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Almost two decades ago, cocaine began to become one of the most addictive recreational drugs in our society. It still commands a large audience. I was surprised to find out that even though most teenagers do not use it, many know where to acquire it. Cocaine can be snorted as a powder or injected, but the more common method of use involves smoking the free base form called crack. It is this form which can hit the brain within seconds and result in an intense euphoric feeling. It can stimulate the brain and the sympathetic nervous system by blocking the reuptake of excitatory neurotransmitters at the neuronal junctions. Unfortunately, this only lasts 20 to 30 minutes as blood enzymes quickly remove the drug. The user then develops a very strong need to repeat the process.
Cocaine comes from the leaf of the cocoa plant found mostly in South America. Native Indians traditionally chewed the cocoa leaves as a way of warding off fatigue. This method allowed for a small, constant flow of drug to the brain. I suppose this could be considered the herbal form of the substance. Medically, it is still used as a local anesthetic for nasal surgery. Addiction is quick to develop with the crack form or when large doses are repeatedly used. It is often very difficult to spot a user at random. This addiction afflicts 5 to 10% of our population which represents a staggering figure. People do not routinely go psychotic or exhibit impaired driving signs while using this drug. It has a more subtle action. Binging refers to the act of repeatedly using the drug until exhaustion sets in. Rats addicted to cocaine lose all interest in food, sex, and their behavior becomes focused on obtaining more cocaine. A binge cycle cannot sustain itself and soon leads to a prolonged sleep followed by a normal appearing period. I have met patients who have emptied their life savings and sold everything before anyone found out that they were addicts. Drug seeking behavior often leads to crime out of necessity.
Cardiac complications are the most common. Chest pains, palpitations and heart attacks are seen in users. The risks increase if you are a cigarette smoker as well. The heart attack of cocaine abuse is due to the drug's ability to constrict blood vessels feeding the heart. Cholesterol build-up has little to do with it. Cocaine can also increase blood pressure and result in bleeding into the brain. The same mechanism can affect the lungs and bowels. Cocaine excess causes seizures, and the same effects on the brain can result in agitation, psychosis and delirium. Some people lack the enzyme that degrades cocaine making them prone to increased risk for complications.
Cocaine side effects are medical emergencies but are often over-looked. Addiction is not plainly obvious unless you are directly suspicious. A simple urine test can determine cocaine use. Treatment is difficult. Between binges, people act normal and believe that they have a voluntary will to control their drug use. Treatment programs are available but rely on self-referral. In-patient treatment for cocaine abuse is of little value. It is a problem that requires on-going support.
Related resources:
Crack Cocaine - How Harmful Is It? What Is Crack Cocaine? Risks of Crack Use, Crack Cocaine in Toronto, from Durham Regional Police Service.
Drug Use and Offending. Statistical tables include Actual Drug Offences Reported to the Police by Drug Type, Canada, 2000. Source: Statistics Canada.
