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a narcotic (alkaloid) extracted from coca leaves; used as a surface anesthetic or taken for pleasure; can become powerfully addictive (同)cocain
a person addicted to cocaine

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コカイン(麻酔剤の一種)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/06/15 23:20:55」(JST)

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Cocaine (INN), also known as benzoylmethylecgonine, is a strong stimulant mostly used as a recreational drug.^[9] It is commonly snorted, inhaled, or injected into the veins. Mental effects may include loss of contact with reality, an intense feeling of happiness, or agitation. Physical symptoms may include a fast heart rate, sweating, and large pupils.^[8] High doses can result in very high blood pressure or body temperature.^[10] Effects begin within seconds to minutes of use and last between five and ninety minutes.^[8] Cocaine has a small number of accepted medical uses such as numbing and decreasing bleeding during nasal surgery.^[11]

Cocaine is addictive due to its effect on the brains reward pathways. After a short period of use there is a high risk that dependence will occur.^[9] Its use also increases the risk of stroke, myocardial infarction, lung problems in those who smoke it, blood infections, and sudden cardiac death.^[9]^[12] Cocaine sold on the street is commonly mixed with local anesthetics, cornstarch, quinine, or sugar which can result in additional toxicity.^[13] Following repeated doses a person may have decreased ability to feel pleasure and be very physicially tired.^[9]

Cocaine acts by inhibiting the reuptake of serotonin, norephinephrine, and dopamine. This results in greater concentrations of these three neurotransmitters in the brain.^[9] It can easily cross the blood–brain barrier and may lead to the breakdown of the barrier.^[14]^[15] Cocaine is made from the leaves of the coca plant which are mostly grown in South America.^[8] In 2013, 419 kilograms were produced legally.^[16] It is estimated that the illegal market for cocaine is 100 to 500 billion USD each year. With further processing crack cocaine can be produced from cocaine.^[9]

After cannabis, cocaine is the most frequently used illegal drug.^[17] Between 14 and 21 million people use the drug globally each year. Use is highest in North America followed by Europe and South America. Between one and three percent of people in the developed world use cocaine at some point in their life.^[9] In 2013 cocaine use directly resulted in 4,300 deaths, up from 2,400 in 1990.^[18] The leaves of the coca plant have been used by Peruvians since ancient times.^[13] Cocaine was first isolated from the leaves in 1860.^[9] Since 1961 the international Single Convention on Narcotic Drugs has required countries to make recreational use of cocaine a criminal offence.^[19]

1 Uses
- 1.1 Medical
- 1.2 Recreational
  - 1.2.1 Oral
    - 1.2.1.1 Coca leaf
  - 1.2.2 Insufflation
  - 1.2.3 Injection
  - 1.2.4 Inhalation
  - 1.2.5 Suppository
2 Adverse effects
- 2.1 Acute
- 2.2 Chronic
- 2.3 Addiction
- 2.4 Dependence and withdrawal
3 Pharmacology
- 3.1 Pharmacodynamics
- 3.2 Pharmacokinetics
4 Physical and chemical properties
- 4.1 Appearance
- 4.2 Forms
  - 4.2.1 Salts
  - 4.2.2 Basic
  - 4.2.3 Crack cocaine
  - 4.2.4 Coca leaf infusions
- 4.3 Biosynthesis
  - 4.3.1 N-methyl-pyrrolinium cation
  - 4.3.2 Robert Robinson's acetonedicarboxylate
  - 4.3.3 Reduction of tropinone
- 4.4 Detection in body fluids
5 History
- 5.1 Discovery
- 5.2 Isolation and naming
- 5.3 Medicalization
- 5.4 Popularization
- 5.5 Prohibition
  - 5.5.1 Prohibition of cocaine in the United States
- 5.6 Modern usage
6 Society and culture
- 6.1 Legal status
- 6.2 Interdiction
- 6.3 Usage
  - 6.3.1 Europe
  - 6.3.2 North America
    - 6.3.2.1 United States
- 6.4 Economics
  - 6.4.1 Production
  - 6.4.2 Synthesis
  - 6.4.3 Trafficking and distribution
    - 6.4.3.1 Caribbean and Mexican routes
    - 6.4.3.2 Chilean route
    - 6.4.3.3 Techniques
  - 6.4.4 Sales to consumers
  - 6.4.5 Consumption
7 Research
8 See also
9 References
10 Bibliography
11 Further reading
12 External links

Uses

Medical

Topical cocaine can be used as a local numbing agent to help with painful procedures in the mouth or nose.^[20]

Cocaine was historically useful as a topical anesthetic in eye and nasal surgery, although it is now predominantly used for nasal and lacrimal duct surgery. The major disadvantages of this use are cocaine's intense vasoconstrictor activity and potential for cardiovascular toxicity. Cocaine has since been largely replaced in Western medicine by synthetic local anesthetics such as benzocaine, proparacaine, lignocaine-xylocaine-lidocaine, and tetracaine though it remains available for use if specified. If vasoconstriction is desired for a procedure (as it reduces bleeding), the anesthetic is combined with a vasoconstrictor such as phenylephrine or epinephrine. In Australia it is currently prescribed for use as a local anesthetic for conditions such as mouth and lung ulcers. Some ENT specialists occasionally use cocaine within the practice when performing procedures such as nasal cauterization. In this scenario dissolved cocaine is soaked into a ball of cotton wool, which is placed in the nostril for the 10–15 minutes immediately before the procedure, thus performing the dual role of both numbing the area to be cauterized, and vasoconstriction. Even when used this way, some of the used cocaine may be absorbed through oral or nasal mucosa and give systemic effects.

Recreational

Addiction experts in psychiatry, chemistry, pharmacology, forensic science, epidemiology, and the police and legal services engaged in delphic analysis regarding 20 popular recreational drugs. Cocaine was ranked the 2nd most addictive and the 2nd most harmful of 20 popular recreational drugs.^[21]

Cocaine is a powerful nervous system stimulant.^[22] Its effects can last from fifteen to thirty minutes, to an hour. The duration of cocaine's effects depends on the amount taken and the route of administration.^[23] Cocaine can be in the form of fine white powder, bitter to the taste. When inhaled or injected, it causes a numbing effect. Crack cocaine is a smokeable form of cocaine made into small “rocks” by processing cocaine with sodium bicarbonate (baking soda) and water.

