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Cocaine Side Effects

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Cocaine is a potent stimulant drug well-known across the globe for its use in traditional medicine and recreational practices. Derived from the South American coca plant, it has been in the limelight more recently because of its illegal use and severe side effects. As a stimulant of the central nervous system, using cocaine leads to a short-lived euphoria that can lead to various social, psychological, and physical consequences [1]. If left unchecked, these consequences can also lead to permanent disability and fatalities.

Understanding how cocaine works and reviewing its side effects profile is the best way to manage its short- and long-term side effects.

Cocaine is a stimulant drug that works by altering the chemical signaling in the brain. It specifically targets three neurotransmitters, including serotonin, norepinephrine, and dopamine. [2] These neurotransmitters are stimulants and uplift the brain by increasing energy and boosting mood. Cocaine increases the levels of these neurotransmitters by blocking their reabsorption, leading to intensification of the underlying euphoria.

While cocaine stimulates the nervous system and boosts confidence, these seemingly positive effects often come at a cost. For instance, the positive effects of cocaine can become compulsive very quickly, forcing users to consume increasing amounts of the substance to replicate them. With increased consumption, cocaine side effects naturally become more frequent and intense, deteriorating the overall health and quality of life.

The effects of cocaine can be classified into long- and short-term. The initial effects are immediate but short-lived, typically lasting up to 30 minutes after consumption. The following are the short-term health effects of cocaine:

Increased Energy & Euphoria: Cocaine immediately creates a sense of excitement, invincibility, and well-being. Most users become talkative, feel energetic, and can accomplish anything. However, this fleeting euphoria is only short-lived and is quickly replaced by a sudden, sharp mood deterioration.
High Blood Pressure and Heart Rate: The stimulant properties of cocaine immediately elevate the blood pressure and heart rate, putting users at risk of stroke or heart attack.
Blood Vessel Constriction: Cocaine is a vasoconstrictor, meaning it can narrow the blood vessels in the body. This effect significantly reduces the oxygen supply to different organs and tissues, increasing the risk of tissue death and organ damage.
Increased Body Temperature and Pupillary Dilatation: Cocaine triggers various physiological changes, causing a rise in the pupils’ core body temperature and dilatation. In extreme cases where larger quantities are consumed, cocaine may cause hyperthermia, a life-threatening rise in body temperature that requires emergency management.
Decreased Appetite: As an appetite suppressant, cocaine can make users feel less hungry. While this side effect may go unnoticed in the short term, it can lead to weight loss and malnutrition in the long run with associated complications.
Paranoia & Anxiety: While cocaine initially appears to induce feelings of happiness and euphoria, it eventually leads to paranoia and anxiety. Many users experience hallucinations, which exacerbate aggressive or erratic behaviors.
Increased Risk Taking: The disinhibiting effects of cocaine can impair judgment, making users more likely to engage in risky activities, such as reckless driving and unprotected sex. Such behaviors also increase the risk of acquiring injuries and sexually transmitted infections. [3]
Cocaine Crash: As mentioned before, the euphoric effects of cocaine are short-lived, eventually ending in a crash. Cocaine crash is characterized by depression, irritability, fatigue, and intense cravings to consume more. These crashes often force users to repeatedly use cocaine, triggering a vicious cycle that ends in addiction.

Long-term use of cocaine can lead to various detrimental effects on both mental and physical health. The severity of these effects may vary depending on the amount of cocaine used and the duration of use.

Mentioned are some long-term effects of cocaine to keep in mind:

