1
Florida Heart CPR*
Cocaine Abuse
1 hour
Objectives
By the end of the course, the student will be familiar with:
A. Current statistics regarding cocaine use
B. Methods of cocaine use and treatment for cocaine users
C. Health and psychological hazards of cocaine use
Extent of Use
Monitoring the Future Study. The Monitoring the Future Study assesses the
extent of drug use among adolescents and young adults across the country.
Data shows that cocaine use among high school seniors had been on a
downward trend since its peak in 1985. The proportion of seniors who have
used cocaine at least once in their lifetimes dropped from 17.3 percent in
1985 to 7.1 percent in 1996. Current use of cocaine decreased from 6.7
percent in 1985 to 2.0 percent in 1996.
In 1996, 6.5 percent of 10th-graders had tried cocaine at least once, up from
5.0 percent in 1995. The percentage of 8th-graders who had ever tried
cocaine rose significantly from 2.3 percent in 1991 to 4.5 percent in 1996. Of
college students in 1995, 3.6 percent had used cocaine within the past year,
and 0.7 percent had used cocaine in the past month. In 1995, 4.4 percent of
young adults 1 to 4 years beyond high school but not in college had used
cocaine within the past year, and 1.5 percent had used cocaine in the past 30
days.
National Household Survey. In 1996, 22 million Americans age 12 and older
had tried cocaine at least once in their lifetimes; about 4.0 million had used
cocaine during the past year; and about 1.7 million had used cocaine in the
past month. These were significant decreases in cocaine use from its peak in
1985. In 1996, about 4.6 million people had used crack cocaine at least once
in their lives, and about 1.3 million people had used crack within the past year.
Drug Abuse Warning Network. The Drug Abuse Warning Network (DAWN)
collects data on drug abuse morbidity and mortality through reports from
hospital emergency departments and a selected sample of medical examiners
in 21 metropolitan areas. Data from the DAWN system continues to show
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Cocaine Abuse
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increases in adverse health consequences associated with the use of
cocaine.
The estimated number of cocaine-related emergency department episodes
has fluctuated since 1988 when it totaled 101,578. After decreasing
significantly to 80,355 in 1990, the number of cocaine-related ER incidents
began an increasing trend in 1991 that reached an estimated 142,494 in
1995. In preliminary figures for 1995, the number of cocaine-related ER
incidents was highest for persons aged 35+. The number for males (94,502)
was more than twice that for females (46,544). Blacks accounted for 77,201
mentions of cocaine use, significantly more than the 41,700 for whites and
11,581 for Hispanics.
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 free-base 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 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
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.
Health and Psychological Hazards
Florida Heart CPR*
Cocaine Abuse
3
Cocaine is a strong central nervous system stimulant that interferes with the
reabsorption process of dopamine, a chemical messenger associated with
pleasure and movement. Dopamine is released as part of the brain's reward
system and is involved in the high that characterizes cocaine consumption.
Physical effects of cocaine use include constricted peripheral blood vessels,
dilated pupils, and increased temperature, heart rate, and blood pressure. The
duration of cocaine's immediate euphoric effects, which include hyper
stimulation, reduced fatigue, and mental clarity, depends on the route of
administration. The faster the absorption, the more intense the high. On the
other hand, the faster the absorption, the shorter the duration of action. The
high from snorting may last 15 to 30 minutes, while that from smoking may
last 5 to 10 minutes. Increased use can reduce the period of stimulation.
Some users of cocaine report feelings of restlessness, irritability, and anxiety.
An appreciable tolerance to the high may be developed, and many addicts
report that they seek but fail to achieve as much pleasure as they did from
their first exposure. Scientific evidence suggests that the powerful
neuropsychological-reinforcing property of cocaine is responsible for an
individual's continued use, despite harmful physical and social consequences.
In rare instances, sudden death can occur on the first use of cocaine or
unexpectedly thereafter. However, there is no way to determine who is prone
to sudden death.
High doses of cocaine and/or prolonged use can trigger paranoia. Smoking
crack cocaine can produce a particularly aggressive paranoid behavior in
users. When addicted individuals stop using cocaine, they often become
depressed. This also may lead to further cocaine use to alleviate depression.
Prolonged cocaine snorting can result in ulceration of the mucous membrane
of the nose and can damage the nasal septum enough to cause it to collapse.
Cocaine-related deaths are often a result of cardiac arrest or seizures
followed by respiratory arrest.
Added danger: Cocaethylene. When people mix cocaine and alcohol
consumption, they are compounding the danger each drug poses and
unknowingly forming a complex chemical experiment within their bodies.
