Cocaine

Cocaine Abuse and Dependence

Cocaine is a powerful central nervous system stimulant with effects similar to those of amphetamines. Cocaine abuse is not new to mankind. Cocaine hydrochloride which is the pure chemical of the product has been abused for more than a 100 years and coca leaves, which is the source of cocaine has been ingested for a thousand years.

There are two basic chemical forms of cocaine:

1- The hydrochloride salt - is a powdered form that dissolves in water and can be taken intravenously or intra-nasally (through the nose).

2- The freebase - is not a neutralised form and can be smoked.

Coke, C, snow, blow, or flake is common street terms used to call the white, crystalline powder form of cocaine. It is common to find cocaine mixed with other white, nonreactive substances such as cornstarch, talcum powder, or other stimulants such as amphetamines. Crack is a freebase form of cocaine that has been processed with ammonia or baking soda to remove the hydrochloride compound of cocaine hydrochloride. When the crack is smoked, the user experiences a high in less than 10 seconds, which made it very popular in the mid-1980s.

Cocaine can be chewed, snorted, injected, smoked, and mainlined. It is important to note that none of these methods is safe, and all of them can lead to overdoses and toxicity.

How Cocaine Affects your Body

Cocaine is capable of producing a feeling of pleasure and euphoria. Cocaine is also one of the most addictive drugs known to man. Cocaine blocks the reuptake of dopamine in nerve terminals. This increases dopamine levels in the nucleus accumbens, which is one of the main pleasure centers in the brain. The pleasure associated with food, water, sex, and drugs of abuse cause increased activity in the nucleus accumbens. When cocaine is used, a pleasurable feeling is felt by direct stimulation of the nucleus accumbens.

With continued use, tolerance develops. Higher and higher doses of cocaine are required to achieve the same level of pleasure experienced previously.

Effects of Cocaine Use

1. Psychological Effects:

1. Excitement, increased energy, euphoria, grandiose thinking, impaired judgment, sexual disinhibition.

2. Higher doses lead to visual and auditory hallucinations.

3. Paranoia and aggressive behavior are also observed. Paranoid psychosis can occur in patients with a predisposition to a psychotic disorder

4. Formication - feeling as if insects are crawling on your body is felt in heavy users.

2. Physical Effects:

1. Increased pulse rate, blood pressure, and dilation of pupils.

2. Cardiac arrhythmias, myocardial infarction, myocarditis, myopathies, cerebrovascular accidents, subarachnoid hemorrhage, and seizures.

3. Obstetric complications such as miscarriage, placental abruption, and premature labor.

Addiction to Cocaine

Cocaine’s ability to stimulate the reward centers of the brain makes it one of the most addictive drugs. Some of the effects of cocaine addiction are given below.

Crash Symptoms - experienced when cocaine effects remove - These symptoms usually resolve in 24 hours:

• Dysphoria - abnormal depression

• Anhedonia - the inability to feel pleasure

• Anxiety, irritation, fatigue, and hypersomnolence (increased sleepiness)

After prolonged use the symptoms are more severe:

• Intense craving

• Depression

• Severe suicidal tendencies

Treating Cocaine Abuse

Cocaine addiction is one of the most difficult to treat due to intense cravings. Relapses and urges to use can occur after months or years when exposed to social cues.

Medical practitioners focus on treating the addiction with a holistic approach and treating the medical complications one by one. Acute intoxications require sedation and, in some cases, antipsychotic agents. Seizures and hypertension should be managed as well.

The treatment of cocaine dependence starts with psychological and social support including motivation, awareness programs, and counseling. Heavy users with stronger dependence require a rehabilitation center or a separate residential setting.

References

1- Harrison, P. Shorter Oxford textbook of psychiatry (6th ed., pp. 478-479)

2- Www1.nyc.gov. 2020. Cocaine Abuse & Addiction. [online] Available at: <https://www1.nyc.gov/site/doh/health/health-topics/cocaine-abuse-and-addiction.page> [Accessed 3 October 2020].

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Health Risks of Problematic to Dependant Cocaine Consumption

Introduction

Cocaine is a widely used substance of abuse all over the world. In Australia alone, there has been a significant increase in the production and supply of cocaine. Naturally, this implies that the demand for cocaine has been increasing.

While cocaine seems to be a product in great demand in Australia, research has revealed that cocaine misuse remains stable to date.

Meaning, previous abusers are still using it. The continuous abuse of cocaine is where the main problem comes arises.

The side effects or the adversities that cocaine consumption can have on their health are vast.

Cocaine use alters health condition and increases the predisposition to several diseases. The majority of cocaine addicts and abusers are adolescents. Cocaine has turned into a 'luxury' to consume at their parties and experience euphoria like never before.

