What Is Cocaine?
Cocaine is a powerful and addictive brain stimulant. It is a popular recreational drug, but illegal in US and most other countries.
Naturally appearing cocaine is an alkaloid benzoylmethylecgonine, extracted from the leaves of a coca plant, mostly raised in South American countries Bolivia, Columbia and Peru (1).
Cocaine Forms and Uses
Coca leaves contain less then 1% of cocaine (1). Some people in South America chew coka leaves; it suppresses hunger, thirst, pain and fatigue. This use should not be understood as a cocaine abuse; it is considered harmless and is not likely addictive.
Coca tea (Mate de coca) is drunk in South America and has about the same effect as leaves.
Cocaine paste (basa, basuco, paco, pasta base de cocaina (PBC), pitillo) contains 40-70% cocaine in the form of cocaine sulphate, obtained by processing coca leaves with sulphuric acid (2). It is intended for smoking.
Cocaine powder is chemically a salt - cocaine hydrochloride. It is a white, crystalline powder, odorless, and having bitter, numbing taste. When sold on streets, cocaine powder is usually mixed (diluted or “cut”) with other substances, like baking soda, lactose, talc, quinine (to increase profit) or anesthetics, like lidocaine which mimics cocaine’s numbing effect. Because of all added substances, it is often impossible to tell how much cocaine is in the powder (can be as low as 1% and up to 95%).
Cocaine powder is intended for snorting (sniffing). Cocaine user typically spreads a ‘line’ of cocaine powder on a hard surface, like a mirror or book, and inhales it into a nose using a straw or other tube, collectively named tooters. Street names for sniffing cocaine: to blow, boost, toot, geeze, ‘do a line’. Cocaine powder can be dissolved in water and used as a nasal spray (liquid lady) or injected into a vein (shot). Repeated administration of cocaine, a dose after dose, is called binging.
Street names for cocaine powder: all-American drug, aspirin, aunt Nora, blow, “C”, Cadillac, C dust, coke, dream, flow, girl, her, king, lady flake, shake, she, snow, soft, stardust, white lady, and so on (3).
Cocaine powder is often mixed with other drugs:
- Cocaine powder + alcohol (liquid lady) taken together results in forming cocaethylene in the liver – this substance adds to cocaine euphoric effect
- Cocaine powder + amphetamines, like ecstasy (speedball)
- Cocaine powder + heroin (belushi, dynamite, H&C, he-she, speedball)
- Cocaine powder + morphine (C&M)
Crack is cocaine in the form of white waxy chunks or ‘rocks’, intended for smoking, using pipes or cigarettes. It is produced from a cocaine powder (cocaine hydrochloride), processed by a base, like baking soda or ammonia and water, during which hydrochloride is removed and about 99% pure cocaine, called freebase is obtained. Crack cocaine can be ‘buffed’ by adding certain substances (possibly dangerous, like levamisol) to increase its bulk or effect. Such adulterated crack cocaine may be light brown or yellow.
The term crack refers to a crackling sound when rocks are heated and smoked. Street names for crack cocaine: base, beam, CDs, crack, freebase, girl, nose candy, pop, rock, rooster, tornado, yam, and so on.
Smoking crack results in a stronger and faster rush than sniffed cocaine. Crack is often combined with other drugs:
- Crack + marijuana (bazooka, caviar, champaigne, coctail…)
- Crack + heroin (speedball, snowball)
Cocaine As a Legal Medication
Cocaine is a local anesthetic and a strong vasoconstrictor (it narrows the blood vessels, thus stopping bleeding) so it was (and still sometimes is) used in surgery of the eye, nose and throat. Cocaine as a local anesthetic can leave scars, so other anesthetics, like procaine have replaced it.
How Cocaine Works?
Cocaine gives a feeling of pleasure (reward) the same way as food, drink, gambling, playing computer games, sex do – by increasing amount of dopamine in the brain, only that effect of cocaine is much stronger and shorter. When the effect of cocaine weans off – usually within minutes to an hour – dopamine falls to under normal level, and profound depression usually follows. This makes an addict to crave for more cocaine. Dopamine also lowers appetite, this is why a cocaine adict often loses weight.
Cocaine has two aditional effects important for health – it narrows the vessels (arteries and veins) and stimulates the heart. This results in increased blood pressure responsible for many cases of stroke (brain hemorrhage) and heart attack in cocaine abusers. This effect of cocaine is due to release of norepinephrine (noradrenaline) from the adrenal gland. Dilating (widening) of pupils is also the efect of norepinephrine.
Cocaine also increases release of serotonine and norepinephrine in the brain, both contributing to euphory, like dopamine.
