Cocaine and Crack

By Paige Bierma, M.A.

When Len Bias, a 22-year-old University of Maryland basketball star, died of cardiac arrest after a cocaine overdose in 1986, some observers felt the tragedy might warn other youth off this stimulant. Whether that happened is unclear. Soon after the basketball player's death, there was demand for a type of cocaine known on the street as "Len Bias." And cocaine was involved in 448,481 emergency room visits in 2005 -- more than any other drug -- almost triple the number reported in 1997, according to the Drug Abuse Warning Network.

Cocaine is popular because it often gives users feelings of tremendous energy, confidence and illusions of invincibility, and euphoria. But its risks are incredibly high, including irregular heartbeat, brain seizures, hypertension, heart attack, stroke, addiction, stimulant-induced psychosis, and, in rare cases, even death.

What is cocaine?

Cocaine, along with amphetamines, is the most widely used illegal stimulant. Derived from coca bushes (primarily in Peru and Bolivia), it's usually processed as a white powdery substance known as "coke," "snow," "blow," or "Colombian marching powder."

South Americans have chewed cocaine in its milder leaf form for thousands of years. In the United States, cocaine was used in various medicines -- and even in Coca-Cola -- during the late 1800s until reports of abuse and death prompted a ban under the 1914 Harrison Narcotic Act. Doctors occasionally still use powder cocaine as a local anesthetic, but non-medical use is illegal.

Cocaine abuse reached its peak in 1982, when the National Household Survey on Drug Abuse (NHSDA) revealed that 10.4 million Americans said they had used it. According to the survey, now called the National Survey on Drug Use and Health, the number of Americans using cocaine dropped to 2.1 million in 2007. Use among the young increased in the late 1990s, but has leveled off in recent years. The University of Michigan's Monitoring the Future survey found that 4.4 percent of high school seniors had used cocaine in 2008.

As with heroin and some other illicit drugs, the stakes are higher today. Cocaine available on the street now is much more concentrated and addictive than the coke used in the early 80s. In her role as associate chief of substance abuse in the biological psychiatry laboratory the Harvard-affiliated McLean Hospital, Dr. Amanda Gruber says some parents tell her they aren't terribly worried about their children trying cocaine because in their youth they used it occasionally and without serious problems. What they don't realize, she says, is that due to cocaine's potency today, young users are more likely to become addicted and to suffer serious health problems, both short- and long-term.

How is cocaine manufactured and used?

Users usually either inhale cocaine through the nose (known as snorting) or inject it. Both methods take the drug directly into the bloodstream and produce an immediate high that can last 10 to 30 minutes. Street dealers generally dilute pure cocaine with cornstarch, talcum powder, sugar, or other drugs such as amphetamines or procaine (a chemically-related local anesthetic).

"Free-basing" cocaine is a method of using chemicals such as ether to convert the powder into a solid, smokable substance similar to "crack" cocaine. (Some Americans heard of free-basing for the first time after comedian Richard Pryor was horribly burned and nearly killed when the coke he was heating to free-base caught on fire; after a long recovery, Pryor incorporated the ordeal into his stage act.)

What are the effects of cocaine use?

Cocaine causes the brain to release large amounts of a chemical known as dopamine, which creates the euphoria that draws many people to the drug. While using cocaine people feel more alert, sometimes overwhelmingly energetic and euphoric, and often report "delusions of grandeur" or a feeling of invincibility. Many users also feel paranoid and extremely nervous. The flood of dopamine is also responsible for the "crash" and depression that you may feel when the drug's effect wears off. Large amounts of cocaine can kill the neurons that make dopamine, says Gruber, which may explain the chronic depression that some users endure, even long after quitting.

Meanwhile, other changes are taking place in the body. Cocaine increases blood pressure, heart rate, and body temperature. If you use it frequently, you may lose your appetite and become sleepless, irritable, and apathetic.

Wanting to regain the high and needing increasing amounts of cocaine to feel that way, you can become addicted in a short amount of time. This insidious "behavior-reinforcing" quality leads people to binge on cocaine for hours -- and sometimes days -- on end.

How can I tell if someone is using cocaine?

Someone high on cocaine will likely have dilated pupils, and those snorting it may sniff frequently and rub their noses. Speech may be loud, sped up, and "chattery," accompanied by frenetic gestures.

What are the risks of cocaine abuse?

