Cocaine

Cocaine is an addictive stimulant drug that’s made from the leaves of the coca plant which grows native to various areas in South America. In the medical field, cocaine is typically used as an anaesthetic, especially for numbing the mucous membranes of the mouth before a medical procedure.

For this reason, cocaine is considered a Schedule II drug, which means that it has a high potential for abuse, but also provides sound, viable uses when administered by a licensed medical professional. However, cocaine is also the second most commonly trafficked illegal drug in the world, with an estimated 1.9 million people aged 18 and over using the drug in the United States alone.

Cocaine comes from the coca plant which is found in various parts of South America, including the Argentine Northwest, Bolivia, Ecuador, Peru, and Colombia. For centuries, it has been a custom among locals to chew on the leaves for its pain relieving and stimulating effects.

It was in 1860 that the purified chemical cocaine hydrochloride was first isolated from the leaves of the coca plant. This was then added into a variety of tonics and elixirs under the belief that the extract was an effective remedy for conditions like impotence and depression.

Supported and used by various notable figures like Sigmund Freud, Thomas Edison, and Sarah Bendardt, cocaine quickly rose to popularity as an all-around magic potion that provided energizing, uplifting, and euphoric effects. Needless to say, the drug was widely used in Hollywood which subsequently influenced the consciousness of the masses. It was even incorporated into Coca-Cola, which is how the famous soda gets its name.

However, in 1905, medical professionals had started to see the negative effects of the drug, including hallucinations, dependence, and nasal damage. Seven years later, the United States recorded 5,000 deaths resulting from cocaine overdose. And in 1922, it was finally banned. Despite this, the drug’s popularity remained on an upward trajectory.

• 36 million Americans aged 12 and over admit to using cocaine at least once
• 2 million Americans admit to using the stimulant regularly in the years 2018
• Cocaine accounts for 6% of all rehab centre check-ins
• Abuse occurs most commonly in young adults aged 18-25 years
• In 2019, 2.2% of high school seniors used cocaine in the past year
• Effects of cocaine typically last a maximum of an hour, but average 15 to 30 minutes
• Cocaine-related overdose deaths have increased 34% between 2016 and 2017

Cocaine is a white, powder-like substance that numbs the tongue if tasted directly. There are two distinct forms of cocaine that are abused. These are the water-soluble hydrochloride salt and the water-insoluble cocaine base which is the derivative called ‘crack cocaine.’ The salt is used by either snorting or by injecting.

The base is processed by mixing it with baking soda or ammonia and water, and then subjecting the mixture to heat to produce a smokable substance. This is where the drug gets its street-name ‘crack’, which pertains to the cracking noise that comes from heating the base.

Cocaine is a highly addictive substance that causes its user to feel elevated and euphoric. The high reaches its peak within minutes after the dose, but the effects are short-lived. And while the experience might feel pleasant and exciting, crashing from the high may leave users feeling far less satisfied.

Some of the short term effects of cocaine include:

• Numbness at the site of use
• Heightened energy levels
• Talkative and sociable
• Loss of inhibitions
• Mental alertness
• Increased sensitivity to light, sound, and touch
• Decreased hunger and appetite
• Decreased need for sleep

In cases where a large dose was used, individuals may also experience bizarre, violent, or intense behaviors. It’s not uncommon for long-term users to experience emotional volatility, irritability, anxiety, panic, and paranoia. Others will react more violently and disproportionately to minor inconveniences or interactions.

There are also physiological signs that come with the high. These include:

• Increased temperature
• Increased heart rate
• Increased respiratory rate
• Blood vessel constriction
• Dilation of the pupils

While the experience during the high might feel desirable, the crash that follows the high can be the opposite. Strong feelings of unwell, discomfort, and pain among others, prompt users to repeat the use of the stimulant in order to avoid the unwanted symptoms of the crash. In doing so, a cycle is created in which users attempt to chase the feeling of the high and avoid the resulting discomfort.

