Cocaine

What have you heard about cocaine? Cocaine is an active drug that is very addictive when taken. It heightens your alertness, energy, and attention span. Yes - it is illegal to handle this kind of addictive drug in the United States. There are a bunch of names given to cocaine. It can be called just a stimulant, or "coke,” “crack,” “Snow,” “rock,” or “blow.”

Ok, here is an origin story of cocaine. This crack is made from coca plant leaves (Erythroxylum coca). The coca plants are kind of hard to come by as it is only grown in the northern and western regions of South America. Its natives are known to consume and chew the leaves over centuries ago as it helps them lessen their appetites and stay alert in their environment. 

Cocaine comes in two different packages/forms. Some come as a rock crystal, while the most common is in the form of a fine, white powder.

Now, if you have a way to interact with this drug’s users, you would know that it is consumed in two primary chemical forms. One is the water-insoluble cocaine base form (or freebase). This form might not be that popular, but it involves processing the cocaine with sodium bicarbonate, aka baking soda, or processing it with ammonia and then adding water. This mixture is then heated to dispel the HCL (hydrochloride) to produce a smokable substance. The second form is quite the popular kid in the block. In its powdered form, users can simply inject it into their system or, you know, snort it in, that simple.

In this present generation, cocaine seems to have topped the addiction chart, becoming the most abused, next to alcohol. Because of its high demand, cocaine dealing has now been susceptible to fraud and corruption. Most dealers often dilute or “cut” it with non-psychoactive substances like flour, cornstarch, talcum powder, or baking soda to increase the quantity of the cocaine, thereby increasing their profits. The cocaine could also be mixed with a chemically related anesthetic, procaine, or another psychoactive crack, amphetamine.

Cocaine, though illegal, can be administered by a medical practitioner for legal medical uses as it can act as a local anesthesia for some throat, eye, and ear surgeries. As previously said, cocaine can be administered/consumed in many different ways. Is it by inhalation, orally, intravenously, or intranasally? All of which have different reaction times on the body. If inhaled through the nose, it is then sponged up through the nasal tissues. For oral intake, the cocaine user rubs the cocaine onto their gums directly. When taken intravenously, the cocaine is dissolved in water and injected into the bloodstream. This method of use heightens the intensity of its effects. Inhalation means that the cocaine is smoked, and the vapor is inhaled into the lungs, where it goes into the bloodstream almost as quickly as the injection method.

In 2020, about 5.5 million Americans were said to have reported past-year cocaine use. Just a little brief before we move deeper; study by the National Institute on Drugs Abuse, NIDA revealed that adults between the ages of 18 years to 25 years are open and susceptible to cocaine abuse and addiction.

For at least 15 years, past-year cocaine substance addiction went through a fall from about 1.5% - 2.5% worldwide. It has been hanging around the 2% margin. Cocaine usage is based on a lot of factors like age, sex, ethnicity, educational level, and employment status, among other factors. In the United States alone, the intake of crack has seen a huge rise since 2013. This can be partly because of its availability in big cities and how easy it is to access by people in the country.

A study conducted by the Centers for Disease Control and Prevention, CDC, stated that there were about 1.9% of individuals between the ages 12 to 17 years (teenagers) into cocaine misuse/addiction. The list of addictions goes on and on; however, it still baffles many as the cost of cocaine is quite high for these younger generations.

If you can conduct a little interview around you, you would find out that most adults who are cocaine addicts typically started the act when they were young adults aged 26 and older.

What do you think is the reason for the high addiction rate in people of such age is two words – supply and demand. What do we mean by that? Well, since the year 2013, Colombia, which happens to be the world’s largest supplier of cocaine, doubled its supply, giving easier access for these set of ages and beyond to lay their hands on the substance. 

In 2016 and 2017, young adults of age between 18 and 25 were the heaviest coke users. Also in the year 2022, about 2.6% men and 1.3% women were cocaine users.

There was about 3.6% cocaine intake as at 2018, in teens aged 16-17 years. Apart from the availability and easy access, one major influence in this behavior in teens is peer pressure and the feeling of “being among.” Also, life stresses may also be an influence, but in rare cases among younger teens.

