Cocaine Use and Its Effects on Health

Cocaine is a purified extract from the leaves of the Erythroxylum coca bush. This plant grows in the Andes region of South America. Different chemical processes produce the two main forms of cocaine:
The white crystalline powdered form can be sniffed through the nose (snorted) or dissolved in water and

taken through a vein (intravenously, or IV). It can also be taken by mouth or rubbed onto the gums. It known on the street as "coke" or "blow"
The freebase form, which has had impurities removed with solvents, is smoked. It is known on the street

as "crack" or "rock" Crack is a smokable, freebase cocaine made from powdered cocaine hydrochloride. It is also called chips, chunks, or rocks. The name crack came about because of the crackling sound that it makes when it is smoked. Cocaine is also called coke, C, snow, flake, or blow. It may contain other substances, such as cornstarch, talcum powder, or sugar. It may also contain other drugs, such as another local anesthetic called procaine or a stimulant such as amphetamine. Cocaine is a very addictive drug, and some people easily lose control over its use. Smoking or injecting cocaine results in nearly instantaneous effects. Rapid absorption through nasal tissues makes snorting cocaine nearly as fast-acting. Whatever the method of taking it in, cocaine quickly enters the bloodstream and travels to the brain. Deep in the brain, cocaine interferes with the chemical messengers - neurotransmitters - that nerves use to communicate with each other. Cocaine blocks norepinephrine, serotonin, dopamine, and other neurotransmitters from being reabsorbed. The resulting chemical buildup between nerves causes euphoria or feeling "high." On the other hand, some people describe other feelings tagging along with the high: irritability, paranoia, restlessness, anxiety. Large doses can cause strange or violent behavior in which the person may have tremors or muscle twitches or become paranoid. After using cocaine, the person feels irritable, tired, and depressed. This is called a coke crash. When a person takes the drug at higher and higher doses (a binge), it can cause increasing irritability, restlessness, and paranoia that can result in a serious loss of touch with reality (paranoid psychosis). Occasionally, sudden death can occur, even with the first use of cocaine. Sudden death from cocaine use may occur because of a heart attack or seizure in which breathing stops. Sudden death is more likely to occur when cocaine is used along with alcohol. Signs of using cocaine include: dilated pupils, high levels of energy and activity, excited, exuberant speech; possession of drug paraphernalia, such as syringes, spoons with smoke stains, small pieces of glass, and razor blades; persistent runny nose and nosebleeds, which may indicate snorting of cocaine; "track marks" where it has been injected into veins; long periods of time without sleeping or eating. Cocaine's immediate effects last 30 minutes to two hours. Smoking or injecting cocaine results in a faster and shorter high, compared to snorting coke. Cocaine can be detected in a urine drug screen up to 6 days after it has been taken. The reality of cocaine hits after the high. Cocaine has powerful negative effects on the heart, brain, and emotions.

