Week 5 Reading: Cocaine – from chewing to crack (or, eats shoots and leaves)

Question 1

Intro concepts

Answer 1

 The ways in which a drug is taken depends on various properties, eg. if it’s a solid, liquid or gas; whether it is soluble and what its melting point is etc
 The different methods to deliver drugs to the brain are called routes of use and the impacts of a drug can vary enormously depending on it’s consumption method

Question 2

Routes of use and main associated harms
o 7 common routes

Answer 2

 1. Chewing – the slowest route to the brain – with levels of the drug peaking 1 – 2 hours after peaking beings. Common with Khat, coca leaves and nicotine gums. Can develop tooth, gum and jaw problems
 2. Drinking and eating – the drug tends to work withing 30 mins. Sometimes the delay means users find it hard to judge when they’ve had enough, increasing the risk of overdose
 3. Rubbing – onto membranes like gums, eyelids and genitals – effective in 15-20 mins. This can cause infection and necrosis. When stimulants are often rubbed into gums the teeth can fall out due to a cutting off of the blood supply
 4. Snorting – hits the brain in 3 to 5 mins. Compulsive snorters can damage their nose, getting nasal ulcers or perforating their septum
 5. Shooting or injecting can be done into veins and hits the brain in 10 – 20 seconds or into the muscle with a high starting in 3 – 5 minutes. Is associated with infection, virus, aids, hepatitis and HIV, thrombosis and risk of sudden death
 6. Smoking – very quick – hitting the brain 10 – 20 seconds. Tobacco smoke is carcinogenic and can cause respiratory issues like asthma and emphysema
 7. Inhaling – used for gases like butane and liquid colvents, which reach the brainwithin seconds and the heart event faster. Inhalants can cause sudden heart and breathing failure and death

Question 3

Chewing

Answer 3

 1. Chewing – the slowest route to the brain – with levels of the drug peaking 1 – 2 hours after peaking beings. Common with Khat, coca leaves and nicotine gums. Can develop tooth, gum and jaw problems


Question 4

Drinking and Eating

Answer 4

2. Drinking and eating – the drug tends to work withing 30 mins. Sometimes the delay means users find it hard to judge when they’ve had enough, increasing the risk of overdose

Question 5

Rubbing

Answer 5

 3. Rubbing – onto membranes like gums, eyelids and genitals – effective in 15-20 mins. This can cause infection and necrosis. When stimulants are often rubbed into gums the teeth can fall out due to a cutting off of the blood supply

Question 6

Snorting

Answer 6

 4. Snorting – hits the brain in 3 to 5 mins. Compulsive snorters can damage their nose, getting nasal ulcers or perforating their septum

Question 7

Injecting

Answer 7

 5. Shooting or injecting can be done into veins and hits the brain in 10 – 20 seconds or into the muscle with a high starting in 3 – 5 minutes. Is associated with infection, virus, aids, hepatitis and HIV, thrombosis and risk of sudden death

Question 8

Smoking

Answer 8

 6. Smoking – very quick – hitting the brain 10 – 20 seconds. Tobacco smoke is carcinogenic and can cause respiratory issues like asthma and emphysema

Question 9

Inhaling

Answer 9

 7. Inhaling – used for gases like butane and liquid colvents, which reach the brainwithin seconds and the heart event faster. Inhalants can cause sudden heart and breathing failure and death

Question 10

 Why are drugs used in different forms?

Answer 10

o There are economic pressures to deliver the biggest hit of drug per unit weight – particularly true for illegal drugs but also with alcohol
o Rugs are consumed within a social context – so sharing eg. a joint makes it easier
o It’s hard to be discreet with certain methods like smoking which may promote alternate methods

Question 11

o Kinetics

Answer 11

= the route of use, which largely determines the speed of onset, how quickly the drug takes effect and the speed of offset. Ie – how quickly it wears off. Both faster offset and onset tend to increase the addictiveness of a drug

Question 12

o Dynamics

Answer 12

= the measure of efficacy of the drug into the brain – how efficient it is at binding with the receptors or enzymes it targets. The greater the efficacy the greater the addictive potential

Question 13

 In other words – kinetics specifies ___ while the dynamics is _______

Answer 13

 In other words – kinetics specifies how the drug moves in and out of the brain, while the dynamics is what it does when it gets there.

Question 14

o Kinetics often has an effect on drugs legal class – eg.

Answer 14

methampethamine can be smoked due to it’s low boiling point so is class A but amphetamine sulphate is another stimulant with a high boiling point so is Class B .
o Injecting a drug always carries more risk than snorting or taking orally.

