Medical term:

Cocaine

Definition

Cocaine is a highly addictive central nervous system stimulant extracted from the leaves of the coca plant, Erythroxylon coca.

Description

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 filled with a mixture of crack and marijuana is known as a "woolah." And either cocaine or crack used in conjunction with heroin is called a "speed-ball." Cocaine used together with alcohol represents the most common fatal two-drug combination.

History

Cocaine is one of the oldest known psychoactive drugs. Coca leaves, the source of cocaine, were used by the Incas and other inhabitants of the Andean region of South America for thousands of years, both as a stimulant and to depress appetite and combat apoxia (altitude sickness).

Despite the long history of coca leaf use, it was not until the latter part of the nineteenth century that the active ingredient of the plant, cocaine hydrochloride, was first extracted from those leaves. The new drug soon became a common ingredient in patent medicines and other popular products (including the original formula for cola). This widespread use quickly raised concerns about the drug's negative effects. In the early 1900s, several legislative steps were taken to address those concerns; the Harrison Act of 1914 banned the use of cocaine and other substances in non-prescription products. In the wake of those actions, cocaine use declined substantially.

The drug culture of the 1960s sparked renewed interest in cocaine. With the advent of crack in the 1980s, use of the drug had once again become a national problem. Cocaine use declined significantly during the early 1990s, but it remains a significant problem and is on the increase in certain geographic areas and among certain age groups. A mid-1990s government report said that Americans spend more money on cocaine than on all other illegal drugs combined.

Causes and symptoms

As with other forms of addiction, cocaine abuse is the result of a complex combination of internal and external factors. Genetic predisposition, family history, and immediate environment can affect a person's probability of becoming addicted.

As many as three to four million people are estimated to be chronic cocaine users. The 1997 National Household Survey on Drug Abuse reported an estimated 600,000 current crack users, showing no significant change since the late 1980s.

How cocaine affects the brain

Extensive research has been conducted to determine how cocaine works on the brain and why it is so addictive. Cocaine has been found to affect an area of the brain known as the ventral tegmental area (VTA), which connects with the nucleus accumbens, a major pleasure center. Like other commonly abused addictive drugs, cocaine's effects are related to the action of the neurotransmitter dopamine, which carries information between neurons. Cocaine interferes with the normal functioning of neurons by blocking the re-uptake of dopamine, which builds up in the synapses and is believed to cause the pleasurable feelings reported by cocaine users.

Short-term effects of use

The short-term effects of cocaine can include:

rapid heartbeat
constricted blood vessels

dilated pupils
increased temperature
increased energy
reduced appetite
increased sense of alertness
euphoria
death due to overdose

Long-term effects of use

The long-term effects of cocaine and crack use include:

dependence, addiction
irritability
mood swings
restlessness
weight loss
auditory hallucinations
paranoia

Cocaine use and pregnancy

The rise in cocaine use as well as the appearance of crack cocaine in the late 1980s spurred fears about its effects on the developing fetus and, since then, several research reports have suggested that prenatal cocaine use could be associated to a wide range of fetal, newborn, and child development problems. According to the Lindesmith Center-Drug Policy Foundation, many of these early reports had methodological flaws, and most researchers nowadays propose more cautious conclusions concerning prenatal cocaine effects. Much evidence would seem to point to the lack of quality prenatal care and the use of alcohol and tobacco as primary factors in poor fetal development among pregnant cocaine users. Research sponsored by the National Institute on Drug Abuse (NIDA) and the Albert Einstein Medical Center in Philadelphia corroborate the Lindensmith Center findings in reporting that the lack of quality prenatal care is associated with undesirable effects often attributed to cocaine exposure such as prematurity, low birth weight, and fetal or infant death. The Center for Disease Control and Prevention (CDC), however, reports that mothers who use cocaine early in pregnancy are five times as likely to have a baby with a malformation of the urinary tract as mothers who do not use the drug. Thus, cocaine use during pregnancy is inadvisable, especially since it is also often associated with the use of alcohol known to cause long-term developmental problems. Supporting the cocaine-exposed expecting mother so as to discourage cocaine use remains an important task for all health caregivers.

