Cocaine Medical Use
Cocaine hydrochloride Topical cocaine can be used as a local numbing agent to help with painful procedures in the mouth or nose. Cocaine may be used for nasal and lacrimal duct surgery. The major disadvantages of this use are cocaine’s potential for cardiovascular toxicity, glaucoma, and pupil dilation.[34] Medicinal use of cocaine has decreased as other synthetic local anesthetics such as benzocaine, proparacaine, lidocaine, and tetracaine are now used more often.[34] If vasoconstriction is desired for a procedure (as it reduces bleeding), the anesthetic is combined with a vasoconstrictor such as phenylephrine or epinephrine. Some otolaryngology (ENT) specialists occasionally use cocaine within the practice when performing procedures such as nasal cauterization. In this scenario dissolved cocaine is soaked into a ball of cotton wool, which is placed in the nostril for the 10–15 minutes immediately before the procedure, thus performing the dual role of both numbing the area to be cauterized, and vasoconstriction. Even when used this way, some of the used cocaine may be absorbed through oral or nasal mucosa and give systemic effects.[35] An alternative method of administration for ENT surgery is mixed with adrenaline and sodium bicarbonate, as Moffett’s solution.[36]
Cocaine hydrochloride (Goprelto), an ester local anesthetic, was approved for medical use in the United States in December 2017, and is indicated for the introduction of local anesthesia of the mucous membranes for diagnostic procedures and surgeries on or through the nasal cavities of adults.[37][2] Cocaine hydrochloride (Numbrino) was approved for medical use in the United States in January 2020.[38][3]
The most common adverse reactions in people treated with Goprelto are headache and epistaxis.[2] The most common adverse reactions in people treated with Numbrino are hypertension, tachycardia, and sinus tachycardia.[3]
Recreational
Cocaine is a nervous system stimulant.[39] Its effects can last from 15 minutes to an hour. The duration of cocaine’s effects depends on the amount taken and the route of administration.[40] Cocaine can be in the form of fine white powder, bitter to the taste. Crack cocaine is a smokeable form of cocaine made into small “rocks” by processing cocaine with sodium bicarbonate (baking soda) and water.[12][41] Crack cocaine is referred to as “crack” because of the crackling sounds it makes when heated.[12]
Cocaine use leads to increases in alertness, feelings of well-being and euphoria, increased energy and motor activity, and increased feelings of competence and sexuality.[42]
Analysis of the correlation between the use of 18 various psychoactive substances shows that cocaine use correlates with other “party drugs” (such as ecstasy or amphetamines), as well as with heroin and benzodiazepines use, and can be considered as a bridge between the use of different groups of drugs.[43]
Coca leaves
Coca leaves are legal in some Andean nations, such as Peru and Bolivia, where they are chewed, consumed in the form of tea, or are sometimes incorporated into food products.[44] Coca leaves are typically mixed with an alkaline substance (such as lime) and chewed into a wad that is retained in the buccal pouch (mouth between gum and cheek, much the same as chewing tobacco is chewed) and sucked of its juices. The juices are absorbed slowly by the mucous membrane of the inner cheek and by the gastrointestinal tract when swallowed. Alternatively, coca leaves can be infused in liquid and consumed like tea. Coca tea, an infusion of coca leaves, is also a traditional method of consumption. The tea has often been recommended for travelers in the Andes to prevent altitude sickness.[45] Its actual effectiveness has never been systematically studied.[45]
In 1986 an article in the Journal of the American Medical Association revealed that U.S. health food stores were selling dried coca leaves to be prepared as an infusion as “Health Inca Tea.”[46] While the packaging claimed it had been “decocainized,” no such process had actually taken place. The article stated that drinking two cups of the tea per day gave a mild stimulation, increased heart rate, and mood elevation, and the tea was essentially harmless. Despite this, the DEA seized several shipments in Hawaii, Chicago, Georgia, and several locations on the East Coast of the United States, and the product was removed from the shelves.[citation needed]
Insufflation
Lines of cocaine prepared for snorting
Nasal insufflation (known colloquially as “snorting”, “sniffing”, or “blowing”) is a common method of ingestion of recreational powdered cocaine.[47] The drug coats and is absorbed through the mucous membranes lining the nasal passages. Cocaine’s desired euphoric effects are delayed when snorted through the nose by about five minutes. This occurs because cocaine’s absorption is slowed by its constricting effect on the blood vessels of the nose.[12] Insufflation of cocaine also leads to the longest duration of its effects (60–90 minutes).[12] When insufflating cocaine, absorption through the nasal membranes is approximately 30–60%[citation needed]
In a study of cocaine users, the average time taken to reach peak subjective effects was 14.6 minutes.[48] Any damage to the inside of the nose is because cocaine highly constricts blood vessels – and therefore blood and oxygen/nutrient flow – to that area.
