Cocaine (Encyclopedia of Medicine)
Cocaine is a highly addictive central nervous system stimulant extracted from the leaves of the coca plant, Erythroxylon coca.
In its most common form, cocaine is a whitish crystalline powder that produces feelings of euphoria when ingested.
Now classified as a Schedule II drug, cocaine has legitimate medical uses as well as a long history of recreational abuse. Administered by a licensed physician, the drug can be used as a local anesthetic for certain eye and ear problems and in some kinds of surgery.
Forms of the drug
In powder form, cocaine is known by such street names as "coke," "blow," "C," "flake," "snow" and "toot." It is most commonly inhaled or "snorted." It may also be dissolved in water and injected.
Crack is a smokable form of cocaine that produces an immediate and more intense high. It comes in off-white chunks or chips called "rocks." Little crumbs of crack are sometimes called "kibbles & bits."
In addition to their stand-alone use, both cocaine and crack are often mixed with other substances. Cocaine may be mixed with methcathinone (a more recent drug of abuse, known as "cat," that is similar to methamphetamine) to create a "wildcat." A hollowed-out cigar...
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Cocaine (Encyclopedia of Science)
Cocaine is a powerful drug that stimulates the body's central nervous system. Prepared from the leaves of the coca shrub that grows in South America, it increases the user's energy and alertness, reduces appetite and the need for sleep, and heightens feelings of pleasure. Although United States law makes its manufacture and use for nonmedical purposes illegal, many people are able to obtain it illegally.
A powerful stimulant
Aside from a few extremely limited medical uses, cocaine has no other purpose except to give a person an intense feeling of pleasure known as a "high." While this may not seem like such a bad thing, the great number of physical side effects that accompany that high, combined with the powerful psychological dependence it creates, makes it an extremely dangerous drug to take. As a very powerful stimulant, cocaine not only gives users more energy, it makes them feel confident and even euphoric (pronounced yew-FOR-ik)eaning they are extremely elated or happy, usually for no reason. This feeling of elation and power makes users believe they can do anything, yet when this high wears off, they usually feel upset, depressed, tired, and even paranoid.
Cocaine has a very interesting history: It has gone from being considered a mild stimulant and then a wonder drug, to a harmless "recreational" drug, and finally to a powerfully...
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Cocaine (Encyclopedia of Drugs and Addictive Substances)
- What Is It Made Of?
- Are There Any Medical Reasons for Taking This Substance?
- Usage Trends
- Cocaine Bugs
- Treatment for Habitual Users
- For More Information
What Kind of Drug Is It?
Cocaine is a natural substance that comes from the leaves of the coca (pronounced KOH-kuh) plant. This plant should not be confused with the cocoa (pronounced KOH-koh) plant, which is the source of chocolate. Cocaine acts as both a and an anestheticA substance used to deaden pain..
The coca plant grows in only one part of the world: the northwestern and central regions of South America. A huge portion of the great Andes Mountain system lies along the western coast of the continent. The warm, humid air and rich soil found among these mountain highlands are well suited for the growth of coca. More than a third of the world's supply of coca leaf is grown in Colombia, a South American coastal nation surrounded by the Pacific Ocean to the west and the Caribbean Sea to the north. The rest is grown in the nearby countries of Peru and Bolivia, which share portions of the massive mountain ranges.
Since the mid-1960s, the huge cocaine trade has been the source of violence and political unrest in Colombia. According to Paul M. Gahlinger in Illegal Drugs: A Complete Guide to Their History, Chemistry, Use, and Abuse, nearly 700 million pounds of coca leaf is produced in South America each year. That is enough leaves to produce well over 500 tons of cocaine. Gahlinger explained that the majority of it "is destined for the United States." The southern part of Colombia is the location of coca leaf processing laboratories. From these labs, converted cocaine powder is shipped to the United States, usually arriving through Mexico; Puerto Rico; Miami, Florida; or New York City.
A Longtime South American Tradition
South Americans in the Andes Mountains have chewed coca leaves for generations. For more than 4,000 years, the mountain people have used coca in much the same way Europeans and North Americans use coffee: for its mild stimulating effects. The leaves are not simply plucked and chewed. Rather, a bit of lime or plant ash is added to the leaves and then the mixture is chewed together. This process helps the naturally
occurring cocaine to be released and absorbed into the user's cheek. After about a half an hour, the wad is spit out.
The leaves are also recognized for their medicinal value. When chewed or made into tea, they reportedly ease digestive troubles and reduce the symptoms of certain psychological ills. When used in whole-leaf form, cocaine does not produce a "highDrug-induced feelings ranging from excitement and joy to extreme grogginess." and is not addictive.
Attempts to introduce coca leaves to North American and European nations were largely unsuccessful. The leaves of the coca plant tend to rot quickly. This caused considerable problems with shipping, because the stimulating effects and the medicinal value of the plant were both lost before it could reach its destination. In 1858, however, German chemist Albert Niemann managed to separate cocaine from the coca leaf. In doing so, he unleashed the world's most powerful naturally occurring stimulant. The salt form (cocaine hydrochloride), commonly known as , travels quite well. Soon, large quantities were being consumed far beyond the Andes Mountains.
Cure-All or Curse?
From the 1860s through the early 1900s, cocaine was thought to be a "cure-all." Medical experts mistakenly believed that, like the whole-leaf form, powder cocaine was also non-addictive. For more than four decades, cocaine use was unregulated and widespread in both Europe and the United States. No prescription was necessary to obtain the drug, and it could easily be purchased at grocery stores, at drugstores, and through mail-order catalogs. Containers of 99.9 percent pure powder cocaine were available for sale on the open market.
Cocaine-laced beverages were extremely popular as well. One coca wine known as Vin Mariani was widely recommended by doctors for improving health. The original formula for Coca-Cola, a beverage created by John Pemberton in the 1880s, is said to have contained 60 milligrams of cocaine per serving. However, claims about the exact amount used have not been backed up by solid evidence. (Coca-Cola no longer uses any cocaine in its products.) Cocaine was seen as a remedy for many conditions, including fatigue, toothaches, hay fever, asthma, seasickness, and vomiting during pregnancy.
