Also known as

White, Wash, Toot, Stones, Snow, Rocks, Percy, Pebbles, Freebase, Crack, Coke, Ching, Charlie, Chang, C, Aunt Nora, bernice, binge, blow, dust, flake, mojo, nose candy, paradise, sneeze, sniff


Stimulant, appetite suppressant


'It can give a powerful high that can leave you feeling really down'.

Powder cocaine (also called coke), freebase and crack are all forms of cocaine. They're all powerful stimulants, with short-lived effects - which means that they temporarily speed up the way your mind and body work, but the effects are short-lived. Both 'freebase' cocaine (powder cocaine that's been prepared for smoking) and 'crack' cocaine (a 'rock' like form of cocaine) can be smoked. This means that they reach the brain very quickly, while snorted powder cocaine gets to the brain more slowly.

All types of cocaine are addictive, but by reaching the brain very quickly freebase or crack tend to have a much stronger effect and be more addictive than snorted powder cocaine. Injecting any form of cocaine will also reach the brain more quickly but this has serious additional risks, including damaging veins and spreading blood bourne viruses, such as HIV and Hep C [1].

Cocaine is one of the most dangerous drugs known to man. Once a person begins taking the drug, it has proven almost impossible to become free of its grip physically and mentally. Physically it stimulates key receptors within the brain that, in turn, create a euphoria to which users quickly develop a tolerance. Only higher dosages and more frequent use can bring about the same effect.

Today, cocaine is a worldwide, multibillion-dollar enterprise. Users encompass all ages, occupations and economic levels, even schoolchildren as young as eight years old [2].

Here are the main effects and risks of taking cocaine -

  • It can make you feel on top of the world, very confident, alert and awake, but some people can get over-confident, arrogant and aggressive and end up taking very careless risks.
  • It raises the body's temperature, makes the heart beat faster and reduces your appetite.
  • When the effects start to wear off, people experience a long 'comedown', when they feel depressed and run down. This crash can happen for days afterwards [1].

What does it look like?

  • coke - is a white powder,
  • crack - is a form of cocaine made into small lumps or rocks that makes a cracking noise when burnt,
  • freebase - cocaine is specially prepared 'coke' and is a crystal-like powder; it is less common than 'coke' and 'crack' [1].
  • Cocaine HCl - white crystalline powder. High quality cocaine HCl will be in the form of larger crystalline flakes which will give the cocaine a more 'fluffy appearance'. Lower quality cocaine will be in much finer powder form. Cocaine powder has a sharp, acidic taste and will rapidly numb the tip of the tongue if dabbed against it.
  • Freebase cocaine - depending on the production method used, could take the form of crystals of base cocaine or a malleable pasty mixture. This may smell of ammonia if this chemical was used in production.

However, in the UK the main form sold at a street level will be rocks of 'crack' cocaine, small hard lumps of the drug which may be white or off white, and around the size of a raisin [3].


The coca bush, erythroxylum coca, has been cultivated in the Andean region of South America for thousands of years and countries such as Peru, Bolivia and Colombia are still the main source of cocaine production today [4].


According to [[1]] released by the Home Office in June 2016 for England and Wales, powder cocaine is the second most commonly used drug (after cannabis) in adults (16 - 59 years olds). 2.2% of the survey respondents reported using cocaine in the last year, which equates to around 725,000 people.

By contrast, powder cocaine is the third most commonly used drug among young adults aged 16 to 24 (4.4% or 274,000 young adults) after cannabis and ecstasy. Both proportions have remained similar to previous years.

The figures for use of crack cocaine are considerably lower. Just 0.1% of adults aged 16 - 59 had used crack in the last year. Although crack cocaine use is relatively rare, it is associated with very problematic use and drug-related crime, predominantly among those also using opioids. Due to the often chaotic nature of users' lives, it is likely that drug surveys often underestimate crack use [5].

Street price

Usually sold in small baggies for $60 - $100 per gram [6].

Cocaine is typically sold by weight, crack by the rock. A single rock of crack-cocaine can cost as little as £5 or as much as £20, but a great deal is sold at around £10 a rock. Price varies with size of the rock, quality, availability and region. A gramme of cocaine costs between £40 and £80, though cocaine is sold at higher and lower prices [1].

On average, a gram of coke powder generally costs £42. A crack rock costs between £10 and £20. Crack is sometimes sold cheaper by the slice or as a 'clubbing rock' for about £10 [1].

According to the Druglink 2012 street drugs survey, the average UK price of cocaine is £46 per gram.

Crack is commonly sold by the rock, with £16 buying 0.25g [5].

Why take it?

Sought after effects

  • sense of euphoria,
  • increased wakefulness,
  • increased confidence [7],
  • exhilaration,
  • elation [4].

Undesired effects

  • anxiety,
  • increased chance of stroke and heart attack,
  • 'comedown' (usually depressed and tired feeling) as effects wear off [7],
  • insomnia,
  • loss of appetite,
  • tension,
  • aggression [4].


It is most likely that many factors such as genetic, environmental, biological, and psychological work together and cause the development of a cocaine addiction. Some of the most common theories include -

  • Genetic - Over the years research has shown that individuals with relatives who have addiction problems are more likely to develop an addiction themselves. The chances are higher if it is a first degree relative like a parent.
  • Biological - Biological factors like changes in the structure and function of the brain have been linked to addiction problems. When dopamine levels are low an individual may abuse substances in order to maintain pleasurable feelings.
    • Brain chemicals - There is some evidence that repeated exposure to cocaine causes changes in certain genes that lead to altered levels of a certain brain chemical called dopamine. Dopamine is associated with the rush that is experienced when an individual takes cocaine. This rush is what is largely responsible for the addiction process.
    • Brain structures - Certain structures and areas of the brain such as the amygdala and prefrontal cortex have been linked specifically to drug cravings including cocaine cravings. In individuals with cocaine abuse disorders these areas have been shown to display various differences compared to the same brain areas in individuals who aren't abusing substances.
    • Effects of the pleasure centres of the brain - Cocaine has been shown to have negative effects on the brain's pleasure centre by leading it to stop responding to naturally occurring pleasure related stimuli. Thus, it begins to change until it will only respond to the presence of cocaine. In the drugs absence the individual will no longer be able to experience pleasure and will feel extremely depressed sometimes to the point of becoming suicidal. Thus, the individual continues taking the drug to avoid that negative mood state [8].
  • Environmental - It has been hypothesised that individuals who have come from unstable home environments have a greater chance of developing an addiction problem. Additionally, life stressors such as child abuse, death of loved ones, or traumatic events cause stress and individuals turn to substance abuse as a type of self-medication [9]

What are the different forms of cocaine?


On the street it is usually sold as a fine, white powder. The powdered, hydrochloride salt form of cocaine can be snorted or dissolved in water and injected [10].

Freebase or crack

Freebase, or crack is cocaine hydrochloride that is processed with ammonia or sodium bicarbonate (baking soda solution) and heated to remove the hydrochloride salt. This 'freebase' form of cocaine is not water-soluble; it comes in a rock crystal that can be heated and its vapours smoked. Crack may be processed with a high percentage of impurities. The term 'crack' refers to the crackling sound heard when it is heated prior to smoking [10].

