Cocaine is a natural alkaloid extracted from the Erythroxylon coca plant, central nervous system stimulant (CNS) and local anesthetic. It can cause significant acute physical and psychic effects, either in chronic, occasional or novice users, instill basic clinical problems or generate clinical complications from prolonged use.
Cocaine use has grown widely over the years. The effects that the substance causes vary with dose, individual user characteristics and mode of administration. For the proper drug rehabilitation this is the best deal.
Most individuals use cocaine associated with other CNS depressant drugs (alcohol, benzodiazepines and marijuana, and opioids) to counteract the sympathomimetic (stimulating) effects of the drug. There may be associated alcohol dependence, producing signs and symptoms of withdrawal and / or delirium in the days following drug administration.
Cocaine and crack sold on the streets, by their illicit nature, have no quality control and have all sorts of dodgy adulteration and refining and alkalinization methods, further increasing the vulnerability of users.
The presence of cocaine in our daily lives and its ability to generate or trigger focal and systemic complications makes it an important differential diagnosis for clinicians and psychiatrists in emergency rooms and requires an evaluation beyond the purely psychic and phenomenological gaze.
Cocaine Treatment – Clinical Evaluation of Users and Dependents:
The clinical assessment should take into account, in addition to detailed research of the individual’s clinical history, information from medical records, family members, friends or even employees. Factors such as route of administration, duration of effects and use of other substances are also taken into account. Laboratory tests also have great relevance, as do physical exams.
Cocaine Treatment – Administration and Bioavailability
Cocaine may be used by any route of administration, oral, intranasal, injectable or pulmonary. The route chosen interferes with the quantity and quality of the effects caused by the substance. The faster is the onset and duration of effects, the greater is the likelihood of dependence and abuse. The particularities of each route expose users to certain risks, such as needle-sharing contamination, exacerbation of asthma, persistent rhinitis, among others.
Oral administration, the habit of chewing or drinking coca leaf teas, is secular and cultural in the Andean countries for its reactive and anorectic characteristics. The leaves have low cocaine concentration (less than 2%), with remote chances of intoxication. Only 2 – 3% of orally ingested cocaine is absorbed into the body, the effects start about 30 minutes later and last about 90 minutes.
The intranasal or aspirated route has 30% bioavailability. Much of the refined powder attaches to the nasal mucosa, where it is absorbed into the local circulation. The effect of cocaine can be felt minutes after the first administration, lasting 30 to 45 minutes.
Smoked cocaine was little used until crack appeared. Cocaine paste, an intermediate refining product, is obtained after maceration and treatment of coca leaves with sulfuric acid, alkaline and kerosene. The cocaine hydrochloride is refined and obtained from the acidification of the paste with hydrochloric acid.