Here are other cocaine stats under the teen category that we should take note of：

Cocaine intake tends to reduce as an adult gets older. By older, we mean more than 34 years of age. However, the NSDUH noticed that there has been a shaking incidence of cocaine use by this set of adults in the United States. According to a recent study, men said to be in their thirties, forties, and above were questioned about their cocaine consumption in the past month from when the surveys were done. About 4,300 older adults said they have been on the cocaine level on an average day in the past month during the years the experiment was conducted. Other interesting cocaine use statistics in seniors include: 

Do you remember the forms cocaine can be administered into the body? Let us remind you; smoking, snorting, injecting, and the last one, orally. No matter the manner it was consumed, all users would experience the same short-term effects. These short-term effects include, but are not limited to, heightened mental alertness, euphoria, increased energy, talkativeness, and increased sensitivity to sound, light, or touch.

Ok. There are also severe physical complications that cocaine addicts pass through due to their excess intake. We are looking at risk of cardiac complications, stroke, seizures, gastrointestinal complications, and coma. People’s body-fighting mechanism and health history also contributes to their cocaine diet problem. 

Let’s dive into more details about each of the ways of using cocaine：

Snorting cocaine is an intranasal use of the substance, and it has made a name for itself as it is quite popular amongst cocaine users. You cannot snort a crystal, or liquid cocaine, meaning it has to be in the powdered form, so that it can quickly absorb into the bloodstream from the nasal tissue. 

When a cocaine user takes in the substance and it is being “active” in the body, the euphoric effects of the crack may last from about 15 to 30 minutes. These effects are apparently slower and less extreme compared to the other methods we will be looking at shortly, like the smoking, and injecting.

Snorting cocaine is associated with several negative long-term health effects, including: 

Now we are at smoking. We would love to call this a Smoking-Inhaling cocaine system. Unlike the snorting part, to smoke a cocaine, it has to be in its crystallized form, aka crack cocaine (also known as “freebase cocaine”). The user applies heat to the crack to produce those harmful vapours that are then inhaled into the body. This process is much faster than that of snorting, as it takes seconds for the drug to reach the brain. The cocaine levels can reach the highest point in the body with this method within 1-5 minutes after inhalation. The highness, however, doesn’t last long as it is brief, lasting to about 5 to 10 minutes after intake. 

Let’s take a look at some of the side effects of smoking cocaine：

In other words, putting cocaine directly into your bloodstream. Has this ever made you think how innovative and a bit psycho many could get in order to have a different feel with their addictive substance, cocaine or not? The cocaine is first of all in its powdered form; then, it is being mixed with water to completely dissolve and create a solution. This solution is then administered intravenously. Like smoking, cocaine reaches the brain very fast when injected, and peak body levels reach about 1–5 minutes after injection.

There are many health troubles that come with injecting cocaine; they include:

Not many users practice this kind of method compared to the others. How it works it, the user can orally ingest the cocaine, either by rubbing the powdered cocaine on the gums, or swallowing it directly, or placing it right under the tongue. Cocaine levels in the body are at their peak, around 1–1.5 hours after oral ingestion.

The health effects (negative) of ingesting cocaine are:

Cocaine affects the part of the brain called the limbic system, which is known to regulate pleasure and motivation. Cocaine intake ends up creating a short-term increase of dopamine, or what we would love to call, the ‘happy hormone’, which gives the user, a short-term feeling of euphoria.

Dopamine works as a pacemaker for several nerve cells throughout the brain. Dopamine is crucial for maintaining those cells active at the proper levels throughout our lives in order to meet our requirements and goals. When we need to mobilize our muscles or mind to perform harder or quicker, dopamine stimulates some of the implicated brain cells to rise to the occasion.

Dopamine is produced by a group of brain cells known as dopaminergic (dopamine-making) cells, which then release the molecules into their environment. Some free-floating dopamine molecules bind to receptor proteins on surrounding (receiving) cells. Once linked, dopamine activates receptors to change electrical impulses in recipient cells, altering their function.