Although experts maintained that powder cocaine was not an addictive drug, frequent and heavy users began showing unmistakable signs of physical and psychological dependenceThe belief that a person needs to take a certain substance in order to function, whether that person really does or not.. By the close of the nineteenth century, reports of nasal damage, addiction, and cocaine-related deaths had surfaced. The toxic and addictive nature of cocaine became public knowledge. By the time the U.S. government stepped in to ban cocaine in 1914, most people were already shunning it.
Usage Decreases until the 1970s
Over the next fifty or so years, cocaine use and abuse was very low. Then, in the 1970s, powder cocaine use began to skyrocket. This trend was followed in the 1980s by a surge in the use of a new form of cocaine called crack. Because is cheaper than powder, it became more readily available to the young and the poor. Crack addiction and crime began to increase rapidly. Television coverage of the epidemic was massive. In response to public concern, the Anti-Drug Abuse Act of 1986 and 1988 was passed. This federal law includes mandatory minimum sentences for first-time offenders. The penalties are much harsher for possession of crack cocaine than powder cocaine.
Andrew Weil and Winifred Rosen noted in their book From Chocolate to Morphine: "Many people can't leave this drug alone if they have it, even though all they get from it after a while is the unpleasant effects characteristic of all stimulants used in excess: anxiety, insomnia, and general feelings of discomfort." Because of
its addictive and destructive nature, a worldwide effort is under way to reduce the production and use of cocaine.
What Is It Made Of?
Cocaine is the most powerful naturally occurring stimulant known. It is found as an alkaloid in the leaves of the Erythroxylon coca trees native to the Andes Mountains. Coca leaves contain 0.5.8 percent cocaine, which can be refined to nearly 100 percent purity. The chemical formula for cocaine is C17H21NO4.
Cocaine in Its Various Forms: Leaves, Paste, Powder, and Freebase
"Drugs and Chemicals of Concern: Cocaine," part of the U.S. Department of Justice, Drug Enforcement Administration (DEA), Diversion Control Program Web site, states that "all mucous membranes readily absorb cocaine." That is why it can be taken in so many different forms. Cocaine is ingested in its mildest form by chewing coca leaves. In addition to cocaine, the leaves contain protein, minerals, vitamins, and more than a dozen alkaloids. Instead of experiencing a or a high, chewers first notice numbness of the mouth followed by increased alertness and a general sense of well-being. This form of cocaine use is completely legal and socially acceptable in the mountain regions of South America. Chewing coca leaves is part of the people's religious tradition as well. The leaves can also be made into tea. Coca leaves are not smoked because the temperature needed to burn them destroys the cocaine alkaloid before it can be inhaled.
coco pasteAn impure freebase made from coca leaves and used mainly in South America; coca paste is smoked and is highly addictive. is a psychoactive drug that produces a rush followed by a high in those who smoke it. (Psychoactive drugs alter the user's mental state or change behavior.) To make the paste, lime water, kerosene (a type of fuel), and sulfuric acid are added to coca leaves. After the bulky leaf matter is removed, an unpleasant-smelling residue remains. This residue, called coca paste, is usually added to tobacco or marijuana cigarettes and smoked.
With additional processing, coca paste can be converted into powder cocaine (cocaine hydrochloride), which can be more than a hundred times more powerful than coca leaves. This powder is diluted with fillers before it is sold on the street in the United States. Common fillers include cheaper drugs such as or sugars such as lactose. Average street powder cocaine is about 60 percent pure.
The most common way to use powder is to snort it into the nose, but it can also be dissolved in water and injected into the veins. Powder cocaine cannot be smoked, but it can be turned into another substance called freebaseTerm referring to the three highly addictive forms of cocaine that can be smoked: 1) coca paste, which is made from processed coca leaves, 2) freebase, which is made with powder cocaine, ammonia, and ether, and 3) crack, which is made with powder cocaine and sodium bicarbonate., which is smokable. Powder cocaine is addictive regardless of the way it is taken.
There are three freebase forms of cocaine, and all of them are highly addictive. The first, coca paste, has already been mentioned. It is made directly from coca leaves and is usually mixed with tobacco or marijuana before being smoked. The second form, simply called freebase, was developed in the mid-1970s. In this process, powder cocaine is converted into freebase by using water, ammonia, and a liquid anesthetic called ether.
Freebasing is a dangerous process because the chemicals are highly explosive and may ignite. Comedian Richard Pryor was badly burned while freebasing. The third and by far the most common form of freebase is crack. Crack forms when cocaine, water, and are combined.
Crack Cocaine: The Drug of the Eighties
Crack is a form of freebase cocaine made from powder cocaine combined with water and sodium bicarbonate. After the resulting mixture is allowed to dry, it is cut into "rocks" weighing between one-tenth and one-half a gram. These rocks resemble human teeth in size, shape, and color. Ten grams of powder cocaine will convert to 8.9 grams of nearly pure crack.
A rock of crack is smoked in a glass pipe. As the crack heats up, the vapors are released and inhaled through the pipe. Sodium bicarbonate is the ingredient that gave crack its name, since it makes a crackling sound when lit. Because crack is inexpensive and delivers large amounts of cocaine to the lungs, it became the most popular form of cocaine shortly after its creation in the 1980s. Although all forms of cocaine are addictive, crack is known as the most highly addictive.
How Is It Taken?
The speed at which cocaine reaches the brain depends on how it is taken. The faster and more intense the high produced in the user, the greater the risk of addiction. Drug researchers have determined patterns in cocaine use. Cocaine abusers are more likely to take the drug at night rather than earlier in the day. They also tend to use up whatever supply they have in one sitting, snorting or injecting the drug over several hours until all of it is gone.