Cocaine increases alertness, feelings of well-being and euphoria, energy and motor activity, feelings of competence and sexuality. Cocaine's effects are very similar to that of amphetamine, however cocaine's effects tend to be much shorter lasting, but more prominent.

Oral

A spoon containing baking soda, cocaine, and a small amount of water. Used in a "poor-man's" crack-cocaine production

Many users rub the powder along the gum line, or onto a cigarette filter which is then smoked, which numbs the gums and teeth – hence the colloquial names of "numbies", "gummers", or "cocoa puffs" for this type of administration. This is mostly done with the small amounts of cocaine remaining on a surface after insufflation (snorting). Another oral method is to wrap up some cocaine in rolling paper and swallow (parachute) it. This is sometimes called a "snow bomb."

Coca leaf

Coca leaves are typically mixed with an alkaline substance (such as lime) and chewed into a wad that is retained in the mouth between gum and cheek (much in the same as chewing tobacco is chewed) and sucked of its juices. The juices are absorbed slowly by the mucous membrane of the inner cheek and by the gastrointestinal tract when swallowed. Alternatively, coca leaves can be infused in liquid and consumed like tea. Ingesting coca leaves generally is an inefficient means of administering cocaine. Advocates of the consumption of the coca leaf state that coca leaf consumption should not be criminalized as it is not actual cocaine, and consequently it is not properly the illicit drug.

Because cocaine is hydrolyzed and rendered inactive in the acidic stomach, it is not readily absorbed when ingested alone. Only when mixed with a highly alkaline substance (such as lime) can it be absorbed into the bloodstream through the stomach. The efficiency of absorption of orally administered cocaine is limited by two additional factors. First, the drug is partly catabolized by the liver. Second, capillaries in the mouth and esophagus constrict after contact with the drug, reducing the surface area over which the drug can be absorbed. Nevertheless, cocaine metabolites can be detected in the urine of subjects that have sipped even one cup of coca leaf infusion. Therefore, this is an actual additional form of administration of cocaine, albeit an inefficient one.

Orally administered cocaine takes approximately 30 minutes to enter the bloodstream. Typically, only a third of an oral dose is absorbed, although absorption has been shown to reach 60% in controlled settings. Given the slow rate of absorption, maximum physiological and psychotropic effects are attained approximately 60 minutes after cocaine is administered by ingestion. While the onset of these effects is slow, the effects are sustained for approximately 60 minutes after their peak is attained.

Contrary to popular belief, both ingestion and insufflation result in approximately the same proportion of the drug being absorbed: 30 to 60%. Compared to ingestion, the faster absorption of insufflated cocaine results in quicker attainment of maximum drug effects. Snorting cocaine produces maximum physiological effects within 40 minutes and maximum psychotropic effects within 20 minutes, however, a more realistic activation period is closer to 5 to 10 minutes, which is similar to ingestion of cocaine. Physiological and psychotropic effects from nasally insufflated cocaine are sustained for approximately 40–60 minutes after the peak effects are attained.^[24]

Coca tea, an infusion of coca leaves, is also a traditional method of consumption. The tea has often been recommended for travelers in the Andes to prevent altitude sickness.^[25] However, its actual effectiveness has never been systematically studied.^[25] This method of consumption has been practised for many centuries by the indigenous tribes of South America. One specific purpose of ancient coca leaf consumption was to increase energy and reduce fatigue in messengers who made multi-day quests to other settlements.

In 1986 an article in the Journal of the American Medical Association revealed that U.S. health food stores were selling dried coca leaves to be prepared as an infusion as “Health Inca Tea.”^[26] While the packaging claimed it had been "decocainized," no such process had actually taken place. The article stated that drinking two cups of the tea per day gave a mild stimulation, increased heart rate, and mood elevation, and the tea was essentially harmless. Despite this, the DEA seized several shipments in Hawaii, Chicago, Georgia, and several locations on the East Coast of the United States, and the product was removed from the shelves.

Insufflation

A man sniffing cocaine

Nasal insufflation (known colloquially as "snorting," "sniffing," or "blowing") is the most common method of ingestion of recreational powdered cocaine in the Western world. The drug coats and is absorbed through the mucous membranes lining the sinuses. When insufflating cocaine, absorption through the nasal membranes is approximately 30–60%, with higher doses leading to increased absorption efficiency. Any material not directly absorbed through the mucous membranes is collected in mucus and swallowed (this "drip" is considered pleasant by some and unpleasant by others). In a study^[27] of cocaine users, the average time taken to reach peak subjective effects was 14.6 minutes. Any damage to the inside of the nose is because cocaine highly constricts blood vessels – and therefore blood and oxygen/nutrient flow – to that area. Nosebleeds after cocaine insufflation are due to irritation and damage of mucus membranes by foreign particles and adulterants and not the cocaine itself; as a vasoconstrictor, cocaine acts to reduce bleeding.

Prior to insufflation, cocaine powder must be divided into very fine particles. Cocaine of high purity breaks into fine dust very easily, except when it is moist (not well stored) and forms "chunks," which reduces the efficiency of nasal absorption.

Rolled up banknotes, hollowed-out pens, cut straws, pointed ends of keys, specialized spoons, long fingernails, and (clean) tampon applicators are often used to insufflate cocaine. Such devices are often called "tooters" by users. The cocaine typically is poured onto a flat, hard surface (such as a mirror, CD case or book) and divided into "bumps", "lines" or "rails", and then insufflated.^[28] The amount of cocaine in a line varies widely from person to person and occasion to occasion (the purity of the cocaine is also a factor), but one line is generally considered to be a single dose and is typically 35 mg (a "bump") to 100 mg (a "rail")^{[dubious – discuss]}. As tolerance builds rapidly in the short-term (hours), many lines are often snorted to produce greater effects.

A study by Bonkovsky and Mehta^[29] reported that, just like shared needles, the sharing of straws used to "snort" cocaine can spread blood diseases such as Hepatitis C.