How long do its effects last?

Onset of effects

- nasal - 2 - 20 minutes [11], 1 - 3 minutes [12]. - all routes - rapid [12].

Duration of effects

- nasal - 10 - 90 minutes [11]. - all routes - 60 - 90 minutes [12].


- all routes - 1 - 4 hours [12].


Cocaine has a similar psychomotor stimulant effect to that of amphetamine and related compounds. It increases transmitter concentrations in both the noradrenergic and the dopaminergic synapse and also acts as an anaesthetic agent. Like amphetamine, it produces euphoria, tachycardia, hypertension and appetite suppression. Cocaine has a strong reinforcing action, causing a rapid psychological dependence, an effect even more pronounced in those who smoke cocaine base. Following a 25-mg dose, blood levels peak in the range 400 - 700 μg/L depending on the route of administration. The main metabolites are benzoylecgonine, ecgonine and ecgonine methyl ester, all of which are inactive. When consumed with alcohol, cocaine also produces the metabolite cocaethylene. Some unchanged cocaine is found in the urine. The plasma half-life of cocaine is 0.7 - 1.5 hours and is dose dependent. The estimated minimal lethal dose is 1.2 g, but susceptible individuals have died from as little as 30 mg applied to mucous membranes, whereas addicts may tolerate up to 5 g daily [13].

Cocaine is an alkaloid ester that acts as a stimulant on the CNS. It works along similar pathways to the amphetamine group, acting on the catecholaminergic neurotransmitters (responsible for dopamine, serotonin and norepinephrine uptake).

Depending on strength and route of administration, levels of cocaine in blood will vary, but generally peak at around 400 - 700 μg/L. Its main metabolites are benzoylecgonine, ecgonine and ecgonine methyl ester, all of which are inactive but which can be detected in bodily fluids.

As well as its stimulant properties, cocaine is an effective local anaesthetic, and has been utilised in medical interventions and minor surgery. When used regularly or at high doses, cocaine can produce adverse reactions such as hypertension (high blood pressure) and tachycardia (increased heart rate), as well as neurological and motor skill/coordination problems.

Cocaine hydrochloride is the salt (base) form of the substance [7].

The most extensively studied effect of cocaine on the central nervous system is the blockade of the dopamine transporter protein's function. This substance acts as a reuptake inhibitor and prevents dopamine from being recycled, causing excessive amounts to build up in the synapse, or junction between neurons. The result is an enhanced and prolonged post-synaptic effect of dopaminergic signaling at dopamine receptors on the receiving neuron. To a lesser extent, cocaine also exhibits functionally similar effects of reuptake inhibition upon the neurotransmitters of serotonin and noradrenaline [14]. It is this sudden flood of neurotransmitters that causes cocaine's characteristic high [11].


Cocaine also enhances the activity of dopamine. It does this by blocking its reuptake into the nerve terminal via the transporter and thus increasing the amount of dopamine available to act at receptors in the synapse [15], [16]. Cocaine may also block reuptake of noradrenaline and serotonin [17], [18], with some authors suggesting that it may enhance noradrenaline release [19].

In addition to these effects cocaine is also a local anaesthetic agent. Like other local anaesthetics, it produces direct effects on cell membranes - cocaine blocks sodium channel activity and thus prevents the generation and conduction of nerve impulses in electrically active cells, such as myocardial and nerve cells [20].


Cocaine is well absorbed when administered via mucous membranes (e.g. intranasally), the gastrointestinal tract and intravenously. Peak concentrations occur within five to ten minutes after intravenous injection or smoking and within 60 minutes after intranasal administration [21]. Cocaine is shorter acting than amphetamines and effects or blood levels may diminish after as little as one hour [22].

Some cocaine is excreted unchanged in the urine, but the majority is metabolised to benzoylecgonine, ecgonine methyl ester, norcocaine and other metabolites [23], [24]. Although cocaine has a short half-life, elimination half-lives of cocaine metabolites are substantially longer [23]. The half-life of cocaine may increase after chronic dosing [23], [25].


  • oral - 25% - 35%,
  • nasal - 40% - 60% [12].

NB - This is for Cocaine HCl. [12].

Lethal dosage

Susceptible individuals have died from as little as 30 mg applied to mucous membranes, whereas addicts may tolerate up to 5 grams daily [11].


Risk assessment

  • toxic dose is highly variable,
  • small doses, particularly in non-tolerant patients, may result in significant intoxication,
  • hyperthermia, headache, cardiac conduction abnormalities, focal neurological signs or chest pain, heralds potentially life-threatening complications [26].

Dose related effects

  • 1 - 3 mg/kg = safe local anaesthetic dose,
  • 20 - 30 mg = usual recreational dose when a line of cocaine is snorted,
  • >1 g = potentially lethal [26].

Pregnancy and lactation

  • teratogenic (increased incidence of miscarriage and foetal death),
  • excreted in breast milk (infant intoxication and withdrawal syndromes are possible) [26].


  • Absorption
  • rapid through the mucous membranes of nasopharynx, lungs, and gastrointestinal tract [26],
    • well absorbed from all routes of administration (nasal, inhalation, IV, oral, rectal and vaginal). Peak concentrations occur between 30 and 120 minutes following oral or nasal use [27].
  • Bioavailability,
    • intranasal 25% - 80%,
    • smoked 60% - 70%,
  • Distribution
    • highly lipid soluble with volume of distribution = 2 L/kg [26],
    • less than 10% protein binding [27],
  • Metabolism
    • rapid,
    • metabolised by liver and plasma cholinesterases to water-soluble metabolites [26].
    • half-life is 30 to 90 minutes [27].
  • Elimination
    • only 1% of the drug appears unchanged in the urine
    • metabolites may persist in the blood and urine for up to 36 hours [26].
    • 10% - 20% is renally excreted unchanged,
    • metabolites may be detected in urine for up to 6 days [27].

Mode of use

Coke is divided into lines and snorted up the nose. It is not easily smoked, unless specially prepared into 'freebase' or 'crack' cocaine. A rock of crack is about the size of a raisin. Like 'freebase', it's usually smoked in a pipe, glass tube, plastic bottle or in foil.

Both powder and crack forms of cocaine can be prepared to make a solution of cocaine for injecting. Sharing needles and syringes or other injecting equipment, when injecting, runs the risk of the injector catching or spreading HIV and hepatitis C infection.

There is also the risk that veins may be damaged and of an abscess or blood clot developing [1].

  • cocaine powder - snorted up the nose, injected,
  • crack - smoked [4].

The most common method of using powder cocaine is snorting - sniffing the powder into the nasal passages. It can also be injected intravenously, ingested orally, or even rubbed on the user's gums. Powdered cocaine can also be smoked, as users occasionally sprinkle it on cigarettes or 'joints'. The drug can also be smoked as crack cocaine or 'freebase' after the powder has been processed into a rock form. Because smoking a substance allows it to reach the brain more quickly than other methods, smoking crack or freebase creates an intense and immediate high (in about 10 to 15 seconds), making the drug even more addictive [28].

