Cocaine is derived from the leaves of the coca plant, which is native to South America. It is most commonly found as a white powder, which likely has several additives or fillers that could be dangerous, or in crystal form as crack cocaine. Cocaine and crack are predominantly manufactured for illicit use in Central and South America and brought into the United States over the Mexican border or they are brought by boat into port cities.
Abuse Throughout History
Like many drugs currently abused, cocaine was originally developed as a medication. It was first used as a surgical anesthetic in the 1880s and then used more widely in over-the-counter tonics and tinctures. Cocaine was originally banned by the Harrison Act in 1914, one of the first drug control laws in the U.S. Once banned, it was no longer available over-the-counter, although doctors could still prescribe it to patients.
The Drug Enforcement Administration (DEA) currently lists cocaine as a Schedule II substance. Although people who abuse cocaine seek out its intense stimulant properties, this drug has some painkilling properties, so it is occasionally used in surgeries as a local anesthetic.
Once the Harrison Act was passed, it was removed from several products, so abuse of medications containing this stimulant decreased; however, in the 1960s, abuse began to rise in popularity again. The substance became a club drug and was popular through the 1970s at parties and discos, prompting the DEA to place cocaine on the Controlled Substances Act (CSA) list as a Schedule II drug.
Crack cocaine was developed in the 1980s as an inexpensive, potent stimulant. This development led to a sharp rise in rates of abuse, especially in urban areas with a lot of poverty. There was an outcry about the crack epidemic, which devastated many communities and led to tougher drug laws and enforcement of those laws.
Although rates of abuse in the U.S. have dropped since the 1980s, it is still one of the most widely abused drugs in the country. At various times since the 1990s, the presence of crack or powdered cocaine has increased, leading to a related rise in abuse of the substance across the nation.
In 2013, Colombia’s illegal coca plant harvest was huge and that led to a greater presence of the drug in North America. The U.S. State Department reported, in 2015, there was more cocaine in the U.S. than at any point in the prior decade. The rate of overdose deaths rose that year to the highest since 2006 and the second-highest since 1999. In just two years, between 2013 and 2015, the number of teenagers and young adults in the country who tried the drug for the first time shot up 61 percent. More than 90 percent of the cocaine found in the U.S. is from Colombia.
Cocaine is one of the most dangerous illicit substances in the country. While it is still considered to have some medical use, most use in the U.S. is nonmedical, so it is illegal. This drug is very dangerous, because it is extremely addictive and because it may contain various adulterants — the most harmful of which is fentanyl.
How Cocaine Abused Today?
Typically, cocaine is either a white or off-white crystalline powder that may be cut with baking powder, sugar, or other inert substances. It may also be cut with other drugs, including lidocaine or fentanyl, which are very different drugs than the stimulant that can quickly cause an overdose and death.
Crack is produced through a process of mixing the powder with baking soda or ammonia until it clumps into “rocks.” The term “crack cocaine” came from the crackling sound the chunks make when the drug is smoked.
Powdered cocaine is most often snorted, but it is sometimes mixed with water and injected intravenously or intramuscularly. The powdered substance may also be rolled into rolling paper and smoked, either alone or with tobacco or marijuana. It may be mixed with an opioid like heroin and injected, which is called a “speedball.”
Smoking crack creates an intense high that lasts for about 15 minutes while snorting powdered cocaine leads to a potent high lasting about 30 minutes. Residual negative effects from both common forms of abuse can last for one or two hours, and the comedown may lead to taking more of the drug in an attempt to stay euphoric and not feel bad. This cycle of abuse is extremely dangerous and can lead to an overdose or other negative side effects.
