Why do people in West Philadelphia do so much cocaine?

I'm always amazed at the prevalence of cocaine use in the West Philadelphia population (and probably other large cities in the United States) which I am allowed to witness when I'm working in the hospitals here.

I would say that about 2-3 patients every night that I admit while on-call are coming in either with a cocaine-related health problem or have a history of doing cocaine in the past. The suprising thing to me is not just the fact that there are patients getting admitted with cocaine-induced chest pain, but that it is viewed as such a common, normal way of life in some communities. Many patients are very up front about their cocaine use and their lack of desire to quit it, much like people who smoke cigarettes.

I've also had no shortage of conversations which go like this:

Me: I'm going to ask you some questions that I ask all my patients. Do you smoke cigarettes?
Patient: No.
Me: How much alcohol do you drink?
Patient: maybe once in a blue moon.
Me: Do you take any drugs? Have you every taken cocaine?
Patient: No.
Me: Did you ever take any drugs?
Patient: Yes, well, I used to do cocaine, but I don't anymore.
Me: When was the last time you did cocaine?
Patient: A week ago.

It sounds moronic, but I've learned the hard way that you absolutely have to ask patients this series of questions or you will miss out on an important piece of their medical history.

In Botswana there was no cocaine. There was also no iv drug abuse. I think there may have been some marijuana and certainly I saw some cases of alcohol abuse, but other than that it was a fairly drug-free society. In addition all citizens of the country get free national health care and Botswana has never been in a war during its entire history of existence.

Perhaps we should start rethinking our classification of what consitutes a First World and a Third World country...