The more dopamine molecules come into touch with receptors, the more the receiving cells' electrical characteristics change. To maintain the receiving cells in each brain area operating at optimal intensities for present demands—neither too high nor too low—dopaminergic cells constantly increase and decrease the quantity of dopamine molecules they release. They control the quantity of dopamine accessible to excite receptors by reabsorbing some previously released dopamine molecules.

Cocaine disrupts this latter regulatory mechanism by binding the dopamine transporter, a protein that dopaminergic cells utilize to collect dopamine molecules from their environment. As a result, with cocaine on board, dopamine molecules that would normally be taken up stay active. Dopamine accumulates and over activates the receiving cells.

Although cocaine inhibits transporters for other neurotransmitter chemicals (norepinephrine and serotonin), its effects on the dopamine pathway are widely regarded as the most important. To appreciate the potency of cocaine's effects, consider that dopamine pathways in the brain are quite old in evolutionary terms. Worms and flies include early rudiments, dating back two billion years in history. Thus, cocaine affects a neuronal circuit in the brain that is critical for survival. Such changes have substantial effects on the individual, which scientists are still striving to comprehend. 

Cocaine produces extremely intense emotions of pleasure by artificially increasing dopamine levels in the NAc. The quantity of dopamine that connects to receptors in the NAc after a cocaine intake can exceed that associated with natural behaviors, resulting in more pleasure than that produced by thirst-quenching or sexual activity. In fact, if given the option, some laboratory animals would refuse food and continue to consume cocaine until they starve.

The limbic system also comprises critical memory areas known as the amygdala and hippocampus. These memory regions assist us in recalling the actions we took that resulted in the pleasures linked with dopamine production in the NAc, such as where we located water and how we attracted a partner. When someone gets cocaine high, these areas store memories of the tremendous pleasure as well as the people, places, and things linked with the substance. Returning to a site where one has used cocaine, or even seeing photos of cocaine-related items, elicits emotionally charged memories and a desire to relive the experience. Scientists believe that repeated cocaine exposure, along with the associated dopamine jolts, changes these cells in ways that eventually turn conscious memory and desire into a near-compulsion to respond to stimuli by seeking and consuming the drug. 

This illicit drug, cocaine is known to attack the brain cells. While some of the effects of cocaine consumption might be short-lived, a constant repetitive pattern of cocaine intake might last for months, even years, and in worse cases, might be irreversible throughout a person’s lifetime. 

We also gathered that these changes and constant use of the illicit drug can lead to addiction, causing a long-term impact on users.

Like other drugs of abuse, cocaine use changes the brain in ways that last for a long time. Studies on animals have shown that cocaine can significantly change the way neurons that release the neurotransmitter glutamate work. When animals are exposed to cocaine over a long period, there are big changes in the reward system, especially in the nucleus accumbens, in terms of how much glutamate is released and the amount of receptor proteins. The glutamate system could be a good place to start when making drugs to treat addiction. The goal would be to reverse the changes in the brain that cocaine makes that make people want to use the drug.

Researchers who study addiction have mostly looked at changes in the brain's reward system. However, drugs also have an effect on the parts of the brain that deal with stress. Stress can make people return to cocaine, and disorders related to cocaine use often happen together with illnesses related to stress. The brain's stress circuits and reward pathways are different, but study shows that they overlap in some ways. The ventral tegmental area of the brain seems to be a key interaction site that sends information about stress and drug cues to other parts of the brain, including areas that make people want cocaine. Animals that have been given cocaine more than once are more likely to look for it when they are stressed, and the more of the drug they have taken, the more stress makes them do this. Research shows that cocaine raises stress hormones, influencing neuroadaptations that change the brain in ways that make it even more sensitive to the drug and cues that are linked to it.

Many other parts of the brain are also affected by long-term cocaine use. For example, studies on animals show that cocaine lowers the activity in the orbitofrontal cortex (OFC). This may explain why people who are hooked on cocaine make bad decisions, not being able to deal with the bad effects of their drug use, and don't really understand what they are doing. Researchers using optogenetic technology, which uses light to turn on certain genetically edited neurons, found that stimulating the OFC helps animals adapt and learn again. This interesting finding suggests that increasing OFC exercise might be a good way to help cocaine addicts understand and be more aware of the effects of their drug use.

