), because the leaves are not in fact chewed; rather, they are sucked. The ball of coca leaves thoroughly soaked in saliva that is kept in the mouth is called "aculli" ('pijcho', in Quechua). Therefore, the coca leaf users who use this traditional method are called "acullicadores" and will be referred to as such in this report (the words 'chew' and 'chewer' that have been used throughout to translate these concepts are just approximations).

2.2 Socio-demographic profile

Coca leaf (Cochabamba)

The prevalent age range is 41 to 45 years (30%). In fact, the age group that goes from 40 to 50 constitutes half the sample. The interviewees' ages range from 19 to 73. There were 33 men and 11 women. ... Most say they are Roman Catholic and only a few say they belong to the Andean religion or to other religious groups.

2.3 Personal background

2.3.1 Family backgrounds

Coca leaf (Cochabamba)

Most interviewees stated that they got along well with family members, in a harmonious and normal way. A minority stated that there were family conflicts, especially those caused by the father's abuse of alcohol. Alcohol consumption is evident in the family context but, in most cases, it is an intermittent problem. Interviewees blame alcohol for problems and fights between couples. In a reduced number of cases, reference is made to alcohol abuse among other close family members. The use of coca leaves is not regarded as being related to this negative context.

2.3.2 The interviewee's current family

Coca leaf (Cochabamba)

Most of the interviewees indicate that they get on well with the people they live. The family atmosphere is described in most cases as harmonious, friendly or normal. There are practically no descriptions of serious family problems among the members or family situations beyond the usual problems.

Most interviewees declare that none of the members in their families uses illicit drugs at present. In some cases, the interviewee was not able to tell us about drugs simply because s/he did not know anything about them. Although most of the them drink alcohol regularly ("we drink chicha [6] and 'chicha' does not harm us", H 107CB); this habit does not usually generate serious family conflicts. Nevertheless, it has had a negative effect on the family situation in a minority of cases.

[6] "Chicha" is a traditional alcoholic beverage resulting from fermenting maize. It is usually made, sold and drunk in bars called "chichenas".

2.3.3 School experience

Coca leaf (Cochabamba)

Most interviewees regard their school experience as positive, above all on account of the friendship links that were forged there. Some have bad souvenirs, however, on account of punishment inflicted by teachers when they failed to do homework. No interviewee related his/her school experience to the use of coca leaves: "We were the children of farmers who 'chewed'. We were taught to 'chew' not at school, but at home, by our grandparents" (H 109CB).

Only a minority never attended school. One of them said: "Our masters did not allow the children of their farm hands to attend school" (HO 13CB).

It must be pointed out that in Bolivia school children do not 'chew' ("acullicar".) This takes place later on in their lives when they start to work.

2.3.4 Work experience

Coca leaf (Cochabamba)

Almost half the interviewees regard their work experience as positive and a similar proportion see it as normal. Only a few regard it negatively. Most interviewees, being farmers, show a high level of job stability. The use of coca leaf is part of their work context:

For us, farmers, agriculture is the only way to earn our living; and when you are a farmer, your are not influenced by anybody and 'the chew' ("acullico") is part of the work we carry out.(H086CB)

The rest exhibit a high level of labour mobility motivated by a search for better economic conditions. A sizeable number of the interviewees single out unequivocally the relationship between work conditions and the 'chew' ("acullico"). There are work conditions, such as working as miners or as fishermen that imply enduring cold temperatures or harsh physical work that lead to an earlier and heavier and more frequent use. Coca leaf will be found wherever more effort and endurance is required, where you sleep less and suffer more from hunger and cold (H054CB): "work has influenced my use"; "I was a miner and this meant I 'chewed' more" (H 183CB).

Bolivian miners believe that just as alcohol is necessary to "warm up one's lungs", the 'chew' protects them against the so-called "mine disease" (silicosis) because, in addition to supplying them more energy, as they 'chew' they keep their mouths shut and so are forced to breath through their nose.

3. Socio-cultural context

3.1 Description of lifestyles

Coca leaf (Cochabamba)

Most interviewees declare that there is a lifestyle characteristic of 'chewers' native to rural communities and mining centres. This lifestyle is associated to intense work and a way of belonging to the community and to the land. This corresponds to the Andean cosmic and religious vision. The "Pachamama" (i.e. Mother Earth) is the Earth and it is a goddess that lives with men in a very close relationship. She owns all natural resources and demands demonstrations of respect and affection; upsetting her, breaking her rules, can lead to disease, misfortune and even death.

Although 'chewers' come from various Andean regions, from cities and from rural communities and may even belong to different social classes, they all preserve the features of the traditional Andean culture. They all practise, to a greater or lesser extent, worship for "Pachamama" and acknowledge the sacred nature of the coca leaf.

It's (coca leaf) everywhere in the family, rituals, etc., because we, those of us who work in the fields, "chew". We farmers are poor and we eat what we have and grow. And in order to produce, we consume coca since it is part of our life. Without the coca leaves we would not be able to work the fields (772e interviewee was native to an agrarian community) (H0 86CB).

Those interviewees who chew but who come from urban contexts are not as forceful about the cultural features associated to the use of coca leaves. They value 'chewing' from an instrumental point of view. City dwellers consider that the lifestyle of 'chewers' cannot be perceived as clearly in a city context. A professional who belongs to the urban middle class - contributes an extreme point of view: "no, there is no lifestyle whatever; anybody can do it ('chew') without distinction of class or race. Everybody should do it (H0 57CB)."

3.2 Significance of coca side-products in the interviewee' lifestyle

Coca leaf (Cochabamba)

The use of the coca leaf has a central place in the farmers' culture. The same can be said of miners. A good many of the interviewees indicate that the coca leaf plays a central role in their work life and in their relationship with others; some others value its contribution in some specific aspect of their lives: "because it heals me" (H1 02CB); "it is valuable when I have to study" (H0 54CB); its primordial place in the traditional cosmic vision: "because (the coca leaf) is sacred" (H1 03CB); "I 'chew' because I believe" (H103CB); "because the coca leaf is part of my engagement with the 'Pachamama' (H1 09CB); because if I don't 'chew' Pachamama gets angry and I won't have a good harvest" (H1 04CB); "everything goes well if I 'chew'" (H0 78CB). Only a few, all of them urban 'chewers' said, "no, it's not important"; and one of them said, "it's not important to 'chew' because I can stop doing it any time" (H0 01CB).

3.3 Culture of use / consumption

Coca leaf (Cochabamba)

In agrarian communities, the general custom before starting the day's work is for the farmers to get together to 'chew'. One of them chooses the best leaves and offers them to 'Pachamama' as he says a few words, implore some benefit from Mother Earth. Some also mention the inclusion of the hills and some Christian saints. Once chosen, the leaves, together with some LEJIA [9], are placed under a stone or buried.

[9] LEJIA, called "llipt'a" or "lluit'a" in Quechua, is used to improve the extraction the alkaloid while 'chewing'. Most of the interviewees declare that its purpose is to "give flavour and consistency to the ‘chew’". It is made mixing the cinders of 'quinoa' (CHENOPODIUM quinoa W) and adding natural flavours such as cinnamon and clove. All these elements are further mixed with cooked potato or sweet potato (IPOMEA batatas L). There are various types of 'lejia' depending on where they were made or their flavour. The 'chewer' will choose one or the other depending on personal taste; he may choose from the 'Orureña', the 'pillagua', etc. All chewers are familiar with the composition of the 'lejia' and its preparation. Sodium bicarbonate or tobacco ashes are used when 'lejia' is not available.

The same person next offers a fistful to each one of the participants, stretching his arm. Each person must receive the coca leaves in a fold of his clothes or holding out both hands, palms up, to receive them (it is rude or sign of contempt to hold out one hand only). Everyone receives his share and then each person begins the careful process of "setting up" the 'chew' by placing the leaves, one by one, in their mouth, cutting off The tips. there follow some descriptions:

You first have Mother Nature, or Bombon, Mallcu Tunari and Mallcu Illimani 'chew' because we hold them to be 'achachilas' (powerful Andean gods). Holding the leaf on your hand, you blow on it saying. "For you, Mallcu Illimani. For you, Pachamama, my Mother. For you Mallcu Tunari. That you may help me, that everything goes well". Now leaves are received in a nylon (a plastic bag), but this is not the traditional ritual, because they should be received with a fold in the corner of one's coat or shirt if you do not have a 'chuspa' (a woven, small bag, square in shape and small - it is decorated with traditional Andean patterns - it hangs across the chest and it is used to keep the coca leaves) because it is rude to receive them in your hands (H109CB).

It is customary, when practising the "ch'alla" (blessing of someone's main belongings or the start of an important undertaking) to burn incense in honour of Pachamama or of the Tio (the Uncle) - the god that looks after the minerals in mines - you also offer (coca leaves) together with q'owa (LEPIDOPHYLLUM Terenusculm H) for they are a must in all rituals (H006CB).