Cocaine HCl is water soluble and can be absorbed across a mucous membrane (e.g. nose, gums). It is often snorted, or rubbed in to gums. Typically, when snorted, the powdered drug is placed on a flat surface; the crystals are made as fine as possible by chopping them with a credit card. The resulting powder is then snorted, often through a tube of rolled-up paper in to the nostril. It dissolves, enters the capillaries and then passes in to the circulatory system.

Cocaine HCl can also be injected. It does not lend itself to smoking as the heat of a cigarette or pipe will cause the cocaine to breakdown, rather than vapourising. Hence this is an inefficient method of use.

Crack cocaine has a lower melting point (95'c) than cocaine HCl and so it can be smoked. This is usually done through a pipe, though some people flake crack in to spliffs and smoke it this way. As crack is not water soluble it cannot be snorted or injected. In order to inject it, some users will acidify crack cocaine, turning it back in to water-soluble salt [3].

Cocaine hydrochloride is most commonly snorted. It can also be injected, rubbed into the gums, added to drinks or food.

Freebase and crack cocaine are usually smoked [29].

Indigenous people of South America have traditionally chewed the leaves of the coca bush, or brewed them as a tea, for use as a stimulant or appetite suppressant [30].

  • The leaves of the coca plant can be chewed or made into a tea and drunk. Coca leaves are used this way legally in many countries as a mild stimulant similar to caffeine.
  • Most often powder cocaine is snorted in small lines. The effects come on gradually and peak after about 15--30 minutes, with a total duration of about an hour.
  • When smoked in the form of 'crack' the effects come on immediately but wear off much more quickly.
  • When injected, the effects are felt immediately and much more intensely [6].

Signs of usage

  • inability to experience pleasure without the use of cocaine,
  • thoughts and actions are consumed by cocaine use,
  • legal trouble as a result of cocaine use,
  • difficulties at work or school due to cocaine,
  • trouble in personal relationship,
  • health effects due to cocaine use [31].


Taking cocaine makes users feel on top of the world, wide-awake, confident and on top of their game - but some people are over-confident on it and so may take very careless risks. Its effect is much like speed (amphetamines), but is usually stronger and doesn't last as long [1].

It can also have other effects -

  • Raising the body's temperature,
  • Making the heart beat faster,
  • Reducing feelings of hunger,
  • After a big night on cocaine, it's not unusual for people to feel like they've got the flu [1].

The effects of crack smoking are virtually immediate, peaking for about two minutes and lasting for only about 10 minutes.

When snorting coke it takes longer to peak but the effects still don't last that long, only around 20 - 30 minutes.

When the effects of any cocaine use start to wear off there can be a very strong temptation to take more, particularly with the long 'come down', the crash period sometimes lasting for days afterwards [1].

Short-term effects

  • loss of appetite,
  • increased heart rate, blood pressure, body temperature,
  • contracted blood vessels,
  • increased rate of breathing,
  • dilated pupils,
  • disturbed sleep patterns,
  • nausea,
  • hyperstimulation,
  • bizarre, erratic, sometimes violent behaviour,
  • hallucinations, hyperexcitability, irritability,
  • tactile hallucination that creates the illusion of bugs burrowing under the skin,
  • intense euphoria,
  • anxiety and paranoia,
  • depression,
  • intense drug craving,
  • panic and psychosis,
  • convulsions, seizures and sudden death from high doses (even one time) [2].

Long-term effects

  • permanent damage to blood vessels of heart and brain,
  • high blood pressure, leading to heart attacks, strokes, and death,
  • liver, kidney and lung damage,
  • destruction of tissues in nose if sniffed,
  • respiratory failure if smoked,
  • infectious diseases and abscesses if injected,
  • malnutrition, weight loss,
  • severe tooth decay,
  • auditory and tactile hallucinations,
  • sexual problems, reproductive damage and infertility (for both men and women),
  • disorientation, apathy, confused exhaustion,
  • irritability and mood disturbances,
  • increased frequency of risky behaviour,
  • delirium or psychosis,
  • severe depression,
  • tolerance and addiction (even after just one use) [2],
  • insomnia,
  • exhaustion,
  • anxiety,
  • paranoia,
  • psychosis,
  • eating disorders,
  • sensitivity to light and sound,
  • hallucinations,
  • heart disease,
  • death [32].

Physical effects

  • bronchodilation,
  • physical euphoria,
  • sublingual numbing,
  • tactile hallucinations,
  • bodily control enhancement,
  • stimulation,
  • appetite suppression,
  • pain relief,
  • abnormal heartbeat,
  • dehydration,
  • frequent urination,
  • increased blood pressure,
  • increased heart rate,
  • increased perspiration,
  • teeth grinding,
  • temporary erectile dysfunction,
  • vasoconstriction [11].

Cognitive effects

  • anxiety,
  • cognitive euphoria,
  • compulsive redosing,
  • depression,
  • irritability,
  • time distortion,
  • analysis enhancement,
  • ego inflation,
  • focus enhancement,
  • increased libido,
  • increased music appreciation,
  • motivation enhancement,
  • thought acceleration,
  • thought organisation,
  • wakefulness,
  • anxiety suppression,
  • cognitive fatigue,
  • disinhibition,
  • motivation suppression,
  • thought deceleration [11].

Positive effects

  • elevated mood,
  • euphoria,
  • stimulation [12].

Neutral effects

  • hyper-inflated ego,
  • numbing effects,
  • sweating,
  • dilated pupils,
  • decreased appetite,
  • decreased sleep [12].

Negative effects

  • increase in irritability,
  • raised heart rate,
  • hypertension (high blood pressure),
  • increase in body temperature,
  • urge to redose [12].

Adverse effects

  • anxiety,
  • paranoia,
  • restlessness,
  • itching,
  • tachycardia,
  • hallucinations,
  • paranoid delusions,
  • bronchospasm,
  • pruritus,
  • fever,
  • chest pain,
  • lung trauma,
  • sore throat,
  • asthma,
  • hoarse voice,
  • shortness of breath,
  • flu-like syndrome [31].


Typical signs and symptoms of current cocaine use include -

  • increased agitation,
  • effusive enthusiasm,
  • disinhibition,
  • increased movement (i.e. hyperactivity),
  • increased common cold-like symptoms and/or nosebleeds,
  • signs of involuntary movements (i.e. muscle tics),
  • changes in concentration and focus [32].

Coming down

  • tension,
  • anxiety,
  • depression,
  • mood swings,
  • total exhaustion [32].


  • nausea,
  • vomiting,
  • extreme anxiety,
  • chest pain,
  • panic,
  • extreme agitation,
  • paranoia,
  • hallucinations,
  • tremors,
  • breathing irregularities,
  • kidney failure,
  • seizures,
  • stroke,
  • heart problems,
  • coma,
  • death [32].


There are many serious risks with taking cocaine. Here's what it could do to you.

