Cocaine

Cocaine (or crack in its impure freebase form) is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. It is a stimulant of the central nervous system and an appetite suppressant, creating what has been described as a euphoric sense of happiness and increased energy. Though most often used recreationally for this effect, cocaine is also a topical anesthetic used in eye, throat, and nose surgery. Cocaine can be psychologically addictive, and its possession, cultivation, and distribution is illegal for non-medicinal and non-government sanctioned purposes in virtually all parts of the world. The name comes from the name of the coca plant plus the alkaloid suffix -ine.

The stimulating qualities of the coca leaf were known to the ancient peoples of Peru and other Pre-Columbian South American societies. In modern Western countries, cocaine has been a feature of the counterculture for well-over a century; there is a long-list of prominent intellectuals, artists, and musicians who have used the drug — names ranging from Sir Arthur Conan Doyle and Sigmund Freud to United States President Ulysses S. Grant. For several decades after its initial release, cocaine could be found in trace amounts in the Coca-Cola beverage. Today, although illegal in virtually all countries, cocaine remains popular in a wide variety of social and personal settings.

Appearance

A pile of Cocaine hydrochloride

Cocaine in its purest form is a white, pearly product. Cocaine appearing in powder form is a salt, typically cocaine hydrochloride. Black market cocaine is frequently adulterated or “cut” with various powdery fillers to increase its surface area; the substances most commonly used in this process are baking soda; sugars, such as lactose, dextrose, inositol, and mannitol; and local anesthetics, such as lidocaine or benzocaine, which mimic or add to cocaine's numbing effect on mucous membranes. Cocaine may also be "cut" with other stimulants such as methamphetamine. Adulterated cocaine is often a white, off-white or pinkish powder.
The color of “crack” cocaine depends upon several factors including the origin of the cocaine used, the method of preparation – with ammonia or sodium bicarbonate – and the presence of impurities, but will generally range from white to a yellowish creme to a light brown. Its texture will also depend on the adulterants, origin and processing of the powdered cocaine, and the method of converting the base; but will range from a crumbly texture, sometimes extremely oily, to a hard, almost crystalline nature.

Forms of cocaine

Cocaine sulfate is produced by macerating coca leaves along with water that has been acidulated with sulfuric acid, or an aromatic-based solvent, like kerosene or benzene. This is often accomplished by putting the ingredients into a vat and stamping on it, in a manner similar to the traditional method for crushing grapes. After the cocaine is extracted, the water is evaporated to yield a pasty mass of impure cocaine sulfate.

Crack cocaine

A pile of crack cocaine ‘rocks’.

Crack is unique because it offers a strong cocaine experience in small, low-priced packages. In the United States, crack cocaine is often sold in small, inexpensive dosage units frequently known as a "blast" (equivalent to one hit or a dollars worth), “nickels”, “nickel rocks”, or "bumps" (referring to the price of $5.00), and also “dimes”, “dime rocks”, or "boulders" and sometimes as “twenties”,"dubs", “solids", "slabs" and “forties.” The quantity provided by such a purchase varies depending upon many factors, such as local availability, which is affected by geographic location. A twenty may yield a quarter gram or half gram on average, yielding 30 minutes to an hour of effect if hits are taken every few minutes. After the $20 or $40 mark, crack and powder cocaine are sold in grams or fractions of ounces. At the intermediate level, crack cocaine is sold either by weight in ounces, referred to by terms such as "eight-ball" (one-eighth of an ounce) or "quarter" and "half" respectively. In the alternate, $20 pieces of crack cocaine are aggregated in units of "fifty pack" and "hundred pack", referring to the number of pieces. At this level, the wholesale price is approximately half the street sale price.

Crack cocaine was extremely popular in the mid- and late 1980s in a period known as the Crack Epidemic, especially in inner cities, though its popularity declined through the 1990s in the United States. There were major anti-drug campaigns launched in the U.S. to try and cull its popularity, the most popular being a series of ads featuring the slogan "The Thrill Can Kill". However, there has been an increase in popularity within Canada in the recent years, where it has been estimated that the drug has become a multi-billion dollar 'industry'.

Although consisting of the same active drug as powder cocaine, crack cocaine in the United States is seen as a drug primarily by and for the inner-city poor; the stereotypical "crack head" is poor, urban, and usually homeless. While insufflated powder cocaine has an associated glamour attributed to its popularity among mostly middle and upper class whites (as well as musicians and entertainers), crack is perceived as a skid row drug of squalor and desperation. The U.S. federal trafficking penalties deal far more harshly towards crack when compared to powdered cocaine. Possession of five grams of crack (or over 500 grams of powder) carries a minimum sentence of five years imprisonment in the US.

