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Cocaine < Back

By Taylor Terca

History

Cocaine, or coke, is a psychoactive stimulant that is derived from the leaves of the South American coca plant. This substance was first recorded to have been used by the Incan people of South America at least 2000 years ago. Cocaine was widely consumed as an ingredient in coca wine in the 1860s. Sigmund Freud believed that cocaine was a “miracle drug” and promoted it as a treatment for depression, alcoholism, opioid addiction, digestive disorders, and many other maladies. Additionally, cocaine was used as a local anesthetic for medical procedures.

In 1885, semi-refined cocaine first appeared, which could be produced much more efficiently and was able to be incorporated into a variety of different forms, including pain drops for toothaches, cigarettes, cigars, inhalants, and even caffeinated beverages (Coca-Cola). However, these new methods of consuming cocaine contained much higher concentrations of the drug, increasing its abuse potential. To address this growing epidemic, the United States Congress passed the 1914 Harrison Narcotic Act, which prohibited cocaine from being included in over-the-counter medications. Further legislation over the next 60 years continued to restrict cocaine use, although it was still used recreationally.



In the 1980’s, crack cocaine use dramatically increased in the United States, particularly in inner city communities, leading to increased overdoses and crime. To combat this, President Ronald Reagan increased the penalties for crack cocaine possession. Partially as a result of these policies, nearly one in every four African American males between the ages of 20 and 29 was either incarcerated or on probation/parole by 1989. By 1995, it was nearly one in three.

More recently, the 2015 National Survey on Drug Use and Health showed that approximately 1.9 million people aged 12 or older (0.7% of the population) were current users of cocaine (including crack cocaine). Although this number is lower than estimates from the early- to mid-2000s, in 2015 cocaine still ranked as the 3rd most prevalent drug of abuse in America, behind marijuana and misused prescription medication.

How It’s Used

Cocaine can be found in multiple forms. Powder cocaine can be taken orally, intravenously, or intranasally (“snorting”), but it cannot be smoked, as the powder breaks down due to heat. Crack cocaine, which received its name due to the crackling sounds it makes when heated, is almost exclusively smoked.

Cocaine has a half-life of 30 minutes to 1½ hours, meaning half of the drug is eliminated from the body in a relatively short amount of time. In order to maintain a high blood level of cocaine, addicts will often engage in “binge” behavior, consuming multiple doses in a short period of time. Injecting and smoking cocaine create higher concentrations of cocaine in the bloodstream compared to oral consumption or snorting, and thus are often the routes of choice for addicts. Depressants, such as alcohol, are often taken along with cocaine to curb the arousal produced by cocaine alone, and these mixtures have even been shown to exacerbate the harmful effects of cocaine.

How It Works

Cocaine acts primarily on 3 major neurotransmitters in the body (dopamine, norepinephrine, and serotonin) by blocking reuptake of these chemicals. This means there is a higher concentration of these chemicals that are able to activate other neurons, resulting in increased activity in these brain systems. The most noticeable effects of cocaine are due to its interaction with dopamine. This cocaine-dopamine interaction is believed to be the most important for the stimulating and addictive properties of this drug. Cocaine can also be used as a local anesthetic, as it blocks nerve conduction in high concentrations.

Cocaine is a sympathomimetic drug, meaning it creates symptoms similar to those creating during a heightened state of arousal (sex, “flight or fight”). These symptoms include increased blood pressure and heart rate, increased breathing rate, and increased body temperature. Behaviorally, its use is marked by feelings of mood amplification (euphoria/dysphoria), enhanced awareness, increased energy, and elevated self-confidence in small amounts. Mild cocaine use can also induce increased aggression, decreased appetite, and decreased sleep. In larger doses, these relatively positive or neutral symptoms gradually become negative or aversive. Severe cocaine use can result in irritability, motor stereotypies (picking/scratching impulsively), delusions of grandiosity, hostility/violence, anorexia, and insomnia.

Cocaine use is often followed by a withdrawal period, also known as a “crash.” This period is marked by feelings of depression, lack of energy, anxiety, and an urge to take the drug again to alleviate these symptoms. As users begin using more of the drug, these symptoms become more severe, resulting in risky drug-seeking behaviors to acquire more of the drug.

Chronic cocaine use has many adverse effects on body systems, but those most greatly affected are the cardiovascular system and the nervous system. The heart muscles and blood vessels are often damaged by the increased stress of an elevated heart rate and blood pressure, resulting in cardiomyopathy, cardiac arrhythmias, and even heart attack and stroke. Brain imaging of chronic users has shown decreased volume in several crucial brain regions, and cocaine use also increases the risk for seizures, hallucinations (such as “cocaine bugs”), and paranoid delusions (feelings of someone out to get them).

Treatment

Currently, cocaine abuse does not have any effective pharmacological treatments; therefore, the most effective treatment that exists are behavioral treatments, such as contingency management and cognitive-behavioral therapy. In contingency management, patients are given points or tickets in exchange for clean urine tests, which can be traded in for items that sponsor healthy living, such as club/gym memberships, dinners, and excursions. This method is used to encourage patients to stay in treatment and help with the initial abstinence from cocaine. Cognitive-behavioral therapy is designed to help patients develop skills and coping mechanisms to continue their abstinence after leaving treatment. These skills include recognizing situations and environments where they are at risk of relapsing and learning how to avoid them.

References

Bose, J., Hedden et al. (2016, September). Key Substance Use and Mental Health Indicators in the United States: Results from the 2015 National Survey on Drug Use and Health. https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2015/NSDUH-FFR1-2015/NSDUH-FFR1-2015.pdf

Karch, S. B. (1999, August). Cocaine: History, Use, Abuse. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1297313/?page=3

Meyer, J. S., & Quenzer, L. F. (2013). Psychopharmacology: drugs, the brain, and behavior (2nd ed.). Sunderland, Massachusetts U.S.A.: Sinauer Associates, Inc.

National Institute on Drug Abuse. How Is Cocaine Addiction Treated? https://www.drugabuse.gov/publications/research-reports/cocaine/what-treatments-are-effective-cocaine-abusers

Turner, D. S. (2017, February 20). Crack Epidemic. https://www.britannica.com/topic/crack-epidemic