Cocaine Abuse: an Introduction

Abuse of cocaine and other psycho stimulants are determined by a complex interaction between the pharmacologic properties and relative availability of each drug. The environmental context, personality and expectations of the user in which the drug is used influence the drug abuse and outcome of the treatment. The concurrent use of several drugs with different pharmacologic effects is increasingly common. Combined use of heroin and cocaine intravenously, are dangerous. Chronic cocaine and psycho stimulant abuse may cause a number of adverse health consequences, like pulmonary disease to reproductive dysfunction. Hypertension and cardiac disease may be exacerbated by drug abuse; combined use of two or more drugs may accentuate medical complications associated with abuse of one of them. Drug abuse increases the risk of exposure to HIV and hepatitis B. Cocaine abuse contribute to the risk for HIV infection in part by suppression of immune function. Concurrent use of cocaine and opiates known as the “speedball” is frequently associated with needle-sharing by IV drug users and contribute to HIV transmission. Intravenous drug abusers continue to represent the largest single group of persons with HIV infection in several major metropolitan areas in the United States.

Cocaine is a stimulant and local anesthetic. The leaves of the coca plant Erythroxylon coca contain ~0.5 to 1% cocaine. Cocaine produces physiologic and behavioral effects when administered oral, intranasal, IV, or via inhalation (smoking).

There has been an increase in both IV administration and inhalation of cocaine via smoking. Changes in mood and sensation are perceived within 3 to 5 min, and peak effects occur at 10 to 20 min following intranasal administration. The effect last up to one hour. Inhaling crack/cocaine or smoking coca paste, a product made by extracting cocaine preparations with flammable solvents, and cocaine free-base smoking is now becoming increasingly common. Free base prepared with sodium bicarbonate (crack), has become increasingly popular because of the relative high potency of the compound and its rapid onset of action 8 to 10 seconds following smoking. Cocaine produces a brief, dose-related stimulation and enhancement of mood and an increase in heart rate and blood pressure. High doses of cocaine may induce lethal fever or high blood pressure. Short duration of the euphorigenic effects of cocaine observed in chronic abusers is probably due to both acute and chronic tolerance. Frequent self-administration of the drug two to three times per hour is often reported by chronic cocaine abusers. Cocaethylene, has been detected in blood and urine of persons who concurrently abuse alcohol and cocaine, which is a metabolite of cocaine. Assumption that cocaine inhalation or IV administration is relatively safe is contradicted by reports of death from respiratory depression, cardiac arrhythmias, and convulsions. Generalized seizures, neurological complications may include headache, ischemic or hemorrhagic stroke, or subarachnoid hemorrhage. Magnetic resonance spectroscopy (MRS) studies have detected disorders of cerebral blood flow and perfusion. Severe pulmonary disease may develop in individuals who inhale crack cocaine; this effect is attributed both to the direct effects of cocaine and to residual contaminants in the smoked material. Liver necrosis has been reported following crack/cocaine use.

Men and women who abuse cocaine may report that the drug enhances libido drive, but, chronic cocaine use causes significant loss of libido and adversely affects reproductive function. Impotence and gynecomastia (development of male breast) have been observed in male cocaine abusers. Women who abuse cocaine may experience major derangements in menstrual cycle function including amenorrhea (lack of menstruation) and infertility. Cocaine abuse by pregnant women, particularly the smoking of crack, has been associated with both an increased risk of congenital malformations in the fetus and peri natal cardiovascular and cerebrovascular disease in the mother. Poor nutrition and health care status also contribute to the risk for perinatal disease.

Cocaine abuse may cause paranoid ideation and visual and auditory hallucinations. Psychological dependence is inability to abstain from frequent compulsive use, has also been reported. Although the occurrence of withdrawal syndromes involving psychomotor agitation and autonomic hyperactivity remains controversial, severe depression called “crashing” following cocaine intoxication may accompany drug withdrawal.

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1 Comment

  • the long September 23, 2017 04.33 pm

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