cocaine

Cocaine is a drug derived from the leaves of the coca plant which is found mainly in Peru and Bolivia. It is a stimulant because it speeds up the functions of the central nervous system - the messages going to and from the brain. Amphetamines (or ‘speed’) and nicotine are also stimulants. It comes in the form of a crystal white powder and has the scientific name cocaine hydrochloride.

Cocaine can be injected, snorted, or even converted to a free-base form and smoked. It is sometimes known as C, coke, flake, nose candy, snow, dust, white, white lady, toot, crack, rock, or freebase.

The effects of cocaine depend on:

• the amount taken
• the person’s experience with the drug
• their expectations
• the mood they are in
• the way in which the drug is taken
• the quality and the purity of the drug

How is it used

Cocaine is inhaled (snorted) through the nose, or injected. It is also smoked through a process known as ‘freebasing’ - where the cocaine is converted to an alkaloid form. Cocaine hydrochloride cannot be smoked, since the drug is destroyed at high temperatures.

‘Crack’ is a very pure form of freebase cocaine sold in the form of small crystals or rocks. Crack is smoked in pipes or in cigarettes, mixed with tobacco or marijuana. Crack has rarely been seen in New Zealand.

Like other illegally manufactured drugs, such as ‘speed’, there are no controls on factors such as the strength and hygiene of cocaine. Cocaine may be mixed, or ‘cut’, with other substances such as sugar, baking soda and talcum powder to increase profits. This increases the risk of experiencing harmful or unpleasant effects.

Cocaine was used as a local anaesthetic for eye, ear and throat surgery. Recently cocaine has been replaced with synthetic anaesthetics (e.g. lidocaine), but it continues to have limited use in certain surgical procedures.

Effects of cocaine

The effects of any drug (including cocaine) vary from person to person. It depends on many factors, including an individual’s size, weight and health, how much and how the drug is taken, whether the person is used to taking it and whether other drugs are taken. It also depends on the environment in which the drug is used- for example, whether the person is alone, with others or at a party.

Immediate Effects

Many people have experienced the following effects shortly after taking cocaine:

• physiological arousal, including increased body temperature and heart rate
• exhilaration
• anxiety
• feelings of well-being
• decreased hunger
• panic
• poor concentration and judgement
• indifference to pain and fatigue
• feelings of great physical strength and mental capacity
• enlarged pupils
• sexual arousal
• unpredictable and/or violent behaviour.

When inhaled, the effects of cocaine peak after 15 to 30 minutes, and then diminish.

In greater quantities

Using large quantities of cocaine repeatedly over a period of hours can lead to:

• extreme agitation
• anxiety
• paranoia
• hallucinations
• dizziness
• nausea and vomiting
• tremors
• unpredictable violent/aggressive behaviour
• loss of concentration
• loss of coordination
• loss of interest in sex
• loss of ambition and motivation
• heart pain
• heart attack
• paranoid psychosis
• increased body temperature
• rapid, irregular and shallow breathing.

Long-term effects

People who have used cocaine over longer periods tend to take cocaine in high quantities-‘binges’ interrupted by ‘crashes’.

A ‘binge’ is where the drug is taken repeatedly over several hours or days. The person may attempt to end the binge by taking a depressant drug such as alcohol, benzodiazepines or heroin. The binge is followed by the ‘crash’-a period characterised by intense depression, lethargy and hunger.

The unpleasant effects of cocaine increase with more frequent, long-term use. This often results in the person discontinuing their use for a period of time. Most of the following symptoms will dissipate once cocaine use ceases:

• restlessness
• nausea
• hyper-excitability
• insomnia
• weight loss
• psychosis
• paranoia
• exhaustion
• hallucinations
• depression/inability to experience pleasure (anhedonia).
• Overdose

The dosage and method of use that can cause cocaine overdose varies from person to person. The effects of overdose are very intense and, generally, short in nature. Although uncommon, deaths have been recorded from cocaine overdose due to:

• seizures
• heart attack
• brain haemorrhage
• kidney failure
• stroke
• repeated convulsions

Dangers in method of use

There are a number of dangers relating 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.
• Cocaine is often mixed with substances that are poisonous when injected. This may cause collapsed veins, abscesses and damage to the heart, liver and brain. In addition, because people who use cocaine often don’t know the exact purity and strength of the drug they are taking, chances of overdose and death are also increased.
• If injected into the skin, either by intent or accident, cocaine causes severe vasoconstriction, which may prevent blood flowing to the tissue, potentially resulting in severe tissue damage. This can occur after just one injection of cocaine.
• There is increased risk of transmission of blood-borne viruses and infections such as HIV, hepatitis B and hepatitis C.
• Smoking cocaine can cause breathing difficulties, chronic cough, chest pain and lung damage.

Long-term injection can result in:

• blood vessels becoming blocked by substances mixed with cocaine, which can lead to major damage to bodily organs
• inflamed blood vessels and abscesses.
• HIV and hepatitis: sharing needles, syringes and other injecting equipment can greatly increase the risk of contracting blood-borne viruses such as hepatitis and HIV (Human Immunodeficiency Virus - the virus that causes AIDS).

Call 0800 787 797 for help and support.

