Abuse of coca and cocaine

Visualization of narrower problems
Long-term effects of cocaine abuse
Coca leaf is the leaf of the coca bush and may be chewed or used for the manufacture of cocaine, a powerful stimulant drug. Cocaine can be sniffed, smoked or injected. It is one of the most addictive drugs known and is characterized as the most pernicious drug currently being abused world-wide, with heavy use often leading to paranoia, psychosis and violence. Coca paste is an intermediary product in the manufacture of cocaine which usually contains an impure mixture of cocaine sulphate and other alkaloids, which is then mixed with tobacco or marijuana. It has a high potential for psychic dependence and psychopathology. "Crack" is a more potent crystalline form of cocaine, composed of small rocks which are usually smoked to give quick, intense highs which usually leave the user desperate for more of the drug. Especially because of its potency and cheapness, it is responsible for serious harmful physiological and psychological effects in non-producer countries.

Coca-leaf chewing is a traditional practice among South American Indians and although officially recognized to be harmful, it is encouraged by their present-day employers, some of whom even pay partly in coca-leaf. Coca-leaf chewing enhances their poverty, malnutrition and exploitation, keeping peasant populations in bondage through debts incurred, and therefore undernourished because of the need to pay debts in kind (food, animals). With prolonged use coca dulls both mind and body, impairing the intelligence of the user's children, and increasing occupational risk when the user is working with a machete or other dangerous instruments. Excessive consumption of coca renders the individual more susceptible to disease and early death.

The use, distribution and sale of cocaine and its by-products are major social and health problems. The social problems include crime: murder, smuggling, selling illegal drugs and laundering money; prostitution; degeneration of the family; losses in productivity for businesses; increasing medical costs; and corruption of police and other government officials.

The major routes of administration of cocaine are sniffing or snorting, injecting, and smoking (including free-base and crack cocaine). Snorting is the process of inhaling cocaine powder through the nose where it is absorbed into the bloodstream through the nasal tissues. Injecting is the act of using a needle to release the drug directly into the bloodstream. Smoking involves inhaling cocaine vapor or smoke into the lungs where absorption into the bloodstream is as rapid as by injection.

The coca bush ([Erythroxylon coca]) is an evergreen shrub primarily grown in the mountainous western region of South America, where it has been used for centuries by Andean Indians, and since 1884 in western medicine, as a local anaesthetic, and to help combat hunger and overcome fatigue and exhaustion caused by the high altitude. Sigmund Freud used it in the belief that it was a cure-all before he recognized the threat of addiction. In the 1880's cocaine for inhalation was easily purchased at the corner drugstore in the US. It was also available in forms to be smoked. In the 1890's cocaine reached its peak per-capita consumption in America that probably never been equalled. As users became addicted, became involved in violent crime and became paranoid and as the drug became associated with prostitution and criminal gangs social concern grew. In 1906 the Food and Drug Act required any over-the-counter remedy containing cocaine list it as an ingredient. In 1914 the Federal Government enacted a law controlling the distribution of opiates and cocaine. The state of New York outlawed the use of cocaine for any reason including medical ones. Cocaine became the archetype of the dangerous drug. About 1970 the drug reappeared in the US.

So great are the addictive properties of cocaine that studies have shown that laboratory animals will time after time select cocaine over their favourite food, until they eventually die of an overdose or starve. In addition to addiction, cocaine's chief effects are as a stimulant for the nervous and circulatory systems. It can induce euphoric excitement and hallucinatory experience. Because it creates a feeling of great muscular strength and mental clarity, the user tends to overestimate the capabilities of the body. This sense of being "super-powerful", combined with the paranoid delusions and auditory, visual and tactile hallucinations that may be induced, can make the user capable of committing serious anti-social acts; stimulation is followed by depression, dependence being mental rather than physical; overdose may be fatal.

Blood vessels constrict when cocaine is used causing a quick rise in blood pressure sometimes causing an angina. The flow of oxygenated blood to the heart is reduced causing damage to heart cells, irregularity or increase in heartbeat and heart attacks. Those who have not previously had heart problems can develop them over time. Cocaine attacks the brain and nervous system causing constricted arteries, broken arteries, stokes, seizures, tremors delirium and psychosis. Blood supplies to the intestines are restricted. Cells in the liver are destroyed. The lungs accumulate fluid. When cocaine is snorted the cells in the lining of the nose are damaged and the sense of smell is lost. Cocaine also harms the immune system, and thus increases the risk of AIDS and some infectious diseases.

With long term use, men may experience difficulty in maintaining an erection or in ejaculating and women may find it difficult to reach orgasm. Cocaine use during pregnancy can cut off oxygen to the foetus, fatally or with complications as premature delivery or detachment of the placenta from the womb. New born babies may be under weight or suffer from withdrawal symptoms: tremors, mood swings and irritability.

Physical effects of cocaine use include constricted peripheral blood vessels, dilated pupils, and increased temperature, heart rate, and blood pressure. The duration of cocaine's immediate euphoric effects, which include hyper-stimulation, reduced fatigue, and mental clarity, depends on the route of administration. The faster the absorption, the more intense the high. On the other hand, the faster the absorption, the shorter the duration of action. The high from snorting may last 15 to 30 minutes, while that from smoking may last 5 to 10 minutes. Increased use can reduce the period of stimulation.

There are over 6 million abusers of cocaine substances. Three-quarters are cocaine abusers, mainly in the USA where in 2001 more than 30 million have tried cocaine and 5 million report regular use, It was estimated that in 1993 criminals in the USA make between $15 billion and $17.5 billion per year out of the sale of cocaine alone. This amounts to between 150 and 175 tonnes per year.

According to a 1999 report, cocaine was tried by 1% to 3% of all European adults. The quantities of cocaine seized in the EU peaked 38 tonnes in 1997, with the largest seizures made in Spain. Cocaine was often used as a second drug by heroin addicts.

Whilst cocaine abuse used to be found more often among rich communities in the Americas and Europe, it now also threatens Africa, the Near and Middle East, South and Southeast Asia and Oceania, as noted in the report of the International Narcotics Control Board for 1991.

The excessive consumption of coca among South American Indians is most marked in the high plateau lands of Peru and Bolivia but is also noted in other South American countries. Coca is used mainly to dull the pangs of hunger, fatigue, disease and mental depression brought on by hard labour and inadequate wages. The traditional belief that coca is mainly beneficial is encouraged, and it is even declared a 'food' by certain Bolivian landowners. Urban youth are now smoking small brown rolls of coca paste mixed with tobacco, a habit that is spreading throughout rural areas in most countries where the coca bush is grown.

The proportion of US high school seniors who have used cocaine at least once in their lifetimes increased from 5.9 percent in 1994 to 9.8 percent in 1999, but reached peak of 17.3 percent in 1985. Current (past month) use of cocaine by seniors decreased from a high of 6.7 percent in 1985 to 2.6 percent in 1999. Also in 1999, 7.7 percent of 10th-graders had tried cocaine at least once, up from a low of 3.3 percent in 1992. The percentage of 8th-graders who had ever tried cocaine has increased from a low of 2.3 percent in 1991 to 4.7 percent in 1999.

The legitimate medical use of cocaine as local anaesthetic is now extremely limited since it can, for the most part, be replaced by synthetic, non-addictive local anaesthetics.

Nearly one in four nonfatal heart attacks suffered by people between the ages of 18 and 45 may be attributed to regular cocaine use.

Cocaine, taken by itself, seldom results in death.
(D) Detailed problems