COCAINE

1. COCAINE T.O Phase I

2. What is Cocaine and where did it come from? • Cocaine is a stimulant: • A drug that keeps you going mentally and physically when you should be tired. • Cocaine comes from the Coca plant. The first use of cocaine was documented in 3000 BC in present-day South America in and around Peru. The Incas would chew the leaf and hold the ball of the coca in their mouths. • This allowed them to run or carry bundles long distances.

3. Early uses of Cocaine • In 1885, Parke-Davis Pharmaceuticals claimed that cocaine could: ‘supply the place of food, make the coward brave, and silence the eloquent.’ • During the start of the 20th century, cocaine was used as a ‘secret’ ingredient in many potent medicines and was advertised as having beneficial effects (see above). • Freud used cocaine as a medication to treat depression and morphine dependence. However, when using cocaine to treat a patient with morphine dependence, the patient experienced cocaine psychosis. Freud then stopped using cocaine to treat his patients.

4. Uses of cocaine today • Cocaine is a schedule II drug – that is, a drug with a high potential for abuse, but with some approved medical uses. • Cocaine is absorbed well into mucous membranes and is sometimes used today as a local anesthetic for nose and throat surgeries.

5. Legal controls on Cocaine • Between 1887 and 1914, 46 states passed laws to regulate the distribution and use of cocaine. • Cocaine was federally regulated in 1914 by the Harrison Act, which banned all non-medical uses of cocaine. This act also prohibited the importation of cocaine and advocated for criminal penalties for those using, or facilitating use (selling). • Now, the penalty for cocaine users was the same as the penalty for those using opium, morphine, and heroin. • For practitioners- strict accounting and limitations were enforced.

6. Legal Controls contd. • 1973 Governor Nelson Rockefeller- pushed through the state legislature a set of anti-drug laws among the most severe in the nation. The purpose was to deter citizens from using or selling drugs and to isolate from society those who were not deterred. • Generally, statutes require judges to impose sentences of 15 years to life for anyone convicted of selling two ounces or possessing four ounces of ‘narcotic drugs,’ typically cocaine or heroin. • In 1979, the legislature amended the laws to increase the amount of drug needed to trigger the 15 to life sentence. • In 1988, concern over crack led to a lowering of the weight threshold for cocaine possession; thus enabling the arrest and prosecution of people possessing small amounts of the drug. Today, these laws remain basically unchanged.

7. Legal controls contd. • Anti-drug abuse act of 1986- Targeted high level crack dealers and manufacturers. • Created and 100:1 quantity ratio between the amounts of crack/cocaine needed to trigger sentences for trafficking cocaine. Ex: If you are convicted of selling 5g/crack, you are required to serve a minimum of 5 years in prison. • To get the same sentence for cocaine, possession of 500g is needed. • In 1988, the act was amended to include first time offenders.

8. How does cocaine work in the body? • All forms of cocaine are highly addictive. As with most mind-altering substances, their greatest impact is on the brain and how it works. • Cocaine blocks the reuptake of the neurotransmitters dopamine, norepinephrine, and serotonin. According to National Institute of Health (1999), Researchers have discovered that, when a pleasurable event is occurring, it is accompanied by a large increase in the amounts of dopamine released in nucleus accumbens by neurons. In the normal communication process, dopamine is released by a neuron into the synapse where it binds with specialized proteins on the neighboring neuron, thereby sending a signal to that neuron. Drugs of abuse are able to interfere with this normal communication process. Scientists have found that cocaine blocks the removal of dopamine from the synapse, resulting in an increase in an accumulation of dopamine. This buildup of dopamine causes continuous stimulation of receiving neurons, probably resulting in the euphoria reported by cocaine users.

9. What did she just say? • In other words, dopamine affects the pleasure center of the brain. When cocaine is used, it interrupts the neurons’ reabsorption of dopamine causing the dopamine to remain in the brain for a longer period of time. • This causes intense, pleasurable effects. As cocaine use is continued, the amount of dopamine produced by the brain decreases. When cocaine use is discontinued, the brain must reestablish normal levels of dopamine production. • However, when there are lower than normal levels of dopamine in the brain, the individual will experience intense, unpleasant effects such as fatigue, irritability, and depression.

