Cocaine

Cocaine is a substance classified as a stimulant, which acts as a central nervous system stimulant.

Cocaine is obtained by extracting it from the leaves of the coca plant. [1] The leaves are used to produce a cocaine base, which is refined with hydrochloric acid into a light-colored, water-soluble powder (cocaine hydrochloride). [1] [2] [3] The powder is most commonly used nasally by snorting. [2] [3] [4] Intravenous use also occurs, although less frequently. [2] [3] Crack and free-base are forms of the cocaine base that can be used by smoking. [1] [2] [3] The purity of cocaine in circulation in Finland varies. [5] [6]

Legal status: Cocaine is classified as a narcotic in Finland. Its use, purchase, sale, and possession are prohibited. [7] [8] The Supreme Court has ruled that cocaine is a highly dangerous narcotic. [9]

How does it work?

Cocaine acts in the central nervous system as a stimulant. It affects the activity of neurotransmitters, particularly dopamine and norepinephrine, by inhibiting their reuptake into the nerve cell. [2] [3] Effects begin within a few minutes and last 20–45 minutes. Smoked cocaine (crack, free-base) has shorter but more intense effects than cocaine used by snorting. [3]

Cocaine’s effects depend on the user’s personal sensitivity, the purity of the substance, dosage size, and method of use. [3]

Psychological effects: Cocaine stimulates, energizes, increases alertness, improves performance, and elevates mood. [2] [4] It relieves social anxiety, inhibitions, and general anxiety. Self-esteem may feel elevated under the influence of cocaine. [3] Common adverse effects include irritability, anxiety, restlessness, and paranoia. Mood swings are also common. [2] [3] [4]

Physical effects: Cocaine raises blood pressure and heart rate. [2] It also increases blood oxygen and glucose levels. Pupils may dilate during use. [2] Cocaine suppresses appetite and reduces the need for sleep. [2] [3]

Key risks

Acute risks: Cocaine use carries a risk of blood clots, arrhythmias, myocarditis, stroke, and overheating of the body. [3] These are typically consequences of overdose. Overdose may also lead to respiratory depression. Other symptoms include hallucinations, panic attacks, and paranoia. These effects resemble those seen with heavy amphetamine use. [1]

Cocaine use has also been linked to sudden epileptic seizures [3], although a clear causal relationship is not confirmed. [10]

Severe complications are unlikely at small doses but increase with higher doses. [3] Uncertainty about the purity and concentration of street cocaine increases the likelihood of negative and unexpected effects. [11]

Risks of polydrug use: Some medications, such as SSRIs and MAO inhibitors, amplify the stimulant effects of cocaine, increasing cardiovascular strain. [3] The combined use of alcohol and cocaine is associated with increased risk of death, though research on the exact causes is mixed. Alcohol and cocaine together produce cocaethylene in the body, which may elevate cardiovascular risks. However, differing outcomes may stem from other variables such as the duration of use or additional risk factors like smoking or existing heart conditions. The effects of cocaethylene are similar to those of cocaine but longer-lasting. Alcohol also slows the metabolism of both cocaine and cocaethylene, prolonging their effects. [12] [13] The simultaneous use of multiple substances increases both short- and long-term drug-related risks. [14]

Risks of heavy use: Long-term cocaine use can lead to malnutrition, sleep disturbances, chronic fatigue, anxiety, depression, memory and concentration problems, headaches, seizures, and panic attacks. [3] Heavy use also increases the likelihood of paranoid thoughts and other psychotic symptoms, which may develop into a multi-day psychosis. [3]

Snorting cocaine can over time cause chronic rhinitis, nosebleeds, loss of smell, and even perforation of the nasal septum. [1] [15]

Cocaine is often adulterated with substances such as levamisole. Reported complications include altered blood cell production, skin necrosis, vasculitis, vascular blockages, and changes in the brain’s white matter. [15]

Dependence: Cocaine has a high potential for psychological dependence if used repeatedly. [1] Withdrawal from cocaine may result in fatigue, exhaustion, depression, suicidal thoughts, and paranoia. [2] [3] [4] Tolerance to cocaine’s euphoria-producing effects builds with ongoing use. [3]

Use During Pregnancy: Cocaine use during pregnancy may cause respiratory difficulties, intestinal damage, brain damage, and seizures in the newborn. The newborn may also have a smaller head circumference. Miscarriage and preterm birth are more likely among mothers who use cocaine. [2]

How can risks be reduced?

Substance use is always risky. With illegal drugs, the uncertainty of composition further increases the danger. Methods to reduce risks never eliminate them entirely.

Dependence and long-term harms can be avoided by using the substance as rarely as possible.

Overdose situations require immediate medical attention.