COCAINE and Crack
Cocaine is a powerfully addictive drug. Once having tried cocaine a user may have difficulty controlling the extent to which he or she will continue to use the drug. Cocaine produces intense euphoria and alertness, makes users feel more energetic and reduces hunger. Cocaine’s effects appear almost immediately after a single dose and lasts about 30 minutes, but some may experience lingering effects for over an hour.
Small amounts of cocaine usually make the user feel euphoric, energetic, talkative, mentally alert, and hypersensitive to sight, sound, and touch. The drug can also temporarily decrease the need for food and sleep. Some users find that cocaine helps them perform simple physical and intellectual tasks more quickly, although others experience the opposite effect.
Users primarily administer cocaine orally, intranasally, intravenously, or by inhalation. When people snort the drug (intranasal use), they inhale cocaine powder through the nostrils, where it is absorbed into the bloodstream through the nasal tissues. Users also may rub the drug onto their gums (oral use). Dissolving cocaine in water and injecting it (intravenous use) releases the drug directly into the bloodstream and heightens the intensity of its effects. When people smoke cocaine (inhalation- crack is the smokable form), they inhale its vapor or smoke into the lungs, where absorption into the bloodstream is almost as rapid as by injection. This fast-euphoric effect is one of the reasons that crack became enormously popular in the mid-1980s.” (NIDA.NIH.gov, accessed 7/29/23) The faster the drug is absorbed, the more intense the resulting high, and the shorter its duration. Snorting cocaine produces a relatively slow onset of the high, but it may last from 15 to 30 minutes. In contrast, the high from smoking is more immediate but may last only 3 to 5 minutes.
Immediate physiologic effects of cocaine use include constricted blood vessels, dilated pupils, and increased body temperature, heart rate, and blood pressure. Large amounts of cocaine lead to bizarre, erratic, and violent behavior along with tremors, vertigo, and muscle twitches.
Psychological effects include feelings of well-being and a grandiose sense of power and ability. As the drug wears off these temporary sensations of mastery are replaced by intense depression. Short-term effects of cocaine abuse are runny nose/nose bleeds due to damaged nasal cavity, dilated pupils, being excited and talkative and having increased alertness and self-esteem, difficulty in concentrating and visual impairment. Users may also exhibit compulsive behaviors (repeated hand washing, teeth grinding), be restless, agitated, combative and exhibit aggressive behavior. Paranoid hallucinations are common.
The long-term effects of cocaine include irritability, mood disturbances, restlessness, paranoia, and auditory hallucinations. Tolerance to cocaine occurs and addicts report that they do not experience as much pleasure with repeated doses as they did from their first dose. Users can become “sensitized” to the drug and may develop seizures after taking their usual dose of cocaine. “Sensitization” may explain why some deaths occur after apparently low doses of cocaine.
Different routes of cocaine administration can produce different medical-adverse effects. Regularly snorting cocaine can lead to loss of sense of smell, nosebleeds, problems with swallowing, hoarseness, and irritation or perforation of the nasal septum. Ingested cocaine can cause severe bowel gangrene due to constricted blood flow to the intestine. Persons who inject cocaine have puncture marks and “tracks” most commonly in their forearms and are at high risk of infection. Among cocaine users the risk of heart attack is increased by a factor of 24 during the first 60 minutes after consuming cocaine, unrelated to the amount ingested. Up to 25% of patients seen in Emergency Rooms for evaluation of chest pain have detectable amounts of cocaine in the urine.
There is a potentially dangerous interaction between cocaine and alcohol. Taken in combination the two drugs may produce cocaethylene which produces euphoria and has a longer duration of action than cocaine. Studies suggest that consuming alcohol and cocaine may be more cardiotoxic than cocaine alone, and “it carries an 18 to 25 fold increase over cocaine alone in risk of immediate death.” (Andrews P (1997). “Cocaethylene toxicity”. Journal of Addictive Diseases. 16 (3): 75–84 https://doi.org/10.1300%2FJ069v16n03_08), Cocaethylene is also considered to be a recreational drug producing a sense of increased and prolonged euphoria. However, cocaethylene has a longer duration of action and is more toxic than either drug alone and in some people may cause severe heart and liver problems.
Crack Cocaine
Crack cocaine is a hard-crystalline substance and is a smokable form of cocaine. Crack produces a very intense high that lasts 2-3 minutes but is limited to 10-15 minutes. Crack is extremely addictive. The user chases this intense high over and over again with more crack but never achieves the same intense feelings. Addicts will do whatever they have to do to obtain the drug or money for the drug, from prostitution, to crimes, to working for dealers. Addicts may be awake for days in a row binging on the drug.
Symptoms of crack addiction include frequent infections, changes in sleep patterns and in attitude or mood, burns or blisters on the fingers or lips, avoiding family or friends, loss of interest in sex, irritability, and anger and irrational behaviors.
Short-term physical effects of using cocaine include increased blood pressure and heart rate, constricted peripheral blood vessels, increased rate of breathing, dilated pupils, hyper-stimulation and intense euphoria, anxiety, paranoia and decreased appetite. Sudden cardiac death may occur – even after one dose.
Long-term effects include severe depression, Irritability and mood disturbances, aggressive and paranoid behavior, delirium or psychosis, tolerance and addiction (even after just one use), auditory and tactile hallucinations, heart attack, seizures and stroke.