  • Cocaine users have died from overdoses. High doses can raise the body's temperature, cause convulsions, a heart attack and heart failure. Risk of overdosing increases if cocaine is mixed with other drugs or alcohol.
  • Over time, snorting cocaine will seriously damage the cartilage in your nose that separates the nostrils; and it is not unknown for heavy users to lose their cartilage and end up with just one really big nostril and a mis-shapen nose.
  • Cocaine is highly risky for anybody with high blood pressure or a heart condition. Even perfectly healthy, young people can have a fit or heart attack after taking too much.
  • Using cocaine a lot makes people feel depressed and run down. It can lead to serious problems with anxiety, paranoia and panic attacks.
  • Cocaine can bring previous mental health problems to the surface. If a relative has had mental health problems, there might be an increased risk for you.
  • Taking cocaine when you're pregnant can damage your baby. It may cause miscarriage, premature labour and low birth weight.
  • Regularly smoking crack can cause breathing problems and pains in the chest.
  • Frequent users find they begin to crave more - so it can become an expensive habit to keep.
  • Injecting drugs can damage veins and cause ulcers and gangrene. Sharing needles or other injecting equipment can spread HIV and hepatitis infections.
  • It's easier to overdose if you're injecting cocaine.
  • 'Speedballing', injecting a mixture of cocaine and heroin, can have fatal results.
  • Heavy crack users may take heroin to try to dull their cravings, so they may get hooked on heroin as well.
  • A form of heroin, called 'white heroin', is easily mistaken for cocaine and people have died or been hospitalised after snorting white heroin, which they thought was cocaine. Heroin is active in smaller doses than cocaine, so if you mistake it for cocaine, you are more likely to overdose, experience respiratory failure (this is what it's called when your breathing stops) and possibly die [1].

Cocaine and alcohol

Using cocaine with alcohol (or other drugs) can substantially increase the risk of side-effects. Alcohol and cocaine together can be particularly dangerous, as they mix together in the body to produce a toxic chemical, called cocaethylene [1].


  • tolerance,
  • paranoia,
  • anxiety,
  • overdose (possibly fatal) [4].


  • strong psychological dependence,
  • psychosis [4].

Heart problems and stroke

When someone uses cocaine, the rush they experience also causes a corresponding spike in his or her blood pressure and pulse rate. The user also experiences an increase in his or her respiration rate. Using the drug can trigger a stroke in some cases. This medical consequence of using coke can occur when the user's blood vessels constrict while his or her blood pressure increases rapidly. The constriction can be severe enough to restrict or cut off blood flow to the brain entirely.

Men under the age of 40 are most at risk for having a stroke as a result of using cocaine. In some cases, the cause of the stroke can be attributed to a malformation in the arteries or veins supplying the brain. In cases where a person has a stroke after using cocaine, they are more likely to experience the type caused by bleeding in the brain than one triggered by a reduction of blood flow to this important organ [33].

Damage to the nose

The other main physical danger you face is damaging or perforating the septum, the thin membrane that separates the nostrils at the top of the nose. Regular coke snorters often suffer instant nosebleeds when snorting the drug. Occasional users may detect next-day bloodied mucus and congestion. Heavy users have their septums dissolved by the corrosive effects of cocaine.

A person using cocaine may find that his or her sense of smell is impaired as a result of using the drug. Trouble swallowing is another one of the dangers of cocaine. One of the signs that may indicate a problem with cocaine addiction is seeing a person with a constantly running nose [33].

Other dangers of cocaine use

An individual who swallows cocaine may be creating the physical conditions required for them to experience bowel gangrene from lack of blood flow to this part of the body. Doing so to avoid being arrested for cocaine possession or because the individual is acting as a 'mule' to transport the drug is a very risky thing to do.

If injecting cocaine is your delivery method of choice, you need to be aware that sharing needles puts you at a higher risk for developing HIV/AIDS. Allergic reactions are also not uncommon when the drug is administered in this way.

A cocaine user who binges on the drug can become irritable or restless. The individual may also feel anxious or become paranoid as a result of his or her drug use. In extreme cases, the person experiences auditory hallucinations as part of an episode of cocaine psychosis. This problem is more likely to affect long-term, regular users of the drug than a person who only uses it occasionally [33].


The mean purity of cocaine in Europe at consumer level is high. In 2011 it varied from 22% (Bulgaria) to 61% (Greece). Overall, cocaine purity stabalised in the European Union over the period 2006 - 11.

The purity of crack is generally higher, but depends not only on the purity of the cocaine used in its manufacture, but also on the method of production. Common adulterants of cocaine are phenacetin, lignocaine, benzocaine, procaine, caffeine, paracetamol and sugars. Some of these may be removed in the production of crack. Occasionally, unusual additives have been reported, such as atropine, diltiazem and other pharmaceutical substances. The free base constitutes 89% of the hydrochloride salt.

The mean purity of crack at consumer level in the few countries reporting data is higher than 25%, varying from 26% (United Kingdom) to 61% (France) [13].

Powder cocaine is often diluted or 'cut' with white powders that have a similar consistency. Cornstarch, flour, talc, procaine (a local anaesthetic), levamisole (a veterinary de-worming medication), powdered sugars, even coffee creamers, vitamin B12 and baby formula may be used [34].

Recent police seizures of 'street' powder cocaine had an average purity of just 32%. A wrap of cocaine powder can be cut with many things, such as sugar or starch, but benzocaine is most common. Benzocaine is a local anaesthetic which can produce a 'numbing' effect similar to cocaine, but without the cocaine 'high'.

The purity of 'crack' depends on the purity of the cocaine used originally to produce the 'crack'. However, recent police seizures had an average purity of 30% [1].

The powder cocaine is usually mixed with substances such as corn starch, talcum powder and/or sugar or other drugs such as procaine (a local anesthetic) or amphetamines [2].

Cocaine in its purest form is a white, pearly product. Cocaine appearing in powder form is a salt, typically cocaine hydrochloride. Adulterated cocaine is often a white, off-white or pinkish powder. Adulterated or 'cut' street cocaine is mixed with various powdery fillers to increase its weight, most commonly used substances are baking soda, lactose, dextrose and local anaesthetics like benzocaine that mimic and add to the numbing effect of cocaine [4].

While cocaine powder is easily cut with other adulterants, purity tends to be higher than, for example, speed. Adulterants include mannitol, sorbitol, amphetamine, lactose, caffeine, lidocaine, benzocaine.

Crack purity will depend on the strength of the cocaine used and the process used. Much literature claims that crack is a purer drug than cocaine HCl and this is not always the case.

Crack can be made in a one-stage or two stage process. A one stage process simply converts the drug from a salt to a base, but does not make it any purer. A two-stage process will convert the drug from salt to base but also refine it.

Most mass-produced crack is produced in a one-step process and so the crack will be of a similar (or lower) purity than the cocaine from which it was manufactured. The crack will only be purer if adulterants present in the cocaine were removed. Regardless, crack will inevitably feel stronger due to the route of administration. Drugs which are smoked deliver more of the drug to the brain more rapidly than drugs which are snorted [3].

According to statistics from the Home Office; UK Border Force; Scottish Government and Northern Ireland Police Service (NIPS) in 2014, cocaine (powder) was the most seized stimulant in the UK, both in terms of number and quantity of seizures. Having been 51% pure in 2003, the purity of domestic resale powder cocaine fell to 20% in 2009. However, it has risen since then and was 36% in 2014.