Cocaine has a short-term effect if an individual uses it for the first time. These effects are, in most instances, desirable to the individual, which gradually develops into an addiction. The short-term effects act in line with dopamine, producing more dopamine and making people lust for the drug. Some of these short-term effects include a noticeable spike in energy, increased alertness, feelings of euphoria, talkativeness, and reduced need to sleep or eat.

Cocaine can also cause short-term mental and physiological changes in its users. Some include dizziness, anxiety, abdominal pain, tremors, restlessness, increased blood temperature, heart rate, body temperature, and irritability. Others include：

There are other negative short-term effects of taking cocaine for the very first time. Its intake can lead to notable and potentially fatal medical complications. These can include:

The way cocaine is taken in can have a big impact on its short-term effects. How quickly you feel the effects, how long they last, and your chance of becoming an addict can change if you smoke, sniff, or inject cocaine into the bloodstream. According to research, injecting cocaine has the strongest effects, followed by smoking and then snorting. This is because the effects happen faster when the drug is taken into the body. But a stronger high also comes with a higher risk of becoming addicted. 

Polysubstance use, which is when someone uses cocaine along with other drugs, can also change the short-term effects of cocaine. Taking cocaine with other stimulants can make the effects of both drugs much stronger, which can greatly raise your risk of overdose, heart damage, or even death. It is very dangerous to mix this stimulant and alcohol because they react to make a substance that makes you more likely to have a stroke or heart attack. Also, taking cocaine with depressants can hide the effects of one or both of them, making you think they aren't doing anything. This can lead to an overdose or liver damage.

When cocaine is used for a long time, it can have many negative effects on your mental and physical health. People who use cocaine on a regular basis can become dependent on it. If someone becomes physically dependent on a drug, their body gets used to having the drug in it so much that they experience withdrawal effects when they cut back on their use or stop using altogether. People who are physically dependent on drugs or alcohol may continue to drink or use them even when they don't want to in order to avoid the unpleasant withdrawal effects. When an individual decides to put a stop to its use, or when the intake is greatly reduced, withdrawal effects include：

When tolerance is low after a time of abstinence, the risk of overdosing is high. Long-term cocaine use can cause brain problems, such as the development of Parkinson's disease and problems with cognitive skills like memory loss, trouble making decisions, lack of focus, trouble controlling impulses, and trouble moving your body. 

Also, using cocaine can raise your risk of having a stroke, seizure, brain tumour, or brain bleeds. As time goes on, long-term cocaine use can also cause anxiety, hallucinations, sadness, or psychosis. Heart disease, stomach problems, losing a lot of weight, and tooth problems are some other health problems that can happen.

Being high on or addicted to cocaine can make it hard to make the right decisions. Not only that, it can lead to you and make people do risky sexual things, like trading sex for drugs or sharing needles. This makes it more likely for someone who uses cocaine to get diseases like HIV and hepatitis C (HCV). Sadly, there are no medicines that can protect against getting HIV or HCV.

Studies that look at how HIV infections start and spread have shown that cocaine intake speeds up the infection process. According to research, cocaine lowers the function of immune cells, helps the HIV virus replicate, and makes the harmful effects of HIV stronger on different kinds of cells in the brain and spinal cord, which leads to even more damage. Studies also show that using cocaine speeds up the growth of NeuroAIDS, a brain condition linked to HIV infection. NeuroAIDS causes cocaine users to have memory loss, issues with movement, and also vision impairment.

People who take cocaine and have the virus infection often have more advanced stages of the disease, with higher viral loads and faster drops in CD4+ cell counts. People who already have HIV are more likely to also have HCV, a virus that affects the liver. Serious illnesses, like immune system problems and neurological diseases, can be caused by co-infection. Liver problems happen a lot, and a lot of people who are sick with both cancer and chronic liver disease die. Even though there is a strong connection between injecting drugs and HIV/HCV, more research is needed to fully understand the molecular processes that cause this higher chance of co-infection in people who do not take drugs.

