1. Cocaine
Presented by: Dr.J.A.Dabhi
Resident
S.B.K.S.M.I.R.C
GUJARAT

2. Cocaine
 What is cocaine?
It is an alkaloid obtained from the
leaves of coca tree, and is a powerful
addictive CNS stimulant.

3. •Cocaine has been
classified as a Schedule
II drug by the United
States.
•Cocaine is extracted
and refined from the
Coca plant.

5. Cocaine
 Coke
 Snow
 Cadillac
 White Lady, etc.

6. Erythroxylum Coca

8. Features
Plant is 8-12 feet tall.
Category: Shrubs
Fruits: Red oval shaped, 1 cm size
and produces only one seed.
Seeds: Brownish oval
Stem diameter: 16cms

9. Coca Fruits

12. Leaves: Green, smooth, glossy,
opaque, oval, tapering at extremities,
2-3 cm wide and 3-11 cm long.
Leaves when chewed have pleasant,
pungent taste.
Poisonous parts: Leaves
Toxins: Methylbenzoylecgonine i.e.
Cocaine an active principal obtained
from leaves (0.5-1% Al.Cocaine)

15. Geographical Distribution
Grows throughout the tropical
regions.
1.Whole of Latin American Countries
such as Columbia, mexico, ecuador,
and other countries such as Chile,
Peru, India, Indonesia, Sri Lanka, etc.
Bolivia-leading producer-80% world
total cocaine producer.

18. High risk geographical areas:
1. Bolivia
2. Peru
3. Brazil – Amazon region
4. Ecuador
5. Columbia
6. Chile

19. Cocaine

20. History
3000 B.C.:Leaves chewed throughot
South America. Coca believed to be a
gift from Go.
1708 A.D. Coca first time mentioned
in materia medica.
1850: Coca tinctures used in throat
surgery
1855: Cocaine 1st time extracted
from coca leaves.

21. 1884: Used as local anaesthetic in
eye surgery
1886: Cocaine introduced in newly
launched soft drink - Coca Cola.
1901: Cocaine removed from Coca
Cola.
1905: Snorting cocaine in the form
of powder became popular.
1910:1st case of nasal damage seen.

22. 1912: U.S. Govt. reports 5000
cocaine related fatalities in one year
1914: Banned of cocaine in U.S.
Cost of making 1 kg cocaine: $200-
$400.
Cost of 1 kg cocaine- at present
$15000 – 35000.

23. w
Cocaine

24. Features
 White powder or crystals
Odourless
 numbing taste
 slightly volatil
melting point 96 degree celsius and
should be protected from heat and
sunlight.

25. Forms: 1. Hydrochloride Salt
2. Freebase

26. Cocaine Hydrochloride

28. Freebase

29. Hydrochloride Salt: It is the
powdered form of cocaine, dissolves
in water and when abused, can be
taken i.v. or snorted.
Freebase: Compound that has not
been neutralized by an acid to make
hydrochloride salt. It can be smoked.

30. Crack: When freebase is heated with
sodium bicarbonate it yields crack.
Why the word crack?
It is smoked.

31. Principle Routes of Abuse
Intravenous
Snorting
Smoking/inhalation
Ingestion: both cocaine and leaves
of coca plants
What is snorting?

32. Snorting

36. Action
Desensitizes the terminal nerves
and causes vasoconstriction at the site
of local application.
When taken i.v. or inhaled,
stimulates the cerebral cortex .

39. Metabolism
Site: Liver
Half Life: 30-90 min.

40. Detection
Metabolites can be detected for
varying lengths of time in urine
depending upon the dose consumed
and sensitivity of the assay.
Metabolites in urine is generally
detected in urine for 24-72 Hrs. even
after brief consumption.

41. With chronic use it is deposited in
body in fats/cns. and is slowly
released. Hence, can be detected in
urine for even couple of weeks.
Metabolites also detectable in
blood, saliva, hair and sweat.

