What is cocaine?

Cocaine is an addictive stimulant that directly affects the brain. Cocaine was called the drug of the 80’s and 90’s due to its great popularity and use at that time. However, cocaine is not a new drug. In fact, it is one of the oldest known drugs. The pure chemical, cocaine hydrochloride, has been used for over 100 years and coca leaves, the source of cocaine, have been ingested for thousands of years.

Basically, there are two chemical forms of cocaine: the hydrochloride salt and the “free base”. The hydrochloride salt, or powder form of cocaine, dissolves in water and, if abused, can be administered intravenously (through a vein) or intranasally (through the nose). Freebase refers to a compound that has not been neutralized by an acid to make the hydrochloride salt. The freebase form of cocaine is smokable.

Cocaine is usually sold on the street in the form of a fine, white, crystalline powder called “coke,” “C,” “snow,” “flake,” or “hit.” Street dealers often dilute it with inert substances such as cornstarch, talcum powder and/or sugar, or with active drugs such as procaine (a chemically related local anesthetic) or with other stimulants such as amphetamines.

What is crack?

Crack is the street name given to the free form of cocaine that has been transformed from cocaine hydrochloride powder into a smokable substance. The term “crack” refers to the crackling sound heard when the mixture is smoked. Crack is treated with ammonia or baking soda (sodium bicarbonate) and water, then heated to remove the hydrochloride.

As crack is smoked, the user experiences a 10-second high. This very immediate euphoric effect is one of the reasons crack became extremely popular in the mid-1980s. Another reason is that crack is cheap to manufacture and buy.

How is cocaine used?

The main routes of administration of peruviancocaine are oral, intranasal, intravenous, and inhalation. The slang terms for these routes are “chewing,” “snorting,” “injecting,” and “smoking” (including free cocaine and crack), respectively. Snorting involves inhaling powdercocaine through the nostrils, where it is absorbed into the bloodstream through nasal tissues. Injecting releases the drug directly into the bloodstream and increases the intensity of its effects. Smoking involves inhaling cocaine vapors or smoke into the lungs, where absorption into the bloodstream is as rapid as by injection. The drug can also be rubbed into mucosal tissues. Some users combine powder or crack with heroin in a “speedball”.

Cocaine use varies from occasional use to repeated or compulsive use, with a variety of patterns in between. There is no one safe way to use purecocaine. Any route of administration can lead to absorption of toxic amounts of cocaine, resulting in acute cardiovascular or cerebrovascular emergencies that can lead to sudden death. Repeated use of cocaine by any route can lead to addiction and other negative health consequences.

How does cocaine produce its effects?

Much research has been devoted to understanding how cocaine produces its pleasurable effects and why it is so addictive. One mechanism is its effects on deep brain structures. Scientists have discovered regions of the brain that, when stimulated, produce feelings of pleasure. One neural system that appears to be most affected by cocaine comes from a deep brain region called the ventral tegmental area (VTA). Nerve cells in the VTA extend to the brain region known as the nucleus accumbens, one of the brain’s major pleasure centers. In animal studies, for example, all kinds of pleasurable stimuli, such as food, water, sex and many drugs, cause increased activity in the nucleus accumbens.

As cocaine abuse continues, tolerance often develops. This means that higher doses and more frequent use of cocaine are needed for the brain to register the same level of pleasure as when it was first used. Recent studies have shown that during periods of cocaine withdrawal, the memory of the euphoria associated with cocaine use, or mere exposure to stimuli associated with drug use, can trigger massive cravings and relapse to drug use, even after long periods of abstinence.

Short-term effects of cocaine use
increased energy
reduced appetite
mental alertness
Increase in heart rate and blood pressure
Contraction of blood vessels
Increased temperature
dilated pupils
The effects of crack appear almost immediately after a single dose and wear off within minutes to hours. Consumed in small amounts (up to 100 mg), fishscalecocaine generally leaves the user euphoric, energetic, talkative, and mentally alert, particularly with regard to visual, auditory, and tactile sensations. It may also temporarily decrease the need to eat and sleep. Some users find that the drug helps them perform simple physical and mental tasks more quickly, while others may experience the opposite effect.