Lidocaine, glucose, caffeine and phenacetin are the adulterants most frequently found in cocaine. While most are largely benign substances with few dangerous side-effects, Phenacetin, an analgesic, has been banned in many countries due to its carcinogenic and kidney-damaging properties.

Cocaine can vary a lot in purity so be sure to start with a small dose [5].


Cocaine is very addictive and it can be difficult to resist the craving for more. This powerful craving can develop because cocaine can change the way your brain works.

Although the powerful psychological dependence that can easily develop is more of a problem than the physical withdrawal symptoms, people who stop using can experience low moods and feel very rough, and this can also tempt them to take more cocaine [1].

Cocaine abuse may lead to problems being around others, doing your job, or new medical problems [35]. You may have the following problems -

  • use of more cocaine than you first wanted to use,
  • no ability to decrease or control your use of cocaine,
  • spending much of your time using cocaine, or dealing with a hangover after you use cocaine,
  • less time spent around others, at work, or doing activities that you enjoy,
  • continued cocaine use, even when it causes physical or mental problems [35].


Cocaine abuse results in powerful stimulant effects. When taken in high doses, a person can lethally overstimulate their body and brain. This is known as a cocaine overdose. During an overdose, a cocaine user may experience the amplification of cocaine's usual effects, such as increased heart rate and body temperature. Experiencing these extreme stimulant effects can lead to the failure of a number of organ systems and physiologic functions - causing the body or brain to shut down, and sometimes resulting in death [36].

  • dangerously high blood pressure,
  • irregular heart rate,
  • extremely high body temperature,
  • extreme anxiety or confusion,
  • psychosis,
  • nausea,
  • agitation or tremors [36].
  • vomiting,
  • passing out,
  • heavy sweating,
  • any signs of heart attack, such as chest pain (tightening in the chest),
  • intense headache,
  • muscle cramps,
  • being unable to urinate,
  • feeling short of breath or breathing irregularly,
  • experiencing tremors or convulsions or signs of seizure, like drooling or frothing or limb spasms or rigidity,
  • grinding teeth,
  • signs of stroke, such as -
    • sudden inability to talk coherently or understand what other people are saying,
    • sudden weakness or loss of feeling in the face, arms or legs (usually on one side of the body),
    • sudden loss of balance or coordination and or
    • sudden vision difficulties [37].

Withdrawal treatment

Withdrawal happens when you have used cocaine for a long period of time, and you suddenly take less or stop taking it [35]. Symptoms may begin within a few hours after you decrease or stop taking cocaine and may include the following -

  • severe sadness or fatigue,
  • restlessness, nervousness, or anxiety,
  • nausea or vomiting,
  • trouble sleeping or difficulty waking up,
  • unpleasant dreams that seem real,
  • seeing, hearing, or feeling things that are not really there,
  • sweating, shaking, or a fast heartbeat,
  • seizure [35].

Dangerous interactions

  • Stimulants - When used in conjunction with other stimulants, the cardiovascular effects of cocaine such as increased heart rate become dangerously high. This is potentially fatal and severely increases the risk of cardiac arrest.
  • Depressants - Because depressants counteract some of the physical effects of cocaine (and vice-versa), the combination can lead users to underestimate the extent of their intoxication and consume larger doses than they otherwise would. Cocaine and opioids is a particularly dangerous combination because cocaine has a short half-life relative to most opioid drugs and as the effects of cocaine wear off, physical side-effects of the opioid can increase resulting in a delayed overdose with serious respiratory depression being a potentially fatal risk.
  • 25x-NBOMe - Both the NBOMe series and this compound induce powerful stimulation and their interaction may cause severe side effects. These can include thought loops, seizures, increased blood pressure, vasoconstriction, increased heart rate, and heart failure (in extreme cases).
  • Alcohol - When used in conjunction with alcohol, a portion of the cocaine undergoes transesterification with ethanol rather than undergoing hydrolysis with water which results in the production of cocaethylene [38]. This creates significant changes in subjective effects such as a longer duration and increased euphoria. Some studies suggest, however, that this could potentially increase the cardiotoxic effects of cocaine to dangerous and unpredictable levels. It is also dangerous to combine alcohol, a depressant, with stimulants due to the risk of excessive intoxication. Stimulants decrease the sedative effect of alcohol which is the main factor most people consider when determining their level of intoxication. Once the stimulant wears off, the effects of alcohol will be significantly increased, leading to intensified disinhibition as well as respiratory depression. If combined, one should strictly limit themselves to only drinking a certain amount of alcohol per hour.
  • DXM - This combination may cause increased heart rate and panic attacks.
  • MXE - Increased heart rate and blood pressure may occur.
  • Tramadol - This combination can increase the risk of seizures.
  • MDMA - The neurotoxic effects of MDMA may be increased when combined with cocaine.
  • MAOIs - This combination may increase the amount of neurotransmitters such as dopamine to dangerous or even fatal levels. Examples include syrian rue, banisteriopsis caapi, 2C-T-2, 2C-T-7, αMT, and some antidepressants [39].
  • Nicotine - Many cocaine users find that consumption of tobacco products during cocaine use enhances the euphoria because nicotine increases the levels of dopamine in the brain. This, however, may have undesirable consequences such as uncontrollable chain smoking during cocaine use (even users who do not smoke cigarettes have been known to chain smoke when using cocaine) in addition to the detrimental health effects and the additional strain on the cardiovascular system caused by tobacco [11].


After continued cycle of use and abuse, a person will become addicted to cocaine. When a man or woman discontinues abusing cocaine, the user will experience a withdrawal symptom called a 'crash' or 'come down' [40].

Phasal model of cocaine withdrawal

Onset within hours to a few days - the 'Crash' phase

The 'Withdrawal' phase - lasting 1-10 weeks

  • lethargy,
  • anxiety,
  • erratic sleep,
  • strong craving,
  • emotional lability,
  • irritability,
  • depression,
  • poor concentration [41].

The 'Extinction' phase - up to 28 weeks

Drug testing

  • Saliva - 1 day,
  • Urine - 4 - 5 days,
  • Hair - up to 90 days [12].

Testing methods used to detect benzoylecgonine, which is the marker for cocaine, may be in the following forms -

  • Blood test,
  • Hair sample test,
  • Saliva test,
  • Urine test [33].

Blood testing for cocaine

A blood test is most likely to be used to determine whether an individual is under the influence of a drug at any given time. It is the most invasive form of testing and must be conducted in a medical laboratory. This is the most expensive type of test, but it is also the most accurate [33].

Hair testing for cocaine

A hair sample test involves taking a small sample of hair (approximately the diameter of a pencil and 1.5 inches long) from the head of the individual being tested. This method is more expensive than conducting a urine test. The average cost of this method is in the $100 - $150 range.

A person is more likely to test positive on a hair test than one using a urine sample. A hair sample test for cocaine can detect the presence of the drug quite readily. Since the tracers can move up and down the hair shaft, it isn't considered a reliable indicator of when the drug was used and for how long. A hair test can reveal cocaine use up to 90 days after use [33].

Cocaine detection in saliva

Saliva tests are becoming more popular for detecting illicit drug use, since they are relatively non-invasive and are less expensive than hair or blood testing. This method is easy to administer to testing subjects and the samples are forwarded to a laboratory for analysis. Coke can be detected in saliva for 24 hours after use.

