A report on Cocaine

Cocaine hydrochloride
Lines of cocaine prepared for snorting
A 2010 study ranking various illegal and legal drugs based on statements by drug-harm experts. Crack cocaine and cocaine was found to be the third and fifth overall most dangerous drugs respectively.
Side effects of chronic cocaine use
A pile of cocaine hydrochloride
A piece of compressed cocaine powder
A woman smoking crack cocaine
"Rocks" of crack cocaine
Biological source of cocaine molecule in the context of the tropane class of molecules. The biological source of each tropane alkaloid is indicated by species, and below that a phylogenetic map is provided.
Biosynthesis of N-methyl-pyrrolinium cation
Biosynthesis of cocaine
Robinson biosynthesis of tropane
Reduction of tropinone
Coca leaf in Bolivia
"Cocaine toothache drops", 1885 advertisement of cocaine for dental pain in children
Advertisement in the January 1896 issue of McClure's Magazine for Burnett's Cocaine "for the hair".
Pope Leo XIII purportedly carried a hip flask of the coca-treated Vin Mariani with him, and awarded a Vatican gold medal to Angelo Mariani.
In this 1904 advice column from the Tacoma Times, "Madame Falloppe" recommended that cold sores be treated with a solution of borax, cocaine, and morphine.
Women purchase cocaine capsules in Berlin, 1929
D.C. Mayor Marion Barry captured on a surveillance camera smoking crack cocaine during a sting operation by the FBI and D.C. Police.
Drug overdoses killed more than 70,200 Americans in 2017, with cocaine overdoses making up 13,942 of those deaths.
United States CBP police inspect a seized shipment of cocaine
The U.S. Coast Guard in Miami offloading confiscated cocaine
Cocaine smuggled in a charango, 2008
Cocaine adulterated with fruit flavoring
Opioid involvement in cocaine overdose deaths. The green line is cocaine and any opioid (top line in 2017). The gray line is cocaine without any opioids (bottom line in 2017). The yellow line is cocaine and other (middle line in 2017).<ref name=NIDA-deaths>{{cite web | url = https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates | title = Overdose Death Rates | archive-url = https://web.archive.org/web/20151128091723/https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates| archive-date=28 November 2015 | work =  By National Institute on Drug Abuse (NIDA) }}</ref>
Delphic analysis regarding 20 popular recreational drugs based on expert opinion. Cocaine was ranked the 2nd in dependence and physical harm and 3rd in social harm.<ref name="Lancet">{{cite journal|vauthors = Nutt D, King LA, Saulsbury W, Blakemore C|title = Development of a rational scale to assess the harm of drugs of potential misuse|journal = Lancet|volume = 369|issue = 9566|pages = 1047–53|date = March 2007|pmid = 17382831|doi = 10.1016/S0140-6736(07)60464-4|s2cid = 5903121|author-link4 = Colin Blakemore|author-link1 = David Nutt }}</ref>
Bottle of cocaine solution, Germany, circa 1915

Strong central nervous system (CNS) stimulant obtained from the leaves of two Coca species native to South America, Erythroxylum coca and Erythroxylum novogranatense.

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Erythroxylum novogranatense var. novogranatense leaves and berries

Coca

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Any of the four cultivated plants in the family Erythroxylaceae, native to western South America.

Any of the four cultivated plants in the family Erythroxylaceae, native to western South America.

Erythroxylum novogranatense var. novogranatense leaves and berries
Coca tree in Colombia
Cocaine, the psychoactive constituent of coca
Coquero (Figure Chewing Coca), 850–1500 C.E. Brooklyn Museum
Workers in Java prepared coca leaves. This product was mainly traded in Amsterdam, and was further processed into cocaine. (Dutch East Indies, before 1940.)
Man holding coca leaf in Bolivia
Llipta is used to improve extraction when chewing coca (Museo de la Coca, Cusco, Peru)
A cup of mate de coca served in a coffee shop in Cuzco, Peru.

Coca is known worldwide for its psychoactive alkaloid, cocaine.

