Cocaine is derived from the cocoa plant which is found primarily in South America. South America accounts for 95% of the world’s production of cocaine, while the United States accounts for 70% of the world’s consumption. The drug was first separated from the plant in 1865. Going back to prehistoric times the natives chewed the leaves of the cocoa plant for energy and alertness.
Processed cocaine is an odorless, white, fluffy powder. For recreational use it is most often snorted so that it is absorbed through the mucous membranes of the nose. Other users inject the drug intravenously or smoke it in it’s solid rock form (crack).
Cocaine brings on a euphoric rush of well-being and confidence. At first cocaine stimulates the higher centers of the central nervous system making users feel excited, energetic, talkative, and euphoric. As more is taken it stimulates other areas of the central nervous system, producing a faster pulse, higher blood pressure, faster and deeper breathing, and further arousal and wakefulness.
As the effects of cocaine subside the user experiences a depression like letdown popularly known as “crashing”. This may include headaches dizziness or even fainting. For occasional users the aftereffects disappear within 24 hours, but they may last longer for people who have taken very high doses.
Cocaine produces these effects largely by increasing the supplies of the neurotransmitter dopamine. In addition cocaine appears to increase activity of the chemicals norepinephrine and serotonin.
High doses of the drug can cause cocaine intoxication, whose symptoms are poor muscle coordination, feeling of grandiosity, bad judgment, anger, aggression, anxiety, and confusion. Some people experience hallucinations or delusions or both, a condition known as cocaine-induced psychotic disorder.
Cocaine use in the United States
The following statistics are from the 2005 National Survey on Drug Use & Health (NSDUH) for the age group 12 years and older.
• Approximately 33.7 million Americans have tried cocaine at least once in their lifetimes, representing 13.8% of the 12 years and older population.
• Approximately 5.5 million (2.3%) used cocaine in the past year and 2.4 million (1%) used cocaine in the past month.
• The incidence of cocaine use generally rose throughout the 1970s to a peak in 1980 (1.7 million new users) and subsequently declined until 1991 (0.7 million new users). Cocaine initiation steadily increased during the 1990s, reaching 1.2 million in 2001.
• Within the past 12 months of the time the survey was taken, 872,000 persons used cocaine for the first time. That is a statistically significant reduction from 2002 when there were more than 1 million past-year cocaine initiates
Cocaine abuse is associated with numerous detrimental health effects. All organ systems can be adversely affected by its use. Cocaine-related psychiatric disorders have been well-documented in the literature. Ten cocaine-induced psychiatric disorders are described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR )1 . These cocaine-induced disorders include the following:
• Cocaine intoxication
• Cocaine withdrawal
• Cocaine intoxication delirium
• Cocaine-induced psychotic disorder with delusions
• Cocaine-induced psychotic disorder with hallucinations
• Cocaine-induced mood disorder
• Cocaine-induced anxiety disorder
• Cocaine-induced sexual dysfunction
• Cocaine-induced sleep disorder
• Cocaine-related disorder not otherwise specified
Mortality related to Cocaine Use
The Drug Abuse Warning Network (DAWN) reports drug-related deaths. For 2003, 122 jurisdictions in 35 metropolitan areas and 6 states submitted mortality data to DAWN.
• In drug misuse deaths, cocaine was among the top 5 drugs in 28 of the 32 metropolitan areas and in all of the 6 states.
• On average, cocaine alone or in combination with other drugs was reported in 39% of drug misuse deaths.
• The etiologies of some of the deaths associated with cocaine abuse include cardiac dysrhythmias, myocardial infarctions, intractable seizures, strokes, and aortic dissection.
Race
• In the 2005 Youth Risk Behavior Survey, Hispanic and white students were significantly more likely than African American students to report lifetime cocaine use (12.2% and 7.7%, respectively, vs 2.3%).
• The 1999 Drug Abuse Warning Network data reported cocaine as an agent in 59%, 36%, and 35% of drug-related emergency department visits among African Americans, Hispanics, and whites, respectively.
Sex
In the 2005 National Youth Risk Behavior Survey, 8.4% of males and 6.8% of females had used cocaine at least once in 2005. According to DAWN, males are disproportionately represented among deaths related to drug misuse or abuse. After adjusting for population size, the rate of drug misuse deaths per 1,000,000 population for males was 2.4 that for females.
Age
Among students surveyed as part of the 2006 Monitoring the Future study, 3.4% of eighth graders, 4.8% of tenth graders, and 8.5% of twelfth graders reported lifetime use of cocaine. Approximately 8.8% of college students and 14.3% of young adults (aged 19-28) surveyed in 2005 reported lifetime use of cocaine.
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