Cocaine

Cocaine belongs to a group of drugs known as "stimulants". Stimulants speed up the messages going between the body and the brain.
Cocaine is extracted from the leaves of the coca bush (Erythroxylum coca), which is native to South America. The coca leaf extract is then processed to create cocaine hydrochloride, freebase and crack.

The leaves of the coca bush have long been chewed and brewed into tea by indigenous people in South America for its stimulant and appetite suppressant properties. Cocaine has been used in a range of energy providing medicines, foods and drinks. It has also been used as a local anesthetic.

What does it look like?

The most common from of cocaine is cocaine hydrochloride. This is a white, crystalline powder with a bitter, numbing taste.

Cocaine hydrochloride can be further processed to produce cocaine base, known as "freebase" and "crack". Freebase is a white powder, while crack generally comes in the form of crystals that range in color from white or creamy color to transparent with a pink or yellow hue.

Cocaine hydrochloride is often mixed, or "cut", with other substances such as lactose and glucose, to dilute it before being sold.

How is it used?

Cocaine hydrochloride is most commonly "snorted" (sniffed through the nose). It can also be injected. Some people rub it into their gums, where it is absorbed into the bloodstream. Others add it to a drink or food. Freebase and crack are usually smoked.

Street names

C, coke, nose candy, snow, white lady, toot, Charlie, blow, white dust and stardust. Freebase is also known as base, and crack is sometimes referred to as rock or wash.

Effects of cocaine

Immediate effects

The effects of cocaine can last anywhere from a few minutes to a couple of hours, depending on how the cocaine is taken and the person taking it. When the immediate "rush" of the cocaine has worn off, the person may experience a "crash". Other immediate effects that may be experienced include:

• increased body temperature and heart rate
• enlarged pupils
• dry mouth
• increased breathing rate
• anxiety, agitation and panic
• paranoia
• unpredictable violent/aggressive behavior
• increased blood pressure and heart rate (after initial slowing)
• reduced appetite

In greater quantities

The immediate effects of cocaine intensify when the drug is taken in greater quantities. People may also experience tremors, muscle twitches, nausea and vomiting, rapid and weak pulse, arrhythmia, chest pain, heart attack, hyperthermia, seizures and stroke.

High quantities and frequent, heavy and long-term use of cocaine can lead to a "cocaine psychosis", which is characterized by paranoid delusions, hallucinations, bizarre, aggressive or violent behavior. These symptoms usually stop a few days after the person takes cocaine, although some people may need treatment. Some people take cocaine in high-dose "binges", which means that they take cocaine repetitively over several hours or days. The binge is followed by the "crash", whereby a person experiences feelings of intense depression, lethargy and hunger.

Overdose

The risk of overdose is high, since the strength and mix of street cocaine is usually unknown. An overdose of cocaine can result in increased heart rate and body temperature, seizures, heart attack, brain hemorrhage, kidney failure, stroke and repeated convulsions. All of these can lead to coma and death.

Long-term effects

Long-term effects of cocaine use include:

• insomnia
• depression
• anxiety, paranoia and psychosis
• eating disorders and weight loss
• sexual dysfunction
• hypertension and irregular heart beat
• sensitivity to light and sound
• hallucinations - some people may even experience sensations of insects crawling under the skin

Some of the other long-term effects of cocaine are related to the method of using cocaine:

• Repeated snorting damages the lining of the nose and nasal passages, and can also damage the structure separating the nostrils.
• Smoking crack cocaine can cause breathing difficulties, chronic cough, bronchitis and other respiratory problems.
• Cocaine is "cut" with substances that are poisonous when injected. They can cause collapsed veins, abscesses and damage to the heart, liver and brain.
• If injected into the skin cocaine can cause severe vasoconstriction, which may prevent blood flowing to the tissue, potentially resulting in severe tissue damage.

Tolerance and dependence

People who use cocaine can develop a tolerance to the euphoric effects of cocaine very quickly. This makes it necessary to take more and more cocaine to get the same effect.

In contrast, some people who use cocaine regularly may develop a "reverse tolerance", whereby they experience the adverse effects of cocaine more intensely.

Dependence on a drug can be psychological, physiological, or both.

A person who is psychologically dependent on cocaine finds that using cocaine becomes more important than other activities in their life. Because of its powerful euphoric effects, people who use cocaine may develop a strong psychological dependence upon it.

Physical dependence on a drug occurs when a person gets used to functioning with the drug present. It is less clear as to whether it is possible to develop a physiological dependence on cocaine.

Withdrawal

If a person who is dependent on cocaine suddenly stops taking it, or significantly cuts down the amount they are using, they can experience withdrawal symptoms.

Cocaine withdrawal generally occurs in three phases: the "crash", the "withdrawal" and the "extinction".

The crash, which usually occurs in the first few days, describes the withdrawal symptoms experienced immediately after the person stops using cocaine. Symptoms can include:

• agitation
• depression or anxiety
• feelings of intense hunger
• intense craving for cocaine
• insomnia or prolonged, but disturbed, sleep
• extreme fatigue and exhaustion.

The withdrawal phase may last up to ten weeks. During this phase, people experience severe cravings for cocaine. Other withdrawal symptoms during this phase include:

• lack of energy 
• an inability to feel pleasure
• anxiety
• angry outbursts

The extinction phase may last indefinitely. It involves intermittent cravings for cocaine. These generally occur in response to people, places or objects that are conditioned cues and provoke memories of taking the drug. These cravings may surface months or years after cocaine use has stopped.

Cocaine, hepatitis and HIV

Sharing needles, syringes and other injecting equipment greatly increases the risk of contracting blood borne viruses such as hepatitis B and hepatitis C and HIV (Human Immunodeficiency Virus—the virus that causes AIDS).

What to do in a crisis

If someone overdoses or has an adverse reaction while using cocaine it is very important that they receive professional help as soon as possible. A quick response can save their life.

• Call an ambulance. Dial 000. Don't delay because you think you or the person might get into trouble. Ambulance officers are not obliged to involve the police.
• Stay with the person until the ambulance arrives. Find out if anyone at the scene knows mouth-to-mouth resuscitation or cardiopulmonary resuscitation (CPR).
• Ensure that the person has adequate air by keeping crowds back and opening windows. Loosen tight clothing.
• If the person is unconscious, don’t leave them on their back - they could choke. Turn them on their side and into the recovery position. Gently tilt their head back so their tongue does not block the airway.
• If the person has stopped breathing, give mouth-to-mouth resuscitation. If there is no pulse, apply CPR.
• Provide the ambulance officers with as much information as you can - how much cocaine was taken, how long ago, and any pre-existing medical conditions.
• Plan to know what to do in a crisis.

•  For more information on the risks of cocaine-related harm, contact the alcohol and drug information service in your state or territory.