Refined cocaine is acidic and therefore not very volatile and subject to degradation at high temperatures. Pulp and crack, of a basic nature, have lower boiling points and can be smoked. Inhaled smoke is composed of cocaine vapors (6.5%) and tiny cocaine particles (93.5%). Both may have from 20 to 85% active substance, their effects are felt in less than 10 seconds and last from 5 to 10 minutes. The variable absorption index: 6 – 32%.
Injecting cocaine begins to act on the central nervous system 30 to 45 seconds after application. The pathway eliminates the absorption stage and the first pass hepatic effect. Thus, the use of cocaine is 100%, requiring a dose 20% lower than ingested or aspirated. The euphoric effect lasts about 20 minutes. For the drug rehabilitation this is important.
Cocaine Treatment – Symptoms:
The symptoms of cocaine use are divided into:
Poisoning: behavioral or psychological changes; euphoria; hyper vigilance, anxiety, sweating, chills, nausea, vomiting, seizures, coma, tachycardia, hypertension and arrhythmia.
Central nervous system stimulation produces anxiety, psychosis, and convulsions. Increased metabolism and hyperactivity may lead to hyperthermia and rhabdomyolysis.
Compulsion and Abuse: Cocaine is capable of stimulating the Central Nervous System gratification system, mediated mainly by the dopaminergic pathway of the brain reinforcement system. System activity seems to contribute to compulsive search and substance abuse behaviors. What generates the non-fulfillment of obligations; substance use at times of risk; legal issues; continued and abusive use.
Withdrawal: oscillating mood, fatigue, vivid dreams, insomnia, hypersomnia, hyperphagia, delay or agitation.
Tolerance for euphoric effects develops quite rapidly, especially in compulsive use. It results from the hyper metabolization of dopamine released in the synapse, the increase in auto-receptor stimulation thresholds and the decrease in presynaptic impulses. On the other hand, there is a reverse tolerance (phenomenon known as sensitization) for motor symptoms, with worsening stereotyped movements, restlessness and anxiety levels.
Addiction: unsuccessful effort to reduce or stop; withdrawal symptoms on withdrawal; frequency of use; long time taken to obtain the drug; high tolerance to the substance.
Cocaine Treatment – Specific Problems:
Pulmonary involvement is a complication related to crack use. Users commonly have chest pain, cough, hemoptysis, which may be due to various clinical conditions, such as atelectasis, pneumo mediastinum, pneumothorax and hemopneumothorax. There may be exacerbation of asthma, thermal airway injuries, deterioration of pulmonary function, broncholitis obliterans, noncardiogenic pulmonary edema and pulmonary infiltrate.
Acute respiratory conditions are highly prevalent after about 1 to 12 hours of use. The main signs and symptoms are: productive cough with blackened sputum, hemoptysis, pain on deep inspiration, heart palpitations, slight worsening of lung capacity.
The use of aspirated cocaine is associated with the appearance of allergic or vasomotor rhinitis, bleeding, ulceration or perforation of the nasal septum, sinusitis or nasal collapse. In addition, the pronounced use of nasal decongestants by these individuals for a long time ends up making them dependent on continued use of the product to avoid rebound effects and discomfort in nasal breathing.
Intravenous cocaine users facilitate the onset of complications secondary to the rupture of the protective skin layer. They are more susceptible to the appearance of cellulitis and abscesses, vasculitis and endocarditis.