Cocaine & Crack: Abuse & Treatment

Essentially two forms of cocaine are abused on the street: hydrochloride salt and freebase. The hydrochloride salt refers to the powdered form of cocaine, which dissolves in water and is usually injected into the vein or snorted into the nose. Freebase is the form of cocaine that is smokable (crack). The acid that neutralizes hydrochloride salt is removed to make crack cocaine.

Cocaine is generally sold on the street as a fine, white, crystalline powder and called coke, C, snow, flake, or blow. Street dealers generally dilute it with substances like cornstarch, talcum powder, and/or sugar. It is also sometimes manufactured with active drugs like procaine (a chemically-related local anesthetic) or other stimulants like amphetamines. Some users combine cocaine powder or crack with heroin to create a "speedball."

How Cocaine is Used
The 4 main ways cocaine is taken and the corresponding slang terms are:
• Orally (chewing)
• Intranasally (snorting - inhaling cocaine powder through the nostrils, where it is absorbed into the bloodstream through the nasal tissues)
• Intravenously (mainlining, injecting - releases the drug directly into the bloodstream and heightening the intensity of its effects)
• Inhalation (smoking, including freebase and crack cocaine - inhalation of the vapor or smoke into the lungs causes absorption into the bloodstream as rapidly as injection)

There is no safe way to use cocaine. Although levels of use range from occasional through repeated or compulsive use, each time cocaine is taken there is a risk of absorption of toxic amounts of cocaine, leading to acute cardiovascular or cerebrovascular emergencies that could result in sudden death.

Repeated cocaine abuse by any means can lead to addiction and other adverse health consequences.

Crack Cocaine – One of the Street’s Most Addictive Drugs
Crack is the street name for the freebase form of cocaine that is smokable. The term "crack" comes from the crackling sound heard when the mixture is smoked. Crack cocaine is processed with ammonia or sodium bicarbonate (baking soda) and water and heated to remove the hydrochloride.

When crack is smoked, the user experiences a high in less than 10 seconds. The immediate euphoric effect helped make crack popular in the mid 1980s, along with its low cost.

Crack cocaine is much more potent than other forms of cocaine. By removing the hydrochloride, crack cocaine is cooked into a more concentrated version. Crack cocaine is smoked, usually through a glass pipe or aluminum can.

Crack cocaine is one of the most addictive street drugs available. Crack users cannot stop, even when they want to.

Crack cocaine was originally thought of as used mainly in ghettos. But it has now become popular among younger and more affluent crowds, due to its low cost and short, powerfully euphoric high.

The euphoric feeling crack cocaine produces is short lived. After the high fades, a crack user can be left with side effects like:

Regular use will lead to addiction. Once addicted, crack cocaine users become desperate for their next fix. They’ll lie, cheat, and steal to get it.

Intense craving can only be satisfied by more and more crack cocaine. As a crack addict develops physical and psychological dependence, they feel they need it to function. Tolerance often develops. This means that higher doses and more frequent use of cocaine are required for the brain to register the same level of pleasure.

Recent studies have shown that when a user abstains from cocaine use, the memory of the euphoria from cocaine use, or just exposure to cues associated with cocaine use, can trigger tremendous craving and relapse, even after long periods of abstinence.

Long-term crack cocaine effects include:

How Cocaine Produces its Effects
Cocaine’s pleasurable effects are produced by its effects on structures deep in the brain that, when stimulated, produce feelings of pleasure. One neural system that appears to be most affected by cocaine originates in a region called the ventral tegmental area (VTA). Nerve cells in the VTA extend to the region of the brain known as the nucleus accumbens, one of the brain's key pleasure centers.

Normally, dopamine is released by a neuron into the synapse, where it can bind with dopamine receptors on neighboring neurons. Then dopamine is recycled back into the transmitting neuron by a specialized protein called the dopamine transporter.

Researchers have discovered that pleasurable events lead to a large increase in dopamine released in the nucleus accumbens by neurons originating in the VTA. When cocaine is present, it attaches to the dopamine transporter and blocks the normal recycling process, resulting in the dopamine building up in the synapse. This contributes to the pleasurable effects of cocaine.

Effects of Cocaine and Crack
Cocaine is extremely detrimental to the body - the consequences can be permanent damage, addiction, and death. While each person who uses cocaine reacts to it differently, the short-term effects and long-term effects of cocaine can be devastating.

Short-Term Cocaine Effects
Short-term effects can be experienced after only one use. They effects are felt immediately. Although not always damaging, they can cause serious bodily damage and death. Deaths related to cocaine effects are often a result of cardiac arrest or seizures and respiratory failure.

The method used affects the rate of absorption and the intensity of the high. Effects are normally felt immediately, although the high from snorting is a little slower in onset. The high may last only a few minutes - or up to a couple hours. Smoking crack cocaine produces a short, intense high lasting 5 to 10 minutes.

In doses up to 100 mg, cocaine makes a user feel euphoric, energetic, talkative, and mentally alert, especially to the sensations of sight, sound, and touch. The cocaine user may not feel the need to eat or sleep. Cocaine also makes users feel they can perform some physical and intellectual tasks faster, although others report it makes them perform more slowly.

A summary of short-term physiological effects of cocaine abuse includes:

Large amounts of cocaine (several hundred milligrams or more) intensify the high, and may also lead to:

Some cocaine users feel restless, irritable, and anxious. Rarely, sudden death occurs on the first use of cocaine or soon after with no warning. Usually, cocaine-related deaths result from cardiac arrest or seizures followed by respiratory arrest.

The Attraction of Cocaine
Many people who try cocaine find the increased energy very attractive. The quick, sustained energetic feeling hooks those who are looking to be more productive in their jobs and other areas of their lives. In the beginning, the perceived benefits can draw in a cocaine user. But increased tolerance and resulting poor life choices become more and more common as the user continues to use cocaine for energy.

Appetite suppression is a dangerously popular effect for those who are trying to lose or maintain their weight, such as fashion models. Cocaine users may go days without eating, becoming addicted to cocaine use to sustain them.

Long-Term Effects of Cocaine
Long-term effects develop after increased periods of cocaine use. The severity of the long-term effects depends on the amount and length of cocaine use.

In addition to serious medical complications, long-term cocaine effects include:

Cocaine is powerfully addictive. Even after trying cocaine one time, it may be too powerful for the individual to maintain control over the draw to use cocaine again, leading to more intense, more frequent use regardless of the original intention.

Tolerance to the high from cocaine develops. Cocaine and crack addicts say they can never derive as much pleasure from it as they did the first time. They usually take more and more crack and cocaine to try to reach more intense and longer lasting euphoric effects.

Some cocaine users do not take more of the drug, but seem to become sensitized to certain effects, especially the anesthetic and convulsant effects. Because of the increased sensitivity, cocaine users may die from doses that are considered quite low.

A cocaine user sometimes binges by taking the drug over and over, usually increasing the dose each time. This causes increasing irritability, restlessness, and paranoia. It can lead to full-blown paranoid psychosis, as the individual loses touch with reality and experiences auditory hallucinations.

Negative behavior can become pervasive as the cocaine habit grows. The lifestyle of the cocaine addict is often characterized by: