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Drug Abuse

Drug abuse

Drug abuse has a wide range of definitions, all of them relating to the use, misuse or overuse of a drug for a non-therapeutic or non-medical effect. Some of the most commonly abused drugs include alcohol, amphetamines, barbiturates, caffeine, cannabis, cocaine, methaqualone, nicotine, opium alkaloids, and minor tranquilizers. Use of these drugs may lead to criminal penalty in addition to physical, social, and pyschologic harm. Other definitions of drug abuse fall into four main categories:

Definitions

Public health definitions

In recent decades, public health practicitioners have attempted to look at drug abuse from a broader perspective than the individual, emphasising the role of society, culture and availability. Rather than alcohol or drug "abuse" many public health professionals have adopted the terms "alcohol and drug problems" or "harmful/problematic use" of drugs.

Mass communication and vernacular usage

The term may be used in newspapers, television, etc. in a ambiguous, catch-all sense rather than as a medical or legal term, sometimes disapprovingly to refer to any drug use at all, particularly of illicit drugs.

Medical definitions

In the modern medical profession, the two most used diagnostic tools in the world, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD), no longer recognise 'drug abuse' as a current medical diagnosis. Instead, they have adopted substance abuse as a blanket term to include drug abuse and other things. However, other definitions differ; they may entail psychological or physical dependence, and may focus on treatment and prevention in terms of the social consequences of substance use.

Historical positions of the American Psychiatric Association

In the early 1950s, the first edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders refered to both alcohol and drug abuse as part of Sociopathic Personality Disturbances, which were thought to be symptoms of deeper psychological disorders or moral weakness . By the third edition, in the 1980s, drug abuse was grouped into 'substance abuse'. In 1972, the American Psychiatric Association created a definition that used legality, social acceptability, and even cultural familiarity as qualifying factors:

…as a general rule, we reserve the term drug abuse to apply to the illegal, nonmedical use of a limited number of substances, most of them drugs, which have properties of altering the mental state in ways that are considered by social norms and defined by statute to be inappropriate, undesirable, harmful, threatening, or, at minimum, culture-alien.

Historical positions of the American Medical Association

In 1966, the American Medical Association's Committee on Alcoholism and Addiction defined abuse of stimulants (amphetamines, primarily) in terms of "medical supervision":

…"use" refers to the proper place of stimulants in medical practice; "misuse" applies to the physician's role in initating a potentially dangerous course of therapy; and "abuse" refers to self-administration of these drugs without medical supervision and particularly in large doses that may lead to psychological dependency, tolerance and abnormal behavior.

Handbook on Drug and Alcohol Abuse

The Handbook on Drug and Alcohol Abuse defines drug abuse as "nonmedical use of drugs, both drugs that have and those that do not have generally accepted medical value".

Political and criminal justice definitions

Most countries have legislation designed to criminalise some drug use. Usually however the legislative process is self-referential, defining abuse in terms of what is made illegal. The legislation concerns lists of drugs specified by the legislation. These drugs are often called illegal drugs but, generally, what is illegal is their unlicensed production, supply and possession. The drugs are also called controlled drugs or controlled substances.

World Health Organization

The World Health Organization (WHO), a public health agency comprised of delegates appointed by the governments of member nations, is considered by many to be a medical authority. Definitions found in WHO reports are often used as the basis for legislation at national, regional and local levels. The WHO also produces the ICD, a major diagnostic resource used by medical professionals worldwide. Although it consists largely of public health professionals, the WHO is an arm of the United Nations political body, and is therefore responsive to the needs of, demands from, and prevailing views among the UN member states that appoint WHO delegates. The manner in which the WHO has recognized and dealt with 'drug abuse' over the years reflects a continuing struggle to reconcile conflicting historical, political, social, cultural, and medical viewpoints. In its early reports, the WHO Expert Committee on Addiction-Producing Drugs used the terms 'abuse' and 'addiction' interchangeably. Beginning in 1950s, attempts were made to distinguish between scientific and emotionally-charged terminology. However, the term 'abuse' was still inserted into definitions of addiction and dependency. In 1957, while not explicitly saying that 'drug abuse' was synonymous with 'addiction', the committee first attempted to clarify existing definitions of addiction and habituation as had been in common parlance since at least 1931:

Drug addiction is a state of periodic or chronic intoxication produced by the repeated consumption of a drug (natural or synthetic). Its characteristics include: (i) an overpowering desire or need (compulsion) to continue taking the drug and to obtain it by any means; (ii) a tendency to increase the dose; (iii) a psychic (psychological) and generally a physical dependence on the effects of the drug; and (iv) detrimental effects on the individual and on society.

Drug habituation (habit) is a condition resulting from the repeated consumption of a drug. Its characteristics include (i) a desire (but not a compulsion) to continue taking the drug for the sense of improved well-being which it engenders; (ii) little or no tendency to increase the dose; (iii) some degree of psychic dependence on the effect of the drug, but absence of physical dependence and hence of an abstinence syndrome [withdrawal], and (iv) detrimental effects, if any, primarily on the individual.

In 1964, a new WHO committee found these definitions to be inadequate, and suggested using the blanket term 'drug dependence':

The definition of addiction gained some acceptance, but confusion in the use of the terms addiction and habituation and misuse of the former continued. Further, the list of drugs abused increased in number and diversity. These difficulties have become increasingly apparent and various attempts have been made to find a term that could be applied to drug abuse generally. The component in common appears to be dependence, whether psychic or physical or both. Hence, use of the term 'drug dependence', with a modifying phase linking it to a particular drug type in order to differentiate one class of drugs from another, had been given most careful consideration. The Expert Committee recommends substitution of the term 'drug dependence' for the terms 'drug addiction' and 'drug habituation'. (emphasis added)

The committee did not clearly define dependence, but did go on to clarify that there was a distinction between physical and psychological ('psychic') dependence. It said that drug abuse was "a state of psychic dependence or physical dependence, or both, on a drug, arising in a person following administration of that drug on a periodic or continued basis." Psychic dependence was defined as a state in which "there is a feeling of satisfaction and psychic drive that requires periodic or continuous administration of the drug to produce pleasure or to avoid discomfort" and all drugs were said to be capable of producing this state:

There is scarcely any agent which can be taken into the body to which some individuals will not get a reaction satisfactory or pleasurable to them, persuading them to continue its use even to the point of abuse — that is, to excessive or persistent use beyond medical need. (emphasis added)

This is believed to be the first reference to "medical need" as a factor in the distinction between use and abuse. In 1965, the same WHO committee commented further, now providing a specific definition of abuse:

Drug abuse is the consumption of a drug apart from medical need or in unnecessary quantities. Its nature and significance may be considered from two points of view: one relates to the interaction between the drug and the individual, the other to the interaction between drug abuse and society. The first viewpoint is concerned with drug dependence and the interplay between the pharmacodynamic actions of the drug and the physiological and psychological status of the individual. The second — the interaction between drug abuse and society — is concerned with the interplay of a wide range of conditions, environmental, sociological, and economic.

Individuals may become dependent upon a wide variety of chemical substances that produce central nervous system effects ranging from stimulation to depression. All of these drugs have one effect in common: they are capable of creating, in certain individuals, a particular state of mind that is termed "psychic dependence ".

Some drugs… induce physical dependence, which is an adaptive state that manifests itself by intense physical disturbances when the administration of the drug is suspended or when its action is affected by the administration of a specific antagonist.

The committee offered several disclaimers of its definitions:

It must be emphasized that drug dependence and drug abuse, as used by the Committee, are general terms and carry no connotation of the degree of risk to public health or of the need for drug control or for a particular type of drug control. The Committee would point out again that the recommendation for the use of the terms drug abuse and drug dependence of this or that type must not be regarded as a re-definition; rather, these terms are intended as descriptive expressions for clarification in scientific reference, interdisciplinary discussions, and national and international procedures.

The 1969 edition of the WHO's International Statistical Classification of Diseases and Related Health Problems (ICD) manual defined drug abuse as "persistent or sporadic excessive drug use inconsistent with or unrelated to acceptable medical practice", modern editions have not used the term because of it's ambiguity, prefering instead to refer to the cluster of symptoms previously called 'drug abuse' as 'substance abuse'. In 1973, these statements and recent legislation based upon the term "dependence" rather than "addiction" or "abuse" were praised by President Richard M. Nixon's National Commission on Marihuana and Drug Abuse in its final report:

The Commission applauds the much-belated attempt by the scientific community to sever its conceptual apparatus from the vocabulary of politics and emotion. "Addiction," like "narcotics" and "drug abuse," has a general connotation of evil, suggesting illicit ecstasy, guilt and sin. Because the public image is conditioned more by cultural perceptions than by medical ones, medically-precise meanings simply cannot be harmonized with common parlance.

And in 1975, the WHO further distanced itself from the term 'drug abuse':

"Drug abuse" is a term in need of some clarification. …The term is really a convenient, but not very precise, way of indicating that (1) an unspecified drug is being used in an uspecified manner and amount … and (2) such use has been judged by some person or group to be wrong (illegal or immoral) and/or harmful to the user or society, or both. What might be called "drug abuse" by some would not necessarily be considered so by others. … For these reasons, the term "drug abuse" is avoided here

The World Health Organization presently prefers to use the terms harmful use and hazardous use (of drugs), in order to distinguish between the health effects of drug abuse rather than the social consequences. Another preferred term is drug misuse, defined as the "use of a substance for a purpose not consistent with legal or medical guidelines, as in the non-medical use of prescription medications." According to WHO, the term misuse is preferred by some in the belief that it is less judgmental. However, the 1957 and 1964–1965 WHO definitions of addiction, dependence and drug abuse persist to the present day in medical literature and have become entrenched in global legislation, despite the disclaimers and reliance on contentious assumptions. The WHO itself continues to use 'drug abuse' in its publications, and uses the term 'abuse' consistently and exclusively when discussing the control and consumption of illegal substances. This is in keeping with guidelines issued by the WHO's parent organization, the United Nations, which discourages any recognition of "recreational" or "responsible" use of drugs. Researchers may take note that somewhat less contentious definitions of addiction, dependence, and tolerance (with no speculation as to their roles in the definition of drug abuse) were jointly issued in 2001 by the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine in the publication "Definitions Related to the Use of Opioids for the Treatment of Pain".

NIDA

The US National Institute on Drug Abuse defines drug abuse as "The use of illegal drugs or the inappropriate use of legal drugs. The repeated use of drugs to produce pleasure, to alleviate stress, or to alter or avoid reality (or all three)."

Nixon Administration

In 1975, psychiatrist Jerome H. Jaffe (in his role as Drug Policy Director in the Nixon Administration) defined drug abuse as "the use, usually by self-administration, of any drug in a manner that deviates from the approved medical or social patterns within a given culture". According to Jaffe, the term "conveys the notion of social disapproval, and it is not necessarily descriptive of any particular pattern of drug use or its potential adverse consequences".

Amphetamines

Amphetamine, also known as speed, is a synthetic stimulant used to suppress the appetite, control weight, and treat disorders including narcolepsy and Attention-deficit hyperactivity disorder. It is also used recreationally and for performance enhancement. These (latter) uses are illegal in most countries.

Amphetamine

Amphetamine is a synthetic drug with strong stimulant effects. In the United States, it is most commonly used for treatment of attention deficit disorders and narcolepsy, but is also approved as a weight loss medication in certain cases of obesity. Within the armed forces only, it is also frequently prescribed as an anti-fatigue pill for pilots or other individuals in situations requiring vigilance and alertness. Amphetamine is also used illegally to take advantage of these effects. The term amphetamine causes a certain amount of confusion because it is often used incorrectly. Loosely, amphetamine can describe other drugs with similar, stimulant effects, namely methamphetamine and methylphenidate. Chemists often use the term "amphetamine class" to describe chemicals that are structurally similar (and often similar in effect as well) to amphetamine--namely, chemicals with an ethyl backbone, terminal phenyl and amine groups, and a methyl group adjacent to the phenyl. A large number of chemicals fall into this category, including the club drug MDMA (Ecstasy) and methamphetamine. It is important to note that such an "amphetamine class" does not technically exist. Phamacodynamically, these drugs all fall under the umbrella of central nervous system stimulants; chemically, they are phenylethylamines. Amphetamine, for example, is methylated phenylethylamine, and methamphetamine is double methylated phenylethylamine. Amphetamine traditionally comes in the salt-form amphetamine sulphate and is comprised of 50% l- and 50% d-amphetamine (where l- and d- refer to levo and dextro, the two optical orientations the amphetamine structure can have). In the United States, pharmaceutical products containing solely amphetamine (for example, Biphetamine) are no longer manufactured. Today, dextroamphetamine (d-amphetamine) sulphate the the predominant form of the drug used; it consists entirely of d-isomer amphetamine, which is acts in a slightly different way on the brain than does l-amphetamine. Attention disorders are often treated using Adderall or generic equivalent formulations of mixed amphetamine salts that contain both d/l-amphetamine and d-amphetamine in the sulfate and saccharate forms mixed to a final ratio of 3 parts d-amphetamine to 1 part l-amphetamine. It was first synthesized in 1887 by the German Chemist L. Edeleano, who called it "phenylisopropylamine".

Medicinal use

The experimental medical use of amphetamines began in the 1920s. It was introduced in most of the world in the form of the pharmaceutical Benzedrine in the late 1920s. The drug was used by the militaries of several nations, especially the air forces, to fight fatigue and increase alertness among servicemen. After decades of reports of abuse, the FDA banned Benzedrine inhalers and limited amphetamines to prescription use in 1959, but illegal use became common. Along with methylphenidate (Ritalin), amphetamine is one of the standard treatments for ADHD. Beneficial effects for ADHD can include improved impulse control, improved concentration, decreased sensory overstimulation and decreased irritability. These effects can be dramatic, particularly in young children. The ADHD medication Adderall is composed of a timed-release combination of four different amphetamine salts. When used within the recommended doses, side effects like loss of appetite tend to decrease over time. However, amphetamines last longer in the body than methylphenidate (Ritalin Concerta), and tend to have stronger side effects on appetite and sleep. Amphetamines are also a standard treatment for narcolepsy as well as other sleeping disorders. They are generally effective over long periods of time without producing addiction or physical dependence. Amphetamines are sometimes used to augment anti-depressant therapy in treatment-resistant depression. Medical use for weight loss is still approved in some countries, but is regarded as obsolete and dangerous in, for example, the United States.

Performance enhancing use

Amphetamines are usually not used by athletes in sports involving extreme cardiovascular efforts, as methamphetamine and amphetamine put a great deal of additional stress on the heart. The United States Air Force uses amphetamines (Dexedrine) as stimulants for pilots, calling them "go-pills". After a mission, the Air Force issues a "no-go pill' (Ambien) to help the pilot sleep. Amphetamines have been popular among some truck drivers, construction workers, and factory workers whose jobs require long or irregular shift work or automatic, repetitive tasks. It is for this reason that they are sometimes labeled a "redneck drug". They are also used by white collar workers trying to stay alert during long hours of multitasking, or by students hoping to improve their academic performance. There has also been at least one report of the coercive administration of amphetemines to cannery workers in Thailand, in order to enhance productivity (Seabrook, 1996). However, the majority of cases of non-medicinal amphetamine use appear to be recreational in nature.

Effects of use

Amphetamines release stores of norepinephrine and dopamine from nerve endings by converting the respective molecular transporters into open channels. Amphetamine also releases stores of serotonin from synaptic vesicles. Like methylphenidate (Ritalin) amphetamines also prevent the monoamine transporters for dopamine and norepinephrine from recycling them (called reuptake inhibition) which leads to increased amounts of dopamine and norepinephrine in synaptic clefts. These combined effects rapidly increases the concentrations of the respective neurotransmitters in the synaptic cleft, which promotes nerve impulse transmission in neurons that have those receptors.

Physiological effects

Short-term physiological effects include decreased appetite, increased stamina and physical energy, increased sexual drive/response, involuntary bodily movements, increased perspiration, hyperactivity, jitteriness, nausea, itchy, blotchy or greasy skin, increased heart rate, irregular heart rate, and headaches. Fatigue can often follow the dose's period of effectiveness. Long-term abuse or overdose effects can include tremor, restlessness, changed sleep patterns, poor skin condition, hyperreflexia, tachypnea, gastrointestinal narrowing, and weakened immune system. Fatigue and depression can follow the excitement stage. Erectile dysfunction, heart problems, stroke, and liver, kidney and lung damage can result from prolonged use. When snorted, amphetamine can lead to a deterioration of the lining of the nostrils. Short-term effects can include alertness, euphoria, increased concentration, rapid talking, increased confidence, increased social responsiveness, nystagmus (eye wiggles), hallucinations, and loss of REM sleep (dreaming) the night after use. Long term psychological effects can include insomnia, mental states resembling schizophrenia, aggressiveness, addiction or dependence with accompanying withdrawal symptoms, irritability, confusion, and panic. Chronic and/or extensively continuous use can lead to amphetamine psychosis which causes delusions and paranoia, but this is uncommon when taken as prescribed.

Legal issues

Example 1: In the United Kingdom, amphetamines are regarded as Class B drugs. The maximum penalty for unauthorised possession is three months' imprisonment and a £2,500 fine. Example 2: In the United States, amphetamine and methamphetamine are Schedule II controlled drugs, classified as a CNS (Central Nervous System) Stimulant. A Schedule II drug is classified as one that: has a high potential for abuse, has a currently accepted medical use and is used under severe restrictions, and has a high possibility of severe psychological and physiological dependence. Internationally, amphetamine is a Schedule II drug under the Convention on Psychotropic Substances.

Books

Major League Baseball

On November 15, 2005, Major League Baseball and the Major League Baseball Player's Association agreed to stiffen penalties for steroid users, as well as to start banning amphetamines. Penalties for use of amphetamines are as follows: A 50-game suspension for the first failed test, a 100-game suspension for the second failed test, and a lifetime ban for the third failed test.

External links

- (D-form — dextroamphetamine)
- (L-form and D,L-forms)
- (L-form — Levamphetamine or L-amphetamine)
- [http://abcnews.go.com/sections/2020/DailyNews/2020_pilotpills021220.html USAF use of amphetamines]
- [http://www.erowid.org/chemicals/amphetamines/amphetamines.shtml Erowid - Amphetamines]
- [http://www.thegooddrugsguide.com/amphetamines/index.htm The Good Drugs Guide - Amphetamines]
- [http://leda.lycaeum.org/?ID=364 Lycaeum - Amphetamines]
- Srisurapanont et al, [http://www.update-software.com/abstracts/AB003022.htm Treatment for amphetamine dependence and abuse]
- [http://www.drugs.com/Amphetamine Drugs.com - Amphetamine]
- [http://www.apaic.org Asia & Pacific Amphetamine - Type Simulant Information Centre] - a very extensive information source mangaged by the United Nations Office on Drugs and Crime.

