Cocaine - kōkānˈ, kōˈkān, alkaloid drug derived from the leaves of the coca shrub. A commonly abused illegal drug, cocaine has limited medical uses, most often in surgical applications that take advantage of the fact that, in addition to its anesthetic effect, it constricts small arteries, lessening bleeding. There are many street names for cocaine, including coke, C, toot, flake, and snow.

Effects and Addictive Nature

Cocaine blocks pain sensation and stimulates the central nervous system, producing a sudden increase in heart rate, temperature, and blood pressure. In the brain, it blocks the synaptic reabsorption of certain neurotransmitters (in particular dopamine). The resultant buildup of neurotransmitters causes pleasurable sensations to be passed along the neural pathways over and over again, creating a feeling of profound well-being, self-confidence, and alertness. It is accompanied by lack of hunger. The effect lasts for 10 to 30 minutes, and the user begins to crave more immediately as the neurotransmitter supply is exhausted. This pattern has led to cocaine's being described as "neuropsychologically addicting" in recognition that traditional definitions of physical vs. psychological addiction do not neatly fit in this case. Most cocaine addicts in treatment report some control over their use for the first two to four years, giving them the illusion that addiction will not develop.

Addiction is characterized by binges (usually of 4 to 24 hours, one to seven times per week), movement to intravenous use or smoking, extreme euphoria, and disregard for anything other than the drug, including food, sleep, sex, family, and survival. The behavior is limited only by the high cost of the drug and its limited availability. Abstinence after a cocaine binge leads to crashing (anxiety, depression, suspiciousness, sleep craving) and withdrawal (absence of pleasure in all things, lack of motivation, and boredom). Many users take other drugs ( alcohol, marijuana, heroin) to attenuate these effects. A dangerous combination of cocaine and heroin, known as a "speedball," is used by some. Withdrawal usually results in further use, often spurred by a conditioned cue such as a specific smell or location linked with cocaine use. If the drug is not taken again there is a gradual lessening of the craving, although conditioned cues may exert an effect years afterward. Long-term use can result in digestive disorders, weight loss, general physical deterioration, and marked deterioration of the nervous system. Most drug-related emergency room visits are cocaine-related.

Modes of Administration; "Crack" Cocaine

Cocaine is either snorted (sniffed), swallowed, injected, or smoked. Habitual snorting can result in serious damage to the nasal mucous membranes; shared needles put the user at increased risk of HIV infection. The street drug comes in the form of a white powder, cocaine hydrochloride. The hydrochloride salt and the cutting agents are removed to create the pure base product "freebase." Freebase is smoked and reaches the brain in seconds. "Crack" cocaine, also called "rock," is a form of freebase that comes in small lumps and makes a crackling sound when heated. It is relatively inexpensive, but must be repeated often.

Crack cocaine magnifies the effects of cocaine and is considered to be more highly and more quickly addictive than snorted cocaine. It causes a very abrupt increase in heart rate and blood pressure that can lead to heart attack and stroke even in young people with no history of vascular disease, sometimes the first time the drug is used. It also crosses the placental barrier; babies born to crack-addicted mothers go through withdrawal and are at a higher risk of stroke, cerebral palsy, and other birth defects.

Treatment

Treatment focuses on disruption of the addict's pattern of binges, followed by prevention of relapses. Counseling combined with treatments such as acupuncture and administration of antidepressants (e.g., desipramine) has met with some success. Treatment is often complicated by underlying social problems, mental illness, and the use of multiple drugs.

Production and Distribution

Most coca is grown in Peru, Bolivia, and Colombia. The farmers, for whom it is a relatively well-paying crop, harvest and dry the leaves, which are then processed into coca paste. Cocaine base is extracted from the paste in informal laboratories, usually in Peru or Bolivia. Further processing continues in Colombia, where the white powder, cocaine hydrochloride, is produced for export. Once in the United States, the cocaine is cut (diluted) with ingredients such as lactose, and sold or further processed into crack.

Import and production have been controlled by enormously powerful cartels such as the Medellín and Cali cartels in Colombia; the highly armed cartels have infiltrated governments and corrupted officials and have been held responsible for assassinations of public officials. Drug trafficking reached the highest levels of government and was at least in part responsible for the U.S. invasion of Panama in 1989 and the arrest and subsequent conviction of Panama's de facto leader, Manuel Noriega.

History of Cocaine Use

Andean Indians have long chewed leaves of the coca plant to decrease hunger and increase their stamina for work. Chewing the leaves produces no "high." Cocaine was first extracted from coca in the 19th cent. and was at first hailed as a miracle drug. By the 1880s in the United States it was freely prescribed by physicians for such maladies as exhaustion, depression, and morphine addiction and was available in many patent medicines. After users and physicians began to realize its dangers and various regulations were enacted, its use decreased, and by the 1920s the epidemic had abated.

Another epidemic began in the United States in the 1970s and peaked in the mid-1980s; again the drug was at first considered harmless. With the latter epidemic and its accompanying crack epidemic (beginning in 1985 and peaking in 1988) violence in crack-infested neighborhoods increased dramatically. Young people with few other opportunities were lured by the power and money of being crack dealers; most carried guns and many were murdered in drug-gang wars that ensued. By the late 1990s the cocaine and crack epidemic had subsided as heroin regained popularity among illicit drug users.

Bibliography

See publications of the Drugs & Crime Data Center and Clearinghouse, the Bureau of Justice Statistics Clearinghouse, and the National Clearinghouse for Alcohol and Drug Information.

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