Injection

Drug injection provides the highest blood levels of drug in the shortest amount of time. Subjective effects not commonly shared with other methods of administration include a ringing in the ears moments after injection (usually when in excess of 120 milligrams) lasting 2 to 5 minutes including tinnitus and audio distortion. This is colloquially referred to as a "bell ringer". In a study of cocaine users, the average time taken to reach peak subjective effects was 3.1 minutes.^[27] The euphoria passes quickly. Aside from the toxic effects of cocaine, there is also danger of circulatory emboli from the insoluble substances that may be used to cut the drug. As with all injected illicit substances, there is a risk of the user contracting blood-borne infections if sterile injecting equipment is not available or used. Additionally, because cocaine is a vasoconstrictor, and usage often entails multiple injections within several hours or less, subsequent injections are progressively more difficult to administer, which in turn may lead to more injection attempts and more sequelae from improperly performed injection.

An injected mixture of cocaine and heroin, known as “speedball” is a particularly dangerous combination, as the converse effects of the drugs actually complement each other, but may also mask the symptoms of an overdose. It has been responsible for numerous deaths, including celebrities such as John Belushi, Chris Farley, Mitch Hedberg, River Phoenix and Layne Staley.

Experimentally, cocaine injections can be delivered to animals such as fruit flies to study the mechanisms of cocaine addiction.^[30]

Inhalation

Inhalation or smoking is one of the several means cocaine is administered. Cocaine is smoked by inhaling the vapor by sublimating solid cocaine by heating.^[31] In a 2000 Brookhaven National Laboratory medical department study, based on self reports of 32 abusers who participated in the study,"peak high" was found at mean of 1.4min +/- 0.5 minutes.^[27]

Smoking freebase or crack cocaine is most often accomplished using a pipe made from a small glass tube, often taken from "love roses," small glass tubes with a paper rose that are promoted as romantic gifts.^[32] These are sometimes called "stems", "horns", "blasters" and "straight shooters". A small piece of clean heavy copper or occasionally stainless steel scouring pad – often called a "brillo" (actual Brillo Pads contain soap, and are not used) or "chore" (named for Chore Boy brand copper scouring pads) – serves as a reduction base and flow modulator in which the "rock" can be melted and boiled to vapor. Crack smokers also sometimes smoke through a soda can with small holes in the bottom.

Crack is smoked by placing it at the end of the pipe; a flame held close to it produces vapor, which is then inhaled by the smoker. The effects, felt almost immediately after smoking, are very intense and do not last long – usually 5 to 15 minutes.

When smoked, cocaine is sometimes combined with other drugs, such as cannabis, often rolled into a joint or blunt. Powdered cocaine is also sometimes smoked, though heat destroys much of the chemical; smokers often sprinkle it on cannabis.

The language referring to paraphernalia and practices of smoking cocaine vary, as do the packaging methods in the street level sale.

Suppository

Little research has been focused on the suppository (anal or vaginal insertion) method of administration, also known as "plugging". This method of administration is commonly administered using an oral syringe. Cocaine can be dissolved in water and withdrawn into an oral syringe which may then be lubricated and inserted into the anus or vagina before the plunger is pushed. Anecdotal evidence of its effects are infrequently discussed, possibly due to social taboos in many cultures. The rectum and the vaginal canal is where the majority of the drug would likely be taken up, through the membranes lining its walls.^{[citation needed]}

Adverse effects

Acute

With excessive or prolonged use, the drug can cause itching, fast heart rate, hallucinations, and paranoid delusions.^[33] Overdoses cause hyperthermia and a marked elevation of blood pressure, which can be life-threatening,^[33] arrhythmias,^[34] and death.^[34]

Anxiety, paranoia and restlessness can also occur, especially during the comedown. With excessive dosage, tremors, convulsions and increased body temperature are observed.^[22] Severe cardiac adverse events, particularly sudden cardiac death, become a serious risk at high doses due to cocaine's blocking effect on cardiac sodium channels.^[34]

Chronic

Side effects of chronic cocaine use

Cocaine hydrochloride

Chronic cocaine intake causes strong imbalances of transmitter levels in order to compensate extremes. Thus, receptors disappear from the cell surface or reappear on it, resulting more or less in an "off" or "working mode" respectively, or they change their susceptibility for binding partners (ligands) – mechanisms called downregulation and upregulation. However, studies suggest cocaine abusers do not show normal age-related loss of striatal dopamine transporter (DAT) sites, suggesting cocaine has neuroprotective properties for dopamine neurons.^[35] Possible side effects include insatiable hunger, aches, insomnia/oversleeping, lethargy, and persistent runny nose. Depression with suicidal ideation may develop in very heavy users. Finally, a loss of vesicular monoamine transporters, neurofilament proteins, and other morphological changes appear to indicate a long term damage of dopamine neurons. All these effects contribute a rise in tolerance thus requiring a larger dosage to achieve the same effect. ^[36] The lack of normal amounts of serotonin and dopamine in the brain is the cause of the dysphoria and depression felt after the initial high. Physical withdrawal is not dangerous. Physiological changes caused by cocaine withdrawal include vivid and unpleasant dreams, insomnia or hypersomnia, increased appetite and psychomotor retardation or agitation.^[36]

Physical side effects from chronic smoking of cocaine include coughing up blood, bronchospasm, itching, fever, diffuse alveolar infiltrates without effusions, pulmonary and systemic eosinophilia, chest pain, lung trauma, sore throat, asthma, hoarse voice, dyspnea (shortness of breath), and an aching, flu-like syndrome. Cocaine constricts blood vessels, dilates pupils, and increases body temperature, heart rate, and blood pressure. It can also cause headaches and gastrointestinal complications such as abdominal pain and nausea. A common but untrue belief is that the smoking of cocaine chemically breaks down tooth enamel and causes tooth decay. However, cocaine does often cause involuntary tooth grinding, known as bruxism, which can deteriorate tooth enamel and lead to gingivitis.^[37] Additionally, stimulants like cocaine, methamphetamine, and even caffeine cause dehydration and dry mouth. Since saliva is an important mechanism in maintaining one's oral pH level, chronic stimulant abusers who do not hydrate sufficiently may experience demineralization of their teeth due to the pH of the tooth surface dropping too low (below 5.5).