Notes

# Category:Schedule II controlled substances Category:Sympathomimetic amines Category:Phenethylamines Category:Stimulants Category:Amphetamines Category:Military drugs ms:Amfetamina ja:アンフェタミン

Caffeine

Caffeine, also known as trimethylxanthine, coffeine, theine, mateine, guaranine, methyltheobromine and 1,3,7-trimethylxanthine, is a xanthine alkaloid found naturally in such foods as coffee beans, tea, kola nuts, Yerba mate, guarana berries, and (in small amounts) cacao beans and Yaupon Holly. For the plant, caffeine acts as a natural pesticide since it paralyzes and kills some of the insects that attempt to feed on the plant. Caffeine-containing beverages, such as coffee, enjoy great popularity. Additionally, it is occasionally used medically in the formulation of some analgesics. Caffeine's main pharmacological properties are: a stimulant action on the central nervous system with psychotropic effects and stimulation of respiration, a stimulation of the heart rate, and a mild diuretic effect.

Chemical properties

Caffeine is an alkaloid of the methylxanthine family, which also includes the similar compounds theophylline and theobromine. In its pure state it is an intensely bitter white powder. Its chemical formula is C₈H₁₀N₄O₂, its systematic name is 1,3,7-trimethyl xanthine or 3,7-dihydro-1,3,7-trimethyl-1H-purine-2,6-dione, and its structure is shown above. Its International Chemical Identifier is InChI=1/C8H10N4O2/c1-10-4-9-6-5(10)7(13)12(3)8(14)11(6)2/h4H,1-3H3.

Physical properties

Pure caffeine occurs as odorless, white, fleecy masses, glistening needles or powder.
- Melting point: 238 °C
- Boiling point: 178 °C (sublimes)
- Density: 1.2 g/cm³
- Volatility: 0.5%
- Vapor pressure: 101 kPa @ 178 °C
- pH: 6.9 (1% solution)
- Solubility in water: 2.17%
- Vapor density: 6.7 g/m³
- Molecular weight: 194.19 g/mol

Caffeine extraction

It is very difficult to know the exact amount of caffeine in a particular drink that is not automatically prepared. The amount of caffeine in a single serving of coffee varies considerably due to many variables. Concentration can vary from bean to bean within a given bush; preparation of the raw bean will affect concentration, as well as multiple variables involved in brewing. To extract caffeine takes some time (about two hours) and requires chemicals unavailable for everyday use and a nice system of distillation and sublimation. To extract caffeine, one must take the beverage one wants to extract the caffeine from and mix it with a solvent with a finer affiliation to the caffeine and a different density. Chloroform is known to possess both these properties. Caffeine will go in the solvent it is the most soluble in, and it is more soluble in chloroform than water. Using a separating funnel, one should take about 30 ml of chloroform and 200 ml of the beverage one wants to extract the caffeine from and agitate for about two minutes. The bottom phase will be the chloroform and the caffeine, so one will keep this phase. Repeating this step about five times should ensure extraction of most of the caffeine. The next step is a distillation using a standard distillation column where one gets rid of most of the chloroform. Finally, one has to sublimate the caffeine under vacuum. If the result is a fine white powder, one's extraction has succeeded.

Sources

One common source of caffeine is the coffee plant, the beans of which are used to make coffee. Caffeine content varies substantially between Arabica and Robusta species and to a lesser degree between varieties of each species. One 'shot' of coffee contains about 40 mg of caffeine. Thus, a "double shot" espresso contains about 80 mg. A single serving (6 fl oz / 150 ml) of strong drip coffee or one-half caffeine tablet would deliver about 100 mg. However, there is a large variation in the amount of caffeine per serve, ranging from about 40 mg to 120 mg. Such variability was shown to be even higher in a study conducted in 2005 by Ben Desbrow, a dietitian of Griffith University. His survey of 99 short blacks found caffeine content ranging from 25 mg to 214 mg. Generally, dark roast coffee has less caffeine than lighter roasts since the roasting process reduces caffeine content of the bean. Tea is another common source of caffeine in many cultures. Tea contains somewhat less caffeine per serving than coffee, (usually about half as much, depending on the strength of the brew), though certain types of tea, such as black and oolong, contain more caffeine. Caffeine is also common in soft drinks such as cola. Such drinks typically contain about 15 mg to 40 mg of caffeine per serving. Most energy drinks such as Red Bull contain 80 mg. Mateine and guaranine are other names for caffeine. The names come from yerba maté and guarana respectively, caffeine-containing plants used for tea and other things. Many yerba maté enthusiasts insist that mateine is a stereoisomer of caffeine and thus a different substance altogether. However, this is impossible; caffeine is an achiral molecule with no stereogenic centers (also known as a chiral centers), and therefore has no stereoisomers. Similar claims are sometimes made of guaranine. Caffeine is sometimes called theine when it is found in tea, as the caffeine in tea was once thought to be a separate compound to the caffeine found in coffee. But tea does contain another xanthine, theophylline whose chemical formula is C₇H₈N₄O₂ compared to caffeine's C₈H₁₀N₄O₂.

Coffee

All fluid ounces are U.S. fluid ounces.
- Coffee, brewed (drip) - 4 to 20 mg/floz (130 to 680 mg/litre) (20 to 100 mg/5 floz)
- Coffee, decaffeinated - 0.4 to 0.6 mg/floz (13 to 20 mg/litre)
- Coffee, instant - 4 to 12 mg/floz (130 to 400 mg/litre)
- Espresso Arabica - ~40 mg/floz (1.36 g/litre)
- Espresso Robusta - ~100 mg/floz (3.4 g/litre)

Teas and other infusions

- Black tea, brewed (USA) - 2.5 to 11 mg/floz (85 to 370 mg per litre)
- Black tea, brewed (other) - 3 to 14 mg/floz (100 to 470 mg/litre)
- Black tea, canned iced - 2 to 3 mg/floz (70 to 100 mg/litre)
- Black tea, instant - 3.5 mg/floz (120 mg/litre)
- Oolong, 3.75 mg/floz (120 mg per litre) (12 to 55 mg per tea bag, i.e. one serving)
- Green tea, 2.5 mg/floz (85 mg/litre) (8 to 30 mg per tea bag, i.e. one serving)
- White tea, 2.0 mg/floz (68 mg/litre) (6 to 25 mg per tea bag, i.e. one serving)
- Decaf, 0.5 mg/oz (17 mg/litre) (1 to 4 mg per tea bag, i.e. one serving)
- Tisanes (i.e. Herbal teas) - caffeine content depends on the herb, e.g. Chamomile and Rooibos "teas" have no caffeine while Yerba mate and Guarana do contain varying quantities. Many tea drinkers characterise herbal tea simply as that which, unlike black or green tea, contains no caffeine.

Chocolate

Chocolate is a weak stimulant due to content of theobromine, theophylline, and caffeine.[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15549276] However, chocolate contains too little of these compounds for a reasonable serving to create effects in humans that are on par with coffee.

Other sources

- Energy drink - 10 mg/floz (340 mg/litre). Some countries limit the caffeine content at 135 mg/litre.
- Soft drink (caffeinated) - 3 to 8 mg/floz (100 to 270 mg/litre, some countries limit the caffeine content in cola drinks to 200 mg/l)
- Pill (caffeine) - 200 mg (100 mg in Canada and many countries within EU)
- Buckfast Tonic Wine - 375 mg/litre (0.05% of caffeine by weight)
- Jolt Gum - 45 mg/piece
- Bawls - 67mg per 10oz, 80 per 12oz

Equivalents to 200 mg of caffeine

- One caffeine pill (Two in some countries where these are 100 mg)
- ~2 shots of espresso from robusta beans (2 floz)
- ~2 "5 floz containers" of regular coffee (10 floz)
- ~1.3 L soft drink (these can vary widely in content)
- ~5 cups (8 floz) of black tea or ~10 cups (8 floz) of green tea
- ~5 cans of soda (these can vary widely in content) In the European Union, a warning must be placed on packaging if the caffeine content of any beverage exceeds 150 mg per litre. This includes caffeine from any source (including guarana, which is often found in energy drinks). In many countries, caffeine is classified as a flavouring.

History

Although tea consumption in China began thousands of years ago, the first documented use of caffeine in a beverage for its pharmacological effect was by the sufis of Yemen, who used coffee to stay awake during prayers in the 15th century. In the 16th century there were coffeehouses in Cairo and Mecca. Coffeehouses opened in Europe in the 17th century. Caffeine was isolated by the German chemist Friedrich Ferdinand Runge in 1819. According to the legend, he did this at the instigation of Johann Wolfgang von Goethe (Weinberg & Bealer 2001).

