A 2001 study reported that the sharing of straws used to “snort” cocaine can spread blood diseases such as hepatitis C. Injection Subjective effects not commonly
shared with other methods of administration include a ringing in the ears moments after injection (usually when over 120 milligrams) lasting two to 5 minutes including tinnitus and audio distortion.
An injected mixture of cocaine and heroin, known as “speedball”, is a particularly dangerous combination, as the converse effects of the drugs actually complement each other,
but may also mask the symptoms of an overdose.
 Cocaine use also increases the risk of having a heart attack.
Smoking freebase cocaine has the additional effect of releasing methylecgonidine into the user’s system due to the pyrolysis of the substance (a side effect which insufflating
or injecting powder cocaine does not create).
 In humans with acute exposure followed by continuous exposure to cocaine at a constant blood concentration, the acute tolerance to the chronotropic cardiac effects of
cocaine begins after about 10 minutes, while acute tolerance to the euphoric effects of cocaine begins after about one hour.
Aside from the toxic effects of cocaine, there is also the danger of circulatory emboli from the insoluble substances that may be used to cut the drug.
 Chronic Side effects of chronic cocaine use Although it has been commonly asserted, the available evidence does not show that chronic use of cocaine is associated with
broad cognitive deficits.
ΔFosB levels have been found to increase upon the use of cocaine.
 Exposure to cocaine may lead to the breakdown of the blood-brain barrier.
 Repeated use is likely to result in cocaine addiction.
[dubious – discuss] The color of “crack” cocaine depends upon several factors including the origin of the cocaine used, the method of preparation – with ammonia or baking
soda – and the presence of impurities.
 Analysis of the correlation between the use of 18 various psychoactive substances shows that cocaine use correlates with other “party drugs” (such as ecstasy or amphetamines),
as well as with heroin and benzodiazepines use, and can be considered as a bridge between the use of different groups of drugs.
Since saliva is an important mechanism in maintaining one’s oral pH level, people who use cocaine over a long period of time who do not hydrate sufficiently may experience
demineralization of their teeth due to the pH of the tooth surface dropping too low (below 5.5).
Crack cocaine Main article: Crack cocaine A woman smoking crack cocaine “Rocks” of crack cocaine Crack is usually smoked in a glass pipe, and once inhaled, it passes from
the lungs directly to the central nervous system, producing an almost immediate “high” that can be very powerful – this initial crescendo of stimulation is known as a “rush”.
 Pyrolysis products of cocaine that occur only when heated/smoked have been shown to change the effect profile, i.e.
 When insufflating cocaine, absorption through the nasal membranes is approximately 30–60% In a study of cocaine users, the average time taken to reach peak subjective
effects was 14.6 minutes.
Detection of cocaine metabolites in hair is possible in regular users until the sections of hair grown during use are cut or fall out.
 Cocaine overdose may cause seizures, abnormally high body temperature and a marked elevation of blood pressure, which can be life-threatening, abnormal heart rhythms,
 Use of cocaine increases the overall risk of death and intravenous use particularly increases the risk of trauma and infectious diseases such as blood infections and
Effects Acute Acute exposure to cocaine has many effects on humans, including euphoria, increases in heart rate and blood pressure, and increases in cortisol secretion from
the adrenal gland.
Benzoylecgonine can be detected in urine within four hours after cocaine intake and remains detectable in concentrations greater than 150 ng/mL typically for up to eight days
after cocaine is used.
Dependence and withdrawal Cocaine dependence develops after even brief periods of regular cocaine use and produces a withdrawal state with emotional-motivational deficits
upon cessation of cocaine use.
 Severe cardiac adverse events, particularly sudden cardiac death, become a serious risk at high doses due to cocaine’s blocking effect on cardiac sodium channels.
 Additionally, stimulants like cocaine, methamphetamine, and even caffeine cause dehydration and dry mouth.
Addiction to crack usually occurs with four to six weeks; much more rapidly than with regular cocaine.
 Incidental exposure of the eye to sublimated cocaine while smoking crack cocaine can cause serious injury to the cornea and long-term loss of visual acuity.
The delay in absorption after oral ingestion may account for the popular belief that cocaine bioavailability from the stomach is lower than after insufflation.
 Studies show that prenatal cocaine exposure (independent of other effects such as, for example, alcohol, tobacco, or physical environment) has no appreciable effect on
childhood growth and development.
Cocaine use also promotes the formation of blood clots.
Some research suggests that smoking freebase cocaine can be even more cardiotoxic than other routes of administration because of methylecgonidine’s effects on lung tissue
and liver tissue.
