Cocaine

Cocaine
Kokain - Cocaine.svg
Cocaine-from-xtal-1983-3D-balls.png
Clinical data
Trade names Psicaine, Delcaine, Ensan Cocaine[ citation needed]
Synonyms Benzoylmethylecgonine, coke
AHFS/ Drugs.com Micromedex Detailed Consumer Information
Pregnancy
category
  • US: C (Risk not ruled out)
Dependence
liability
Addiction
liability
High [3]
Routes of
administration
Topical, oral, insufflation, intravenous
Drug class
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailability
Metabolism liver CYP3A4
Onset of action seconds to minutes [9]
Biological half-life 1 hour
Duration of action 5 to 90 minutes [9]
Excretion Kidney
Identifiers
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
PDB ligand
ECHA InfoCard 100.000.030
Chemical and physical data
Formula C17H21NO4
Molar mass 303.353 g/mol
3D model ( JSmol)
Melting point 98 °C (208 °F)
Boiling point 187 °C (369 °F)
Solubility in water ~1.8 mg/mL (20 °C)
See also: data page
 NYesY  (verify)

Cocaine, also known as coke, is a strong stimulant mostly used as a recreational drug. [10] It is commonly snorted, inhaled as smoke, or as a solution injected into a vein. [9] Mental effects may include loss of contact with reality, an intense feeling of happiness, or agitation. [9] Physical symptoms may include a fast heart rate, sweating, and large pupils. [9] High doses can result in very high blood pressure or body temperature. [11] Effects begin within seconds to minutes of use and last between five and ninety minutes. [9] Cocaine has a small number of accepted medical uses such as numbing and decreasing bleeding during nasal surgery. [12]

Cocaine is addictive due to its effect on the reward pathway in the brain. [10] After a short period of use, there is a high risk that dependence will occur. [10] Its use also increases the risk of stroke, myocardial infarction, lung problems in those who smoke it, blood infections, and sudden cardiac death. [10] [13] Cocaine sold on the street is commonly mixed with local anesthetics, cornstarch, quinine, or sugar, which can result in additional toxicity. [14] Following repeated doses a person may have decreased ability to feel pleasure and be very physically tired. [10]

Cocaine acts by inhibiting the reuptake of serotonin, norepinephrine, and dopamine. [10] This results in greater concentrations of these three neurotransmitters in the brain. [10] It can easily cross the blood–brain barrier and may lead to the breakdown of the barrier. [15] [16] Cocaine is a naturally occurring substance found in the coca plant which are mostly grown in South America. [9] In 2013, 419 kilograms were produced legally. [17] It is estimated that the illegal market for cocaine is 100 to 500 billion USD each year. [10] With further processing crack cocaine can be produced from cocaine. [10]

After cannabis, cocaine is the most frequently used illegal drug globally. [18] Between 14 and 21 million people use the drug each year. [10] Use is highest in North America followed by Europe and South America. [10] Between one and three percent of people in the developed world have used cocaine at some point in their life. [10] In 2013 cocaine use directly resulted in 4,300 deaths, up from 2,400 in 1990. [19] The leaves of the coca plant have been used by Peruvians since ancient times. [14] Cocaine was first isolated from the leaves in 1860. [10] Since 1961 the international Single Convention on Narcotic Drugs has required countries to make recreational use of cocaine a crime. [20]

Uses

Medical

Topical cocaine can be used as a local numbing agent to help with painful procedures in the mouth or nose. [21] TAC is one such formulation used for pediatrics.

Cocaine was historically useful as a topical anesthetic in eye and nasal surgery, although it is now predominantly used for nasal and lacrimal duct surgery. The major disadvantages of this use are cocaine's intense vasoconstrictor activity and the potential for cardiovascular toxicity. Cocaine has since been largely replaced in Western medicine by synthetic local anesthetics such as benzocaine, proparacaine, lidocaine, and tetracaine though it remains available for use if specified. If vasoconstriction is desired for a procedure (as it reduces bleeding), the anesthetic is combined with a vasoconstrictor such as phenylephrine or epinephrine. In Australia it is currently[ when?] prescribed for use as a local anesthetic for conditions such as mouth and lung ulcers.[ citation needed] Some ENT specialists occasionally use cocaine within the practice when performing procedures such as nasal cauterization. In this scenario dissolved cocaine is soaked into a ball of cotton wool, which is placed in the nostril for the 10–15 minutes immediately before the procedure, thus performing the dual role of both numbing the area to be cauterized, and vasoconstriction. Even when used this way, some of the used cocaine may be absorbed through oral or nasal mucosa and give systemic effects.[ citation needed] An alternative method of administration for ENT surgery is mixed with adrenaline and sodium bicarbonate, as Moffett's solution.

