Cocaine is often used to refer to all coca products, especially when used in the phrase “cocaine-related problems”. When used with the other terms below, cocaine refers to cocaine hydrochloride, the while powder form of cocaine prepared from coca leaves. It is water-soluble and burns at a very high temperature: this allows it to be snorted, swallowed or injected, but not smoked.
Coca paste is a paste prepared from coca leaves as part of the process of manufacturing cocaine hydrochloride. It is not soluble in water, though it is soluble with kerosene or petrol, and is usually smoked with tobacco or cannabis. It is almost exclusively found in South America.
Crack or cocaine freebase is a brown or beige crystal produced by heating cocaine hydrochloride with other chemicals. It is smoked and has become very popular in North America.
Generally cocaine users consume a range of other psychoactive drugs as well. There appears to be very little [pure] cocaine use, and few people initially experiment with cocaine: most cocaine users have a prior history of drug use. Globally, cocaine users tend to smoke tobacco and drink alcohol, frequently smoke cannabis, and, to a lesser extent, take benzodiazepines and other illicit drugs. Countries such as Australia, Brazil, Canada, Mexico, The Netherlands, Spain, Sweden and Zimbabwe note the use of alcohol with cocaine either to moderate the effects of cocaine or to reduce negative after-effects. These and other countries report the use of cannabis to reduce negative cocaine reactions. Australia, Nigeria, and The Russian Federation report that alcohol and tobacco are used with cocaine to enhance the pleasurable effects of the drug.
Australia and The Republic of Korea note the use of amphetamine and cocaine together to enhance the effects of each drug, and The Netherlands reports the use of “speedballs“, a combination of heroin and cocaine injected together. In South American countries, coca paste is often smoked with tobacco or cannabis, with alcohol, and sometimes with hallucinogens. The majority of coca leaf chewers in Peru do not use it with any other substances, while about a third regularly mix it with alcohol and tobacco use.
Overall, fewer people in participating countries have used cocaine than have used alcohol, tobacco or cannabis. Also, in most countries, cocaine is not the drug associated with the greatest level of harm. Other illicit drugs viewed as more problematic than cocaine are amphetamines (Australia, Brazil, Republic of Korea, Sweden), inhalants (Bolivia, Brazil), benzodiazepines (Brazil), heroin (Egypt, the Maldives), “cheaper and more available drugs (The Russian Federation). The general public, in most of the countries surveyed are reportedly poorly informed about cocaine-related harm or drug-related harm in general: specifically, there is little knowledge about the role played by drugs such as alcohol in causing problems usually associated with cocaine use.
Low doses of cocaine are tried one to several times on an intermittent basis, often among younger people such as adolescents and young adults. Other drugs, such as alcohol and cannabis, are often tried prior to cocaine being used.
This is the most typical pattern of cocaine use, in which the drug is used as an aid in social intercourse. Acute sensations such as euphoria, enhanced self-confidence and greater energy are experienced. Negative effects may include anxiety, irritation, panic attacks, as well as accidents and injuries which may occur due to the user’s excitement and poor judgement. A mild withdrawal syndrome follows even small acute doses, usually comprising fatigue, depression and agitation. However, there are generally few problems associated with this pattern of use.
Cocaine is used to obtain a particular effect in a specific situation e.g. to focus attention or increase energy in some occupations, or to augment sexual performance. While this use is occasional, few problems are likely. But tolerance develops to the drug’s effects if it is used often, requiring larger doses to maintain the desired effect and potentially leading to more frequent use. Snorting cocaine is most identified with these first three categories though cocaine injecting and using paste and crack are also found in these types of use.
This is where cocaine use becomes an integral part of the user’s lifestyle. It is similar to the next category, but the user is able to maintain a level of control, and social functioning is maintained. Intensive cocaine users and, to a lesser extent, occasional and situation-specific users, use rituals or rules to help them control their drug use. Intensive users are often reported to start taking cocaine because of peer pressure or as an escape from unfavorable circumstances. A majority of intensive users are reported to have a poor self-image and negative view of cocaine use. Injection, crack and coca paste use are also more identified with intensive cocaine users, though some snort cocaine.
An uncommon type of use is where some intensive users’ lives become totally focused on obtaining and using the drug. High doses and routes of administration such as smoking or injecting (which can deliver a large amount of drug to the brain very quickly) combine to produce rapid and maximal effect. The drug is administered repeatedly in an attempt to maintain the initial effects of exhilaration and enhanced self-confidence.
This sequence, known as a “run”, cannot be sustained and is followed by a period of physical and emotional exhaustion (the “crash”), a prolonged period of sleep, then fatigue and depression. The user often repeats the cycle to relieve the negative feelings from the crash.
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