Signs of Cocaine Abuse
The stimulant in cocaine increases levels of dopamine, a neurotransmitter associated with high energy and elevated mood that triggers the brain’s reward system. Various symptoms are associated with this:
- Extreme happiness or excitability
- Chattiness and lowered inhibitions, especially in social situations
- Mental alertness and increased reaction time
- Hypersensitivity to sight, touch, sound, or other stimulation
- Irritability or moodiness
- Anxiety, which may turn into paranoia
- Decreased appetite
- Sleep disturbances or sleeping less
There are Also Physical Side Effects Associated With Abusing the Drug:
- Constricted blood vessels, leading to high blood pressure
- Dilated pupils
- Elevated body temperature, which often seems like the person has a fever
- Changes to heart rate and rhythm
- Chest pain
- Physical shaking, tremors, and muscle twitches
There are Specific Behavioral Signs That Someone May Be High on Cocaine.
- Moving, thinking, or speaking quickly
- Acting nervous or aggressive
- Being suspicious of people around them
- Being overly excited
As the drug wears off, the person may be very tired, irritable, and depressed. They may move more slowly and have trouble thinking clearly. The comedown effects after cocaine or crack wears off may lead to cravings for more of the stimulant, in an effort to make the negative experience go away. This will cause the brain to release more dopamine than it would normally, and this change in neurochemistry can lead to addiction.
Current Abuse Statistics: Who is at Risk?
The Center for Behavioral Health Statistics and Quality (CBHSQ) Report found that 1.7 million young adults, ages 18 to 25, in the U.S. abused cocaine at least once in the past year, during the 2014-2015 survey year. This means about 1 in 20 people in this age group try it at least once in a given year. The National Survey on Drug Use and Health (NSDUH) for 2015 found that about 968,000 people ages 12 and older started abusing it in the past year, which was a 26 percent increase from 2014, the previous survey year.
Overdose deaths also rose. There were 4,400 reported in 2012; 4,900 in 2013; 5,400 in 2014; and 6,800 in 2015. In 2011, about half of the 1,252,500 emergency room admissions involved illicit drugs, which represents about 402 ER admissions out of every 100,000 people — 505,224 ER admissions involved cocaine, which was about 40.3 percent. Although young adults are the most likely group to abuse intoxicating substances in the country, the Drug Abuse Warning Network (DAWN) Report found that those 45 to 54 years old had the highest rate of hospitalizations for cocaine abuse.
In 2016, the Monitoring the Future (MTF) Survey found that 2.3 percent of 12th-grade students abused cocaine or crack at least once in the prior survey year.
The Danger of Polysubstance Abuse With Cocaine
The 2011 DAWN Report found that 10,388 emergency department admissions involved combinations of illicit drugs, often cocaine and another drug like alcohol or heroin. Sometimes, mixing drugs is unintentional – for example, someone with a prescription for a painkiller may also abuse an illicit drug like cocaine without realizing how dangerous it is to mix these substances. In other cases, polysubstance abuse is intentional, with the goal of achieving specific effects or reducing the negative side effects of a drug. In other instances, people who sell illicit drugs will mix adulterants into the drug to make more money while selling less of the substance; in some cases, these adulterants are other addictive, dangerous drugs that can cause an overdose very quickly.
One of the most common forms of polysubstance abuse is mixing alcohol and cocaine. Alcohol is a legal central nervous system (CNS) depressant, which in the U.S. can be consumed by people ages 21 and older. However, it is also one of the most widely abused drugs, and many people drink alcohol while also abusing other substances. The mixture of alcohol and cocaine, however, is one of the few combinations that produces a third intoxicating chemical: cocaethylene. This substance is produced by the liver and can increase the feeling of intoxication.
Two studies found that about half of all cocaine-dependent people in treatment for this addiction are also dependent on alcohol. Abusing these two drugs together increases dangerous side effects like cardiovascular damage, cognitive impairment, and liver damage. Cocaethylene also builds up in the liver over time, increasing damage to the organ and leading to liver failure sooner than alcohol abuse alone would.
This is the term used to describe a combination of heroin and cocaine. A speedball is supposed to prevent the sleepiness or “nodding” associated with heroin while reducing the shakiness and anxiety associated with the stimulant effects. Abuse of this drug combination on purpose is rare nowadays, but it was popular during the 1980s. Although people who struggle with drug abuse sought to reduce the negative effects of both potent illicit drugs, they instead increased their risk of overdose death, heart damage, and brain damage.