There are customs, such as ceremonies in honour oƒ Pachamama, to see the future, to call back spirits who are causing harm to their relatives, in witchcraft, ... I saw this in our ancestors (H008CB).

To heal spells or "cast evils" (denomination of a culturally defined sickness) (H102CB).

To heal spells or "cast evils" (denomination of a culturally defined sickness) (H102CB). We always 'chew' on behalf of a being (a supernatural being) and we speak in Quechua (H024CB). As we start to 'chew', three coca leaves, the best, are given to Earth in offering; all those participating cross themselves. We kiss the soil that covers (the coca leaves), the intervention of the Virgin Earth or Pachamama is implored (H054CB).

Before 'chewing', before throwing the first leaf we cross ourselves (we make the sign of the cross) and we ask the Pachamama to be good to us, to grant us a good harvest, a good produce. Because the Pachamama is the owner of everything and we live and have food thanks to her (H129CB).

Without exception, everyone regards the 'chew' as positive, as an activity that is closely related to work. This aspect is emphasised by these who work in the fields or in mining:

If you don't use the coca (leaf), you can't work. (H023CB)

We farmers do it ('chew') usually in a given work context, this is very different from what is done by city dwellers. (H075CB)

Knowledge of the various uses of the coca leaf is widespread among these workers. This knowledge does not refer only to the energizer use at work but it also includes the various uses in rituals, medicinal applications, as a means for communication and as small amounts of money.

When people 'chew' at work seeking primarily its energizer properties, there is a clear relationship between the 'chew' and the amount of effort required: the harder the work, the more necessary the 'chew' becomes. Therefore, in general, men 'chew' more than women, especially among miners.

Almost all 'chewers' use the coca leaf as medicine for many, varied applications. Most have teas "for stomach ache"; women for menstrual pain and they know how to brew the teas themselves. It is also used for toothaches and headaches. The coca leaf is an ingredient in lotions and mixtures for "rubbing" for articulation ailments. It is also used to prepare cough syrups together with orange juice and onion extract. It is also used for sore throats, hypertension and mellitus diabetes. The Andean healers use the coca leaf to heal culturally defined diseases called "aire", "japekha" and the like. The external use of coca leaves in plasters is widespread in the rural context and is used in broken bones, contusions and treatment of wounds.

The "yatiris" or soothsayers use the coca leaf for the diagnosis of disease and to identify the person who will heal them: the physician or the "jampiri" (healer). Again, through divining, they help to find lost objects, advise on trips, business and sentimental decisions, etc.

The coca leaf teas are used to help digestion and are an alternative to tea or coffee after meals, especially in the urban context. Some have them daily at breakfast. Most 'chewers' drink coca leaf tea and use the leaves for medicinal purposes.

Although in Bolivia one can buy medicinal mixtures prepared according to traditional formulas and for various ailments, many of our interviewees healed themselves with mixtures they prepare themselves. Most 'chewers' in fact know how to prepare such mixtures and for what they serve. There follow some illustrations of this:

For coughing, you soak the coca leaves overnight and the following day you mix them with orange juice. You boil this for a short while. You drink this everyday together with juice made from onions and your cough goes away. That's how our grandmother healed us and I learnt it from her, so I do it and it works well (H 129CB).

The "picjcho" (the ball of coca leaves soaked in saliva) is wrapped up, salt is added and then it is applied to suck away the smelling (H022CB).

A healer, who was included in the sub-sample, names some diseases and how the coca leaves are used:

For, 'limphu’, abortion induced by accident, for 'chullpa', a psychological disease that goes into your heart on a full moon night; for 'japeq'a', a disease that toddlers suffer from - the toddler falls and cries and cries, pushes its head backwards; for 'chullpa tullu' or osteomyelitis, when bones come out; for sentimental contact between persons, when 'munachis' amulets are used for evil air; the person's face becomes crooked or is paralysed. The coca (leaf) is used to treat all of them. It is surrounded by 'q'owa' leaves (to fill a place with sweet smelling smoke) or a tea is made, depending on the problem (H1 09CB).

The interviewees know many places where you can find a good healer: "they live in Arque", "they are in Oruro, the ones in the mines are good"; "From La Paz, Potosi and Oruro"; "the best ones come from Charazani: the Kallawayas"; "the best are in Chuquisaca, in Bombona, to be precise"; "those from Puca Pampa", etc. Most 'chewers' have sought the services of these healers.

Most of the 'chewers' we interviewed said that they didn't know how healers came to have the knowledge they possess; they said, "I don't know" or, more frequently, "they were taught by their ancestors". " I was taught by my grandfather. Besides, you study the properties of all plants - it doesn't happen first like that (i.e. your becoming a healer)". A minority answered referring to Andean myths.

It is an inherited gift (H057CB). Healers are predestined by nature itself. They say, although I haven't seen it myself that when a strike of lightening kills them, another brings them back to life and the third makes them stand up and go. This the 'yatiri' (soothsayer), predestined by James. Others have their fate read in coca (leaves) to see whether they will be "yariris" or healers (H083CB).

Most coca 'chewers' do not know how to "read coca leaves" (i.e. divining but know who does it: the 'yatiris'). A third of them know some sort of primitive procedure to "read one's luck", that is, to foretell how they will fare during the day or as they start a trip or business deal.

I pick some ten (coca) leaves and I throw them all on a table. If they fall with the dark side up, it means sorrow, if they end with the shining side up, it means joy (H 122CB).

I know how to read some things in coca leaves. If something gets lost in a house and the leaves fall with the green side up, it means the object is in the house, if it falls white up, it is elsewhere. Good is green (the top side of the leaf) and evil is white. If a woman is deceitful, it falls white; if she doesn't, green. To read, you need the best leaves, they must be of a medium size, only four. Before throwing them, you must pray. I had my fortune told in coca leaves when I was cheated by a friend, I was told he cast a spell on me at the cemetery. This showed in coca. The healer took me to the place and we found a can oƒ Nido milk (Nestle's registered name), my photograph was there, full of pins, with grey socks, a pair of underpants; everything was wrapped up in black paper. He told that that's why I was having problems, I bled a lot from my nose. Next to what we found, there was a notice that said I would die drinking 'chicha'. Seeing this, my mother, she almost died! After, I cast off the spell, I had a lot of work. Many people offered me work. That healer tells your fortune for 1 Bolivian (US$ 0.20) and he sees well into the coca leaves (Hl 17CB).

Most 'chewers' have had their fortune told, had it "read in coca leaves" to find out about lost objects, to make sure a partner was faithful; to clear doubts about travelling. In the city of Cochabamba, the 'yatiris' that tell your fortune operate in public places and people from all social classes demand their services. If they don't speak Quechua, they are accompanied by an interpreter. Yatiris sit on the floor, the Quechua way, with their legs. There is a cloth spread on the floor and the coca leaves picked for the divination, leaves of different sizes, a little bronze bell and a cross. The client must put on the 'aguayo' (the name for the multicoloured cloth on the floor) an amount of money known as the 'silla' and only then does the fortune telling start. First there are prayers. The specialist, 'yatiri' drops the coca leaves onto the 'aguayo' from a certain height and goes on to read them as he talks and explains what his findings. If there are doubts or the client wants to have a more detailed information about something, the 'yatiri' repeats the process from the beginning. Only a minority of our interviewees who did not 'chew' have made consultations with soothsayers.

Most people make an offering before 'chewing'. Pachamama is mentioned and she is asked for the fulfilment of some immediate goal.

You make offerings to Pachamama, be it to bring good spirits (as protection) or evil spirits (for witchcraft) (H008CB).

Whenever you 'chew', remember Pachamama (H 129CB).

Offerings take place of Tuesdays and Fridays and on yearly festivals specially dedicated to that end. The following is a description of the 'ch'alla', or blessing.

The 'ch'alla' is celebrated with your family. On the table for offering, you put the 'q'owa': incense, a little statue of a llama made out of a llama's fat, 'mysteries', small square pieces of white candy with a picture on the centre - the latter depending on the activity we require the Pachamama to help us with. There is a different type of mystery for every type of activity. You can find pictures for every type of activity: for business, for love, to have a car, for the various free professions. The q'owa also includes other types of candy - sweet coloured balls and tasting of coca. All of it is put on top of embers until it burns out. Pachamama is the Earth, God (H 117CB).

Most coca leaf 'chewers', especially so those who have a rural background and belong to a low social class, believe that coca leaf is a foodstuff and that it can substitute traditional foodstuffs. A minority makes a clear difference between its effect in lessening a sensation of hunger and its being a foodstuff people believe it is indispensable. The confusion is worsened by media articles and publications that show the contents of proteins, vitamins and minerals the coca leaf has. Some of this information is published by the authorities as a way of countering the eradication of the coca bush. We quote the following regarding this point:

I have not tasted (it), but I believe that the coca leaf can replace foodstuff (H043CB).

