Cocaine Abuse

What is cocaine?

Cocaine is a powerfully addictive stimulant that directly affects the brain. Cocaine was labelled 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.

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 local anaesthesia for some eye, ear, and throat surgeries.

There are basically two chemical forms of cocaine: the hydrochloride salt and the ‘free base’. The hydrochloride salt dissolves in water and, when abused, can be taken intravenously (by vein) or intranasally (in the nose). Free base refers to a compound that has not been neutralised by an acid to make the hydrochloride salt.

Cocaine is generally sold on the street as a fine, white, crystalline powder, known as coke, 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 anaesthetic) or with such other stimulants as amphetamines.

How is it used?

The principal routes of cocaine administration are oral, intranasal, intravenous, and inhalation. It can be snorted, sniffed, smoked, or injected. 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 vapour or smoke into the lungs, where absorption into the bloodstream is as rapid as by injection. The drug also can be rubbed onto mucous tissues. Each of these methods of administration poses great risks to the user.

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 perform simple physical and intellectual tasks more quickly, while others experience the opposite effect.

The duration of cocaine’s immediate euphoric effects depends upon the route of administration. 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 intensify the user’s high, but may also lead to bizarre, erratic, and violent behaviour. These users may experience tremors, vertigo, muscle twitches, paranoia, or, with repeated doses, a toxic reaction closely resembling amphetamine poisoning. 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. Thus, an individual may have difficulty predicting or controlling the extent to which he or she will continue to want or use the drug. Cocaine’s stimulant and addictive effects are thought to be primarily a result of its ability to inhibit the re-absorption 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.

Some users increase their doses to intensify and prolong the euphoric effects. While tolerance to the high can occur, users can also become more sensitive (sensitisation) to cocaine’s anaesthetic and convulsant effects, without increasing the dose taken. This increased sensitivity may explain some deaths occurring after apparently low doses of cocaine.

Medical complications of cocaine abuse

Despite a popular myth, cocaine does not enhance performance whether it is on the job, in sports, at school, or with a sexual partner. On the contrary, long-term use can lead to loss of concentration, irritability, loss of memory, paranoia, loss of energy, anxiety, and a loss of interest in sex. The controlling effect cocaine has on an addict's life can lead to exclusion of all other facets of life. There can be severe medical complications associated with cocaine use. Some of the most frequent complications are:

1. Cardiovascular effects - disturbances of heart rhythm, heart attack

2. Respiratory effects - chest pain, respiratory failure,

3. Neurological effects - stroke, seizures, and headaches

4. Gastrointestinal problems - abdominal pain, nausea.

Research has revealed that an added danger of cocaine use is when cocaine and alcohol are consumed at the same time. When these substances are mixed, the human liver combines cocaine and alcohol and manufactures a third substance, cocaethylene. This intensifies cocaine's euphoric effects, while also possibly increasing the risk of sudden death.

Evidence suggests that users who smoke or inject cocaine may be at even greater risk of causing harm to themselves than those who snort the substance. For example, cocaine smokers also suffer from acute respiratory problems including coughing, shortness of breath, and severe chest pains with lung trauma and bleeding. A user who injects cocaine is at risk of transmitting or acquiring diseases if needles or other injection equipment are shared.

How is cocaine detected?

These are various tests to evaluate the type (and roughly measure the amount) of legal and illegal drugs a person has taken. Toxicology screening is most often performed on blood or urine (the specimens of choice) but can be performed on gastric contents (vomit or lavage fluids) if performed soon after the substance is ingested. Drugs remain in the body at varying lengths. The longer we use drugs, the harder it is for the body to cleanse itself. Cocaine and its primary metabolite benzoylecgonine are routinely detected by a variety of laboratory techniques. The initial screening cutoff level is 300 ng/ml for cocaine and its metabolite benzoylecgonine. Use of cocaine for euphoria may result in positive urines above this level for 48-72 hours post dose. Longer times will be observed in the habituated person using large quantities.

How to suspect if someone is using cocaine?

Sometimes it's tough to tell if someone is using cocaine. But there are signs, which can be looked for. If there are one or more of the following warning signs, the person may be using cocaine or other illicit drugs:

* Red, bloodshot eyes

* A runny nose or frequently sniffing

* A change in eating or sleeping patterns

* A change in groups of friends

* A change in school grades or behaviour

* Acting withdrawn, depressed, tired, or careless about personal appearance

* Losing interest in school, family, or activities he or she used to enjoy

* Frequently needing money

How can Cocaine Abuse be treated?

Behavioural treatments have been found to be effective for treating cocaine addiction. These include both self-care at home and rehabilitation programmes. Behavioural therapies are often the only available, effective treatment approaches to many drug problems, including cocaine addiction. After stabilisation, recovery begins with a learning process of breaking old habits, ties with cocaine-using friends and identifying triggers that increase desire to use cocaine.

Cognitive-behavioral therapy is another approach of managing this problem. Cognitive-behavioural coping skills treatment is a short-term, focused approach to helping cocaine-addicted individuals become abstinent from cocaine and other substances. These learning processes are often employed to help individuals reduce drug use. This approach attempts to help patients to recognise, avoid and cope up with 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 behaviors associated with drug abuse.

Patients are encouraged to specifically identify these triggers and to restructure their life-styles to avoid them further in life. Many patients identify certain music or movies with cocaine and must learn to deal with these issues. The most difficult aspect of treatment and recovery from cocaine involves recovery from guilt and intense shame felt by most users. Dealing with these painful issues takes time and trust. An experienced counsellor or another recovering addict can be of great help.

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