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Cocaine, Erythroxylum coca

Also known as

coke, flake, snow, toot, blow, nose candy, her, she, lady flake, liquid lady, crack, rock, Charlie, bump

What does it do?

coca plant leaves

Cocaine is extracted from the
leaves of Erythroxylum coca

The alkaloid cocaine is the main active component but a number of other alkaloids, including methylecgonine cinnamate, benzoylecgonine, truxilline, hydroxytropacocaine, tropacocaine, ecgonine, cuscohygrine, dihydrocuscohygrine, nicotine and hygrine are found.

Cocaine is one of the most powerful stimulants known. It's ability to suppress hunger has made it a popular choice for those, especially young women, who wish to remain slim.

Cocaine's effect is almost immediate and, depending on the dose and the method of administration, may last from twenty minutes to a few hours. It produces euphoria with restlessness and hyperactivity but can also increase blood pressure and accelerate the heart rate and increase body temperature.

The after effects of cocaine, for some people, can  include depression and discomfort which may lead to a desire to have another dose. Some multisubstance users take a combination of cocaine and heroin, known as speedballing, to take the jagged edge off the comedown from the cocaine.

Is it Addictive?

There is still some debate as to whether cocaine is truly addictive rather than simply resulting in a strong dependency in some cases. It is known that many casual users can go for weeks without using cocaine but, a small minority of users undoubtedly come to rely totally on cocaine. In the following 'reliance' is used in preference to 'addiction'. As with all substances, the effect of large amounts will be more detrimental than 'normal' doses and, since it affects the central nervous system, used regularly in large amounts it is more likely to create reliance. This type of use, described by the WHO as 'compulsive/dysfunctional', was found to be 'uncommon' by the cocaine survey conducted in 1992-4.

The 'World Drugs Report 2009' from the United Nations Office on Drugs and Crime, UNODC, estimates that between 16 and 21 million people, worldwide, used cocaine at least once in the previous year. Other surveys have suggested that no more than 25% of users use cocaine at least once a month. For the UK, there are estimated to be 1 million annual prevalence cocaine users and in 2007/8 23,000 people received drug treatment where use of cocaine was the primary drug. This very low percentage requiring help with cocaine use suggests that it is not truly addictive in the way that, say, nicotine is.

In recent years, there has been a steady fall in the use of cocaine. There is no consensus on the causes of this fall. The fact that many hundreds of thousands, if not millions, of people have given up using cocaine without requiring help from treatment programmes is a clear indication that cocaine is not the strongly addictive substance it is often portrayed to be.

Is it Harmful?

Short-term, it is generally said that the harm done by cocaine is associated with hyperthermia, the elevation of body temperature which, if uncontrolled, can produce kidney failure.

It is generally believed that regular use in large amounts over a long period is required for harm to arise, particularly increased risk of cardiac problems as a result of the elevated heart rate produced. High blood pressure can also be a longer term problem. Collapse of the septum, the tissue between the nostrils is a well-known effect of regular use.

There is growing evidence, however, that use of alcohol and cocaine at the same time is the most frequent cause of problems. Though it was once thought that combined use was mostly coincidental since both substances are available at social gatherings it now appears that many users deliberately use both because it is perceived that the combination gives heightened euphoria and prolongs the effects of cocaine.

When the Alcohol Education and Research Council (AERC)'s 'Alcohol Academy' looked into cocaethylene, in a paper published in April 2010, it found strong indications that many users combine alcohol and cocaine but there is little knowledge about the greatly increased risks arising.

There has been insufficient work to be sure of the extent of combined usage but anecdotal reports of users suggest it is widespread and some studies of persons entering treatment for cocaine problems have found as much as 75% combined use.

Erythroxylum coca, cocaine

A mature coca bush

It should be said that whilst the scientific understanding of the reactions between alcohol and cocaine and the effects of cocaethylene are good, there is little systematic information on the actual effects on users. A 2000 paper by Dr Carl Hart found little or no difference in the intensity of cocaethylene versus cocaine though cocaethylene was found to take longer to decay. There have, certainly, been reports of deaths during a single period of consumption but it is not possible to say how often such deaths arise or what is the true cause.

There is a tendency to focus on the illegal substance use rather than the combination. In 2011, for example, 112 death certificates issued in England and Wales mentioned cocaine overdose as at least a contributory factor in the cause of death. The official statistics for drug poisoning deaths show that 59 of those certificates mentioned only cocaine (from the 'drugs' covered) and that 50 also mentioned alcohol (not one of the 'drugs' covered). What is not knowable is whether all of those 50 deaths occurred to persons in the 59 'cocaine only' group.

During the period 1992-94 the World Health Organisation (WHO) conducted research, in nineteen countries, on cocaine use and its effects. The countries included producer countries, like Colombia and Bolivia, countries where use of cocaine was high, like the USA, and countries where there was, at that time, little or no use of cocaine, like Russia and Nigeria.

In 1995, an 'information package' was produced setting out the results of the research. Normally, this information package would have been the basis for a WHO report but the USA announced that it would withdraw funding from the WHO if the information was made public. Finally, in 2009, the papers were leaked and it is possible to study the results.

It should be stressed that this work was a sort of pilot study to test the methods of collecting data prior to conducting worldwide research. Sample sizes are, thus, quite small and much of the information collected is anecdotal. The similarity of situations across vastly different countries, however, gives the conclusions a degree of validity.

The main conclusions from the work included;

  •  It is not possible to describe an "average cocaine user". An enormous variety was found in the types of people who use cocaine, the amount of drug used, the frequency of use, the duration and intensity of use, the reasons for using and any associated problems they experience.

  •  Health problems from the use of legal substances, particularly alcohol and tobacco, are greater than health problems from cocaine use.
  •  Few experts describe cocaine as invariably harmful to health. Cocaine-related problems are widely perceived to be more common and more severe for intensive, high-dosage users and very rare and much less severe for occasional, low-dosage users.
  •  A majority of health consequences may not be directly attributed to cocaine use. Cocaine often contributes to or exacerbates the conditions reported, rather than causing them.

  •  Use of coca leaves appears to have no negative health effects and has positive therapeutic, sacred and social functions for indigenous Andean populations.

  •  In many settings, educational and prevention programmes generally do not dispel myths but sensationalize, perpetuate stereotyping and misinformation.

There is increasingly a view that the most harm caused by cocaine is done in the producing areas. Production methods, especially the need to conceal cultivation often by felling clearings in forests, are damaging to the environment and the large sums of money to be made from the illegal cocaine trade lead to very serious violent crime which is capable of destabilising whole countries.