Cocaine Abuse

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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.

**Administrator** Posts : 174 Location : India

What is cocaine?

* Cocaine is an illegal drug. It may be made into a white powder that can be snorted (sniffed) into your nose. It may also be mixed with water and injected (given with a needle). The needle is stuck into a vein (blood vessel). The white powder may also be made into "crack" cocaine or "free base" and smoked. Cocaine may also be rubbed on body areas, such as your gums or your vagina (birth canal).

* The effect of cocaine is a feeling that may be described as a great amount of excitement and joy. You may have this "high" feeling within seconds or minutes of using cocaine. This feeling may only last for a few minutes, or it may last for a few hours. Because of how cocaine makes you feel, you may want to keep using more.

How does cocaine work?

* Your brain produces a substance called dopamine (DOH-pah-meen) when you feel happy. After a time, the dopamine decreases because “transporters” mop up the dopamine. The transporters put the dopamine back in the area in your brain where it is kept until your next happy event. Cocaine works by keeping the transporters from mopping up the dopamine. While the dopamine stays free, you have a feeling of great happiness or well being.

* The first time you use cocaine you will usually feel a great amount of excitement and joy. If you use cocaine a second time, you will probably not have the same effect. The high feeling may not be as strong, and you may not feel as good. This may happen because your brain will make more transporters to mop up the dopamine. The new transporters work more quickly to mop up dopamine when you have used cocaine before. Cocaine will not affect you as well or as long as it did the first time you used it.

What is cocaine abuse?

Cocaine abuse is when ongoing cocaine use leads to problems being around others, doing your job, or new medical problems. When cocaine use is at it's worse, cocaine abusers will have three or more of the following problems:

* Two or more of the following withdrawal symptoms. These symptoms will happen hours or days after using less cocaine:

o Feeling anxious.

o Feeling restless.

o Feeling sick to your stomach, or throwing up.

o Having seizures (convulsions).

o Increased shaking in your hands.

o Seeing, hearing or feeling things that are not really there.

o Sweating, or fast heartbeat.

o Trouble sleeping.

* Using more cocaine than you first wanted to. You may use more, or use it over a longer time than you first wanted to.

* Being unable to decrease or control your use of cocaine. You may want cocaine all of the time. You may feel it is not possible to decrease or control the amount of cocaine you are using.

* Much of your time is spent using cocaine, or dealing with a hangover after using cocaine. "Hangover" is a word used for how you feel four to six hours after using a drug. You may feel very tired and sick to your stomach.

* You spend less time around others, at work, or doing activities that you enjoy. You may spend most or all of your time using or searching for cocaine.

* Even with a physical or mental condition that gets worse when using cocaine, you keep using the drug. For example, after using cocaine, you may get depressed (very sad). Even though you know this will happen, you keep using cocaine.

What is cocaine dependence?

* You may become dependent on cocaine after only using it a short time. If you become dependent, you will find it harder and harder to not use cocaine whenever it is available. You may need to use cocaine often to get a high feeling, since cocaine effects may wear off quickly. You may quickly spend large amounts of money to buy the drug. You may start stealing, selling sex, or drug dealing for money to buy more cocaine.

* You may need to stop using cocaine for several days to get more money, or to rest. You may not take care of your family, or go to work. You may also develop mental and physical problems over time. These may include being very sad, angry, or nervous, and losing weight. Most people who are dependent on cocaine also develop tolerance (TOL-er-ans) to the drug. Most people who are dependent on cocaine also go through withdrawal.

What is cocaine tolerance?

Tolerance to cocaine means that you need more cocaine to get the high feeling that you want. You will feel less of a high feeling from the same amount of cocaine taken in the past.

What is withdrawal?

Cocaine withdrawal will happen if you have taken a lot of cocaine over a long period of time. If you take less cocaine than you usually do, or completely stop taking it, you will go through withdrawal. A few hours after decreasing or stopping cocaine use, you may have feelings of great sadness and anxiety. You may also have two or more of the following signs and symptoms:

* A very tired feeling.

* Hunger.

* Moving very slowly, or restlessness.