This type of testing doesn't have any nationally-adopted standards or cutoffs for determining the cutoff for a positive test. The test results vary, depending on the brand selected for the test, which may make this method less reliable than other available options [33].

Urine tests for cocaine use

A popular choice for cocaine testing is to have the subject provide a urine sample. A urine test is relatively inexpensive and can detect relatively recent (within the past seven days) use as well as long-term exposure to the drug.

These types of tests are available for home use; however the results must be verified by a laboratory to validate the results. Along with testing the sample for the presence of the cocaine metabolite benzoylecgonine, a testing facility must also run other tests on the sample to determine its pH level and creatinine concentration.

Cocaine is detectable by standard drug tests on urine up to 72 hours after use. Long-term, habitual users may have traces of cocaine in their system for longer than the standard three days.

The level of concentration that triggers a positive result for coke use is 300 ng/ml. If an individual has a higher level than this number in his or her system, they have failed the drug test. A follow-up test will be ordered to confirm the first result, and the level considered "positive" at this point is 150 ng/ml.

People who are or may be asked to submit to a cocaine test may be wondering if there is a way to figure out how to beat it by looking for information on the Internet. There may be anecdotal accounts of people beating the test by using certain measures, such as switching urine samples, drinking a preparation that promises to 'detox' them or drinking large amounts of water to dilute their urine, none of these methods are foolproof [33].


  • 'Coke', 'freebase' and 'crack' are all Class A drugs - that means they're illegal to have, give away or sell.
  • Possession can get you up to seven years in jail.
  • Supplying someone else, including your friends, can get you life and an unlimited fine [1].

What if you're caught?

  • If the Police catch you with cocaine, they'll always take some action. This could include a formal caution, arrest and prosecution.
  • A conviction for a drug-related offence could have a serious impact. It can stop you visiting certain countries - for example the United States - and limit the types of jobs you can apply for [1].

Did you know?

  • Like drinking and driving, driving when high is illegal - and you can still be unfit to drive the day after using cocaine. You can get a heavy fine, be disqualified from driving or even go to prison.
  • Allowing other people to supply drugs in your house or any other premises is illegal. If the police catch people supplying illegal drugs in a club they can potentially prosecute the landlord, club owner or any person concerned in the management of the premises [1].

Mixing with other drugs

Cocaine is a stimulant, an 'upper', and can mix strangely with 'downers'. Be careful.

Please note that there have been very few scientific studies into the effects of combining psychoactive drugs. The information presented here is anecdotal. It is based on the subjective reports of experienced users. Different people will respond differently to different drugs and drug combinations. Know your body [42].

Avoid mixing drugs as interactions can be unpredictable and dangerous. Using cocaine with alcohol can be especially risky as they combine in the body to produce a metabolite called cocaethylene. Cocaethylene remains in the body longer than either alcohol or cocaine alone and puts extra stress on the heart and liver with potentially serious consequences [5].

  • alcohol - the two combine to form cocaethylene in the body, a compound which increases the effect and puts more stress on the heart [42], mixing alcohol and cocaine may cause the following effects -
    • chest pain,
    • heart palpitations,
    • confusion,
    • stroke,
    • seizures,
    • coma,
    • nausea and vomiting,
    • irritability,
    • HIV or hepatitis,
    • malnutrition,
    • traumatic injuries due to violence [43].
  • amphetamines - unlikely combination as the effects are so similar; increased strain on heart, increased toxicity,
  • cannabis - can take the edge off the buzz,
  • ecstasy - popular club combination, no obvious dangers other than increased physical strain,
  • heroin - known as a 'speedball', the two drugs amplify each other - cocaine acts as powerful stimulant, causing a rapid heartbeat, but wears off more quickly than heroin, which then slows the heart down. As a result, your heart can lose rhythm, entirely increasing the risk of heart failure. John Belushi and River Phoenix died taking speedballs [42]. Effects of concurrent heroin and cocaine use include -
    • renal disease,
    • breakdown of muscle tissue,
    • nosebleeds,
    • problems swallowing,
    • nasal septum perforation,
    • contraction of hepatitis or HIV,
    • abscesses,
    • track lines,
    • collapsed veins,
    • anxieties,
    • irritability,
    • paranoia,
    • depressed breathing,
    • severe itching,
    • coma,
    • drowsiness,
    • dizziness [43], [44], [45].
  • ketamine - a modern combination, known as CK1; clubbers like to mix coke with low doses of ketamine; coke diminishes the psychedelic effects of K; don't mix anything with high doses of Ketamine,
  • LSD - has its own speedy effect; not a good combination,
  • magic mushrooms - no known dangers,
  • tobacco - smokers usually smoke more cigarettes [42].

Combining cocaine with alcohol

Using cocaine and alcohol together is quite common among users. This can be a dangerous combination, however, since using the two substances together tends to compound the effects of each one. Research into the issue of using cocaine and alcohol together has found that the human liver produces a substance called cocaethylene when a person uses both substances at the same time. The cocaethylene intensifies the euphoric effect produced by ingesting the cocaine, resulting in a more intense 'high' for the user. This combination can also be attractive to cocaine users because it helps to prolong the good feelings they experience.

It makes sense that cocaine and alcohol use would be related, since a number of social cocaine users tend to ingest the drug while attending parties or at a bar. Consuming alcohol is part of their social activity, and they may not think about the fact that they are ingesting two potentially dangerous substances at the same time. People who drink alcohol and use cocaine at the same time may find that they can continue drinking longer than when they are consuming alcohol alone.

As the coke user continues this practice of combining the drug with alcohol, the cocaethylene builds up in his or her liver. This substance may be linked to the increasing number of relatively young people (in their 30's and 40's) who are experiencing heart health issues. An underlying heart condition that is triggered by cocaethylene may be to blame, and further research will need to be conducted to shed more light on what part this third drug plays on the health of people who ingest cocaine while consuming alcohol [33].

Harm reduction

Be aware of variable purity (range 2% - 70% approx). Most serious cocaine/crack problems are related to dose levels and how that dose reaches the brain.

Mixing with other drugs and alcohol should be avoided or kept within the user's own known limits. Mixing the two creates a third substance called cocaethylene which is a more potent version of the two.

Be aware that sharing with mates is a serious offence.

Try not to use alone - at the very least make sure someone knows where you are, and don't use alone in a locked room or isolated place.

Set a strict limit on expenditure and quantity. Don't get cocaine on credit: if you can't afford it you can't afford it! [7]

  • Eat and sleep well before and after taking cocaine to replace energy and nutrients lost during use,
  • If snorting, wash your nose out after each session and use vitamin E cream to reduce damage,
  • Avoid using a bank note as a snorter and try not to share- a post it or a straw is disposable, reducing the risk of blood borne viruses,
  • The analgesic effect of cocaine can increase the risk of gum and other oral damage. Have chewing gum handy!
  • If injecting: don't use citric acid (dissolve in sterile water), use the smallest needle possible, only use clean equipment, rotate your sites, wash injecting sites/ hands and never share equipment!
  • Try to have a few drug free days a week to allow your body to recover,
  • Avoid mixing with other drugs especially downers such as heroin (known as 'speedball') as this can cause more strain on your heart and may mask the effects of an overdose,
  • Avoid mixing with alcohol as this creates a new drug in the body; cocaethylene (coke-a-eth-i-leen) which may be very toxic and could increase your risk of a heart attack or stroke,
  • Taking cocaine with alcohol can also reduce your awareness of how drunk you are (meaning you might drink more) [46].

