Does Cocaine Have Any Legit Medical Uses?

Cocaine is more than just a street drug,

Cocaine
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Whenever the word "cocaine" is mentioned, the first thing that comes to mind is its abuse on the streets and the terrible consequences of dependence on the drug. And it's true, cocaine is most commonly abused as an illicit drug. However, although rarely discussed, cocaine also has medical uses.

Cocaine as a Street Drug

On the street, cocaine is sold as a crystalline powder. This powder is diluted or "cut" with sugars to increase its street value.

Cocaine is also turned into crack, which takes the form of irregularly shaped chunks that are called "rocks."

Powdered cocaine can either be snorted or dissolved in water and turned into a solution that is injected into veins. Crack is smoked.

When ingested, cocaine causes euphoria. It can also cause increased alertness, restlessness, irritability, and paranoia. Cocaine increase blood pressure and heart rate and can lead to heart attack and stroke.

Cocaine as Medicine

Cocaine has any legitimate uses and is an excellent topical anesthetic. (Topical means applied to the skin.) For example, consider the following position statement:

The American Academy of Otolaryngology-Head and Neck Surgery, Inc. considers cocaine to be a valuable anesthetic and vasoconstricting agent when used as part of the treatment of a patient by a physician. No other single drug combines the anesthetic and vasoconstricting properties of cocaine.

In fairness, the fact that cocaine has anesthetic properties should come as no surprise to some readers who realize that cocaine and lidocaine are chemical cousins, and lidocaine is used as an anesthetic during dental procedures. Nevertheless, it's compelling to take a closer look at cocaine as a medical treatment.

Cocaine: A Closer Look

Cocaine is an alkaloid derivative refined from coca leaves. Coca leaves grow on Erythroxylum Coca, a plant commonly found in South America.

Cocaine is readily absorbed across mucus membranes including the linings of the nose and mouth, which explains why people who abuse the drug snort it or rub it on their gums.

As a drug of abuse, cocaine works on the brain by blocking the reuptake of dopamine—the "feel good" neurotransmitter. Cocaine also works by blocking the reuptake of the neurotransmitters serotonin and norepinephrine, which also contribute to a short-lasting rush or euphoria experienced after ingestion. Other effects of the drug include increased heart rate and increased blood pressure as well as a boost in self-confidence, vigilance, and well-being.

Over time, the chronic use of cocaine reduces the concentration of neurotransmitter metabolites thus permanently messing with the brain. Signs of chronic abuse include an intense craving for more drug and feelings of irritability, violent outbursts, paranoia, and depression. Repeated doses may also lead to involuntary motor activity, heart disease, seizures, psychoses, respiratory failure, sexual dysfunction, and death.

In addition to powder, cocaine can also be abused in the form of crack. Crack is a yellow-white "rock" processed with ammonia or baking soda. Crack rock is smoked or "freebased" using a crack pipe.

Crack is even more potent, addictive, and dangerous than cocaine powder. People who have used crack only once have become addicted. Furthermore, crack pipes burn so hot that they can damage the lips and mouth resulting in bleeding. When people share a crack pipe, they can also share blood and diseases like HIV.

Cocaine as an Anesthetic

Cocaine is a particularly effective local anesthetic which works by blocking nerve impulses.

Specifically by blocking norepinephrine uptake, cocaine causes vasoconstriction and anesthesia.

As a medical treatment, cocaine is used during procedures involving the upper respiratory tract. In addition to anesthesia and vasoconstriction of the upper respiratory tract, cocaine also shrinks the mucosa or mucous membranes.

Cocaine used during medical procedures comes in the form of a topical solution. This cocaine hydrochloride solution comes in three different concentrations: one percent, four percent or 10 percent. Because of potential toxicity, usually only the 1 percent or 4 percent solutions are used.

Cocaine probably suffers from an image problem. Because most people automatically associate this drug with abuse, its use is feared, reviled, or parodied. In reality, however, like many other drugs that are often abused, including marijuana, opioids, and (possibly) MDMA, cocaine does have legitimate and beneficial uses. Please note, however, that the clinical uses of cocaine are absolutely confined to a clinical setting when administered by a physician. Cocaine bought off the street is always dangerous bad news ... always.

Sources

Drug Fact Sheet: Cocaine. www.dea.gov

Prosser JM, Perrone J. Chapter 181. Cocaine, Methamphetamine, and Other Amphetamines. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. New York, NY: McGraw-Hill; 2011.

O'Brien CP. Chapter 24. Drug Addiction. In: Brunton LL, Chabner BA, Knollmann BC. eds. Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e. New York, NY: McGraw-Hill; 2011.

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