10. Other effects of cocaine in the body • Cocaine is generally used either intranasally (snorted) or I.V. (injected). • Snorting is used with the intention of getting very fine hydrochloride powder high into the nasal passages. From there, it is absorbed rapidly and reaches the brain quickly (about 5 minutes). • I.V. use- delivers a very high concentration of the drug to the brain, producing a rapid and brief effect. The same effects are produced when smoking crack. The user can feel the effects in as little as 30 seconds.

11. Effects of short term use • Acute toxicity- acute cocaine poisoning leads to profound CNS stimulation, progresses to convulsions, and can lead to respiratory or cardiac arrest. This is similar to an overdose of amphetamines, however, cocaine has a greater individual variation, making it harder to estimate a lethal dose. • Some severe and unpredictable toxic reactions can occur. Cocaine can trigger a chaotic heart rhythm called ventricular fibrillation. This prevents the vagus nerve from controlling the heartbeat. • IV cocaine users can experience allergic reactions to either the drug, or some additive in the drug. The lungs fill rapidly with fluid and death can occur. • Users may also experience decreased appetite, increased energy, dilated pupils, and constricted blood vessels.

12. Long term effects • Chronic toxicity- regular snorting of cocaine can irritate the nasal septum. This leads to a chronically inflamed, runny nose. Nosebleeds will often occur as well. • Long term users can experience irritability, restlessness, paranoia, auditory hallucinations, cocaine psychosis, and addiction. • Cocaine psychosis- mirrors paranoid schizophrenia. Users can experience delusions, hallucinations, and lose touch with reality. Most times, the individual recovers as the drug leaves the system. However, this is not always the case.

13. Medical complications • Cardiovascular Effects • Respiratory Effects • Neurological Effects • Gastrointestinal Complications • Death Other Physical Symptoms • Nausea • Chest Pain • Blurred Vision • Muscle Spasms • Convulsions • Coma

14. What happens if cocaine is mixed with other chemicals? • Polysubstance abuse can have deadly results. • When cocaine and alcohol are mixed, the liver combines them and produces a third substance known as cocaethylene. • This substance moves to the brain and creates effects similar to those of cocaine, but more harmful. • These effects can include; increased aggression, anxiety, violence, hypertension, cardiovascular problems, and death. • Mixing cocaine with OTC meds, marijuana, heroin, ecstasy, or inhalants can also be deadly. The intervention process becomes complicated due to the powerful physiological, cognitive, behavioral, and interpersonal effects.

15. So how many people have actually experienced these effects? • According to the Office of National Drug Control Policy, medical examiners noted cocaine 4,864 times in drug-related deaths during 1999. This made cocaine the most frequently reported drug that year. • In 2000, admissions to U.S. hospital ERs accounted for 29% of all substance related admissions. • During 2000 alone, there were 174,881 ER admissions in the U.S. that involved cocaine in some way. • From January to June of 2001, there were 96,125 mentions of cocaine in ERs. • This makes cocaine the most frequently mentioned illicit substance in medical ER settings.

16. Who’s using cocaine? • According to the 2000 National Household Survey on Drug Abuse, about 11% of Americans ages 12 and over reported using cocaine at least once during their lifetime. 1.5% reported this use occurred within the previous year. • 0.5% (1,213,000) of individuals 12 and over reported they were currently using cocaine. • In 2006, 6 million Americans ages 12 and over reported abusing cocaine in any form, 1.5 million abused crack at least once in the year prior to being surveyed. • 2007 NIDA survey: 2.0% of 8th graders, 3.4% of 10th graders, and 5.2% of 12th graders had abused cocaine in any form and 1.3% of 8th graders, 1.3% of 10th graders, and 1.9% of 12th graders had abused crack at least once in the year prior to being surveyed.

17. Who’s using cocaine contd. • The National Institute of Health reports cocaine use is highest among men and those persons 18 to 25 years old. • Ethnically, results show African Americans have the highest use, followed by Hispanics, with Caucasians using the least.

18. So what have we learned? • Cocaine in any form is highly addictive. • Cocaine has many harmful short and long term effects; it can even kill you. • Polysubstance abuse can cause death and has many negative physiological and psychological effects. ‘We may do whatever we like; we must only be prepared to face the consequences.’