Story highlights
Cocaine produces a neurological high that can alter the brain
Science says there is no safe level of cocaine use
Future addiction treatments could include a vaccine
“When it snows in your nose, you catch cold in your brain.” – poet Allen Ginsberg
It has many names – coke, toot, powder, blow – and is one of the most addictive stimulants around.
Its raw form, the coca leaf, has been chewed and ingested for thousands of years. Cocaine as we know it, a bitter, numbing powder called cocaine hydrochloride, has been around since only the mid-1800s, when it was marketed in toothache drops, sinus pills and nausea powders for pain relief.
Back then, doctors also used cocaine as a topical anesthetic for nose, throat and dental surgeries, a practice still in existence today. Although rare, some physicians still use it to stop nosebleeds or to control pain and bleeding during minor nose surgeries, such as sinus surgery.
In the late 1800s, cocaine became famous as the primary flavoring in Coca-Cola. In the early 1900s, the soft-drink company replaced it with an extract of the coca leaves – sans stimulant.
Cocaine burst back onto the American scene in the ‘70s as the “champagne of drugs”: expensive, with high status. At the time, no one knew of its inherent dangers, and according to the Drug Enforcement Administration, as the price dropped over the next decade, nearly 6 million Americans used cocaine on a regular basis.
“Cocaine made me talk forever. The most nonsensical rubbish that you could ever think of.” – singer/songwriter Elton John
The high of a small amount of cocaine has been described as completely euphoric, producing a physical lightness and a boost of self-confidence that can leave a user begging for more. The intensity and length of the high depends on the method of ingestion: snorting a powdered form or rubbing it into the gums, liquefying it and “shooting up” intravenously or smoking a base form known as crack.
The National Institute on Drug Abuse says that snorting a line of cocaine produces a slow-building high that lasts 15 to 30 minutes. Smoking crack speeds up the rush, but it fizzles out even faster, within five or 10 minutes. Injecting provides the fastest high, followed by an equally spectacular decline.
“Eventually, alas, I realized the main purpose of buying cocaine is to run out of it.” – comedian George Carlin
The limited high is often what propels people to increase the dose or frequency of use, and that can be especially dangerous. Bodily reactions to any amount of the drug include dilated pupils and constricted blood vessels, with increased heart rate, blood pressure and temperature. Tremors, muscle spasms, panic and paranoia can set in with larger amounts of cocaine, along with headaches, seizures, stomach pain and nausea.
Although prescription opioid and heroin deaths in the US far outnumber those from cocaine, there was a 1.6-fold rise in deaths from cocaine between 2010 and 2015.
According to the National Survey on Drug Use and Health, there are about a million and a half Americans using cocaine right now; that number has stayed relatively constant since 2009. Not surprisingly, young people ages 18 to 25 use cocaine more than any other group.
Globally, the number of cocaine users has stayed stable between 1998 and 2014, largely due to a decline in production. But that doesn’t mean the number is low. According to the World Drug Report, there were 17 million people around the world using cocaine in 2015.
“Of course cocaine is not addictive, darling. I should know; I’ve been doing it for years.” – actress Tallulah Bankhead
Just how does cocaine cause addiction? By changing the brain.
Cocaine creates a euphoric high by flooding the brain with neurochemicals such as dopamine, serotonin and norepinephrine, some of the body’s main pleasure chemicals. It blocks them from being absorbed, creating a chemical buildup in the reward center of the brain. The result: a rush of energy, alertness and high-flying mood.
Being rewarded is additive, so users return for another hit. Studies show that as the brain is exposed to more and more cocaine, its reward center adapts, becoming less receptive to natural positives such as food or affection.
That’s just one reason for cocaine’s seductive leverage. It also affects the way the brain responds to stress and makes choices. Animal studies suggest that the need for cocaine is increased by stress: The more cocaine animals were given, the more stress they felt and the more they wanted cocaine.
Research in animals and humans also shows that the drug reduces functioning in the orbitofrontal cortex, which controls decision-making abilities. In fact, studies of people with long-term cocaine addiction show reduced gray matter in the executive area of the brain as well as in the hippocampus, the area responsible for learning and memory.