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cocaine information
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What is
cocaine?
Cocaine is a powerfully addictive
stimulant that directly affects the brain. Cocaine has been labeled the drug of
the 1980s and '90s, because of its extensive popularity and use during this
period. However, cocaine is not a new drug. In fact, it is one of the oldest
known drugs. The pure chemical, cocaine hydrochloride, has been an abused
substance for more than 100 years, and coca leaves, the source of cocaine, have
been ingested for thousands of years.
Pure cocaine was first extracted
from the leaf of the Erythroxylon coca bush, which grows primarily in Peru and
Bolivia, in the mid-19th century. In the early 1900s, it became the main
stimulant drug used in most of the tonics/elixirs that were developed to treat
a wide variety of illnesses. Today, cocaine is a Schedule II drug, meaning that
it has high potential for abuse, but can be administered by a doctor for
legitimate medical uses, such as a local anesthetic for some eye, ear, and
throat surgeries.
There are basically two chemical
forms of cocaine: the hydrochloride salt and the "freebase." The hydrochloride
salt, or powdered form of cocaine, dissolves in water and, when abused, can be
taken intravenously (by vein) or intranasally (in the nose). Freebase refers to
a compound that has not been neutralized by an acid to make the hydrochloride
salt. The freebase form of cocaine is smokable.
Cocaine is generally sold on the
street as a fine, white, crystalline powder, known as "coke," "C," "snow,"
"flake," or "blow." Street dealers generally dilute it with such inert
substances as cornstarch, talcum powder, and/or sugar, or with such active
drugs as procaine (a chemically-related local anesthetic) or with such other
stimulants as amphetamines.
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| What is
the scope of cocaine use in the United States? |
Dependence or Abuse of
Specific Substances among Past Year Users of Substances:
2002
 |
The percentage of youths aged 12
to 17 who had ever used cocaine increased slightly from 2001 to 2002 (2.3 to
2.7 percent). Among young adults aged 18 to 25, the rate increased slightly
from 14.9 percent in 2001 to 15.4 percent in 2002.
From 1965 to 1967, only
0.1 percent of youths had ever used cocaine, but rates rose throughout the
1970s and 1980s, reaching 2.2 percent in 1987. A period of decline followed in
the early 1990s, after which the trend reversed, reaching a peak at 2.7 percent
in 2002.
The percentage of young
adults aged 18 to 25 who had ever used cocaine was below 1 percent during the
mid-1960s, but rose steadily throughout the 1970s and early 1980s, reaching
17.9 percent in 1984. By 1996, the rate had dropped to 10.1 percent, but
climbed to 15.4 percent in 2002.
How is cocaine used?
The principal routes of
cocaine administration are oral, intranasal, intravenous, and inhalation. The
slang terms for these routes are, respectively, "chewing," "snorting,"
"mainlining," "injecting," and "smoking" (including freebase and crack
cocaine). Snorting is the process of inhaling cocaine powder through the
nostrils, where it is absorbed into the bloodstream through the nasal tissues.
Injecting releases the drug directly into the bloodstream, and heightens the
intensity of its effects. Smoking involves the inhalation of cocaine vapor or
smoke into the lungs, where absorption into the bloodstream is as rapid as by
injection. The drug can also be rubbed onto mucous tissues. Some users combine
cocaine powder or crack with heroin in a "speedball."
Cocaine use ranges from
occasional use to repeated or compulsive use, with a variety of patterns
between these extremes. There is no safe way to use cocaine. Any route of
administration can lead to absorption of toxic amounts of cocaine, leading to
acute cardiovascular or cerebrovascular emergencies that could result in sudden
death. Repeated cocaine use by any route of administration can produce
addiction and other adverse health consequences.
How does
cocaine produce its effects?
A great amount of
research has been devoted to understanding the way cocaine produces its
pleasurable effects, and the reasons it is so addictive. One mechanism is
through its effects on structures deep in the brain. Scientists have discovered
regions within the brain that, when stimulated, produce feelings of pleasure.
One neural system that appears to be most affected by cocaine originates in a
region, located deep within the brain, called the ventral tegmental area (VTA).
Nerve cells originating in the VTA extend to the region of the brain known as
the nucleus accumbens, one of the brain's key pleasure centers. In studies
using animals, for example, all types of pleasurable stimuli, such as food,
water, sex, and many drugs of abuse, cause increased activity in the nucleus
accumbens.
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| Cocaine in the brain - In
the normal communication process, dopamine is released by a neuron into the
synapse, where it can bind with dopamine receptors on neighboring neurons.
Normally dopamine is then recycled back into the transmitting neuron by a
specialized protein called the dopamine transporter. If cocaine is present, it
attaches to the dopamine transporter and blocks the normal recycling process,
resulting in a build-up of dopamine in the synapse which contributes to the
pleasurable effects of cocaine. |
Researchers have
discovered that, when a pleasurable event is occurring, it is accompanied by a
large increase in the amounts of dopamine released in the nucleus accumbens by
neurons originating in the VTA. In the normal communication process, dopamine
is released by a neuron into the synapse (the small gap between two neurons),
where it binds with specialized proteins (called dopamine receptors) on the
neighboring neuron, thereby sending a signal to that neuron. Drugs of abuse are
able to interfere with this normal communication process. For example,
scientists have discovered that cocaine blocks the removal of dopamine from the
synapse, resulting in an accumulation of dopamine. This buildup of dopamine
causes continuous stimulation of receiving neurons, probably resulting in the
euphoria commonly reported by cocaine abusers.