Rolled up banknotes, hollowed-out pens, cut straws, pointed ends of keys, specialized spoons,[49] long fingernails, and (clean) tampon applicators are often used to insufflate cocaine. The cocaine typically is poured onto a flat, hard surface (such as a mirror, CD case or book) and divided into “bumps,” “lines” or “rails,” and then insufflated.[50] A 2001 study reported that the sharing of straws used to “snort” cocaine can spread blood diseases such as hepatitis C.[51]
Injection
Subjective effects not commonly shared with other methods of administration include a ringing in the ears moments after injection (usually when over 120 milligrams) lasting two to 5 minutes including tinnitus and audio distortion. This is colloquially referred to as a “bell ringer”. In a study of cocaine users, the average time taken to reach peak subjective effects was 3.1 minutes.[48] The euphoria passes quickly. Aside from the toxic effects of cocaine, there is also the danger of circulatory emboli from the insoluble substances that may be used to cut the drug. As with all injected illicit substances, there is a risk of the user contracting blood-borne infections if sterile injecting equipment is not available or used.
An injected mixture of cocaine and heroin, known as “speedball“, is a particularly dangerous combination, as the converse effects of the drugs actually complement each other, but may also mask the symptoms of an overdose. It has been responsible for numerous deaths, including celebrities such as comedians/actors John Belushi and Chris Farley, Mitch Hedberg, River Phoenix, grunge singer Layne Staley and actor Philip Seymour Hoffman. Experimentally, cocaine injections can be delivered to animals such as fruit flies to study the mechanisms of cocaine addiction.[52]
Inhalation
The onset of cocaine’s desired euphoric effects is fastest with inhaling cocaine and begins after 3–5 seconds.[12] In contrast, inhalation of cocaine leads to the shortest duration of its effects (5–15 minutes).[12] The two main ways cocaine is smoked are freebasing and by using cocaine which has been converted to smokable “crack cocaine“. Cocaine is smoked by inhaling the vapor produced when solid cocaine is heated to the point that it sublimates.[53] In a 2000 Brookhaven National Laboratory medical department study, based on self-reports of 32 people who used cocaine who participated in the study,”peak high” was found at a mean of 1.4min +/- 0.5 minutes.[48] Pyrolysis products of cocaine that occur only when heated/smoked have been shown to change the effect profile, i.e. anhydroecgonine methyl ester, when co-administered with cocaine, increases the dopamine in CPu and NAc brain regions, and has M1– and M3– receptor affinity.[54]
Smoking freebase or crack cocaine is most often accomplished using a pipe made from a small glass tube, often taken from “love roses“, small glass tubes with a paper rose that are promoted as romantic gifts.[55] These are sometimes called “stems”, “horns”, “blasters” and “straight shooters”. A small piece of clean heavy copper or occasionally stainless steel scouring pad – often called a “brillo” (actual Brillo Pads contain soap, and are not used) or “chore” (named for Chore Boy brand copper scouring pads) – serves as a reduction base and flow modulator in which the “rock” can be melted and boiled to vapor. Crack is smoked by placing it at the end of the pipe; a flame held close to it produces vapor, which is then inhaled by the smoker. The effects felt almost immediately after smoking, are very intense and do not last long – usually 2 to 10 minutes.[56] When smoked, cocaine is sometimes combined with other drugs, such as cannabis, often rolled into a joint or blunt.