People who abuse cocaine may take benzodiazepines to reduce the negative side effects from binges, like aggression, shakiness, paranoia, and rapid heartbeat. However, the sedative drugs only mask the effects of too much cocaine, and benzos may increase the stimulant’s bioavailability, leading to an overdose faster.
Fentanyl and Other Opioids as Adulterants
Recently, the practice of mixing illicit opioid drugs into powdered cocaine has increased opioid overdose deaths among a population that does not typically abuse opioids. Heroin and synthetic opioids, especially illicit fentanyl, have been found more frequently in cocaine.
An assessment of overdose deaths over several years found that cocaine-related overdose deaths rose from 2000 to 2006, began declining from 2006 to 2010, and again increased after 2010; however, abuse did not increase after 2010 and instead reportedly decreased. Investigations uncovered overdose deaths caused by a potent mixture of heroin and cocaine, which were unintentional. Often, people addicted to opioids accidentally consumed it, and those struggling with addiction accidentally ingested heroin because the substances were mixed without the user’s knowledge.
While many people who abuse cocaine mix the drug with other substances, intentionally or accidentally, just abusing the drug by itself is harmful. Short-term effects can trigger mental health changes and cause damage to the body through high blood pressure or high body temperature. Abusing cocaine for a long time can cause serious damage, leading to chronic illnesses.
Long-term Damage From Abuse
Prolonged abuse of cocaine can lead to various negative effects.
- Seizures or a seizure disorder
- Heart disease from chronic high blood pressure
- Heart attack, stroke, or pulmonary embolism from a blood clot
- Lung damage or disease
- Damage to the nasal septum and upper palate if snorted
- Hallucinations, especially tactile hallucinations of bugs crawling under the skin
- Mood disorders, especially severe depression
- Delirium or psychosis
- Brain damage, including dementia or Parkinson’s disease
Cocaine binges can also cause both an overdose and long-term damage. There are specific symptoms to look for to detect a possible overdose.
- Trouble breathing
- High blood pressure, leading to heart attack
- Hyperthermia or high body temperature
- Kidney damage and failure from hyperthermia
- Extreme aggression toward oneself or others
- Delusions, paranoia, or psychosis
If you see someone suffering from an overdose, call 911 immediately.
A cocaine binge is likely to cause an overdose, but sudden high blood pressure, elevated body temperature, and loss of touch with reality can also lead to chronic health problems like mental illness, heart damage, and kidney damage. These issues will need long-term treatment and are not reversible. It is important to get treatment to end addiction before physical and mental harm cannot be managed.
Treating Cocaine Addiction With Medical Interventions
Any amount of cocaine abuse is too much. Since it is such a powerful stimulant, releasing dopamine and stimulating the brain’s reward system immediately, addiction to the drug can start quickly and escalate rapidly. It is crucial to get professional help from addiction specialists to address addiction to this stimulant.
There are three important, basic steps to overcoming any addiction, including cocaine abuse: medically supervised detox, behavioral therapy in a rehabilitation program, and an aftercare plan that includes several forms of social support.
There are intense and uncomfortable withdrawal symptoms associated with detox and various potential chronic health problems. Working with physicians and medical practitioners to monitor these symptoms will reduce the risk of relapsing back into cocaine abuse due to physical discomfort and psychological cravings.
Mental health problems can be managed with small doses of prescription medications, which may be discontinued once detox is complete. If depression, anxiety, or psychosis continue, these conditions can be medically managed on an ongoing basis. Screening for these conditions is an important part of the detox process.
The most important part of overcoming cocaine addiction is getting behavioral therapy through a rehabilitation program. Working in groups and on an individual basis to understand triggers and change behaviors around drugs will reduce the risk of relapse. Once a specific rehabilitation program is complete, a therapist will help to prepare an aftercare plan. This plan will include lifestyle changes like good nutrition and regular exercise, methods to manage stress, and ongoing therapy and/or support group participation.