Mechanism of Action

Caffeine is thought to act by blocking adenosine receptors on the surface of cells. This thereby blocks a pathway leading to breakdown of cyclic adenosine monophosphate (cAMP). The usual effect of adenosine in nerve cells is to inhibit nerve conduction by inhibiting post-synaptic potentials. The caffeine molecule, being structurally similar to adenosine, binds to the same receptors but does not stimulate them, thereby decreasing the adenosine action. The resulting increased nerve activity causes the release of the hormone epinephrine (adrenaline), which in turn leads to several effects such as higher heart rate, increased blood pressure, increased blood flow to muscles, decreased blood flow to the skin and inner organs, and release of glucose by the liver. It also increases the levels of the neurotransmitter dopamine in the brain, similar to amphetamines. Other purported mechanisms of action of caffeine include mobilisation of intracellular calcium and inhibition of specific phosphodiesterases, however these only occur at high non-physiological concentrations.

Metabolism and toxicology

Caffeine is completely absorbed from the stomach and small intestine, within 45 minutes of ingestion. It is widely distributed in total body water and is eliminated by apparent first-order kinetics that can be described by a one-compartment open-model system. Caffeine is metabolized in the liver by the cytochrome P-450 enzyme system. The first metabolic products of caffeine are three dimethylxanthines: paraxanthine (84%), theobromine (12%) and theophylline (4%). Paraxanthine increases lipolysis, leading to elevated glycerol and free fatty acid levels in the blood plasma. Theobromine, the principal alkaloid in cocoa (chocolate), can dilate blood vessels and increase urine volume. Theophylline relaxes smooth muscles of the bronchi and is used to treat asthma. However, the therapeutic dose is many time greater than the levels achieved from caffeine metabolism. Each of these metabolites is further metabolised and then excreted in the urine. Caffeine is quickly and completely removed from the brain, and, unlike other CNS stimulants or alcohol, its effects are short-lived. In many people, caffeine does not negatively affect concentration or higher mental functions, and hence caffeinated drinks are often consumed in the course of work. Continued consumption of caffeine can lead to tolerance. Upon withdrawal, the body becomes oversensitive to adenosine, causing the blood pressure to drop dramatically, leading to headache and other symptoms. Any accumulated sleep debt will be fully felt on withdrawal as well. Intravenous caffeine (in the form of caffeine benzoate 500 mg over 1 hour) is occasionally used medically to treat post-lumbar puncture ("spinal tap") headache[http://www.emedicine.com/neuro/topic557.htm]. Although caffeine solutions are often used as a chemical standard for bitterness, caffeine is added to some soft drinks such as colas, Irn-Bru and Mountain Dew ostensibly for its taste. Mountain Dew While safe for humans, caffeine and its related compounds theobromine and theophylline are considerably more toxic to some other animals such as dogs, horses and parrots due to a much poorer ability to metabolize these compounds. Caffeine does more damage to spiders than most drugs.

Toxicity

Too much caffeine can lead to caffeine intoxication. The symptoms of this disorder are restlessness, nervousness, excitement, insomnia, flushed face, diuresis, gastrointestinal complaints, even hallucinations. They can occur in some people after as little as 250 mg per day. More than 1,000 mg per day may result in muscle twitching, rambling flow of thought and speech, cardiac arrhythmia or tachycardia, and psychomotor agitation. Caffeine intoxication can lead to symptoms similar to those of panic disorder and generalized anxiety disorder. The minimum lethal dose ever reported is 3,200 mg, intravenously. The LD₅₀ of caffeine is estimated between 13 and 19 grams for oral administration for an average adult. The LD₅₀ of caffeine is dependent on weight and estimated to be about 150 to 200 mg per kg of body mass, roughly 140 to 180 cups of coffee for an average adult taken within a limited timeframe that is dependent on half-life. The half-life, or time it takes for the amount of caffeine in the blood to decrease by 50%, ranges from 3.5 to 10 hours. In adults the half-life is generally around 5 hours. However contraceptive pills increase this to around 12 hours, and, for women over 3 months pregnant, it varies from 10 to 18 hours. In infants and young children, the half-life may be longer than in adults. With common coffee and a very rare half-life of 100 hours, it would require 3 cups of coffee every hour for 100 hours just to reach LD₅₀. Though achieving lethal dose with coffee would be exceptionally difficult, there have been many reported deaths from intentional overdosing on caffeine pills. Studies in humans have shown that caffeine may cause miscarriage or may slow the growth of a developing fetus when given in doses greater than 300 mg (an amount equal to three cups of coffee) a day. In addition, use of large amounts of caffeine by the mother during pregnancy may cause problems with the heart rhythm of the fetus. Excessive ingestion of caffeine can result in increased blood pressure and pulse, increased urine production, vasoconstriction (tightening or constricting of superficial blood vessels) sometimes resulting in cold hands or fingers, increased amounts of fatty acids in the blood, and increased production of gastric acid. Those suffering from overdose should seek medical attention. If medical care is not possible, they should find a quiet place to rest. Within an hour after the effects first arise, peak influence on the body should occur, with a 15-30 minute plateau, after which the effects should abate and the sufferer can return to normal activity.

Withdrawal

Caffeine withdrawal usually manifests itself in long drawn-out headaches. A feeling of "pressure" is created and the sufferer has difficulty concentrating and maintaining a train of thought. Unless the user can identify the fact that they are going into caffeine withdrawal, usually they regard it as a common or garden headache. The feeling is sometimes described as similar to dehydration, but can be recognized by the fact that from soon after they get up (assuming morning usage) the feeling slowly comes on then stays steady. Although painkillers such as asprin can relieve symptoms, often a small dose of caffeine does the best job. A cup of white or black tea relieves the symptoms quite well and almost instantly.

Abuse

Caffeine, in its many forms, has been used for its stimulating effects. In modern times, though, the substance can be produced in much higher quantities, and has found its way into many products. Purer forms, such as those in caffeine pills, are easily available. These pills are sometimes used by college students and shift workers to last an entire night without sleep. Caffeine pills have been under media fire for recent and past deaths of students, usually take on the form of a caffeine overdose. One such example of this was the death of a North Carolina student, Jason Allen. He swallowed most of a bottle of 90 such pills [http://www.collegepublisher.com/media/paper87/DFPArchive/science/1103981.html]. This was the equivalent of about 250 cups of coffee (or, alternatively, a gallon and a half (5 liters) of espresso, or 22 gallons (~85 liters) of caffeinated Mountain Dew (this soft drink is not available in caffeinated form in all areas). Allen probably ingested about 18 grams of caffeine, since caffeine pills are restricted to 200 milligrams or less in the U.S., and most manufacturers make them in that size. A few other deaths by caffeine overdose have been known, almost always in the case of massive pill consumption. Long periods of abuse can lead to detrimental effects on the esophagus; persons who consume high amounts of caffeine may have a risk for higher incidents of peptic ulcers, erosive esophagitis, and gastroesophageal reflux disease. They may also have heart problems, insomnia, chronic muscle tension, and nervousness. The term caffeinism has been coined to mean addiction to (or debilitating dependence on) caffeine.

References

- Weinberg BA, Bealer BK. The world of caffeine. New York & London: Routledge, 2001. ISBN 0-415-92722-6.
- Noever, R., J. Cronise, and R. A. Relwani. 1995. Using spider-web patterns to determine toxicity. NASA Tech Briefs 19(4):82. Published in New Scientist magazine, 27 April 1995.

External links

- [http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202105.html US National Library of Medicine: MedlinePlus® Drug Information: Caffeine]
- [http://www.erowid.org/chemicals/caffeine/caffeine.shtml Erowid Caffeine Vault]
- [http://www.mrkland.com/fun/xocoatl/caffeine.htm Caffeine in chocolate?]
- [http://chemistry.about.com/od/moleculescompounds/a/caffeine.htm Caffeine Chemistry]
- [http://www.CaffeineWeb.com Site dedicated to "Caffeinism's Mimicry of Mental Illness"]
- [http://www.thenakedscientists.com/html/columnists/dalyacolumn2.htm Why do plants make caffeine?]
- [http://www.cspinet.org/new/cafchart.htm Caffeine Content of Foods]
- [http://www.benbest.com/health/caffeine.html Is Caffeine a Health Hazard?]
- [http://www.coffeefaq.com/caffaq.html The Caffeine FAQ]
- [http://www.compchemwiki.org/index.php?title=Caffeine Computational Chemistry Wiki]
- [http://www.energyfiend.com/death-by-caffeine/ Death by Caffeine Calculator (humor)]
- [http://www.energyfiend.com/the-caffeine-database/ Caffeine content of drinks, mints, chocolates, and pills]
- [http://www.nescafe.com/ Nescafe - Coffee company] Category:Xanthines Category:Coffee ms:Kafeina ja:カフェイン simple:Caffeine th:คาเฟอีน

Cocaine

:This article is about the drug Cocaine. For the blues song by J.J. Cale (later covered by Eric Clapton) see Cocaine (song) Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. It is a stimulant of the central nervous system and an appetite suppressant, creating what has been described as a euphoric sense of happiness and increased energy. Though most often used recreationally for this effect, cocaine is also a topical anesthetic that was used in eye and throat surgery in the 19th and early 20th centuries. Cocaine is an addictive substance, and its possession, cultivation, and distribution is illegal for non-medicinal / non-government sanctioned purposes in virtually all of the world.