Cardiovascular Issues: Cocaine use can put a significant amount of strain on the circulatory system and the heart. The repeated vasoconstriction of the vessels with chronically high heart rate can put a user at risk of stroke, heart attacks, and irregular heart rhythms. Using cocaine can also stiffen the vessels, further increasing the risk of long-term heart diseases. [4]
Respiratory Damage: Crack cocaine, a particular strain of cocaine, can cause significant damage to the airways and lungs. Many chronic users end up with long-term respiratory issues, such as pneumonia and bronchitis. Additionally, snorting the powder damages the nasal passages, leading to septum perforation, loss of sense of smell, and repeated nosebleeds.
Mental Health Disorders: Chronic use of cocaine has been linked to various mental health disorders, such as paranoia, anxiety, depression, and psychosis. More on the cocaine side effects on mental health can be found in later sections of the article.
Neurological Damage: The neurotoxic health effects of cocaine are often severe enough to alter the brain structure and function. These disorders can eventually lead to movement disorders, seizures, strokes, and memory impairment. Studies suggest that chronic cocaine use can also lead to cognitive decline, making it difficult for users to manage emotions or perform basic tasks.
Gastrointestinal Issues: Long-term cocaine side effects include a reduction in the blood flow to the gut, leading to colitis, ulcers, and even gangrene and tissue death. These conditions can be harrowing and even life-threatening if adequate treatment is not sought.
Sexual Dysfunction: Long-term cocaine abuse can negatively impact sexual function, leading to erectile dysfunction in males and reduced sexual satisfaction in females. These issues can also exacerbate mental health issues, such as poor self-esteem, and cause relationship difficulties. [5]
Liver and Kidney Damage: Long-term cocaine use can strain the liver and the kidneys, altering their function and disturbing the natural homeostasis. It can also cause the muscles to break down, a condition known as rhabdomyolysis that can lead to kidney failure. Cocaine-associated high blood pressure can also hurt the kidneys and induce metabolic complications in the body.
Inefficient Immune System: Using cocaine regularly can weaken the immune system, making users more prone to acquiring infections. The risk of getting infections is further compounded by risky behaviors commonly seen in cocaine users, such as needle sharing. Such practices put them at risk of acquiring blood-borne diseases, like HIV and Hepatitis B and C, which their body is unable to handle.

Cocaine can have profound effects on mental health, even after it is entirely out of the system. Some common mental health issues related to cocaine use include the following:

Panic Disorders & Anxiety: Cocaine can lead to profound anxiety and panic, regardless of the duration of use. In the case of chronic exposure, users experience higher anxiety levels, a general sense of impending doom, and frequent panic attacks. These symptoms can significantly disturb daily functioning and often lead to social isolation.
Hallucinations & Paranoia: Long-term cocaine use can cause hallucinations and delusions. For instance, some users may feel they are being followed or watched, while others may hear voices. The symptoms, if left untreated, eventually convert to psychosis, which can make users a threat to themselves and others. [6]
Depression: The effects of cocaine on dopamine can trigger depressive episodes, especially when its effects are wearing off. With time, the brain becomes utterly dependent on cocaine to manufacture dopamine and loses its ability to produce its own. Consequently, many users report feeling depressed, worthless, and suicidal.
Cognitive Impairments: Long-term cocaine use can impair cognition, leading to problems with attention, memory, and executive functioning. These issues often persist despite completely cutting off cocaine, causing issues in personal and professional lives.
Irritability & Aggression: Using cocaine can lead to irritability and aggression, especially when taken with alcohol and other substances. Its disinhibiting effects on the brain, along with feelings of paranoia, can often trigger violent behaviors, posing a threat to users and others around them.

Contrary to what most people believe, the side effects associated with cocaine use are not limited to mental and physical health. Its chronic use can often cause disturbances in the economic and social domains, leading to the following issues:

Relationship Breakdown: Cocaine use can negatively impact relationships with friends, families, and romantic partners. Consistent mood swings, erratic behaviors, and monetary problems due to cocaine addiction may cause conflict and even breakups.
Issues With Finances & Employment: Cocaine abuse can interfere with a user’s ability to maintain employment. Problems like frequent absenteeism, poor decision-making, and reduced productivity can lead to loss of employment, and financial issues may follow shortly after.
Legal Problems: Cocaine remains illegal in most parts of the world, and its manufacture, possession, and consumption can lead to serious legal issues. Users may face incarceration, arrest, and a criminal record, further complicating their ability to rebuild and live an everyday life.
Effect on Communities: The social cost associated with cocaine use extends well beyond a single individual. Its chronic abuse can destabilize the entire community, mainly due to associated problems like addiction, drug trafficking, and crime. Cocaine abuse can tear families apart and drain resources as a lot of time and money are spent in law enforcement and healthcare sectors to deal with the associated issues.

Cocaine is a highly addictive substance due to its potent effect on the reward system in the brain. As users continue to take it, they develop a tolerance. This tolerance requires them to use higher doses to enjoy the same euphoric effects, leading to complete dependence on the substance to function in everyday life. [7]

Cocaine dependence can be of two different types, including:

Physical Dependence: As the user’s body becomes habitual of having cocaine in their blood, its absence causes physical withdrawal symptoms. These symptoms commonly include increased appetite, fatigue, sleep disturbances, intense cravings, and unpleasant dreams. The withdrawal process is extremely distressing and often forces users to relapse to control the symptoms, reinforcing the underlying addiction.
Psychological Dependence: Cocaine addiction often comes with psychological dependence, which includes an overwhelming mental need to use the drug. Consequently, many people experience obsessive thoughts about acquiring and using cocaine despite being fully aware of the adverse effects associated with its use. Unfortunately, psychological dependence is very hard to control and can become increasingly difficult to manage with time.