Cocaine is taken in one of four ways. The leaves of the coca plant, combined with lime or plant ash, are chewed, releasing small amounts of cocaine alkaloid in the process. Some of the cocaine is absorbed by the mucous membranes of the mouth and the intestines absorb some of the juice as it is swallowed. The small amount of cocaine entering the bloodstream numbs the mouth, decreases the feeling of hunger, and has a stimulant effect. Rather than feeling a high, users report feelings of well-being that can last one to two hours.
Snorted, Injected, or Smokedhey Are All Addicting
Powder cocaine is snorted through the nose in 20 to 30 milligram doses called "lines." Lines of powder cocaine, about the width of a straw, are placed on a smooth surface and inhaled through one
nostril at a time. In less than a minute, the cocaine travels through the network of blood vessels in the nasal cavity and reaches the brain. The high obtained from snorting powder cocaine is the least intense of all methods of ingestion. The drug causes the blood vessels in the nose to constrict, or tighten up. Thus, the high that is produced is milder, but longer lasting than the high achieved by the remaining two ingestion methods: injecting and smoking.
Some users take powder cocaine, dissolve it in water, and inject the solution directly into their bloodstream through veins. The of taking cocaine is considered the most dangerous method because it involves the use of needles. In a matter of seconds, the injected cocaine reaches the brain, resulting in an almost immediate rush. IV cocaine use is highly addictive because the rush generally lasts only a few minutes, and the remaining high drops off quickly. To maintain the high, users inject another dose after about fifteen minutes.
Cocaine is also smoked. Users change the cocaine powder into paste or rock form in order to smoke it. If inhaled deeply into the lungs, cocaine vapors will enter the bloodstream in just three seconds. The immediate brain rush occurs slightly faster than the injection method and is achieved without the use of needles. Smoking cocaine is highly addictive because it creates the fastest and most intense rush and subsequent high.
Are There Any Medical Reasons for Taking This Substance?
The age-old tradition of chewing coca leaves continues to be part of the daily culture of South American Indians. This practice has often been compared to the American coffee break. Coca leaves are chewed to increase energy and reduce feelings of nausea in users.
After 1860, cocaine was being processed into powder and shipped to the United States and Europe. When mixed with water and taken by mouth in its liquid form, it was considered a common nonprescription remedy for hay fever, children's toothaches, asthma, and nausea. Snorting and injecting cocaine were somewhat less popular methods of ingestion through the early 1900s.
Only Acceptable Use Is as an Anesthetic
As more and more people used cocaine, it became increasingly obvious that the drug was harmful. Users were getting addicted. In 1914, the Harrison Narcotic Act banned the use of cocaine in the United States, except when used by a physician as a .
Cocaine was the first local, or topically applied, anesthetic ever used. In 1884, physician Carl Koller (1857944) started using the drug as a topical anesthetic for eye surgery. Soon it was being used by dentists and veterinarians to deaden pain at the site of surgical incisions. But it was William S. Halsted, the father of modern surgery, who found that cocaine injected under the skin (rather than just rubbed on top of the skin) made an even more effective local anesthetic for surgery. When used in this way, cocaine numbs the site of application almost immediately and lessens bleeding.
Typically, a 1 percent cocaine solution is used for surgical purposes. This highly diluted solution does not have a psychoactive or changing effect on the brain. While cocaine is still used for ear, nose, and throat surgery, another drug called lidocaine has replaced it as the most widely used local anesthetic of modern times.
When cocaine became popular in the late 1870s, it was thought to be a non-addictive "cure-all." The drug was routinely found in family medicine cabinets, and its use was completely legal. Cocaine use was accepted among factory workers to boost energy and ensure peak efficiency. But by the 1890s, cocaine had become an increasingly abused recreational drug, taken purely for the high it produced in users. During this time of widespread use, medical journals began to report on the toxic and addictive properties of cocaine.
The Era of Prohibition
Public support turned against cocaine around the same time that efforts were being made to ban alcohol in the United States. From 1920 to 1933, a nationwide ban existed on the manufacture and sale of all alcoholic beverages. This was known as the era of prohibition. At that time, alcohol was viewed as a destructive force in society. Crime, poverty, gambling, prostitution, and declining family values were blamed on excessive alcohol use. Even before this great push for Prohibition, however, the Harrison Act of 1914 was passed. This act classified cocaine as a and prohibited its use in the United States except as a local anesthetic. Tough drug laws were passed between the 1930s and the 1960s, and cocaine use dropped dramatically.
It was not until the 1970s that cocaine use began to rise once more. The drug became part of the disco scene, an era well known for its glittery nightlife, brightly lit dance clubs, outrageous outfits, and distinctive music. Cocaine gave clubbers the energy to dance the night away. Powder cocaine was quite expensive, though, and by the 1980s a new and cheaper form of the drug was being manufactured. It was called crack cocaine, and it was inexpensive enough to appeal to middle- and lower-income buyers. Crack can be smoked, it delivers a more intense high than powder cocaine, and it costs about one-tenth the price. Drug dealers had opened up a whole new market, and hundreds of thousands of new users became hooked on crack.
Cocaine use peaked in 1985 when the number of Americans who had ever used cocaine soared to 25 million. In response to the increase in cocaine-related hospital emergency visits, crack gained
a reputation as the most destructive and addictive drug of the 1980s. The Anti-Drug Abuse Act of 1986 and 1988 was passed, making possession of crack a far more serious offense than possession of powder cocaine.
By the time the law was passed, cocaine use was already on its way down. It declined steeply until 1992, when the trend once again reversed. According to the U.S. Department of Health and Human Services, the cocaine-using population had crept back up to about 3 million people by 1993. The gradual increase continued. By 1999, reported cocaine use hit 3.7 million or 1.7 percent of Americans.
Four years later, the 2003 National Survey on Drug Use and Health (NSDUH), conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), showed a downward trend in cocaine use among Americans. About 2.3 million persons were classified as "current cocaine users" that year, and 604,000 of those users smoked crack. Rates of use were highest among people age eighteen to twenty-five, with 2.2 percent of that age group using powder cocaine.