Diagnosis

Diagnosing cocaine addiction can be difficult. Many of the signs of short-term cocaine use are not obvious. Since cocaine users often also use other drugs, it may not be easy to distinguish the effects of one drug from another.

Cocaine use has been documented in significant numbers of eighth graders as well as older teens. Over all age groups, more men than women use the drug. The highest rate of cocaine use is found among adults 18 to 25 years old.

Medical complications

Cocaine has been linked to several serious health problems, including:

arrhythmia
heart attacks
chest pain
respiratory failure
strokes
seizures

Other complications may vary depending on how the drug is administered. Prolonged snorting, for example, can irritate the nasal septum, producing nosebleeds, chronic runny nose, and other problems. Intravenous users face an increased risk of infectious diseases such as HIV/AIDS and hepatitis.

Testing

Drug testing can be useful in diagnosing and treating cocaine abuse. Urine testing can detect cocaine; besides providing an objective alternative to reliance on what a patient says, such tests can also be used as a follow-up to treatment to confirm that the patient has remained drug-free.

Treatment

The last two decades have seen a dramatic rise in the number of cocaine addicts seeking treatment. But like all forms of drug abuse, cocaine abuse/addiction is a multifaceted phenomenon involving environmental, social, and familial as well as physiological factors. This greatly complicates the challenge of effectively treating cocaine addiction.

Pharmacological treatments

To date, no medications have been approved specifically for treating cocaine addiction. But several were under development at this writing. Selegeline, delivered either via a time-release pill or a transdermal patch, shows promise as a possible anti-cocaine medication. Clinical studies have shown the drug disulfiram (also used to treat alcoholics) to be effective in treating cocaine abusers. In addition, antidepressant medications are sometimes used to control the mood swings associated with the early stages of cocaine withdrawal. Research in 2004 was looking at new approach—treating cocaine addiction with a virus that helped clear the drug from the brain.

Behavioral approaches

A wide range of behavioral interventions have been successfully used to treat cocaine addiction. The approach used must be tailored to the specific needs of each individual patient, however.

Contingency management rewards drug abstinence (confirmed by urine testing) with points or vouchers which patients can exchange for such things as an evening out or membership in a gym. Cognitive-behavioral therapy helps users learn to recognize and avoid situations most likely to lead to cocaine use and to develop healthier ways to cope with stressful situations. Residential programs/therapeutic communities may also be helpful, particularly in more severe cases. Patients typically spend six to 12 months in such programs, which may also include vocational training and other features.

Alternative treatment

Various alternative or complementary approaches have been used in treating cocaine addiction, often in combination with more conventional therapies. In Japan, the herb acorus has been traditionally used both to assist early-stage cocaine withdrawal and in later recovery stages. Other herbs sometimes used to treat drug addictions of various kinds include kola nut, guarana seed and yohimbe (to boost short-term energy), and valerian root, hops leaf, scullcap leaf, and chamomile (to calm the patient). The amino acids phenylalanine and tyrosine have been used to reduce cocaine addicts' craving for the drug, and vitamin therapy may be used to help strengthen the patient. Gentle massage has been used to help infants born with congenital cocaine addiction. Other techniques, such as acupuncture, EEG biofeedback, and visualization, may also be useful in treating addiction.

Prognosis

Because addiction involves so many different factors, prospects for individual addicts vary widely. A 2004 study found that recovered drug addicts often crave the drug for years and are at risk for relapse. However, research also has consistently shown that treatment can significantly reduce both drug abuse and subsequent criminal activity. The comprehensive Services Research Outcomes Study (1998) found a 45% drop in cocaine use five years after treatment, compared to use during the five years before treatment. The study also found that females generally respond better to treatment than males, and older patients tend to reduce their drug use more than younger patients.