Although some absorption and systemic effects may occur, the use of cocaine as a topical anesthetic and vasoconstrictor is generally safe, rarely causing cardiovascular toxicity,
glaucoma, and pupil dilation.
 A single dose of cocaine induces tolerance to the drug’s effects.
 In 2017, the Global Burden of Disease study found that cocaine use caused around 7300 deaths annually world-wide.
 Cocaine also causes vasoconstriction, thus reducing bleeding during minor surgical procedures.
This is followed by an equally intense low, leaving the user craving more drug.
This change can be identified rather quickly, and may be sustained weeks after the last dose of the drug.
 Cocaine also blocks sodium channels, thereby interfering with the propagation of action potentials; thus, like lignocaine and novocaine, it acts as a local
 In the United States, cocaine is regulated as a Schedule II drug under the Controlled Substances Act, meaning that it has a high potential for abuse and has an accepted
medical use for treatment.
 Inhalation See also: Crack cocaine The onset of cocaine’s euphoric effects is fastest with inhalation, beginning after 3–5 seconds.
Consumption of large doses of cocaine can cause violent outbursts, especially by those with preexisting psychosis.
 Any damage to the inside of the nose is because cocaine highly constricts blood vessels – and therefore blood and oxygen/nutrient flow – to that area.
As with all injected illicit substances, there is a risk of the user contracting blood-borne infections if sterile injecting equipment is not available or used.
The duration of cocaine’s effects depends on the amount taken and the route of administration.
 When smoked, cocaine is sometimes combined with other drugs, such as cannabis, often rolled into a joint or blunt.
Using sophisticated technologies, scientists are now finding that exposure to cocaine during fetal development may lead to subtle, yet significant, later deficits in some
children, including deficits in some aspects of cognitive performance, information-processing, and attention to tasks—abilities that are important for success in school.
 The rate and extent of absorption from inhalation of cocaine is similar or greater than with intravenous injection, as inhalation provides access directly to the pulmonary
 As cocaine also has numbing and blood vessel constriction properties, it is occasionally used during surgery on the throat or inside of the nose to control pain, bleeding,
and vocal cord spasm.
Snorting cocaine produces maximum physiological effects within 40 minutes and maximum psychotropic effects within 20 minutes.
 There are also warnings about the threat of breastfeeding: The March of Dimes said “it is likely that cocaine will reach the baby through breast milk,” and advises the
following regarding cocaine use during pregnancy: Cocaine use during pregnancy can affect a pregnant woman and her unborn baby in many ways.
 DNA damage is increased in the brain of rodents by administration of cocaine.
 Physical effects may include a fast heart rate, sweating, and dilated pupils.
In a study of cocaine users, the average time taken to reach peak subjective effects was 3.1 minutes.
 While rarely used medically today, its accepted uses are as a topical local anesthetic for the upper respiratory tract as well as to reduce bleeding in the mouth, throat
and nasal cavities.
 Cocaine hydrochloride (Goprelto), an ester local anesthetic, was approved for medical use in the United States in December 2017, and is indicated for the introduction
of local anesthesia of the mucous membranes for diagnostic procedures and surgeries on or through the nasal cavities of adults.
 They self-administer cocaine at lower doses than control, but have a greater likelihood of relapse when the drug is withheld.
 Powder cocaine (cocaine hydrochloride) must be heated to a high temperature (about 197 °C), and considerable decomposition/burning occurs at these high temperatures.
 High doses can result in high blood pressure or high body temperature.
The article stated that drinking two cups of the tea per day gave a mild stimulation, increased heart rate, and mood elevation, and the tea was essentially harmless.
 Since 1961, the international Single Convention on Narcotic Drugs has required countries to make recreational use of cocaine a crime.
Cocaine’s binding properties are such that it attaches so this hydrogen bond will not form and is blocked from formation due to the tightly locked orientation of the cocaine
Medical Cocaine hydrochloride Topical cocaine is sometimes used as a local numbing agent and vasoconstrictor to help control pain and bleeding with surgery of the nose, mouth,
throat or lacrimal duct.
 Cocaine has a short elimination half life of 0.7–1.5 hours and is extensively metabolized by plasma esterases but also by liver cholinesterases, with only about 1% excreted
unchanged in the urine.
 With excessive or prolonged use, the drug can cause itching, fast heart rate, and paranoid delusions or sensations of insects crawling on the skin.
Experimentally, cocaine injections can be delivered to animals such as fruit flies to study the mechanisms of cocaine addiction.
 Each subsequent dose of cocaine continues to increase ΔFosB levels with no ceiling of tolerance.
 Mortality Persons with regular or problematic use of cocaine have a significantly higher rate of death, and are specifically at higher risk of traumatic deaths and deaths
attributable to infectious disease.
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