The typical cocaine user comes from a large metropolitan area rather than a small town, but these metropolitan areas span the entire country. In other words, cocaine is abused widely throughout the big cities of the United States, with no concentration of use showing up in any specific state or section of the country.
According to "Pulse Check," a report available on the Office of National Drug Control Policy Web site, as of January 2004, the characteristics of powder cocaine users had not changed. The crack-using population, however, was aging considerably. Only in Cleveland, Ohio, and St. Louis, Missouri, were there reports of new use among young people. The results of the Monitoring the Future (MTF) survey, a joint effort of the University of Michigan and the National Institute on Drug Abuse (NIDA), seemed to back up these results. Annual use of powder cocaine among tenth and twelfth graders rose about one-half of 1 percent between 2003 and 2004. However, increases in crack cocaine use were reported to be much lower.
No single risk factor predicts cocaine use, but a person's willingness to take risks is often a factor in his or her decision to try it for the first time. Young people who smoke cigarettes are ten times as likely to use an illegal drug than their nonsmoking peers. In the past, students who used cocaine had to be willing to be very different from the norm. The trend of acceptance began changing in the 1990s, however. According to the 2004 MTF study, the perceived risk and disapproval of powder cocaine and crack use decreased among eighth, tenth, and twelfth graders.
Effects on the Body
When smoked or injected, cocaine quickly brings on an intense rush in the user, followed by a high. Snorting the drug does not produce the rush, and the high is slightly delayed because constricted blood vessels release the cocaine into the system at a slower rate.
Small doses of cocaine can cause users to feel self-confident, uninhibited, talkative, clever, and in control. Users have reported that they feel as if they can take on and accomplish just about any task. Their energy levels increase, and their appetites decrease. Larger doses and heavy use can cause the opposite effects. Heavy users often have difficulty expressing themselves verbally. They just cannot seem to find the right words to say what they want to say. They may also suffer memory problems, become extremely confused, and show signs of aggression, antisocial behavior, and .
The pleasurable feelings from cocaine use last only twenty to thirty minutes if it is snorted and only five to ten minutes if it is smoked or injected into the veins. When the high is over, the user feels tired, sluggish, and low. This cycle can trigger a dangerous pattern of repeated cocaine use as the user tries to recapture the first high. As the user "takes more of the drug," explained Elaine Landau in Cocaine, "he or she develops a toleranceA condition in which higher and higher doses of a drug are needed to produce the original effect or high experienced. for it. The same amount of cocaine will no longer make that person feel as good as it once did. Higher cocaine doses and increasingly frequent use of the drug become necessary. Many cocaine users say that in time they [need] significant amounts of the drug just to feel normal."
Harm to the Brain
In 1999, two NIDA-funded studies confirmed that heavy cocaine use could cause long-lasting brain impairment. Because cocaine reduces blood flow to the brain, some abusers develop problems with their attention span, memory, and problem-solving skills. Even a month after their last use, heavy users still found it difficult to perform tasks involving planning and reasoning. Users can become psychologically dependent on cocaine, using the drug to take the place of real-life experiences and problem-solving strategies. People who become dependent and then quit using cocaine often experience an intense craving for the drug long after the last use.
It has been known for years that cocaine use narrows blood vessels, raises blood pressure and body temperature, and increases the user's heart rate. These changes put a user at a high risk for life-threatening events. Sudden death can result from heart failure, respiratory failure, seizures, and . In 2003, even more evidence came to light about cocaine's negative effects on the heart and circulatory system. Patrick Zickler reported in NIDA Notes that heavy users of cocaine also seem to "have elevated levels of a blood protein that increases in concentration" among people at risk for a heart attack.
The Dopamine Connection
Drug researchers found out long ago that cocaine interferes with the regulation of the brain's levels. Dopamine is a neuro-transmitterA substance that helps spread nerve impulses from one nerve cell to another. and acts on the part of the brain responsible for filtering incoming information, making choices, judging behavior, and deciding when and how to act. Dopamine levels are associated with movement, emotional response, and the ability to experience pleasure.
Cocaine blocks the normal flow of dopamine, allowing greater-than-normal amounts of the chemical to build up in the spaces between the neurons. Too much dopamine in the brain produces negative effects: dopamine receptors become over-stimulated, and this can cause the brain to lose the ability to produce feelings of pleasure on its own. Although a cocaine-induced high typically lasts from fifteen to thirty minutes, the low can last from one to two days. Scientists suspect that continued use of cocaine actually reduces both the amount of dopamine and the number of dopamine receptors in the brain. So, once the cocaine-induced high is over, the user can fall into a period of deep and lasting depression. "In the same way that [the] brain will interpret the presence of cocaine as one of the most pleasurable experiences," wrote Heather Lehr Wagner in Cocaine, "it will interpret the absence of cocaine as one of the most painful."
The Myth of Nonaddiction
As late as the 1980s, there was a myth that cocaine was not addictive. Addiction occurs when drug use is no longer a voluntary choice but an uncontrollable compulsion. Some crack users report addiction after just one use.
When a person addicted to a substance stops taking that substance, he or she experiences unpleasant symptoms. Cocaine withdrawal symptoms include an intense and irresistible craving for the drug, along with depression, irritability, exhaustion, extreme hunger, and sometimes paranoia. It is now known that cocaine is extremely addictive. In fact, it is one of the easiest drugs to get animals to take willingly. Animal research indicates that after repeated ingestion of cocaine, nearly 100 percent of monkeys and rats tested will continue to self-administer the drug whenever they are given the chance.
The most serious effect of using cocaine is the possibility of sudden death. It can happen after the first use or anytime thereafter. Sudden death can occur with cocaine use alone, but is more common when combined with alcohol or other drugs. Other side effects include irreversible damage to the heart and liver, along with damage inflicted by strokes and seizures.