Chronic intranasal usage can degrade the cartilage separating the nostrils (the septum nasi), leading eventually to its complete disappearance. Due to the absorption of the cocaine from cocaine hydrochloride, the remaining hydrochloride forms a dilute hydrochloric acid.^[38]

Cocaine may also greatly increase this risk of developing rare autoimmune or connective tissue diseases such as lupus, Goodpasture syndrome, vasculitis, glomerulonephritis, Stevens–Johnson syndrome, and other diseases.^[39]^[40]^[41]^[42] It can also cause a wide array of kidney diseases and kidney failure.^[43]^[44]

Cocaine misuse doubles both the risks of hemorrhagic and ischemic strokes,^[45] as well as increases the risk of other infarctions, such as myocardial infarction.^[46]

Addiction

Cocaine addiction occurs through accumbal ΔFosB overexpression, which arises through transcriptional regulation and epigenetic remodeling of the nucleus accumbens.

Dependence and withdrawal

Cocaine dependence is a form of psychological dependence that develops from regular cocaine use and produces a withdrawal state with emotional-motivational deficits upon cessation of cocaine use.

Pharmacology

Pharmacodynamics

The pharmacodynamics of cocaine involve the complex relationships of neurotransmitters (inhibiting monoamine uptake in rats with ratios of about: serotonin:dopamine = 2:3, serotonin:norepinephrine = 2:5^[47]) The most extensively studied effect of cocaine on the central nervous system is the blockade of the dopamine transporter protein. Dopamine transmitter released during neural signaling is normally recycled via the transporter; i.e., the transporter binds the transmitter and pumps it out of the synaptic cleft back into the presynaptic neuron, where it is taken up into storage vesicles. Cocaine binds tightly at the dopamine transporter forming a complex that blocks the transporter's function. The dopamine transporter can no longer perform its reuptake function, and thus dopamine accumulates in the synaptic cleft.

Cocaine's effects on serotonin (5-hydroxytryptamine, 5-HT) show across multiple serotonin receptors, and is shown to inhibit the re-uptake of 5-HT3 specifically as an important contributor to the effects of cocaine. The overabundance of 5-HT3 receptors in cocaine conditioned rats display this trait, however the exact effect of 5-HT3 in this process is unclear.^[48] The 5-HT2 receptor (particularly the subtypes 5-HT2AR, 5-HT2BR and 5-HT2CR) show influence in the evocation of hyperactivity displayed in cocaine use.^[49]

Cocaine has been demonstrated to bind as to directly stabilize the DAT transporter on the open outward-facing conformation. Further, cocaine binds in such a way as to inhibit a hydrogen bond innate to DAT. Cocaine's binding properties are such that it attaches so this hydrogen bond will not form and is blocked from formation due to the tightly locked orientation of the cocaine molecule. Research studies have suggested that the affinity for the transporter is not what is involved in habituation of the substance so much as the conformation and binding properties to where and how on the transporter the molecule binds.^[50]

Sigma receptors are affected by cocaine, as cocaine functions as a sigma ligand agonist.^[51] Further specific receptors it has been demonstrated to function on are NMDA and the D1 dopamine receptor.^[52]

Cocaine also blocks sodium channels, thereby interfering with the propagation of action potentials;^[34] thus, like lignocaine and novocaine, it acts as a local anesthetic. It also functions on the binding sites to the dopamine and serotonin sodium dependent transport area as targets as separate mechanisms from its reuptake of those transporters; unique to its local anesthetic value which makes it in a class of functionality different from both its own derived phenyltropanes analogues which have that removed. In addition to this cocaine has some target binding to the site of the Kappa-opioid receptor as well.^[53] Cocaine also causes vasoconstriction, thus reducing bleeding during minor surgical procedures. The locomotor enhancing properties of cocaine may be attributable to its enhancement of dopaminergic transmission from the substantia nigra. Recent research points to an important role of circadian mechanisms^[54] and clock genes^[55] in behavioral actions of cocaine.

Cocaine can often cause reduced food intake, many chronic users lose their appetite and can experience severe malnutrition and significant weight loss. Cocaine effects, further, are shown to be potentiated for the user when used in conjunction with new surroundings and stimuli, and otherwise novel environs.^[56]

Pharmacokinetics

Cocaine is extensively metabolized, primarily in the liver, with only about 1% excreted unchanged in the urine. The metabolism is dominated by hydrolytic ester cleavage, so the eliminated metabolites consist mostly of benzoylecgonine (BE), the major metabolite, and other significant metabolites in lesser amounts such as ecgonine methyl ester (EME) and ecgonine. Further minor metabolites of cocaine include norcocaine, p-hydroxycocaine, m-hydroxycocaine, p-hydroxybenzoylecgonine (pOHBE), and m-hydroxybenzoylecgonine.^[57] If consumed with alcohol, cocaine combines with alcohol in the liver to form cocaethylene. Studies have suggested cocaethylene is both more euphoric, and has a higher cardiovascular toxicity than cocaine by itself.^[58]^[59]^[60]

Depending on liver and kidney function, cocaine metabolites are detectable in urine. Benzoylecgonine can be detected in urine within four hours after cocaine intake and remains detectable in concentrations greater than 150 ng/mL typically for up to eight days after cocaine is used. Detection of accumulation of cocaine metabolites in hair is possible in regular users until the sections of hair grown during use are cut or fall out.

Physical and chemical properties

Appearance

A pile of cocaine hydrochloride

A piece of compressed cocaine powder

Cocaine in its purest form is a white, pearly product. Cocaine appearing in powder form is a salt, typically cocaine hydrochloride (CAS 53-21-4). Street market cocaine is frequently adulterated or “cut” with various powdery fillers to increase its weight; the substances most commonly used in this process are baking soda; sugars, such as lactose, dextrose, inositol, and mannitol; and local anesthetics, such as lidocaine or benzocaine, which mimic or add to cocaine's numbing effect on mucous membranes. Cocaine may also be "cut" with other stimulants such as methamphetamine.^[61] Adulterated cocaine is often a white, off-white or pinkish powder.

The color of “crack” cocaine depends upon several factors including the origin of the cocaine used, the method of preparation – with ammonia or baking soda – and the presence of impurities, but will generally range from white to a yellowish cream to a light brown. Its texture will also depend on the adulterants, origin and processing of the powdered cocaine, and the method of converting the base. It ranges from a crumbly texture, sometimes extremely oily, to a hard, almost crystalline nature.

