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.
Crack is the street name given to the freebase
form of cocaine that has been processed from the powdered cocaine hydrochloride form to a
smokable substance. The term "crack" refers to the crackling sound heard when
the mixture is smoked. Crack cocaine is processed with ammonia or sodium bicarbonate
(baking soda) and water, and heated to remove the hydrochloride.
Because crack is smoked, the user experiences a high in less than 10 seconds. This
rather immediate and euphoric effect is one of the reasons that crack became enormously
popular in the mid 1980s. Another reason is that crack is inexpensive both to produce and
In 1997, an estimated 1.5 million Americans (0.7 percent of those age
12 and older) were current cocaine users, according to the 1997 National Household Survey
on Drug Abuse (NHSDA). This number has not changed significantly since 1992, although it
is a dramatic decrease from the 1985 peak of 5.7 million cocaine users(3 percent of the
population). Based upon additional data sources that take into account users
underrepresented in the NHSDA, the Office of National Drug Control Policy estimates the
number of chronic cocaine users at 3.6 million.
Adults 18 to 25 years old have a higher rate of current cocaine use than those in any
other age group. Overall, men have a higher rate of current cocaine use than do women.
Also, according to the 1997 NHSDA, rates of current cocaine use were 1.4 percent for
African Americans, 0.8 percent for Hispanics, and 0.6 percent for Caucasians.
Crack cocaine remains a serious problem in the United States. The NHSDA estimated the
number of current crack users to be about 604,000 in 1997, which does not reflect any
significant change since 1988.
The 1998 Monitoring the Future Survey, which annually surveys teen attitudes and recent
drug use, reports that lifetime and past-year use of crack increased among eighth graders
to its highest levels since 1991, the first year data were available for this grade. The
percentage of eighth graders reporting crack use at least once in their lives increased
from 2.7 percent in 1997 to 3.2 percent in 1998. Past-year use of crack also rose slightly
among this group, although no changes were found for other grades.
Data from the Drug Abuse Warning Network (DAWN) showed that cocaine-related emergency
room visits, after increasing 78 percent between 1990 and 1994, remained level between
1994 and 1996, with 152,433 cocaine-related episodes reported in 1996.
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
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
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.
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.
|Increased heart rate/blood pressure|
|Constricted blood vessels|
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.
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.
|Irritability and mood disturbances|
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.
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.
|Heart rhythm disturbances|
|Seizures and headaches|
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
The full extent of the effects of prenatal drug
exposure on a child is not completely known, but many scientific studies have documented
that babies born to mothers who abuse cocaine during pregnancy are often prematurely
delivered, have low birth weights and smaller head circumferences, and are often shorter
Estimating the full extent of the consequences of maternal drug abuse is difficult, and
determining the specific hazard of a particular drug to the unborn child is even more
problematic, given that, typically, more than one substance is abused. Such factors as the
amount and number of all drugs abused; inadequate prenatal care; abuse and neglect of the
children, due to the mother's lifestyle; socio-economic status; poor maternal nutrition;
other health problems; and exposure to sexually transmitted diseases, are just some
examples of the difficulty in determining the direct impact of perinatal cocaine use, for
example, on maternal and fetal outcome.
Many may recall that "crack babies," or babies born to mothers who used
cocaine while pregnant, were written off by many a decade ago as a lost generation. They
were predicted to suffer from severe, irreversible damage, including reduced intelligence
and social skills. It was later found that this was a gross exaggeration. Most
crack-exposed babies appear to recover quite well. However, the fact that most of these
children appear normal should not be over-interpreted as a positive sign. Using
sophisticated technologies, scientists are now finding that exposure to cocaine during
fetal development may lead to subtle, but significant, deficits later, especially with
behaviors that are crucial to success in the classroom, such as blocking out distractions
and concentrating for long periods of time.
|source: NIDA Research Report - Cocaine Abuse and Addiction:
Publication No. 99-4342, Printed May 1999