Ritalin: 20 mg sustained-release (SR) tablets

Stimulant

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Overarching term that covers many drugs including those that increase activity of the central nervous system and the body, drugs that are pleasurable and invigorating, or drugs that have sympathomimetic effects.

Overarching term that covers many drugs including those that increase activity of the central nervous system and the body, drugs that are pleasurable and invigorating, or drugs that have sympathomimetic effects.

Ritalin: 20 mg sustained-release (SR) tablets
A chart comparing the chemical structures of different amphetamine derivatives
Roasted coffee beans, a common source of caffeine.
Tablets containing MDMA
Lines of illicit cocaine, used as a recreational stimulant
Catha edulis

It was estimated in 2015 that the percentage of the world population that had used cocaine during a year was 0.4%.

Addiction experts in psychiatry, chemistry, pharmacology, forensic science, epidemiology, and the police and legal services engaged in delphic analysis regarding 20 popular recreational drugs. Ecstasy was ranked 18th in dependence, physical harm, and social harm.

MDMA

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Potent central nervous system (CNS) stimulant primarily used for recreational purposes.

Potent central nervous system (CNS) stimulant primarily used for recreational purposes.

Addiction experts in psychiatry, chemistry, pharmacology, forensic science, epidemiology, and the police and legal services engaged in delphic analysis regarding 20 popular recreational drugs. Ecstasy was ranked 18th in dependence, physical harm, and social harm.
MDMA induced transporter reversal on human serotonin transporters (SERT), which leads to serotonin release.
In the serotonergic neurons of humans, extracellular MDMA releases serotonin via serotonin transporters (SERT). Intracellular MDMA inhibits VMAT2 and, to a much lesser extent, MAO-A.
Main metabolic pathways of MDMA in humans.
Alexander and Ann Shulgin in December 2011
A 1995 Vibe Tribe rave in Erskineville, New South Wales, Australia being broken up by police. MDMA use spread globally along with rave culture.
UNODC map showing the use of ecstasy by country in 2014 for the global population aged 15–64

This was broadly similar to the percentage of people who use cocaine or amphetamines, but lower than for cannabis or opioids.

Amphetamine

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Strong central nervous system (CNS) stimulant that is used in the treatment of attention deficit hyperactivity disorder (ADHD), narcolepsy, and obesity.

Strong central nervous system (CNS) stimulant that is used in the treatment of attention deficit hyperactivity disorder (ADHD), narcolepsy, and obesity.

It has been implicated in addictions to alcohol, cannabinoids, cocaine, methylphenidate, nicotine, opioids, phencyclidine, propofol, and substituted amphetamines, among others.

Adriaen Brouwer, TheSmokers (1636)

Recreational drug use

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Altered state of consciousness either for pleasure or for some other casual purpose or pastime by modifying the perceptions, feelings, and emotions of the user.

Altered state of consciousness either for pleasure or for some other casual purpose or pastime by modifying the perceptions, feelings, and emotions of the user.

Adriaen Brouwer, TheSmokers (1636)
Edgar Degas, L'Absinthe (1876)
Bhang eaters from India c. 1790. Bhang is an edible preparation of cannabis native to the Indian subcontinent. It has been used in food and drink as early as 1000 BCE by Hindus in ancient India.
A man smoking cannabis in Kolkata, India
A rational harm assessment of drugs<ref>{{Cite journal|last1=Blakemore|first1=Colin|last2=Saulsbury|first2=William|last3=King|first3=Leslie A.|last4=Nutt|first4=David|date=2007-03-24|title=Development of a rational scale to assess the harm of drugs of potential misuse|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)60464-4/abstract|journal=The Lancet|language=en|volume=369|issue=9566|pages=1047–1053|doi=10.1016/S0140-6736(07)60464-4|issn=0140-6736|pmid=17382831|s2cid=5903121}}</ref>
This 1914 photo shows intoxicated men at a sobering-up room
alt=A chart showing dependence potential versus safety ratio.|An analysis of the dangers of drugs<ref>{{Cite book|url=https://books.google.com/books?id=xpZhjBuDkuwC&pg=PA149|title=Drugs and Society: U.S. Public Policy|last=Fish|first=Jefferson M.|date=2006|publisher=Rowman & Littlefield|isbn=9780742542457|language=en}}</ref>
Total recorded alcohol per capita consumption (15+), in liters of pure alcohol
Caffeinated alcoholic beverages, such as Vodka Red Bull, are widespread and legal routes of administration for multiple drugs.
Insufflation of powdered drug
Injection of heroin
Cocaine is a commonly used stimulant
alt=A chart showing relative drug harm.|A chart showing relative drug harm.