42. Blood and saliva: Provide accurate
conc. of the drug consumed.
Urine: Provides longer window of
opportunity for detection.

43. Speedball: Mixture of cocaine and
heroin. Taken i.v.

44. Acute Effects
Local: Anaesthetic when comes in
contact with mucous membrane.
Increase energy
Euphoria
Mental Alertness
Increase heart rate/B.P./temp.
Dilates pupil
Vasoconstriction

45. Long-term Effects
It is powerful addictive drug.
Once having tried, an individual may
have difficulty in predicting the extent
to which he will continue to use the
drug.
Abusers are of upper class society
peoples to enhance self image or
improve professional performance.

46. Reason for addiction?
Its stimulant and addictive effects are
thought to be primarily a result of its
ability to inhibit the reabsorption of
dopamine by nerve cells.
Note: Dopamine is directly or
indirectly involved in addictive
properties of every major drug of
abuse

47. Cocaine in brain: In normal
communication process, dopamine is
released by neuron into the synapse,
where it can bind with dopamine
receptors on neighbouring neurons.
Normally dopamine is then recycled
back into the transmitting neuron by a
dopamine transporter.

48. If cocaine is present, it attatches to
the dopamine transporter and blocks
the normal recycling process, resulting
in a building up of dopamine in the
synapse which contributes to the
pleasurable effects of cocaine.

50. Long term effects of cocaine

51. Long-term effect of cocaine may lead
to:
 Irritability
Dependency- Discuss that not each
and every causes dependency.
 Mood disturbances
Restlessness
Paranoia
Auditory hallucinations

52. Consequences of cocaine abuse
Cardiovascular - arrhythmia
heart attack
Respiratory – Chest pain
Resp. failure
CNS – stroke
seizures
headaches

53. GIT – abdominal pain
nausea
Tongue and teeth are black
Regular snorting can lead to loss of
sensation of smell, nose bleeding,
problem of swallowing, hoarseness
and irritation of nasal septum leading
to chronically inflammed running nose

56. Ingested cocaine can cause bowel
gangrene due to reduced blood flow.
Many chronic cocaine habitual
suffers loss of appetites and can
experience significant weight loss and
malnourishment.

57. Cocaine bugs phenomenon: Grains of
sand are lying under skin or some small
insects are creeping on the skin giving
rise to itching sensation – a form of
tactile hallucination.
Loss of libido
Impotence
Gynecomastia
Irregular menstrual cycle, infertility,
amenorrhea

58. Crack Babies: Increased risk of foetal
malformation fo cardiovascular and
cerebrovascular system due to chronic
abuse of cocaine by the mother.

59. Treatment
Specific antidote-Amyl Nitrate by
inhalation.
Only symptomatic treatment
Consultation with psychiatric –
psychotherapy, and other related
counseling.

60. Symptomatic Treatment Includes
Diazepam for seizure.
Propanolol for ventricular
arrhythmias.
Haloperidol for pshchosis.

61. Fatal dose:1 – 1.5 gram orally.
Fatal Period: Few minutes to few
hours.
Chronic abuser can tolerate up to
10 gms per day.

62. Autopsy Findings
No specific findings
Injection marks,
 Atrophy, inflammation of nasal
mucosa.
Endocarditis due to aseptic i.v.
infusion of drug.
Pulmonary granulomatosis due to
infusion of adulterated particles viz.
starch, talc, etc.

63. Endocarditis

65. CSF rhinorrhoea due to thinning of
cribriform plate.
Cocaine can be recovered by
sampling from recent injection sites or
by swabs from the nasal mucosa.
Brain is the excellent source.

66. Circumstances of Poisoning
Generally accidental overdose.
Rarely used for homicide/sucide.
Aphrodisiac - to increase the
duration of sexual act by desensitizing
the sensory nerves of glans penis
when applied locally.
Prostitutes injects cocaine solution
into the vagina to produce local
anaesthetic effect during coitus.