History

The coca leaf

For thousands of years and still today, South American indigenous peoples have chewed the coca leaf (Erythroxylon coca), a plant which contains vital nutrients as well as numerous alkaloids, including cocaine. The leaf was and is chewed almost universally by some indigenous communities, but there is no evidence that its habitual use ever led to any of the negative consequences generally associated with habitual cocaine use today. It is an important source of nutrition and energy in a region that is lacking in other food sources and oxygen; the vitamins and protein present in the leaves, as well as the cocaine alkaloid, helps provide the energy and strength necessary for steep walks in this mountainous area and days without eating. indigenous communities When the Spaniards conquered South America, they at first ignored Aboriginal claims that the leaf gave them strength and energy, and declared the practice of chewing it the work of the Devil. But after discovering that these claims were true, they legalized and taxed the leaf, taking 10% of the value of each crop. These taxes were for a time the main source of support for the Roman Catholic Church in the region. In 1609 Padre Blas Valera wrote:

Coca protects the body from many ailments, and our doctors use it in powdered form to reduce the swelling of wounds, to strengthen broken bones, to expel cold from the body or prevent it from entering, and to cure rotten wounds or sores that are full of maggots. And if it does so much for outward ailments, will not its singular virtue have even greater effect in the entrails of those who eat it?

Isolation

Although the stimulant and hunger-suppressant properties of coca had been known for many centuries, the isolation of the cocaine alkaloid was not achieved until 1855. Although many scientists had attempted to isolate cocaine, no one had been successful for two reasons: the knowledge of chemistry required was insufficient at the time, and coca does not grow in Europe and is easily ruined during travel. The cocaine alkaloid was first isolated by the German chemist Friedrich Gaedcke in 1855. Gaedcke named the alkaloid “erythroxyline”, and published a description in the journal Archives de Pharmacie. In 1856 Friederich Wöhler asked Dr. Carl Scherzer, a scientist aboard the Novara (an Austrian frigate sent by Emperor Franz Joseph to circle the globe), to bring him a large amount of coca leaves from South America. In 1859 the ship finished its travels and Wöhler received a trunk full of coca. Wöhler passed on the leaves to Albert Niemann, a Ph.D. student at the University of Göttingen in Germany, who then developed an improved purification process. Niemann described every step he took to isolate cocaine in his dissertation entitled On a New Organic Base in the Coca Leaves, which was published in 1860 — it also earned him his Ph.D. and is now in the British Library. He wrote of the alkaloid's “colourless transparent prisms” and said that, “Its solutions have an alkaline reaction, a bitter taste, promote the flow of saliva and leave a peculiar numbness, followed by a sense of cold when applied to the tongue.” Niemann named the alkaloid “cocaine” — as with other alkaloids its name carried the “-ine” suffix (from Latin -ina).

Popularization

In 1859 an Italian doctor Paolo Mantegazza returned from Peru, where he had witnessed first-hand the use of coca by the natives. He proceeded to experiment on himself and upon his return to Milan he wrote a paper in which he described the effects. In this paper he declared coca and cocaine (at the time they were assumed to be the same) as being useful medicinally, in the treatment of “a furred tongue in the morning, flatulence, [and] whitening of the teeth.” flatulence gold medal to Angelo Mariani.]] A chemist named Angelo Mariani who read Mantegaza’s paper became immediately intrigued with coca, and its economic potential. In 1863 Mariani started marketing a wine called Vin Mariani which had been treated with coca leaves. The ethanol in the wine acted as a solvent and extracted the cocaine from the coca leaves, altering the drink’s effect. It contained 6 mg cocaine per ounce of wine, but Vin Mariani which was to be exported contained 7.2 mg per ounce in order to compete with the higher cocaine content of similar drinks in the United States. A “pinch of coca leaves” was included in John Styth Pemberton's original 1886 recipe for Coca-Cola, though the company began using decocainized leaves in 1906 when the Pure Food and Drug Act was passed. The only known measure of the amount of cocaine in Coca-Cola was determined in 1902 as being as little as 1/400 of a grain (0.2 mg) per ounce of syrup. (6 ppm.) The actual amount of cocaine that Coca-Cola contained during the first twenty years of its production is impossible to determine. In 1879 cocaine began to be used to treat morphine addiction. Cocaine was introduced into clinical use as a local anaesthetic in Germany in 1884, about the same time as Sigmund Freud published his work Über Coca, in which he wrote that cocaine causes:

...exhilaration and lasting euphoria, which in no way differs from the normal euphoria of the healthy person...You perceive an increase of self-control and possess more vitality and capacity for work....In other words, you are simply normal, and it is soon hard to believe you are under the influence of any drug....Long intensive physical work is performed without any fatigue...This result is enjoyed without any of the unpleasant after-effects that follow exhilaration brought about by alcohol....Absolutely no craving for the further use of cocaine appears after the first, or even after repeated taking of the drug...

Über CocaIn 1885 the U.S. manufacturer Parke-Davis sold cocaine in various forms, including cigarettes, powder, and even a cocaine mixture that could be injected directly into the user’s veins with the included needle. The company promised that its cocaine products would “supply the place of food, make the coward brave, the silent eloquent and ... render the sufferer insensitive to pain.” By late Victorian era cocaine use had appeared as a vice in literature, for example as the cucaine injected by Arthur Conan Doyle’s fictional Sherlock Holmes. In 1909 Ernest Shackleton took “Forced March” brand cocaine tablets to Antarctica, as did Captain Scott a year later on his ill-fated journey to the south pole.

Prohibition

By the turn of the twentieth century, the addictive properties of cocaine had become clear to many, and the problem of cocaine abuse began to capture public attention in the United States. The dangers of cocaine abuse became part of a moral panic that was tied to the dominant racial and social anxieties of the day. In 1903 the American Journal of Pharmacy stressed that most cocaine abusers were “bohemians, gamblers, high- and low-class prostitutes, night porters, bell boys, burglars, racketeers, pimps, and casual laborers.” In 1914 Dr. Christopher Koch of Pennsylvania’s State Pharmacy Board made the racial innuendo explicit, testifying that, “Most of the attacks upon the white women of the South are the direct result of a cocaine-crazed Negro brain.” Mass media manufactured an epidemic of cocaine use amongst African-Americans in the Southern United States, although there is little evidence that such an epidemic actually took place, to play upon racial prejudices of the era. In the same year, the Harrison Narcotics Tax Act banned the nonprescription use of cocaine-containing products, and it was officially outlawed as a narcotic in 1922.

Modern usage

In most Western countries, cocaine, also known as "coke", "stardust", "snow", "white", and "blow", is a popular recreational drug. In the United States, the introduction of "crack" cocaine introduced it to a generally poorer inner-city market. Use of the powder form has stayed relatively constant, experiencing a new height of use during the late 1990s and early 2000s in the USA, and has become much more popular in the last few years in the UK. Cocaine use is prevalent across all socioeconomic strata, including age, demographics, economic, social, political, religious, and livelihood. Cocaine in its various forms comes in second only to cannabis as the most popular illegal recreational drug in the United States, and is number one in street value sold each year. The estimated U.S. cocaine market exceeded $35 billion in street value for the year 2003, exceeding revenues by corporations such as AT&T and Starbucks. There is a tremendous demand for cocaine in the U.S. market, particularly among those who are making incomes affording luxury spending, such as single adults and various professionals. Cocaine’s status as a club drug shows its immense popularity among the “party crowd”. Cocaine’s high revenues may be due to the drug’s psychologically addictive nature, which makes the cessation of use quite difficult when compared to less addictive drugs such as marijuana. It has become much more popular as a middle class drug in the United Kingdom in recent years.

Pharmacology

Appearance

United Kingdom Cocaine in its purest form is an off-white or pink chunky product. Cocaine appearing in powder form is a salt, typically cocaine hydrochloride (CAS 53-21-4). Cocaine is frequently adulterated or “cut” with various powdery fillers to increase its volume; the substances most commonly used in this process are baking soda, sugars, such as lactose, inositol, and mannitol, and local anesthetics, such as lidocaine. Adulterated cocaine is often a white or off-white powder. The color of “crack” cocaine depends upon several factors including the origin of the cocaine used, the method of preparation — with ammonia or sodium bicarbonate, and the presence of impurities, but will generally range from a light brown to a pale brown. Its texture will also depend on the factors which affect color, but will range from a crumbly texture, which is usually the lighter variety, to hard, almost crystalline nature, which is usually the darker variety.

Forms of cocaine

Cocaine sulfate

Cocaine sulfate is produced by macerating coca leaves along with water that has been acidulated with sulfuric acid. This is often accomplished by putting the ingredients into a vat and stamping on it, in a manner not dissimilar to the traditional method for crushing grapes. After the cocaine is extracted, the water is evaporated to yield a pastey mass of impure cocaine sulfate. The sulfate itself is an intermediate step to producing cocaine hydrochloride. In South America it is commonly smoked along with tobacco, and is known as pasta, basuco, basa, pitillo, or simply paste.

