Definition

Cocaine is a powerfully addictive stimulant that directly affects the brain. 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. It quickly became popular as an ingredient in patent medicines (throat lozenges, tonics, etc.) and other products (e.g., Coca Cola, from which it was later removed).

Concern soon mounted due to instances of addiction, psychotic behavior, convulsion, and death. A series of steps, including passage of the Pure Food and Drug Act of 1906, were taken to combat health and behavioral problems associated with the use of cocaine and other drugs. Finally, the Harrison Act of 1914 was enacted, outlawing the use of cocaine and opiates in over-the-counter products and making these drugs available only by prescription. Cocaine use soon dropped dramatically and remained at minimal levels for nearly half a century.

In the 1960s, illicit cocaine use rebounded. Although cocaine powder was expensive, selling at about $100 per gram, use of the drug had become common among middle- and upper-middle-class Americans by the late 1970s. A kind of generational forgetting had occurred. Lost were the lessons about cocaine’s toxicity and the dangers of abuse that had been learned from the cocaine epidemic earlier in the century. By the mid-1980s, there was widespread evidence of physiological and psychological problems among cocaine users, with increased emergency-room episodes and admissions to treatment.

Today, cocaine is a Schedule II drug, meaning that it has high potential for abuse, but can be administered by a doctor for legitimate medical uses, such as a local anesthetic for some eye, ear, and throat surgeries.

There are basically two chemical forms of cocaine: the hydrochloride salt and the “freebase.” The hydrochloride salt, or powdered form of cocaine, dissolves in water and, when abused, can be taken intravenously (by vein) or intranasally (in 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 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 such inert substances as cornstarch, talcum powder, and/or sugar, or with such active drugs as procaine (a chemically-related local anesthetic) or with such other stimulants as amphetamines.

Cocaine is a stimulant that makes users feel “high,” euphoric, energetic, and mentally alert after taking the drug. Cocaine is a highly addictive drug that can cause severe mental and physical problems. It is possible to overdose and die.

Cocaine is a powerfully addictive drug of abuse. Once having tried cocaine, an individual cannot predict or control the extent to which he or she will continue to use the drug.

The major routes of administration of cocaine are sniffing or snorting, injecting, and smoking (including free-base and crack cocaine). Snorting is the process of inhaling cocaine powder through the nose where it is absorbed into the bloodstream through the nasal tissues. Injecting is the act of using a needle to release the drug directly into the bloodstream. Smoking involves inhaling cocaine vapor or smoke into the lungs where absorption into the bloodstream is as rapid as by injection.

“Crack” is the street name given to cocaine that has been processed from cocaine hydrochloride to a free base for smoking. Rather than requiring the more volatile method of processing cocaine using ether, crack cocaine is processed with ammonia or sodium bicarbonate (baking soda) and water and heated to remove the hydrochloride, thus producing a form of cocaine that can be smoked. The term “crack” refers to the crackling sound heard when the mixture is smoked (heated), presumably from the sodium bicarbonate.

There is great risk whether cocaine is ingested by inhalation (snorting), injection, or smoking. It appears that compulsive cocaine use may develop even more rapidly if the substance is smoked rather than snorted. Smoking allows extremely high doses of cocaine to reach the brain very quickly and brings an intense and immediate high. The injecting drug user is at risk for transmitting or acquiring HIV infection/AIDS if needles or other injection equipment are shared.

Health Hazards

Cocaine is a strong central nervous system stimulant that interferes with the reabsorption process of dopamine, a chemical messenger associated with pleasure and movement. Dopamine is released as part of the brain’s reward system and is involved in the high that characterizes cocaine consumption.

Physical effects of cocaine use include constricted peripheral blood vessels, dilated pupils, and increased temperature, heart rate, and blood pressure. The duration of cocaine’s immediate euphoric effects, which include hyper-stimulation, reduced fatigue, and mental clarity, depends on the route of administration. The faster the cocaine is absorbed, the more intense the high. On the other hand, the faster the absorption, the shorter the duration of action. The high from snorting may last 15 to 30 minutes, while that from smoking may last 5 to 10 minutes. Increased use can reduce the period of stimulation.

Some users of cocaine report feelings of restlessness, irritability, and anxiety. An appreciable tolerance to the high may be developed, and many addicts report that they seek but fail to achieve as much pleasure as they did from their first exposure. Scientific evidence suggests that the powerful neuropsychologic reinforcing property of cocaine is responsible for an individual’s continued use, despite harmful physical and social consequences. In rare instances, sudden death can occur on the first use of cocaine or unexpectedly thereafter. However, there is no way to determine who is prone to sudden death.

High doses of cocaine and/or prolonged use can trigger paranoia. Smoking crack cocaine can produce a particularly aggressive paranoid behavior in users. When addicted individuals stop using cocaine, they often become depressed. This also may lead to further cocaine use to alleviate depression. Prolonged cocaine snorting can result in ulceration of the mucous membrane of the nose and can damage the nasal septum enough to cause it to collapse. Cocaine-related deaths are often a result of cardiac arrest or seizures followed by respiratory arrest.

Added Danger: Cocaethylene

When people mix cocaine and alcohol consumption, they are compounding the danger each drug poses and unknowingly forming a complex chemical experiment within their bodies. NIDA-funded researchers have found that the human liver combines cocaine and alcohol and manufactures a third substance, cocaethylene, that intensifies cocaine’s euphoric effects, while possibly increasing the risk of sudden death.

Short-term effects of cocaine use

Cocaine’s effects appear almost immediately after a single dose, and disappear within a few minutes or hours. Taken in small amounts (up to 100 mg), cocaine usually makes the user feel euphoric, energetic, talkative, and mentally alert, especially to the sensations of sight, sound, and touch. It can also temporarily decrease the need for food and sleep. Some users find that the drug helps them to perform simple physical and intellectual tasks more quickly, while others can experience the opposite effect.

The duration of cocaine’s immediate euphoric effects depends upon the route of administration. The faster cocaine is absorbed, the more intense the high. Also, the faster the absorption, the shorter the duration of action. 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.

The short-term physiological effects of cocaine include constricted blood vessels; dilated pupils; and increased temperature, heart rate, and blood pressure. Large amounts (several hundred milligrams or more) intensify the user’s high, but may also lead to bizarre, erratic, and violent behavior. These users may experience tremors, vertigo, muscle twitches, paranoia, or, with repeated doses, a toxic reaction closely resembling amphetamine poisoning. Some users of cocaine report feelings of restlessness, irritability, and anxiety.

Long-term effects of cocaine include: addiction, irritability and mood disturbances restlessness, paranoia and auditory hallucinations.

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 a full-blown paranoid psychosis, in which the individual loses touch with reality and experiences auditory hallucinations.

Symptoms
Side Effects Cocaine Use

Immediate:

 
• Fast heartbeat and breathing and increases in blood pressure and body temperature  
• Erratic or violent behavior  
• Blurred vision, chest pain, nausea, fever, muscle spasms, convulsions and death from convulsions, heart failure or brain failure

   

Long Term:

 
• Dependence and depression  
• Feelings of restlessness, irritability, mood swings, paranoia, sleeplessness, and weight loss.  
• Emotional problems and isolation from family and friends  
• Psychosis, paranoia, depression, anxiety disorders, and delusions  
• Damage and holes on the inside of the nose and inflamed nasal passages  
• Increased risk of hepatitis and HIV  
• Severe respiratory infections  
• Heart attacks, chest pain, respiratory failure, strokes, and abdominal pain and nausea

Warning signs of cocaine use:

 
• Red, bloodshot eyes  
• A runny nose or frequently sniffing  
• A change in eating or sleeping patterns  
• A change in groups of friends  
• A change in behavior  
• Acting withdrawn, depressed, tired, or careless about personal appearance  
• Losing interest in school, family, or activities previously enjoyed  
• Frequently needing money

Causes

Cocaine is an “upper” (stimulant) that gives its user a false sense of limitless power and energy. When users “come down,” they are usually depressed, edgy, and craving for more. No one can predict whether he or she will become dependent and addicted, or whether the next dose will be deadly.