There are regions where there is a shortage of food, but the inhabitants make up with the coca leaf; they are well and healthy (H054CB).

On occasions we haven't got money to have lunch and so we buy coca (leaves) because it is cheaper (H1 17CB).

(Coca leaves) are food. My father has told me that their juice is like meat (H1 14CB).

There are those who 'pijcha' ('chew') without eating (H109CB).

(Coca leaves) have a lot of vitamins, calcium, iron (H103CB). We had it scientifically explained that the coca (leaf) doesn't just serve to make drug (cocaine hydrochloride), but that it has many derivatives (components) that can serve as food and as vitamins. Unfortunately, we are not making use of this in our country. It is likely that in countries that are already developed, they are takng advantage of this (as a nutrient) and that they are "pulling our leg" (H083CB).

Other interviewees furnished opposing or better argued points of view:

No. (The coca leaf) is not a foodstuff since it makes you sleepy and removes the sensation of hunger. When you work a lot, you don't get tired, it's true, but you cannot use it instead of food because your stomach will make noises at night all the same - unless you 'chew' from dawn to dusk. But you would waste away from weakness, from lack of food (H095 CB).

(The coca leaf) is food, but not very much; because a little later you still feel hungry (H061 CB).

(The coca leaf) makes hunger go, just like food (H078CB).

All the interviewees, without exception, indicate that the 'chew' improves their performance and productivity at work. When work is hard, as it is in certain farming or mining tasks, its use is viewed is indispensable "without coca ('chew') we wouldn't be able to work" (H006CB).

The coca leaf is also used in other situations: as a token or present to one's future in-laws when asking for permission to many their daughter. The acceptance of the token or gift is taken to mean that the request has been granted. To indicate solidarity and membership of a group, as a symbol of identity, in meetings, funeral gatherings, and various other community rituals.

Most interviewees see no reasons for not 'chewing' or situations in which it should not be done. Most think there are no differences in the amount men and women 'chew' while working. A third of the interviewees state that men 'chew' more because they carry out the most tiring jobs; only a few state the opposite. There follow some illustrative quotations:

Women 'chew' just like men since they work twice as much taking care of the children (H008CB).

A women is happy with her spinning wheel and loom and she 'chews' less (H083CB).

Women? On occasions more, sometimes less; it all depends on the type of work done (H103CB).

Out in the country, we women 'chew' more, not in the city (H078CB).

Some 'chew' more, for example the women who sweep the streets who use it as filter not to breathe in the dust (H022CB).

Most interviewees say that 'chewing' continues in old age although heavy work is no longer carried out. Most do not make a difference between consumption levels of adults and old people. A fourth of our interviewees state that consumption increases in old age; a somewhat smaller proportion consider that consumption is dropped.

Except for infancy ("because they do not work nor do they know the traditions"), there is no set age for 'chewing'. Most start when they are 16 or 18 or when they start working hard. In rural communities, this happens when the young men return from compulsory military service at 19. Women 'chew' when they marry and the use is widespread in the fields and in the mines, "he who doesn't 'chew' gets a nickname and is isolated from the community." (H083CB)

Just under half of our interviewees taught their children, close relatives or friends to 'chew'. It must be remarked that learning to 'chew' is part of the process of socialisation and therefore, it is not necessarily taught in a formal manner, nor is the learning done in a purposeful way: "the 'chew' is not taught, it is learnt (observing the elder and reproducing their behaviour)". (H083CB)

In an urban context, in general, the various features associated to the traditional culture of the coca leaf are modified due to processes of acculturation and adaptation. As a result of these processes, some traditional uses become redundant or have been forgotten; others have changed their original true purpose and scope. The main differences are: eople 'chew' less in cities.

Out in the fields, it is a need, in the city, it is mainly for amusement. (H061 CB)

There is a ritualistic use and also a casual use associated to alcohol abuse, in various social strata. Here the level of consumption seems to equal that for hard work.

There is no perception of a specific lifestyle associated to 'chewing.' Although a few follow certain rules when 'chewing', rules they associate to the sacred nature of the coca leaf, these tend to be different from the traditional rules (for example, to make the sign of the cross before 'chewing').

Most don't know where to locate good healers because, in general, because they don't usually require their traditional services nor do they use traditional medicine in fighting against certain ailments (except for the coca leaf tea - whose use is, as we indicated above, quite widespread). None knows how to 'read in coca leaves' and, in general, when they do make use of 'yatiris', or traditional soothsayers, they do so for the same reasons and with the same expectations as the ones that drive them to look at playing cards or studying a horoscope.

Urban 'chewers', or those who are from non-Andean cultural regions, do not observe rituals in a strict manner, but they do assimilate some of them or, on occasions, re-elaborate them completely. There are, again, in the urban context, 'chewers' who do not know any of the rituals and Andean customs; or, if they know them, they no longer observe them.

There are 'chewers' in cities who only use coca leaves at parties and in social gatherings where alcohol is drunk, presumably to stay awake and diminish the depressor effects of alcohol. Students and teachers 'chew' in order to stay awake and improve their concentration (according to the data obtained, this practice is not detrimental to the quality of work performed.

Urban 'chewers' who have been uprooted from their original communities or who were born in the city, 'chew' less frequently and if they still hold on to ritual practices, they carry them out less periodically and systematically. Nevertheless, the yearly practice of making offerings to (the gods) in carnival time, is quite widespread and is carried out by people from all social strata.

Finally, and as an example of the dynamism and plasticity characteristic of all cultural processes, we furnish the following practice mentioned by an interviewee, a middle class, urban university student: "you make an offer to the piglet with coca leaves, each night at the bar. The purpose of the piglet is to attract patrons; on occasions, I do the offering myself" (H081CB). This piglet is, in fact, a piggy bank that some retail merchants use in their premises.

3.4 Typology of use/users

3.4.1 Definition of types

Coca leaf (Cochabamba)


Use takes place in festive or social contexts associated to enjoyment. Use is not primary in the lifestyles of the individuals involved although it may be so in certain conceptions of how to spend leisure time, (predominance of night life entertainment). The aim of use here is mainly to achieve greater enjoyment, but it is not a must. In fact, alcohol plays a more important role in the achievement of this goal. The party itself and the social intercourse that takes places are more important than use. The latter can take place in public contexts (bars, discotheques, etc.) or private (at home).


The use of coca leaves is primary to their lifestyles and, in general, it maintains its sacred character (see the definition in the footnote 8 in this chapter). It has multiple functions and its use and various applications are fully integrated in the traditional culture and in the Andean cosmic vision; instrumental and energizer, intimately associated to the work the users carry out (so as to increase their performance and to fight off fatigue, sleep and cold); medicinal: to heel and to diagnose culturally-defined ailments; magical-religious: to communicate with the super-natural world and thus obtain its protection; social: to maintain social cohesion and co-operation among the community members and as catalyst for relationships. In this type, these uses are maintained, although to a varying extent.

Use starts at the end of adolescence with the incorporation into working life and the characteristic use pattern (low quantities and daily use) is maintained relatively steady over time. All the users value the beneficial aspects of the coca leaf and its ritual and symbolic significance; none of the mentions problems, side-effects or negative consequences.

This type represents 66% of the sub-sample for the coca leaf. Three sub-types can be distinguished, depending on the extent to which they fit the traditional use model: a first sub-type which preserves with slight alterations the characteristic features of the traditional model (it represents 55% of the type, 36% of the sub-sample); two other sub-types in which one of the magic uses is given predominance: magical-religious (21% of the type and 14% of the sub-sample) and social (24% of the type and 16% of the sub-sample).


A model of use that exhibits modifications due to processes of acculturation and adaptation to the ways of life of contemporary society. It is more frequent in the urban context where the coca leaf and its uses do not have a primary importance in the users' lifestyles. As a result of acculturation and adaptation some traditional uses have become irrelevant or have become lost; others have changed their original meaning and scope. These users do not adhere strictly to traditional rituals, although they assimilate some of them and, sometimes, may even re-elaborate them completely. The basic characteristic feature is a decontextualised use, though to a varying extent and, emphasis on a given use, with a strictly instrumental function (energizer, socio-casual, medicinal), and relative exclusion of the others.

Although the pattern of use is like the one described for the traditional type, it exhibits significant differences in addition to these already pointed out in the definition: low or non-existent link with work activities; regularity in use but lower frequency of use; use of higher amounts in given situations. The link between the coca leaf and the traditional Andean cosmic vision is still there even if somewhat diffuse. In spite of these differences, all the users classified in this type value the beneficial effects of the coca leaf and none of them mentioned any negative consequences.

