2. Scope of the Problem of Cocaine Use
Disorders
Between 0.3 and 0.4% of the world’s population have used cocaine in the last
year.
In the United States, adults between 18 and 25 years of age are three times
as likely to use cocaine as any other age group.
Contrary to mass media campaigns, cocaine is not automatically addictive.
Perhaps 15% of those who begin to use cocaine will ultimately become
addicted, and 28% become regular users.
3. Pharmacology of Cocaine
When snorted or injected effects are short-lived, lasting only about 30-90
minutes.
Cocaine forces the release of dopamine, affecting the brain’s reward center.
Tolerance to euphoria develops quickly, leading to different (dangerous)
methods to get more effect.
Cocaine abusers are known to become depressed after its use.
4. Drug Interactions Involving Cocaine
There has been little research into cocaine–pharmaceutical interactions.
Abusers may turn to other chemicals to control the unwanted side effects of
their cocaine use.
Using cocaine and alcohol at the same time may be life threatening for a
number of reasons.
It is not uncommon for cocaine abusers to use both cocaine and a narcotic
together (speedballing).
5. Methods of Cocaine Misuse (1 of 4)
Snorting, injection, smoking, or sublingual ingestion
Insufflation (snorting) began in 1903; those who snort
cocaine usually arrange the powder on a piece of glass in
a thin line. One gram of cocaine will usually yield around
30 lines of cocaine.
Only about 60% of the cocaine inhaled this way is
absorbed. Because it is a vasoconstrictor, which makes it
even more difficult to abuse in this way.
Biotransformation results in 70–80% of snorted cocaine
not reaching the brain.
6. Methods of Cocaine Misuse (2 of 4)
Intravenous cocaine administration
It is possible to mix the cocaine powder with water and inject it.
Intravenously administered cocaine reaches the brain in under 30 seconds, and
virtually all of the injected cocaine will be absorbed into the user’s body.
Sublingual cocaine misuse
An unknown percentage of the cocaine is absorbed in this way.
7. Subjective Effects of Misused Cocaine
Several factors influence the subjective experience of cocaine abuse:
The individual’s expectations
The dose and purity
The physiological effects
Tolerance develops rapidly, which can lead to massive amounts of usage
(“Coke run”) followed by depression that elevate to suicidal levels.
8. Complications of Cocaine Misuse and
Cocaine Use Disorder
Cocaine abuse is a factor in 40–50% of all deaths associated with illicit drug
use, and it leads to physical addiction within 1 year among 6% of people who
use it.
Respiratory system problems
Chest pain, cough, and damage to lungs
Observed increase in the number of fatal asthma cases
“Crack lung” and pneumothorax
“Snorters” may experience sore throat, inflamed sinuses, bleeding from the sinuses,
hoarseness, and a breakdown in the cartilage in the nose
9. Complications of Cocaine Misuse and
Cocaine Use Disorder
Cardiovascular system damage
Cocaine misuse leads to the buildup of plaque in the coronary arteries of abusers
18 to 45 years of age.
Cocaine results in several coronary symptoms, including severe hypertension,
coronary artery dissection, and sudden cardiac death.
Cocaine has been found to be directly toxic to the muscle tissues of the heart and
interferes with cardiac electric activity.
10. Complications of Cocaine Misuse and
Cocaine Use Disorder
Digestive system damage
May cause liver disease
Other bowel issues, including decreased gastric motility, perforation of the bowel,
and bowel ischemia
Cocaine misuse and CNS damage
Causes a reduction in cerebral blood flow in at least 50% of those who abuse it
Cognitive skill deficits and increased risk of stroke
11. Complications of Cocaine Misuse and
Cocaine Use Disorder
Cocaine’s effects on emotions and perceptions
May experience some degree of depression and/or anxiety and increased risk of
homicide and suicide
Can exacerbate symptoms of Tourette’s syndrome and tardive dyskinesia
May develop hallucinations
Drug induced psychosis similar to that seen in schizophrenia—“coke paranoia”
12. Complications of Cocaine Misuse and
Cocaine Use Disorder
Cocaine withdrawal
May experience deep depression within 15 minutes after last use
Fatigue, vivid and intense dreams, sleep disorders (both insomnia and
hypersomnia), anorexia, and psychomotor agitation or retardation
Occult insomnia—sleeping less than one realizes; associated with relapse