Freebase

As the name implies, “freebase” is the base form of cocaine, as opposed to the salt form of cocaine hydrochloride. Whereas cocaine hydrochloride is extremely soluble in water, cocaine base is insoluble in water and is therefore not suitable for drinking, snorting or injecting. Cocaine hydrochloride is not well-suited for smoking because the temperature at which it vaporizes is very high, and close to the temperature at which it burns; however, cocaine base vaporizes at a low temperature, which makes it suitable for inhalation. Smoking freebase is preferred by many users because the cocaine is absorbed immediately into blood via the lungs, where it reaches the brain in about five seconds. The rush is much more intense than sniffing the same amount of cocaine nasally, but the effects do not last as long. The peak of the freebase rush is over almost as soon as the user exhales the vapor, but the high typically lasts 5–10 minutes afterwards. What makes freebase a particularly dangerous drug is that users typically don't wait that long for their next hit and will continue to smoke freebase until none is left. These effects are similar to those that can be achieved by injecting or “slamming” cocaine hydrochloride, but without the risks associated with intravenous drug use (although there are other serious risks associated with smoking freebase). Freebase cocaine is produced by first dissolving cocaine hydrochloride in water. Once dissolved in water, cocaine hydrochloride (Coc HCl) disassociates into protonated cocaine ion (CocH⁺) and chloride ion (Cl^-). Any solids that remain in the solution are not cocaine (they are part of the cut) and are removed by filtering. A base, typically ammonia (NH₃), is added to the solution to remove the extra proton from the cocaine. The following net chemical reaction takes place:

NH₃ + CocH⁺ + Cl^- → NH₄Cl + Coc

As freebase cocaine (Coc) is insoluble in water, it precipitates and the solution becomes cloudy. To recover the freebase, diethyl ether is added to the solution: Since freebase is highly soluble in ether, a vigorous shaking of the mixture results in the freebase being dissolved in the ether. As ether is insoluble in water, it can be siphoned off. The ether is then left to evaporate, leaving behind the nearly pure freebase. This procedure is dangerous because of the hazards of handling diethyl ether: it is extremely flammable, its vapors are heavier than air and can “creep” from an open bottle, and in the presence of oxygen it can form peroxides which can spontaneously combust. Demonstrative of the dangers of the practice, the famous comedian Richard Pryor used to perform a well known skit in which he pokes fun at himself during a 1980 incident in which he caused an explosion and set himself on fire while attempting to smoke “freebase”, presumably still wet with ether.

Crack cocaine

Richard Pryor Because of the dangers of using ether to produce pure freebase cocaine, cocaine producers began to omit the step of removing the freebase cocaine precipitate from the ammonia mixture. Typically, filtration processes are also omitted. The end result of this process is that the cut, in addition to the ammonium salt (NH₄Cl), remains in the freebase cocaine after the mixture is evaporated. The “rock” which is thus formed also contains a small amount of water. When the rock is heated this water boils, making a crackling sound (hence the name “crack”). Baking soda is now most often used as a base rather than ammonia for reasons of lowered stench and toxicity; however, any weak base can be used to make crack cocaine. Strong bases, such as sodium hydroxide, tend to hydrolyze some of the cocaine into useless ecgonine. The net reaction when using baking soda (also called sodium bicarbonate, with a chemical formula of NaHCO₃) is:

CocH⁺ + Cl^- + NaHCO₃ → Coc + H₂O + CO₂ + NaCl

Crack is unique because it offers a strong cocaine experience in small, low-priced packages. In the United States, crack cocaine is often sold in small, inexpensive dosage units frequently known as “nickels” or “nickel rocks” (referring to the price of $5.00), and also “dimes” or “dime rocks” ($10.00) and sometimes as “twenties” or “solids”, and “forties”. The quantity provided by such a purchase varies depending upon many factors, such as local availability, which is affected by geographic location. A twenty may yield a quarter gram or half gram on average, yielding 30 minutes to an hour of effect if hits are taken every few minutes. After the $20 or $40 mark, crack and powder cocaine are sold in grams or fractions of ounces. Many inner-city addicts with a regular dealer will “work a corner”, taking money from anyone who wants crack, making a buy from the dealer, then delivering part of the product while keeping some for themselves. Although consisting of the same active drug as powder cocaine, crack cocaine in the United States is seen as a drug primarily by and for the inner city poor (the stereotypical "crack head" is a poor, urban, usually homeless person of color). While insufflated powder cocaine has an associated glamour attributed to its popularity among mostly middle and upper class whites (as well as musicians and entertainers), crack is perceived as a skid row drug of squalor and desperation. In many jurisdictions in the US, possession or sale of crack cocaine carries a harsher penalty than an equivalent amount of powder cocaine. Street names for crack include “Devil’s dandruff”, “Devilsmoke”, “Devil drug”, "Devil's Candy", “hard”, “dope”, “work”, “smoke”, “yoda”, “yayo”, “yay”, “bones”, “yola”, "candy", “matter”, "boy", and “food”; but most commonly, it is simply called “rock”. Crack cocaine was extremely popular in the mid- and late 1980s, especially in inner cities, although its popularity declined through the 1990s. In 1998, Gary Webb's book Dark Alliance: The CIA, the Contras, and the Crack Cocaine Explosion linked the “crack explosion” to the CIA funding of the anti-communism Contras fighting against sandinistas in Nicaragua.

Methods of administration

Chewed/eaten

The simplest way to administer cocaine is to chew on the leaves of the plant. Physical restrictions mean when taken this way, only small amounts of cocaine make it into the bloodstream and the effect is that of a mild stimulant. Mate de coca or coca-leaf tea is also a traditional method of consumption and is often recommended to treat altitude sickness. In 1986 an article in the Journal of the American Medical Association revealed that health food stores were selling coca-leaf tea as “Health Inca Tea”. While the packaging claimed it had been “decocainized”, no such process had taken place—they were selling a controlled substance off the shelves. The article stated that drinking two cups of the tea per day gave a mild stimulation, increased heart rate, and mood elevation, and the tea was essentially harmless. Despite this, the DEA seized several shipments in Hawaii, Chicago, Illinois, Georgia, and several locations on the East Coast of the United States, and the product was removed from the shelves.

Insufflation

Insufflation (known colloquially as “snorting” or “sniffing”) is the most common method of ingestion of recreational powder cocaine in the Western world. Contrary to widespread belief, cocaine is not actually inhaled using this method; rather the drug coats and is absorbed through the mucous membranes lining the sinuses. When insufflating cocaine, absorption through the nasal membranes is approximately 80%. Any material not directly absorbed through the mucous membranes is collected in mucous and swallowed. Chronic use results in ongoing rhinitis and necrosis of the nasal membranes. Cellulose granulomas from adulterants have also been found in the lungs of recreational “sniffers”. Prior to insufflation cocaine powder must be divided into very fine particles. Cocaine of high purity breaks into smallest dust very easily, except when it's moist(not well stored) and forms “chunks”, which reduce the efficiency of nasal absorption. Rolled up paper currency, hollowed-out pens and cut straws are often used to insufflate cocaine. Such devices are often referred to as 'tooters' by users. The cocaine typically is poured onto a flat, hard surface (such as a mirror) and divided into "lines" (usually with a razor blade or credit card) which are then insufflated. The amount of cocaine in a line varies widely from person to person and occassion to occassion (the purity of the cocaine is also a factor), but one line is generally considered to be a single dose.

Injected

The intravenous route of administration provides the highest blood levels of drug in the shortest time. It can get to the brain within 15 seconds. Injection of cocaine produces an exhilarating rush so intense that often the user may vomit uncontrollably, although the euphoria passes quickly as the liver rapidly metabolizes the drug. Aside from the toxic effects of cocaine, there is also danger of circulatory emboli from the insoluble substances that may be used to cut the drug. Obviously, there is also a risk of serious infection associated with the use of contaminated needles. An injected mixture of cocaine and heroin, known as “speedball” or “moonrock”, is a particularly popular and dangerous combination, as the converse effects of the drugs actually complement each other, but may also mask the symptoms of an overdose. It has been responsible for numerous deaths, particularly in and around Los Angeles, including celebrities such as John Belushi and Chris Farley. Experimentally, cocaine injections can be delivered to animals such as fruit flies [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15262059&query_hl=21] to study the mechanisms of cocaine addiction.

Smoked

(see also: Crack cocaine above) Smoking freebase or crack cocaine is most often accomplished using a pipe made from a small glass tube about one quarter-inch (about 6 mm) in diameter and up to several inches long. These are sometimes called “straight shooters”; readily available in convenience stores or smoke shops. They will sometimes contain a small paper flower and are promoted as a romantic gift. Buyers usually ask for a “rose” or a “flower”. An alternate method is to use a small length of a radio antenna or similar metal tube. To avoid burning the user’s fingers and lips on the metal pipe, a small piece of paper or cardboard (such as a piece torn from a matchbook cover) is wrapped around one end of the pipe and held in place with either a rubber band or a piece of adhesive tape. A small piece of steel or copper scouring pad—often called a “brillo” or “chore”, from the scouring pads of the same name—is placed into one end of the tube after having the soapy cleanser coating burned off the metal. It then serves as a crude filter in which the “rock” can melt and boil to vapor. The “rock” is placed at the end of the pipe closest to the filter and the other end of the pipe is placed in the mouth. A flame from a cigarette lighter or handheld torch is then held under the rock. As the rock is heated, it melts and burns away to vapor which the user inhales as smoke. The effects are felt almost immediately after smoking, are very intense, and do not last long — usually five to fifteen minutes. Most users will want more after this time, especially frequent users. “Crack houses” depend on these cravings by providing users a place to smoke, and a ready supply of small bags for sale. A heavily used crackpipe tends to fracture at the end from overheating with the flame used to heat the crack as the user obsessively attempts to inhale every bit of the drug on the metal wool filter. The end is often broken further as the user “pushes” the pipe. “Pushing” is a technique used to partially recover crack which hardens on the inside wall of the pipe as the pipe cools. The user pushes the metal wool filter through the pipe from one end to the other to collect the build-up inside the pipe. The ends of the pipe can be broken by the object used to push the filter, frequently a small screwdriver or stiff piece of wire. The user will often remove the most jagged edges and continue using the pipe until it becomes so short that it burns the lips and fingers. To continue using the pipe, the user will sometimes wrap a small piece of paper or cardboard around one end and hold it in place with a rubber band or adhesive tape. Of course, not all people who smoke crack cocaine will let it get that short, and will get a new or different pipe. The tell-tale signs of a used crack pipe are a glass tube with burn marks at one or both ends and a clump of metal wool inside. When smoked, cocaine is sometimes combined with other drugs, such as cannabis; often rolled into a joint or blunt. This combination is known as “primo”, “hype”, B-151er or a “woo”. Crack smokers who are being drug tested may also make their “primo” with cigarette tobacco instead of cannabis, since a crack smoker can test clean within 2 to 3 days of use, if only urine (and not hair) is being tested.

