DESCRIPTION/OVERVIEW
Cocaine is a powerfully addictive stimulant that
directly affects the brain. Cocaine is not a new drug.
In fact, it is one of the oldest known drugs. The pure
chemical, cocaine hydrochloride, has been an
abused substance for more than 100 years, and
coca leaves, the source of cocaine, have been
ingested for thousands of years.(1)
Pure cocaine was first extracted from the leaf of the
Erythroxylon coca bush, which grows primarily in
Peru and Bolivia, in the mid-19th century. In the early
1900s, it became the main stimulant drug used in
most of the tonics/elixirs that were developed to treat
a wide variety of illnesses.(2)
Cocaine abuse has a long history and is rooted into
the drug culture in the U.S. It is an intense euphoric
drug with strong addictive potential. With the
increase in purity, the advent of the free-base form
of the cocaine ("crack"), and its easy availability on
the street, cocaine continues to burden both the law
enforcement and health care systems in America.(3)
The powdered, hydrochloride salt form of cocaine
can be snorted or dissolved in water and injected.
Crack is cocaine that has not been neutralized by an
acid to make the hydrochloride salt. This form of
cocaine comes in a rock crystal that can be heated
and its vapors smoked. The term “crack” refers to
the crackling sound heard when it is heated.(4)
STREET NAMES
Blow, nose candy, snowball, tornado, wicky stick
SHORT-TERM EFFECTS
Cocaine’s effects appear almost immediately after a
single dose, and disappear within a few minutes or
hours. Taken in small amounts (up to 100 mg),
cocaine usually makes the user feel euphoric,
energetic, talkative, and mentally alert, especially to
the sensations of sight, sound, and touch. It can also
temporarily decrease the need for food and sleep.
Some users find that the drug helps them perform
simple physical and intellectual tasks more quickly,
while others experience the opposite effect.(6)
The duration of cocaine’s immediate euphoric effects
depends upon the route of administration. The faster
the absorption, the more intense the high. Also, the
faster the absorption, the shorter the duration of
action. The high from snorting is relatively slow in
onset, and may last 15 to 30 minutes, while that from
smoking may last 5 to 10 minutes.(7)
The short-term physiological effects of cocaine
include constricted blood vessels; dilated pupils; and
increased temperature, heart rate, and blood
pressure. Large amounts (several hundred
milligrams or more) intensify the user’s high, but may
also lead to bizarre, erratic, and violent behavior.
These users may experience tremors, vertigo,
muscle twitches, paranoia, or, with repeated doses, a
toxic reaction closely resembling amphetamine
poisoning. Some users of cocaine report feelings of
restlessness, irritability, and anxiety. In rare
instances, sudden death can occur on the first use of
cocaine or unexpectedly thereafter. Cocaine-related
deaths are often a result of cardiac arrest or seizures
followed by respiratory arrest.(8)
LONG-TERM EFFECTS
Cocaine is a powerfully addictive drug. Thus, an
individual may have difficulty predicting or controlling
the extent to which he or she will continue to want or
use the drug. Cocaine’s stimulant and addictive
effects are thought to be primarily a result of its
ability to inhibit the reabsorption of dopamine by
nerve cells. Dopamine is released as part of the
brain’s reward system, and is either directly or
indirectly involved in the addictive properties of every
major drug of abuse.(9)
An appreciable tolerance to cocaine’s high may
develop, with many addicts reporting that they seek
but fail to achieve as much pleasure as they did from
their first experience. Some users will frequently
increase their doses to intensify and prolong the
euphoric effects. While tolerance to the high can
occur, users can also become more sensitive
(sensitization) to cocaine’s anesthetic and convulsant
effects, without increasing the dose taken. This
increased sensitivity may explain some deaths
occurring after apparently low doses of cocaine.(10)
Use of cocaine in a binge, during which the drug is
taken repeatedly and at increasingly high doses,
leads to a state of increasing irritability, restlessness,
and paranoia. This may result in a full-blown
paranoid psychosis, in which the individual loses
touch with reality and experiences auditory
hallucinations.(11)
USE/USER POPULATION
2005 rates of cocaine use were relatively high, and
overall, use appears to be stable. According to the
