Cocaine

Cocaine has replaced heroin in some areas as the most commonly abused of the hard drugs.14,18 It is one of the most potent of the CNS stimulants. Introduced to medicine and the public in the late 19th century, it soon became the "third scourge of mankind." Cocaine can be sniffed, shot intravenously, or smoked as "crack." While originally said to be nonaddictive (just like heroin), it is now realized that it is a very potent addictive compound, especially the crack (free base) form. When smoked as crack, it is immediately absorbed by the lungs and reaches the brain within seconds. It takes slightly longer for its action to affect the brain when injected intravenously. Cocaine is a relatively short-acting drug such that to maintain a high, one has to take it every 15 min to an hour. Since it is a potent vasoconstrictor, snorting the drug can occasionally cause ulceration and perforation of the nasal septum with long-term use. Cocaine has also been linked to myocardial infarctions, cerebral hemorrhages and dissecting aortic aneurysms.18-21

Sudden death caused by an overdose of cocaine is linked to all three routes of abuse. It is more common, however, following intravenous injection and smoking of crack than snorting. Cocaine-related deaths are generally not dose related. Cocaine causes sudden death by two mechanisms: (1) cardiac arrhythmia caused by the direct action of the cocaine on the myocardium, and (2) cardiopulmonary arrest induced by the CNS action of the drug. Cocaine, being a potent stimulant of the CNS, in overdoses can overstimulate the CNS with subsequent cardiopulmonary arrest.

Cocaine acts on the heart to increase heart rate and force of contraction by blocking the reuptake of norepinephrine at the neuroeffector junctions. It also causes increased release of catecholamines, which also stimulate the heart. Cocaine works on the alpha receptors in the coronary arteries to cause contraction, reducing myocardial perfusion. Thus, as the myocardium needs increasing amounts of oxygen, due to the stimulation of the beta-1 receptors, the amount of blood perfusing the myocardium is reduced by vasoconstriction of the coronary arteries.

Cocaine is rapidly hydrolyzed to benzoylecgonine and other derivatives by blood cholinesterases. Continued breakdown of cocaine will continue in the test tube unless it is inhibited by the addition of fluoride. After being taken, cocaine appears almost immediately in the urine. If the urine screen is negative for cocaine metabolites, the blood will also be negative.

Habitual, prolonged, heavy use of cocaine can make an individual aggressive, violent, and paranoid. A chemical paranoid psychosis may be induced by the prolonged and heavy use of cocaine. Such individuals may become extremely violent and assaultive. They are often immune to the effects of pepper spray. They may die suddenly and unexpectedly during or immediately after a struggle.

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Drug Addiction Report

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