With all the attention given to the legitimately lethal opioid crisis, an old scourge has been stealthily crawling from the shadows and becoming an increasing danger: cocaine. As illicit opioid use finally seems to be declining, cocaine abuse rates are rising.
Methamphetamine (meth) use increased by nearly 500% from 2013 to 2019. Cocaine use jumped much less, only 21% over the same period, but that is still a significant increase. In late 2019, the U.S. Congress voted to allow money slated for opioid treatment to be used for resurgent stimulants cocaine and methamphetamine.
The rise in cocaine use is alarming because cocaine can be just as deadly as opioids and there are fewer and less effective antidotes for individuals experiencing overdoses. There is no equivalent of the opioid overdose reversal drug naloxone (Narcan) for cocaine, for example.
What Is Cocaine?
Cocaine—also known as coke, blow, snow, and Bolivian marching powder, among other nicknames—is a chemical in the leaves of the coca plant that has been used for thousands of years in Latin America. The 15th-century explorer Amerigo Vespucci mentioned it in his memoirs.
Unlike opioids, which are depressants, cocaine is a central nervous system stimulant. While opioids cause the body to slow down, stimulants make the body speed up, increasing blood pressure and heart rate.
This can cause desirable effects, such as increased energy and alertness, but it also can kill you. Cocaine, like other drugs, also stimulates dopamine production and causes euphoria.
Forms of Cocaine
Cocaine is used in several different forms and ways, including:
- As a powder that is insufflated (snorted) or rubbed on the gums.
- Dissolved as a liquid that is injected.
- As crack, a crystalline rock form (freebase) that is smoked with a special pipe or mixed with tobacco or marijuana.
The type of cocaine a person uses determines how quickly it takes effect and how long the effects last. The euphoria from snorting cocaine takes longer to go into effect but lasts up to 30 minutes, while smoking or injecting cocaine produces euphoria faster but only lasts 10 minutes or fewer.
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Brief History of Cocaine Use
In the Andes Mountains in Bolivia, the indigenous Aymara people (who predate the Incas) were known to chew the leaves in their religious ceremonies. The dose of cocaine released by chewing was relatively low, however, and they didn’t chew it all of the time. After their subjugation by the Spanish, the Aymaras’ coca leaf use became less discriminant.
It wasn’t until the second half of the 19th century when scientists in Europe isolated the chemical that it became potent enough to cause real problems. At first, medical practitioners experimented with it as an anesthetic for eye surgery, then as a general anesthetic and tonic.
By 1900, cocaine was considered a wonder drug but it was as unregulated as caffeine. It was taken for a variety of medical complaints but also for pleasure. It was routinely added to pharmaceutical products, wines, nonalcoholic beverages, and even cigars.
Yes, Coca-Cola once contained cocaine. Originally intended as a tonic, it became a soft drink. When Coca-Cola was introduced, the amount of cocaine in a six-ounce bottle was less than 5 mg—considered by some to be the minimum threshold that cocaine noticeably affects the body—but it soon dropped significantly.
It wasn’t until the 1914 Harrison Narcotics Tax Act that cocaine became more regulated and harder to obtain legally.
There were three main reasons given for passing the act:
- Cocaine was addictive. Early cocaine proponent Sigmund Freud struggled with cocaine addiction for more than a decade. Even the creator of Sherlock Holmes, who had been given his fictional detective an occasional cocaine habit in an 1890 story, had him quit in 1904 as the risks of addiction became better known.
- Cocaine caused sometimes fatal overdoses. Cocaine’s use for general anesthesia has resulted in people dying on the operating table. Illicit use is more likely to kill.
- Cocaine might cause violence. Particularly, it was feared, among the lower classes and minorities. This was supported by scurrilous newspaper stories, including one in the New York Times in 1914.
Whatever the motivation for such cocaine warnings, cocaine use can be deadly and regulation was needed.
Cocaine Side Effects
Cocaine was legal because it had and has medical uses. It is still legally prescribed in some circumstances and is a schedule II drug on the Drug Enforcement Administration’s lists of controlled substances. Other stimulants, such as drugs for people with attention deficit/hyperactivity disorder (ADHD), are also legal though much abused.
However, cocaine has many negative side effects that make its legal use rare and its illegal abuse damaging mentally and physically. Not everybody experiences increased alertness or energy, either. Cocaine may have the reverse effect.
Possible side effects include:
- Dilated pupils
- Hypersensitive vision, hearing, and touch
- Restlessness or irritation
- Feelings of being cold or hot
- Violent, unpredictable, and strange behavior
- Constriction of blood vessels, which could cause headaches, high blood pressure (hypertension), fast or irregular heartbeat, stroke, or erectile dysfunction
How Cocaine Is Used
How cocaine is used may cause other side effects:
- Loss of the sense of smell (olfaction)
- Persistent runny nose
- Difficulty swallowing
- Respiratory distress
- Death of intestinal tissue due to reduced blood flow
Injecting cocaine with needles:
- Higher risk for contracting HIV, hepatitis C, and other blood-borne diseases
- Skin or soft tissue infections
- Scarring or collapsed veins
Because cocaine use can impair judgment, any cocaine use can lead to HIV through unprotected sexual activity.