The frequent, repetitive use of cocaine will lead to dependence, abuse, and addiction. This extended exposure to the stimulant drug may result to some, if not all, of the following long term effects:

• Heightened reaction to stress
• Development of a tolerance requiring higher doses to experience the same effect
• Panic attacks
• Psychosis
• Consistent chest pain
• Increased risk of stroke and seizures
• Increased risk of movement disorders like Parkinson’s

Cocaine renders its powerful effects by working directly with the brain. The stimulant interferes with the brain’s reward pathway. The molecules from the cocaine drug block the re-uptake of certain neurotransmitter called dopamine. And in doing so, cocaine prevents the excess dopamine from being reabsorbed, effectively increasing the concentration of the neurotransmitter at a given time.

The effect is a heightened feeling of euphoria, which is among the many different effects that cocaine has on the system. But there’s more to the mechanism of cocaine than just that. Some studies have found that cocaine also increases the body’s response to stress, which may explain why cocaine abuse and stress disorders typically occur together.

With an increased sensitivity to stress, even minor, everyday inconveniences and discomfort become significantly challenging for users to overcome. Struggling to cope with the stresses of daily life, users are then forced to return to cocaine and indulge in its benefits of euphoria, elevation, and heightened energy levels.

Presently, there are no medications that are approved for the treatment of cocaine, but research is slowly uncovering the potential benefits of a variety of known medications to improve the process of intervention. Disulfarim, which is typically used to treat alcohol dependence, has been found to show some promise in the treatment of cocaine addiction. However, results vary from patient to patient.

Doctors are also exploring the potential of a cocaine vaccine. This shot aims to minimize the risk of relapse, encouraging the body to create specific antibodies that prevent cocaine from entering the brain. But the vaccine is still in its infantile phase, and it might take years more of research to polish out its effects and create consistent benefits for all of those who receive it.

That said, behavioral treatment and therapy remain the best choices for cocaine abuse treatment. One commonly used method is called the contingency management strategy that involves incentives. Users enrolled in rehab program are provided points for every milestone or achievement during the treatment process.

For example, a patient who reaches a certain number of days in the program receives points, which can then be exchanged for incentives like a special dinner at a restaurant of their choice, a fully paid gym membership, or various other prizes.

Another commonly used method is cognitive behavioral therapy which is directed towards helping patients develop their own strategies to avoid relapse. Some lessons might include how to identify situations that might trigger cravings, how to cope with stress, and how to overcome the desire to return to drug use.

Finally, there are therapeutic communities. Placing patients in a group where they feel they’re not alone can significantly help them feel more motivated to participate in the process. These communities also provide a safe space for patients to practice interactions and simulate life once prepared to re-enter society.

Cocaine abuse relapse isn’t only possible, but is considered likely because of the changes in brain chemistry that the drug products when used long-term. According to statistics, 24% of people who complete a cocaine abuse rehabilitation program relapse to weekly cocaine use within a year of treatment.

Scientists believe that stress plays a key role in a patient’s likelihood to relapse. As cocaine alters a patient’s sensitivity to stress, they become more prone to feeling dissatisfied and uncomfortable even with minor stressors. These effects stay in place long after the drug is removed, and persist for much of the rest of an individual’s life.

When subject to stress, a patient might feel the need to relax, unwind, or relieve the burden. And while they might be successful in handling the stress early on after treatment, the accumulated pressure of stress over the long term can push them to relapse.

Individuals become more prone to relapse when exposed to the any of the following factors:

• No or inconsistent of follow-up through treatment aftercare programs
• Exposure to drug using friends and relatives
• Exposure to high stress situations or repeated minor stresses on a frequent basis
• Insufficient support from family and friends
• Lack of a safe space to vent emotions, stress, and worries
• Engaging in activities associated with drug use like gambling
• Indulging in media that encourages the use of drugs

Relapse is typically expected after the treatment of cocaine abuse, which is why rehabilitation programs usually incorporate an aftercare program to assist patients as they re-enter society.

While the effects of the stimulant drug may be felt for the rest of a person’s life, it’s still possible for a person to live drug-free. Proper support, healthy relationships, regular, routine check-ups, and a positive outlook all assist in the recovery process. With the right mindset and a strong network of friends, family, and specialists assisting in the intervention, a cocaine abuser stands the chance to experience a happy, healthy, and fulfilling life after treatment.