Cocaine can be taken in a number of ways, but the most common are insufflation (snorting), swallowing and occasionally injecting. For each route of administration, there are different health considerations that must be taken into account [7].

  • Snorting - always make sure you cut up your lines carefully (so as not to get too much), using a clean edge and on a clean surface. If possible use a new straw or other object to inhale, or if reusing make sure it's been thoroughly sterilised first, as bacteria and some viruses can linger for a long time. Never share a straw or other object with anyone else without cleaning it first.
  • Swallowing - if wrapping yourself, carefully check how much you're putting in a bomb. If someone else, particularly someone you don't know, is doing it, try to keep an eye on what they're doing. Using more than one paper can lessen any unpleasant taste and also slow the release of the substance into your system.
  • Injecting - this is rarely done with cocaine and only once it has been mixed with water, which should always be clean and as sterile as possible. Be very careful how much you use, as injecting needs far smaller amounts than other methods such as snorting [7].


  • It is difficult to obtain 100% pure cocaine, therefore we highly advise you to test your drug before taking it. Powdered cocaine is frequently cut with other powdered white substances, such as adulterants and speed, to increase its volume and weight. It is extremely difficult to know what these other drugs and impurities might be, so for your own safety and wellbeing, do try to test the purity of your cocaine before using it.
  • Part of reducing the harm to your body is maintaining good hygiene. Before snorting the cocaine, divide it on a clean surface and snort it with an unused straw; try not to use a note as you never know what's on it.
  • Injecting cocaine can cause damage to the skin and veins, which might lead to sores. Sharing needles puts you at risk of infections such as HIV, Hepatitis B and Hepatitis C. It is also the most addictive way of taking cocaine.
  • If you have any pre-existing heart conditions or are pregnant, we strongly advise you to stay away from cocaine. It increases your heart rate significantly and can cause problems for the foetus [47].


  • Avoid mixing cocaine with other drugs, especially alcohol. Cocaine makes you feel sober which can lead to excessive and unsafe levels of drinking. More importantly, cocaine and alcohol react to form cocaethylene, a harmful substance that subjects your heart and liver to prolonged periods of stress. The risk of sudden death is 18 times greater when alcohol and cocaine are used together.
  • Cocaine can make you engage in riskier behaviour. It can also cloud your judgement and lead you to make irrational decisions. Try not to do it alone, especially if you are new to the drug.
  • Taking cocaine in excessive amounts can cause heart attacks, seizures or death. In the event that you overdose, be sure to call emergency services. You will not get into any trouble [47]. Here are some of the symptoms that people show -
    • disorganised behaviour,
    • fear,
    • paranoia, suspiciousness,
    • hallucinations,
    • irritability and aggressiveness, often panic attacks,
    • some people can become extremely antisociable,
    • in extreme cases, stroke, seizures, pulmonary oedema, aorta rupture heart attack or death can occur [47].
  • Snorting only through one nostril can cause bleeding and build up. Try alternating between the two nostrils and washing them with water [47].


  • Cocaine can make you feel on top of the world. One of the reasons people become addicted to it is due to the temptation to do it over and over again once the effect has worn off. It has also been shown that frequent cocaine use dramatically reduces the blood reaching the brain and may lead to brain damage or dysfunction. Like any other drug, we advise you not to binge and to keep your cocaine consumption for special occasion.
  • You might find it hard to fall asleep after taking cocaine. It also suppresses your appetite, so try to drink plenty of water the next day and have a health and nutritious breakfast, loaded with proteins fibres and carbohydrates, even if you are not hungry.
  • Never take more cocaine to overcome the hangover! [47]

Taking cocaine always carries dangers, and the only way to avoid harm is to avoid taking it. The highest rates of harm caused by cocaine are suffered by a small proportion of addicted users who persistently take large amounts of cocaine, often by smoking or injecting it, often with other drugs. Occasional social users are taking a risk, but they are less likely to get harmed, if they can avoid addiction [48].

What are you taking and how?

The riskiness of cocaine use varies hugely. Be very cautious about how much you consume, remembering that because purity is so variable, a line from one batch could be the equivalent of 5 lines from another batch. It is always possible to take more, but never possible to un-take what you have already taken! Snorting cocaine is thought to be less frequently harmful than injecting it or smoking crack [48].

Could you get addicted?

Anyone can get addicted. Having a little, once in a while, with other people around is obviously less risky than taking it in uncontrolled amounts, regularly, alone. However, the addictive qualities of this drug make it quite easy for moderate, social use to slide into chaotic, constant use. Being very vigilant over your use is vital. If you are taking more and more cocaine, more and more regularly, you may be on a slippery slope, as tolerance builds up encouraging higher doses, and cravings intensify. If you are struggling to control your use, or think you are addicted, seek professional help. The earlier you get help, the better the chance of avoiding lasting harm to your life [48].

Are you considering the harms cocaine can cause to others?

Cocaine addiction often spreads through social and familial networks. Many people who end up struggling with the harms of the drug first try cocaine when it is shared by well-intentioned friends and family. If you offer cocaine to others, there is a small but significant risk that the recipient will become addicted as a direct or indirect result [48].

Never share injecting or snorting equipment.

It is always best not to use drugs alone but with people you trust, who have knowledge of first aid and who will seek medical help for you if necessary [5].

Health implications

With short-term use, cocaine users can experience anxiety, paranoia and disrupted sleep. The suppression of appetite can lead to weight loss, and users will experience exhaustion and fatigue.

Snorting of cocaine can lead to perforation of the septum, and rubbing cocaine into the gums can cause gum disease and cavities.

Crack smokers often experience bronchial problems, exhibited by coughing and black phlegm. Regular use can cause anxiety, depression and ultimately psychosis. Deaths do occur, predominantly through heart failure or haemorrhages.

Cocaine used in conjunction with alcohol forms a compound called cocaethylene; this compound increases the strain on the liver and regular use of cocaine with alcohol increases the risk of liver damage.

Cocaine used in combination with other drugs that elevate blood pressure increases the risk of serious health problems. Some users end up using other drugs such as benzodiazepines to offset the come-down caused by excessive cocaine use.

An increasingly large population is using cocaine alongside heroin, sometimes smoked but increasingly injecting both drugs together (snowballing). This brings with it the risks of dependency associated with heroin use alongside the risks and costs of a cocaine habit.

Cocaine is not thought to be physically addictive. However, the intensely pleasurable high and the less pleasurable comedown can lead to regular and increasingly problematic use. The very rapid high and comedown from crack increases the likelihood of dependency [3].


  • if snorted - razor blade, hard level surface (such as a mirror or glass), tube or rolled banknote,
  • if injected - needles & syringes, water, swabs,
  • if smoked - tinfoil, matches/lighter, crack pipe (bong) either commercially manufactured in glass/ pyrex or home-made from a drinks can or glassware [4].


