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Cocaine crosses the blood-brain barrier via a proton-coupled organic cation antiporter    and to a lesser extent via passive diffusion across cell membranes. A single dose of cocaine induces tolerance to the drug’s effects. Addicts who abstain from cocaine experience cocaine craving and drug withdrawal , with depression , decreased libido , decreased ability to feel pleasure and fatigue.
It also increases risk of stroke , heart attack , cardiac arrhythmia, lung injury when smoked , and sudden cardiac death. Coca leaves have been used by Andean civilizations since ancient times.
Globally, in , cocaine was used by an estimated 20 million people 0. The highest prevalence of cocaine use was in Australia and New Zealand 2. Topical cocaine is sometimes used as a local numbing agent and vasoconstrictor to help control pain and bleeding with surgery of the nose, mouth, throat or lacrimal duct. Although some absorption and systemic effects may occur, the use of cocaine as a topical anesthetic and vasoconstrictor is generally safe, rarely causing cardiovascular toxicity, glaucoma , and pupil dilation.
Cocaine hydrochloride Goprelto , an ester local anesthetic, was approved for medical use in the United States in December , and is indicated for the introduction of local anesthesia of the mucous membranes for diagnostic procedures and surgeries on or through the nasal cavities of adults. The most common adverse reactions in people treated with Goprelto are headache and epistaxis.
Cocaine is a central nervous system stimulant. The duration of cocaine’s effects depends on the amount taken and the route of administration. Crack cocaine is a smokeable form of cocaine made into small “rocks” by processing cocaine with sodium bicarbonate baking soda and water. Cocaine use leads to increases in alertness, feelings of well-being and euphoria , increased energy and motor activity, and increased feelings of competence and sexuality.
Analysis of the correlation between the use of 18 various psychoactive substances shows that cocaine use correlates with other ” party drugs ” such as ecstasy or amphetamines , as well as with heroin and benzodiazepines use, and can be considered as a bridge between the use of different groups of drugs.
It is legal for people to use Coca leaves in some Andean nations, such as Peru and Bolivia, where they are chewed, consumed in the form of tea, or are sometimes incorporated into food products. The juices are absorbed slowly by the mucous membrane of the inner cheek and by the gastrointestinal tract when swallowed. Alternatively, coca leaves can be infused in liquid and consumed like tea. Coca tea , an infusion of coca leaves, is also a traditional method of consumption.
The tea has often been recommended for travelers in the Andes to prevent altitude sickness. While the packaging claimed it had been “decocainized”, no such process had actually taken place. The article stated that drinking two cups of the tea per day gave a mild stimulation , increased heart rate , and mood elevation, and the tea was essentially harmless.
Nasal insufflation known colloquially as “snorting”, “sniffing”, or “blowing” is a common method of ingestion of recreational powdered cocaine. Cocaine’s desired euphoric effects are delayed when snorted through the nose by about five minutes. This occurs because cocaine’s absorption is slowed by its constricting effect on the blood vessels of the nose.
In a study of cocaine users, the average time taken to reach peak subjective effects was Rolled up banknotes , hollowed-out pens , cut straws , pointed ends of keys, specialized spoons,  long fingernails , and clean tampon applicators are often used to insufflate cocaine.
The cocaine typically is poured onto a flat, hard surface such as a mobile phone screen, mirror, CD case or book and divided into “bumps”, “lines” or “rails”, and then insufflated. Subjective effects not commonly shared with other methods of administration include a ringing in the ears moments after injection usually when over milligrams lasting two to 5 minutes including tinnitus and audio distortion.
This is colloquially referred to as a “bell ringer”. In a study of cocaine users, the average time taken to reach peak subjective effects was 3. Aside from the toxic effects of cocaine, there is also the danger of circulatory emboli from the insoluble substances that may be used to cut the drug. As with all injected illicit substances , there is a risk of the user contracting blood-borne infections if sterile injecting equipment is not available or used.
An injected mixture of cocaine and heroin , known as ” speedball “, is a particularly dangerous combination, as the converse effects of the drugs actually complement each other, but may also mask the symptoms of an overdose.
Experimentally, cocaine injections can be delivered to animals such as fruit flies to study the mechanisms of cocaine addiction. The onset of cocaine’s desired euphoric effects is fastest with inhaling cocaine and begins after 3—5 seconds. Cocaine is smoked by inhaling the vapor produced when solid cocaine is heated to the point that it sublimates. Smoking freebase or crack cocaine is most often accomplished using a pipe made from a small glass tube, often taken from ” love roses “, small glass tubes with a paper rose that are promoted as romantic gifts.
A small piece of clean heavy copper or occasionally stainless steel scouring pad — often called a “brillo” actual Brillo Pads contain soap, and are not used or “chore” named for Chore Boy brand copper scouring pads — serves as a reduction base and flow modulator in which the “rock” can be melted and boiled to vapor. Crack is smoked by placing it at the end of the pipe; a flame held close to it produces vapor, which is then inhaled by the smoker.
The effects felt almost immediately after smoking, are very intense and do not last long — usually 2 to 10 minutes. Opioid involvement in cocaine overdose deaths. The green line is cocaine and any opioid top line in The gray line is cocaine without any opioids bottom line in The yellow line is cocaine and other synthetic opioids middle line in Delphic analysis regarding 20 popular recreational drugs based on expert opinion.
Cocaine was ranked the 2nd in dependence and physical harm and 3rd in social harm. Acute exposure to cocaine has many effects on humans, including euphoria, increases in heart rate and blood pressure, and increases in cortisol secretion from the adrenal gland.
