cocaine

Cocaine is a powerful stimulant derived from the leaves of the coca plant (Erythroxylum coca). It exists as a water-soluble hydrochloride salt suitable for insufflation or injection, and as a freebase form that is typically smoked as crack cocaine. Both forms act quickly and produce intense euphoria, increased energy, and heightened alertness, but they also carry significant health risks.

Pharmacology and effects: Cocaine blocks the dopamine transporter, increasing dopamine levels in brain reward pathways, and also affects norepinephrine and serotonin. Effects vary by route of administration but commonly include rapid onset, vasoconstriction, elevated heart rate and blood pressure, dilated pupils, decreased appetite, and insomnia. Short-term use can cause anxiety, paranoia, and tremors; overdose can lead to seizures, cardiac arrhythmias, hyperthermia, and death.

Medical use and legality: Historically, cocaine has been used as a local anesthetic in eye, ear, and throat procedures, but such uses are now rare due to safer alternatives. In many countries it is a controlled substance; in the United States it is classified as Schedule II, indicating a high potential for abuse but some accepted medical uses. Legal status and penalties vary by jurisdiction.

Risks and treatment: Prolonged or high-dose use can lead to dependence and a range of health problems, including nasal damage from insufflation, malnutrition, weight loss, cognitive and mood disturbances, and cardiovascular disease. There is no approved medication specifically for cocaine use disorder; treatment typically involves psychosocial interventions such as cognitive-behavioral therapy, contingency management, and support groups, along with management of medical and psychiatric comorbidities.