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Speedball Cocaine Abuse and Freebase Crack Addiction

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What is cocaine?
Cocaine is a powerfully addictive stimulant that directly affects the brain. Cocaine was labeled the drug of the 1980s and ‘90s, because of its extensive popularity and use during this period. However, cocaine is not a new drug. In fact, it is one of the oldest known drugs. The pure chemical, cocaine hydrochloride, has been an abused substance for more than 100 years, and coca leaves, the source of cocaine, have been ingested for thousands of years. Pure cocaine was first extracted from the leaf of the Erythroxylon coca bush, which grows primarily in Peru and Bolivia, in the mid- 19th century. In the early 1900s, it became the main stimulant drug used in most of the tonics/ elixirs that were developed to treat a wide variety of illnesses. Today, cocaine is a Schedule II drug, meaning that it has high potential for abuse, but can be administered by a doctor for legitimate medical uses, such as local anesthesia for some eye, ear, and throat surgeries. There are basically two chemical forms of cocaine: the hydrochloride salt and the “freebase.” The hydrochloride salt, or powdered form of cocaine, dissolves in water and, when abused, can be taken intravenously (by vein) or intranasally (in the nose). Freebase refers to a compound that has not been neutralized by an acid to make the hydrochloride salt. The freebase form of cocaine is smokable. Cocaine is generally sold on the street as a fine, white, crystalline powder, known as “coke,” “C,” “snow,” “flake,” or “blow.” Street dealers generally dilute it with such inert substances as cornstarch, talcum powder, and/or sugar, or with such active drugs as procaine (a chemically related local anesthetic) or with such other stimulants as amphetamines. 

What is crack?
Crack is the street name given to a freebase form of cocaine that has been processed from the powdered cocaine hydrochloride form to a smokable substance. The term “crack” refers to the crackling sound heard when the mixture is smoked. Crack cocaine is processed with ammonia or sodium bicarbonate (baking soda) and water, and heated to remove the hydrochloride. Because crack is smoked, the user experiences a high in less than 10 seconds. This rather immediate and euphoric effect is one of the reasons that crack became enormously popular in the mid 1980s. Another reason is that crack is inexpensive both to produce and to buy. Crack cocaine remains a serious problem in the United States. The National Survey on Drug Use and Health (NSDUH) estimated the number of current crack users to be about 567,000 in 2002. 

What is the scope of cocaine use in the United States?
In 2002, an estimated 1.5 million Americans could be classified as dependent on or abusing cocaine in the past 12 months, according to the NSDUH. The same survey estimates that there are 2.0 million current (past-month) users. Cocaine initiation steadily increased during the 1990s, reaching 1.2 million in 2001. Adults 18 to 25 years old have a higher rate of current cocaine use than those in any other age group. Overall, men have a higher rate of current cocaine use than do women. Also, according to the 2002 NSDUH, estimated rates of current cocaine users were 2.0 percent for American Indians or Alaskan Natives, 1.6 percent for African-Americans, 0.8 percent for both Whites and Hispanics, 0.6 percent for Native Hawaiian or other Pacific Islanders, and 0.2 percent for Asians. The 2003 Monitoring the Future Survey, which annually surveys teen attitudes and recent drug use, reports that crack cocaine use decreased among 10th-graders in 30-day, annual, and lifetime use prevalence periods. This was the only statistically significant change affecting cocaine in any form. Past-year use of crack declined from 2.3 percent in 2002 to 1.6 percent in 2003. Last year, the rate increased from 1.8 percent to 2.3 percent, and this year’s decline brings it to approximately its 2001 level. Data from the Drug Abuse Warning Network (DAWN) showed that cocaine-related emergency department visits increased 33 percent between 1995 and 2002, rising from 58 to 78 mentions per 100,000 population.

How is cocaine used?
The principal routes of cocaine administration are oral, intranasal, intravenous, and inhalation. The slang terms for these are respectively “chewing,” “snorting,” “mainlining” or “injecting,” and “smoking” (including freebase and crack cocaine). Snorting is the process of inhaling cocaine powder through the nostrils, where it is absorbed into the bloodstream through the nasal tissues. Injecting releases the drug directly into the bloodstream, and heightens the intensity of its effects. Smoking involves the inhalation of cocaine vapor or smoke into the lungs, where absorption into the
bloodstream is as rapid as by injection. The drug also can be rubbed onto mucous tissues. Some users combine cocaine powder or crack with heroin in a “speedball.” Cocaine use ranges from occasional use to repeated or compulsive use, with a variety of patterns between these extremes. Other than medical uses, there is no safe way to use cocaine. Any route of administration can lead to absorption of toxic amounts of cocaine, leading to acute cardiovascular or cerebrovascular emergencies that could result in sudden death. Repeated cocaine use by any route of administration can produce addiction and other adverse health consequences. 

How does cocaine produce its effects?
Agreat amount of research has been devoted to understanding the way cocaine produces its pleasurable effects, and the reasons it is so addictive. One mechanism is through its effects on structures deep in the brain. Scientists have discovered regions within the brain that are stimulated by rewards. One neural system that appears to be most affected by cocaine originates in a region located deep within the brain called the ventral tegmental area (VTA). Nerve cells originating in the VTA extend to the region of the brain known as the nucleus accumbens, one of the brain’s key areas involved in reward. In studies using animals, for example, all types of rewarding stimuli, such as food, water, sex, and many drugs of abuse, cause increased activity in the nucleus accumbens. Researchers have discovered that, when a rewarding event is occurring, it is accompanied by a large increase in the amounts of dopamine released in the nucleus accumbens by neurons originating in the VTA. In the normal communication process, dopamine is released by a neuron into the ynapse (the small gap between two neurons), where it binds with specialized proteins (called dopamine receptors) on the neighboring neuron, thereby sending a signal to that neuron. Drugs of abuse are able to interfere with this normal communication process.


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