Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Street use: The cocaine
destined for street use in the United States is generally isolated and
converted to cocaine hydrochloride in South American labs. This cocaine salt,
which can be as pure as 95%, is then smuggled into the country. As it passes
through many hands from the importer to the user, it is usually diluted ("cut"
or "stepped on") at each stage of distribution to increase each dealer's
profit. The final product can be from 1% to 95% pure. Common additives are
sugars, such as mannitol, lactose, or glucose, or even sugar substitutes, and local anesthetics such as tetracaine, procaine, and lidocaine. Quinine, talc, and cornstarch have also been used. Other illicit drugs, such as heroin, codeine, amphetamine,
phencyclidine (PCP), LSD, and hashish, can be mixed in as well. Some consumers may unknowingly purchase a supply without any cocaine but just a cocaine substitute such as caffeine, amphetamine, PCP, procaine, and lidocaine.
However, field reports are identifying new groups of users: teenagers smoking crack with marijuana in some cities, Hispanic crack users in Texas, middle-class suburban users of cocaine hydrochloride, and female crack users in their 30s with no prior drug use history.
Methods of abuse: Cocaine in the powder, hydrochloride salt form may
be injected, mixed with liquor, swallowed, or applied to oral, vaginal, or even rectal mucous membranes. This drug is most commonly used by snorting or sniffing.
With snorting, the usual ritual is to place a line
of coke, about 0.3 cm wide by 2.5 cm long, on a smooth surface. The finely
divided powder is then snorted (inhaled quickly) into a nostril through a plastic or glass straw or a rolled currency bill. This ritual is usually repeated within a few minutes using the other nostril. Special spoons and other paraphernalia are available for snorting cocaine.
Cocaine is generally not taken by mouth for
recreational purposes. Toxic reactions, including death, have occurred in
people who swallow the drug to avoid police detection or border authorities.
This smuggling attempt is known as body packing. This crystalline white powder can be dissolved in water and used intravenously ("slammed"). In this form, it has a high melting point, so it cannot be smoked and is the most widely used form of the drug.
Freebasing involves the conversion of cocaine hydrochloride into cocaine sulfate that is "free" of the additives and nearly 100% pure. It is not water soluble and has a low melting point, so it can be smoked. The freebaser runs the risk of being burned by the conversion process because a highly volatile solvent, such as ether, is being used.
Crack is extracted from powder cocaine using baking soda and heat -- a relatively safe method compared with the ether technique. The waxy base becomes rocks of cocaine, ready to be sold in vials. This rock cocaine is also easy to smoke, the most common form of use in the streets. Cocaine sulfate is also available as coca paste known as basuco, bazooka, piticin, pistol, pitillos, or tocos and is widely smoked in South America. Because the freebase is resistant to destruction by heat, it can be smoked either in cigarettes, including marijuana cigarettes, or in "coke pipes." Smoking the freebase produces a more powerful effect more rapidly, but it is also more dangerous because the safe dose can easily be exceeded. A user describes the comparison: "Snorting coke is like driving 50 miles per hour. Smoking crack is like driving 150 miles per hour without brakes!"
Why cocaine becomes addictive: Research with cocaine has shown that all laboratory animals can become compulsive cocaine users. Animals will work more persistently at pressing a bar for cocaine than for any drug, including opiates. An addicted monkey pressed the bar 12,800 times until it got a single dose of cocaine. If the animal survives, it will return to the task of obtaining more cocaine.
The human response is similar to that of the laboratory animal. The cocaine-dependent human prefers it to all other activities and will use the drug until the user or the supply is exhausted. These people will exhibit behavior entirely different from their previous lifestyle.
Cocaine-driven humans will compel themselves to perform unusual acts compared with their former standards of conduct. For example, a cocaine user may sell her child to obtain more cocaine. There are many stories of professionals, such as lawyers, physicians, bankers, and athletes, with daily habits costing hundreds to thousands of dollars, with binges in the $20,000-$50,000 range. The result may be loss of job and profession, loss of family,
friends and housing, bankruptcy, and death.
dose:Although this drug has
been in use for more than 5,000 years, the toxic dose or the amount of cocaine
that will cause death or some significant medical consequence of overdose is unknown. The
average lethal dose by the IV route or by inhalation is about 750 mg-800 mg. This
is subject to significant individual variation because deaths have occurred in
doctors' offices with as little as 25 mg applied to the mucous membrane or the snorting of a single line in recreational use where the average dose of
one line is 20 mg.
Effects:The method of use dictates the onset of
activity and duration of its effects. If snorted, the effects will peak within
30 minutes with its duration of effect lasting one to three hours. If swallowed with
alcohol, effects peak in 30 minutes and last about three hours. If used
intravenously or inhaled/smoked, the effects peak in seconds to two minutes but
last only 15-30 minutes. The breakdown products of the drug will be excreted
and can be detected in the urine for 24-72 hours. For chronic users, it can be detected for up to