Treatment
The widespread abuse of cocaine has stimulated extensive efforts to develop treatment programs for this type of drug abuse.

Researchers are also looking at medications that help alleviate the severe craving that people in treatment for cocaine addiction often experience. Several medications are currently being investigated to test their safety and efficacy in treating cocaine addiction.

In addition to treatment medications, behavioral interventions, particularly cognitive behavioral therapy, can be effective in decreasing drug use by patients in treatment for cocaine abuse. Providing the optimal combination of treatment services for each individual is critical to successful treatment outcome.

Principles of Effective Treatment

No single treatment is appropriate for all individuals. Matching treatment settings, interventions, and services to each individual’s particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society.

Treatment needs to be readily available. Because individuals who are addicted to drugs may be uncertain about entering treatment, taking advantage of opportunities when they are ready for treatment is crucial. Potential treatment applicants can be lost if treatment is not immediately available or is not readily accessible.

Effective treatment attends to multiple needs of the individual, not just his or her drug use. To be effective, treatment must address the individual’s drug use and any associated medical, psychological, social, vocational, and legal problems.

An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure that the plan meets the person’s changing needs. A patient may require varying combinations of services and treatment components during the course of treatment and recovery. In addition to counseling or psychotherapy, a patient at times may require medication, other medical services, family therapy, parenting instruction, vocational rehabilitation, and social and legal services. It is critical that the treatment approach be appropriate to the individual’s age, gender, ethnicity, and culture.

Remaining in treatment for an adequate period of time is critical for treatment effectiveness. The appropriate duration for an individual depends on his or her problems and needs (see pages 11-49). Research indicates that for most patients, the threshold of significant improvement is reached at about 3 months in treatment. After this threshold is reached, additional treatment can produce further progress toward recovery. Because people often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment.

Counseling (individual and/or group) and other behavioral therapies are critical components of effective treatment for addiction. In therapy, patients address issues of motivation, build skills to resist drug use, replace drug-using activities with constructive and rewarding nondrug-using activities, and improve problem-solving abilities.

Behavioral therapy also facilitates interpersonal relationships and the individual’s ability to function in the family and community.

Addicted or drug-abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way. Because addictive disorders and mental disorders often occur in the same individual, patients presenting for either condition should be assessed and treated for the co-occurrence of the other type of disorder.

Medical detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use. Medical detoxification safely manages the acute physical symptoms of withdrawal associated with stopping drug use. While detoxification alone is rarely sufficient to help addicts achieve long-term abstinence, for some individuals it is a strongly indicated precursor to effective drug addiction treatment.

Treatment does not need to be voluntary to be effective. Strong motivation can facilitate the treatment process. Sanctions or enticements in the family, employment setting, or criminal justice system can increase significantly both treatment entry and retention rates and the success of drug treatment interventions.

Possible drug use during treatment must be monitored continuously. Lapses to drug use can occur during treatment. The objective monitoring of a patient’s drug and alcohol use during treatment, such as through urinalysis or other tests, can help the patient withstand urges to use drugs. Such monitoring also can provide early evidence of drug use so that the individual’s treatment plan can be adjusted. Feedback to patients who test positive for illicit drug use is an important element of monitoring.

Treatment programs should provide assessment for HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases, and counseling to help patients modify or change behaviors that place themselves or others at risk of infection. Counseling can help patients avoid high-risk behavior. Counseling also can help people who are already infected manage their illness.

Recovery from drug addiction can be a long-term process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug use can occur during or after successful treatment episodes. Addicted individuals may require prolonged treatment and multiple episodes of treatment to achieve long-term abstinence and fully restored functioning. Participation in self-help support programs during and following treatment often is helpful in maintaining abstinence.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.