Some research also supports the idea that 12-step programs used in conjunction with other approaches can significantly enhance the prospects for a positive outcome. One study of people in outpatient drug-treatment programs found that participation in a 12-step program nearly doubled their chances of remaining drug-free.

Key terms

Apoxia — Apoxia refers to altitude sickness.

Arrhythmia — Irregular heartbeat.

Central nervous system — Part of the nervous system consisting of the brain, cranial nerves and spinal cord. The brain is the center of higher processes, such as thought and emotion and is responsible for the coordination and control of bodily activities and the interpretation of information from the senses. The cranial nerves and spinal cord link the brain to the peripheral nervous system, that is the nerves present in the rest of body.

Nasal septum — The membrane that separates the nostrils.

Neurotransmitter — A chemical that carries nerve impulses across a synapse.

Synapse — The gap between two nerve cells.

Prevention

Despite significant variation over time, cocaine addiction has proven to be a persistent public health problem. Interdiction and source control are expensive and have failed to eliminate the problem, and some law enforcement officials are now recommending more emphasis on demand reduction through education and other measures to address the causes of cocaine addiction.

Resources

Periodicals

Avants, S. Kelly. "A Randomized Controlled Trial of Auricular Acupuncture for Cocaine Dependence." JAMA November 22, 2000.

"Craving for Cocaine May Last for Years after Recovery." Health & Medicine Week April 19, 2004: 846.

Goode, Erica. "Acupuncture Helps Some Quell Need for Cocaine." New York Times August 15, 2000: D7.

LeDuff, Charlie. "Cocaine Quietly Reclaims Its Hold as Good Times Return." New York Times August 21, 2000: 2.

"Treating Cocaine Addiction With Viruses." Ascribe Health News Service June 21, 2004.

Organizations

Cocaine Anonymous. 6125 Washington Blvd. Suite 202, Culver City, CA 90232. (800) 347-8998.

Nar-Anon Family Group Headquarters, Inc. P.O. Box 2562, Palos Verdes Peninsula, CA 90274. (310) 547-5800.

cocaine

[ko-kān´]

an alkaloid obtained from the leaves of various species of Erythroxylon (coca plants) or produced synthetically; used as a topical anesthetic for surgery of mucous membranes. Abuse of cocaine by inhalation through the nose (“snorting”) is a serious health problem. Chronic users develop ulceration of the nasal mucosa that can eventually lead to perforation of the septum. Its systemic toxic effects are related to its sympathomimetic characteristics, including vasoconstriction, tachycardia, and hypertension. Cardiac dysrhythmias and high fever have caused serious consequences and even death in some cocaine users.

crack cocaine a smokable form of cocaine prepared for illicit use, characterized by rapid absorption and onset of euphoric effects.

co·caine

(kō-kān'),

C₁₇H₂₁N_O4; Benzoylmethylecgonine; a crystalline alkaloid obtained from the leaves of Erythroxylon coca (family Erythroxylaceae) and other species of Erythroxylon, or by synthesis from ecgonine or its derivatives; a potent central nervous system stimulant, vasoconstrictor, and topical anesthetic, widely abused as a euphoriant and associated with the risk of severe adverse physical and mental effects.

