Guidelines on cocaine, the use, the treatment
Cocaine is a white crystalline and smell-less powder (hydrochloride salt) extracted from the leaves of the coca, a plant that grows in the Andean highlands of South America. Its street names in Italy are coke and snow, whereas on the international trade it is also named powder lines, freebase, c, dust, rock, coke, flake and blow. Pure cocaine was isolated by Albert Niemann in 1860. in the ‘80s of that century it was used as an anaesthetic and pain blocker in the eye, nose and throat surgery. Its therapeutic applications fell in disuse after the development of strong drugs without generating dependence. Freud, that experimented it repeatedly, used to call it “magic drug” and he wrote also a song in 1884. Some doctors used to prescribe cocaine as antidote against opium dependence; then they found that also cocaine created dependence and lots of patients used to combine the use of both drugs. In the years immediately after its issue on the market, cocaine became popular as powder or mixed in other product, like wine and cigarettes. In 1886 Coca Cola was born, containing both cocaine and caffeine. The sale remained free in the USA until 1914, when the use was prohibited after registering thousands of cases of dependence and over 5,000 deaths connected with this substance. In the following years the ban was extended all over the world.
- How is cocaine abused?
- How does cocaine affect the brain?
- What adverse effetcs does cocaine have on health?
- How much cocaine is produced and consumed?
1. How is cocaine abused?
Three routes of administration are commonly used for cocaine: snorting, injecting, and smoking. Snorting is the process of inhaling cocaine powder through the nose, where it is absorbed into the bloodstream through the nasal tissues.
Injecting is the use of a needle to insert the drug directly into the bloodstream.
Smoking involves inhaling cocaine vapour or smoke into the lungs, where absorption into the bloodstream is as rapid as it is by injection.
All three methods of cocaine abuse can lead to addiction and other severe health problems, including increasing the risk of contracting HIV/AIDS and other infectious diseases.
The intensity and duration of cocaine’s effects—which include increased energy, reduced fatigue, and mental alertness—depend on the route of drug administration.
The faster cocaine is absorbed into the bloodstream and delivered to the brain, the more intense the high.
Injecting or smoking cocaine produces a quicker, stronger high than snorting.
On the other hand, faster absorption usually means shorter duration of action: the high from snorting cocaine may last 15 to 30 minutes, but the high from smoking may last only 5 to 10 minutes.
In order to sustain the high, a cocaine abuser has to administer the drug again. For this reason, cocaine is sometimes abused in binges—taken repeatedly within a relatively short period of time, at increasingly higher doses.
2. How does cocaine affect the brain?
Cocaine is a strong central nervous system stimulant that increases levels of dopamine, a brain chemical (or neurotransmitter) associated with pleasure and movement, in the brain’s reward circuit. Certain brain cells, or neurons, use dopamine to communicate.
Normally, dopamine is released by a neuron in response to a pleasurable signal (e.g., the smell of good food), and then recycled back into the cell that released it, thus shutting off the signal between neurons.
Cocaine acts by preventing the dopamine from being recycled, causing excessive amounts of the neurotransmitter to build up, amplifying the message to and response of the receiving neuron, and ultimately disrupting normal communication.
It is this excess of dopamine that is responsible for cocaine’s euphoric effects.
With repeated use, cocaine can cause long-term changes in the brain’s reward system and in other brain systems as well, which may eventually lead to addiction. With repeated use, tolerance to the cocaine high also often develops.
Many cocaine abusers report that they seek but fail to achieve as much pleasure as they did from their first exposure.
Some users will increase their dose in an attempt to intensify and prolong the euphoria, but this can also increase the risk of adverse psychological or physiological effects.
3. What adverse effects does cocaine have on health?
Abusing cocaine has a variety of adverse effects on the body. For example, cocaine constricts blood vessels, dilates pupils, and increases body temperature, heart rate, and blood pressure. It can also cause headaches and gastrointestinal complications such as abdominal pain and nausea.
Because cocaine tends to decrease appetite, chronic users can become malnourished as well. Different methods of taking cocaine can produce different adverse effects. Regular intranasal use (snorting) of cocaine, for example, can lead to loss of the sense of smell; nosebleeds; problems with swallowing; hoarseness; and a chronically runny nose. Ingesting cocaine can cause severe bowel gangrene as a result of reduced blood flow.
Injecting cocaine can bring about severe allergic reactions and increased risk for contracting HIV/AIDS and other blood-borne diseases.
