COCAINE

THE USE OF COCAINE

Cocaine (benzoylmethylecgonine) (INN) is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" and the alkaloid suffix -ine, forming cocaine. It is a stimulant, an appetite suppressant, and a topical anesthetic. Biologically, cocaine acts as a serotonin–norepinephrine–dopamine reuptake inhibitor, also known as a triple reuptake inhibitor (TRI). It is addictive because of its effect on themesolimbic reward pathway. Unlike most molecules, cocaine has pockets with both high hydrophilic and lipophilic efficiency, violating the rule of hydrophilic-lipophilic balance. This causes it to cross the blood–brain barrier far better than other psychoactive chemicals and may even induce blood brain barrier breakdown.

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:

• Powdered cocaine -- commonly known on the street as "coke" or "blow" -- dissolves in water. Users can snort or inject powdered cocaine.
• Crack cocaine -- commonly known on the street as "crack" or "rock" -- is made by a chemical process that leaves it in its "freebase" form, which can be smoked.

Cocaine -- a high-priced way of getting high -- has a mystique. Called "the caviar of street drugs," Cocaine is seen as the status-heavy drug of celebrities, fashion models, and Wall Street traders. Movies like "Blow" and books like Killing Pablosensationalize the business and use of cocaine. The reality of cocaine hits after the high. Cocaine has powerful negative effects on the heart, brain, and emotions. Many cocaine users fall prey to addiction, with long-term and life threatening consequences. Even occasional users run the risk of sudden death with cocaine use. Read on for the not-so-glamorous truth about cocaine use and its effects.

What's so great about being high on coke?

Cocaine users often describe the euphoric feeling as:

• an increasing sense of energy and alertness
• an extremely elevated mood
• a feeling of supremacy

on the other hand, some people describe other feelings tagging along with the high:

• irritability
• paranoia
• restlessness
• anxiety

Signs of using cocaine include:

• dilated pupils
• high levels of energy and activity
• excited, exuberant speech

Cocaine's immediate effects wear off in 30 minutes to two hours. Smoking or injecting cocaine results in a faster and shorter high, compared to snorting coke.

PHYSIOLOGICAL EFFECTS OF COCAINE

• Heart. Cocaine is bad for the heart. Cocaine increases heart rate and blood pressure while constricting the arteries supplying blood to the heart. The result can be a heart attack, even in young people without heart disease. Cocaine can also trigger a deadly abnormal heart rhythm called arrhythmia.

• Brain. Cocaine can constrict blood vessels in the brain, causing strokes. This can happen even in young people without other risk factors for strokes. Cocaine causes seizures and can lead to bizarre or violent behavior.

• Lungs and respiratory system. Snorting cocaine damages the nose and sinuses. Regular use can cause nasal perforation. Smoking crack cocaine irritates the lungs and, in some people, causes permanent lung damage.

• Gastrointestinal tract. Cocaine constricts blood vessels supplying the gut. The resulting oxygen starvation can cause ulcers, or even perforation of the stomach or intestines.

• 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.

• Sexual function. Although cocaine has a reputation as an aphrodisiac, it actually may make you less able to finish what you start. Chronic cocaine use can impair sexual function in men and women. In men, cocaine can cause delayed or impaired ejaculation.

Cocaine acts in the deep areas of the brain. These are the areas that reward us for "good behavior" -- those activities that lead to food, sex, and healthy pleasure. Stimulating this brain area with cocaine feels good. And it can 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.

There is no "safe" frequency of use for cocaine. It's impossible to predict whether a person will become physically or psychologically dependent on cocaine.

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 concentrating
• inability to feel pleasure
• increased craving for cocaine
• physical symptoms including aches, pains, tremors, and chills

Cocaine withdrawal is rarely medically serious. 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.