What Is Cocaine? How Addictive Is Cocaine?

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Main Category: Alcohol / Addiction / Illegal Drugs
Article Date: 11 Sep 2011 - 13:00 PDT


Cocaine is a bitter, addictive pain blocker that is extracted from the leaves of Erythroxylon coca, also known as the coca scrub, a plant that comes from the Andean highlands in South America. Cocaine is the most powerful stimulant of natural origin. The name of "cocaine" came from the plant "coca". When Coca-Cola first came out it contained nine milligrams of cocaine per glass - in 1903 it was removed, but the drink still has coca flavoring.

William S. Halstead (1852-1922), an American surgeon, injected cocaine into nerve trunks and demonstrated its numbing effect. It soon became used as an anesthetic agent. In 1898 August Bier, a German surgeon used cocaine as a spinal anesthetic. Not long afterwards the medical profession became aware of the addictive nature of cocaine and safer anesthetics were developed. Cocaine in its basic form stopped being used clinically as a pain blocker.

Today, cocaine is commonly used as a recreational drug.


Erythroxylon coca

Recreational cocaine, often termed illicit cocaine, and informally known as "powder, snow, ski, soft, blow, slopes,coca, and nose candy", is presented as a white crystalline powder or as an off-white chunky substance. In powder form it is usually cocaine hydrochloride (C₁₇H₂₁NO₄), which is then diluted with other substances, such as local anesthetic (lidocaine), sugars (lactose), inositol, and mannitol. By adulterating the cocaine in this way the seller can make more profits.

Cocaine can be:

• Snorted - inhaled through the nose. It enters the bloodstream via the nasal tissues.
• Injected - where it is released directly into the bloodstream.
• Smoking - cocaine is inhaled as vapor or smoke into the lungs, where it rapidly enters the bloodstream.

Crack is the street name for a type of cocaine that has had the hydrochloride removed, making it possible to smoke. When the mixture is heated it makes a crackling sound, hence the name. It is processed with baking soda (sodium bicarbonate) or ammonia and water, and heated to remove the hydrochloride. The crack smoker receives large doses of cocaine - the effect is virtually immediate, as with injected cocaine. The extremely intense feelings derived from smoking crack are short-lived.

Overdosing on cocaine can lead to seizures, and life-threatening heart failure, cerebral hemorrhage, stroke and respiratory failure. There is no specific medication for cocaine overdose. Some studies have shown that those who inject or smoke cocaine have a greater risk of complications than individuals who snort it. Smokers will typically become compulsive cocaine users more rapidly than those who snort it.

Smoking cocaine increases the risk of developing respiratory problems, such as shortness of breath, coughing, and lung trauma (including bleeding).

Colombia is the world's largest producer of coca (plant) - however, its government's anti-drugs policy has succeeded in bringing this down significantly. Peru is the second largest producer, followed by Bolivia. The USA is by far the world's largest consumer of cocaine. Many experts say that the war on illicit drugs, such as cocaine, will only succeed if authorities combat demand, and not just the supply. (Source: United Nations Office of Drugs and Crime - UNODC)

Medical effects of cocaine

Cocaine has a very powerful stimulating effect on the nervous system, it raises levels of dopamine, a neurotransmitter linked to pleasure and movement in the brain's reward circuit - the effects generally last from 15 to 30 minutes, or up to an hour, depending on how it is taken.

Neurons release dopamine in response to a pleasurable stimulus, such as the smell of good food. It is then recycled back into that same neuron, thus shutting off the signal between neurons. Cocaine stops the dopamine from getting back into the neuron - it stops the dopamine from being recycled - resulting in an accumulation of dopamine. This amplifies the message to and response of the receptive neurons, and ultimately disrupting normal communication. The excess dopamine gives the user a feeling of enhanced well-being, euphoria, alertness, motor activity and energy. Some describe increased sensations of sexuality and competence.