What controlled substances are considered generally unlawful to possess varies by country, but usually includes methamphetamine, heroin, cocaine, LSD, psilocybin mushrooms, MDMA, Lean, and club drugs.

Heroin paraphernalia in a Jack Daniels tin

Heroin

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Opioid used as a recreational drug for its euphoric effects.

Opioid used as a recreational drug for its euphoric effects.

Heroin paraphernalia in a Jack Daniels tin
Advertising sign from Bayer for use in US drug stores, dating from before the federal prohibition of Heroin in 1924
A 2010 study ranking various illegal and legal drugs based on statements by drug-harm experts. Heroin was found to be the second overall most dangerous drug.
Short-term effects of usage
Long-term effects of intravenous usage, including – and indeed primarily because of – the effects of the contaminants common in illegal heroin and contaminated needles.
Black tar heroin
Advertisement for Bayer Heroin
Bayer Heroin bottle
International drug routes
Afghanistan opium poppy cultivation, 1994–2016 (hectares)
Primary worldwide producers of heroin
Addiction experts in psychiatry, chemistry, pharmacology, forensic science, epidemiology, and the police and legal services engaged in delphic analysis regarding 20 popular recreational drugs. Heroin was ranked 1st in dependence, physical harm, and social harm.
Drug overdoses killed more than 70,200 in the US in 2017, with heroin involved in 15,482 of those deaths.<ref name=NIDA-deaths>{{cite web | url = http://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates | title = Overdose Death Rates | archive-url = https://web.archive.org/web/20151128091723/http://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates | archive-date=28 November 2015 | work = National Institute on Drug Abuse (NIDA) }}</ref>
US yearly overdose deaths involving heroin.<ref name=NIDA-deaths/>
US yearly deaths from all opioid drugs. Included in this number are opioid analgesics, along with heroin and illicit .<ref name=NIDA-deaths/>

In 1964, the Brain Committee recommended that only selected approved doctors working at approved specialized centres be allowed to prescribe diamorphine and cocaine to users.

Playing can induce an intense state of happiness and contentment, like this young girl playing in the snow.

Euphoria

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Experience of pleasure or excitement and intense feelings of well-being and happiness.

Experience of pleasure or excitement and intense feelings of well-being and happiness.

Playing can induce an intense state of happiness and contentment, like this young girl playing in the snow.
A large dose of methamphetamine causes a drug-induced euphoria.

Sigmund Freud's 1884 monograph Über Coca described (his own) consumption of cocaine producing "the normal euphoria of a healthy person", while about 1890 the German neuropsychiatrist Carl Wernicke lectured about the "abnormal euphoria" in patients with mania.

Skeletal formula of dopamine

Dopamine

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Neuromodulatory molecule that plays several important roles in cells.

Neuromodulatory molecule that plays several important roles in cells.