This type represents 44% of the sub-sample and three sub-types can also be identified depending on the predominance or exclusivity of coca leaf use: energizer (60% of the type; 20% of the sub-sample); socio-casual (27% of the type, 9% of the sub-sample); and, medicinal (13% and 5%, respectively).

4. Drug use history

4.1 Drug careers

Coca leaf (Cochabamba)

Over half of the interviewees do not know any type of illicit drug. Only a few have ever seen cocaine hydrochloride and some others, coca paste. Except one of them, the interviewees who had seen the side products just mentioned, added, "but I have not tried them".

In the Quechua language, mother tongue of almost half the interviewees, there is no term for drug. Among those interviewees whose mother tongue is Quechua or Aymara and who are bilingual, and among people from low social classes, the word 'drug' is associated almost exclusively with cocaine hydrochloride. This association is likely to be very common given that it is frequently made in the mass media. The same persons are surprised to learn that alcohol, certain pharmaceutical products and other substances they are more or less familiarised with fall in the category of psychoactive drugs.

Alcohol abuse appears implicitly as the most important use for most of the interviewees. This is so because alcohol drinking is maintained, one way or another, throughout a person's life. The use of tobacco, on the other hand, seems to be less significant. A 'chewer' who is a miner says, "I no longer smoke because I only did it when 1 was in the pit" (H128CB). Only one of our interviewees, a university student said he had tried various drugs, including coca paste and cocaine hydrochloride, before the 'chew'.

In spite of what has been said about the use of alcohol, interviewees indicate they prefer to 'chew' the coca leaf (recall that the 'chew' is not regarded anywhere as drug abuse).

4.2 Drug preferences and consequences of their use

Coca leaf (Cochabamba)

As it already been pointed out, the coca leaf is not regarded as a "drug" by our interviewees, especially by farmers. For them the word "drug" is associated to some harm to health. The 'chew' is regarded as something that is "natural and necessary". Most interviewees think that alcohol is the drug that causes the most damage: "alcohol is harmful and it gets you drunk, not so (the) coca (leaf)" (H083CB).

A fourth of our interviewees have had problems associated to alcohol abuse. These situations occur normally in an urban context: as a way of illustration: "I feel bad, because my ribs hurt from drinking so much alcohol" (H1 23CB).

It must be pointed out that some of the farmers we interviewed regard 'chicha' (a local alcoholic beverage made from fermented maize) as being different from an "alcoholic beverage". These are some of their opinions: "I don't like the 'chicha' around here because it has alcohol" (H1 1OCB), "I like 'chicha', not so alcoholic drinks." (H1 03CB)

4.3 Multiple use of coca side-products and other drugs

Coca leaf (Cochabamba)

Most of our interviewees indicate that a simultaneous use of coca leaf and alcohol is indispensable: "to give flavour to the 'pijchu' (the ball of coca leaves one 'chews')" (H0 OICB).

Regarding the relationship between the 'chew' and use of alcohol, it is necessary to make a distinction between work and social use contexts. When 'chewing' at work, the use of alcohol is minimal; it is used in the ritual practices before the beginning of the activity. In the social context, alcohol use may be high.

The amounts of alcohol used simultaneously with coca leaf vary considerably: "just a drink" (H0 57CB), "two bottles of 'singani' (aqua vita) for 8 people" (H1 28CB). There are preferences for the type of alcohol one drinks while 'chewing'. Most prefer to do it with 'chicha': "chicha turns the 'picjchu' sweeter; can't do without 'lejia'. (H0 53CB)"

When asked about the beverage that worst complements the 'chew', they indicated a great variety. It would seem that this is a very personal issue.

Only one of the interviewees stated that excessive alcohol abuse led him to 'chewing' more: "I used to sleep in the street when drunk and it is there that I learnt to drink (alcohol) and to 'chew' more." (H0 95CB).

Smoking does not always happen when 'chewing'. Smoking is indispensable only in rituals of offering and in other specific situations that form part of a ceremony. Some of our interviewees never smoke.

A minority of the 'chewers' we interviewed make use of drugs other than alcohol and tobacco.

5. Initiation of use of coca side-products

5.1 Age and year of initiation

Coca leaf (Cochabamba)

Average initiation age (on the first day of use) is approximately 19. Most interviewees were initiated before their 20th birthday. Over a third of the farmers were initiated before 15. A third of the interviewees were initiated before the sixties, over half the interviewees in the 60's and 70's. The rest in the 80's.

5.2 Context of use

Coca leaf (Cochabamba)

The initiation into the ‘chew’ is usually associated to work, mainly work in the fields and in the mines. Nevertheless, a significant number of the interviewees are initiated through collective religious ceremonies, funeral parties and like rituals.

Most interviewees are initiated by reproducing the behaviour they observe in family members, colleagues at work and, less frequently, friends (it is part of the socialisation process in rural areas). Initiation in the 'chew' in other socialisation contexts affects a minority of users. The latter only takes places in the cities.

5.3 Method of supply

Coca leaf (Cochabamba)

On the first day, the coca leaves were given by someone. This is the usual situation. The individuals who have coca leaves, share them out in the group. Coca leaves are always available in community work and ritual contexts.

5.4 Amount and method of use

Coca leaf (Cochabamba)

The amounts used in the first day of ‘chew’ vary: from a minimal quantity (0.4 grams) to greater quantities - in some cases over 50 grams. The most common situation is that two balls be 'chewed' the first day. The normal practice is to 'chew' three times on a working day. A "pijchu" ('ball') weighing approximately 8 grams is used every time.

5.5 Previous knowledge and reasons to use

Coca leaf (Cochabamba)

All the interviewees had a good prior knowledge about the coca leaf and the reasons why it is 'chewed'. Most used it the first time as part of a context of work or ritual. A minority used it for its medicinal effects. Most interviewees, particularly traditional coca leaf 'chewers', state that the predominant reason for the first use was to feel its invigorating effects.

5.6 Effects and evaluation of the first use

Coca leaf (Cochabamba)

Curiosity for feeling the effects described by experienced 'chewers' (more energy, less sensation of hunger and thirst). On occasions, you experience the surprise of perceiving that your tongue goes numb: "everybody laughed when looking at me, because my tongue was stiff, numb; and I wanted to shout and I couldn't. (H183CB)"

Most individuals praise and value the taste and sensation of lucidity, on occasions, tranquillity, that overcame you a little after starting the 'chew'.

Those who used it first as part of work, felt that on having done it, they perceived a kind of "positive change" in their social status (passing ritual): "one begins to 'chew' aged 10-12 when one goes into the pit; it is like joining the array: it makes a man of you. You are respected" (H1 83CB).

Most state that you cannot turn down the initiation into the 'chew': "no, since I was a miner, I had to 'chew'. to work" (H128CB); "I could not turn down 'the chew' on that occasion because I know that the person who doesn't share the culture of his ancestors must be very much of a renegade. (H0 43CB)"

Most of the interviewees stated that they liked to undergo their first experience: they value the flavour of the coca leaf, the experience of a concrete effect (take away your thirst, tiredness, feeling invigorated, etc.) or, they relate their experience with events that happen later in a magic relationship: "the first experience had good results: things went well for me that month and then I wanted to continue with that kind of luck and so I continued (to 'chew')" (H083CB).

Some interviewees describe the fear they experienced when facing the unknown: "I was afraid I would have a diarrhoea because I knew 'the chew' made some people sick." (H022CB). "I knew I was not supposed to swallow the leaves; that makes you sick." (H095CB). Only a minority of the interviewees describe actual negative experiences such as pain in their lower stomach, numbing of the tips, tongue and palate.

6. Characteristics and evolution of use

6.1 Length of use

Coca leaf (Cochabamba)

According to the data gathered, most interviewees have used it regularly after the first experience. This regular use takes place in most cases before they are 20.

Most of the sub-sample have been using it for over 10 years; over half, more than 20 years. The 'chewers' who have used it longest are the farmers; among these, a 65 year-old Quechua farmer and a 63 year old Quechua woman who still works selling vegetables. Only a few have started to use it recently (less than five years); most of these are instrumental type 'chewers' who are city-dwellers.

During the career of use, over half the sub-sample had periods with higher levels of consumption (intensive periods). These periods, among farmers, coincide with more work in the fields: sowing, harvesting, etc. In other cases, the periods of intensive use coincide with festivals or rituals. It would be better, though, to refer to these periods as occasions when the level of consumption is above the usual, customary level. These characteristics of the career of use are not as common among the instrumental type users.

It can be said that practically all the interviewees had 'chewed' in the last six months and are, therefore, active users (according to the criterion adopted by the project). Nearly half had 'chewed' the day before the interview and practically all of them the month before.