Mechanism of action

Cocaine is a potent blocker of the dopamine transporter (DAT) and a less potent blocker of the norepinephrine transporter (NET) and serotonin transporter (SERT). Cocaine also blocks sodium channels, thereby interfering with the propagation of action potentials; thus, like lidocaine and novocaine, it acts as a local anesthetic. The locomotor enhancing properties of cocaine may be attributable to its enhancement of dopaminergic transmission from the substantia nigra. Recent research points to an important role of circadian mechanisms [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12865893&query_hl=16] and clock genes [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15967985&query_hl=18] in behavioral actions of cocaine. After cocaine is introduced to the body it travels to reward areas of the brain: the ventral tegmental area (VTA), the nucleus accumbens and the prefrontal cortex. These areas are saturated with dopamine synapses. Normally, after dopamine is released in the synaptic cleft, it binds to the dopamine receptors; reuptake sites (protein transported structures) will utilize the rest of the neurotransmitter (dopamine). In the presence of cocaine the normal process of reuptaking is breached. Cocaine binds to the uptake sites, which leaves a higher concentration of dopamine in the synaptic cleft. The higher activation of dopamine receptors in the post-synaptic cell causes various intracellular changes, which ultimately lead to changes in firing patterns. Since nicotine increases the levels of dopamine in the brain, many cocaine users find that consumption of tobacco products during cocaine use enhances the euphoria. This, however, may have undesirable consequences, such as uncontrollable chain smoking during cocaine use (even users who don't normally smoke cigarettes have been known to chain smoke when using cocaine), in addition to the detrimental health effects and the additional strain on the cardiovascular system caused by tobacco.

Metabolism and excretion

Cocaine is extensively metabolized, primarily in the liver, with only about 1% excreted unchanged in the urine. It is mostly eliminated as benzoylecgonine, the major metabolite of cocaine, and is also excreted in lesser amounts as ecgonine methyl ester and ecgonine. If taken with alcohol, cocaine combines with the ethanol in the liver to form cocaethylene, which is both more euphorigenic and has higher cardiovascular toxicity than cocaine by itself. Cocaine metabolites are detectable in urine for up to four days after cocaine is used. Benzoylecgonine can be detected in urine within four hours after cocaine inhalation and remains detectable in concentrations greater than 1000 ng/ml for as long as 48 hours. Detection in hair is possible in regular users until the sections of hair grown during use are cut or fall out.

Effects and health issues

Cocaine is a potent central nervous system stimulant. Its effects can last from 20 minutes to several hours, depending upon the dosage of cocaine taken and its purity. The initial signs of stimulation are hyperactivity, restlessness, increased blood pressure, increased heart rate and euphoria. The euphoria is sometimes followed by feelings of discomfort and depression and a craving to re-experience the drug. Side effects can include twitching and paranoia, which usually increase with frequent usage. With excessive dosage the drug can produce hallucinations, paranoid delusions, tachycardia, itching, and delusional parasitosis . Overdose causes tachyarrhythmias and a marked elevation of blood pressure. These can be life threatening, especially if the user has existing cardiac problems. Cocaine consumed by “snorting” very rarely causes overdose. Cocaine raises the amount of dopamine and serotonin in the nucleus accumbens; the "crash" experienced after the initial high is marked by an undershooting of normal levels afterwards. This is because neurons run out of dopamine and serotonin neurotransmittors. Receptors disappear as a response mechanism to too much neurotransmitter. This contributes to the rise in an abuser's tolerance thus requiring a larger dosage to achieve the same effect. The lack of normal amounts of serotonin and dopamine in the brain is the cause of the dysphoria and depression felt after the initial high. The diagnostic criteria for cocaine withdrawal is characterized by a dysphoric mood, fatigue, unpleasant dreams, insomnia or hypersomnia, increased appetite, psychomotor retardation or agitation, and anxiety. The LD₅₀ of Cocaine when administered to mice is 95.1 mg/kg. Toxicity results in seizures, followed by respiratory and circulatory depression of medullar origin. This may lead to death from respiratory failure, stroke, cerebral hemorrhage, or heart-failure. Cocaine is also highly pyrogenic, because the stimulation and increased muscular activity cause greater heat production. Heat loss is inhibited by the intense vasoconstriction. Cocaine-induced hyperthermia may cause muscle cell destruction and myoglobinuria resulting in renal failure. There is no specific antidote for cocaine overdose. Cocaine abuse is associated with a lifetime risk of heart attack that is seven times that of non-users. During the hour after cocaine is used, heart attack risk rises 24-fold. It accounts for 25% of the heart attacks in the 18–45 year-old age group. Side effects from chronic smoking of cocaine include chest pain, lung trauma, shortness of breath, sore throat, hoarse voice, dyspnea, and an aching, flu-like syndrome. A common misconception is that the smoking of cocaine breaks down tooth enamel and causes tooth decay. Although this is not true, the lifestyle of frequent cocaine users may include poor dental hygiene, which often results in tooth decay. In addition, cocaine often causes involuntary tooth grinding, known as bruxism, which can deteriorate tooth enamel and lead to gingivitis. Chronic intranasal usage can degrade the cartilage separating the nostrils (the Septum nasi), leading eventually to its complete disappearance.

Cocaine as a local anesthetic

Cocaine was historically useful as a topical anesthetic in eye and nasal surgery. The major disadvantages of this use are cocaine's intense vasoconstrictor activity and potential for cardiovascular toxicity. Cocaine has since been replaced in Western medicine by synthetic local anaesthetics such as benzocaine, proparacaine, and tetracaine. If vasoconstriction is desired for a procedure (as it reduces bleeding), the anesthetic is combined with a vasoconstrictor such as phenylephrine or epinephrine. In Australia it is currently prescribed for use as a local anesthetic for conditions such as mouth and lung ulcers. Some Australian ENT specialists occasionally use cocaine within the practice when peforming procedures such as nasal cauterization. In this scenario dissolved cocaine is soaked into a ball of cotton wool, which is placed in the nostril for the 10-15 minutes immediately prior to the procedure, thus performing the dual role of both numbing the area to be cauterized and also vasoconstriction.

Cocaine addiction

Cocaine addiction is the obsessive or uncontrollable abuse of cocaine. Cognitive Behavioral Therapy (CBT) shows promising results. Spiritual based Twelve-step programs such as Cocaine Anonymous (modeled on Alcoholics Anonymous) have some success combatting this problem. A cocaine vaccine is also being tested which may prevent the recipient from feeling the desirable effects of the drug, although a similar effort to develop a heroin vaccine was abandoned as ineffective in the 1970s. Cocaine has positive reinforcement effects, which refers to the effect that certain stimuli have on behavior. Good feelings become associated with the drug, causing a frequent user to take the drug as a response to bad news or mild depression. This activation strengthens the response that was just made. If the drug was taken by a fast acting route such as injection or inhalation, the response will be the act of taking more cocaine, so the response will be reinforced. Powder cocaine, being a club drug is most commonly available in the evening and night hours. Since cocaine is a stimulant, a user will often drink large amounts of alcohol during and after usage in order to sleep. These several hours of temporary relief and pleasure will further reinforce the positive response. Other downers such as heroin and various pharmaceuticals are often used for the same purpose, further increasing addiction potential and harmfulness. It is speculated that cocaine's addictive properties stem from its DAT-blocking effects (in particular, increasing the dopaminergic transmission from ventral tegmental area neurons). However, a study has shown that mice with no dopamine transporters still exhibit the rewarding effects of cocaine administration [http://www.pnas.org/cgi/content/full/95/13/7699]. Later work demonstrated that a combined DAT/SERT knockout eliminated the rewarding effects [http://www.pnas.org/cgi/content/full/98/9/5300]. The rewarding effects of cocaine are influenced by circadian rhythms [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15087244&query_hl=23], possibly by involving a set of genes termed "clock genes" [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16094306&query_hl=18].

Treatment

GVG

ventral tegmental area Studies have shown that gamma vinyl-gamma-aminobutyric acid (gamma vinyl-GABA, or GVG), a drug normally used to treat epilepsy, blocks cocaine's action in the brains of primates. GVG increases the amount of the neurotransmitter GABA in the brain and reduces the level of dopamine in the region of the brain which is thought to be involved in addiction. In January 2005 the US Food and Drug Administration gave permission for a Phase I clinical trial of GVG for the treatment of addiction. Another drug currently tested for anti-addictive properties is the cannabinoid antagonist rimonabant.

GBR 12909

GBR 12909 (Vanoxerine) is a selective dopamine uptake inhibitor. Because of this, it reduces cocaine's effect on the brain, and may help to treat cocaine addiction. Studies have shown that GBR, when given to primates, suppresses cocaine self-administration.