Effect of Cocaine
Short Term Effects of Cocaine:
Pleasurable and unwanted effects of cocaine appearing few seconds to two days after cocaine abuse (4,5):
- Pleasurable psychological effects within minutes after using cocaine : euphoria, mental clarity, increased awareness of sensations of sight, sound and touch, supreme confidence, talkiness, sociability, increased desire for sex, less need for food and sleep
- Physical effects: dilated pupils, increased heart rate, body temperature and blood pressure
- Cocaine effect onset and durationdepends on the persons emotional and physical state, attitude toward the drug, regularity of use, dose ( a single dose is usually between 10 and 120 mg), purity and form of cocaine used. Effect of:
- smoked cocaine may appear in 7 seconds, peak in 1-2 minutes and last for 20 minutes
- injected cocaine may appear in 15 seconds, peak in 3-5 minutes and last 20-30 minutes
- snorted cocaine may appear in 3 minutes, peak in 15 minutes and last 45-90 minutes
- ingested (usually with alcohol) cocaine may appear in 10 minutes, peak in 60 minutes and last for 60 minutes
- Unpleasant feelings (a crash) when the effect of the cocaine wears off: depression, suicidal thoughts, exhaustion, anxiety, irritability, restlessness, craving for more drug
- Symptoms of cocaine overdose may include:
- Restlessness, inability to sleep (insomnia), violent behaviour, vertigo, dizziness, cold sweets, twitching of facial or finger muscles
- Hallucinations (cocaine bugs, smells, snow lights, voices)
- Loss of appetite, nausea, vomiting, abdominal pain
- Coughing up black mucus
- ‘Crack lungs’ (inflamed lungs – pneumonitis): coughing up blood, chest pain, difficulty breathing, itchy skin, fever
- Pneumothorax (lung collapse) resulting in a sharp chest pain, neck pain, air bubbles under the neck skin (subcutaneus emphysema) that feel like rice krispies (after smoking crack)
- Severe symptoms of cocaine overdose: severe headache, seizures, hyperthermia (high fever), slow heart rate, slow breathing, loss of consciousness, death. The lethal dose (that causes death) may be as low as 20 mg of cocaine when injected, or between 500 mg and 1.4 g when ingested (4). An inch long line of cocaine typically contains 25-100 mg of cocaine.
Long Term Effects of Cocaine
Prolonged use or high doses of cocaine may have the following effects (4,5):
Psychological effects of cocaine:
- Panic attacks
- Delusions – false beliefs
- Hallucinations – sensations of things that are not there (voices, smells..)
- Paranoia – a fear that someone follows you or wants to make you harm
Physical effects of cocaine:
- After snorting cocaine, cocaine nose may develop: frequent nose rubbing, blocked nose, nosebleeds, sinusitis, ulcers in the nose, holes in the nasal septum, loss of smell, hoarseness, difficulty swallowing (after snorting cocaine)
- After smoking cocaine: ‘crack lips’ and fingers (burns)
- After injecting cocaine: skin infections (cellulitis – a reddened underskin patch around the site of injection), track marks (dark lines above the injection site due to inflamed veins) on the forearm or top of the foot, hepatitis B,C or AIDS due to sharing contaminated needles
- After long-term ingesting of cocaine, bowel gangrene (a death of a part of the bowel) may develop
- Angina pectoris or heart attack (even in young users) due to thickened and narrowed arteries resulting in insufficient delivery of oxygen to the heart
- Irregular heart beat (arrhythmia)
- Stroke caused by spikes of high blood pressure
- Weight loss, malnutrition, poor health in general
- Decreased amount of nerves that release dopamine (‘rewarding substance’), resulting in difficulty to achieve pleasure with usual activities
Heart attack or death is posible even after a single cocaine use.
Changes in behaviour:
- Cocaine user sells things to get money for the drug
- Loss of contact with reality
- Aggressiveness, especially after smoking crack
- Using nasal spray decongestants to treat blocked nose
- Breaking relationships with the family, friends, losing job
Cocaine and Pregnancy
Cocaine abuse in pregnant women increases risk of placenta abruption, premature labour, birth defects, low birth weight or miscarriage. Cocaine passes in milk during breastfeeding, resulting in baby’s irritability and lack of appetite.
Cocaine Withdrawal Symptoms
A person who has stopped using cocaine may experience:
- Restlessness, fatigue, inability to sleep
- Depression, suicidal thoughts, mood swings
- Craving for cocaine
Cocaine Addiction Potential
Cocaine is believed to cause only psychological and not physical addiction. More and more drug may be neded to achieve a desirable euphoric effect.
During a period of abstinence, a strong memory about pleasant experience with cocaine remains. Things reminding a former user to cocaine, like money, mirrors, inhaling tubes, can trigger craving for cocaine.
After a long-term cocaine abuse, stores of dopamine in the brain can be depleted and addicted person may not be able to achieve pleasure by usualy things, like food and sex, without cocaine. This is the cause for cocaine craving even months or years after cocaine withdrawal.
- Coca leaves (tni.org)
- Coca paste (encyclopedia.com)
- Street names for cocaine (whitehousedrugpolicy.gov)
- Cocaine effect onset and duration; symptoms and signs of cocaine overdose (emedicine.medscape.com)
- Short and long-term effect of cocaine abuse (drugabuse.gov)