Cocaine—also known on the street by slang terms like coke, blow, snow, or powder—is an alkaloid featuring local anesthetic action on the peripheral nervous system and potent stimulation of the central nervous system (CNS). It is derived from the leaves of the coca plant (Erythroxylum coca), native to the Andes region and cultivated across South America, Indonesia, and parts of Africa.
What do we know about cocaine, its effects, and its risks?
Chemical processing of coca leaves yields several derivative forms:
- COCAINE SULFATE: Coca paste, also known as basuko or bazooka. Coca paste is an intermediate byproduct in cocaine hydrochloride synthesis, containing approximately 50% cocaine sulfate along with other alkaloids and refining contaminants such as kerosene and sulfuric acid.
- COCAINE HYDROCHLORIDE: Commonly referred to as cocaine, this is the primary form of consumption. Refining coca paste yields cocaine hydrochloride—an odorless, bitter, white crystalline powder easily absorbed through mucous membranes. It is typically snorted, though it can also be administered intravenously or smoked.
- FREEBASE COCAINE / CRACK: The white powder is dissolved in distilled water and mixed with an alkaline substance, such as sodium bicarbonate, causing cocaine crystals to precipitate. As an interesting note, the name “crack” stems from the crackling sound crystals produce when heated and smoked through a pipe.
In our experience within nightlife and recreational settings, the most prevalent route of cocaine consumption is nasal (“snorting”). Occasionally, smoked consumption is observed by coating cigarettes in cocaine powder.
Pharmacokinetics show that cocaine rapidly crosses body membranes, including placental and blood-brain barriers. Absorption, peak plasma concentrations, bioavailability, and blood levels depend on the pharmacological form and administration route. With nasal inhalation, onset typically occurs within 10 minutes, peaking at 30 minutes, and wearing off around 60 minutes.
What are the sought-after effects?
- Motor, verbal, and cognitive hyperactivity.
- Increased sense of energy and mental alertness.
- Appetite suppression and reduced fatigue.
- Insomnia.
- Euphoria, empathy, and entactogenic feelings.
- Increased sociability and disinhibition.
- Heightened libido.
However, as with any substance, use carries risk. Regarding toxicity—keeping in mind that the route of administration impacts absorption rate and intensity—the following clinical manifestations may be observed:
- MILD TO MODERATE TOXICITY PRESENTATION:
- Excitement, restlessness, incoherent speech, tachycardia, mydriasis (dilated pupils), hypertension, nausea (sometimes vomiting), tremors, diaphoresis (sweating), hyperthermia.
- PSYCHOLOGICAL EFFECTS:
- Prominent psychological effects include heightened euphoria and sociability.
- Variable symptoms: anxiety, irritability, dysphoria, grandiosity, impaired judgment, psychomotor agitation, hypervigilance (potentially progressing to cocaine-induced psychosis with hallucinations and delusions), and post-use depression (“crash”).
- Cocaine-induced psychosis.
- SEVERE COMPLICATIONS:
- Severe complications typically result from high doses, prolonged use, or co-ingestion with other substances:
- Severe hyperthermia, DIC (disseminated intravascular coagulation), renal failure, seizures, coma, respiratory arrest, and death.
- Extreme tachycardia, arrhythmias, heart failure, myocardial ischemia/infarction, and ventricular fibrillation.
- Cerebral hemorrhage and ischemic stroke preceded by severe headache.
FIRST AID AND CLINICAL MANAGEMENT FOR COCAINE TOXICITY
- GENERAL MEASURES
- Assess vital signs and ensure airway patentcy.
- Perform basic CPR if indicated. Administer high-flow oxygen, providing endotracheal intubation and mechanical ventilation if necessary.
- Urgent transfer to an emergency medical center.
- ECG monitoring and continuous pulse oximetry.
- Reassure the patient and move them to a quiet, low-stimulus environment.