Modes of administration

Insufflation (known colloquially as “snorting," “sniffing," or "blowing") is the most common method of ingestion of recreational powder cocaine in the Western world. Contrary to widespread belief, cocaine is not actually inhaled using this method; rather the drug coats and is absorbed through the mucous membranes lining the sinuses. When insufflating cocaine, absorption through the nasal membranes is approximately 30-60 percent, with higher doses leading to increased absorption efficiency. Any material not directly absorbed through the mucous membranes is collected in mucus and swallowed (this "drip" is considered pleasant by some and unpleasant by others). In a studyof cocaine users, the average time taken to reach peak subjective effects was 14.6 minutes. Chronic use results in ongoing rhinitis and necrosis of the nasal membranes. Many users report a burning sensation in the nostrils after cocaine's anesthetic effects wear off. Any damage to the inside of the nose is because cocaine highly constricts blood vessels — and therefore blood & oxygen/nutrient flow-- to that area. If this restriction of adequate blood supply is bad enough and, especially prolonged enough, the tissue there can die.

Prior to insufflation, cocaine powder must be divided into very fine particles. Cocaine of high purity breaks into fine dust very easily, except when it is moist (not well stored) and forms “chunks,” which reduces the efficiency of nasal absorption. Rolled up banknotes, hollowed-out pens, cut straws, pointed ends of keys, and specialized spoons are often used to insufflate cocaine. Such devices are often referred to as "tooters" by users. The cocaine typically is poured onto a flat, hard surface (such as a mirror) and divided into "lines", which are then insufflated. The amount of cocaine in a line varies widely from person to person and occasion to occasion (the purity of the cocaine is also a factor), but one line is generally considered to be a single dose and is typically 35mg-100mg. However as tolerance builds rapidly in the short-term (hours), many lines are often snorted to produce greater effects.

Drug injection provides the highest blood levels of drug in the shortest amount of time. Upon injection, cocaine reaches the brain in a matter of seconds, and the exhilarating rush that follows can be so intense that it induces some users to vomit uncontrollably. In a study of cocaine users, the average time taken to reach peak subjective effects was 3.1 minutes. The euphoria passes quickly. Aside from the toxic effects of cocaine, there is also danger of circulatory emboli from the insoluble substances that may be used to cut the drug. There is also a risk of serious infection associated with the use of contaminated needles.

An injected mixture of cocaine and heroin, known as “speedball” or “moonrock”, is a particularly popular and dangerous combination, as the converse effects of the drugs actually complement each other, but may also mask the symptoms of an overdose. It has been responsible for numerous deaths, particularly in and around Los Angeles, including celebrities such as John Belushi, Chris Farley, River Phoenix and Layne Staley (in Seattle).

Smoking freebase or crack cocaine is most often accomplished using a pipe made from a small glass tube about one quarter-inch (about 6 mm) in diameter and on the average, four inches long. These are sometimes called "stems", "horns", "blasters" and "straight shooters," readily available in convenience stores or smoke shops. They will sometimes contain a small paper flower and are promoted as a romantic gift. Buyers usually ask for a "rose" or a "flower." An alternate method is to use a small length of a radio antenna or similar metal tube. To avoid burning the user’s fingers and lips on the metal pipe, a small piece of paper or cardboard (such as a piece torn from a matchbook cover) is wrapped around one end of the pipe and held in place with either a rubber band or a piece of adhesive tape. A popular (usually pejorative) term for crack pipes is "glass dick."
A small piece (approximately one inch) of heavy steel or copper scouring pad — often called a "brillo" or "chore", from the scouring pads of the same name — is placed into one end of the tube and carefully packed down to approximately three-quarter inch. Prior to insertion, the "brillo" is burnt off, to remove any oily coatings that may be present. It then serves as a reduction base and flow modulator in which the "rock" can melt and boil to vapor.

Another option is to use a deep socket, say 12mm, wrapped with electrical tape. Instead of Chore Boy, users typically employ high grade (very fine) speaker wire rolled into a ball as the filter medium. A Zippo lighter is recommended because of the stronger flame, but the taste of naptha is quite noticeable. However, the socket is practically indestructible and inconspicuous.
A more common option is to find a discarded soda can and puncture several small holes on the side of the can by the bottom. Tobacco ash is then placed in the divot created and the drug is placed on top. the mouthpiece is the original opening of the can. creating an cost effective alternative to a proper crack pipe.

The "rock" is placed at the end of the pipe closest to the filter and the other end of the pipe is placed in the mouth. A flame from a cigarette lighter or handheld torch is then held under the rock. As the rock is heated, it melts and burns away to vapor, which the user inhales as smoke. The effects, felt almost immediately after smoking, are very intense and do not last long — usually five to fifteen minutes. In a study of cocaine users, the average time taken to reach peak subjective effects was 1.4 minutes. Most users will want more after this time, especially frequent users. "Crack houses" depend on these cravings by providing users a place to smoke, and a ready supply of small bags for sale.