The duration of cocaine’s immediate euphoric effects depends on the route of administration. The faster the absorption, the more intense the euphoria. Likewise, the faster the absorption, the shorter the duration of action. The inhalation effect is relatively slow and may last 15 to 30 minutes, whereas the smoking effect may last 5 to 10 minutes.

Short-term physiological effects of cocaine include constriction of blood vessels, dilation of pupils, increased temperature, heart rate and blood pressure. Large amounts (several hundred milligrams or more) intensify the user’s euphoria, but can also lead to bizarre, erratic and violent behavior. These users may experience tremors, dizziness, muscle spasms, paranoia or, with repeated doses, a toxic reaction very similar to amphetamine intoxication. Some cocaine users report feelings of restlessness, irritability and anxiety. In rare cases, sudden death may occur when cocaine is first used or unexpectedly thereafter. Cocaine-related deaths often result from cardiac arrest or seizures followed by respiratory arrest.

What are the long-term effects of cocaine use?
Dependence
Irritability and mood swings
feverish activity
Paranoia
auditory hallucinations
Cocaina is an addictive drug. Once a person has tried cocaine, it can be difficult to predict or control how long he or she will continue to use it. The stimulant and addictive effects of cocaine are believed to derive primarily from its ability to inhibit the reuptake of dopamine by nerve cells. Dopamine is released as part of the brain’s reward system and is directly or indirectly involved in the addictive properties of all major drugs.

An appreciable tolerance to the euphoria of cocaine can develop, and many addicts report trying to get the same pleasure from the first experience but failing. Some users often increase doses to intensify and prolong the euphoric effects. While euphoric tolerance may develop, users may also become more sensitive (sensitized) to the paralyzing and convulsive effects of cocaine without increasing the dose. This increased sensitivity may account for some deaths that occur after apparently low doses of cocaina.

Excessive use, when the drug is taken repeatedly and in increasing doses, leads to a state of increasing irritability, restlessness, and paranoia. This can lead to full-blown paranoid psychosis, in which the individual loses touch with reality and experiences auditory hallucinations.

What are the medical complications of cocaine abuse?
Cardiovascular effects:

heart rhythm disorders
heart attack
Respiratory effects:

chest pain
Respiratory failure
Neurological effects:

leakage
seizures and headaches
Gastrointestinal complications:

abdominal pain
nausea
Cocaine use has been linked to many types of heart disease. Cocaine has been found to trigger chaotic heart rhythms called ventricular fibrillation, increase heart rate and breathing, and increase blood pressure and body temperature. Physical symptoms may include chest pain, nausea, blurred vision, fever, muscle spasms, convulsions, and coma.

Different routes of cocaine administration can produce different side effects. Regular snorting of cocaine, for example, can cause loss of smell, nosebleeds, swallowing problems, hoarseness and general irritation of the nasal septum, which can lead to chronic inflammation and runny nose. Cocaine ingestion can cause severe intestinal gangrene due to reduced blood flow. People who inject cocaine have puncture marks and “trails,” most often on the forearms. Intravenous cocaine users may also have an allergic reaction, either to the drug or to a street cocaine additive, which can lead, in severe cases, to death. Because cocaine tends to reduce food intake, many chronic cocaine users lose their appetite and may experience significant weight loss and malnutrition.

Research has revealed a potentially dangerous interaction between cocaine and alcohol. Taken in combination, the two drugs are converted by the body into cocaethylene. Cocaethylene has a longer-lasting action on the brain and is more toxic than the two drugs taken separately. Although more research is needed, it should be noted that the combination of cocaine and alcohol is the most common two-drug combination resulting in drug-related death.