Cocaine & Other Drugs

Cocaine is often mixed with other drugs to enhance its desirable effects or to help the person cope with the undesirable effects of cocaine. These substances may include alcohol, cannabis, heroin or benzodiazepines. The consequences of mixing cocaine with other substances are often unpredictable. Mixing cocaine with alcohol produces a substance in the blood called ‘cocaethylene’, which can be more toxic to the body than the cocaine itself. Injecting cocaine and heroin at the same time can affect the area of the brain that controls breathing, increasing the chances of coma and death.

Generally, health risks increase when mixing cocaine with other drugs, especially when large quantities are taken.

Tolerance & Dependence

Tolerance

Initial tolerance to cocaine develops rapidly with continual heavy use. After this initial level is reached, people who use cocaine don’t appear to develop tolerance for increasing amounts. Regular users may in fact develop a ‘reverse tolerance’, whereby they experience the effects of the drug more intensely. Tolerance to cocaine may not be obvious due to the tendency to mix cocaine with other drugs such as heroin and alcohol.

Dependence

Physical dependence upon a drug occurs when a person’s body is used to functioning with the drug present in the system. Physical dependence on cocaine has not yet been established.

Psychological dependence occurs when using a drug becomes more important than other activities in a person’s life. Because of its powerful euphoric effects, cocaine users may develop a strong psychological dependence upon it. Even after long periods of abstinence, strong cravings can persist.

A person who has become dependent upon cocaine may find it difficult to stop using it. Those who have stopped using cocaine may be prone to relapse.

Withdrawal

Withdrawal symptoms occur when a person dependent on a drug stops using it or significantly cuts down the amount they are using. Cocaine withdrawal generally occurs in three phases:

1. ‘Crash’, which describes symptoms experienced immediately after the person stops using cocaine - usually in the first two to four days. Symptoms include:

• agitation
• depression
• intense craving for the drug
• extreme fatigue.

2. Withdrawal, which can last up to ten weeks and is characterised by:

• depression
• lack of energy
• anxiety
• intense craving
• angry outbursts.

3. Extinction, which can last indefinitely, and includes symptoms of episodic cravings for cocaine, usually in response to conditioned cues. These cravings may surface months or years after the person has stopped using cocaine.

Other withdrawal symptoms that may be experienced include:

• lack of motivation
• inability to feel any pleasure
• nausea/vomiting
• shaking
• irritability/agitation
• muscle pain
• long, but disturbed sleep.
• Treatment options

There are a number of drug treatment options available in New Zealand. While abstinence may be a suitable treatment aim for some people, many programs recognise that for others this may not be possible or realistic. Most programs adopt strategies that have an overall aim of reducing the harms and risks related to the person’s drug use.

Some treatment options include counselling, withdrawal (detoxification) and pharmacotherapy. Residential and ‘out-patient’ programs are available.

Ring 0800 787 797 for more on options available.

Pregnancy & Breastfeeding

Pregnancy

Research indicates that effects of cocaine use during pregnancy may cause bleeding, miscarriage, premature labour and stillbirth.

Cocaine increases the heart rate in both the mother and baby, and the supply of blood and oxygen to the baby is reduced. This means the baby is more likely to be small and grow slowly both before and after birth. If cocaine is used close to birth, the baby may be born intoxicated, showing symptoms of hyperactivity and agitation. Withdrawal symptoms can occur in the babies of mothers who use cocaine regularly. These include sleepiness and lack of responsiveness./

To date, research is inconclusive as to whether children of mothers who use cocaine experience any long-term mental or physical effects. Some studies suggest that malformations of the genito-urinary tract, heart, limbs and/or face occur in the babies of women who use cocaine.

Breastfeeding

It is likely that cocaine will reach the baby through breast milk. The effect this has on the baby will depend on factors such as the amount and strength of cocaine used, and the time between using cocaine and feeding the baby. Symptoms may include the baby being irritable, unsettled and difficult to feed.

See your doctor or other health professional if you are taking or planning to take any substances while pregnant or breastfeeding, including prescribed and over-the-counter medications.

Legal Implications

Cocaine is a Class A drug. The maximum penalty for importation/ manufacture/supply is life imprisonment and for possession 6 months jail and/or $1000 fine.

Cocaine & Driving

It is illegal for anyone to drive under the influence of any drug (including cocaine). Breaking this law carries penalties including disqualification from driving, heavy fines and/or imprisonment. Due to the nature of its psychological and physical effects, it is dangerous to drive a vehicle after taking cocaine. If cocaine is combined with other drugs, such as alcohol, the risk of accident is further increased.

Cocaine & Social Problems

Cocaine users can become preoccupied with purchasing, preparing, using and recovering from the effects of use of cocaine, neglecting other areas of their life. All areas of a person’s life, including family, work, and personal relationships, can be affected by drug use. For example, arguments over drug use can cause family and relationship problems that may lead to break-up. Some effects of cocaine, such as anxiety, paranoia and irrational behaviour, may further exacerbate these problems.

Reducing the risks

New Zealand drug policy is based on harm minimisation. This is about reducing drug-related harm to both the community and individual drug users.

Harm-minimisation strategies range from encouraging ‘non-use’ through to providing the means for people to use drugs with fewer risks.

For further ‘tips’ on how to reduce the risks of using cocaine, call 0800 797 787

Remember there is no safe level of drug use.

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 111. 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 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.
• Arrange with friends before cocaine is taken about what to do in a crisis.