Aggressive behavior may be displayed by both addicts and casual users. Cocaine can induce psychosis characterized by paranoia, impaired reality testing , hallucinations , irritability, and physical aggression. Cocaine intoxication can cause hyperawareness, hypervigilance , and psychomotor agitation and delirium. Consumption of large doses of cocaine can cause violent outbursts, especially by those with preexisting psychosis.
Crack-related violence is also systemic, relating to disputes between crack dealers and users. Acute exposure may also lead to angina , heart attack , and congestive heart failure. With excessive dosage, tremors, convulsions and increased body temperature are observed.
Although it has been commonly asserted, the available evidence does not show that chronic use of cocaine is associated with broad cognitive deficits. Physical side effects from chronic smoking of cocaine include coughing up blood , bronchospasm , itching , fever , diffuse alveolar infiltrates without effusions, pulmonary and systemic eosinophilia , chest pain, lung trauma, sore throat, asthma , hoarse voice, dyspnea shortness of breath , and an aching, flu -like syndrome. Cocaine constricts blood vessels , dilates pupils , and increases body temperature, heart rate, and blood pressure.
It can also cause headaches and gastrointestinal complications such as abdominal pain and nausea. A common but untrue belief is that the smoking of cocaine chemically breaks down tooth enamel and causes tooth decay. Cocaine can cause involuntary tooth grinding, known as bruxism , which can deteriorate tooth enamel and lead to gingivitis. Since saliva is an important mechanism in maintaining one’s oral pH level, people who use cocaine over a long period of time who do not hydrate sufficiently may experience demineralization of their teeth due to the pH of the tooth surface dropping too low below 5.
Cocaine use also promotes the formation of blood clots. Chronic intranasal usage can degrade the cartilage separating the nostrils the septum nasi , leading eventually to its complete disappearance.
Due to the absorption of the cocaine from cocaine hydrochloride, the remaining hydrochloride forms a dilute hydrochloric acid. Illicitly-sold cocaine may be contaminated with levamisole. Cocaine use leads to an increased risk of hemorrhagic and ischemic strokes.
This change can be identified rather quickly, and may be sustained weeks after the last dose of the drug. DNA damage is increased in the brain of rodents by administration of cocaine.
Cocaine dependence develops after even brief periods of regular cocaine use  and produces a withdrawal state with emotional-motivational deficits upon cessation of cocaine use. Crack baby is a term for a child born to a mother who used crack cocaine during her pregnancy. The threat that cocaine use during pregnancy poses to the fetus is now considered exaggerated. Many recall that “crack babies”, or babies born to mothers who used crack cocaine while pregnant, were at one time written off by many as a lost generation.
They were predicted to suffer from severe, irreversible damage, including reduced intelligence and social skills. It was later found that this was a gross exaggeration.
However, the fact that most of these children appear normal should not be over-interpreted as indicating that there is no cause for concern. Using sophisticated technologies, scientists are now finding that exposure to cocaine during fetal development may lead to subtle, yet significant, later deficits in some children, including deficits in some aspects of cognitive performance, information-processing, and attention to tasks—abilities that are important for success in school.
There are also warnings about the threat of breastfeeding : The March of Dimes said “it is likely that cocaine will reach the baby through breast milk,” and advises the following regarding cocaine use during pregnancy:. Cocaine use during pregnancy can affect a pregnant woman and her unborn baby in many ways. During the early months of pregnancy, it may increase the risk of miscarriage. Later in pregnancy, it can trigger preterm labor labor that occurs before 37 weeks of pregnancy or cause the baby to grow poorly.
As a result, cocaine-exposed babies are more likely than unexposed babies to be born with low birth weight less than 5. Low-birthweight babies are 20 times more likely to die in their first month of life than normal-weight babies, and face an increased risk of lifelong disabilities such as mental retardation and cerebral palsy.
Cocaine-exposed babies also tend to have smaller heads, which generally reflect smaller brains. Some studies suggest that cocaine-exposed babies are at increased risk of birth defects, including urinary tract defects and, possibly, heart defects.
Cocaine also may cause an unborn baby to have a stroke, irreversible brain damage, or a heart attack. Persons with regular or problematic use of cocaine have a significantly higher rate of death, and are specifically at higher risk of traumatic deaths and deaths attributable to infectious disease. The extent of absorption of cocaine into the systemic circulation after nasal insufflation is similar to that after oral ingestion. The rate of absorption after nasal insufflation is somewhat limited by cocaine-induced vasoconstriction of capillaries in the nasal mucosa.
The onset of absorption after oral ingestion is delayed because cocaine is a weak base with a pKa of 8. The delay in absorption after oral ingestion may account for the popular belief that cocaine bioavailability from the stomach is lower than after insufflation. Compared to ingestion, the faster absorption of insufflated cocaine results in quicker attainment of maximum drug effects. Snorting cocaine produces maximum physiological effects within 40 minutes and maximum psychotropic effects within 20 minutes.
Physiological and psychotropic effects from nasally insufflated cocaine are sustained for approximately 40—60 minutes after the peak effects are attained. Cocaine has a short elimination half life of 0. Depending on liver and kidney function, cocaine metabolites are detectable in urine. Detection of cocaine metabolites in hair is possible in regular users until the sections of hair grown during use are cut or fall out.
Dopamine neurotransmitter released during neural signaling is normally recycled via the transporter; i.
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