NIDA-funded researchers have found that the human liver combines cocaine
and alcohol and manufactures a third substance, cocaethylene, that
intensifies cocaine's euphoric effects, while possibly increasing the risk of
sudden death.
Greater Risk for Women
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Cocaine Abuse
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Estimates on the extent of drug abuse by women vary. One NIDA study
reported in 1994 that more than 220,000 women had used an illicit drug
during their pregnancies. Of this group, more than one-fifth had used
powdered cocaine or crack.When a woman uses drugs, she and her unborn
child are exposed to significant health risks. During pregnancy, almost all
drugs cross the placenta and enter the bloodstream of the developing baby.
The most serious possible adverse effects on the unborn child's health include
premature delivery and low birthweight. Other possible problems include
ectopic pregnancy, stillbirth, sudden infant death syndrome, and small
gestational size. The woman who uses drugs is herself at increased risk of
hemorrhage, spontaneous abortion, toxicity, sexually transmitted diseases,
and nutritional deficiencies. In addition, drug use by women puts them and
their children at risk for HIV/AIDS.
Treatment
The widespread abuse of cocaine has stimulated extensive efforts to develop
treatment programs for this type of drug abuse. According to the State Alcohol
and Drug Abuse Profile, in FY 1994, States reported 326,031 patients
entering treatment with cocaine as the primary drug of abuse, representing 43
percent of treatment admissions. Another study, NIDA's Drug Services
Research Survey, estimates that 31 percent of a sample of drug treatment
clients had used cocaine or crack cocaine within 30 days prior to admission
for treatment. Data from treatment programs using different therapeutic
approaches indicate that outpatient cocaine treatment can be successful. One
report suggests that from 30 percent to 90 percent of abusers remaining in
outpatient treatment programs cease cocaine use.
NIDA has initiated a program with the purpose of discovering new medications
that can be used in the treatment of cocaine abuse. Several medications are
currently being investigated to test their safety and efficacy in treating cocaine
addiction. In addition to pharmacological treatments, behavioral interventions
also have been developed that are effective in decreasing drug use by
patients in treatment for cocaine abuse. Providing the optimal combination of
treatment services for each individual is critical to successful treatment
outcome.
Information provided by the NIH & NIDA
Florida Heart CPR*
Cocaine Abuse
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Florida Heart CPR*
Cocaine Abuse Assessment
1. _____ is the street name given to cocaine that has been processed from cocaine
hydrochloride to a free base for smoking.
a. Blow
b. Coke
c. Crack
d. White girl
2. Cocaine is a strong central nervous system ______ that interferes with the
reabsorption process of dopamine, a chemical messenger associated with
pleasure and movement.
a. Stimulant
b. Depressant
c. Inhibitor
d. Alpha blocker
3. _______ is released as part of the brain's reward system and is involved in the
high that characterizes cocaine consumption.
a. Serotonin
b. Dopamine
c. Adrenaline
d. Noradrenaline
4. When addicted individuals stop using cocaine, they often become ______.
a. Paranoid
b. Aggressive
c. Depressed
d. Schizoid
5. The ___________ collects data on drug abuse morbidity and mortality through
reports from hospital emergency departments and a selected sample of medical
examiners in 21 metropolitan areas.
a. DAWN
b. CDC
c. NIH
d. DHHS
6. Data shows that cocaine use among high school seniors had been on a(n)
______ trend since its peak in 1985.
a. Downward
b. Upward
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Cocaine Abuse
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c. Level
d. Skyrocketing
7. The major methods of administration of cocaine are _______ (including freebase and crack cocaine).
a. Sniffing or snorting
b. Injecting
c. Smoking
d. All of the above
8. Rather than requiring the more volatile method of processing cocaine using
______ , crack cocaine is processed with ammonia or sodium bicarbonate
(baking soda) and water and heated to remove the hydrochloride.
a. Ether
b. Ethyl alcohol
c. Diether alcohol
d. Potassium bicarbonate
9. The most serious possible adverse effects of cocaine use by a mother on an
unborn child's health include premature delivery and low birth weight. Other
possible problems include ectopic pregnancy, _______.
a. stillbirth
b. sudden infant death syndrome
c. small gestational size
d. All of the above
10. The woman who uses drugs is herself at increased risk of hemorrhage,
spontaneous abortion, toxicity, ____ and ______.
a. Sexually transmitted infections
b. Nutritional deficiencies
c. Both a and b
d. Neither a nor b
Florida Heart CPR*
Cocaine Abuse