Long term usage can lead to gradual changes in the brain's reward system, as well as other systems in the brain, which seriously raise the risk of addiction.

Severe or even minor social or physical problems are rare among occasional cocaine users (However, forensic pathologists insist there is no safe amount of cocaine; see further down in this article).

High risk of addiction

Animal laboratory studies have demonstrated how addictive cocaine can be. Animals will work much more persistently for a cocaine bar than any other drug, even opiates. Addicted humans eventually prefer taking cocaine to any other activity - their lifestyles may alter completely as the addiction takes hold more firmly. There have been cases of mothers selling their child, professionals spending thousands of dollars with binges costing from $20,000 to $50,000. Some may lose their jobs, families, become bankrupt, and even die.

Brain alterations - scientists at the University of Cambridge, England, identified abnormal brain structure in the frontal lobe of the brain of cocaine users that are associated with their cocaine-using behavior. They scanned the brains of 120 individuals, half of whom were addicted to cocaine. They found that the cocaine users had widespread loss of grey matter that was directly linked to how long they had been using cocaine - the longer the abuse, the greater the loss. They also found that those with the most reduction in volume had the greatest cocaine compulsivity.

They also found that the basal ganglia, the brain reward system where cocaine exerts its actions, was much larger among those dependent on cocaine. However, there was no association between the size of the enlargement and how long the person had been doing cocaine. The scientists believe that the enlargement may have occurred before cocaine usage, meaning that there are people who are more vulnerable to the effects of cocaine.

Dr Karen Ersche, of the Behavioural and Clinical Neuroscience Institute at the University of Cambridge, said:

"This research gives us important insight into why some people are more vulnerable to drug addiction. Not only is this important for the future development of more effective therapeutic interventions for people who have become dependent on drugs, it will also inform improved strategies to prevent drug addiction in the first place."

Dr Ersche explained that cocaine changes the way an individual thinks and feels. Those addicted to it feel an uncontrollable, overwhelming need for the drug, even in the face of very unpleasant consequences.

Dr Ersche said:

"People with cocaine dependence describe their out-of-control drug use as a 'compulsion' to use cocaine. Our current work has laid the foundation for a better understanding of cocaine dependence and why this compulsion occurs.

Our findings are important because they show a clear relationship between the brain, the duration of cocaine use and some of the common attention problems that people with cocaine dependence report. These data show that cocaine dependence is a disorder of the brain, which is very relevant information for the treatment of people who are trying to beat their addiction." "

Whether cocaine dependence is an inherited trait is unknown, Dr. Ersche says. This is something she and her team are currently investigating. Cocaine is highly addictive, however, a considerable number of people who take it never develop an addiction. (Link to article)

Exposure during teenage years - exposure to cocaine during adolescent years raises the "reinforcing effects" that make people vulnerable to developing an addiction, researchers from the University of Valencia, Spain found. The same was found with ecstasy. Adolescents who take cocaine often take ecstasy simultaneously - known as polyconsumption. According to studies carried out in Spain, 44% of cocaine users also take ecstasy, a practice that started off during adolescence. (Link to article)

Cocaine affects an epigenetic process - researchers at NIDA (National Institute on Drug Abuse, USA) identified a key epigenetic mechanism in the brain that helps explain cocaine's addictiveness. Cocaine affected an epigenetic process - a process that can influence gene expression without altering a gene's sequence - called histome methylation. These epigenetic alterations in the brain's pleasure circuits, which appear to be the first affected by long-term cocaine exposure, are thought to contribute to an acquired preference for cocaine.

NIDA Director Dr. Nora D. Volkow, said:

"This fundamental discovery advances our understanding of how cocaine addiction works. Although more research will be required, these findings have identified a key new player in the molecular cascade triggered by repeated cocaine exposure, and thus a potential novel target for the development of addiction medications."

