Cocaine Abuse

Cocaine Abuse Overview

Cocaine is presently the most abused major stimulant in America. It has recently become the drug most frequently involved in emergency department visits. It is not a new drug of abuse but is now considered the caviar of recreational drugs. Thus, this distinction is reflected in its description—champagne of drugs, gold dust, Cadillac of drugs, status stimulant, yuppie drug, and others. Street names for cocaine also reflect its appearance or method of use (such as flake, snow, toot, blow, nose candy, her, she, lady flake, liquid lady [a mixture of cocaine and alcohol], speedball [cocaine and heroin], crack, rock). And it can also express its method of preparation, such as freebase. It is more popularly known simply as coke.

A common myth is that cocaine is not addictive because it lacks the physical withdrawal symptoms seen in alcohol or heroin addiction. Cocaine has powerful psychological addictive properties. As more than one user has reflected, "If it is not addictive, then why can't I stop?" The trend in drug abuse in the United States is presently multiple or polydrug abuse, and cocaine is no exception. Cocaine is often used with alcohol, sedatives such as Valium, Ativan, or heroin, as an upper/downer combination. The other drug is also used to moderate the side effects of the primary addiction. A common polydrug abuse problem, seen especially in adolescents, is cocaine, alcohol, and marijuana.

Drug abuse, chemical dependency, and addictive behavior spare no one and are spread throughout society. They do not respect age, profession, race, religion, or physical attributes.

• History: Cocaine is a naturally occurring alkaloid usually extracted from the leaves of the coca shrub, which was originally found in the Andes Mountains of Peru and Bolivia. With its appreciation as a lucrative cash crop, it is now cultivated in Colombia, Argentina, Brazil, Mexico, the West Indies, Ecuador, and Java. Coca leaves were mixed with lime and chewed by the Peruvian Indians as early as the sixth century to allay the effects of cold, hunger, and fatigue. It is still used as such as a gift from the Sun God. In this sense, coca is an important sociocultural tradition for Peruvian and Bolivian Indians and should not to be confused with the cocaine snorting, smoking, and injecting of the Western abuser. Coca was later introduced to Europe, where the alkaloid cocaine was isolated. Its medicinal effects on depression, alcohol and morphine addiction, fatigue, and as a local anesthetic were discovered. However, these discoveries were not without cost to those who experimented with it. The result was addiction and dependency on the drug.

   

• A brain tonic: In 1886, an elixir containing cocaine from the coca leaf and caffeine from the African kola nut was marketed in Atlanta. It was sold as a brain tonic recommended for headaches, alcoholism, morphine addiction, abdominal pain, and menstrual cramps. This elixir, appropriately named Coca-Cola, rapidly became one of the most popular elixirs in the country. But because of the adverse effects of cocaine, appreciated even then, the Coca-Cola Company agreed to use decocainized coca leaves in 1903. Cocaine came under strict control in the United States in 1914 with the Harrison Narcotic Act. It is listed as a narcotic and dangerous. Though its use is dangerous, it is not a narcotic, but its use is subject to the same penalties as those for opium, morphine, and heroin.

   

• Limited medical use: Cocaine has little medical use. Because of its anesthetic effect, it was used for eye surgery. But because of its profound ability to vasoconstrict blood vessels (that is, make veins and arteries narrow, thus stopping bleeding), it can lead to scarring and delayed healing of the cornea. It is still available for use in the nose for surgery, stopping nosebleeds, and as a local anesthetic for cuts in children.

   

• Street use: The cocaine destined for street use in the United States is generally isolated and converted to cocaine hydrochloride in South American labs. This cocaine salt, which can be as pure as 95%, is then smuggled into the country. As it passes through many hands from the importer to the user, it is usually diluted ("cut" or "stepped on") at each stage of distribution to increase each dealer's profit. The final product can be from 1% to 95% pure. Common additives are sugars, such as mannitol, lactose, or glucose, or even sugar substitutes, and local anesthetics such as tetracaine, procaine, and lidocaine. Quinine, talc, and cornstarch have also been used. Other illicit drugs, such as heroin, codeine, amphetamine, phencyclidine (PCP), LSD, and hashish, can be mixed in as well. Some consumers may unknowingly purchase a supply without any cocaine, but just a cocaine substitute such as caffeine, amphetamine, PCP, procaine, and lidocaine.