Using drugs, having HIV, and having hepatitis may all make the diseases spread faster. For instance, HIV speeds up the development of hepatitis-associated liver disease, which makes HCV infection more likely to happen. Researchers have found that people who have both HIV and HCV are more likely to die than people who only have one of the infections. Using drugs and having HIV at the same time probably make the HIV disease worse and make it harder for the body to mount an immune reaction.

When closely watched, patients with both HIV and HCV can benefit from drug abuse treatment and antiretroviral therapies. Antiretroviral therapy doesn't work for everyone, and it can have serious side effects that need to be closely watched by a doctor. Anyone who has ever injected cocaine drugs should get tested for HIV and HCV because the diseases are easily spread through injection.

Maternal cocaine use simply means a woman who is with a fetus consumes cocaine, even without thinking about the possible side effects it can have on the child. When such a woman who is pregnant with a child consumes the substance, she and the unborn child are at risk of contracting the side effects that come with the drug usage. Cocaine is so powerful that it can enter into the placental barrier, and the fetus would be exposed to the harmful effects of cocaine intake. The concerning risks linked with cocaine use during pregnancy are as many as one could count, but some include

Pregnancy and cocaine intake are bad combo, for you and your child. If you are an expectant mother and you are also addicted to cocaine, we advise that you seek help and assistance as early as possible. 

After talking about the risks involved with cocaine usage during pregnancy, there are additional risks that come once the baby has been delivered and the mother decides to breastfeed while also consuming cocaine.

However, also know that breastfeeding comes with a lot of advantages, both on the baby and the mother. Let’s take a look at some of the infant-related benefits：

Not only does the infant enjoy benefits while feeding from the mother’s milk, the mother herself may experience benefits like a reduction in ovarian and breast cancers, diabetes, and cardiovascular disease.

Having talked about all that, we can now talk about what happens when a mother who is constantly on “cocaine menace” breastfeeds her youngling. While reports of cocaine being found inside breast milk are one in a dozen, the chemical properties of the illicit drug show that it is possible for it to pass into breast milk in significant amounts. With that significant amount, it can be absorbed by the young infant and broken down in the gut. With the little number of research work on this, it is still possible that its ingestion via breast milk would lead to these adverse effects below

Babies are more likely to get hurt because their bodies can't process and get rid of drugs as good as adults can. Because of this, even small amounts of cocaine can stay in the infant's body for a long time and do a lot of damage.

High levels of cocaine have been found in human milk, which can make babies sleepy, which has its own short- and long-term effects. Also, if cocaine is smoked, the smoke can be bad for babies, with this said, breastfeeding mothers or anyone else shouldn't smoke cocaine near babies.

Because breastfeeding is so important, moms who are nursing and also use cocaine need to work with their healthcare and treatment providers to make sure the baby gets the benefits of breastfeeding while also staying away from cocaine. There shouldn't really be a problem with breastfeeding for those mothers who were addicted to cocaine in the past, but no longer. However, experts say that mothers who have a drug use problem and who continue to use cocaine on and off shouldn't breastfeed for about 24 hours after the cocaine intake. Women who have problems with drugs and want to breastfeed should ideally be in treatment both during and after pregnancy.

The first step in treating cocaine addiction is to stop using the drug. It usually takes about a week to get cleaned from cocaine. It can be very hard to break the cycle of long-term drug use. If someone is addicted to cocaine, they will have strong cravings for it for the first few days without it. This would be a tough choice for them, but if they wish to let go, they have to give it their determination as it would be the moment the "cravings" would be heightened.

You might find the strength to fight the urge to give in to the drug again by joining a medically supported detox programme at an inpatient treatment centre. Treatment centers can help people get the assistance they need to stay off the drug.

Behavioural treatments, especially cognitive-behavioral therapy, have been shown to help people who use cocaine cut down and stay clean. To get the best results, treatment must be tailored to each patient's needs. This usually means a mix of treatment, social support, and other services.

As of now, there are no FDA-approved drugs that can treat cocaine addiction. One of NIDA's top study goals is still to find a drug that can treat cocaine addiction and other types of addiction.