Question 15

o Coca in the Andes

Answer 15

 Cocaine is the psychoactive component of the coca plan – a which it acts as a natural insecticide
 Found in the andes of peru and Bolivia
 Used by indigenous people for thousands of years
 Although now most of the worlds supply is grown in Columbia
 Coca is used in medicine, religious rituals and in social life of indigenous culture
 It’s often chewed with lime juice – which forms a ‘quid’ which when sucked helps to extract the cocaine from the leaves. – but the process is slow and peak concentration reaches the brain after about 2 hours.
 Because of the slow delivery there is little to no addictive quality

Question 16

o Cocaine in Europe

Answer 16

 Leaves weren’t successfully transported to Europe despite effort – bu tpotency was often lost in the travel.
 It wasn’t until new and far stronger forms appeared in the mid 1800s that it was widely used by Europeans.
* The first was pure cocaine hydrochloride – isolated by Friedriche Gaedeck in 1855.
* The second was intro’d by angelo marianai who fortified alcohol with coca leaves to produce vin mariani – which was 10% alcohol and 8.5% cocaine . It was advertised as an elixir of sorts to prevent illness giving life and vigour etc. Was used by queen Victoria and the pope leo 8th
 Meanwhile the medical establishment was trying to work out whether cocaine had therapeutic used
* Freud in 1884 experimented with it as a cure for depression and morhphine addiction (realising later it was almost as addictive as morphine)
* Karl Koller found it could be used for eye and nose surgery as a local anaesthetic as it dulled pain and constricted blood vessels.
 Injecting cocaine was made popular by sherlock holmes
 It also became widely available in the US with coca cola – or pembertons French wine cola

Question 17

 Understanding cocaine

Answer 17

o By the early 1900s, the properties of coaine including it’s harms were better understood.
o In overdose, it constricts blood vessels in the heart, causes heart attacks, seizures, pulmonary oedema (fluid in the lungs or can rupture the aorta.
o In heavy use can cause myocardial fibrosis where normal heart muscle is replaced with fibrous tissue so the heart can’t pump blood properly and cocaine can increase thromboxane production causing blood clots.
o Regular use can also lead to psychosis with paranoisa, delusions and formication (a phantom sensation of insects on the skin)
o Using cocaine while pregnant carries 8x risk of sudden infant death syndrome
 Cocaine causes blocking of dopamine reuptake.
 With chewing these effects are slow, which means the brain has type to adapt
 But a faster rush and crash in dopamine is associated with other modes of administration which makes it more addictive

Question 18

 Crack in the Cities

Answer 18

o The backlash against cocaine led to ever stricter controls during the first half of the 20th century, until its outright prohibition and a concerted international effort to reduce production as part of the war on drugs.
 This was partially successful at first, but the reduction in supply wasn’t accompanied by a decrease in demand in the West, causing the price of cocaine to sky-rocket.
o The increase in international border controls and rise in costs as large columes of the drug were seized, led to producers trying to develop cheaper forms of cocaine that would be easier to transport and the result was crack
o Crack first appeared in the US in 1984
o Crack is the freebase form of cocaine (rather than the salt that is formed when the organic base reacts with hydrochloric acid). Crack vaporises at 90 degrees, whilst cocaine hydrochloride caporises at 190 degrees and in air will burn and lose efficacy before it can reach this temp
o Along with lung problem, crack smokers experience psychosis, aggression, heart failure and are more likely to fall into addiction
o Crack is more harmful than cocaine on nearly every measure
 Crack is often used in poor urban demographics whilst non-crack cocaine is used by people in employment who fund their drug use out of wages whilst crack is often funded through crime

Question 19

 Why is crack twice as addictive as cocaine?

Answer 19

o The addictiveness of a drug is determined by both kinetics (how the drug gets into the brain) and what it does when its there.
o Crack was rated at 100 along with heroine on a scale of addictiveness whilst cocaine power was scored a 50
 The two substances have identical dynamic effects but the difference in addictiveness is due to the kinetics – as crack can be smoked
o Smoking crack causes a faster high and swifter come down than snorting or injecting cocaine powder making it more likely to cause dependence
o Because cocaine induces anit-social behaviour whilst making users less concerned for the welfare of others, what begins as an experience sought after for its pleasurable effects can also become the means of escaping the social consequences of actions whilst intoxicated. – the cocaine user can get caught in a cycle of egotistical and self-interested behaviour when ‘high’ that then drives them back to the drug to minisie feelings of regret and remorse
o With crack the aggressive risk taking aspects of the drug are amplified – making it common in gang culture to help them before acts of violence and dissociate themselves from feelings of regret

Question 20

 Conclusion

Answer 20

o Virtually all harm caused by cocaine doesn’t occur when it is released very slowly into the brain by chewing; coca leaf doesn’t cause heart problems or addiction and avoids the nose and lung problems caused by snorting or smoking.
o In Bolivia coca chewing is no legal as a result – as it’s not the drug that’s harmful but its route of admission
o When cocaine was available as a salt and being used widely in Mairiana wine there was an increase in harm and addiction which we don’t want to repeat – so legalising and completely prohibiting aren’t good responses - we need a middle ground