Binge-patterned cocaine use may lead to irritability, restlessness, and anxiety. Cocaine abusers can also experience severe paranoia—a temporary state of full-blown paranoid psychosis—in which they lose touch with reality and experience auditory hallucinations.
Regardless of the route or frequency of use, cocaine abusers can experience acute cardiovascular or cerebro-vascular emergencies, such as a heart attack or stroke, which may cause sudden death.
Cocaine-related deaths are often a result of cardiac arrest or seizure followed by respiratory arrest. Poly-drug use—use of more than one drug—is common among substance abusers.
When people consume two or more psychoactive drugs together, such as cocaine and alcohol, they compound the danger each drug poses and unknowingly perform a complex chemical experiment within their bodies.
Researchers have found that the human liver combines cocaine and alcohol to produce a third substance, cocaethylene, which intensifies cocaine’s euphoric effects.
Cocaethylene is associated with a greater risk of sudden death than cocaine alone.
4. How much cocaine is produced and consumed?
Cocaine represents the major worldwide drug after cannabis.
In 2008, the total extension of coke cultivation was 167.600 hectares, with a decrease by 8% in the Andean Region compared with the previous year, thanks to a significant reduction of the plantations in Colombia (-18%), not compensated by the increases in Bolivia (6%) and Peru.
A relevant increase has been registered in the Pacific area and in some minor cultivation areas. The same trend was registered in the estimations of cocaine production, decreased by 15%, from 994 metric tons in 2007 to 845 in 2008.
Colombia remains the major cultivating and producing country. UNODC (United Nations Office on Drugs and Crimes) estimates that, in 2007, there were in the world between 15.6 and 20.8 million cocaine users, equal to 0.4-0.5% of the total population between the age of 15 and 64.
The figures suggest that the major market is based in North America, followed by Western Europe and Central and South America. Since 2000, cocaine prices have been decreasing in Europe, along with the increased use, both among the general population and usual users.
The increased offer, sponsored by drug-dealers searching for an alternative market to the American one, is a key factor of this phenomenon.
The increased sales combined with the stronger European currencies than dollar compensated the decline of the prices and reduced the margins of profit.
In 2007, cocaine seizures were stable, around 710 tons, with 45% in South America, 28% in North America and 11% in Europe.
In this continent, the seizures were growing in the last 20 years, although, in 2007, the number of seizures (92,000) had increased, the quantity of substance decreased (877 tons versus 121 tons of 2006).
Spain has the record in terms of European seizures, both for the number and the quantity, with almost the half of the total.
It is difficult to estimate the actual volume of cocaine on the market, since its illegal and clandestine nature; lots of the figures registered are based on partial and unconfirmed data.
The estimations published are often wrong and far from the actual ones. In 2007, the average purity of street cocaine in Europe varied from 22% and 57% and the average price for a gram (in the 19 countries that were monitoring the data) ranged from 44 to 88 Euros, with an average 58-67 Euros in the half of the countries: this has indicated a constant decrease of the price of street cocaine since 2002.
5. Who are the users?
The table reports the estimations on the cocaine use provided by the European Observatory on Drugs and Drug-addictions of Lisbon, in its Annual Report 2009.
Prevalence of the cocaine use among the European population
|
Period of use |
||
Life |
Last year |
Last month |
|
15–64 years |
|
|
|
Number of users in Europe (estimations) |
13 million |
4 million |
1,5 million |
European average |
3.9 % |
1.2 % |
0.4 % |
Variations |
0.1–8.3 % |
0.0–3.1 % |
0.0–1.1 % |
Countries with minor prevalence |
Romania (0.1 %) |
Romania (0.0 %) |
Czech Republic, Greece, |
Countries with major prevalence |
Spain (8.3 %) |
Spain (3.1 %) |
Spain (1.1 %) |
15-34 years |
|
|
|
Number of users in Europe (Estimations) |
7,5 million |
3 million |
1 million |
European average |
5.6 % |
2.2 % |
0.8 % |
Variation |
0.1–12.0 % |
0.1–5.5 % |
0.0–2.1 % |
Countries with minor prevalence |
Romania (0.1 %) |
Romania (0.1 %) |
Esthonia, Romania (0.0 %) |
Countries with major prevalence |
UK (12.0 %) |
UK (4.5 %) |
UK (2.1 %) |
15-24 years |
|
|
|
Number of users in Europe (Estimations) |
3 million |
1,5 million |
0,6 millio |
European average |
4.4 % |
2.2 % |
0.9 % |
Variation |
0.1–9.9 % |
0.1–5.6 % |
0.0–2.5 % |
Countries with minor prevalence |
Romania (0.1 %) |
Romania (0.1 %) |
Esthonia, Romania (0.0 %) |
Countries with major prevalence |
UK (9.9 %) |
Denmark (5.6 %) |
UK (2.5 %) |
The estimations of prevalence are based on the most recent National surveys, between 2001 and 2008, for which a year is not indicated |
|||
In Europe all patients with cocaine abuse ask for treatment at local surgeries, although some of them are probably treated in private clinics.