Forms

Salts

Cocaine is a weakly alkaline compound (an "alkaloid"), and can therefore combine with acidic compounds to form various salts. The hydrochloride (HCl) salt of cocaine is by far the most commonly encountered, although the sulfate (-SO₄) and the nitrate (-NO₃) are occasionally seen. Different salts dissolve to a greater or lesser extent in various solvents – the hydrochloride salt is polar in character and is quite soluble in water.

Basic

As the name implies, “freebase” is the base form of cocaine, as opposed to the salt form. It is practically insoluble in water whereas hydrochloride salt is water-soluble.

Smoking freebase cocaine has the additional effect of releasing methylecgonidine into the user's system due to the pyrolysis of the substance (a side effect which insufflating or injecting powder cocaine does not create). Some research suggests that smoking freebase cocaine can be even more cardiotoxic than other routes of administration^[62] because of methylecgonidine's effects on lung tissue^[63] and liver tissue.^[64]

Pure cocaine is prepared by neutralizing its compounding salt with an alkaline solution which will precipitate to non-polar basic cocaine. It is further refined through aqueous-solvent liquid-liquid extraction.

Crack cocaine

A woman smoking crack cocaine

"Rocks" of crack cocaine

Crack is a lower purity form of free-base cocaine that is usually produced by neutralization of cocaine hydrochloride with a solution of baking soda (sodium bicarbonate, NaHCO₃) and water, producing a very hard/brittle, off-white-to-brown colored, amorphous material that contains sodium carbonate, entrapped water, and other by-products as the main impurities.

The "freebase" and "crack" forms of cocaine are usually administered by vaporization of the powdered substance into smoke, which is then inhaled.^[65]

The origin of the name "crack" comes from the "crackling" sound (and hence the onomatopoeic moniker “crack”) that is produced when the cocaine and its impurities (i.e. water, sodium bicarbonate) are heated past the point of vaporization.^[66]

Pure cocaine base/crack can be smoked because it vaporizes smoothly, with little or no decomposition at 98 °C (208 °F),^[67] which is below the boiling point of water. The smoke produced from cocaine base is usually described as having a very distinctive, pleasant taste.

In contrast, cocaine hydrochloride does not vaporize until heated to a much higher temperature (about 197 °C), and considerable decomposition/burning occurs at these high temperatures. This effectively destroys some of the cocaine, and yields a sharp, acrid, and foul-tasting smoke.

Smoking or vaporizing cocaine and inhaling it into the lungs produces an almost immediate "high" that can be very powerful (and addicting) quite rapidly – this initial crescendo of stimulation is known as a "rush". While the stimulating effects may last for hours, the euphoric sensation is very brief, prompting the user to smoke more immediately.

Coca leaf infusions

Coca herbal infusion (also referred to as coca tea) is used in coca-leaf producing countries much as any herbal medicinal infusion would elsewhere in the world. The free and legal commercialization of dried coca leaves under the form of filtration bags to be used as "coca tea" has been actively promoted by the governments of Peru and Bolivia for many years as a drink having medicinal powers. Visitors to the city of Cuzco in Peru, and La Paz in Bolivia are greeted with the offering of coca leaf infusions (prepared in tea pots with whole coca leaves) purportedly to help the newly arrived traveler overcome the malaise of high altitude sickness. The effects of drinking coca tea are a mild stimulation and mood lift. It does not produce any significant numbing of the mouth nor does it give a rush like snorting cocaine. In order to prevent the demonization of this product, its promoters publicize the unproven concept that much of the effect of the ingestion of coca leaf infusion would come from the secondary alkaloids, as being not only quantitatively different from pure cocaine but also qualitatively different.

It has been promoted as an adjuvant for the treatment of cocaine dependence. In one controversial study, coca leaf infusion was used—in addition to counseling—to treat 23 addicted coca-paste smokers in Lima, Peru. Relapses fell from an average of four times per month before treatment with coca tea to one during the treatment. The duration of abstinence increased from an average of 32 days prior to treatment to 217 days during treatment. These results suggest that the administration of coca leaf infusion plus counseling would be an effective method for preventing relapse during treatment for cocaine addiction. Importantly, these results also suggest strongly that the primary pharmacologically active metabolite in coca leaf infusions is actually cocaine and not the secondary alkaloids.^{[improper synthesis?]}

The cocaine metabolite benzoylecgonine can be detected in the urine of people a few hours after drinking one cup of coca leaf infusion.^[68]

Biosynthesis

The first synthesis and elucidation of the cocaine molecule was by Richard Willstätter in 1898.^[69] Willstätter's synthesis derived cocaine from tropinone. Since then, Robert Robinson and Edward Leete have made significant contributions to the mechanism of the synthesis. (-NO₃)

The additional carbon atoms required for the synthesis of cocaine are derived from acetyl-CoA, by addition of two acetyl-CoA units to the N-methyl-Δ¹-pyrrolinium cation.^[70] The first addition is a Mannich-like reaction with the enolate anion from acetyl-CoA acting as a nucleophile towards the pyrrolinium cation. The second addition occurs through a Claisen condensation. This produces a racemic mixture of the 2-substituted pyrrolidine, with the retention of the thioester from the Claisen condensation. In formation of tropinone from racemic ethyl [2,3-13C₂]₄(Nmethyl-2-pyrrolidinyl)-3-oxobutanoate there is no preference for either stereoisomer.^[71] In the biosynthesis of cocaine, however, only the (S)-enantiomer can cyclize to form the tropane ring system of cocaine. The stereoselectivity of this reaction was further investigated through study of prochiral methylene hydrogen discrimination.^[72] This is due to the extra chiral center at C-2.^[73] This process occurs through an oxidation, which regenerates the pyrrolinium cation and formation of an enolate anion, and an intramolecular Mannich reaction. The tropane ring system undergoes hydrolysis, SAM-dependent methylation, and reduction via NADPH for the formation of methylecgonine. The benzoyl moiety required for the formation of the cocaine diester is synthesized from phenylalanine via cinnamic acid.^[74] Benzoyl-CoA then combines the two units to form cocaine.

