Cocaine, also called crystal or coke, is an addictive stimulant drug isolated from the leaves of the coca plant, which grows in South America.

Cocaine is usually consumed in one of two forms: The first is a water-soluble hydrochloric salt, sold as a white powder that is most commonly snorted, but is sometimes diluted and injected into a vein. Although it is usually thought to be pure, sometimes the white powder contains traces of synthetic opioids or stimulants (such as amphetamines), which make the use of the drug especially dangerous.

The second form, called crack, is obtained when you add sodium bicarbonate and water to the white powder, and then heat the mixture until it turns into a solid nugget. The name crack refers to the sound that is heard when the nugget is heated and smoked. Crack is cheaper than cocaine, and its effect is faster and stronger.

Cocaine (including crack) is a highly addictive drug that increases the levels of the neurotransmitter dopamine in the brain’s reward system. The effects of cocaine are felt very quickly, usually within a few minutes after intake, but the effect is short-lived and can disappear after 5 to 10 minutes, depending on how the drug is consumed.

A bit of history


It appears that the Incas chewed coca leaves, and were the first to discover the properties of the coca plant. In the 16th century, Christian clerics in Peru tried to encourage the authorities to ban chewing coca leaves on the grounds that it contradicted the Christian faith. They were only partially successful in their efforts, in that coca wasn’t banned but restrictions were placed on the areas where the plant could be grown.

In the 19th century, a German chemist, Albert Niemann, succeeded in extracting cocaine from coca leaves. Niemann was probably the first to identify the potential uses of cocaine, given that he tried it and reported that the substance caused numbness. Other researchers injected it into the feet of frogs and concluded that cocaine could be utilized as a local anesthetic. Toward the end of the 19th century, another researcher published his conclusions, suggesting that cocaine be used as an anesthetic before surgery.

In the last decade of the 19th century, cocaine was the subject of many studies, but in addition to recognizing its medical uses as an anesthetic, it became clear that cocaine has addictive properties, and that it is toxic and deadly at high dosages.

At the same time, the use of cocaine became fashionable. It was incorporated into popular culture via soft drinks, the most famous of which is Coca-Cola. The common beverage contained a certain amount of cocaine until 1903, when reports of adverse effects caused manufacturers to eliminate the substance from the recipe, and leave only the essential oils extracted from the coca leaves.

At the beginning of the 20th century, cocaine arrived on the street, where it was sold as an illicit drug, but the proliferation of users who became addicted, resulting in reports of thousands of deaths, prompted the US authorities to ban the drug in 1922. Its use declined as a result, but in the early 1970s cocaine enjoyed renewed popularity, especially among the white-collar crowd. The high demand prompted the Colombian drug cartel to flood the United States with the smuggled drug. According to various reports, about 10 million Americans consumed cocaine in the 1980s.

In 1985 a new product appeared on the streets: crack. Thanks to its low price (about 80 percent cheaper than heroin, according to various estimates) and ease of production, crack spread quickly from the United States to the rest of the world.

Today crack is known as a cheap and common drug that is used by a range of populations. In the United States crack users include men and women across diverse socioeconomic groups, and even children as young as 12 and 13.


Why do people use cocaine?


Cocaine triggers quick and powerful feelings of euphoria, pleasure, arousal and increased energy—known as being “high” in slang—due to the large amounts of dopamine that flood the reward and pleasure pathways in the brain after drug intake. These arousal and energy effects are probably part of what attracted business people, athletes and celebrities to the drug in the 1980s and after, as was widely reported in the media over the years. It seems that the characteristics of the drug, along with its high cost (about $130 per gram), partly determine the types of people who are drawn to it.


What are the adverse health effects of cocaine?


Prolonged use of cocaine causes long-term changes in the brain, affecting the release of neurotransmitters, such as glutamate and dopamine, which are involved in the reward system, stress management, brain metabolism and brain structure.

Cocaine’s rapid and powerful effect—namely, the rapid release of dopamine in the brain, which triggers the reward system—reinforces the need for the drug at increasing doses and stimulates cravings. In other words, it leads to addiction.

The short-term effects include dilated pupils, constricted blood vessels, nausea, increased body temperature and blood pressure, rapid or irregular heart rate, tremors and convulsions, restlessness, paranoid thoughts, irritability and auditory hallucinations. Long-term sniffing of cocaine can cause the loss of the sense of smell, nosebleeds, runny nose, difficulty swallowing, and irreversible damage to the nasal septum. Smoking cocaine affects the respiratory system, triggering frequent coughing, asthma attacks, and respiratory infections.

Other common effects are malnutrition, which occurs because cocaine use reduces appetite, as well as movement disorders, such as Parkinson’s disease, which can occur in the long run, many years after an individual has stopped consuming massive amounts of the drug.

Cocaine also affects cardiac function and can lead to life-threatening conditions, such as heart attacks, arrhythmias, and heart failure. In addition, cocaine consumption can induce stroke, neurological disorders, and respiratory arrest.


How can we treat cocaine addiction?


Addiction to cocaine, like to other drugs, is complex and characterized by a variety of social, familial and environmental factors, in addition to the medical issues. As a result, the current approach to treating cocaine addiction addresses all these factors.

Unlike other substance addictions, there are currently no medications to treat cocaine addiction that are approved by the US Food and Drug Administration (FDA). Nonetheless, there are quite a few studies that are currently evaluating the treatment feasibility of certain medications, including those that have already been approved for treating other types of addictions. Moreover, certain psychotherapeutic methods, which can help identify situations that tend to trigger recurrence of cocaine use, have been shown to be effective in preventing relapse. Some practitioners recommend that patients enter residential therapeutic communities, which offer vocational rehabilitation and emotional and social support, or participate in some type of support group therapy.

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