Cocaine is derived from leaves of the coca plant, which thrives in the Andes Mountains of South America. Colombia produces most of the world’s cocaine today. Thousands of years ago, natives chewed coca leaves or drank tea or wine made from the leaves to relieve tiredness and hunger. Some cultures employed coca in religious practices. Spanish conquerors introduced Europeans to coca usage, but it never enjoyed widespread popularity in that form.
Dr. Clif CleavelandCocaine was first isolated from coca in 1855. Use of the drug became widespread after drug companies perfected mass production. In an 1884 essay, Sigmund Freud wrote of the drug’s value in treating depression. Cocaine became a common component of many over-the-counter tonics. Syringes filled with cocaine could be ordered from a Sears catalog. Coca-Cola included small concentrations of cocaine in its syrup from 1886 to 1903. Addiction to cocaine became a burgeoning public health problem with little legislative response to the issue.
Regulation began with the Pure Food and Drug Act of 1914, which required accurate labeling of medicinal products. The Harrison Act of 1914 regulated the importation and manufacture of opiates and cocaine and banned use of the drugs for treating addicts. Further limitation of these drugs followed in 1922 with the passage of the Narcotics and Drugs Import and Export Act, which ended nonmedicinal use of cocaine. This measure established a Federal Narcotics Control Board, launching more vigorous national enforcement of drug laws.
Today, legal use of cocaine is limited to local anesthesia in hospitals or outpatient surgical centers.
Illicit use of cocaine resurged in the 1980s. Affluent users snorted “lines” of powered cocaine. Poor street users injected dissolved cocaine or smoked or snorted a crystallized form of the drug (“crack”), which was more rapidly effective. Highly purified, freebase cocaine was the most potent product available, causing almost immediate effects. Trafficking in cocaine led to clashes among gangs in cities.
Cocaine rapidly enters the brain when injected, smoked or snorted. The drug blocks the re-uptake of the neurotransmitter dopamine, which causes euphoria and heightened awareness and activity levels. Concentrations of serotonin, norepinephrine and other brain chemicals are increased. The high lasts from minutes to half an hour and is followed by an intense craving for more drug. A regular user may experience hallucinations and delusions. Drug-seeking becomes the dominant activity of an addict. Violent behavior characterizes withdrawal.
Cocaine raises blood pressure, increases pulse rate and raises bodily temperature. Overdose may lead to dangerous cardiac arrhythmias, heart attack or stroke. Temperature may rise dangerously. Use of shared, nonsterile needles increases the risk of HIV, hepatitis and bacterial infections, especially of heart valves.
In recent years, cocaine has often been laced with levamisole, a veterinary medication. The mixture causes severe skin damage and blocks white blood cell production.
Although its use is declining, cocaine accounted for more than 10,000 of the estimated 64,000 deaths due to drug overdose in 2016.
Combining cocaine with heroin increases the risk of a fatal outcome.
Chronic use of cocaine reduces gray matter in the brain, especially in the frontal area where decision-making and emotional control are based. Months of abstinence are required for a return of functional brain scans to normal.
Babies born to mothers who used cocaine during pregnancy are at risk of behavioral and cognitive problems later in childhood.
No specific drugs have been approved to treat cocaine withdrawal, overdosage or addiction. Structured inpatient or outpatient programs offer the best hope for recovery. Such programs are expensive. Many small towns and rural areas lack treatment facilities. States that choose to slash Medicaid programs reduce treatment options for their addicted residents.
Despite greater publicity for addiction to opiates, cocaine remains the second most frequently used illicit drug, behind cannabis. A national survey in 2012 indicated that almost 5 million Americans age 12 and over had used cocaine in the previous year. Thirty-eight million acknowledged use of the drug at some point in their lives.
Prevention of addiction to drugs – whether cocaine, methamphetamine or opiates – requires educational programs from kindergarten forward. High school is too late. Attitudes of risk-taking may already be ingrained by that age. Ideally, every school year’s health-education curriculum should include a segment on the dangers related to drug experimentation and use.
Clif Cleaveland, M.D., is a retired internist and former president of the American College of Physicians. Email him at ccleaveland@timesfreepress.com.