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.1
The name "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.2
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.3
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.
Contents of this article:
Cocaine as a recreational drug
Today, cocaine is commonly used as a recreational drug.
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.4
Cocaine can be:
- Snorted - inhaled through the nose. It enters the bloodstream via the nasal tissues.5
- Injected - where it is released directly into the bloodstream.5
- Smoking - cocaine is inhaled as vapor or smoke into the lungs, where it rapidly enters the bloodstream.5
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.6
Overdosing on cocaine can lead to seizures, and life-threatening heart failure, cerebral hemorrhage, stroke and respiratory failure - even regular usage without overdosing raises the risk of detrimental health consequences (see paragraph below).
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.7
Smoking cocaine increases the risk of developing respiratory problems, such as shortness of breath, coughing, and lung trauma (including bleeding).8
Stroke and heart attack risk
Researchers from the University of Sydney, Australia, conducted a study demonstrating that recreational cocaine users have a significantly higher risk of having a heart attack or stroke compared to those who never use the drug.9
Recreational cocaine users tend to have harder arteries, thicker heart muscle walls, and higher blood pressure than lifetime non-users.
Regular cocaine users were found to have an 8mm Hg higher systolic blood pressure compared to non-users, as well as an up to 35% increased risk in the hardening of the aorta.
The researchers added that cocaine users are not usually aware of these cardiovascular risks.
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 only 5 minutes depending on how it is taken.10
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 disrupts 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.
Risk of addiction
Cocaine is a highly addictive drug. People who are addicted may 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 on binges costing from $20,000 to $50,000. Some may lose their jobs, families, become bankrupt, and even die.
Physical changes in the brain
Scientists at the University of Cambridge in England identified abnormal brain structure in the frontal lobe of the brain of cocaine users that are associated with their cocaine-using behavior.
The team 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.
The researchers also found that those with the most reduction in volume had the greatest cocaine compulsivity.11
The basal ganglia, the brain reward system where cocaine exerts its actions, was also found to be 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, who works at 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 added:
"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. This is something the team is currently investigating. Cocaine is highly addictive, however, a considerable number of people who take it never become hooked.
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.12
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. "Epigenetic" means resulting from external rather than genetic influences
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.13
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 cocaine changes the reward pathway by repressing a histome demethylating enzyme called G9A - this enzyme plays a vital role in epigenetic control of gene expression.
The team reported 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."
Other health risks
Data suggests cocaine is the 2nd most addictive and
the 2nd most harmful of 20 popular recreational drugs
The consumption of cocaine can have the following effects on a human:14
- Constriction of blood vessels.
- Dilation of pupils.
- Elevated body temperature.
- Accelerated heart rate.
- Hypertension (high blood pressure).
- Abdominal pain.
- 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 restlessness.
- 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 failure.
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.15
Some studies suggest that the risk of suicide is greater when a person is coming down from a cocaine binge, or 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.16
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%.17
Treatment for 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.18
The NTA (National Treatment Agency for Substance Misuse, UK) says that 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.19
The National Health Service advises people to visit their GP (general practitioner, primary care physician), who can direct them to suitable specialists and centers.
According to the US Library of Medicine, individuals who stopped using cocaine can still feel powerful cravings for the drug, sometimes even years later.21
Production and demand
In 2012 the Office of National Drug Control Policy (ONDCP) released results of the annual U.S. Government estimate measuring cocaine production in Colombia. According to the ONDCP, "the new survey now places Colombia behind Peru (325 metric tons in 2010) and Bolivia (265 metric tons in 2011) in cocaine production."20
Video - a cocaine documentary
This BBC documentary contains compelling real-life stories as well as computer graphics which illustrate the highs and lows created by cocaine. Once the drug of just the rich and famous, today it is the most popular Class A drug in the United Kingdom. More than 1.2 million Brits took the drug in 2009.