Health Risks Associated with Long-Term Cocaine Consumption

Cocaine usage is increasingly popular among young generations. In Australia, teenagers and young adults have started using cocaine as a party drug for its euphoria and pleasure. As a result, both methamphetamine and ecstasy consumption and demand have decreased significantly.

Here is a brief yet comprehensive review of the health risks on health due to the consumption of cocaine in the problematic to the dependent range.

Effects On The Nervous System

Cocaine consumption mainly affects the brain. Because of this powerful stimulation, the person feels 'high' or goes into a state of 'ecstasy.'

When cocaine use becomes a regular habit leading to addiction, it takes a toll on mental health and deteriorates the nervous system.

Some worrisome effects suffered by the nervous system due to the problematic to dependant usage of cocaine include:

● Decreased Sensitivity to Dopamine:

● Dopamine is the primary neurotransmitter that promotes feelings of happiness and contentment in an individual. Cocaine increases dopamine levels in the brain, causing the 'high' feeling.

● Over time, excessive levels of dopamine may start accumulating in the brain. Since they cannot find a pathway to exit and the inflow keeps increasing, dopamine fills up the brain and destroys neurons.

● Brian cell or neuronal degeneration is a dangerous sign and can lead to seizures.

● Neuronal Damage:

In an attempt to save itself, the brain tries to change the shape of its neurons to prevent further damage by altering the structure and function of the brain.

● Movement Disorders:

Due to extensive damage, the brain fails to synchronize and function properly. Users might experience symptoms of Parkinson's and other movement-related disorders.

● Other Effects:

Other impacts of long-term or problematic dependence on cocaine include common symptoms like headaches, dizziness, paranoia, hallucinations, mood swings, etc.

Effects on The Digestive System

Cocaine severely affects the stomach and the digestive system. However, the harmful effects of cocaine on the digestive tract can be reversed upon cessation

of cocaine use.

In chronic users and addicts, digestive symptoms might predominate.

● Weight Loss:

Cocaine leads to satiety and contentment. A user starts to ignore his/her natural temptations, hunger being one of them. When you ignore your carnal desires, especially hunger, you are bound to experience something serious. Extreme levels of weight loss and malnutrition are some of them.

● Stomach Ulcers:

Thanks to the unwanted after-effects of consuming cocaine, the stomach has to suffer in unexpected ways. The toxicity of cocaine not only alters the mucosal lining of the stomach; it can also erode the gastric lining. Gastric erosion leads to painful ulcers. If left untreated, ulcers lead to perforation and a risk of bleeding.

● Bowel Abnormalities:

Apart from the stomach, the small intestines and the large intestine both suffer. The large intestine tissue decay due to the toxic effects of the cocaine 'leftovers' leading to eroded bowel tissue.

Effects on The Respiratory System

The respiratory system is perhaps the most vulnerable organ to the toxic agents that the body inhales or ingests. It suffers greatly, and ultimately the user succumbs to its lethal complications.

● Lung Injury:

Lung complications depend on the route of cocaine use. In cases where cocaine is inhaled for a long time, the entire airway, including alveoli and bronchi, are damaged. Extensive damage compromises the respiratory system and puts a strain on normal breathing.

● Respiratory Symptoms:

Several respiratory symptoms become a routine part of one's life with long term use. Symptoms, including wheezing, cough, and pain during breathing, are examples. Often, people with chronic cocaine abuse complain of having dark-coloured sputum.

● Edema:

Many users suffer from edema of the vocal cords, the adenoids, and the larynx. Edema further exacerbates the problem and causes speech difficulties.

While cocaine leads to temporary euphoria and high, it has severe health consequences. Cocaine makes a user vulnerable to several other problems, most of which do not appear until it's too late.

References:

1. Chalmers, J., Matthew-Simmons, F., & Hughes, C. E. (2013). The recent expansion in the Australian cocaine market: who are the new users and what are the harms?. Current drug abuse reviews, 6(2), 98–111. https://doi.org/10.2174/1874473706666131205150424

2. Akwe JA (2017) Pulmonary Effects of Cocaine Use. J Lung Pulm Respir Res 4(2): 00121. DOI: 10.15406/jlprr.2017.04.00121

3. Tiwari, A., Moghal, M., & Meleagros, L. (2006). Life-threatening abdominal complications following cocaine abuse. Journal of the Royal Society of Medicine, 99(2), 51–52. https://doi.org/10.1258/jrsm.99.2.51

4. Prakash, A., & Das, G. (1993). Cocaine and the nervous system. International journal of clinical pharmacology, therapy, and toxicology, 31(12), 575–581.

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