6.2 Abstinence periods

Coca leaf (Cochabamba)

Approximately a third of the interviewees have stopped 'chewing' on various occasions for short periods - periods that last from a few weeks up to three months. Nevertheless, these interruptions have not been frequent for most cases. Their occurrence was due to various circumstances. Some of these are: "I had no money" (H078CB); "I was in the city" (H129CB), "my brothers who live in Santa Cruz (a Bolivian city) came and they tell me off for 'chewing'" (Hl 17CB); "I could not 'chew' when I was in the USA because my relatives could not send me coca leaves because of the problem of traffic of drugs with the Yankees - they confuse the leaves with cocaine hydrochloride" (H027CB); "because of the raining period, we don’t work and so these is no need to 'chew'"(H 184CB). These short periods without use are more frequent among instrumental 'chewers'.

A minority stopped using for periods lasting more than 6 months. The main reason why they stopped 'chewing' was their compulsory military service (the 'chew' is not permitted) and in one or two cases, travelling outside the country.

6.3 Characteristics of use: quantity, frequency and method

6.3.1 Initial period

Coca leaf (Cochabamba)

Over half the interviewees 'chewed' daily during the initial period, although with breaks. A minority 'chewed' on weekly periods (1 to 4 sessions/days of use per week); another 'chewed' monthly (1 to 3 sessions per month) and the rest, sporadically (less than a session per month).

The quantities in this period vary from a few leaves (approximately one gram) up to 920 grams over a week. Most users, especially the traditional type, used an average amount of 24 to 32 grams on use days (3 or 4 8-gram 'balls' approximately.)

Instrumental type 'chewers' exhibit in this period weekly or monthly frequencies of use. When using, the amounts are, approximately, 3 ‘balls' daily.

6.3.2 Intensive period

Coca leaf (Cochabamba)

During the intensive period, the approximate average quantity used is 130 grams/day and frequency is always daily (in fact, several times a day). The amounts used vary significantly: from amounts not exceeding 30 grams/day - an amount that is quite common - to amounts that go beyond 200 grams/day. Some interviewees have used greater amounts, which could be regarded as exceptional. For example, a long-distance driver who used up to 1380 grams/trip (a trip usually lasts more than a day); a former miner who used 230 grams/day when working in the pit; a farmer who used 460 grams daily when he worked 'treading on coca leaves'. This very tiring work is part of the process of macerating the coca leaves in the first phase of the elaboration of cocaine hydrochloride (for a description of the process of elaboration of coca paste see section 2.1).

In general, this period does not last long. Traditional type users, i.e. 'chewers' show a very steady pattern of use that includes, in addition, periodical or seasonal increases, closely related to periods when work demands are higher. When these periods end, the level of use drops and returns to a habitual pattern. Among instrumental type users, users who consume mainly for casual purposes, here again one notices a short period of intensive daily use. In these cases, the increases are usually related to concrete festivals or ritual uses.

6.3.3 Current or last period of use

Coca leaf (Cochabamba)

In the last month of use (current or last period), the prevailing frequency of use is still daily for most interviewees. A fourth use weekly and the rest, a minority sporadically.

The amounts of coca leaves used vary a lot. Nearly all use from 1 to 4 'balls' ('pijchos') per day (8 to 32 grams of coca leaves). A minority use smaller amounts.

6.3.4 Habitual use

Coca leaf (Cochabamba)

Most users maintain rather stable frequencies and amounts during their careers of use. Most of the sub-sample maintain a daily frequency (most of these interviewees belong to the traditional type). Among the rest, most use with a weekly frequency and a minority 2 or 3 times monthly or sporadically.

In all cases, they usually maintain the same level of use that was determined during the initial period, with few changes and with certain regularity. There is more variability among city dwellers. One notices periods of more intense use. Traditional users tend to maintain a stable daily pattern of use from the start. Nearly a third of them show a progressive increase in use, during the initial period, until this levels off: in general at 24 to 32 grams/day (this assumes 'chewing' 3 to 4 balls of coca leaves during a working day. Variations usually occur when work becomes more intensive.

Instrumental use, solely for medicinal purposes (2 cases) is daily from the beginning and supposes stable use of a small amount (15 to 20 coca leaves). These consumers do not use 'lejia' nor baking soda.

6.4 Evolution of use

6.4.1 Temporary patterns of use

Coca leaf (Cochabamba)

Most coca leaf users exhibit a stable pattern of use over time. This is particularly so among traditional type users and is not affected by periodic increases in use (equivalent to intensive periods) related to increases in work demands in agriculture, festive periods or rituals. Among the traditional users one must consider some exceptional cases that correspond to the ascending and descending patterns. All of them are due to the undertaking of tasks that demand greater effort over long periods. When these activities cease, the level of consumption drops and then levels off.

Temporary patterns that exhibit increases and decreases, that is, irregular and intermittent patterns, although a minority, are more frequent among instrumental type users who tend to be city dwellers.

6.4.2 Evolution of frequencies and amounts

Coca leaf (Cochabamba)

For most interviewees, the level of use in their careers remains relatively stable: Frequency of use is daily and the amounts range from 3 to 4 balls/day (this is equivalent to 24 to 32 grams). The evolution of use, right from the beginning, undergoes only minor changes during periods of greater work demands. As mentioned elsewhere, there is a close relationship between the amount used and the increase in work among the traditional type users.

Among the instrumental type users, the level of use tends to be stable over time. Nevertheless, there is more variability among these users. Frequency of use may vary from daily to weekly or even to sporadic, or vice-versa in particular periods of some persons' careers of use. The amounts may vary from a few leaves to several 'balls' per day; never more than 4 (this is equivalent to 32 grams of coca leaves). These users may also show higher increases in the amounts used both under very specific circumstances and during very short periods.

6.4.3 Evolution of the methods of use

Coca leaf (Cochabamba)

The method of use ('the chew') does not change throughout the career of use.

7. Context of use and supply

7.1 Context of use

7.1.1 Initial period

Coca leaf (Cochabamba)

Use takes place predominantly at work, especially amongst 'chewers' who are farmers or miners. In the traditional type of use, the context of use is one's relatives: the coca leaf is shared at work, home, in rituals and ceremonies and social gatherings.

The 'chew' with one's fellow workers, friends and neighbours both at work and in ceremonial, ritual and social activities is quite common amongst most interviewees. These social relationships with other users are more important than the relationships amongst 'chewers' who are not farmers or amongst city dweller 'chewers'. Only a few' chew' exclusively in entertainment contexts such as bars and the like. They belong to a sub-type of the instrumental type: the socio-casual sub-type.

There is also consumption while being alone - this is characteristic of a minority. It is related to the kind of work performed: long-distance drivers, farmers selling their produce; students and professionals while studying or working alone.

7.1.2 Intensive period

Coca leaf (Cochabamba)

In this period, the context of use (places, surroundings, persons and activities) does not change much. In any case, as it has been shown in previous chapters, the workplace gains significance, especially among farmers. So do rituals and ceremonies.

7.1.3 Current or last period of use

Coca leaf (Cochabamba)

The context of use characteristic in the current or last period (last month of use) are the same as in the two periods described earlier. 'Chewing' takes place preferably at work, with relatives and friends. Ceremonial and casual activities are significant in most cases.

Nearly a third of the traditional 'chewers' also use it anywhere (some interviewees came to the interviews with their 'chew balls' in their mouths) and by themselves on occasions, even if not doing any particular job. Some others use mainly as part of ceremonies or rituals. City dweller 'chewers' use in surroundings of social interaction related to leisure activities (bars and the like). It is only in these scenarios that the 'chew' is directly associated to alcohol abuse.

7.1.4 Habitual use

Coca leaf (Cochabamba)

Throughout the careers of use of our interviewees, the characteristic places of use are: the work place and one's home or the home of one's friends and relatives (coca leaf). The social links that are characteristic throughout the career of use are: relatives, work mates and friends. The predominant activities where use takes place throughout the career are: work, rituals and socialising in the community and in groups.

7.2 Street market

7.2.1 Availability

Coca leaf (Cochabamba)

Since coca leaf is legal in Bolivia, this can be freely obtained in the normalised market just like any other product. Coca leaf is bought and sold in markets in the cities. The dealers tend to be women who sell it by the pound (one pound equals 460 grams), ounces (one ounce is equal to 30 grams) or handfuls (a handful is equal to, approximately, 16 grams). 'Lejia' of various types, origins and quality can also be obtained (see footnote 3, chapter 3) and, house-rolled tobacco cigarettes, known as "k'uyunas" (this Quechua word means crooked - it describes the shape of such cigarettes quite well). These cigarettes are smoked when 'chewing'. In some offering rituals, the use of tobacco, especially 'k'uyunas' is indispensable.

7.2.2 Methods and occasions of supply; changes in the operation of market

Coca leaf (Cochabamba)

Most interviewees buy the coca leaf in the open market. In the sub-sample there are some producers who use their own product, logically. A minority receive it as part payment for work. Interviewees say it is more difficult to buy coca leaves in the rainy season (because of problems in the transport of the goods) when there is a clear diminution in supply. This seems to be the only significant variation in the operation of the market. This reduction in supply increases the price.

