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Cocaine, the most potent stimulant of natural origin, is extracted from the leaves of the coca plant (Erythroxylum coca), which is indigenous to the Andean highlands of South America. Natives in this region chew or brew coca leaves into a tea for refreshment and to relieve fatigue, similar to the customs of chewing tobacco and drinking tea or coffee.
Pure cocaine was first isolated in the 1880s and used as a local anesthetic in eye surgery. It was particularly useful in surgery of the nose and throat because of its ability to provide anesthesia, as well as to constrict blood vessels and limit bleeding. Many of its therapeutic applications are now obsolete due to the development of safer drugs.
Illicit cocaine is usually distributed as a white crystalline powder or as an off-white chunky material. The powder, usually cocaine hydrochloride, is often diluted with a variety of substances, the most common being sugars such as lactose, inositol, and mannitol, and local anesthetics such as lidocaine. The adulteration increases the volume and thus multiplies profits. Cocaine hydrochloride is generally snorted or dissolved in water and injected. It is rarely smoked because it is heat labile (destroyed by high temperatures).
"Crack," the chunk or "rock" form of cocaine, is a ready-to-use freebase. On the illicit market, it is sold in small, inexpensive dosage units that are smoked. Smoking delivers large quantities of cocaine to the lungs, producing effects comparable to intravenous injection. Drug effects are felt almost immediately, are very intense, and are quickly over. Once introduced in the mid-1980s, crack abuse spread rapidly and made the cocaine experience available to anyone with $10 and access to a dealer. In addition to other toxicities associated with cocaine abuse, cocaine smokers suffer from acute respiratory problems including cough, shortness of breath, and severe chest pains with lung trauma and bleeding. It is noteworthy that the emergence of crack was accompanied by a dramatic increase in drug abuse problems and drug-related violence.
The intensity of the psychological effects of cocaine, as with most psychoactive drugs, depends on the dose and rate of entry to the brain. Cocaine reaches the brain through the snorting method in three to five minutes. Intravenous injection of cocaine produces a rush in 15 to 30 seconds, and smoking produces an almost immediate intense experience. The euphoric effects of cocaine are almost indistinguishable from those of amphetamine, although they do not last as long. These intense effects can be followed by a dysphoric crash. To avoid the fatigue and the depression of coming down, frequent repeated doses are taken. Excessive doses of cocaine may lead to seizures and death from respiratory failure, stroke, or heart failure. There is no specific antidote for cocaine overdose.
Cocaine is the second most commonly used illicit drug (following marijuana) in the United States. According to the 2003 National Survey on Drug Use and Health, more than 34 million Americans (14.7%) age 12 or older had used cocaine at least once in their lifetime. There are no drugs approved for replacement-pharmacotherapy (drugs taken on a chronic basis as a substitute for the abused drug, like methadone for heroin addiction). Cocaine addiction treatment relies heavily on psychotherapy and drugs like antidepressants to relieve some of the effects of cocaine abuse.
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