Recreational

Cocaine is a powerful nervous system stimulant. [22] Its effects can last from fifteen or thirty minutes to an hour. The duration of cocaine's effects depends on the amount taken and the route of administration. [23] Cocaine can be in the form of fine white powder, bitter to the taste. When inhaled or injected, it causes a numbing effect. Crack cocaine is a smokeable form of cocaine made into small "rocks" by processing cocaine with sodium bicarbonate (baking soda) and water.[ citation needed]

Cocaine increases alertness, feelings of well-being and euphoria, energy and motor activity, feelings of competence and sexuality. Cocaine's stimulant effects are similar to that of amphetamine, however, these effects tend to be much shorter lasting and more prominent.[ citation needed]

Oral

A spoon containing baking soda, cocaine, and a small amount of water. Used in a "poor-man's" crack-cocaine production

Many users rub the powder along the gum line, or onto a cigarette filter which is then smoked, which numbs the gums and teeth – hence the colloquial names of "numbies", "gummers", or "cocoa puffs" for this type of administration. This is mostly done with the small amounts of cocaine remaining on a surface after insufflation (snorting). Another oral method is to wrap up some cocaine in rolling paper and swallow ( parachute) it. This is sometimes called a "snow bomb."[ citation needed]

Coca leaves

Coca leaves are typically mixed with an alkaline substance (such as lime) and chewed into a wad that is retained in the mouth between gum and cheek (much the same as chewing tobacco is chewed) and sucked of its juices. The juices are absorbed slowly by the mucous membrane of the inner cheek and by the gastrointestinal tract when swallowed. Alternatively, coca leaves can be infused in liquid and consumed like tea. Ingesting coca leaves generally is an inefficient means of administering cocaine. Advocates of the consumption of the coca leaf state that coca leaf consumption should not be criminalized as it is not actual cocaine, and consequently it is not properly the illicit drug.[ citation needed]

Because cocaine is hydrolyzed and rendered inactive in the acidic stomach, it is not readily absorbed when ingested alone. Only when mixed with a highly alkaline substance (such as lime) can it be absorbed into the bloodstream through the stomach. The efficiency of absorption of orally administered cocaine is limited by two additional factors. First, the drug is partly catabolized by the liver. Second, capillaries in the mouth and esophagus constrict after contact with the drug, reducing the surface area over which the drug can be absorbed. Nevertheless, cocaine metabolites can be detected in the urine of subjects that have sipped even one cup of coca leaf infusion. Therefore, this is an actual additional form of administration of cocaine, albeit an inefficient one.[ citation needed]

Orally administered cocaine takes approximately 30 minutes to enter the bloodstream. Typically, only a third of an oral dose is absorbed, although absorption has been shown to reach 60% in controlled settings. Given the slow rate of absorption, maximum physiological and psychotropic effects are attained approximately 60 minutes after cocaine is administered by ingestion. While the onset of these effects is slow, the effects are sustained for approximately 60 minutes after their peak is attained.[ citation needed]

Contrary to popular belief, both ingestion and insufflation result in approximately the same proportion of the drug being absorbed: 30 to 60%. Compared to ingestion, the faster absorption of insufflated cocaine results in quicker attainment of maximum drug effects. Snorting cocaine produces maximum physiological effects within 40 minutes and maximum psychotropic effects within 20 minutes, however, a more realistic activation period is closer to 5 to 10 minutes. Physiological and psychotropic effects from nasally insufflated cocaine are sustained for approximately 40–60 minutes after the peak effects are attained. [24]

Coca tea, an infusion of coca leaves, is also a traditional method of consumption. The tea has often been recommended for travelers in the Andes to prevent altitude sickness. [25] However, its actual effectiveness has never been systematically studied. [25] This method of consumption has been practised for many centuries by the indigenous tribes of South America. One specific purpose of ancient coca leaf consumption was to increase energy and reduce fatigue in messengers who made multi-day quests to other settlements.[ citation needed]

In 1986 an article in the Journal of the American Medical Association revealed that U.S. health food stores were selling dried coca leaves to be prepared as an infusion as "Health Inca Tea." [26] While the packaging claimed it had been "decocainized", no such process had actually taken place. The article stated that drinking two cups of the tea per day gave a mild stimulation, increased heart rate, and mood elevation, and the tea was essentially harmless. Despite this, the DEA seized several shipments in Hawaii, Chicago, Georgia, and several locations on the East Coast of the United States, and the product was removed from the shelves.

Insufflation

Lines of cocaine prepared for insufflation

Nasal insufflation (known colloquially as "snorting", "sniffing", or "blowing") is a common method of ingestion of recreational powdered cocaine. [27] The drug coats and is absorbed through the mucous membranes lining the nasal passages. When insufflating cocaine, absorption through the nasal membranes is approximately 30–60%, 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 study of cocaine users, the average time taken to reach peak subjective effects was 14.6 minutes. [28] Any damage to the inside of the nose is because cocaine highly constricts blood vessels – and therefore blood and oxygen/nutrient flow – to that area. Nosebleeds after cocaine insufflation are due to irritation and damage of mucus membranes by foreign particles and adulterants and not the cocaine itself;[ citation needed] as a vasoconstrictor, cocaine acts to reduce bleeding.