7.2.3 Characteristics of suppliers and relationships between users and suppliers

Coca leaf (Cochabamba)

The relation is strictly one of business. Coca leaf retailers buy from producers 50-kilogram bales, and then sell the coca leaves in small amounts. The price of the leaves increases as it travels away from the centres of production, generating work for a series of tradesmen.

A minority of interviewees, farmers who grow the coca bush, use their own produce and sell the rest in the coca leaf markets in settlements near the growing area (Chapare). The growers tend to be Quechua or Aymara native farmers or even former miners. Their only real income comes from the sale of the coca leaves which permits them to live in a modest way.

In spite of the fact that the purchase and sale of the coca leaf is legal, there are usually problems in transporting the bales or even smaller amounts away from the growing zones. One of the interviewees says the following: "they (the police) tried to confiscate it from me (at the road control points) for having five or ten pounds of coca leaves (2 to 4 kilograms)" (H083CB).

7.3 Amounts, price and quality

7.3.1 Amounts and form

Coca leaf (Cochabamba)

Most coca leaf 'chewers' buy it in small amounts (under 460 grams). Only a few buy more (up to 4 pounds, 1840 grams) and do so for family consumption. Only one interviewee buys 4 to 5 kilograms for his personal consumption given that where he lives, in the mining region, its prise is higher. Another exchanges his produce for coca leaf. He says: I exchange a sack of potatoes weighing 11.5 kilograms for two and a half pounds (1150 grams) of coca leaf or a sack of broad beans (VICIA Fava L.) for a pound of coca leaves (460 grams). But this is not a fixed system; sometimes the coca leaf goes up or my produce goes up, in winter. Then you don't change for the same amounts. (H129CB).

7.3.2 Price and quality

Coca leaf (Cochabamba)

The smallest amount bought is approximately 16 grams (a handful) for 20 cents of a Boliviano (US$ 0.04). A pound (460 grams) from the Chapare region costs Bolivianos 3 (US$ 0.65). The coca leaf from La Paz - preferred on account of its taste and sweet flavour) costs 7 Bolivianos per pound (US$ 1.7). You get a discount for larger amounts.

Interviewees regard the price-quality relationship as good. Fresh coca leaves cost more and the price goes up in the rainy season.

Some interviewees relate price rises to measures taken to curb drug traffic. One says the following:

The price goes up when the 'narcos' (traffickers) are buying a lot to elaborate cocaine; it goes down when the 'leopardos' (specialised police body) do not allow them to elaborate and so the price goes down. (H086CB).

By their taste, they recognise spoilt leaves but, seemingly, they cannot detect the presence of weed killers or insecticides. Some think the producers would be able to do so.

I don't know about that ... Now that you ask it might be good to know when (the coca leaf) has weed killers. I think the producer knows this in detail. (HO 12CB).

A producer, however, said the following:

It is not easy to tell, but the Yankees have brought white butterflies to feed on the coca leaf and now it is hard work to grow coca. (H1 05CB).

Most interviewees state that the money spent on coca does not affect their economy. A minority answered: "It is very expensive." A woman who sells vegetables from a stall in the open air market said: "Sometimes I only earn enough money to buy my coca leaves" (H078CB).

On average, the monthly expense on coca leave is approximately US $5 to $6. In some mining companies, the miners are given coca leaves and this is discounted from the pay.

8. Reasons, functions, effects and consequences of use

8.1 Reasons and functions

8.1.1 Initial period

Coca leaf (Cochabamba)

The coca leaf is fully integrated in the traditional Andean culture whose main function is to be a source of energies for the execution of work especially among farmers and miners (traditional use). The relation 'chew'-work is inseparable in most of the many narratives made by interviewees: "you don't chew without a reason; the main reason is work" (H1 29CB), "the 'chew' is important for us farmers; we would die of fatigue if we didn't do it" (H0 75CB).

Approximately a third of the interviewees also mentioned other reasons for use during the initial period (from the first experience until the establishment of regular pattern of use): socio-cultural, ritualistic or socialising reasons; a signal of belonging to the community "I had to 'chew' until I learnt to be part of the community" (H1 83CB).

The search for a stimulating effect is predominant among students: "I concentrate better." (H0 51CB), and also among instrumental type users who 'chew' to fight off fatigue and sleepiness (for example, long-distance night driving).

8.1.2 Intensive period

Coca leaf (Cochabamba)

The predominant reasons and functions that motivate use in this period (a period of variable duration, characterised by a particularly high level of use vis-a-vis habitual use) are still related to work: there is more 'chew' in response to more demanding work. In the case of instrumental type users, there is a particular concentration of ritual or festive activities. Once these are over, use descends to habitual levels.

8.1.3 Current or last periodd

Coca leaf (Cochabamba)

In the current or last period (last month of use), most traditional 'chewers' indicate as their main reason for use, the energy it gives them for the execution of their work. Its use is also important in rituals and community festivals since the 'chew' plays a key function in most of the (traditional Andean culture). Most city-dwellers (instrumental type users) use when they participate in ritual activities and community festivals, for the reasons mentioned above and, in socialising surroundings since the coca leaf, its use and mutual exchange are fully integrated in them and regulated by culture.

We 'chew' in the get-togethers we have on Friday nights with some relatives and friends. It is a harmonious environment where we meet. These get-togethers are in devotion of a patron saint, the lord of god fathers we light up candles, we pray, we 'chew' and we have a few drinks. (H1 27CB).

8.1.4 Habitual use

Coca leaf (Cochabamba)

The predominant characteristic reasons and functions throughout the interviewees' career of use are the following: energizer (instrumental), linked to work and cultural - when referring to coca leaf.

8.1.5 Evolution use: reasons and functions

Coca leaf (Cochabamba)

The reasons and functions for use remain constant throughout their careers of use in most cases.

8.2 Effects

8.2.1 Postive effects and strategies

Coca leaf (Cochabamba)

The most outstanding immediate positive effects are a diminution in the sensation of fatigue and a greater motivation for work. In addition, users enjoy the taste of the coca leaf and perceive that while 'chewing' they feel less hunger and thirst. A minority say that feel "a lot of energy" and, at the same time, "peace and tranquillity"; others single out its medicinal properties.

It helps digestion. It heals diabetes. Since I started 'chewing', my health has improved. (H1 02CB).

Most users indicate that the effects are better perceived when the coca leaf is chewed together with 'lejia' which, in addition, increases its pleasant taste. This is particularly so with sweet 'lejia' (see footnote 3, in chapter 3).

8.2.2 Negative effects and strategies

Coca leaf (Cochabamba)

Nearly all interviewees declare they have never experienced any negative effect when 'chewing': "nobody feels negative effects. The (coca) leaf is very good for everything, not in vain did the Incas use it." (H0 57CB).

A few say that on occasions they experience certain disagreeable effects; for example, when the taste of the leaf becomes piquant, they interpret this as a signal of bad luck. So they get rid of the 'ball'. Some interviewees say they don't like the numbness of their tongue and that sometimes they feel a "burning" of their gums or tongue. Others indicate that they don't like the smell or the residues that linger in their mouth after 'chewing’ nor the green colouring of their teeth. Only one indicated that if he has more than the usual amount he feels nausea, restlessness and "mental fatigue", another related diarrhoea to use, a problem he fixed drinking a camomile tea (Maricaria Chamomilla C.)

8.3 Consequences

8.3.1 Craving and strategies to stop using

Coca leaf (Cochabamba)

As it has been explained in section 6.2 (Periods of Abstinence) in Chapter 6, most interviewees have used continuously throughout their career of use. Among the minority who stopped using for longer than six months (while doing military service or staying abroad) only a few reported a need for 'chewing' in certain circumstances. Nevertheless, this "need" did not seem significant nor did it create a state of anxiety that required treatment. In fact, all of them declare that they didn’t do anything about it; they just "grinned and bore it". Rather than craving, what they express is nostalgia for everything, not just for the 'chew'.

8.3.2 Positive consequences in relevant aspects of social life

Coca leaf (Cochabamba)

All the interviewees are of the opinion that the use of the coca leaf has positive consequences, in general terms.

Over half the interviewees consider it helps in their study, improving concentration and reducing fatigue. Students see as positive the fact that they can stay up to study. A minority do not find any contribution to study. The remaining interviewees did not comment on this aspect since they are not students.

Most interviewees find the 'chew' positive for work. Work benefits from 'chewing'; the more so the more intense work is because the 'chew' increases productivity and diminishes fatigue. This opinion is widely held among farmers, former miners and long-distance (lorry/bus) drivers. A few do not find the coca leaf advantageous in this context, nor have they used it for that purpose.