   

  • Population surveys released by the National Institute on Drug Abuse indicate that most cocaine users are older, inner-city crack addicts. 

     

  • However, field reports are identifying new groups of users: teenagers smoking crack with marijuana in some cities, Hispanic crack users in Texas, middle-class suburban users of cocaine hydrochloride, and female crack users in their 30s with no prior drug use history.
  
  
• Methods of abuse: Coke in this hydrochloride salt form may be injected; swallowed; applied to oral, vaginal, or even rectal mucous membranes; or mixed with liquor. Coke is most commonly used by snorting or sniffing.

   

  • With snorting, the usual ritual is to place a line of coke, about 0.3 cm wide by 2.5 cm long, on a smooth surface. The finely divided powder is then snorted (inhaled quickly) into a nostril through a plastic or glass straw or a rolled currency bill. This ritual is usually repeated within a few minutes using the other nostril. Special spoons and other paraphernalia are available for snorting cocaine.

     

  • Cocaine is generally not taken by mouth for recreational purposes. Toxic reactions, including death, have occurred in people who swallow the drug to avoid police detection or border authorities. This smuggling attempt is known as body packing. This crystalline white powder can be dissolved in water and used intravenously ("slammed"). In this form, it has a high melting point, so it cannot be smoked and is the most widely used form of the drug.

     

  • Freebasing involves the conversion of cocaine hydrochloride into cocaine sulfate that is "free" of the additives and nearly 100% pure. It is not water soluble and has a low melting point, so it can be smoked. The freebaser runs the risk of being burned by the conversion process because a highly volatile solvent, such as ether, is being used.

     

  • Crack is extracted from coke using baking soda and heat—a relatively safe method compared with the ether technique. The waxy base becomes rocks of cocaine, ready to be sold in vials. This rock cocaine is also easy to smoke, the most common form of use in the streets. Cocaine sulfate is also available as coca paste known as basuco, bazooka, piticin, pistol, pitillos, or tocos and is widely smoked in South America. Because the freebase is resistant to destruction by heat, it can be smoked either in cigarettes, including marijuana cigarettes, or in "coke pipes." Smoking the freebase produces a more powerful effect more rapidly, but it is also more dangerous because the safe dose can easily be exceeded. A user describes the comparison: "Snorting coke is like driving 50 miles per hour. Smoking crack is like driving 150 miles per hour without brakes!"
  
  
• Why cocaine becomes addictive: Research with cocaine has shown that all laboratory animals can become compulsive cocaine users. Animals will work more persistently at pressing a bar for cocaine than for any drug, including opiates. An addicted monkey pressed the bar 12,800 times until it got a single dose of cocaine. If the animal survives, it will return to the task of obtaining more cocaine.

   

  • The human response is similar to that of the laboratory animal. The cocaine-dependent human prefers it to all other activities and will use the drug until the user or the supply is exhausted. These persons will exhibit behavior entirely different from their previous lifestyle.

     

  • Cocaine-driven humans will compel themselves to perform unusual acts compared with their former standards of conduct. For example, a cocaine user may sell her child to obtain more cocaine. There are many stories of professionals, such as lawyers, physicians, bankers, and athletes, with daily habits costing hundreds to thousands of dollars, with binges in the $20,000-$50,000 range. The result may be loss of job and profession, loss of family, bankruptcy, and death.
  
  
• Lethal dose: Although this drug has been in use for more than 5000 years, the toxic dose or the amount of cocaine that will cause death or some significant medical consequence is unknown. The average lethal dose by the IV route or by inhalation is about 750-800 mg. This is subject to significant individual variation because deaths have occurred in doctors' offices with as little as 25 mg applied to the mucous membrane or the snorting of a single line in recreational use where the average dose of 1 line is 20 mg.

   

• Effects: The method of use dictates the onset of activity and duration of its effects. If snorted, the effects will peak within 30 minutes with its duration of effect lasting 1-3 hours. If swallowed with alcohol, effects peak in 30 minutes and last about 3 hours. If used intravenously or inhaled/smoked, the effects peak in seconds to 2 minutes but last only 15-30 minutes. The breakdown products of the drug will be excreted and can be detected in the urine for 24-72 hours. For chronic users, it can be detected for up to 2 weeks.