Cocaine (snow, coke, girl, lady) is an alkaloid derived from the shrub Erythroxylon coca, a plant indigenous to Bolivia and Peru, where its leaves are chewed by peasants for their stimulating effect. Cocaine was isolated in 1860, and after 1884 it became the first effective local anesthetic, the only purpose for which it is still used in medicine. In 1914 cocaine was placed under the same laws as morphine and heroin and was legally classifed as a narcotic.

Street cocaine varies in purity; other substances are mixed with it. It is rarely taken by mouth as the effect is too mild. There are three methods of use. Inhaling, injecting (subcutaneous 0r intravenous), And Smoking. The last two methods may cause cardiac arrest.

The euphoria produced by cocaine is intense, and cocaine may, in fact, be the most addictive drug available to drug users. Psychological dependence may occur after a single dose of this drug. The effects of cocaine are usually lasting 30 minutes to an hour after intravenous or intranasal use; however, active metabolites of cocaine may remain in the brain for as long as 10 days. There is often a period of depression following the acute drug effect. This depression can include suicidal ideation, particularly after periods of extensive cocaine use.

Crack, an extremely potent freebase form of cocaine, is sold in small, ready to smoke amounts. Its existence has increased the number of persons with cocaine addiction. Crack is so addictive, that persons have been known to literally sell their children into prostitution to obtain money for the drug. Many urban emergency rooms and police department report extremes of violent behavior in crack-addicted persons.

Chronic use is associated with a runny or clogged nose, which is often self-treated with nasal decongestant sprays. Noses may also become inflamed, swollen & ulcerated; heavy users occasionally have perforated septa. Freebasing may damage the surface of the lungs, and injection involves the usual dangers of infection and increased risk of contracting Acquired Immune Deficiency Syndrome (AIDS) through the practice of sharing needles.

Cocaine abuse is common among middle-class and upper socioeconomic status persons. Cocaine abuse can be associated with severe disruption in job performance and family life. Even infrequent cocaine abuse can lead to accidental overdose resulting in death.

Cocaine abuse can also lead to cocaine dependence, even in persons who thought they were not at risk for becoming dependent.

The central nervous system (CNS) effects of cocaine are elation, euphoria, heightened self-esteem, and improved performance of mental and physical tasks.

Cocaine intoxication is characterized by extreme agitation, irritability, impaired judgment, impulsive sexual behavior, aggression, increased psychomotor activity, and mania. Tachycardia, hypertension, and mydriasis occur. The course of cocaine intoxication is usually self-limited, full recovery occurring within 48 hours. As the drug�s effects wear off, the person experiences marked dysphoria and agitation, which can be relived by taking more cocaine. The dysphoric mood is associated with anxiety, irritability, and fatigue.

When the crash extends beyond 24 hours after the last use, the person may use alcohol, sedatives, or antianxiety agents, such as diazepam to alleviate these symptoms.

Although cocaine is often used as an aphrodisiac and as a method to delay orgasm, both acute use and chronic use often lead to impotence. Common neurological effects include focal neurological signs and symptoms, such as numbness and weakness; persistent headache, and loss of consciousness. Life-threatening neurological conditions associated with cocaine abuse include seizures and strokes (paralysis)

In high doses cocaine can induce seizures and depression of centers of respiration, resulting in death. Death can also come from a combination of opioids and cocaine taken together intravenously (a speedball.).

Symptoms of psychosis are common in habitual intravenous abusers and freebasers. Cocaine intoxication with high doses may lead to transient ideas of reference, paranoid ideation, increased sexual desire, and bizarre behavior. Sensory disturbances and false beliefs that others are against them are associated with prolonged use and classified as cocaine delusional disorder. Violent impulses may be carried out. Sometimes person believes that bugs are crawling just beneath the skin

Cocaine withdrawal consists of symptoms that reach a peak in two to four days, is followed by depression and irritability persisting for weeks. Abrupt cocaine withdrawal by a chronic user may produce a severe craving for the drug and drug-seeking behavior. Some persons become hypresomnolent and complain of fatigue, anhedonia, depression, suicidal ideas, and general malaise. These symptoms usually resolve within a few weeks or months. An underlying emotional disorder may then surface, which may include a dependence on alcohol or sleeping pills if those substances were used to manage the crash after each bout of cocaine abuse.

Cocaine abuse should be suspected if a person shows a change in personality characterized by irritability, disturbed concentration, compulsive behavioral, sensory changes, sleeplessness, and weight loss. Increased debt (to support the expensive cocaine habit) should also arouse suspicion, Cocaine users often excuse themselves from social situations frequently (every 30 minutes) to snort or inject the drug privately.

The treatment of cocaine abuse requires the coordination of social, psychological, and biological strategies. The most critical social intervention is removing persons from their drug source; In fact, hospitalizations often toxicological analysis should always be part of the treatment programme to make sure patients are staying abstinent. Psychological intervention should be directed toward the underlying causes for the pattern of the abuse. The use of family and group therapy and support groups is often indicated in the treatment of cocaine abuse. Biological intervention includes the use of three medicines bromocriptine (Parlodel) and desipramine (Norpramin), Doxepin (Spectra).