Substance Abuse: CNS Stimulants - Amphetamines & Cocaine

Methods of Use

Cocaine use ranges from episodic or occasional use to repeated or compulsive use, with a variety of patterns between these extremes. The major methods of administration of cocaine are sniffing or snorting, 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 is the act of using a needle to release the drug directly into the bloodstream. Smoking involves the inhalation of cocaine vapor or smoke into the lungs where absorption into the bloodstream is as rapid as by injection.

There is great risk no matter how cocaine is ingested. It appears that compulsive cocaine use may develop even more rapidly if the substance is smoked rather than taken intranasally. Smoking allows extremely high doses of cocaine to reach the brain very quickly and brings an intense and immediate high. The injecting drug user is at risk for transmitting or acquiring the HIV infection/AIDS if needles or other injection equipment is shared.

"Crack" is the street name given to cocaine that has been processed from cocaine hydrochloride to a 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 smoked (heated), presumably from the sodium bicarbonate.

Crack resembles hard shavings that are similar to slivers of soap, and is often sold in small vials, in folding papers, or in heavy aluminum foil. Sometimes the crack material is broken into tiny chunks that are sold as "crack rocks." Unlike freebase, which requires the use of elaborate paraphernalia, crack can be smoked either in a pipe or mixed with marijuana. On occasion, crack cocaine also contains a small amount of PCP, a particularly hazardous "dissociative anesthetic" known as "angel dust."

An intensified form of cocaine, crack is now considered one of the most addictive substances ever known, more so than heroin, barbiturates, and alcohol. Because its vapors are inhaled, crack is quickly absorbed through the lungs into the bloodstream and reaches the brain within a matter of seconds. This action is even faster than when cocaine is snorted or injected. Once within the brain, crack produces a short, intense, electrifying feeling of euphoria.

Then, within several minutes of the pleasant "high," a smoker generally develops a severe crisis-like "hangover" characterized by deep depression, extreme sadness, irritability, occasional feelings of paranoia, and an overwhelming craving for more of the drug. However, it is the withdrawal hangover, not the euphoric high, that makes crack so addictive.

Inhaling crack vapors rapidly bankrupts the brain of neurotransmitters--substances that enable the transfer of nerve impulses between nerve cells and thus control mood and behavior. This sudden release of neurotransmitter substances actually causes the intense euphoria, an extremely pleasant feeling. But cocaine also prevents the return of the neurotransmitters, including norepinephrine, dopamine, and serotonin for reuse in the nerve cells. Consequently, the loss of neurotransmitters produces an emergency craving to replenish these natural chemicals of the brain. "The crack abuser misidentifies the craving as a need for more cocaine and focuses on nothing else." Very soon, getting crack, smoking crack, and experiencing crack, become more important than anything else.

Crack users have become innovative in their simultaneous use of smokable rock with other psychoactives. Sometimes crack smokers place rocks of freebase in marijuana to produce "champagne" or "caviar"--crack-laced joints. Smokable speedballs or "hot rocks" are combinations of crack and "tar" heroin. To concoct "space base," some users mix PCP (phencyclidine) with crack, while others prepare "crack coolers" by adding crack or regular cocaine to wine coolers.

Sometimes a mixture of cocaine and heroin (referred to as a speedball) is taken. Such combined or even sequential use of cocaine and a depressant, smooths out the stimulant's effects, reduces nervousness and excitability, and softens "crashing" after an extended cocaine binge. Nonetheless, speedballing does increase the risks of drug dependency, toxic overdoses, and financial disaster, as well as deeper involvement with the law. John Belushi, a famous comedian, allegedly died because of speedballing--multiple injections of a cocaine-heroin mixture--which resulted in a sudden buildup of either or both drugs to toxic levels that proved deadly.

A new cocaine danger called "freebasing," surfaced in the 1970's. Through an elaborate "do-it-yourself" process, cocaine hydrochloride powder is changed into a smokable and more potent substance called "base" or "freebase." The actual procedure which is extremely dangerous, involves treating the cocaine powder with a strong alkali and then ether. Comedian Richard Pryor apparently was involved in a freebasing accident that set fire to his clothing and left him with third-degree burns on the upper half of his body.

The freebase is then smoked in a water pipe or sprinkled on a marijuana or tobacco cigarette. Within a few minutes, the stimulant reaches the brain and produces a sudden and intense "high." This euphoria subsides quickly and is often followed by a very uncomfortable restlessness, irritability, and depression. In order to maintain the "high" and avoid the "crash," freebase smokers sometimes continue smoking until they are either exhausted or have run out of cocaine.

More recently, still another form of smokable cocaine, basuco, surfaced in Miami and then in New York City. Cocaine basuco (or bazuko) is sometimes called cocaine sulfate, coca paste, or just simply base. A crude form of cocaine, basuco is highly contaminated with lead and petroleum by-products. The drug is typically mixed with tobacco or marijuana and smoked as a cigarette. Relatively cheap in comparison with crack, basuco has sold for about $1 per dose. This low price and its high potency and rapid, addictive effect, make basuco a "triple threat" among abused drugs.

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