Nearly half consider it is indirectly advantageous for their personal income because it increases their productivity. For others whose income results from growing, transporting or selling the coca leaf, it is their livelihood: "It is the source of life. My wife and children eat thanks to it." (H1 14CB). Some declare that its therapeutic properties help them to save money by being a cheaper alternative to formal medicines. A woman who treats her diabetes with coca leaf says, "I save Bolivianos 40 (US$ 8) on a doctor and medicines." (H1 30CB). A few declare it lacks any advantage in this aspect.

Most think the coca leaf is a positive influence on physical health, invigorating and energising one: "it keeps you healthy" (H1 09CB), "it protects your teeth against cavities" (H1 14CB), "everyone should use (the coca leaf), that way people would be healthy" (H0 57CB).

A minority think 'chewing' has no positive consequences. This way of thinking does not necessarily rule out the therapeutic value of other ways of using the coca leaf teas or other uses (mentioned in section 3.3, chapter 3). It is also important to recall the diagnostic and treatment of culturally defined diseases.

Most find it helps lucidity and capacity for concentration. Nearly a third indicate it does not affect mental health or intellectual functions.

The second aspect (the first is work) interviewees find the coca leaf has the greatest positive consequences is socialising and, in a wider sense, the survival of the traditional Andean culture. Most indicate that the fact of sharing the 'chew' improves sociability and, according to traditional type users, it also expresses and reinforces community links. 'Chewing' as part of festivities fosters socialising, especially when alcohol is drunk simultaneously. In the ritual and religious contexts, the 'chew' and the other uses of the coca leaf express and reinforce the feelings of belonging and cultural identity. For most traditional type users, not 'chewing' can be identified as a rejection of traditional Andean identity and of the systems of values and beliefs they share; it can even be an offence.

Although some interviewees declare that the 'chew' "tranquillizes" and so fosters a diminution in aggressiveness and avoiding conflicts, such effects must be regarded as irrelevant.

Most think that the 'chew' reinforces their courage to face up to problems. The rest, about a quarter, find no positive consequences in this regard.

Just under half the interviewees indicate that the coca leaf influences in avoiding accidents because its use increases the level of alertness and helps to fight against fatigue and sleepiness. This point of view is confirmed by two long-distance drives who always 'chew' while driving: "I believe that if I hadn't used (the coca leaf) in my trips, I would have had many accidents. Because coca takes away sleepiness, you are more alert on the road" (H0 57CB). Nearly a quarter think the coca leaf has no effect on avoiding accidents; the rest, over a third, do not comment on this respect.

In short, only a few consider that none of the aspects considered has improved as a result of using the coca leaf. The rest, (a minority) when they rank them, mention one or several of the following: health, study, livelihood, and avoiding accidents while the majority identify the advantages gained in the execution of their work and/or in socialising as well as its role as expression and symbol of cultural integration and belonging to a community.

8.3.3 Negatives consequences of use

Coca leaf (Cochabamba)

Nearly all 'chewers' say that use does not involve any negative consequence.

A minority state that those who do not chew reject 'chewers'. This rejection arises from being "modern"; the 'chew' then is seen as a sign of 'backwardness' and 'poverty', something to do with 'the indigenous population'. This tends to happen to anything associated to traditional Andean culture. Growers of the coca bush point out the repression they suffer from law-enforcement agencies. This is what a grower from the Chapare region says:

They want to associate us to drug traffic. We sometimes have problems with the UMOPAR (drug-enforcement police body) who do what the DEA 'gringos' (from the USA) tell them to do. (H1 03CB).

A minority state that the coca leaf "brings about problems" only when it is used together with alcohol. The problems here are associated more to alcohol abuse.

Nearly the totality of interviewees consider that the expense made on purchasing the coca leaf is not detrimental to their economy.

Nearly a quarter have witnessed discussions over the price of the leaf, but such events are common in the process of negotiating a price. They have also witnessed violent scenes produced by law-enforcement agencies.

There are problems every day as a result of their wanting to reduce the coca fields. Members of UMOPAR take us out of our houses, they beat us, they rape our wives and daughters. We have to run away when they do house searches. (H1 14CB).

Nearly all 'chewers' state they have not been pressurised to abandon the 'chew’. However, some stop 'chewing' when they move out of their permanent residence or to avoid rejection from visitors or other people. This would account for a good many of the interruptions in use for short periods.

9. Health related problems and health care services

9.1 Perceptions of risk

Coca leaf (Cochabamba)

Nearly all interviewees think there are no risks involved in using the coca leaf. It is not an addiction but a habit (belonging to the traditional cultural context) (H0 13CB). Traditional type users explain in certain detail that the characteristics that define their use are not problematic (in fact, they make a distinction with other types of use that might be): culturally regulated use (by customary use), mainly associated to work and to the amounts and frequency as determined by "tradition".

As indicated throughout this report, use as performed by all traditional users (most individuals in the sub-sample and in the user population as a whole) and most instrumental type users corresponds to these characteristics. The remaining users, though not fitting the traditional pattern of use, also use moderately and none of them reports on "problematic, uncontrolled or risky use".

The following are mentioned as risk indicators: using "outside the work context" (H0 01CB), "every day, including rest days" (H1 29CB), not to observe pauses lasting 3 to 4 hours between one 'chew ball' and the next (habitual use frequency). All these indicators are strictly related to work patterns. In general, it is also considered as a risk factor to use "exaggerated amounts" or when there is no justifying motive. Risk factors will only become real if there is excessive length of use or frequency. Should these circumstances exist, something thought to be exceptional, and if they happen together, some interviewees think the 'chew' could become an 'addiction'. If this situation arises (something equivalent to dependence), these users will not be able to stop 'chewing' and if they do, "they will despair" or, according to these interviewees "would strongly feel the lack of the coca leaf".

Rounding up this point and purely as a theoretical exercise, it is worth considering the possible existence of traditional type users who can be regarded as drug abusers. Were they to exist (the data obtained seems to hint at it), they would be aged individuals, no longer capable of performing work or participating in community activities, be they religious of festive, who do not feed well and whose main energy source is their 'chew' of the coca leaf. They 'chew as they have done all their lives; even though the reasons for doing it have long disappeared. It might be that 'chewing' is their only activity. If this is true, it might merit some investigation: this 'dependence' on the coca leaf does not imply a problem from the perspective of public health, nor, probably for the old people themselves. In any case, the number of these cases must be negligible, being fewer than of those that are prescribed benzodiazepines in developed countries.

Further exploring this theoretical aspect, it is also possible that some individuals develop a dysfunctional use of the coca leaf with consequence, similar to those for other coca side-products. This unlikely type of use would effectively require the daily 'chew' of massive amounts of coca leaf - with the inherent technical problems involved (it is worth remembering that in the 'chew' the leaves are sucked - not chewed, in fact). It is more likely for isolated cases of individuals whose level of use is very intense, not related with traditional use; a more or less compulsive use (dependence?), similar to the use that exists for certain stimulant beverages and having similar consequences.

9.2 Knowledge about treatment services

Coca leaf (Cochabamba)

Virtually all interviewees are completely unaware of the existence of treatment services for drug-related problems. A third confuse them with institutions that deal with prevention since their names are often heard/seen in the mass media. Only three interviewees mentioned the name of one of the most important and best-known services in Cochabamba and, only one knew its address (having been hospitalised because of alcoholism). Other than this interviewee, none knew about the existence or characteristics of the treatment or rehabilitation programmes.

9.3 Use of the treatment services and risky behaviors

Coca leaf (Cochabamba)

None of the interviewees has had health problems caused by or related to using the coca leaf, nor has any of them sought out help to quit the 'chew' or gone to a treatment centre or met someone who has. The one interviewee who has used treatment services did so because of alcoholism.

10. Final remarks, conclusions and recommendations

Lifestyles and the role of use

Coca leaf (Cochabamba)

The lifestyle associated with coca leaf, traditional type users (Cochabamba) is intense work and a relationship between the individual and nature (mother Earth) - the traditional Andean cosmic vision. Its characteristics correspond basically to Quechua and Aymara traditional culture. In this lifestyle, the 'chew' and the various other uses of the coca leaf play a central role. Some instrumental type users exhibit some of these features but their lifestyles are not specific and the coca leaf plays a secondary if not negligible role.

A culture of use

Coca leaf (Cochabamba)

Once again, the use of the coca leaf has to be treated separately given its integration in a traditional cultural context where it is a socialising element (traditional use). The move towards migration to the city and the resulting acculturation has somehow modified or re-elaborated some of the features and cultural/traditional contents of its use showing the flexibility that characterises cultural processes. An example of this is the 'chew' as practised by qualified professionals and intellectuals who belong to the white urban middle class, as a symbol of belonging and identity.

