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COCAINE
COCAINE
THE FACTS
Cocaine is a powerful addictive stimulant the
directly affects the brain. 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.
HOW COCAINE IS USED:
There are several different methods of cocaine
use, they are: oral, intranasal, intravenous, and
inhalation. The slang terms for these routes are,
respectively, chewing, snorting( Snorting is the
process of inhaling cocaine powder through the
nostrils, where it is absorbed into the bloodstream
through the nasal tissues). ,mainlining, injecting
(Injecting releases the drug directly into the
bloodstream, and heightens the intensity of its
effects). , and smoking (including freebase and
crack cocaine). 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 type of administration
can produce addiction and other adverse health
consequences
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.
EFFECTS
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.
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.
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.
Medical Effects
of Cocaine
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.
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.
Cocaine abusers, especially those who inject, are
at increased risk for contracting such infectious
diseases as human immunodeficiency virus (HIV/AIDS)
and hepatitis. In fact, use and abuse of illicit
drugs, including crack cocaine, have become the
leading risk factors for new cases of HIV. Drug
abuse-related spread of HIV can result from direct
transmission of the virus through the sharing of
contaminated needles and paraphernalia between
injecting drug users. It can also result from
indirect transmission, such as an HIV-infected
mother transmitting the virus perinatally to her
child. This is particularly alarming, given that
more than 60 percent of new AIDS cases are women.
Research has also shown that drug use can interfere
with judgement about risk-taking behavior, and can
potentially lead to reduced precautions about having
sex, the sharing of needles and injection
paraphernalia, and the trading of sex for drugs, by
both men and women.
Additionally, hepatitis C is spreading rapidly
among injection drug users; current estimates
indicate infection rates of 65 to 90 percent in this
population. At present, there is no vaccine for the
hepatitis C virus, and the only treatment is
expensive, often unsuccessful, and may have serious
side effects.
STREET NAMES:
Coke, Snow, Nose Candy, Flake, Blow, Big C, Lady,
White, and Snowbirds
Treatment
There has been an enormous increase in the number
of people seeking treatment for cocaine addiction.
The majority of individuals seeking treatment smoke
crack, and are likely to be poly-drug users, or
users of more than one substance. The widespread
abuse of cocaine has stimulated extensive efforts to
develop treatment programs for this type of drug
abuse. Cocaine abuse and addiction is a complex
problem involving biological changes in the brain as
well as a myriad of social, familial, and
environmental factors. Therefore, treatment of
cocaine addiction is complex, and must address a
variety of problems. e.
Many behavioral treatments have been found to be
effective for cocaine addiction, including both
residential and outpatient approaches. Behavioral
therapies are often the only available treatment for
cocaine addiction. It is important to match the
best treatment regimen to the needs of the patient. This
may include adding to or removing from an
individual's treatment regimen a number of different
components or elements. A behavioral therapy
component that is showing positive results in many
cocaine-addicted populations, is contingency
management. Cognitive-behavioral therapy is another
approach. Cognitive-behavioral coping skills
treatment, for example, is a short-term, focused
approach to helping cocaine-addicted individuals
become abstinent from cocaine and other substances.
The underlying assumption is that learning processes
play an important role in the development and
continuation of cocaine abuse and dependence. The
same learning processes can be employed to help
individuals reduce drug use. This approach attempts
to help patients to recognize, avoid, and cope;
recognize the situations in which they are most
likely to use cocaine, avoid these situations when
appropriate, and cope more effectively with a range
of problems and problematic behaviors associated
with drug abuse. Therapeutic communities, or
residential programs with planned lengths of stay of
6 to 12 months, offer another alternative to those
in need of treatment for cocaine addiction.
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