As part of their research, scientists are trying to make drugs that can help people who are addicted to cocaine control their strong cravings and drugs that can stop people from relapsing, like stress. Several substances are being tested to see if they are safe and effective. One of these is a vaccine that would keep cocaine in the bloodstream and stop it from getting to the brain. The latest study shows that while medications can help treat addiction, the best way to cut down on drug use in the long run is to combine them with a full behavioural treatment programme.

Genetics and neuroimaging or brain imaging, two very new areas of science, are helping us learn a lot more about cocaine abuse.

Researchers think that genes play a role in 42 to 79 percent of the risk that comes with the intake of cocaine and being dependent on it. As you might expect, a complex disease as addiction involves a lot of different genes, and the surroundings can change how these genes are expressed. There seems to be a lot of overlap in the genes that make people more likely to become addicted to this illicit drug. This could mean that there is a similar biological route for addiction that works for all drugs.

As external factors often change how genes affect the risk of getting a disease, researchers need to find out how certain gene-by-environment interactions affect the development of addiction. In the area of epigenetics, scientists are finding out how the environment can change gene expression over time without changing the specific genetic code.

Animal studies are being used to find out how long-term cocaine exposure changes the way genes are expressed in the brain, especially in the reward system. Studies have tied certain epigenetic changes caused by cocaine to changes in the brain and behaviors that are typical of addiction, like being more sensitive to the positive effects of cocaine. Even if the drug exposure doesn't happen before birth, the epigenetic changes that cocaine causes can be passed on to the next generation. While a lot more genetic and epigenetic study is needed, understanding addiction at the molecular level holds a lot of potential for making diagnoses better. For example, by finding biomarkers for disease severity or treatment response, this could lead to more accurate diagnoses.

Brain imaging could be used to find signs of drug addiction, but more study is needed. These technologies have helped us understand what makes us want drugs and how drugs may stop our brains from responding to cocaine. Researchers use a new brain imaging method called resting-state functional magnetic resonance imaging (rs-fMRI) to look at brain activity when a person is awake and not doing a specific task. They use this method to compare the functional brain networks of people who have used cocaine for a long time and people who have not used cocaine. According to these studies, people who are addicted to cocaine have less communication between different brain regions and between the two hemispheres. Researchers have also found a link between less connection between some brain regions and important addiction-related behaviors, such as impulsivity and the chance of return.

Neuroimaging techniques are also showing how cocaine users' brains may heal after stopping using the drug for a while. For instance, these methods show that years of cocaine use are linked to less grey matter in certain parts of the brain. But people who didn't use cocaine for about 9 months had brain matter amounts that were the same as or higher than those of people who had never used the drug. More research showed that the extra grey matter was found in areas other than those that were changed by cocaine use. This suggests that the changes in the brain that happen during recovery are more complex than just undoing the changes that happened during addiction. The researchers also discovered that longer periods of abstinence were linked to more grey matter in parts of the brain that affect behavior.

Researchers using fMRI have also found that giving up cocaine has important healing benefits on the brain. People who were currently using cocaine had less activity in a part of the brain that controls response inhibition during a motor control task. However, people who had been sober for an average of 8 months showed the same patterns of activation and levels of performance as people who had never used cocaine. The results show that quitting smoking or drinking helps this part of the brain work better again.
The human connectome is the brain's network of linked pathways. Researchers are working together on a number of large-scale projects to map it. For instance, the National Institutes of Health backs the Human Connectome Project, which makes maps of the brain as it grows, as an adult, and as it ages. By making a picture of the normal brain, scientists will learn more about how the brain works differently in people with behavioral disorders. This will help them make better diagnoses and treatments.

There is short- and long-term health problems linked to cocaine use, including its overdose. It is important to get help to stop or lessen these problems before they become life-threatening. Behavior therapies are one type of addiction treatment. They can be given in outpatient addiction treatment, inpatient addiction treatment, and long-term residential rehab centers. People who want to stop using cocaine may also find that peer support groups like Cocaine Anonymous are helpful.

For additional information on cocaine, please refer to the following sources on NIDA’s Web site, www.drugabuse.gov or contact DrugPubs at 877-NIDA-NIH (877-643-2644; TTY/TDD: 240-645-0228).

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