Careers of use

Coca leaf (Cochabamba)

For most coca leaf 'chewers' [what is considered] the drug is cocaine hydrochloride because that is how it is portrayed in the mass media. Accordingly, none of them regards the coca leaf as a drug nor does any of them accept its being considered alongside the other coca side-products. In fact, these interviewees have only used alcohol (most of them) in their career of use and tobacco (a few). Before using coca side-products other than coca leaf, most interviewees had used alcohol, tobacco and marijuana. The latter tends to be the illicit drug of initiation in all the participating centres.

Mulitple use

Coca leaf (Cochabamba)

Alcohol abuse associated to the 'chew' while working is limited and constitutes an element in the traditional religious rituals (traditional use, Cochabamba). In socialising contexts, private or public, the level of consumption is higher fulfilling a culturally defined function in such contexts: mediator in social intercourse, stimulant or a booster of sociability and enjoyment, means to reach pleasurable levels, etc.

Initiation into use (coca-side products)

Coca leaf (Cochabamba)

Whereas the coca leaf has been used for thousands of years, the other coca side-products belong to the last half of this century [1900s]: Ibadan, cocaine hydrochloride in the 80's and crack in the late 80's; Cochabamba, coca paste in the 80's and cocaine hydrochloride from the middle of the decade; Rio de Janeiro, intravenous cocaine hydrochloride use from the late 70's (any beginnings of use after 1985 are not common). In Sao Paolo, use starts later - it is likely that some of the differences between these cities lie in the age differences between the interviewees from these cities - they are younger in Sao Paolo).

Duration and characteristics of the career of use

Coca leaf (Cochabamba)

Most careers of use last over 5 years and there are also frequent examples of careers lasting over 10 years. Those lasting less than 5 years are about a quarter. The longest careers of course correspond to the coca leaf sub-sample (Cochabamba); over half the interviewees have used for over 20 years.

The period between the first experience of use and the start of a regular pattern of use has been called initial period. This does not always appear in every case. Most coca leaf lack an initial period.

The traditional use of the coca leaf (Cochabamba) exhibits periods of maximum use that are periodic and regular, reflecting seasonal changes in the agricultural/festive cycles. Such periods are usually short (days or weeks). Among instrumental type users there are also intensive periods associated to religious or festive activities; once these are over, use goes back to its usual level.

Characteristics of use

Coca leaf (Cochabamba)

The most characteristic frequency, especially among dysfunctional type users or among traditional type users (coca leaf, Cochabamba) is daily use. Use with weekly, monthly or occasional frequencies is very common among ... instrumental type users of coca leaf in Cochabamba.

The amount of coca leaf used (Cochabamba) tends to remain stable over time - including its periodic increases. This means 3 or 4 'balls' per day (24 or 32 grams of coca leaf) for traditional users. Instrumental type users exhibit more variability and the amount is context-based. The increase in intensive periods is quite marked (an average of 130 grams/day) but it does not last long and the use falls back to habitual levels once the causes disappear. In exceptional cases and only due to work demands does the intensive period last long with high level of use.

Use context

Coca leaf (Cochabamba)

Use at the work place/context is predominant among traditional coca leaf 'chewers' (Cochabamba) .... The relative importance of the work place/context for use does not usually change throughout the career of use while the user remains an active worker. Use in the private context (private house) is also significant in the coca leaf sub-sample (traditional and instrumental type) (Cochabamba).

Use in a public context is ... the usual context mainly ... or the sub-type socio-casual/recreational (instrumental use) for the coca leaf sub-sample (Cochabamba).

Except for coca leaf traditional type users (Cochabamba) who tend to 'chew' together with work mates and relatives while working mainly in agriculture, users in the other samples and sub-samples tend to use mainly among friends and acquaintances.

Traditional type use (coca leaf) is associated to work and/or ritual/socialising contexts and so remains stable. In fact, a change in the work/socialising/ritual context will mean a change in the pattern of use.

Reasons and functions of use

Coca leaf (Cochabamba)

The main reason for using the coca leaf (Cochabamba) is its association with work (energy giving) and its main function that of improving productivity, lessen the sensations of hunger and fatigue as well as sleepiness and cold. Cultural reasons (ritual and symbolic) are also significant and, to a lesser extent, socialising. These reasons and functions are maintained throughout but their relative importance may vary according to circumstances of use. For example, its energy-giving function losses importance when work demands decrease.

Positive effects of use

Coca leaf (Cochabamba)

Coca leaf users described as immediate positive effects the diminution in the sensation of fatigue and an increase in their motivation to work. In a second place, they mention the pleasant taste of the coca leaf and its medicinal properties. These effects and their corresponding evaluation remain constant throughout.

Negative effects of use

Coca leaf (Cochabamba)

Virtually no user in the coca leaf sub-sample (Cochabamba) mentions any significant negative effect. Only a few indicate that the 'chew’ causes an unpleasant taste or smell or regard the local anaesthetic properties as negative.

Positive consequences or advantages for health and social life

Coca leaf (Cochabamba)

Coca leaf users consider that use has positive effects in the following aspects (in decreasing order of importance). At least half of the sub-sample claim socialising (it includes cultural integration and a sense of belonging), work (increase in productivity), health (it makes one stronger and it has medicinal properties), capacity to deal with living in society (it increases one's courage and strengthens your will), study (it improves one's concentration capacity), livelihood (indirectly, by its effect on work and, directly as a source of income: production, transport and retail sale), helps to avoid accidents (it increases a state of alertness and it diminishes fatigue and sleepiness). Only a few claim that none of the above has improved as a result of use. For most, the aspects most benefited are work, socialising and socio-cultural integration.

Familiarity with treatment services

Coca leaf (Cochabamba)

Virtually none of the coca leaf users (Cochabamba) are aware of their existence.

Use of the treatment services

Coca leaf (Cochabamba)

None of the interviewees in the coca leaf sub-sample (Cochabamba) has had problems because of this side-product and so no one has sought out help or treatment. Moreover, they do not know anyone who has, not even by hear-say. Only one of the interviewees had received treatment and on account of alcoholism.

10.2 Conclusions

Coca leaf (Cochabamba)

The growth of the coca bush is fundamental in the subsistence economy of many farmers in Bolivia. It is a rather efficient crop since the leaves can be harvested three or four times a year. In addition it satisfies an internal (legal) demand because of its multiple applications in the traditional Andean culture. Moreover, the transport to the market and the retail sale (both legal activities) generate employment and a source of precarious income to the retailers and their families.

The coca leaf still plays many functions and its 'chew' and other applications are fully integrated in the Andean traditional culture and the cosmic vision. Most traditional users fall into this model of use. The coca leaf holds an important place in the various aspects of their lives.

The following are the main uses of the coca leaf.

As a source of energy (the predominant use): it increases performance at work and helps to fight against tiredness, sleepiness and cold. In addition, the 'chew' organises the periods of work and rest. It is not considered a foodstuff although it diminishes the sensation of hunger and it provides some minerals and vitamins. It may be used as a foodstuff when there is a shortage of traditional foodstuffs.

Medicinal. It is used for organic diseases, on account of its chemical properties in herbal teas, syrups and plasters made with the leaves. It is also used to diagnose and treat culturally defined diseases whose aetiology is supernatural, of psychosomatic nature, expressing interpersonal or social structure conflicts.

Magical-religious. It is used for communicating with the supernatural world and to obtain protection. It is used by soothsayers to avoid or to find out causes of bad luck. It is used also in all the magic-religious rituals, especially in offerings to the 'Pachamama' that personifies the Earth so as to obtain sufficient foodstuffs, protect one's health and the environment.

Social. It is used to maintain social cohesion and co-operation among the members of the community. It also plays an important role in all the communal ceremonies, in the reciprocal interchanges of work and in socialising.

The instrumental type of use, prevalent in the cities and among the non-ethnic Quechua and Aymara population, exhibits changes away from the traditional uses due to acculturation and adaptation to modern lifestyles. Hence some traditional uses have become irrelevant or meaningless. This type of users value the coca leaf mainly for its energy-giving and medicinal properties and do not know about its ritual, customary uses or, prefer to ignore them. An important issue is the defence of the coca leaf as a symbol of identity and belonging. Users and non-users also reject the view that associates coca leaf use to a backward way of life characteristic of indigenous populations (the expression of a prejudice).

Users value positively, to varying degrees, the beneficial effects of the coca leaf energy-giving, medicinal, ritual and symbolic significance. None mentions problems or negative effects or consequences resulting from or associated to its use. These characteristics distinguish it clearly from the other coca side-products: the use of the coca leaf is not perceived or identified at any time or by anyone as drug use. The culturally established use of this side-product (traditional type use) and the instrumental type use do not lead to problems for public health nor for the users themselves.


General Recommendations


Education and Prevention




Research and Data-gathering Systems


Coca Leaf

The Program on Substance Abuse and the World Health Organization should undertake a study of the nutritional and therapeutic advantages of the coca leaves.

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