The leaves of the coca plant (Erythroxylon coca) have been utilised by people for a range of purposes for thousands of years. It grows indigenously on the slopes of the Andes mountain range (mostly in Peru) but has been cultivated by people across the whole of western South America for centuries. The leaves are traditionally chewed for a number of benefits - it was widely used for mystical, religious, social and medicinal purposes. It was chewed not merely for its stimulant properties - which warded off fatigue and provided the energy and strength necessary for walking and working; the physical demands of the body combating low oxygen levels at high altitude, to help stave off hunger and provide basic protein and as an anaesthetic.

When the Spanish 'conquistadors' arrived in South America, they initially dismissed tales of coca's potency as native superstition. However, once they learned how effective it actually was, and how poorly the natives coped without it, they quickly moved to regulate and tax it, introducing a 'tithe' as they developed and imposed a administrative system on the indigenous people.

Coca eventually reached Europe via trade routes, but it did not travel well and much of the plants potency was lost during the long travel times of the period and crude storage methods. It was not until 1855 that the German chemist Friedrich Gaedcke isolated the cocaine alkaloid, which he named 'erythroxyline'. Another German, Richard Willstatter, synthesised the cocaine molecule in 1898.

In 1863 an Italian chemist named Angelo Mariani brought onto the market a wine called 'Vin Mariani', a potent mix of wine and coca leaf. The ethanol in the wine acted as a solvent and extracted the cocaine from the leaves - creating an 'in vivo' compound called cocaethlyene that hugely reinforced the impact of both drugs and has a range of effects that are both intoxicating and euphoric and dangerously toxic. It is well known that Pope Leo XIII consumed it daily, pronounced it a 'tonic' and even awarded it a Papal seal of approval.

The drug affected many of the great writers of the time. Including Ibsen, Émile Zola, Alexander Dumas and Jules Verne, It began to appear in their writing, Sir Arthur Conan Doyle made Holmes a user by injection, see 'The Seven Percent Solution', much to the disapproval of staid old Watson. Robert Louis Stephenson wrote 'The Strange Case of Dr Jekyll and Mr Hyde' during a six-day binge and it has been suggested the duality of the central character is a rumination on the positive and destructive effects of the drug.

Cocaine was hailed as something of a 'wonder drug' in the late 19th century, with exponents such as Sigmund Freud praising its anaesthetic and psychological uses, particularly in the treatment of addiction. Many products, not just medicinal but even foods (Coca Cola perhaps being the most famous), began to contain it, and there was little appreciation of its own addictive properties - the actress Tallulah Bankhead commented - Cocaine habit-forming? Of course not. I ought to know. I've been using it for years. In London in 1916, Harrods were selling a kit described as 'A Welcome Present for Friends at the Front' containing cocaine, morphine, syringes and needles.

Cocaine had a less blatant profile in the first half of the twentieth century, in part due to the social, legal and moral attitudes to intoxication particularly in the USA, where the 'cocaine crazed negro' became a fantasy figure of fear particularly among white supremacists and tales of coloured criminals oblivious to the physical effects of bullets and driven by insatiable lust for white women became common in the tabloid press in the years before the second world war.

In 'I get a kick out of you', from the 'Anything Goes' musical, Cole Porter wrote, Some get a kick from cocaine, which was later changed (from 'Some like the perfume in Spain') to the better known later 'from champagne'. (The perfume went better with the next line about taking 'just one small sniff').

This was a time when other drugs, such as amphetamines, cannabis and LSD became more popular, although cocaine was still widely used by jazz musicians, many of them had switched to heroin as their drug of first choice. It experienced a revival, however, in the late 1970's as the drug of choice amongst young, hard-working, hard-partying professionals, and has seen a resurgence in its general popularity since. A decade later it was the drug of choice for the upwardly mobile aspirational world of high finance and corporate trading.

The history of Hollywood after the decline of the studio system in part maps the revival of interest in cocaine.

There is a fascinating relationship between Hollywood and cocaine both in terms of the heavy use of the drug by leading artists and in the inevitable connection, a mirror of the writers of the 19th century introducing the drug into their own work. Cocaine is the means by which the heroes of 'Easy Rider' tried to get rich quick and fail. Many of the great American writers and directors have found the energising, stimulating effects of the drug irresistible. Coppola and Scorsese and Oliver Stone have spoken at length about their problems, as has Stephen King. Virtually every crime or gangster movie has cocaine involved in some fashion and an endless number of famous actors and actresses have had serious problems with the drug.

The early moral ambiguities of these films has been replaced by the now ubiquitous tale of the cops versus the evil drug cartels or their murderous henchmen and while the cocaine wars of recent history have been hideous affairs, it is all too easily forgotten that the 'Iran-Contra' affair and the Noriega saga are examples where political expediency, power and the colossal sums of money involved in the cocaine trade and the ruthless and homicidal tendencies of the political groupings such as FARC, The Revolutionary Armed Forces of Colombia, the cartels and gangs from the Medellin and Cali cartels, Escobar's war on the state and the current situation in Mexico and Brazil [7].

Humans have known about the stimulant effects of the Coca plant since ancient South American cultures chewed the leaves in everyday activities and religious rituals. Cocaine first appeared in American society in the 1880's as a surgical anaesthetic, and soon became a common household drug, as well as an ingredient in Coca-Cola and in several types of wines. Snorting cocaine was slowly becoming popular in the early 1900's until the drug was banned in 1914 as a result of the Harrison Act. Abuse began rising again in the 1960's, causing Congress to classify it as a Schedule II drug in 1970 [49]. Later, in the mid-1980's, crack cocaine, which is derived from powder cocaine, became an enormously popular drug of abuse. Today, synthetic forms of cocaine such as Novocain are still used as local anaesthetics for surgical purposes; however, medical use has become more sporadic with the introduction of safer and more improved pharmaceuticals. Illicit, recreational use of cocaine remains popular today [28].

For over a thousand years people have chewed the leaves of Eryhtoxylon coca, a plant that has many alkaloids, including cocaine.

The isolation of the Cocaine alkaloid was not achieved until 1855 by the German chemist Friedrich Gaedcke, who named the alkaloid 'Erythroxyline'.

In 1856 Albert Niemann developed an improved purification process.

In 1879, Vassili von Anrep devised an experiment to demonstrate the analgesic properties of this alkaloid. He prepared two separate jars, one containing a cocaine-salt solution, while the other contained only salt water. He then submerged a frog's legs into the two jars, one leg in the treatment and one in the control, and proceeded to stimulate the legs in several different ways. The leg that had been immersed in the cocaine solution reacted very differently from the leg that had been immersed in salt water.

Later, other substances derived from cocaine, including eucaine, procaine (= Novocaine), tetracaine (= Pantocaine) (1930), lidocaine (= Xylocaine) (1944), mepivacaine (= Scandicaine) (1957), prilocain (= Xylonest) (1960), bupivacaine (1963), and etidocain (= Duranest) (1972), were also used as local anaesthetics (Busch and Rummel 1990; Schneider 1993, 19*). Holocaine was also regarded as a substitute [12].


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