* Unable to sleep, or unable to wake up from sleeping.

* Unpleasant dreams that seem very real.

You may feel a great need for cocaine. You may not enjoy the things you used to, and you may feel very unhappy. You may think about, plan to, or try to kill yourself.

What problems may acute or chronic use of cocaine cause? Acute use of cocaine means snorting, smoking, or injecting a lot of cocaine at one time. Chronic use of cocaine means using cocaine over a long period of time. Acute or chronic use of cocaine may lead to cocaine intoxication (in-tocks-ih-KAY-shun). Cocaine intoxication may cause one or more of the following signs and symptoms:

* Being easily angered, having mood swings, or threatening to hurt other people.

* Being unable to focus on one thing, or talking when your words do not make sense to other people.

* Feeling that you are the center of everyone's attention, or thinking that people are following you.

* Having a headache, or hearing ringing in your ears.

* Hearing or feeling things that you know are not there ("coke bugs").

* Not enjoying the things you used to enjoy, or thinking about, planning to, or trying to kill yourself.

Severe (very bad) cocaine intoxication may cause:

* Seizures (convulsions).

* Heart attack.

* Your heartbeat to be irregular.

* Your body temperature to rise very high.

* Death.

How does using cocaine affect your body over time?

* Cocaine decreases the size of your blood vessels. This makes your heart beat faster, and raises your blood pressure. Less blood and oxygen is able to reach your organs. Cocaine also raises your body temperature. Snorting cocaine into your nose or rubbing cocaine on body areas makes the area constrict (get smaller). The areas may become damaged and scarred. The cartilage that separates the two sides of your nose may bleed, or a hole may develop.

* Long-term cocaine use may affect your brain, heart, lungs, stomach, and bowels. Cocaine may cause seizures (convulsions), a stroke, or movements that you cannot control. These may include head jerking, constant chewing, and frequent eye blinking. If you have fast, jerky movements, and are unable to sit still, this may be called "crack dancing". Cocaine may cause an increased heart rate and blood pressure, and an irregular heartbeat. You may also develop a heart infection (in-FECK-shun), or have a heart attack.

* Cocaine may cause ulcers (sores) and scarring in your mouth and throat. You may have symptoms of asthma (AZ-muh) including coughing and spitting up mucus. Your lungs may bleed, or you may get "crack lung". This is a condition causing fever, painful breathing, and coughing. You may develop holes in your bowel, or a stomach ulcer. If there is not enough blood, oxygen and nutrition reaching part of your bowel, you may get gangrene (gang-GREEN). You may need to be treated with medicine or surgery for these conditions. These conditions may be very serious, and you may die.

* People who try to hide cocaine in their bodies are called "body packers" or "mules". This may lead to severe medical problems including bowel obstruction (plugging) that may need surgery. If the cocaine packet in the body breaks, it may cause cocaine intoxication, a large stomach ulcer, and death.

What happens to you and your baby if you use cocaine while you are pregnant?

* Using cocaine while pregnant may cause many medical problems for your unborn baby. Your baby's brain, heart, stomach and bowels may not grow or develop correctly. Pregnant women who use cocaine are more likely to miscarry (lose) their baby, or have their baby too early. Their baby may be born with many medical problems, or be born dead. There may be other problems during pregnancy that are very dangerous for both mother and baby.

* Babies born to women who use cocaine may go through withdrawal. Withdrawal symptoms in newborns may include seizures, or problems waking and feeding the baby. The babies may overreact to sounds or movement by violently jerking or jumping. They may vomit (throw up), or have diarrhea (loose BM's). As these children grow, they are often slow learners and have other behavior problems.

Do you want to stop using cocaine?

If you want to stop using cocaine, talk to your caregiver. Your caregiver will help you find a program for people with cocaine dependence. Your treatment will depend on how much and how long you used cocaine. You may be treated in the hospital, or as an outpatient. Treatments may include medicines to help you cope with withdrawal symptoms. They may also include talking therapy in groups, or one-to-one with a counselor. Treatment may include learning ways to deal with the people you knew when you were using cocaine. You may learn lifestyle changes that help you manage your life after cocaine.

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