N-methyl-pyrrolinium cation

Biosynthesis of N-methyl-pyrrolinium cation

Biosynthesis of cocaine

Robinson biosynthesis of tropane

Reduction of tropinone

The biosynthesis begins with L-Glutamine, which is derived to L-ornithine in plants. The major contribution of L-ornithine and L-arginine as a precursor to the tropane ring was confirmed by Edward Leete.^[75] Ornithine then undergoes a pyridoxal phosphate-dependent decarboxylation to form putrescine. In animals, however, the urea cycle derives putrescine from ornithine. L-ornithine is converted to L-arginine,^[76] which is then decarboxylated via PLP to form agmatine. Hydrolysis of the imine derives N-carbamoylputrescine followed with hydrolysis of the urea to form putrescine. The separate pathways of converting ornithine to putrescine in plants and animals have converged. A SAM-dependent N-methylation of putrescine gives the N-methylputrescine product, which then undergoes oxidative deamination by the action of diamine oxidase to yield the aminoaldehyde. Schiff base formation confirms the biosynthesis of the N-methyl-Δ¹-pyrrolinium cation.

Robert Robinson's acetonedicarboxylate

The biosynthesis of the tropane alkaloid, however, is still uncertain. Hemscheidt proposes that Robinson's acetonedicarboxylate emerges as a potential intermediate for this reaction.^[77] Condensation of N-methylpyrrolinium and acetonedicarboxylate would generate the oxobutyrate. Decarboxylation leads to tropane alkaloid formation.

Reduction of tropinone

The reduction of tropinone is mediated by NADPH-dependent reductase enzymes, which have been characterized in multiple plant species.^[78] These plant species all contain two types of the reductase enzymes, tropinone reductase I and tropinone reductase II. TRI produces tropine and TRII produces pseudotropine. Due to differing kinetic and pH/activity characteristics of the enzymes and by the 25-fold higher activity of TRI over TRII, the majority of the tropinone reduction is from TRI to form tropine.^[79]

Detection in body fluids

Cocaine and its major metabolites may be quantitated in blood, plasma or urine to monitor for abuse, confirm a diagnosis of poisoning or assist in the forensic investigation of a traffic or other criminal violation or a sudden death. Most commercial cocaine immunoassay screening tests cross-react appreciably with the major cocaine metabolites, but chromatographic techniques can easily distinguish and separately measure each of these substances. When interpreting the results of a test, it is important to consider the cocaine usage history of the individual, since a chronic user can develop tolerance to doses that would incapacitate a cocaine-naive individual, and the chronic user often has high baseline values of the metabolites in his system. Cautious interpretation of testing results may allow a distinction between passive or active usage, and between smoking versus other routes of administration.^[80] In 2011, researchers at John Jay College of Criminal Justice reported that dietary zinc supplements can mask the presence of cocaine and other drugs in urine. Similar claims have been made in web forums on that topic.^[81]

History

Discovery

Coca leaf in Bolivia

For over a thousand years South American indigenous peoples have chewed the leaves of Erythroxylon coca, a plant that contains vital nutrients as well as numerous alkaloids, including cocaine. The coca leaf was, and still is, chewed almost universally by some indigenous communities. The remains of coca leaves have been found with ancient Peruvian mummies, and pottery from the time period depicts humans with bulged cheeks, indicating the presence of something on which they are chewing.^[82] There is also evidence that these cultures used a mixture of coca leaves and saliva as an anesthetic for the performance of trepanation.^[83]

When the Spanish arrived in South America, most at first ignored aboriginal claims that the leaf gave them strength and energy, and declared the practice of chewing it the work of the Devil.^{[citation needed]} But after discovering that these claims were true, they legalized and taxed the leaf, taking 10% off the value of each crop.^[84] In 1569, Nicolás Monardes described the indigenous peoples' practice of chewing a mixture of tobacco and coca leaves to induce "great contentment":^[85]

When they wished to make themselves drunk and out of judgment they chewed a mixture of tobacco and coca leaves which make them go as they were out of their wittes.

In 1609, Padre Blas Valera wrote:

Coca protects the body from many ailments, and our doctors use it in powdered form to reduce the swelling of wounds, to strengthen broken bones, to expel cold from the body or prevent it from entering, and to cure rotten wounds or sores that are full of maggots. And if it does so much for outward ailments, will not its singular virtue have even greater effect in the entrails of those who eat it?^{[citation needed]}

Isolation and naming

Although the stimulant and hunger-suppressant properties of coca had been known for many centuries, the isolation of the cocaine alkaloid was not achieved until 1855. Various European scientists had attempted to isolate cocaine, but none had been successful for two reasons: the knowledge of chemistry required was insufficient at the time.^{[citation needed]} Additionally contemporary conditions of sea-shipping from South America could degrade the cocaine in the plant samples available to Europeans.^{[citation needed]}

The cocaine alkaloid was first isolated by the German chemist Friedrich Gaedcke in 1855. Gaedcke named the alkaloid "erythroxyline", and published a description in the journal Archiv der Pharmazie.^[86]

In 1856, Friedrich Wöhler asked Dr. Carl Scherzer, a scientist aboard the Novara (an Austrian frigate sent by Emperor Franz Joseph to circle the globe), to bring him a large amount of coca leaves from South America. In 1859, the ship finished its travels and Wöhler received a trunk full of coca. Wöhler passed on the leaves to Albert Niemann, a Ph.D. student at the University of Göttingen in Germany, who then developed an improved purification process.^[87]

Niemann described every step he took to isolate cocaine in his dissertation titled Über eine neue organische Base in den Cocablättern (On a New Organic Base in the Coca Leaves), which was published in 1860—it earned him his Ph.D. and is now in the British Library. He wrote of the alkaloid's "colourless transparent prisms" and said that, "Its solutions have an alkaline reaction, a bitter taste, promote the flow of saliva and leave a peculiar numbness, followed by a sense of cold when applied to the tongue." Niemann named the alkaloid "cocaine" from "coca" (from Quechua "cuca") + suffix "ine".^[87]^[88] Because of its use as a local anesthetic, a suffix "-caine" was later extracted and used to form names of synthetic local anesthetics.

The first synthesis and elucidation of the structure of the cocaine molecule was by Richard Willstätter in 1898.^[69] The synthesis started from tropinone, a related natural product and took five steps. The name comes from "coca" and the alkaloid suffix "-ine", forming "cocaine".

Medicalization

"Cocaine toothache drops", 1885 advertisement of cocaine for dental pain in children

Advertisement in the January 1896 issue of McClure's Magazine for Burnett's Cocaine "for the hair".