National Survey on Drug Use and Health (NSDUH),
the rate of past year use for cocaine (powder and
crack combined) among individuals aged 12 and
older (2.4%) has remained stable since 2002; it is
much lower than that for marijuana (10.6%), but is
higher than that for methamphetamine (0.6%) or
heroin (0.2%). Among adults, NSDUH data show that
rates of past year use for cocaine (powder and crack
combined) among young adults (aged 18 to 25) are
stable but remain the highest among all age groups
(see National Drug Threat Assessment, Appendix B,
Table 1). Monitoring the Future (MTF) and NSDUH
also indicate stable rates of adolescent cocaine use
(see National Drug Threat Assessment, Appendix B,
Table 2). The number of treatment admissions to
publicly funded treatment facilities for cocaine has
decreased since the mid-1990s despite increased
access to drug treatment. Cocaine is the only major
drug of abuse for which treatment admissions have
decreased (see National Drug Threat Assessment,
Appendix C, Chart 1).(16)
Among students surveyed as part of the 2005
Monitoring the Future study, 3.7% of eighth graders,
5.2% of tenth graders, and 8.0% of twelfth graders
reported lifetime(17) use of cocaine. In 2004, these
percentages were 3.4%, 5.4%, and 8.1%,
respectively.(18)
According to the National Survey on Drug Use and
Health (NSDUH, 2004), 34.15 million Americans ages
12 and older (14.7% of this age group) had used
cocaine once in their lifetime and 2.0 million were
current users of cocaine in 2004. The new initiates of
cocaine abuse were about 1 million in 2004.
According to the Monitoring the Future Study (MTF,
2005), the percentages of eighth, tenth and twelfth
graders reported using cocaine once in their life time
were 3.7, 5.2 and 8.0, respectively, while the
corresponding numbers for the current cocaine
users (used in the past month) were 1.0, 1.5 and 2.3,
respectively. Cocaine abuse occurs in both genders
and among all ethnic groups of the U.S.(19)
Daven Salmi, LCDC
Cocaine is a powerfully addictive stimulant that
directly affects the brain. Cocaine is not a new drug.
In fact, it is one of the oldest known drugs. The pure
chemical, cocaine hydrochloride, has been an
abused substance for more than 100 years, and
coca leaves, the source of cocaine, have been
ingested for thousands of years.(1)
Pure cocaine was first extracted from the leaf of the
Erythroxylon coca bush, which grows primarily in
Peru and Bolivia, in the mid-19th century. In the early
1900s, it became the main stimulant drug used in
most of the tonics/elixirs that were developed to treat
a wide variety of illnesses.(2)
Cocaine abuse has a long history and is rooted into
the drug culture in the U.S. It is an intense euphoric
drug with strong addictive potential. With the
increase in purity, the advent of the free-base form
of the cocaine ("crack"), and its easy availability on
the street, cocaine continues to burden both the law
enforcement and health care systems in America.(3)
The powdered, hydrochloride salt form of cocaine
can be snorted or dissolved in water and injected.
Crack is cocaine that has not been neutralized by an
acid to make the hydrochloride salt. This form of
cocaine comes in a rock crystal that can be heated
and its vapors smoked. The term “crack” refers to
the crackling sound heard when it is heated.(4)
STREET NAMES
Blow, nose candy, snowball, tornado, wicky stick
SHORT-TERM EFFECTS
Cocaine’s effects appear almost immediately after a
single dose, and disappear within a few minutes or
hours. Taken in small amounts (up to 100 mg),
cocaine usually makes the user feel euphoric,
energetic, talkative, and mentally alert, especially to
the sensations of sight, sound, and touch. It can also
temporarily decrease the need for food and sleep.
Some users find that the drug helps them perform
simple physical and intellectual tasks more quickly,
while others experience the opposite effect.(6)
The duration of cocaine’s immediate euphoric effects
depends upon the route of administration. The faster
the absorption, the more intense the high. Also, the
faster the absorption, the shorter the duration of
action. The high from snorting is relatively slow in
onset, and may last 15 to 30 minutes, while that from
smoking may last 5 to 10 minutes.(7)
The short-term physiological effects of cocaine
include constricted blood vessels; dilated pupils; and
increased temperature, heart rate, and blood
pressure. Large amounts (several hundred
milligrams or more) intensify the user’s high, but may
also lead to bizarre, erratic, and violent behavior.