The coca bush is indigenous to Bolivia and Peru, where for centuries natives have chewed its leaves along with limestone pellets or plant ashes to withstand hunger, thirst, and fatigue. During the 19th century, cocaine was widely used in medicine as a stimulant, antidepressant, and topical anesthetic, but because of its strong potential for inducing dependency it is no longer administered systemically. Its popularity as a recreational drug waned slightly after amphetamines became available in the 1920s but returned in the 1960s. Cocaine is generally sold on the street as the hydrochloride salt, a fine white powder known as "coke," "snow," "flake," or "blow." Street dealers cut or adulterate it with inert substances such as cornstarch, talcum powder, and sugar, or with active drugs such as procaine and benzocaine. In powder form it is usually "snorted" into the nostrils, although it may also be absorbed through the buccal, vaginal, or rectal mucosa or injected. A smokable form of cocaine can be prepared from the hydrochloride by a process called "freebasing." Production of pure free base cocaine is hazardous because it employs highly flammable solvents. The drug commonly called "crack" is a crude form of free base prepared from cocaine hydrochloride with ammonia or sodium bicarbonate and water. The hardened product of this process is cracked into irregular fragments called "rock," "ready rock," "french fries," or "teeth." Street use of crack exploded upon its introduction in the 1980s, causing increases in emergency department admissions for cocaine overdose, drug-related deaths, and births of cocaine-dependent babies. Administration of cocaine quickly produces intense euphoria, accompanied by a sense of increased energy, alertness, and self-confidence and diminished need for food and sleep. Pulse, blood pressure, and respiratory rate are increased. Higher doses can lead to bizarre or violent behavior, paranoia, chest pain, tremors, seizures, coma, and death due to coronary artery spasm or respiratory arrest. Smoked crack cocaine reaches the brain more quickly than snorted cocaine. The effects of either form wear off in less than 30 minutes, to be succeeded by profound depression, irritability, and fatigue ("coke crash"). Prolonged use of cocaine leads to chronic symptoms including restlessness, irritability, depression, insomnia, and a reversible psychosis characterized by paranoia, hallucinations, and delusions. Repeated snorting of cocaine causes rhinitis, which can culminate in perforation of the nasal septum. Cocaine is not truly addictive because tolerance does not develop. In fact, some regular users note increasing sensitivity to its physical and psychological effects. However, psychological dependency can develop in less than 2 weeks. Withdrawal is associated with intense craving for another dose. Sustained abstinence may lead to anxiety, depression, and disorders of appetite and sleep.

cocaine

(kō-kān′, kō′kān′)

A colorless or white crystalline alkaloid, C₁₇H₂₁NO₄, extracted from coca leaves, sometimes used in medicine as a local anesthetic especially for the eyes, nose, or throat and widely used as an illicit drug for its euphoric and stimulating effects.

