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Drug Descriptions Advanced Pain Treatment

COCAINE

Cocaine is a powerfully addictive stimulant, which is extracted from the leaves of the coca plant (Erythroxylon coca), indigenous to the Andean highlands of South America.  There are basically two chemical forms of cocaine – hydrochloride, which is snorted or injected, and freebase, which is smoked.

The hydrochloride form of cocaine is sold on the street as a fine, white, crystalline powder, which has usually been diluted with inert substances such as cornstarch, talcum powder, sugars (examples lactose and mannitol), chemically related local anesthetics (examples procaine and lidocaine), or other stimulants such as amphetamines.

The freebase form (which is smoked) has not been neutralized with an acid to make the hydrochloride salt. It can be processed from the hydrochloride salt form using ammonia or sodium bicarbonate (baking soda) and water, and then heating to remove the hydrochloride. This compound is known as Crack Cocaine, referring to the crackling sound heard when the mixture is smoked.
Street names for Cocaine include Coke, Big C, Snow, Flake, Blow, Nose Candy, Lady and Snowbird. Street names for Crack Cocaine include Crack, Rock, Hard Rock, Base and Freebase.

Effects of Use

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, is dependent on the route of administration. The faster the cocaine is absorbed, the more intense the high and 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. In rare instances, sudden death can occur on the first use of cocaine or unexpectedly thereafter.  There is no way to determine who is prone to sudden death.

Health Hazards

There is a great risk associated with cocaine use whether the drug is snorted, injected or smoked.  Prolonged cocaine snorting can result in ulceration of the mucous membranes of the nose and can damage the nasal septum enough to cause it to collapse.  The injecting drug user is at risk for transmitting or acquiring HIV infection/AIDS if needles or other injection equipment are shared.  Cocaine smokers suffer from acute respiratory problems including coughing, shortness of breath, and severe chest pains with lung trauma and bleeding. In addition, it appears that compulsive cocaine use may develop even more rapidly if the substance is smoked rather than snorted.

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.  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.  When addicted individuals stop using cocaine, they often become depressed, which in turn may lead to further cocaine use to alleviate the depression.

High doses of cocaine and/or prolonged use can trigger paranoia. Smoking crack cocaine can produce a particularly aggressive paranoid behavior in users.  Excessive doses of cocaine may lead to seizures and death from respiratory failure, stroke, cerebral hemorrhage, or heart failure. There is no specific antidote for cocaine overdose.

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.  Researchers have found that the human liver combines cocaine and alcohol and manufactures a third substance, cocaethylene, which intensifies cocaine's euphoric effects, while possibly increasing the risk of sudden death.

Treatment

The widespread abuse of cocaine has stimulated extensive efforts to develop treatment programs for this type of drug abuse.  The top research priority is to find a medication to block or greatly reduce the effects of cocaine, to be used as one part of a comprehensive treatment program. Researchers are also looking at medications that help alleviate the severe craving that people in treatment for cocaine addiction often experience.
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.

Extent of Use

The National Household Survey on Drug Abuse (NHSDA) reported that, in 1999, 3.7 million Americans used cocaine, or 1.7 percent of the household population aged 12 and over.  Although cocaine use has not significantly changed over the last six years, the number of first-time users has increased 63 percent, from 574,000 in 1991, to 934,000 in 1998. While these numbers indicate that cocaine is still a threat to the United States, cocaine use is significantly less prevalent than it was during the early 1980s. Cocaine use peaked in 1982 when 10.4 million Americans (5.6 percent of the population) reportedly used cocaine.

The 1999 NHSDA found the highest rate of monthly cocaine use was for those aged 18 to 25 at 1.7 percent, increasing from 1.2 percent in 1997. Rates declined between 1996 and 1998 for ages 26 to 34, while rates slightly increased for the 12 to 17 and 35 and older age groups. Studies also show people are experimenting with cocaine at younger and younger ages. NHSDA found a steady decline in the mean age of first use from 23.6 years in 1992 to 20.6 years in 1998.  Overall, men have a higher rate of current cocaine use than do women.  Crack cocaine still remains a serious problem in the United States. The NHSDA estimated the number of current crack users to be about 604,000 in 1997, which does not reflect any significant change since 1988.

The Monitoring the Future Survey, which annually surveys teen attitudes and recent drug use found that the proportion of high school seniors who have used cocaine at least once in their lifetimes has increased from a low of 5.9 percent in 1994 to 9.8 percent in 1999. However, this is lower than its peak of 17.3 percent in 1985. Current (past month) use of cocaine by seniors decreased from a high of 6.7 percent in 1985 to 2.6 percent in 1999. Also in 1999, 7.7 percent of 10th-graders had tried cocaine at least once, up from a low of 3.3 percent in 1992. The percentage of 8th-graders who had ever tried cocaine has increased from a low of 2.3 percent in 1991 to 4.7 percent in 1999.
Lifetime use of crack cocaine, according to MTF, also increased amongst eighth, tenth, and twelfth graders, from an average of 2.0 percent in 1991 to 3.9 percent in 1999. To make matters worse, perceived risk and disapproval of cocaine and crack use both decreased during the 1990s at all three grade levels.

Data from the Drug Abuse Warning Network (DAWN) showed that cocaine-related emergency room visits, after increasing 78 percent between 1990 and 1994, remained level between 1994 and 1996, with 152,433 cocaine-related episodes reported in 1996.

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  • It is not intended as medical advice for individual conditions or treatment.
  • It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals.

Talk to your doctor or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor or pharmacist can provide you with advice on what is safe and effective for you.

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