Skeletal formula of dopamine
Dopamine processing in a synapse. After release dopamine can either be taken up again by the presynaptic terminal, or broken down by enzymes.
TH: tyrosine hydroxylase
DOPA: L-DOPA
DAT: dopamine transporter
DDC: DOPA decarboxylase
VMAT: vesicular monoamine transporter 2
MAO: Monoamine oxidase
COMT: Catechol-O-methyl transferase
HVA: Homovanillic acid
Major dopamine pathways. As part of the reward pathway, dopamine is manufactured in nerve cell bodies located within the ventral tegmental area (VTA) and is released in the nucleus accumbens and the prefrontal cortex. The motor functions of dopamine are linked to a separate pathway, with cell bodies in the substantia nigra that manufacture and release dopamine into the dorsal striatum.
Main circuits of the basal ganglia. The dopaminergic pathway from the substantia nigra pars compacta to the striatum is shown in light blue.
Illustration of dopaminergic reward structures
Dopamine HCl preparation, single dose vial for intravenous administration
Cocaine increases dopamine levels by blocking dopamine transporters (DAT), which transport dopamine back into a synaptic terminal after it has been emitted.
Methamphetamine hydrochloride also known as crystal meth
Dopamine can be found in the peel and fruit pulp of bananas.

Cocaine, substituted amphetamines (including methamphetamine), Adderall, methylphenidate (marketed as Ritalin or Concerta), and other psychostimulants exert their effects primarily or partly by increasing dopamine levels in the brain by a variety of mechanisms.

Alcohol is a widely used and abused psychoactive drug. The global alcoholic drinks market was expected to exceed $1 trillion in 2013. Beer is the third-most popular drink overall, after water and tea.

Psychoactive drug

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Psychoactive_Drugs_Legend.jpg: 1. caffeine

Psychoactive_Drugs_Legend.jpg: 1. caffeine

Alcohol is a widely used and abused psychoactive drug. The global alcoholic drinks market was expected to exceed $1 trillion in 2013. Beer is the third-most popular drink overall, after water and tea.
Zoloft (sertraline) is an SSRI antidepressant.
Timothy Leary was a leading proponent of spiritual hallucinogen use.
Illustration of the major elements of neurotransmission. Depending on its method of action, a psychoactive substance may block the receptors on the post-synaptic neuron (dendrite), or block reuptake or affect neurotransmitter synthesis in the pre-synaptic neuron (axon).
Comparison of the perceived harm for various psychoactive drugs from a poll among medical psychiatrists specialized in addiction treatment (David Nutt et al. 2007).
Historical image of legal heroin bottle

Examples: amphetamine, caffeine, cocaine, nicotine, modafinil

CT scan of the brain showing a prior right-sided ischemic stroke from blockage of an artery. Changes on a CT may not be visible early on.

Stroke

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Medical condition in which poor blood flow to the brain causes cell death.

Medical condition in which poor blood flow to the brain causes cell death.

CT scan of the brain showing a prior right-sided ischemic stroke from blockage of an artery. Changes on a CT may not be visible early on.
There are two main categories of strokes. Ischemic (top), typically caused by a blood clot in an artery (1a) resulting in brain death to the affected area (2a). Hemorrhagic (bottom), caused by blood leaking into or around the brain from a ruptured blood vessel (1b) allowing blood to pool in the affected area (2b) thus increasing the pressure on the brain.
A slice of brain from the autopsy of a person who had an acute middle cerebral artery (MCA) stroke
CT scan of an intraparenchymal bleed (bottom arrow) with surrounding edema (top arrow)
Illustration of an embolic stroke, showing a blockage lodged in a blood vessel.
Histopathology at high magnification of a normal neuron, and an ischemic stroke at approximately 24 hours on H&E stain: The neurons become hypereosinophilic and there is an infiltrate of neutrophils. There is slight edema and loss of normal architecture in the surrounding neuropil.
A CT showing early signs of a middle cerebral artery stroke with loss of definition of the gyri and grey white boundary
Dens media sign in a patient with middle cerebral artery infarction shown on the left. Right image after 7 hours.
12-lead ECG of a patient with a stroke, showing large deeply inverted T-waves. Various ECG changes may occur in people with strokes and other brain disorders.
Walking with an orthosis after a stroke
Stroke deaths per million persons in 2012
Hippocrates first described the sudden paralysis that is often associated with stroke.

Users of stimulants such as cocaine and methamphetamine are at a high risk for ischemic strokes.