  • Vascular problems. Cocaine has "vasoconstrictive" effects that can result in hypertension (high blood pressure), heart attacks, strokes, and damage to other organs such as the kidneys due to a loss of blood flow.
  • Nasal problems. People who snort cocaine may permanently injure their nasal membranes, which can bleed and develop ulcers. In some cases, a hole forms in the nasal septum, the skin between the nostrils.
  • Infectious disease. People who inject cocaine and share needles with other users are more likely to contract infectious diseases such as AIDS and hepatitis.
  • Pregnancy complications. Using cocaine while pregnant can cause premature births, low birth weights, and can contribute to birth defects in newborns.
  • Psychological problems. Using coke regularly can cause depression, mania, paranoia, anxiety, compulsively repetitive acts, bizarre hallucinations, schizophrenia-like behavior, and even violent psychotic disorders.
  • Liver damage. This is rare but can be very serious.
  • Death. In rare instances cocaine has caused deaths due to heart attacks, disturbances in heart rhythm ("arrhythmia"), brain seizures, and respiratory failure -- even in first-time users. In addition, researchers say that when a person uses cocaine while drinking alcohol, the two substances combine to form an even more toxic product in the body. Cocaine and alcohol is the most common two-drug combo in drug-related deaths, according to NIDA.

What is crack cocaine?

Illegal manufacturers mix powder cocaine with water and ammonia or baking soda to form pellets or "rocks" of crack cocaine, which is smoked. Crack enters the bloodstream very quickly (in 8 to 10 seconds), producing a sudden and intense high that lasts only a few minutes. Crack -- so called because of the crackling noise it makes when heated and smoked -- was developed in the mid-1980s as a quicker, cheaper alternative to traditional cocaine. Unfortunately, it is one of the most addictive substances ever created, leading some addicts to sell all their possessions and even themselves to obtain it. In 2007, an estimated 610,000 people used crack cocaine, according to the National Survey on Drug Use and Health.

What are the effects and signs of crack use?

The symptoms are generally the same as someone high on powder cocaine, although some researchers say that crack cocaine is more likely to produce paranoid, aggressive behavior. The "binge and crash" pattern is also the same as that found in regular powder cocaine abusers. Because crack is smoked, regular users may also experience wheezing and chest congestion.

What are the risks of crack abuse?

Crack abuse carries the same health problems associated with powder cocaine use, but these risks are magnified because it is more potent and because it is smoked. The possibility of fatal brain seizures and heart attacks increases, and chronic lung and liver damage is common among users. Aggressive and suicidal behavior among crack addicts is also widespread.

Crack has proven even more addictive than powder cocaine, and in the 1980s and '90s crack use resulted in epidemic levels of "crack babies" -- babies born afflicted by cocaine.

How are crack and cocaine abuse treated?

To date, cocaine addiction has proven a confounding problem to treat. Long-time cocaine users show a strong tendency towards relapse -- the intense craving and vivid memories of the high seem to last even years. (As one former user told us, "I'm afraid sometimes that I'll start up again, because the craving never really goes away.") However, the National Institute on Drug Abuse (NIDA) is continuing to research and test potential medications to help ease withdrawal symptoms among people dependent on cocaine. Recent clinical trials have shown encouraging results, although no medications have yet been approved for treating cocaine dependence. Ultimately, the NIDA believes that a combination of drug and behavior therapy will prove the most effective means of treatment in the future.

One thing that seems apparent, however, is that immediate and enduring abstinence is essential to treatment success. The drug's effects are too powerful, and the "binge and crash" cycle too risky, to attempt the kind of "maintenance therapy" used with heroin addicts.

Many users seeking treatment are suffering from other problems as well, including addiction to other drugs and psychological disorders, which further complicate matters. Therapy, drug counseling, and support groups such as Narcotics Anonymous can help many people deal with these problems.

References

Cocaine: Abuse and Addiction. National Institute on Drug Abuse. National Institutes of Health Publication Number 10-4166. Revised September 2010. www.drugabuse.gov

National Institute on Drug Abuse. NIDA InfoFacts: Crack and Cocaine. April 2006. http://www.nida.nih.gov/Infofacts/cocaine.html

Office of Applied Studies. Results from the 2007 National Survey on Drug Use and Health: National Findings. http://www.oas.samhsa.gov

Kampman K. The Search for Medications to Treat Stimulant Dependence. Addiction Science and clinical Practice. June 2008; 4(2).

Substance Abuse and Mental Health Services Administration. National Estimates of Drug-Related Emergency Department Visits. March 2007.

Monitoring the Future: National Results on Adolescent Drug Use (2008). http://www.monitoringthefuture.org/new.html

Substance Abuse and Mental Health Services Administration. Results from the 2007 National Survey on Drug Use and Health: National Findings. September 2008. http://www.oas.samhsa.gov/NSDUH/2k7NSDUH/2k7results.cfm#CH2

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