What is cocaine?
Cocaine is a powerfully addictive stimulant that directly affects the brain. It has been labelled the drug of the 1980s and 1990s because of its extensive popularity and use during this period. However, it is not a new drug. In fact, it is one of the oldest known drugs. The pure chemical, cocaine hydrochloride, has been an abused substance for more than 100 years, and coca leaves, the source of cocaine, have been ingested for thousands of years.
Pure cocaine was first extracted from the leaf of the Erythroxylon coca bush, which grows primarily in Peru and Bolivia, in the mid-19th century. In the early 1900s, it became the main stimulant drug used in most of the tonics/elixirs that were developed to treat a wide variety of illnesses. Today, cocaine is a Schedule II drug, meaning that it has a high potential for abuse, but can be administered by a doctor for legitimate medical uses, such as a local anaesthetic for some eye, ear and throat surgeries.
There are two chemical forms of cocaine: the hydrochloride salt and the ‘freebase’. The hydrochloride salt, or powdered form, dissolves in water and, when abused, can be taken intravenously (by vein) or intranasally (via the nose). Freebase refers to a compound that has not been neutralised by an acid to make the hydrochloride salt. The freebase form of cocaine is smokable.
Cocaine is generally sold on the street as a fine, white, crystalline powder, known as ‘coke’, ‘C’, ‘snow’, ‘flake’ or ‘blow’. Street dealers generally dilute it with inert substances such as corn starch, talcum powder and/or sugar, or with active drugs such as procaine (a chemically related local anaesthetic) or with other stimulants as amphetamines.
How is it used?
The principal methods of cocaine use are oral (‘chewing’), intranasal (‘snorting’), intravenous (‘mainlining’ or ‘injecting’) and inhalation (‘smoking’ – including freebase and crack cocaine). Snorting is the process of inhaling cocaine powder through the nostrils, where it is absorbed into the bloodstream through the nasal tissues. Injecting releases the drug directly into the bloodstream, and heightens the intensity of its effects. Smoking involves the inhalation of cocaine vapour or smoke into the lungs, where absorption into the bloodstream is as rapid as by injection. The drug can also be rubbed onto mucous tissues. Some users combine cocaine powder or crack with heroin in a ‘speedball’.
Cocaine use ranges from occasional use to repeated or compulsive use, with a variety of patterns between these extremes. There is no safe way to use cocaine. Any route of administration can lead to absorption of toxic amounts of cocaine, leading to acute cardiovascular or cerebrovascular emergencies that could result in sudden death. Repeated use by any route of administration can produce addiction and other adverse health consequences.
How does cocaine produce its effects?
A great amount of research has been devoted to understanding the way cocaine produces its pleasurable effects, and the reasons it is so addictive. One mechanism is through its effects on structures deep within the brain. Scientists have discovered regions within the brain that, when stimulated, produce feelings of pleasure. One neural system that appears to be most affected by cocaine originates in a region, located deep within the brain, called the ventral tegmental area (VTA). Nerve cells originating in the VTA extend to the region of the brain known as the nucleus accumbens, one of the brain’s key pleasure centres. In studies using animals, for example, all types of pleasurable stimuli, such as food, water, sex, and many drugs of abuse, cause increased activity in the nucleus accumbens.
Researchers have discovered that, when a pleasurable event is occurring, it is accompanied by a large increase in the amounts of dopamine released in the nucleus accumbens by neurons originating in the VTA. In the normal communication process, dopamine is released by a neuron into the synapse, where it can bind with dopamine receptors on neighbouring neurons. Normally dopamine is then recycled back into the transmitting neuron by a specialised protein called the dopamine transporter. If cocaine is present, it attaches to the dopamine transporter and blocks the normal recycling process, resulting in a build-up of dopamine in the synapse, which contributes to the pleasurable effects of cocaine.
As cocaine abuse continues, tolerance often develops. This means higher doses and more frequent use are required for the brain to register the same level of pleasure experienced during initial use. Recent studies have shown that, during periods of abstinence from cocaine use, the memory of the euphoria associated with cocaine use, or mere exposure to cues associated with drug use, can trigger tremendous craving and relapse to drug use, even after long periods of abstinence.
What are the short-term effects?
Cocaine’s effects appear almost immediately after a single dose and disappear within a few minutes or hours. Taken in small amounts (up to 100mg), cocaine usually makes the user feel euphoric, energetic, talkative and mentally alert, especially to the sensations of sight, sound and touch. Some other effects are:
• increased energy
• decreased appetite
• mental alertness
• increased heart rate
• increased blood pressure
• constricted blood vessels
• increased temperature
• dilated pupils
Cocaine can also temporarily decrease the need for food and sleep. Some users find that the drug helps them perform simple physical and intellectual tasks more quickly, while others can 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 high. Also, the faster the absorption, the shorter the duration. The high from snorting is relatively slow in onset and may last 15 to 30 minutes, while that from smoking may last 5 to 10 minutes.