Rolled up banknotes, hollowed-out pens, cut straws, pointed ends of keys, specialized spoons, long fingernails, and (clean) tampon applicators are often used to insufflate cocaine. Such devices are often called "tooters" by users. The cocaine typically is poured onto a flat, hard surface (such as a mirror, CD case or book) and divided into "bumps", "lines" or "rails", and then insufflated. [29] 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 35 mg (a "bump") to 100 mg (a "rail").[ dubious ] As tolerance builds rapidly in the short-term (hours), many lines are often snorted to produce greater effects.[ citation needed] A 2001 study reported that the sharing of straws used to "snort" cocaine can spread blood diseases such as hepatitis C. [30]

Injection

Drug injection by turning the drug into a solution provides the highest blood levels of drug in the shortest amount of time. Subjective effects not commonly shared with other methods of administration include a ringing in the ears moments after injection (usually when in excess of 120 milligrams) lasting 2 to 5 minutes including tinnitus and audio distortion. This is colloquially referred to as a "bell ringer". In a study of cocaine users, the average time taken to reach peak subjective effects was 3.1 minutes. [28] 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. As with all injected illicit substances, there is a risk of the user contracting blood-borne infections if sterile injecting equipment is not available or used. Additionally, because cocaine is a vasoconstrictor, and usage often entails multiple injections within several hours or less, subsequent injections are progressively more difficult to administer, which in turn may lead to more injection attempts and more consequences from improperly performed injection.[ citation needed]

An injected mixture of cocaine and heroin, known as " speedball" is a particularly 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, including celebrities such as comedians/actors John Belushi and Chris Farley, Mitch Hedberg, River Phoenix, grunge singer Layne Staley and actor Philip Seymour Hoffman. Experimentally, cocaine injections can be delivered to animals such as fruit flies to study the mechanisms of cocaine addiction. [31]

Inhalation

Inhalation by smoking cocaine is one of the several ways the drug is consumed. The two main ways cocaine is smoked are freebasing and by using cocaine which has been converted to smokable " crack cocaine". Cocaine is smoked by inhaling the vapor produced when solid cocaine is heated to the point that it sublimates. [32] In a 2000 Brookhaven National Laboratory medical department study, based on self reports of 32 abusers who participated in the study,"peak high" was found at mean of 1.4min +/- 0.5 minutes. [28] Pyrolysis products of cocaine that occur only when heated/smoked have been shown to change the effect profile, i.e. anhydroecgonine methyl ester when co-administered with cocaine increases the dopamine in CPu and NAc brain regions, and has M1- and M3- receptor affinity. [33]

Smoking freebase or crack cocaine is most often accomplished using a pipe made from a small glass tube, often taken from " love roses", small glass tubes with a paper rose that are promoted as romantic gifts. [34] These are sometimes called "stems", "horns", "blasters" and "straight shooters". A small piece of clean heavy copper or occasionally stainless steel scouring pad – often called a "brillo" (actual Brillo Pads contain soap, and are not used) or "chore" (named for Chore Boy brand copper scouring pads) – serves as a reduction base and flow modulator in which the "rock" can be melted and boiled to vapor. Crack smokers also sometimes smoke through a soda can with small holes on the side or bottom.[ citation needed] Crack is smoked by placing it at the end of the pipe; a flame held close to it produces vapor, which is then inhaled by the smoker. The effects, felt almost immediately after smoking, are very intense and do not last long – usually 2 to 10 minutes. [35] When smoked, cocaine is sometimes combined with other drugs, such as cannabis, often rolled into a joint or blunt. Powdered cocaine is also sometimes smoked, though heat destroys much of the chemical; smokers often sprinkle it on cannabis.[ citation needed] The language referring to paraphernalia and practices of smoking cocaine vary, as do the packaging methods in the street level sale.[ citation needed]

Suppository

Another way users consume cocaine is by making it into a suppository which they then insert into the anus or vagina. The drug is then absorbed by the membranes of these body parts. Little research has been focused on the suppository (anal or vaginal insertion) method of administration, also known as "plugging". This method of administration is commonly administered using an oral syringe. Cocaine can be dissolved in water and withdrawn into an oral syringe which may then be lubricated and inserted into the anus or vagina before the plunger is pushed. Anecdotal evidence of its effects is infrequently discussed, possibly due to social taboos in many cultures. The rectum and the vaginal canal is where the majority of the drug would be taken up through the membranes lining its walls.[ citation needed]

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