A heavily used crackpipe tends to fracture at the end from overheating with the flame used to heat the crack as the user attempts to inhale every bit of the drug on the metal wool filter. The end is often broken further as the user "pushes" the pipe. "Pushing" is a technique used to partially recover crack that hardens on the inside wall of the pipe as the pipe cools. The user pushes the metal wool filter through the pipe from one end to the other to collect the build-up inside the pipe, which is a very pure and potent form of the base. The ends of the pipe can be broken by the object used to push the filter, frequently a small screwdriver or stiff piece of wire. The user will often remove the most jagged edges and continue using the pipe until it becomes so short that it burns the lips and fingers. To continue using the pipe, the user will sometimes wrap a small piece of paper or cardboard around one end and hold it in place with a rubber band or adhesive tape. Of course, not all people who smoke crack cocaine will let it get that short, and will get a new or different pipe. The tell-tale signs of a used crack pipe are a glass tube with burn marks at one or both ends and a clump of metal wool inside. The language used to refer to the paraphernalia and practices of smoking cocaine vary tremendously across regions of the United States, as do the packaging methods utilized in the street level sale.

Effects and health issues

Cocaine is a potent central nervous system stimulant. Its effects can last from 20 minutes to several hours, depending upon the dosage of cocaine taken, purity, and method of administration.The initial signs of stimulation are hyperactivity, restlessness, increased blood pressure, increased heart rate and euphoria. The euphoria is sometimes followed by feelings of discomfort and depression and a craving to experience the drug again. Sexual interest and pleasure can be amplified. Side effects can include twitching, paranoia, and impotence, which usually increases with frequent usage.

With excessive dosage the drug can produce hallucinations, paranoid delusions, tachycardia, itching, and formication. Overdose causes tachyarrhythmias and a marked elevation of blood pressure. These can be life-threatening, especially if the user has existing cardiac problems.

Toxicity results in seizures, followed by respiratory and circulatory depression of medullar origin. This may lead to death from respiratory failure, stroke, cerebral hemorrhage, or heart-failure. Cocaine is also highly pyrogenic, because the stimulation and increased muscular activity cause greater heat production. Heat loss is inhibited by the intense vasoconstriction. Cocaine-induced hyperthermia may cause muscle cell destruction and myoglobinuria resulting in renal failure. There is no specific antidote for cocaine overdose.

Cocaine's primary acute effect on brain chemistry is to raise the amount of dopamine and serotonin in the nucleus accumbens (the pleasure center in the brain); this effect ceases, due to metabolism of cocaine to inactive compounds and particularly due to the depletion of the transmitter resources (tachyphylaxis). This can be experienced acutely as feelings of depression, as a "crash" after the initial high. Further mechanisms occur in chronic cocaine use.

Chronic use contributes to the rise in an abuser's tolerance thus requiring a larger dosage to achieve the same effect. The lack of normal amounts of serotonin and dopamine in the brain is the cause of the dysphoria and depression felt after the initial high. The diagnostic criteria for cocaine withdrawal is characterized by a dysphoric mood, fatigue, unpleasant dreams, insomnia or hypersomnia, E.D., increased appetite, psychomotor retardation or agitation, and anxiety.
Cocaine abuse also has multiple physical health consequences. It is associated with a lifetime risk of heart attack that is seven times that of non-users. During the hour after cocaine is used, heart attack risk rises 24-fold.

Side effects from chronic smoking of cocaine include chest pain, lung trauma, shortness of breath, sore throat, hoarse voice, dyspnea, and an aching, flu-like syndrome. A common misconception is that the smoking of cocaine chemically breaks down tooth enamel and causes tooth decay. However, cocaine does often cause involuntary tooth grinding, known as bruxism, which can deteriorate tooth enamel and lead to gingivitis.

Chronic intranasal usage can degrade the cartilage separating the nostrils leading eventually to its complete disappearance. Due to the absorption of the cocaine from cocaine hydrochloride, the remaining hydrochloride forms a dilute hydrochloric acid.
Cocaine may also greatly increase this risk of developing rare autoimmune or connective tissue diseases such as lupus, Goodpasture's disease, vasculitis, glomerulonephritis, Stevens-Johnson syndrome and other diseases. It can also cause a wide array of kidney diseases and renal failure. While these conditions are normally found in chronic use they can also be caused by short term exposure in susceptible individuals.

Consumption

World annual cocaine consumption currently stands at around 600 metric tons, with the United States consuming around 300 metric tons, 50% of the total, Europe about 150 metric tons, 25% of the total, and the rest of the world the remaining 150 metric tons or 25%. According to the United Nations Office on Drugs and Crime 2006 World Drug Report, the United States has the world's greatest rate of cocaine consumption by people aged 15 to 64, 2.8%. It is closely followed by Spain with 2.7%, and England & Wales with 2.4%. Most Western European countries have a consumption rate between 1% and 2%.