With the discovery of this new alkaloid, Western medicine was quick to exploit the possible uses of this plant.

In 1879, Vassili von Anrep, of the University of Würzburg, devised an experiment to demonstrate the analgesic properties of the newly discovered alkaloid. He prepared two separate jars, one containing a cocaine-salt solution, with the other containing merely salt water. He then submerged a frog's legs into the two jars, one leg in the treatment and one in the control solution, and proceeded to stimulate the legs in several different ways. The leg that had been immersed in the cocaine solution reacted very differently from the leg that had been immersed in salt water.^[89]

Karl Koller (a close associate of Sigmund Freud, who would write about cocaine later) experimented with cocaine for ophthalmic usage. In an infamous experiment in 1884, he experimented upon himself by applying a cocaine solution to his own eye and then pricking it with pins. His findings were presented to the Heidelberg Ophthalmological Society. Also in 1884, Jellinek demonstrated the effects of cocaine as a respiratory system anesthetic. In 1885, William Halsted demonstrated nerve-block anesthesia,^[90] and James Leonard Corning demonstrated peridural anesthesia.^[91] 1898 saw Heinrich Quincke use cocaine for spinal anesthesia.

Today, cocaine has very limited medical use. See the section Cocaine as a local anesthetic

Popularization

Pope Leo XIII purportedly carried a hipflask of the coca-treated Vin Mariani with him, and awarded a Vatican gold medal to Angelo Mariani.^[92]

In 1859, an Italian doctor, Paolo Mantegazza, returned from Peru, where he had witnessed first-hand the use of coca by the local indigenous peoples. He proceeded to experiment on himself and upon his return to Milan he wrote a paper in which he described the effects. In this paper he declared coca and cocaine (at the time they were assumed to be the same) as being useful medicinally, in the treatment of "a furred tongue in the morning, flatulence, and whitening of the teeth."

A chemist named Angelo Mariani who read Mantegazza's paper became immediately intrigued with coca and its economic potential. In 1863, Mariani started marketing a wine called Vin Mariani, which had been treated with coca leaves, to become cocawine. The ethanol in wine acted as a solvent and extracted the cocaine from the coca leaves, altering the drink's effect. It contained 6 mg cocaine per ounce of wine, but Vin Mariani which was to be exported contained 7.2 mg per ounce, to compete with the higher cocaine content of similar drinks in the United States. A "pinch of coca leaves" was included in John Styth Pemberton's original 1886 recipe for Coca-Cola, though the company began using decocainized leaves in 1906 when the Pure Food and Drug Act was passed.

In 1879 cocaine began to be used to treat morphine addiction. Cocaine was introduced into clinical use as a local anesthetic in Germany in 1884, about the same time as Sigmund Freud published his work Über Coca, in which he wrote that cocaine causes:^{[citation needed]}

Exhilaration and lasting euphoria, which in no way differs from the normal euphoria of the healthy person. You perceive an increase of self-control and possess more vitality and capacity for work. In other words, you are simply normal, and it is soon hard to believe you are under the influence of any drug. Long intensive physical work is performed without any fatigue. This result is enjoyed without any of the unpleasant after-effects that follow exhilaration brought about by alcoholic beverages. No craving for the further use of cocaine appears after the first, or even after repeated taking of the drug.

In 1885 the U.S. manufacturer Parke-Davis sold cocaine in various forms, including cigarettes, powder, and even a cocaine mixture that could be injected directly into the user's veins with the included needle. The company promised that its cocaine products would "supply the place of food, make the coward brave, the silent eloquent and render the sufferer insensitive to pain."

By the late Victorian era cocaine use had appeared as a vice in literature. For example, it was injected by Arthur Conan Doyle's fictional Sherlock Holmes, generally to offset the boredom he felt when he was not working on a case.

In early 20th-century Memphis, Tennessee, cocaine was sold in neighborhood drugstores on Beale Street, costing five or ten cents for a small boxful. Stevedores along the Mississippi River used the drug as a stimulant, and white employers encouraged its use by black laborers.^[93]

In 1909, Ernest Shackleton took "Forced March" brand cocaine tablets to Antarctica, as did Captain Scott a year later on his ill-fated journey to the South Pole.^[94]

During the mid-1940s, amidst WWII, cocaine was considered for inclusion as an ingredient of a future generation of 'pep pills' for the German military code named D-IX.^[95]

Prohibition

Women purchase cocaine capsules in Berlin, 1924

Prohibition of cocaine in the United States

Calls for prohibition began long before the Harrison Act was passed by Congress in 1914 – a law requiring cocaine and narcotics to be dispensed only with a doctor's order.^[96] Before this, various factors and groups acted on primarily a state level influencing a move towards prohibition and away from a laissez-faire attitude.^[97] Cocaine consumption had grown in 1903 to about five times that of 1890, predominately by non-medical users outside the middle-aged, white, professional class. Cocaine became associated with laborers, youths, blacks and the urban underworld.^[98]

Popularization of cocaine is first evident with laborers who used it as a stimulant to increase productivity,^[98] often supplied by employers.^[99] African American workers were believed by employers to be better at physical work and it was thought that it provided added strength to their constitution which, according to the Medical News, made blacks “impervious to the extremes of heat and cold.”^[98] Instead, cocaine use quickly acquired a reputation as dangerous and in 1897, the first state bill of control for cocaine sales came from a mining county in Colorado.^[100] Laborers from other races used cocaine, such as in northern cities, where cocaine was often cheaper than alcohol.^[99] In the Northeast in particular, cocaine became popular amongst workers in factories, textile mills and on rail roads.^[101] In some instances, cocaine use supplemented or replaced caffeine as the drug-of-choice to keep workers awake and working overtime.^[101]

Fears of coerced cocaine use, and in particular that young girls would become addicted and thereby enter prostitution, were widespread.^[102]^[103] Tales of the corruption of the youth by cocaine were common but there is little evidence to support their veracity.^[102] Mainstream media reported cocaine epidemics as early as 1894 in Dallas, Texas. Reports of the cocaine epidemic would foreshadow a familiar theme in later so-called epidemics, namely that cocaine presented a social threat more dangerous than simple health effects and had insidious results when used by blacks and members of the lower class. Similar anxiety-ridden reports appeared throughout cities in the South leading some to declare that “the cocaine habit has assumed the proportions of an epidemic among the colored people.” In 1900, state legislatures in Alabama, Georgia and Tennessee considered anti-cocaine bills for the first time.^[104]

