Recreational Drugs Revealed: Cocaine

ThePharmacyStudent7 years ago

Cocaine is one hell of a drug. On the one hand, you have arguably America’s most popular party favor that has withstood the tests of time to unify generations with its uncanny ability to keep the night alive. On the other hand, you have an incredibly potent chemical that has profound action in the brain and manifestations throughout the body that can lead to a multitude of health complications including death.

Cocaine is currently considered a schedule II narcotic by the DEA. This means that cocaine actually has a medical purpose. A MEDICAL FUCKING PURPOSE. Cocaine was introduced into the medical world in the latter half of the 19th century for eye surgeries. Cocaine is a potent vasoconstrictor, which means it decreases complications of bleeding and also provides a local anesthetic effect to numb the area on which it’s applied. Having said that, don’t show up to a hospital blacked out after stabbing your own eye with a spork with the genius idea of convincing your kleptomaniac pledge brother to steal a stash of cocaine while you’re in the OR. Just because it can be used in a medical setting doesn’t mean it’s actually used.

Now onto non-medical coke. So what exactly goes on in your body after you blow that first line off the mirror your aforementioned klepto pledge brother stole from some bar?

1. The most prominent effect of cocaine is that it works to inhibit the reuptake of neurotransmitters in the presynaptic terminal of the axon. What the fuck does that mean? The synapses of your brain are little spaces between neurons of your nervous system that temporarily house neurotransmitters for chemical messaging in the brain. Upon cocaine ingestion, the synapses are effectively flooded with an array of neurotransmitters like norepinephrine, serotonin and dopamine. The longer those neurotransmitters hang out in the synapses, the more effects they can produce throughout the body by interacting with receptors in the nervous system. Norepinephrine will work directly on the heart to increase your heart rate, on the lungs to increase how fast you breathe, and on your blood vessels via constriction. Serotonin is associated with producing some of cocaine’s euphoric effects. Dopamine is associated with the reward system of your brain and is commonly linked to becoming addicted to the drug.

2. Cocaine also works to block sodium channels in the body, which produces the local anesthetic effect that numbs the areas with which it comes into contact. You can find sodium channels anywhere in the body — a little dab of cocaine on the tongue and you’ll probably feel like you can swallow the damn thing.

3. Cocaine works to increase the release of glutamate, the main excitatory neurotransmitter within the brain. Fun fact for those unfortunate souls who find that they can’t sleep through a miserable hangover after drinking into the early hours of the morning: a long night of drinking also results in increased glutamate production, which is what’s keeping you awake to dwell in your cesspit of misery.

As you can see, cocaine does a good job of making a multitude of neurotransmitters more available to your brain. Thus, cocaine ingestion and the subsequent increased concentration of neurotransmitters available to the brain has a mind-fuckingly large number of effects throughout the body. For this reason, it’s hard to really quantify and detail every one of these effects. Generally speaking, though, snorting coke takes about 20-30 minutes to get to work on your neurotransmitters, and the unquantifiable effects will last for about an hour before they wear off.

Having said all that, with good comes bad. I’m not going to sit here and tell you what you should or shouldn’t do. In the event that you make the decision to put some blow up your nose, there are some things you really need to be looking for to make sure you keep yourself and those around you safe.

Assuming you have pure cocaine in front of you, roughly 80% of that cocaine is going to reach the brain to do its deed. Therefore, as little as 20 milligrams of cocaine can result in an overdose. This is especially problematic, as unless you have a special type of degenerate friend who can verify the purity of your cocaine and then weigh out every single bump or line before ingestion, it’s really hard to tell exactly how much coke you’re doing. To make matters even less cut-and-dry, reports of acute cocaine intoxication have shown 100-fold differences in blood concentrations of cocaine. Some people’s bodies can just plain handle it better than others, so don’t ever assume, “He was fine after that line, so I will be too.”

Cocaine-related toxicities can be a manifestation of any organ system. Simply put, that increase in your blood pressure and heart rate can tighten your blood vessels and constrict blood flow to the point where any one of your organs doesn’t get enough oxygen. Even if you’re otherwise healthy, cocaine use has a strong correlation with causing a stroke or heart attack. This becomes an especially tricky situation in the context of a stroke, as signs of a stroke include facial droopiness, arm weakness, and slurred speech — which readily mirrors signs of alcohol intoxication. If you think someone might be suffering a stroke, ask that person to smile or lift their arms up; if one side of their face or one arm is drooping compared to the other side, you need to call 911 immediately. Likewise, pain in the chest or radiating into the arm, nausea, shortness of breath, cold sweats, lightheadedness, and localized pain in the jaw, neck, back, or head could be a sign that you or your friend is having a heart attack.

Let me make it explicitly clear: if you ever notice signs of heart attack, stroke, or anything else out of the ordinary in either yourself or others, you need to call 911 immediately. Don’t wait 5 minutes then see how that person is doing, don’t toss them into the back of a pledge’s car to be driven to the hospital — call 911.

Another sign of cocaine toxicity is mild to severe agitation. I was going to say that might look like someone throwing a TV down a flight of stairs for no reason, but you idiots seem to be pretty good at throwing TVs around without the assistance of blow. So instead, refer to a relative increase in aggressive and agitated behaviors in the individuals around you to make that call. For use as another possible tell, you’ll also notice that the pupils often become large and remain dilated as a result of cocaine ingestion.

For those of you who haven’t worked at a bar to come home to watching Drugs, Inc. at 3 a.m., the price of cocaine increases pretty substantially with every set of hands it touches. Pure cocaine from Pablo Escobar’s coke mules is difficult to find, as it’s often adulterated with other products to cut the powder and increase profit margins. A couple of common agents that do this are levamisole and clenbuterol. To give you an idea, levamisole was reported to be present in up to 80% of urine samples that also tested positive for cocaine. In addition, levamisole was used in the treatment of colon cancer and has anti-parasitic effects that make it handy for treating ringworm and tapeworm. It’s not just the actual cocaine that can fuck up your day; cutting agents can pose their own independent dangers to your health as well, so always, always, always keep an eye on yourself and those around you if you choose to use.

Be smart, have fun, stay safe..

Have an anonymous question you want ThePharmacyStudent to answer for you in a mailbag column? Send him an email here.

[via Micromedex Solutions, Uptodate — Cocaine: Acute intoxication, Uptodate — Clinical manifestations, diagnosis, and management of the cardiovascular complications of cocaine abuse, Uptodate — Cocaine use disorder in adults: Epidemiology, pharmacology, clinical manifestations, medical consequences, and diagnosis, Stroke.org, Heart.org]

Image via Shutterstock