Physiological and Psychological Effects of Cocaine. Addiction Cocaine acts in the deep areas of the brain. Stimulating this brain areas with cocaine create a powerful craving to use more cocaine. Repeated cocaine use leads to tolerance (that is, increasingly higher doses are needed to attain the same effect), dependence, and addiction. Central nervous system and psychiatric effects: Users who have pleasurable experiences report varying degrees of euphoria; increased energy, excitement, and sociability; less hunger and fatigue; a marked feeling of increased physical and mental strength; and decreased sensation of pain. Some will feel a great sense of power and competence that may be associated with the delusion or false sense of grandeur, known as cocainomania. There can be talkativeness, good humor, and laughing. Dilated pupils, nausea, vomiting, headache, sensation of your surroundings or yourself moving or spinning). With or even without increased amounts of coke, these can progress to excitement, flightiness, emotional instability, restlessness, irritability, apprehension, inability to sit still, cold sweats, tremors, twitching of small muscles (especially of the eyes and other face muscles, fingers, feet), and muscle jerks. The effects of cocaine on the teeth may include teeth grinding. The cocaine user may also experience hallucinations (cocaine bugs, snow lights, voices and sounds, smells) and cocaine psychosis. Cocaine psychosis resembles paranoid schizophrenia and can bring on paranoia, mania and psychosis. Brain effects: The effects of cocaine on the brain include alteration of responsiveness of the brain to various chemicals. These chemicals or neurotransmitters, such asnorepinephrine, dopamine, serotonon, acetylcholine, and gamma-aminobutyric acid, are responsible for most of the complications of cocaine. One study of people who sought care in an emergency department reported that 22% complained of anxiety , 13% dizziness, 10% headache, 9% nausea, 9% psychosis, and 9% confusion. Ear, nose, and throat effects: Because the majority of users sniff or snort cocaine through their nose, there are a variety of nasal and sinus diseases. Many users complain of nasal irritation, nasal crusting, recurrent nosebleeds, nasal stuffiness, facial pain caused by sinusitis, and hoarseness. The mucous membrane of both sides of the septum (the cartilage that separates the nostrils) can be damaged by decreased blood supply, along with drying, crusting, and nose picking. This results in a perforation or hole in the septum with more crusting, foul secretions, nosebleeds, and whistling with nasal breathing, the so-called coke nose. Lung effects: The direct effects of smoking cocaine are responsible for most lung and breathing complications. The large surface area of the lungs and its great blood supply cause rapid and profound brain stimulation known as the head rush. Smoking the freebase, crack, or paste is done using a glass pipe, water pipes, or cigarettes, which are heated by butane lighters or matches. The residue from the tars, matches, cocaine contaminants, and additives, such as marijuana, often cause chronic bronchitis, chronic coughing, and coughing up black, nonbloody phlegm. These conditions can cause shortness of breath and chest pain. Utilizing the technique of deep inhalation and breath holding to maximize the amount of cocaine inhaled and absorbed can cause the lung to collapse. These cocaine users will complain of sharp chest pain, often worse with deep breathing,neck pain, difficult or painful swallowing, and air under the skin in the neck that feels like Rice Krispies under the skin when touched (subcutaneous emphysema). Though unusual, the user's lungs can fill with

fluid(pulmonary edema), causing extreme shortness of breath, sometimes respiratory failure, and death. Kidneys. Cocaine can cause sudden, overwhelming kidney failure through a process called rhabdomyolysis. In people with high blood pressure, regular cocaine use can accelerate the long-term kidney damage caused by high blood pressure. Cardiovascular (heart, blood vessels) effects: The major effect of cocaine is to stimulate the sympathetic nervous system. This system is responsible for the "fight or flight response" and is controlled primarily by adrenaline or epinephrine. The effects include increased heart rate, blood vessel narrowing, and high blood pressure. Angina or the chest pain that is felt with decreased blood supply to the heart and heart attack have accounted for more reports in medical journals than any other complication of cocaine intoxication. Pregnancy effects: Cocaine use during pregnancy can increase the complications of pregnancy and affect the fetus directly. These abusers may also use other drugs, alcohol, and nicotine, which adversely affect the pregnancy as well. They have an increased rate of miscarriages and placenta abruption, in which the placenta separates from the wall of the uterus and results in stillbirth. There is increasing information that cocaine may cause birth defects with increased rates of malformation, low birth weights, and behavioral abnormalities. Infections: The infectious complications related to IV use of cocaine are not unique to cocaine. All IV drug users are at risk for infections due to nonsterile techniques of IV injections. Contagious viruses such as hepatitis B, hepatitis C, and HIV (AIDS virus) are transmitted by sharing IV needles. The abuser may complain of pain, swelling, and redness at the injection site or fever. Abusers may also complain of jaundice or turning yellow, abdominal pain, nausea, vomiting, loss of appetite, or the multitude of complaints that accompany hepatitis and AIDS. Body packers or stuffers: People smuggle the processed cocaine across international borders. They often swallow drug-filled packets or stuff them into body openings such as the vagina or rectum. The "body packer" or "mule" can carry 50-200 tightly wrapped condoms or latex bags filled with high-grade cocaine hydrochloride. If the containers break or leak, the cocaine can be absorbed by the person's body, resulting in massive intoxication, seizures, and death. A similar problem may occur with "body stuffers." These are cocaine users or traffickers who swallow bags of cocaine when arrested so there is no evidence. After using cocaine regularly for an extended period, dependence (addiction) develops. When dependence is present, stopping cocaine suddenly leads to withdrawal. Symptoms of withdrawal from cocaine are more psychological than physiological. Typically, cocaine withdrawal symptoms include: depression and anxiety, fatigue, difficulty in concentrating, incapacity to feel pleasure, increased craving for cocaine, and physical symptoms including aches, pains, tremors, and chills. In certain people, withdrawal from cocaine may cause suicidal thoughts. Typically, withdrawal symptoms from cocaine addiction resolve within one to two weeks. However, intense craving for cocaine may return, even years after the last use.