And There Is More./h3>
The point of ingestion determines the specific side effects cocaine will cause in a user. For instance, snorting powder cocaine over time will damage the septum and ulcerate the mucous membrane of the nose. Users who snort cocaine are prone to nosebleeds.
The bleeding may occur without warning and could cause considerable disruption if it happens in public. For instance, schools are required to evacuate and thoroughly clean areas where human blood has spilled. This precaution must be taken to decrease the risk of transmitting blood-borne viruses such as HIV (the human immunodeficiency virus), which causes AIDS (acquired immunodeficiency syndrome).
Smoking crack cocaine can cause lung trauma and bleeding. Injecting cocaine into the veins often causes inflammation and infections. It also carries a greater risk for contracting HIV/AIDS and hepatitis because users sometimes share needles. Cocaine also has a reputation for lowering users' inhibitionsInner thoughts that keep people from engaging in certain activities.. Users may take unusual risks that can lead to long-term consequences. These risks can range from unsafe sexual encounters to automobile crashes caused by poor judgment or aggression.
New information released by NIDA in 2004 revealed that cocaine might negatively affect a user's immune system. "Cocaine itself has a direct biological effect that may decrease an abuser's ability to fight off infections," wrote Patrick Zickler in NIDA Notes. This information, reported by a team of doctors at Harvard Medical School and the McLean Hospital Alcohol and Drug Abuse Research Center, could help explain why drug abusers have such a high incidence of infections.
Other research findings published in NIDA Notes show that cocaine has a definite negative effect on unborn babies. Children born to mothers who took cocaine when they were pregnant usually have lower-than-average birth weights, small heads, and the potential for more behavioral problems than other children. "At age two," wrote Robert Mathias, "cocaine-exposed children did significantly poorer in mental development than children" who were not exposed to cocaine.
These findings suggest that cocaine-exposed children may require extra assistance to overcome learning difficulties. Experts such as Dr. Lynn Singer of Case Western Reserve University believe that early educational programs can help these youths develop the skills they will need to succeed in school.
Reactions with Other Drugs or Substances
Cocaine is almost always used with other drugs, including alcohol, heroin, amphetamines, and marijuana. Combining drugs increases the chances of overdosing or experiencing serious side effects. The most common drug to be combined with cocaine is alcohol. Alcoholic beverages prolong the cocaine high and tend to reduce drug-induced paranoia. This combination creates a new substance, . Cocaethylene is as powerful as cocaine, and its effects last longer. However, it can be more toxic to the heart. NIDA statistics indicate that the combination of cocaine and alcohol results in more deaths than any other illegal drug combination.
The combination of cocaine and heroin is called a "speedballA combination of cocaine (a stimulant) and heroin (a depressant); this combination increases the chances of serious adverse reactions and can be more toxic than either drug alone.." It is especially dangerous because cocaine speeds up the respiratory system, while heroin depresses it, or slows it down. At very high doses, however, cocaine can begin to depress the respiratory system as well. In speedballing, cocaine and heroin are typically ingested at the same time, but some users ingest the drugs alternately to feel either more energetic or more relaxed. This combination can be more toxic than using either drug alone. Comedian John Belushi died from speedballing in 1982.
Amphetamines are often combined with cocaine to extend the high. Cocaine creates a rush but it is short-lived. Adding amphetamines extends the high for up to ten hours. Using these drugs together increases the chances of an overdose and increases toxic effects.
Treatment for Habitual Users
In an article for the New York Times, Linda Carroll reported that certain people are more likely to become addicted to cocaine than others. The reason for this seems to be some sort of inborn flaw in the brain's wiring. "The leading suspect," noted Carroll, "is a defect in the dopamine system." Studies conducted on monkeys seem to back up this theory. Five monkeys involved in a Wake Forest University medical school experiment were allowed to take cocaine whenever they wanted for a whole year. At the end of the year, the "addicted monkeys ended up with a 15 percent to 20 percent decrease in dopamine receptors," wrote Carroll. The five monkeys were reexamined nine months after the conclusion of the experiment. The brains of three of them had returned to normal, but the brains of the other two still had lower-than-normal amounts of dopamine receptors in them.
The biggest challenge to cocaine treatment and rehabilitation is preventing relapse (the return to using drugs) caused by a persistent and intense craving for cocaine. Although cocaine addiction can be treated successfully, there is no single program that is effective for
everyone. NIDA recommends a dual approach to treatment, healing both the body and the mind. It suggests behavioral therapies, medications, rehabilitation, and social services. The idea is to treat the whole person.
Regarding medication, NIDA research reports that medications that act on dopamine receptors might reduce the intense craving and depression in former cocaine users. Behavioral therapies can include group and/or individual counseling, popular twelve-step programs, and chemical dependency inpatient and outpatient programs.
A Simple but Promising New Treatment Approach
On January 5, 2005, the National Institutes of Health (NIH) announced that peer counseling actually helped reduce cocaine and heroin abuse. The study was conducted by doctors at Boston University Schools of Medicine and Public Health and involved 1,175 male and female drug abusers. The process took only twenty minutes and consisted of "a motivational interview with a substance abuse outreach worker who also was a recovering addict," according to the NIH press release.
Members of the study were also given referrals to drug abuse treatment programs and a list of different types of treatment methods. In addition, they received a phone call ten days later to check on their progress. These simple interventions motivated a significantly higher percentage of abusers to stay away from drugs over a six-month period.
When cocaine use progresses to a point of dependence, it can be devastating. At this stage, drug seeking often becomes the user's first priority. Suddenly, values such as love of family and friends and commitment to work can take second place to finding, buying, and using cocaine. "Cocaine addiction almost always interferes with social and economic functioning," stated Weil and Rosen. Addicts may end up spending "phenomenal amounts of money on their habits ($15,000 a year and more)," the authors explained. "They become paranoid, isolated, and depressed, unable to stop thinking about their next dose."
