Coca is a plant that the devil invented for the total destruction of the natives.
- Don Diego De Robles, 16th-Century Orthodox Catholic artist.

Cocaine - or Charlie; Coke; Blow; Snow; Flake; C; Candycaine (or cane); Cat's pee (for crack); Incentive; Bazooka; Bouncing powder; Dama Blanca; Nose Powder; Peruvian Lady; Roxanne - is a powerfully addictive short-acting drug that directly stimulates the brain, the heart, blood vessels and the nervous system.

What is Cocaine?

It's great for sex but really it's an a***hole's drug.
- Sir Elton John.

Coca¹ leaves, the source of cocaine, have been chewed and ingested for thousands of years. Human beings are drug users; most drugs are derived from natural substances which, in moderation, have a benign effect. The pure chemical, cocaine hydrochloride, (C₁₇H₂₁NO₄), has been an abused substance for over a century. This leads on to the problems that we have with cocaine abuse (as opposed to use) in that we, as a society, have the 'more, NOW!' bug. So rather than chew a coca leaf, we take refined lines of it, at concentrations that are far from natural.

Cocaine is the oldest-known effective local anaesthetic, first used in ophthalmic surgery in 1884 by Karl Koller. It is due to its powerful anaesthetic properties (first noticed by future psychoanalyst Sigmund Freud) that the flesh it directly touches is liable to suffer secondary damage; this is why habitual cocaine 'snorters' tend to lose the partition (septum) between their nostrils.

Cocaine is generally sold by drug-dealers as a fine, white, crystalline powder, which has been 'cut' (diluted) with innocuous substances such as flour, cornstarch, talcum powder or icing sugar, because they want to make more profit. However, drug dealers sometimes don't have such innocent 'mixers' so the next batch they sell might have been combined with active drugs like procaine (a chemically-related local anaesthetic) or other stimulants such as amphetamines and painkilling drugs like paracetamol and aspirin which are dangerous in large doses.

The possession and distribution of cocaine, a Class A drug in the UK, is illegal and carries consequences such as jail sentences or large fines. People with a drugs conviction may find they have problems with visa applications.

Why do People Take Cocaine?

Cocaine is a stimulant which provides a feeling of alertness, mild euphoria and (usually misplaced) self-confidence. It is a mood-enhancer and heightens sexual interest. Some people think it increases their performance when it is usually their perception which has changed.

Cocaine in Popular Culture

• Cocaine Decisions - sung by Frank Zappa.

• Cocaine - written and sung by JJ Cale; also performed by Eric Clapton.

• Simply Everyone's Taking Cocaine a poem by Murray Lachlan Young.

• The Strange Case of Dr Jekyll and Mr Hyde was written by Robert Louis Stephenson while he was on a six-day cocaine binge.

• [Cocaine is] 'so transcendentally stimulating and clarifying to the mind that its secondary action is a matter of small moment' according to Sherlock Holmes (written by Sir Arthur Conan Doyle).

How Cocaine is Used

Cocaine can be:

• Snorted through the nose.

• Rubbed onto places like the gums.

• Injected. Injecting cocaine - or indeed any drug - carries the added risk of infection with hepatitis B and HIV, the virus that causes AIDS, if the user shares a needle with a person already infected with the virus.

• Or smoked, in a form known as 'crack'.

Crack Cocaine

Crack cocaine is produced by mixing base cocaine with a solution of baking soda and water and heating until all the water has gone. This produces the distinctive 'crack' sound by which it is named. Some crack-partakers describe the buzz they get as a 'whole-body orgasm'. Crack is very, very addictive; much more so than cocaine. Therefore an intense craving for more soon develops, and heavy users may experience formication (the sensation of insects crawling beneath the skin). Eventually the brain starts to lose its ability to send out the 'feelgood' signals, leading to more hits as the user tries in vain to relive the original high.

How Cocaine was used Historically

In 1886 a 'valuable brain-tonic and cure for all nervous afflictions' was introduced. The new beverage 'offering the virtues of coca without the vices of alcohol' contained 60mg of cocaine per serving until 1903. It was a popular drink then, and it remains so today, although the drug is now removed from the coca leaves which are still used for flavouring Coca-Cola™.

Cocaine used to be used in cigarettes  'guaranteed to lift depression'; chocolate; medicines; tonics and toothache cures. Ryno's Hay Fever and Catarrh Remedy was a best-seller - it was 99% cocaine. The pharmaceutical company which promoted it claimed that it 'could make the coward brave, the silent eloquent, and render the sufferer insensitive to pain'.

