the street name given to cocaine that has been processed from cocaine
hydrochloride to a free base for smoking. Rather than requiring the
more volatile method of processing cocaine, using ether, crack cocaine
is processed with ammonia or sodium bicarbonate (baking soda) and
water and heated to remove the hydrochloride, thus producing a form
of cocaine that can be smoked. The term "crack" refers to
the crackling sound heard when the mixture is smoked (heated), presumably
from the sodium bicarbonate.
Cocaine is a powerfully addictive drug of abuse. Once having tried
cocaine, an individual cannot predict or control the extent to which
he or she will continue to use the drug.
The major routes of
administration of cocaine are sniffing or snorting, injecting, and
smoking (including free-base and crack cocaine). Snorting is the process
of inhaling cocaine powder through the nose where it is absorbed into
the bloodstream through the nasal tissues. Injecting is the act of
using a needle to release the drug directly into the bloodstream.
Smoking involves inhaling cocaine vapor or smoke into the lungs where
absorption into the bloodstream is as rapid as by injection.
There is great risk whether cocaine is ingested by inhalation (snorting),
injection, or smoking. It appears that compulsive cocaine use may
develop even more rapidly if the substance is smoked rather than snorted.
Smoking allows extremely high doses of cocaine to reach the brain
very quickly and brings an intense and immediate high. The injecting
drug user is at risk for transmitting or acquiring HIV infection/AIDS
if needles or other injection equipment are shared.
Cocaine is a strong central nervous system stimulant that interferes
with the reabsorption process of dopamine, a chemical messenger associated
with pleasure and movement. Dopamine is released as part of the brain's
reward system and is involved in the high that characterizes cocaine
Physical effects of cocaine use include constricted peripheral blood
vessels, dilated pupils, and increased temperature, heart rate, and
blood pressure. The duration of cocaine's immediate euphoric effects,
which include hyper-stimulation, reduced fatigue, and mental clarity,
depends on the route of administration. The faster the absorption,
the more intense the high. On the other hand, the faster the absorption,
the shorter the duration of action. The high from snorting may last
15 to 30 minutes, while that from smoking may last 5 to 10 minutes.
Increased use can reduce the period of stimulation.
Some users of cocaine report feelings of restlessness, irritability,
and anxiety. An appreciable tolerance to the high may be developed,
and many addicts report that they seek but fail to achieve as much
pleasure as they did from their first exposure. Scientific evidence
suggests that the powerful neuropsychologic reinforcing property of
cocaine is responsible for an individual's continued use, despite
harmful physical and social consequences. In rare instances, sudden
death can occur on the first use of cocaine or unexpectedly thereafter.
However, there is no way to determine who is prone to sudden death.
High doses of cocaine and/or prolonged use can trigger paranoia. Smoking
crack cocaine can produce a particularly aggressive paranoid behavior
in users. When addicted individuals stop using cocaine, they often
become depressed. This also may lead to further cocaine use to alleviate
depression. Prolonged cocaine snorting can result in ulceration of
the mucous membrane of the nose and can damage the nasal septum enough
to cause it to collapse. Cocaine-related deaths are often a result
of cardiac arrest or seizures followed by respiratory arrest.
Added Danger: Cocaethylene
When people mix cocaine and alcohol consumption, they are compounding
the danger each drug poses and unknowingly forming a complex
chemical experiment within their bodies. NIDA-funded researchers
have found that the human liver combines cocaine and alcohol
and manufactures a third substance, cocaethylene, that intensifies
cocaine's euphoric effects, while possibly increasing the risk
of sudden death.
The widespread abuse of cocaine
has stimulated extensive efforts to develop treatment programs
for this type of drug abuse. NIDA's top research priority is
to find a medication to block or greatly reduce the effects
of cocaine, to be used as one part of a comprehensive treatment
program. NIDA-funded researchers are also looking at medications
that help alleviate the severe craving that people in treatment
for cocaine addiction often experience. Several medications
are currently being investigated to test their safety and efficacy
in treating cocaine addiction.
In addition to treatment medications, behavioral interventions,
particularly cognitive behavioral therapy, can be effective
in decreasing drug use by patients in treatment for cocaine
abuse. Providing the optimal combination of treatment services
for each individual is critical to successful treatment outcome.
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