These patients have the major gap between men and women (5:1) and the highest age average (about 32 years) among drug-addicts in general.
This occurs mainly in countries with the highest number of users for whom cocaine is the primary drug, especially in Italy, where the relation man-woman is 8:1 and the average age is 35 years.
In Spain, Italy and Ireland there is a long interval (9-12) between the beginning of the use and the beginning of the treatment.
Most of the patients snort (55%) or smoke (32%), whereas less than 7% inject it.
A survey, conducted in 14 countries in 2006, revealed that about 63% of cocaine users usually practice poly-abuse.
Among them, 42% also abuse alcohol, 28% abuse cannabis and 16% heroin. Cocaine is also often mentioned as secondary drug, especially by patients with heroin abuse problems (28%).
There are two main groups of patients treated for cocaine abuse: individuals socially integrated that abuse cocaine in powder and marginalized people that abuse cocaine in the form of crack, combined with opioids.
The former group usually snorts it, sometimes along with alcohol or cannabis, but not opiates.
The latter injects it, abuse both cocaine and opiates, sometimes smokes crack and is in severe health and social conditions.
Lots of them enter a treatment by decision of justice authorities.
6. What treatment options exist?
Behavioural interventions—particularly, cognitive-behavioural therapy—have been shown to be effective for decreasing cocaine use and preventing relapse. Treatment must be tailored to the individual patient’s needs in order to optimize outcomes—this often involves a combination of treatment, social supports, and other services.
Currently, there are no FDA-approved medications for treating cocaine addiction; thus, developing a medication to treat cocaine and other forms of addiction remains one of NIDA’s top research priorities.
Researchers are seeking to develop medications that help alleviate the severe craving associated with cocaine addiction, as well as medications that counteract cocaine-related relapse triggers, such as stress.
Several compounds are currently being investigated for their safety and efficacy, including a vaccine that would sequester cocaine in the bloodstream and prevent it from reaching the brain.
Current research suggests that while medications are effective in treating addiction, combining them with a comprehensive behavioural therapy program is the most effective method to reduce drug use in the long term.
Some countries are trying to solve the problem and 11, including Italy, show the existence, along with the traditional services, of treatment programmes for cocaine addicts, although there are discrepancies among experts about the availability of these services. Ireland, Italy and Spain have realized specific strategies and programmes for cocaine addicts. In Italy, the National cocaine project started in 2007 has set specialized services, opening (after working hours) according to the needs of the cocaine addicts and their families.
7. Sources
United Nations Office on Drugs and Crimes (UNODC) World Health Organization (WHO) European Observatory on Drugs and Drug-addictions (EODDA) National Institute on Drug Abuse, United States (NIDA)8. Useful Links
In Italy
Board of Ministers, Drug Department
http://www.politicheantidroga.it/
Osservatorio Fumo, Alcol e Droga dell’Istituto Superiore di Sanità (OSSFAD)
(Observatory on Smoke, Alcohol and Drug of the High Health Institute)
http://www.iss.it/ofad/index.php?lang=1
Ministry of the Interior
http://www.interno.it/mininterno/export/sites/default/it/temi/droga/
In the word
World Health Organization (WHO)
http://www.who.int
United Nations Office on Drug and Crime (UNODC)
http://www.unodc.org
Treatnet (international network of treatment and rehabilitation centres)
http://www.unodc.org/treatment/en/index.html
European Observatory on Drugs and Drug-addictions (EMCDDA)
http://www.emcdda.europa.eu/html.cfm/index190EN.html
National Institute on Drug Abuse, USA
http://www.nida.nih.gov
about cocaine
http://www.nida.nih.gov/DrugPages/Cocaine.html