The scientists found that one mechanism by which cocaine changes the reward pathway is by repressing a histome demethylating enzyme called G9A - this enzyme plays a vital role in epigenetic control of gene expression.

The researchers found that animals exposed to long-term cocaine displayed dramatic changes in gene expression, as well as a powerful preference for cocaine. By repressing G9a, they were able to block the gene expression changes and reduce addiction to cocaine.

Team leader, Dr. Eric J. Nestler, director of the Brain Institute at Mount Sinai School of Medicine, said:

"The more complete picture that we have today of the genetic and epigenetic processes triggered by chronic cocaine give us a better understanding of the broader principles governing biochemical regulation in the brain which will help us identify not only additional pathways involved but potentially new therapeutic approaches." (Link to article )

Cocaine - the second most addictive recreational drug

The Lancet data suggests cocaine is ranked both the 2nd most addictive and the 2nd most harmful of 20 popular recreational drugs

The health risks from cocaine

The consumption of cocaine can have the following effects on a human:

• Constriction of blood vessels
• Dilation of pupils
• Elevated body temperature
• Accelerated heart rate
• Hypertension (high blood pressure)
• Headaches
• Abdominal pain
• Nausea
• Decreased appetite - which among chronic users can lead to malnourishment
• Regular snorting - loss of sense of smell, nosebleeds, swallowing problems, persistent runny nose, and hoarseness
• Regular ingestion - severe bowel gangrene caused by a reduction in blood flow
• Injecting - severe allergic reactions, higher risk of blood-borne diseases, such as HIV/AIDS and hepatitis
• Binge pattern cocaine use - irritability, anxiety, and restleness
• Cocaine abuse - severe paranoia (may be a full-blown paranoid psychosis episode). The individual might lose his/her sense of reality and hear things that are not there (auditory hallucinations)
• Heart attack
• Stroke
• Respiratory arrest

Cocaethylene - substance abusers commonly take more than one drug at the same time. People who take cocaine and alcohol simultaneously may find that their liver produces cocaethylene, which intensifies the euphoric effects of cocaine. However, cocaethylene is linked to a significantly greater risk of sudden death, compared to cocaine alone.

Some studies have indicated that there is a risk of suicide after coming down from a cocaine binge, or when withdrawing from the drug.

Cocaine related deaths in Europe - forensic pathologists in south-west Spain revealed that over 3% of all sudden deaths are related to cocaine use. They believe the rest of Europe probably has a similar prevalence. The pathologists stress that a "safe" recreational amount of cocaine does not exist. Out of 668 sudden deaths that occurred between 2003 and 2006, 3.1% (21) were linked to cocaine use - they were all male and aged between 21 and 45. In most of the cases, the men had problems with the heart and its related systems. (Link to article)

Study leader, Dr Joaquín Lucena, MD PhD, Head of the Forensic Pathology Service at the Institute of Legal Medicine (Seville, Spain), said:

"Our findings show that cocaine use causes adverse changes to the heart and arteries that then lead to sudden death."

In Florida, the number of cocaine deaths per 100,000 people rose from 150 in the year 2000 to nearly 300 in 2005, an increase of almost 100%. (Link to article)

Treatment for cocaine addiction

Treatment for cocaine addiction and other stimulants is completely different from heroin treatment. There are no effective substitute drugs for the patient who is dependent on cocaine. Some medications may be prescribed as part of treatment, but they will be for symptoms related to withdrawal.

Depending on the nature of the drug abuse, some patients will be advised to attend a residential rehabilitation program, or a structured day program.

According to the National Health Service, UK, best results have been found to come from counseling, social support and some specialist medications. Most patients respond well to targeted treatment. According to NTA (National Treatment Agency for Substance Misuse, UK), out of every 10 people who go into treatment for powder cocaine problems, seven either stop completely or significantly reduce their consumption within six months. The National Health Service advises people to visit their GP (general practitioner, primary care physician), who can direct them to suitable specialists and centers.

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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