These users may experience tremors, vertigo,
muscle twitches, paranoia, or, with repeated doses, a
toxic reaction closely resembling amphetamine
poisoning. Some users of cocaine report feelings of
restlessness, irritability, and anxiety. In rare
instances, sudden death can occur on the first use of
cocaine or unexpectedly thereafter. Cocaine-related
deaths are often a result of cardiac arrest or seizures
followed by respiratory arrest.(8)
LONG-TERM EFFECTS
Cocaine is a powerfully addictive drug. Thus, an
individual may have difficulty predicting or controlling
the extent to which he or she will continue to want or
use the drug. Cocaine’s stimulant and addictive
effects are thought to be primarily a result of its
ability to inhibit the reabsorption of dopamine by
nerve cells. Dopamine is released as part of the
brain’s reward system, and is either directly or
indirectly involved in the addictive properties of every
major drug of abuse.(9)
An appreciable tolerance to cocaine’s high may
develop, with many addicts reporting that they seek
but fail to achieve as much pleasure as they did from
their first experience. Some users will frequently
increase their doses to intensify and prolong the
euphoric effects. While tolerance to the high can
occur, users can also become more sensitive
(sensitization) to cocaine’s anesthetic and convulsant
effects, without increasing the dose taken. This
increased sensitivity may explain some deaths
occurring after apparently low doses of cocaine.(10)
Use of cocaine in a binge, during which the drug is
taken repeatedly and at increasingly high doses,
leads to a state of increasing irritability, restlessness,
and paranoia. This may result in a full-blown
paranoid psychosis, in which the individual loses
touch with reality and experiences auditory
hallucinations.(11)
USE/USER POPULATION
2005 rates of cocaine use were relatively high, and
overall, use appears to be stable. According to the
National Survey on Drug Use and Health (NSDUH),
the rate of past year use for cocaine (powder and
crack combined) among individuals aged 12 and
older (2.4%) has remained stable since 2002; it is
much lower than that for marijuana (10.6%), but is
higher than that for methamphetamine (0.6%) or
heroin (0.2%). Among adults, NSDUH data show that
rates of past year use for cocaine (powder and crack
combined) among young adults (aged 18 to 25) are
stable but remain the highest among all age groups
(see National Drug Threat Assessment, Appendix B,
Table 1). Monitoring the Future (MTF) and NSDUH
also indicate stable rates of adolescent cocaine use
(see National Drug Threat Assessment, Appendix B,
Table 2). The number of treatment admissions to
publicly funded treatment facilities for cocaine has
decreased since the mid-1990s despite increased
access to drug treatment. Cocaine is the only major
drug of abuse for which treatment admissions have
decreased (see National Drug Threat Assessment,
Appendix C, Chart 1).(16)
Among students surveyed as part of the 2005
Monitoring the Future study, 3.7% of eighth graders,
5.2% of tenth graders, and 8.0% of twelfth graders
reported lifetime(17) use of cocaine. In 2004, these
percentages were 3.4%, 5.4%, and 8.1%,
respectively.(18)
According to the National Survey on Drug Use and
Health (NSDUH, 2004), 34.15 million Americans ages
12 and older (14.7% of this age group) had used
cocaine once in their lifetime and 2.0 million were
current users of cocaine in 2004. The new initiates of
cocaine abuse were about 1 million in 2004.
According to the Monitoring the Future Study (MTF,
2005), the percentages of eighth, tenth and twelfth
graders reported using cocaine once in their life time
were 3.7, 5.2 and 8.0, respectively, while the
corresponding numbers for the current cocaine
users (used in the past month) were 1.0, 1.5 and 2.3,
respectively. Cocaine abuse occurs in both genders
and among all ethnic groups of the U.S.(19)
Daven Salmi, LCDC
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