Usage

Cocaine has become the second most popular illegal recreational drug in the U.S. Cocaine is generally used by privileged middle to upper class communities. It is also popular amongst college students, not just to aid in studying, but also as a party drug. Its users span over different ages, races, and professions. In the 1970s and 80's the drug became particularly popular in the disco culture as cocaine usage was very common and popular in many discos such as Studio 54.

The National Household Survey on Drug Abuse (NHSDA) reported in 1999 that cocaine was used by 3.7 million Americans, or 1.7 percent of the household population age 12 and older. Estimates of the current number of those who use cocaine regularly (at least once per month) vary, but 1.5 million is a widely accepted figure within the research community.
Although cocaine use had not significantly changed over the six years prior to 1999, the number of first-time users went up from 574,000 in 1991, to 934,000 in 1998 — an increase of 63%. While these numbers indicated that cocaine is still widely present in the United States, cocaine use was significantly less prevalent than it was during the early 1980s. Cocaine use peaked in 1982 when 10.4 million Americans (5.6 percent of the population) reportedly used the drug.

Usage among youth

The 1999 Monitoring the Future (MTF) survey found the proportion of American students reporting use of powder cocaine rose during the 1990s. In 1991, 2.3 percent of eighth-graders stated that they had used cocaine in their lifetime. This figure rose to 4.7 percent in 1999. For the older grades, increases began in 1992 and continued through the beginning of 1999. Between those years, lifetime use of cocaine went from 3.3 percent to 7.7 percent for tenth-graders and from 6.1 percent to 9.8 percent for twelfth-graders. Lifetime use of crack cocaine, according to MTF, also increased among eighth-, tenth-, and twelfth-graders, from an average of 2 percent in 1991 to 3.9 percent in 1999.

Perceived risk and disapproval of cocaine and crack use both decreased during the 1990s at all three grade levels. The 1999 NHSDA found the highest rate of monthly cocaine use was for those aged 18–25 at 1.7 percent, an increase from 1.2 percent in 1997. Rates declined between 1996 and 1998 for ages 26–34, while rates slightly increased for the 12–17 and 35+ age groups. Studies also show people are experimenting with cocaine at younger ages. NHSDA found a steady decline in the mean age of first use from 23.6 years in 1992 to 20.6 years in 1998.

Addiction

Cocaine addiction is the excessive intake of cocaine, and can result in physiological damage, lethargy, depression, or a potentially fatal overdose. The immediate craving to use more cocaine is strong and very common, because euphoric effects usually subside in most users within an hour of the last dosage, leading to serial cocaine readministrations, and prolonged, multi-dose binge use in those who are addicted. When administration stops after binge use, it is followed by a "crash", the onset of severely dysphoric mood with escalating exhaustion until sleep is achieved. Resumption of use may occur upon awakening or may not occur for several days, but the intense euphoria such use can, as it has in many users, produce intense craving and develop rather quickly into addiction. The risk of becoming cocaine-dependent within 2 years of first use(recent-onset) is 5-6%; after 10 years, it's 15-16%. These are the aggregate rates for all types of use considered, i.e., smoking, snorting, injecting. Among recent-onset users, the relative rates are higher for smoking (3.4 times) and much higher for injecting (31 times). They also vary, based on other characteristics, such as gender: among recent-onset users, females are 3.3 times more likely to become addicted, compared to males; age: among recent-onset users, those who started using at ages 12 or 13 were 4 times as likely to become addicted, compared to those who started between ages 18 and 20; and race: among recent-onset users, non-Hispanic Blacks are 7 times as likely to become addicted, compared to non-Hispanic Whites. Many habitual abusers develop a transient manic-like condition similar to amphetamine psychosis and schizophrenia, whose symptoms include aggression, severe paranoia, and tactile hallucinations (including the feeling of insects under the skin, or "coke bugs") during binges.

Cocaine has positive reinforcement effects, which refers to the effect that certain stimuli have on behavior. Good feelings become associated with the drug, causing a frequent user to take the drug as a response to bad news or mild depression. This activation strengthens the response that was just made. If the drug was taken by a fast acting route such as injection or inhalation, the response will be the act of taking more cocaine, so the response will be reinforced. Powder cocaine, being a club drug is mostly consumed in the evening and night hours. Because cocaine is a stimulant, a user will often drink large amounts of alcohol during and after usage or smoke cannabis to dull "crash" effects and hasten slumber. Benzodiazepines (e.g., xanax®, rohypnol®) are also used for this purpose. Other drugs such as heroin and various pharmaceuticals are often used to amplify reinforcement or to minimize such negative effects, further increasing addiction potential and harmfulness.