Cocaine overdose deaths are considerably less common than opioid overdose deaths, but overdose isn’t the primary worry with cocaine abuse. Long-term use of cocaine can damage the brain (Parkinson’s disease), the mind (paranoia, auditory hallucinations), the lungs (difficulty breathing), and the heart. This damage may not be reversed if you stop.
How Does Cocaine Kill You?
Too much cocaine can cause an overdose that can have negative effects, such as a heart attack, stroke, or death.
Viewed on a magnetic resonance angiography (MRA)–an examination similar to magnetic resonance imaging (MRI)–cocaine use, even doses far smaller than most people use, can darken areas of the brain related to blood flow. That’s because cocaine and other stimulants increase blood pressure but make the blood vessels narrower.
It’s like hooking up an ordinary garden hose to a fire hydrant and turning it on full blast. The chance that the hose will rupture or become plugged is very high.
How Much Is a Lethal Dose of Cocaine?
The difference between a dose that has the desired effect and a lethal dose of cocaine is difficult to determine until you overdose because it is different for everyone. It depends on:
- Your medical history. If you have an underlying health condition already, you are more likely to suffer worse effects of cocaine use.
- How much tolerance you have developed. One reason it’s so difficult to answer the question of how deadly is cocaine is that regular users can develop tolerance. They can handle doses of cocaine that would kill a new user.
- The purity of the cocaine. Cocaine is often “cut” with another substance—flour, powdered milk, a laxative, levamisole (a cattle dewormer) or another numbing agent—to increase profits. Sometimes there is incidental useless filler from the process of making the cocaine.
- And sometimes a less expensive opioid or other psychoactive drug is added—heroin, fentanyl—to intensify the effect (a speedball). If the users aren’t aware of this, or if the cutting agent is contaminated, it can kill them.
- Luck. With good luck, users might survive a dose that would kill most people. With bad luck, they may die the first time they try.
Between 1.5 and 2 grams of cocaine all at once would likely cause an overdose in most people, even regular users.
How Is Cocaine Abuse Treated?
There is no generally accepted medication-assisted treatment (MAT) for cocaine use disorder, though some populations of users can benefit from certain drugs.
The most effective treatments for those dependent on cocaine may be behavioral therapies, especially contingency management–specifically, voucher-based reinforcement therapy (VBRT) to promote abstinence, coupled with community reinforcement therapy.
Contingency management (CM) is when people in rehab for substance use disorder are rewarded for clean urine tests. The form of reward may be cash, a prize, a voucher, or just an affirmation written on a piece of paper.
Some critics deride this as paying someone not to do drugs, but it works. The addition of CM makes abstinence 100% more likely.
VBRT is a form of contingency management in which individuals are given vouchers exchangeable for goods or services whenever their urine tests are free of drugs or alcohol.
Combinations of individual, group, and family therapy are also effective. Community reinforcement therapy is a type of cognitive behavioral therapy that emphasizes removing the incentives to abuse cocaine and reinforcing the incentives to remain abstinent.
Reasons for the rise in cocaine use may be as simple as supply: there is more cocaine on the market because cocaine cultivators are producing more cocaine. The overprescription of attention deficit/hyperactivity drugs (ADHD) to young people may also have prepared the ground for some (although taken as directed, ADHD drugs have a low risk of addiction).
The crackdown on the diversion of prescription opioids may also be having an impact, as users look for other drugs when their first choice is harder to obtain. Cocaine is not a safe alternative. It may be more deadly.
Stopping cocaine use as soon as possible leads to better outcomes. Better yet, never start.
- journalistsresource.org – Cocaine Use is On the Rise
- apnews.com – Feds to let states tap opioid funds for meth, cocaine surge
- drugabuse.gov – Cocaine
- ncbi.nlm.nih.gov – The history of cocaine in medicine and its importance to the discovery of the different forms of anaesthesia
- sciencenews.org – U.S. drug deaths dipped in 2018, but cocaine and meth overdoses rose
- ncbi.nlm.nih.gov – Consumption of coca in history
- salon.com – Original Coca-Cola had a very small amount of cocaine
- history.com – Cocaine
- thenation.com – How the Myth of the ‘Negro Cocaine Fiend’ Helped Shape American Drug Policy
- nytimes.com – NEGRO COCAINE “FIENDS” ARE A NEW SOUTHERN MENACE
- drugabuse.gov – Overdose Death Rates
- vox.com – The rise in meth and cocaine overdoses, explained
- consumer.healthday.com – Street Drugs and Stroke
- quora.com – What is considered a lethal dose of cocaine for regular users of the drug? Is 2 g a day lethal?
- advances.sciencemag.org – The treatment of cocaine use disorder
- seattletimes.com – Prizes for sobriety: As Washington meth use rises, this treatment is one of few that works
- ncbi.nlm.nih.gov – Extended Voucher-Based Reinforcement Therapy for Long-term Drug Abstinence
- pubs.niaaa.nih.gov – The Community- Reinforcement Approach
- slate.com – Is Ritalin “Chemically Similar” to Cocaine?
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