Vin Mariani was a wine with an essential ingredient - cocaine. A variety of assertions were made about its health benefits, including Health, Strength, Energy and Vitality, Hastens Convalescence especially after Influenza and Fortifies, Strengthens, Stimulates and Refreshes the Body and the Brain. This coca wine was very popular in high quarters: His Holiness Pope Leo XIII honoured Corsican-born pharmacist and businessman Angelo Mariani with a Vatican gold medal as a mark of his gratitude.

The Brompton Cocktail

The Brompton Cocktail² was an elixir of cocaine, morphine (heroin), alcohol and flavoured syrup which used to be prescribed to patients dying of cancer. Popular in the 1930s, it is now banned. The orgasmic, euphoric exit must have seemed a better way to end a life than an agonisingly painful drawn-out last gasp as well as being beneficial for the attending loved ones around the death bed.

Progression

A 'drug-user' does not necessarily utilise one single drug in their lifetime. Some analysing drug use believe in the idea of progression: a susceptible individual starts with one seemingly innocuous drug that many have tried and then left alone, such as cannabis - then 'progresses' through harder drugs like cocaine before becoming seriously unstuck with something like heroin. Although most 'soft' drug-users do not progress in this way, there is evidence to suggest that many hard drug users followed a progressive line of addiction.

Medical Consequences of Cocaine Abuse

Cardiovascular Effects

A growing number of reports have related cocaine use with the onset of myocardial infarction (heart disease) in young, otherwise healthy, people. Several studies have suggested that cocaine may be cardiotoxic (cause heart muscle damage).

• Disturbances in heart rhythm (fast or irregular heartbeats).
• Myocardial infarction.
• Spasm and narrowing of the arteries that lead to the heart muscle.
• Aneurysm.
• Thrombosis (blood clot).
• High blood pressure.

Respiratory Effects

• Respiratory failure.
• 'Crack lung' (severe chest pain and breathing problems).

Neurological Effects

• Haemorrhage.
• Seizure.
• Stroke.
• Headache.
• Drug-induced psychosis (a condition known as toxic paranoid psychosis).
• Depression.
• Hallucinations.

Gastrointestinal Complications

• Abdominal pain.
• Constipation.
• Perforation of the stomach lining.
• Bloody diarrhoea.
• Vomiting.

Due to reduced blood flow, ingested cocaine can cause gangrene of the bowel. Loss of appetite leads to malnourishment, which in turn can lead to related disorders such as anorexia nervosa. Cocaine can be detected in urine for five days after ingestion and up to three weeks later in heavy users.

Personality Changes

• Mood disturbances/swings.
• Short temper.
• Anger.
• Restlessness/tiredness/inability to sleep.
• Irritability.
• Anxiety disorders/fear/phobia/panic attacks.
• Carelessness about personal appearance, bathing and grooming.
• Change in friends/groups of friends.
• Frequently in need of money.
• Loss of interest in work/school, family, pets and hobbies or activities previously enjoyed.
• Abuse of relationships - for example, stealing from family members to pay for the next 'hit'.
• Inability to think clearly³.
• Losing touch with reality.

Effects During Pregnancy

Cocaine use by expectant mothers can lead to miscarriage, stillbirth, premature labour, low birthweight babies and birth defects. Cocaine increases the risk of placental abruption, which is when the placenta detaches from the inside of the womb; and ante-partum haemorrhage, a life-threatening condition for both mother and child. Cocaine use doubles the risk of premature birth, which can lead to other complications like immature lungs, cerebral palsy, visual and hearing impairments, and slow development of the child.

Babies may even be born addicted to cocaine if the mother continues to take it during late pregnancy. Any drug travels through the bloodstream of a foetus via the mother's umbilical cord. If a baby has been used to having cocaine course through its body in utero (inside the womb) he or she will go through 'withdrawal' once born.

Cosmetic Effects

• Runny nose/frequent sniffing.
• Red, bloodshot eyes with dark circles beneath.
• Weight loss/skeletal look.
• Septum damage.

Death

Death can result from cocaine abuse⁴, either through overdose, allergic reaction, or the combination of the effects with other dangerous drugs or substances, such as alcohol. The human liver combines cocaine and alcohol and creates a third substance, cocaethylene, which magnifies cocaine's euphoric effects. The mixture of cocaine and alcohol is the most common two-drug combination which results in drug-related death.

Fluid in the lungs (pulmonary edema) occurs because extremely intoxicated (drunk or drugged or both) sleeping people often lose the reflexive tendency to clear their throat of mucus, or they may drown in their own vomit. A state of intoxication can be achieved where the abuser endangers his ability to breathe altogether.

For every social drug-related death, there are family and friends left behind to pick up the pieces. If you are an addict, seek help⁵ to cure your addiction.

Please Note: h2g2 is not a definitive medical resource. If you have any health concerns you must always seek advice from your local GP. You can also visit NHS Direct or BBC Health Conditions.