cocaine

Coke, snow, C, girl, stardust, crack, rock Substance abuse An alkaloid powder–benzoylmethyl-ecgonine C₁₇H₂₁NO₄—derived from Erythoxylon coca; cocaine is used in medicine as a topical anesthetic; it is a potent psychostimulant, and evokes intense physical and psychological addiction Statistics 3 million Americans use cocaine regularly–600,000 use heroin, 10-15% of US population has tried cocaine–40% of those between age 25-30; 10-15% become addicted; cocaine is implicated in 5/1000 deaths in ages 25-30; up to 25% of MVA fatalities in drivers aged 15-45 in NYC had cocaine in their system Clinical Neurologic Sx–agitation, disorientation, convulsions, TIAs, CVAs, mood swings, delirium; cardiovascular Sx–arrhythmia–eg V tach, V fib, myocarditis, acute MI; cocaine's adverse effects on myocardial O₂ supply are exacerbated by cigarette smoking, ↑ demand for O₂, ↓ diameter of coronary arteries; other features include fetal damage, sudden death, hyperpyrexia, cerebral vasculitis, nasal changes, ↓ O₂-diffusing capacity, spontaneous pneumomediastinum, eating disorders–eg bulimia and anorexia, and madarosis–singeing of eyebrows and eyelashes due to hot vapors associated with smoking crack; chronic abuse is associated with ↑ sensitivity–'reverse tolerance' to cocaine's non-euphorigenic effects–eg hyperactivity and anesthesia Chronic abuse Seizures are common in habitual abusers, who have diffuse cortical atrophy, by CT and diffuse slowing of waves on EEG Desired effects Stimulates CNS, causing intense euphoria–±45 mins in duration, ↓ hunger, indifference to pain and fatigue, illusions of great physical strength and mental ability Adverse effects Cardiovascular, malnutrition, anemia Drug testing Plasma T_1⁄2 90 mins; urine and serum are screened for benzoylecgonine, cocaine's major metabolite, by enzyme-labeled competitive immunoassay–see EMIT, and confirmed for legal purposes by the 'gold standard' method, GC-MS Pathology-Brain Subarachnoid hemorrhage, cortical atrophy GI tract GI ischemia due to adrenergic vasoconstriction Heart Mononuclear cell inflammation of myocardium with myocytic necrosis Lungs Congestion, spontaneous pneumothorax Oral cavity Cocaine's pH of 4. 5 causes dental erosion, and ↑ caries in cocaine abusers, although this may be related to altered eating habits Pregnancy Abruptio placentae, premature labor, vaginal bleeding after injection of cocaine, placental vasoconstriction, spontaneous abortion, congenital malformation, ↑ perinatal mortality, neurologic and behavior defects, tachycardia, HTN Psychiatric disorders Dysphoria, paranoid psychosis, depression Sexual dysfunction Cocaine's myth as an aphrodisiac derives from its ability to delay ejaculation and orgasm, causing temporary mood elevation, and heightened sensory awareness, a myth that may be undeserved; chronic cocaine abuse evokes impotence, subfertility–eg, ↓ sperm counts, ↓ motility, ↑ abnormal sperm forms Management Cocaine-induced acute rhabdomyolysis may respond to dantrolene, a drug used in malignant hyperthermia; pharmacologic management of cocaine dependence and withdrawal has failed with antidepressants–eg desipramine and flupenthixol, dopaminergics–eg bromocriptine, mazindol, flupentixol, opiate antagonists–eg naltrexone and mixed agonists-antagonists–eg buprenorphine, anxiolytics–eg buspirone and anticonvulsants–eg carbamazepine; psychotherapy and behavior therapy have been equally ineffective Cause of death Arrhythmia due to ventricular fibrillation and cardiovascular collapse, respiratory arrest with pulmonary edema, cerebrovascular insults associated with HTN. See Binge, Cocaine nose, Crack, Freebase, Kindling.

co·caine

(kō-kān')

A crystalline alkaloid obtained from the leaves of Erythroxylon coca (family Erythroxylaceae) and other species of Erythroxylon, or by synthesis from ecgonine or its derivatives; a potent central nervous system stimulant, vasoconstrictor, and topical anesthetic, widely abused as a euphoriant and then associated with the risk of severe adverse physical and mental effects.

cocaine

The main alkaloid of the bush Erythroxylon coca , introduced to medicine by Sigmund Freud. Cocaine was the first effective local anaesthetic drug, but is now little used in medicine, having been replaced by safer and less damaging analogues. It is a major ‘recreational’ drug, producing a euphoria similar to that of AMPHETAMINE (amfetamine) and has many undesirable behavioural and social effects. Recent research indicates that regular use of cocaine inhibits the ability of brain cells to form new dendrites and synaptic connections with other cells under conditions of normal physiological stimulation. This occurs because cocaine and amphetamines (amfetamines) cause dendrites to grow in a similar way without the appropriate stimuli. The suggestion is that cocaine use may interfere with the ability to formulate original ideas. Psychological testing indicates that some users suffer persistent cognitive loss. See also CRACK.

cocaine

an alkaloid substance obtained from leaves and young twigs of the coca plant (Erythroxylon coca), used as a local anaesthetic and as a stimulant.

cocaine

Alkaloid derivative from coca leaves used as a local anaesthetic. It also produces a small dilatation of the pupil but does not act on the ciliary muscle.

co·caine

(kō-kān')

Benzoylmethylecgonine; a crystalline alkaloid obtained from the leaves of Erythroxylon coca and other species of Erythroxylon, or by synthesis from ecgonine or its derivatives; a potent central nervous system stimulant, vasoconstrictor, and topical anesthetic, widely abused as a euphoriant and associated with the risk of severe adverse physical and mental effects.

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