Street name for cocaine, the most potent stimulant of natural origin, a bitter addictive anesthetic (pain blocker) which is extracted from the leaves of the coca scrub (Erythroxylon coca) indigenous to the Andean highlands of South America.

From the name of the plant came the name cocaine and its street name coke (and Coke as in Coca Cola, which once contained it).

Once the American surgeon William S. Halstead (1852-1922) had injected cocaine into nerve trunks and showed it numbed feeling, cocaine came into use as an anesthetic agent. It was first employed as a spinal anesthetic in 1898 by the German surgeon August Bier. Soon thereafter the addictiveness of cocaine was discovered. Safer anesthetics were developed in the 20th century and cocaine fell into disuse in medicine as a pain blocker. Tragically, cocaine continues in use as a highly addictive and destructive street drug, an inadvertent contribution by medicine to the contemporary drug culture.

Illicit cocaine is usually distributed as a white crystalline powder or as an off-white chunky material. Cocaine base is converted into the powder form, which is usually cocaine hydrochloride, by diluting it with other substances. The substances most commonly used in this process are sugars, such as lactose, inositol, and mannitol, and local anesthetics, such as lidocaine. The adulteration of cocaine increases its volume and thus multiplies profits.

The major routes of administration of cocaine are snorting, injecting, and smoking (including freebase and crack cocaine). Snorting is inhaling cocaine powder through the nose where it is absorbed into the bloodstream through the nasal tissues. Injecting is using a needle to release the drug directly into the bloodstream. Smoking involves inhaling cocaine vapor or smoke into the lungs, where it is absorbed into the bloodstream as quickly as when it is injected.

“Crack” is the street name given to cocaine that has been processed from cocaine hydrochloride to a ready-to-use free base for smoking. Rather than requiring the more volatile method of processing cocaine using ether, crack cocaine is processed with ammonia or sodium bicarbonate (baking soda) and water and heated to remove the hydrochloride, thus producing a form of cocaine that can be smoked. The term “crack” refers to the crackling sound heard when the mixture is heated, presumably from the sodium bicarbonate.

On the illicit market, crack, or “rock,” is sold in small, inexpensive dosage units. Smoking this form of the drug delivers large quantities of cocaine to the lungs, producing effects comparable to intravenous injection. These effects are felt almost immediately after smoking, are very intense, and do not last long.

There is great risk associated with cocaine use whether the drug is ingested by snorting, injecting, or smoking. Excessive doses of cocaine may lead to seizures and death from respiratory failure, stroke, cerebral hemorrhage (bleeding into the brain), or heart failure.

There is no specific antidote for cocaine overdose. Evidence suggests that users who smoke or inject cocaine may be at even greater risk than those who snort it. Cocaine smokers suffer from acute respiratory problems including coughing, shortness of breath, and severe chest pains with lung trauma and bleeding. In addition, it appears that compulsive cocaine use may develop even more rapidly if the substance is smoked rather than snorted.

The injecting cocaine user is at risk for transmitting or acquiring HIV infection/AIDS if needles or other injection equipment are shared.

Colombia is the world’s leading producer of cocaine. Three-quarters of the world’s annual yield of cocaine is produced there from cocaine base imported from Peru and Bolivia and from locally grown coca. Colombia is the nation with the largest number of acres of coca under cultivation. To transport cocaine, traffickers have started using a new concealment method whereby they add chemical compounds to cocaine hydrochloride to produce “black cocaine.” The cocaine in this substance is not detected by standard chemical tests or drug-sniffing canines.

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