Habitual users often find themselves trapped in a web of deception and criminal behavior. Users desperate for more drugs may turn to robbery or prostitution in order to finance their habit. NIDA Notes stated that "cocaine use in 'crack' exchanges also contribute[s] to transmission of HIV/AIDS." Conviction of an illegal drug offense can trigger minimum mandatory prison sentences. Also, students convicted of cocaine possession can be disqualified from obtaining federal college grants and loans. In addition, NIDA-funded research shows that drug abusers cost employers about twice as much in medical and workers' compensation claims than drug-free workers. As a result, more and more businesses are requiring drug screening for employees.
Under the U.S. Controlled Substance Act of 1970, cocaine is a Schedule II drug. This means that cocaine has a high potential for abuse and that abuse may lead to severe physical and psychological dependence. It also means that cocaine has accepted medical uses with severe restrictions. The only legal use of cocaine in the United States is as a local anesthetic.
The Anti-Drug Abuse Act of 1986 and 1988 established mandatory minimum drug sentencing guidelines for cocaine use and possession. Federal law carries a much harsher penalty for crack cocaine than for powder cocaine. Because more African Americans tend to use crack than powder, this law continues to result in harsher prison terms for blacks. Possession of 5 grams of crack or 500 grams of powder carries a first-offense penalty of not less than five years in prison. Despite the severity of this penalty, according to Landau, about "85 percent of those imprisoned for drug abuse" will continue to "use cocaine or other drugs after leaving prison."
In the United Kingdom, cocaine and crack are considered Class A drugs under the 1971 Misuse of Drugs Act. Possession of the drugs can result in a fine and a prison term of up to seven years. Supplying, or selling, either form of cocaine can lead to a lifetime prison sentence.
For More Information
Brecher, Edward M., and others. The Consumers Union Report on Licit and Illicit Drugs. Boston: Little Brown & Co., 1972.
Gahlinger, Paul M. Illegal Drugs: A Complete Guide to Their History, Chemistry, Use, and Abuse. Las Vegas, NV: Sagebrush Press, 2001.
Landau, Elaine. Cocaine. New York: Franklin Watts, 2003.
Robbins, Paul R. Crack and Cocaine Drug Dangers. Berkeley Heights, NJ: Enslow Publishers, Inc., 1999.
Wagner, Heather Lehr. Cocaine. Philadelphia: Chelsea House, 2003.
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See also: Alcohol; Amphetamines; Heroin; Marijuana
Cocaine (Encyclopedia of Drugs, Alcohol, and Addictive Behavior)
The abuse of cocaine has become a major public-health problem in the United States since the 1970s. During that period it emerged from relative obscurity, described by experts as a harmless recreational drug with minimal toxicity. By the mid-1980s, cocaine use had increased substantially and its ability to lead to drug taking at levels that caused severe medical and psychological problems was obvious. Cocaine (also known as "coke," "snow," "lady," "CRACK" and "ready rock"), is an ALKALOID with both local anesthetic and PSYCHOMOTOR STIMULANT properties. It is generally taken in binge cycles, with periods of hours to days in which users take the drug repeatedly, alternating with periods of days to weeks when no cocaine is used. Many users are recalcitrant to treatment, and the introduction of substantial criminal penalties associated with its possession and sale have not yet been effective in reducing its prevalence of heavy use. In fact, although occasional use of cocaine diminished somewhat by the early 1990s, heavier use did not.
Cocaine is extracted from the COCA PLANT (Erythroxylon coca), a shrub now found mainly in the Andean highlands and the northwestern parts of the Amazon in South America. The history of coca plant use by the cultures and civilizations who lived in these areas (including the Inca) goes back more than a thousand years, with evidence of use found archeologically in their burial sites. The Inca called the plant a "gift of the Sun god" and believed that the leaf had supernatural powers. They used the leaves much as the highland Indians of South America do today. A wad of leaves, along with some ash, is placed in the mouth and both chewed and sucked. The ash helps in the extraction of the cocaine from the coca leafnd the cocaine is efficiently absorbed through the mucous membranes of the mouth.
During the height of the Inca Empire (11th-15th centuries) coca leaves were reserved for the nobility and for religious ceremonies, since it was believed that coca was of divine origin. With the conquest of the Inca Empire by the Spanish in the 1500s, coca use was banned. The Conquistadors soon discovered, however, that their Indian slaves worked harder and required less food if they were allowed to chew coca. The Catholic church began to cultivate coca plants, and in many cases the Indians were paid in coca leaves.
Although glowing reports of the stimulant effects of coca reached Europe, coca use did not achieve popularity. This was no doubt related to the fact that coca plants could not be grown in Europe and the active ingredient in the coca leaves did not survive the long ocean voyage from South America. After the isolation of cocaine from coca leaves by the German chemist Albert Niemann in 1860 and the subsequent purification of the drug, it became more popular. It was aided in this regard by commercial endeavors in which cocaine was combined with wine (e.g., Vin de Coca), products for which there appeared many enthusiastic and uncritical endorsements by notables of the time.
Both interest in and use of cocaine spread to the United States, where extracts of coca leaves were added to many patent medicines. Physicians began prescribing it for a variety of ills including dyspepsia, gastrointestinal disorders, headache, neuralgia, toothache, and morend use increased dramatically. By the beginning of the twentieth century, cocaine's harmful effects were noted and caused a reassessment of its utility. As part of a broader regulatory effort, the U.S. government began to control its manufacture and sale. In 1914, the HARRISON NARCOTIC ACT forbade use of cocaine in over-the-counter medications and required the registration of those involved in the importation, manufacture, and sale of either coca or opium products. This had the effect of substantially reducing cocaine use in the United States, which remained relatively low until the late 1960s, when it moved into the spotlight once again.