As a consequence of cocaine tolerance and addiction, individuals actively using this drug are at a constant risk of an overdose. [8] Cocaine overdose occurs when a person uses the drug in vast quantities that exhaust the body’s metabolic system, triggering a toxic reaction. Following are some common symptoms of cocaine overdose:

Seizures
Chest pains
Shortness of breath
Severe confusion or agitation
Extreme hyperthermia
Unconsciousness or coma

Remember that cocaine overdose is a medical emergency and requires urgent treatment to avoid fatality. Even if a person survives, the overdose can cause permanent damage to the brain, heart, and other vital body organs.

Minimizing or preventing cocaine side effects primarily includes reducing or avoiding its use. However, people who are already exposed to or dependent on the substance can use strategies like education, rehabilitation, medical care, and harm reduction.

Education

Raising awareness regarding cocaine and its potential dangers is crucial to promote abstinence. Despite its widespread use, a considerable chunk of the population remains unaware of cocaine’s risks to the heart, brain, kidneys, and other organs. Public health campaigns and local awareness programs can help people make informed choices.

Harm Reduction

For those actively using cocaine, strategies like staying hydrated, moderate consumption, and avoiding drug mixing can be helpful. Moreover, choosing safer methods of use can also reduce the associated risks, such as preferring snorting instead of sharing needles. However, remember that abstinence is the safest approach to combat the side effects in the best way possible.

Medical Monitoring

Regular medical check-ups can help users monitor the impact of cocaine on their organs. Mental health assessments may also be necessary to screen users for possible psychiatric issues, like paranoia, depression, and anxiety, so that they can seek treatment as needed.

Mental Health Support

Cocaine can rapidly worsen mental health, signifying the need to get help. Therapies like cognitive behavioral therapy, along with regular counseling, can help people manage cravings and potential triggers.

Rehabilitation

Those addicted to cocaine can seek help from professional rehabilitation centers. These centers are equipped to manage cocaine addiction professionally in safe environments. The multi-step approach offered at these rehabs involves detoxification, counseling, regular therapy, and peer-led support to cut back on cocaine use and avoid potential side effects.

While cocaine remains an easy way to boost mood and happiness, the short-lived euphoria it triggers often comes at an enormous cost to mental well-being, physical health, and social stability. Cocaine’s side effects are far-reaching and can be devastating not only for the user but their families and communities at large. Education remains an essential step in minimizing cocaine use, particularly in younger communities, so that they can acknowledge these side effects and deter experimentation. For those already affected by cocaine abuse and addiction, help must be sought from suitable sources to make recovery possible.

[1] Cregler LL. Adverse health consequences of cocaine abuse. Journal of the National Medical Association. 1989 Jan;81(1):27.

[2] Nestler EJ. The neurobiology of cocaine addiction. Science & practice perspectives. 2005 Dec;3(1):4.

[3] Gowin JL, May AC, Wittmann M, Tapert SF, Paulus MP. Doubling down: increased risk-taking behavior following a loss by individuals with cocaine use disorder is associated with striatal and anterior cingulate dysfunction. Biological psychiatry: cognitive ne

[4] Kim ST, Park T. Acute and chronic effects of cocaine on cardiovascular health. International journal of molecular sciences. 2019 Jan 29;20(3):584.

[5] Cocores JA, Miller NS, Pottash AC, Gold MS. Sexual dysfunction in abusers of cocaine and alcohol. The American journal of drug and alcohol abuse. 1988 Jan 1;14(2):169-73.

[6] Brady KT, Lydiard RB, Malcolm R, Ballenger JC. Cocaine-induced psychosis. The Journal of clinical psychiatry. 1991 Dec 1;52(12):509-12.

[7] Schwartz EK, Wolkowicz NR, De Aquino JP, MacLean RR, Sofuoglu M. Cocaine use disorder (CUD): current clinical perspectives. Substance Abuse and Rehabilitation. 2022 Jan 1:25-46.

[8] Richards JR, Le JK. Cocaine toxicity. InStatPearls [Internet] 2023 Jun 8. StatPearls Publishing.

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