Cocaine

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The abuse of cocaine is a major public-health problem in the United States. In the 1970s, people began taking cocaine as a recreational drug. Experts believed that cocaine was harmless. Many movies and books from this decade show cocaine use as a popular, sophisticated social activity. By the mid-1980s, when many people were using cocaine in large quantities, experts and the public began to recognize the drug's dangers. Cocaine use can cause severe medical and psychological problems.

Cocaine (also known as "coke," "snow," "lady," "crack," and "ready rock"), is an alkaloid that can act both as a local anesthetic and as a stimulant. Users generally take cocaine in binges: They take the drug repeatedly for several days, and then use no cocaine for several days or weeks. Many users resist getting treatment. Users caught possessing or selling cocaine face stiff criminal penalties, but these punishments have not been effective at reducing the rate of heavy cocaine use. In fact, the number of people who used cocaine rarely or occasionally declined during the 1990s. However, the number of frequent or heavy users only decreased slightly.

The major medical use of cocaine is as a local anesthetic, particularly for procedures that involve the nose, throat, or mouth. It is the only local anesthetic that causes vasoconstriction, or narrowing of the blood vessels. For this reason, cocaine is useful in surgeries that require a minimum of bleeding. In addition, cocaine shrinks membranes, giving the surgeon a better view. When used in appropriate doses for necessary surgeries, and with appropriate medical caution, cocaine appears to be both useful and safe as a local anesthetic.

As an illegal drug, cocaine can be taken in a number of ways. These "routes of administration" include oral (by mouth), intranasal (through the nose), intravenous (by injection into the veins), and smoking. The effects of cocaine are similar no matter what the route. However, the way in which a person takes cocaine influences the likelihood that he or she will abuse it. This is because some methods of taking the drug act more quickly to increase levels of cocaine in the brain. The amount of cocaine in the brain determines the sensations that the user will feel. A person who gets the largest and quickest changes in cocaine brain levels is more likely to take the drug again.

Cocaine abusers do not take cocaine orally, because cocaine taken by mouth is absorbed into the brain slowly. By this method, it takes more than an hour to reach peak brain levels of cocaine. Abusers are more likely to inhale cocaine into the nose as a powder. By this method, the drug is quickly absorbed from the mucous membranes in the nose. Because of its local anesthetic actions, cocaine numbs or "freezes" the mucous membranes. A person buying cocaine on the street will test its purity by inhaling a small amount to see if this numbing occurs. When cocaine is inhaled, or "snorted," cocaine blood levels peak about twenty to thirty minutes later. Users who inhale cocaine report that they are ready to take a second dose of the drug within thirty to forty minutes after the first dose. Snorting was the most common way for people to use cocaine in the mid-1980s. Later, users discovered that smoking or injecting cocaine gets the drug to the brain faster. These became the preferred methods for taking the drug.

When taken by intravenous injection, cocaine reaches peak blood levels immediately, and users experience a "rush." Brain levels of cocaine increase quickly, so the user feels the drug's effects just as quickly. As blood levels of cocaine decrease, so do the effects, and users are ready for another intravenous dose within thirty to forty minutes. Users who inject cocaine are more likely to combine theircocaine with heroin (a combination known as a "speedball") than are users who take it in other ways.

The smokable form of cocaine came into widespread use in the mid-1980s. Freebase, or crack, is a form of cocaine that is not destroyed when heated. As with injected cocaine, blood levels peak almost immediately and the user feels a strong rush. Users can prepare their own freebase from the powdered form they buy on the street, or they can buy it in the form of crack.

Freebase and crack offer an instant high. They are easier to use than other forms of the drug and also less expensive. As a result, users tend to take the drug repeatedly. Repeated high doses of cocaine are very toxic, or poisonous, causing serious damage to the user's health.

Cocaine is frequently taken in combination with other drugs such as alcohol, marijuana, and heroin. In fact, almost 75 percent of cocaine deaths reported in 1989 involved the use of other drugs. Relatively low doses of cocaine can be highly toxic when taken together with alcohol.

Cocaine use leads to a broad range of medical complications affecting nearly every one of the body's organ systems. At low doses, cocaine causes increases in heart rate, blood pressure, respiration (breathing), and body temperature. A person intoxicated by cocaine can suffer from heart attacks, stroke, contractions of blood vessels (which interferes with blood flow), and cardiac arrhythmia (irregular heartbeat).

When taken repeatedly over long periods, cocaine can cause changes in behavior, including irritability, hypervigilance (being overly watchful or alert), paranoid thinking, excessive activity, and eating and sleep disturbances. Repeated cocaine use can also cause severe mental disturbances. The user may develop a psychosis in which he or she feels paranoid and anxious and has hallucinations. Some users display unpredictable, odd behavior that may become violent.Stopping cocaine use after a binge often causes a crash, in which the user becomes depressed, feels tired, and has eating and sleep disturbances. At first during the crash, the person does not crave more cocaine. But as time goes on, the user may think of little else other than finding the next dose.

A major effect of cocaine on human behavior is its ability to change a person's moods. The user's desire to feel this effect again is what makes cocaine a drug of abuse. Research shows that cocaine produces a feeling of euphoria, or intense well-being. People feel more energetic and friendly when on cocaine. These effects occur whether a person injects or smokes cocaine.

A person who takes cocaine repeatedly will develop tolerance to many of its behavioral effects. When the original dose no longer has much of an effect, the user must take increasingly larger amounts of cocaine to achieve the high. These larger doses present greater risks to the user's heart and blood vessels.

Users of cocaine and other stimulant drugs claim that the drug improves their performance of many activities. No evidence exists to support this claim. In general, cocaine has little effect on performance except when a person is unable to perform up to usual standards because of fatigue. In this situation, cocaine can enable the person to perform as if he or she were not tired. But this effect lasts for only a short time.

Cocaine was first synthesized in 1855. It was not until 1880, however, that the medical world studied its effects. In 1886 John Pemberton included cocaine as the main ingredient in his new soft drink, Coca-Cola, contributing to public acceptance of cocaine. It was cocaine s energizing effect on the consumer that was initially responsible for Coca-Cola s popularity.

Public disapproval over the use of that substance forced Pemberton to remove cocaine from Coca-Cola in1903. Eventually people became so concerned about the dangers of cocaine that it was outlawed in 1920. Today cocaine in anyform is illegal.

Coca Plant; Cocaine: Withdrawal; Cocaine Treatment: Behavioral Approaches; Cocaine Treatment: Medications; Complications from Injecting Drugs; Crack; Users.

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