Cocaine is a drug with both anesthetic and stimulant properties. Its local anesthetic and vasoconstriction effects remain its major medical use. The local anesthetic effect was established by Carl Koller in the mid-1880s, in experiments on the eye, but because it has been found to cause sloughing of the cornea, it is no longer used in eye surgery. Because it is the only local anesthetic capable of causing intense vasoconstriction, cocaine is beneficial in surgeries where shrinking of the mucous membranes and the associated increased visualization and decreased bleeding are necessary. Therefore, it remains useful for topical administration in the upper respiratory tract. When used in clinically appropriate doses, and with medical safeguards in place, cocaine appears to be a useful and safe local anesthetic.
Cocaine can be taken by a number of routes of administrationral, intranasal, intravenous, and smoked. Although the effects of cocaine are similar no matter what the route, route clearly contributes to the likelihood that the drug will be abused. The likelihood that cocaine will be taken for nonmedical purposes is assumed to be related to the rate of increase in cocaine brain level (as measured by blood levels) associated with those routes that provide the largest and most rapid changes in brain level being associated with greater self-administration. The oral route of administration, not a route used by cocaine abusers, is characterized by relatively slow absorption and peak levels that do not appear until approximately an hour after ingestion. Cocaine, however, is quickly absorbed from the nasal mucosa when it is inhaled into the nose as a powder (cocaine hydrochloride). Because of its local anesthetic properties, cocaine numbs or "freezes" the mucous membranes, a quality used by those purchasing the drug on the street to test for purity. When cocaine is used intranasally ("snorting"), cocaine blood levels, as well as subjective and physiological effects, peak at about 20 to 30 minutes, and reports of a "rush" are minimal. Intranasal users report that they are ready to take a second dose of the drug within 30 to 40 minutes after the first dose. Although this route was the most common way for people to use cocaine in the mid-1980s, it is not as efficient in getting the drug to the brain as either smoking or intravenous injection, and it has declined in popularity.
When taken intravenously, venous blood levels peak virtually immediately and subjects report a substantial, dose-related rush. This route was, until the mid-1980s, traditionally the choice of the experienced user, since it provided a rapid increase in brain levels of cocaine with a parallel increase in subjective effects. Blood levels of cocaine dissipate in parallel with subjective effects, and subjects report that they are ready for another intravenous dose within about 30 to 40 minutes. Users of intravenous cocaine are also more likely to combine their cocaine with HEROIN (e.g., a "speedball") than are users by other routes.
In the mid-1980s, smoked cocaine began to achieve popularity. FREEBASE, or "crack," is cocaine base, which is not destroyed at temperatures required to volatilize it. As with intravenous cocaine, blood levels peak almost immediately and, as with intravenous cocaine, a substantial rush ensues after smoking it. Users can prepare their own free-base from the powdered form they purchase on the street, or they can purchase it in the form of crack, or "ready-rock." The development of a smokable form of cocaine provided a more socially acceptable route of drug administration (both NICOTINE and MARIJUANA cigarettes provided the model for smoking cocaine), resulting in a drug that was both easy to use and highly toxic, since the route allowed for frequent repeated dosing with a readily available and relatively inexpensive drug. The use of intravenous
Cocaine is frequently taken in combination with other drugs such as alcohol, marijuana, and OPIATES. In fact, almost 75 percent of cocaine deaths reported in 1989 involved co-ingestion of other drugs. When taken in combination with alcohol, a metaboliteOCAETHYLENEs formed, which appears to be only slightly less potent than cocaine in its behavioral effects. It is possible that some of the toxicity reported after relatively low doses of cocaine might well be due to the combination of cocaine and alcohol.
Cocaine is broken down rapidly by enzymes (esterases) in the blood and liver. The major metabolites of this action (all relatively inactive) are BENZOYLECGONINE, ecgonine, and ecgonine methyl ester, all of which are excreted in the urine. Cocaethylene is an additional metabolite when cocaine and alcohol are ingested in combination. People with deficient plasma cholinesterase activityetuses, infants, pregnant women, patients with liver disease, and the elderlyre all likely to be sensitive to cocaine and therefore at higher risk for adverse effects than are others.
Research has been focused on the neurochemical and neuroanatomical substrates that mediate cocaine's reinforcing effects. Although a number of NEUROTRANSMITTER systems are involved, there is growing evidence that cocaine's effects on dopaminergic neurons in the mesolimbic and/or mesocortical neuronal systems of the brain are most closely associated with its reinforcing and other behavioral effects. The initial site of action in the brain for its reinforcing effects has been hypothesized to be the dopamine transporter of mesolimbocortical neurons. Cocaine action at the DOPAMINE transporter has the effect of inhibiting dopamine re-uptake, resulting in higher levels of dopamine at the synapse. These dopaminergic pathways may mediate the reinforcing effects of other stimulants and opiates as well. A substantial body of evidence suggests that dopamine plays a major role in mediating cocaine's reinforcing effects, although it is clear that cocaine affects not only the dopamine but also the SEROTONIN and noradrenaline systems.
In addition to blocking the re-uptake of several neurotransmitters, cocaine use results in central nervous system stimulation and local anesthesia. This latter effect may be responsible for the neural and myocardial depression seen after taking large doses. Cocaine use has been implicated in a broad range of medical complications covering virtually every one of the body's organ systems. At low doses, cocaine causes increases in heart rate, blood pressure, respiration, and body temperature. There have been suggestions that cocaine's cardiovascular effects can interact with ongoing behavior, resulting in increased toxicity. Cocaine intoxication has been associated with cardiovascular toxicity, related to both its local anesthetic effects and its inhibition of neuronal uptake of catecholamines, including heart attacks, stroke, vasospasm, and cardiac arrhythmias.
Cocaine is generally taken in binges, repeatedly, for several hours or days, followed by a period in which none is taken. When taken repeatedly, chronic cocaine intoxication can cause a psychosis, characterized by paranoia, anxiety, a stereotyped repetitive behavior pattern, and vivid visual, auditory, and tactile hallucinations. Less severe behavioral reactions to repeated cocaine use include irritability, hypervigilance, paranoid thinking, hyperactivity, and eating and sleep disturbances. In addition, when a cocaine binge ceases, there appears to be a crash response, characterized by depression, fatigue, and eating and sleep disturbances. Initially, the crash is accompanied by little cocaine craving, but as time increases since the last dose of cocaine, compulsive drug seeking can occur in which users think of little else but the next dose.