Large amounts (several hundred milligrams or more) intensify the user’s high, but may also lead to bizarre, erratic and violent behaviour. These users may experience tremors, vertigo, muscle twitches, paranoia, or, with repeated doses, a toxic reaction closely resembling amphetamine poisoning. Some users report feelings of restlessness, irritability and anxiety. In rare instances, sudden death can occur on the first use or unexpectedly thereafter. Cocaine-related deaths are often a result of cardiac arrest or seizures followed by respiratory arrest.
What are the long-term effects?
• irritability
• mood disturbances
• restlessness
• paranoia
• auditory hallucinations
Tolerance to cocaine’s high may develop, with many addicts reporting that they seek but fail to achieve as much pleasure as they did from their first experience. Some users will frequently increase their doses to intensify and prolong the euphoric effects. While tolerance to the high can occur, users can also become more sensitive (sensitisation) to its anaesthetic and convulsant effects, without increasing the dose taken. This increased sensitivity may explain some deaths occurring after apparently low doses of cocaine.
Use of cocaine in a binge, during which the drug is taken repeatedly and at increasingly high doses, leads to a state of increasing irritability, restlessness and paranoia. This may result in full-blown paranoid psychosis, in which the individual loses touch with reality and experiences auditory hallucinations.
What are the medical complications of cocaine abuse?
There are enormous medical complications associated with cocaine use. Some of the most frequent complications are cardiovascular effects, including disturbances in heart rhythm and heart attacks; such respiratory effects as chest pain and respiratory failure; neurological effects, including strokes, seizures and headaches; and gastrointestinal complications, including abdominal pain and nausea.
Cardiovascular effects:
• disturbances in heart rhythm
• heart attacks
Respiratory effects:
• chest pain
• respiratory failure
Neurological effects:
• strokes
• seizures
• headaches
Gastrointestinal effects:
• abdominal pain
• nausea
Cocaine use has been linked to many types of heart disease. It has been found to trigger chaotic heart rhythms, called ventricular fibrillation; accelerate heartbeat and breathing, and increase blood pressure and body temperature.
Different routes of cocaine administration can produce different adverse effects. Regularly snorting cocaine, for example, can lead to loss of sense of smell, nosebleeds, problems with swallowing, hoarseness, and an overall irritation of the nasal septum, which can lead to a chronically inflamed, runny nose. Ingested cocaine can cause severe bowel gangrene, due to reduced blood flow. And persons who inject cocaine have puncture marks and ‘tracks’, most commonly in their forearms. Intravenous cocaine users may also experience an allergic reaction, either to the drug or to some additive in street cocaine, which can result, in severe cases, in death. Because cocaine has a tendency to decrease food intake, many chronic cocaine users lose their appetites and can experience significant weight loss and malnourishment.
Research has revealed a potentially dangerous interaction between cocaine and alcohol. Taken in combination, the two drugs are converted by the body to cocaethylene. Cocaethylene has a longer duration of action in the brain and is more toxic than either drug alone. While more research needs to be done, it is noteworthy that the mixture of cocaine and alcohol is the most common two-drug combination that results in drug-related death.
What is crack cocaine?
The chemical cocaine hydrochloride is commonly known as cocaine. Some users chemically process it in order to remove the hydrochloride. This process is called ‘freebasing’ and makes the drug more potent.
Crack is a solid form of free-based cocaine. It is called ‘crack’ because it snaps and cracks when heated and smoked. Since crack is an already prepared form of freebased cocaine, the user does not have to buy the equipment or be exposed to the explosive chemicals associated with freebasing. Crack is most often packaged in phials or plastic bags and sold in small quantities, usually 300mg to 500mg, or enough for two to three inhalations.
Traditionally, cocaine was a rich man’s drug, due to the large expense of a cocaine habit. Now, crack is being sold at prices low enough that even adolescents can afford to buy it. But this is misleading: once a person is addicted to cocaine, tolerance rises, the habit need increases, and so does the expense.
How is it used?
The substance is placed in a glass pipe (or hash pipe) with a fine mesh screen under it. This is then heated and the vapours inhaled. The vapours of the freebase are absorbed through the lungs into the bloodstream and transported to the brain within 10 to 15 seconds. One inhalation will produce a degree of intoxication usually lasting 10 to 15 minutes.
What are crack cocaine’s adverse effects?
As with any street drug, what is sold may not be what it is claimed to be. Predicting side effects is difficult when the actual contents are not known. Life-threatening reactions have been reported whether it’s the first, the 100th, or any other time crack is used. You do not have to overdose on crack to die from it.