As cocaine abuse
continues, tolerance often develops. This means that higher doses and more
frequent use of cocaine are required for the brain to register the same level
of pleasure experienced during initial use. Recent studies have shown that,
during periods of abstinence from cocaine use, the memory of the euphoria
associated with cocaine use, or mere exposure to cues associated with drug use,
can trigger tremendous craving and relapse to drug use, even after long periods
of abstinence.
What are
the short-term effects of cocaine use?
| Cocaine's effects appear
almost immediately after a single dose, and disappear within a few minutes or
hours. Taken in small amounts (up to 100 mg), cocaine usually makes the user
feel euphoric, energetic, talkative, and mentally alert, especially to the
sensations of sight, sound, and touch. It can also temporarily decrease the
need for food and sleep. Some users find that the drug helps them to perform
simple physical and intellectual tasks more quickly, while others can
experience the opposite effect. |
Short-term
effects of cocaine
»Increased energy
»Decreased appetite
»Mental alertness
»Increased heart rate
»Increased blood pressure
»Constricted blood vessels
»Increased temperature
»Dilated pupils |
The duration of cocaine's
immediate euphoric effects depends upon the route of administration. The faster
the absorption, the more intense the high. Also, the faster the absorption, the
shorter the duration of action. The high from snorting is relatively slow in
onset, and may last 15 to 30 minutes, while that from smoking may last 5 to 10
minutes
The short-term physiological effects of cocaine include constricted
blood vessels; dilated pupils; and increased temperature, heart rate, and blood
pressure. Large amounts (several hundred milligrams or more) intensify the
user's high, but may also lead to bizarre, erratic, and violent behavior. These
users may experience tremors, vertigo, muscle twitches, paranoia, or, with
repeated doses, a toxic reaction closely resembling amphetamine poisoning. Some
users of cocaine report feelings of restlessness, irritability, and anxiety. In
rare instances, sudden death can occur on the first use of cocaine or
unexpectedly thereafter. Cocaine-related deaths are often a result of cardiac
arrest or seizures followed by respiratory arrest.
What are the long-term effects of cocaine use?
| Cocaine is a powerfully
addictive drug. Once having tried cocaine, an individual may have difficulty
predicting or controlling the extent to which he or she will continue to use
the drug. Cocaine's stimulant and addictive effects are thought to be primarily
a result of its ability to inhibit the reabsorption of dopamine by nerve cells.
Dopamine is released as part of the brain's reward system, and is either
directly or indirectly involved in the addictive properties of every major drug
of abuse. |
Long-term effects
of cocaine Addiction
»Irritability
»Mood disturbances
»Restlessness
»Paranoia
»Auditory hallucinations |
An appreciable tolerance
to cocaine's high may develop, with many addicts reporting that they seek but
fail to achieve as much pleasure as they did from their first experience. Some
users will frequently increase their doses to intensify and prolong the
euphoric effects. While tolerance to the high can occur, users can also become
more sensitive (sensitization) to cocaine's anesthetic and convulsant effects,
without increasing the dose taken. This increased sensitivity may explain some
deaths occurring after apparently low doses of cocaine.
Use of cocaine in a
binge, during which the drug is taken repeatedly and at increasingly high
doses, leads to a state of increasing irritability, restlessness, and paranoia.
This may result in a full-blown paranoid psychosis, in which the individual
loses touch with reality and experiences auditory hallucinations.
What are
the medical complications of cocaine abuse?
There are enormous
medical complications associated with cocaine use. Some of the most frequent
complications are cardiovascular effects, including disturbances in heart
rhythm and heart attacks; such respiratory effects as chest pain and
respiratory failure; neurological effects, including strokes, seizure, and
headaches; and gastrointestinal complications, including abdominal pain and
nausea.
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Medical
consequences of cocaine abuse
Cardiovascular effects
»disturbances in heart rhythm
»heart attacks
Respiratory
effects
»chest pain
»respiratory failure
Neurological
effects
»strokes
»seizures
»headaches
Gastrointestinal
effects
»abdominal pain
»nausea |
Cocaine use has
been linked to many types of heart disease. Cocaine has been found to trigger
chaotic heart rhythms, called ventricular fibrillation; accelerate heartbeat
and breathing; and increase blood pressure and body temperature. Physical
symptoms may include chest pain, nausea, blurred vision, fever, muscle spasms,
convulsions and coma.
Different routes of
cocaine administration can produce different adverse effects. Regularly
snorting cocaine, for example, can lead to loss of sense of smell, nosebleeds,
problems with swallowing, hoarseness, and an overall irritation of the nasal
septum, which can lead to a chronically inflamed, runny nose. Ingested cocaine
can cause severe bowel gangrene, due to reduced blood flow. And, persons who
inject cocaine have puncture marks and "tracks," most commonly in their
forearms. Intravenous cocaine users may also experience an allergic reaction,
either to the drug, or to some additive in street cocaine, which can result, in
severe cases, in death. Because cocaine has a tendency to decrease food intake,
many chronic cocaine users lose their appetites and can experience significant
weight loss and malnourishment.
Research has revealed a
potentially dangerous interaction between cocaine and alcohol. Taken in
combination, the two drugs are converted by the body to cocaethylene.
Cocaethylene has a longer duration of action in the brain and is more toxic
than either drug alone. While more research needs to be done, it is noteworthy
that the mixture of cocaine and alcohol is the most common two-drug combination
that results in drug-related death. |
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