Nonhuman Research Subjects.
One of cocaine's characteristics, as a PSYCHOMOTOR STIMU-LANT, is its ability to elicit increases in the motor behavior of animals. Single low doses produce increases in exploration, locomotion, and grooming. With increasing doses, locomotor activity decreases and stereotyped behavior patterns emerge (continuous repetitious chains of behavior). When administered repeatedly, cocaine produces increased levels of locomotor activity, increases in stereotyped behavior, and increases in susceptibility to drug-induced seizures (i.e., "kindling"). This sensitization occurs in a number of different species and has been suggested as a model for psychosis or schizophrenia in humans. Although sensitization to cocaine's unconditioned behavioral effects generally occurs, such effects are related to dose, environmental context, and schedule of cocaine administration. For example, sensitization occurs more readily when dosing is intermittent rather than continuous and when dosing occurs in the same environment as testing.
Learned behaviors, typically generated in the laboratory using operant schedules of reinforcement in which animals make responses that have consequences (e.g., press a lever to get food), generally show a rate-dependent effect of cocaine. As with AMPHETAMINE, cocaine engenders increases in low rates of responding and decreases in high rates of responding. Environmental variables and behavioral context can modify this effect. For example, responding maintained by food delivery was decreased by doses of cocaine that either had no effect or increased comparable rates of responding maintained by shock avoidance. Cocaine's effects can also be modified by drug history. Although repeated administration can result in the development of sensitization to cocaine's effects on unlearned behaviors, repeated administration generally results in tolerance to cocaine's effects on schedule-controlled responding. This decrease in effect of the same dose after repeated dosing is influenced by behavioral as well as pharmacological factors.
Human Research Subjects.
A major behavioral effect of cocaine in humans is its mood-altering effect, generally believed related to its potential for abuse. Traditionally, subjective effects have provided the basis for classifying a substance as having abuse potentialnd the cocaine-engendered profile of subjective effects is prototypic of stimulant drugs of abuse. Thus, cocaine produces dose-related reports of "high," "liking," and "euphoria"; increases in stimulant-related factors, such as increases on Vigor and Friendliness scale scores; ratings of "stimulated"; and decreases in various sedation scores. Subjective effects correlate well with single intravenous or smoked doses of cocaine, peaking soon after administration and dissipating in parallel with decreasing plasma concentrations. When cocaine is administered repeatedly, tolerance develops rapidly to many of its subjective effects and the same dose no longer exerts much of an effect. This means that the user must take increasingly larger amounts of cocaine to achieve the same effect. Tolerance to the cardiovascular effects of cocaine is less complete; the result here is a potential for drug-induced toxicity, since more and more drug is taken when the subjective effects are not present but the disruptions in cardiovascular function are still present.
Although users of stimulant drugs claim that their performance of many activities is improved by cocaine use, the data do not support their assertions. In general, cocaine has little effect on performance except under conditions in which performance has deteriorated from fatigue. Under those conditions, cocaine can bring it back to nonfatigue levels. This effect, however, is relatively short-lived, since cocaine has a half-life of less than one hour.
Despite substantial efforts directed toward treatment of cocaine abuse, in the mid-1990s we are still unable to treat successfully many of the cocaine abusers who seek treatment. For many years the only approach to treating these people was psychological or behavioral. As of 1994, the most promising of these include behavioral therapy, relapse prevention, rehabilitation (e.g., vocational, educational, and social-skills training) and supportive psychotherapy. A major problem with these treatment approaches is related to their lack of selectivity. Rather than tailoring programs to an individual's background, drug-use history, psychiatric state, and socioeconomic level, individuals receive the treatment being delivered by the particular program they happen to attend. Treatment programs that focus on specific target populations will be far more successful than those which cover all who apply. For example, patients with relatively mild symptoms might do quite well in a behavioral intervention with some relapse-prevention instructions but those with more severe problems might require the addition of pharmacotherapy.
Pharmacological approaches to treating cocaine abusers have focused on potential neurophysiological changes related to chronic cocaine use. Thus, because dopamine appears to mediate cocaine's reinforcing effects, dopamine agonists such as AM-ANTADINE and bromocriptine have been tried. METHYLPHENIDATE, a stimulant, has been suggested as a possible substitution medication, and ANTIDEPRESSANTS such as desipramine have been studied because of their actions on the dopaminergic system. In addition, because cocaine blocks re-uptake of SEROTONIN at nerve terminals, serotonin-uptake blockers, such as fluoxetine, have also been tested. Although most of the potential medications have been shown to be successful in some patients under open label conditions, none have been clearly successful in double blind placebo-controlled clinical trials.
Clearly, no medication yet exists for the treatment of cocaine abuse. It may well be that different medications may be effective for the various target populations and that variations in dosages and durations of treatment might be required, depending on a variety of patient characteristics. In fact, several medications have been shown to be effective only for small and carefully delineated populations (e.g., lithium for cocaine abusers diagnosed with concurrent bipolar manic-depressive or cyclothymic disorders). An artificial enzyme has been developed that inactivates cocaine as soon as it enters the blood-stream by binding the cocaine and breaking it into two inactive metabolites, and this has the potential for destroying much of the cocaine before it reaches the brain. As of 1994, this technique is unavailable for human use. In addition, and most importantly, cocaine abuse (and drug abuse in general) is a behavioral problem, and it is unlikely that any medication will be effective unless it is combined with an appropriate behavioral intervention.
(SEE ALSO: ; Colombia As Drug Source; Epidemics of Drug Abuse; Epidemiology of Drug Abuse; National Household Survey on Drug Abuse; )
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MARIAN W. FISCHMAN