Venlafaxine

Venlafaxine (Effexor), although not a dopamine re-uptake inhibitor, is a potent serotonin-norepinephrine reuptake inhibitor which has been successfully used to combat the depression caused by cocaine and to a lesser extent, the addiction associated with the drug itself. Venlafaxine has been shown to have significant withdrawal problems itself, and can lead to lifetime use due to these withdrawal effects. A statistically significant number of people prescribed Effexor have committed suicide (2 attempts per 1000 patients, vs 156 suicides per 1000 untreated depressives).

Legal status

The production, the distribution and the sales of cocaine products are restricted (and illegal in most contexts) in most countries.

Africa

- In Nigeria, it is a crime to be seen with cocaine.
- In South Africa, it is a crime to have cocaine in your posession.

Asia

- In Pakistan, use and possession of cocaine is illegal.
- In Singapore, possession of more than 15 grams of cocaine results in a mandatory death sentence.

Middle east

- Saudi Arabia, use and possession of cocaine is punishable by death.

Australia & Oceania

- Australia: Cocaine is a Schedule 8 (controlled) drug permitting some medical use, but is otherwise outlawed.
- New Zealand: Cocaine is a Class A drug. The coca leaf and preparations of cocaine containing no more than 0.1% cocaine base, in such a way that the cocaine cannot be recovered, are both classified as Class C

Europe

- The United Kingdom: Cocaine is a Class A drug, controlled by the Misuse of Drugs Act 1971. However some medical use is permitted

North America

- Canada: Cocaine is a Schedule I drug.
- The United States of America: Cocaine is classified as a Schedule II stimulant.

South America

- Peru and Bolivia: Limited cultivation of coca is legal in Peru and Bolivia, where chewing the leaves and drinking coca tea are considered cultural practices, in particular in the mountaineous regions. Processed cocaine is illegal.

Usage

In the United States

Overall usage

The National Household Survey on Drug Abuse (NHSDA) reported in 1999 that cocaine was used by 3.7 million Americans, or 1.7 percent of the household population aged 12 and over. Estimates of the current number of those who use cocaine regularly (at least once per month) vary, but 1.5 million is a widely accepted figure within the research community. Although cocaine use had not significantly changed over the six years prior to 1999, the number of first-time users went from 574,000 in 1991, to 934,000 in 1998 — an increase of 63%. While these numbers indicated that cocaine is still widely present in the United States, cocaine use was significantly less prevalent than it was during the early 1980s. Cocaine use peaked in 1982 when 10.4 million Americans (5.6 percent of the population) reportedly used the drug.

Usage among youth

The 1999 Monitoring the Future (MTF) survey found the proportion of American students reporting use of powder cocaine rose during the 1990s. In 1991, 2.3 percent of eighth-graders stated that they had used cocaine in their lifetime. This figure rose to 4.7 percent in 1999. For the older grades, increases began in 1992 and continued through the beginning of 1999. Between those years, lifetime use of cocaine went from 3.3 percent to 7.7 percent for tenth-graders and from 6.1 percent to 9.8 percent for twelfth-graders. Lifetime use of crack cocaine, according to MTF, also increased among eighth-, tenth-, and twelfth-graders, from an average of 2 percent in 1991 to 3.9 percent in 1999. Perceived risk and disapproval of cocaine and crack use both decreased during the 1990s at all three grade levels. The 1999 NHSDA found the highest rate of monthly cocaine use was for those aged 18–25 at 1.7 percent, an increase from 1.2 percent in 1997. Rates declined between 1996 and 1998 for ages 26–34, while rates slightly increased for the 12–17 and 35+ age groups. Studies also show people are experimenting with cocaine at younger ages. NHSDA found a steady decline in the mean age of first use from 23.6 years in 1992 to 20.6 years in 1998.

Availability

Cocaine is readily available in all major U.S. metropolitan areas. According to the Summer 1998 Pulse Check, published by the U.S. Office of National Drug Control Policy, cocaine use had stabilized across the country, with a few increases reported in San Diego, Bridgeport, Miami, and Boston. In the West, cocaine usage was lower, which was thought to be because some users were switching to methamphetamine, which was cheaper and provides a longer-lasting high. Numbers of cocaine users are still very large, with a concentration among city-dwelling youth.

Sources

In 1999, Colombia was the world's leading producer of cocaine. Three-quarters of the world's annual yield of cocaine was produced there, both from cocaine base imported from Peru and Bolivia, and from locally grown coca. There was a 28 percent increase in the amount of potentially harvestable coca plants in Colombia in 1998. This, combined with crop reductions in Bolivia and Peru, made Colombia the nation with the largest area of coca under cultivation. Attempts to eradicate coca fields through the use of defoliants have devastated the farming economy of Colombia, and strains appear to have been developed that are immune to their use. Whether these strains are natural mutations or the product of human tampering is unclear. These strains have also shown to be more potent than those previously grown, increasing profits for the drug cartels responsible for the exporting of cocaine. The combination of the destruction of non-drug farms and the spread of new strains of the coca plant have made the cultivation of coca an even more attractive, and in some cases necessary, economic decision.

Distribution

Cocaine shipments from South America transported through Mexico or Central America are generally moved over land or by air to staging sites in northern Mexico. The cocaine is then broken down into smaller loads for smuggling across the U.S.–Mexico border. The primary cocaine importation points in the United States are in Arizona, southern California, southern Florida, and Texas. Typically, land vehicles are driven across the U.S.-Mexico border. Cocaine is also carried in small, concealed, kilogram quantities across the border by couriers known as “mules” (or “burros”), who enter the United States either legally through ports of entry or illegally through undesignated points along the border. Colombian traffickers have also started using a new concealment method whereby they add chemical compounds to cocaine hydrochloride to produce “black cocaine”. The cocaine in this substance is not detected by standard chemical tests or drug-sniffing canines. Cocaine traffickers from Colombia, and recently Mexico, have also established a labyrinth of smuggling routes throughout the Caribbean, the Bahama Island chain, and South Florida. They often hire traffickers from Mexico or the Dominican Republic to transport the drug. The traffickers use a variety of smuggling techniques to transfer their drug to U.S. markets. These include airdrops of 500–700 kg in the Bahama Islands or off the coast of Puerto Rico, mid-ocean boat-to-boat transfers of 500–2,000 kg, and the commercial shipment of tonnes of cocaine through the port of Miami. Bulk cargo ships are also used to smuggle cocaine to staging sites in the western Caribbean–Gulf of Mexico area. These vessels are typically 150–250 foot (50–80 m) coastal freighters that carry an average cocaine load of approximately 2.5 tonnes. Commercial fishing vessels are also used for smuggling operations. In areas with a high volume of recreational traffic, smugglers use the same types of vessels, such as go-fast boats, as those used by the local populations.

Works concerning cocaine

Books about cocaine

- Cocaine: an unauthorized biography by Dominic Streatfeild
- Novel, With Cocaine, by M. Ageyev
- Über Coca by Sigmund Freud
- The Triumph of Surgery by Jürgen Thorwald - Ch. 6 - The second battle against Pain (The early use of cocaine solution in eye surgery)
- More, Now, Again by Elizabeth Wurtzel
- Snowblind by Robert Sabbag
- Celerino III Castillo & Dave Harmon (1994). Powderburns: Cocaine, Contras & the Drug War, Sundial. ISBN 0889625786 (paperback) ISBN 0809548550 (hardcover; Borgo Pr; 3rd ed.; 1995).
- Alexander Cockburn & Jeffrey St. Clair (1999). Whiteout: The CIA, Drugs and the Press, Verso. ISBN 1859841392 (cloth), ISBN 1859842585 (paperback). Cites 116 books.
- Frederick P. Hitz (1999). Obscuring Propriety: The CIA and Drugs, International Journal of Intelligence and Counterintelligence, 12(4): 448-462 DOI:10.1080/088506099304990
- Robert Parry (1999). Lost History: Contras, Cocaine, the Press & “Project Truth”, Media Consortium. ISBN 1893517004.
- Richard Smart (Hard Cover 1985). The Snow Papers T

Drug abuse

Definitions

Public health definitions

Mass communication and vernacular usage

Medical definitions

Historical positions of the American Psychiatric Association

Historical positions of the American Medical Association

Handbook on Drug and Alcohol Abuse

Political and criminal justice definitions

World Health Organization

NIDA

Nixon Administration

Amphetamines

Amphetamine

Medicinal use

Performance enhancing use

Effects of use

Physiological effects

Legal issues

Books

Major League Baseball

See also

External links

Notes

Caffeine

Chemical properties

Physical properties

Caffeine extraction

Sources

Coffee

Teas and other infusions

Chocolate

Other sources

Equivalents to 200 mg of caffeine

History

Mechanism of Action

Metabolism and toxicology

Toxicity

Withdrawal

Abuse

References

External links

Cocaine

History

The coca leaf

Isolation

Popularization

Prohibition

Modern usage

Pharmacology

Appearance

Forms of cocaine

Cocaine sulfate

Freebase

Crack cocaine

Methods of administration

Chewed/eaten

Insufflation

Injected

Smoked

Mechanism of action

Metabolism and excretion

Effects and health issues

Cocaine as a local anesthetic

Cocaine addiction

Treatment

GVG

GBR 12909

Venlafaxine

Legal status

Africa

Asia

Middle east

Australia & Oceania

Europe

North America

South America

Usage

In the United States

Overall usage