Hyperbolic reports of the effect of cocaine on African Americans went hand-in-hand with this hysteria. In 1901, the Atlanta Constitution reported that “Use of the drug [cocaine] among negroes is growing to an alarming extent.”^[105] The New York Times reported that under the influence of cocaine, “sexual desires are increased and perverted … peaceful negroes become quarrelsome, and timid negroes develop a degree of 'Dutch courage' that is sometimes almost incredible.”^[106] A medical doctor even wrote “cocaine is often the direct incentive to the crime of rape by the negroes.”^[106] To complete the characterization, a judge in Mississippi declared that supplying a “negro” with cocaine was more dangerous than injecting a dog with rabies.^[107]

These attitudes not only influenced drug law and policy but also led to increased violence against African Americans. In 1906, a major race riot led by whites erupted; it was sparked by reports of crimes committed by black ‘cocaine fiends.’^[105] Indeed, white-led, race riots spawning from reports of blacks under the influence of cocaine were not uncommon.^[108] Police in the South widely adopted the use of a heavier caliber handguns so as to better stop a cocaine-crazed black person – believed to be empowered with super-human strength.^[109] Another dangerous myth perpetuated amongst police was that cocaine imbued African Americans with tremendous accuracy with firearms and therefore police were better advised to shoot first in questionable circumstances.^[110] Ultimately public opinion rested against the cocaine user. Criminality was commonly believed to be a natural result of cocaine use.^[111] Much of the influence for these kind of perceptions came from the widespread publicity given to notorious cases.^[97] While the historical reality of cocaine’s effect on violence and crime is difficult to disentangle from inflamed perceptions, it does appear that public opinion was swayed by the image of the violent, cocaine-crazed fiend and pushed over the edge by a few violent episodes.^[111] It was an image of the cocaine-user that carried acute racial overtones.^[97]

Before any substantive federal regulation of cocaine, state and local municipalities evoked their own means to regulate cocaine. Because of the initial lack of targeted legislation, on both federal and state level, the most typical strategy by law enforcement was the application of nuisance laws pertaining to vagrancy and disturbing the peace.^[112] Subsequent legislative actions aimed at controlling the distribution of cocaine rather than its manufacture.^[113] Reformers took this approach in part because of legal precedents which made it easier to control distributors such as pharmacies; state and local boards of health or boards of pharmacy often took the place of regulatory bodies for controlling the distribution of cocaine.^[113] Some states took the position of outright banning of all forms of cocaine sale; Georgia was the first to do this in 1902.^[114] A New Orleans ordinance banned cocaine sales as well but left an ill-defined exception for therapeutic uses.^[113] A more common requirement was to restrict the sale of cocaine or impose labeling requirements. A 1907 California law limiting sale of cocaine to only those with a physician’s prescription resulted in the arrest of over 50 store owners and clerks in the first year.^[113] A 1913 New York state law limited druggists’ cocaine stocks to under 5 ounces. Labeling requirements initially operated on a state level with some states even going so far as to require that cocaine and cocaine-containing products be labeled as poison.^[115]

Eventually the federal government stepped in and instituted a national labeling requirement for cocaine and cocaine-containing products through the Food and Drug Act of 1906.^[115] The next important federal regulation was the Harrison Narcotics Tax Act of 1914. While this act is often seen as the start of prohibition, the act itself was not actually a prohibition on cocaine, but instead set up a regulatory and licensing regime.^[96] The Harrison Act did not recognize addiction as a treatable condition and therefore the therapeutic use of cocaine, heroin or morphine to such individuals was outlawed – leading the Journal of American Medicine to remark, “[the addict] is denied the medical care he urgently needs, open, above-board sources from which he formerly obtained his drug supply are closed to him, and he is driven to the underworld where he can get his drug, but of course, surreptitiously and in violation of the law.”^[116] The Harrison Act left manufacturers of cocaine untouched so long as they met certain purity and labeling standards.^[117] Despite that cocaine was typically illegal to sell and legal outlets were more rare, the quantities of legal cocaine produced declined very little.^[117] Legal cocaine quantities did not decrease until the Jones-Miller Act of 1922 put serious restrictions on cocaine manufactures.^[117]

Modern usage

D.C. Mayor Marion Barry captured on a surveillance camera smoking crack cocaine during a sting operation by the FBI and D.C. Police.

In many countries, cocaine is a popular recreational drug. In the United States, the development of "crack" cocaine introduced the substance to a generally poorer inner-city market. Use of the powder form has stayed relatively constant, experiencing a new height of use during the late 1990s and early 2000s in the U.S., and has become much more popular in the last few years in the UK.^{[citation needed]}^[when?]

Cocaine use is prevalent across all socioeconomic strata, including age, demographics, economic, social, political, religious, and livelihood.^{[citation needed]}

The estimated U.S. cocaine market exceeded US$70 billion in street value for the year 2005, exceeding revenues by corporations such as Starbucks.^[118]^[119] There is a tremendous demand for cocaine in the U.S. market, particularly among those who are making incomes affording luxury spending, such as single adults and professionals with discretionary income. Cocaine’s status as a club drug shows its immense popularity among the "party crowd".

In 1995 the World Health Organization (WHO) and the United Nations Interregional Crime and Justice Research Institute (UNICRI) announced in a press release the publication of the results of the largest global study on cocaine use ever undertaken. However, a decision by an American representative in the World Health Assembly banned the publication of the study, because it seemed to make a case for the positive uses of cocaine. An excerpt of the report strongly conflicted with accepted paradigms, for example "that occasional cocaine use does not typically lead to severe or even minor physical or social problems."^[120] In the sixth meeting of the B committee the US representative threatened that "If WHO activities relating to drugs failed to reinforce proven drug control approaches, funds for the relevant programs should be curtailed". This led to the decision to discontinue publication. A part of the study has been recuperated. Available are profiles of cocaine use in 20 countries.

It was reported in October 2010 that the use of cocaine in Australia has doubled since monitoring began in 2003.^[121]

A problem with illegal cocaine use, especially in the higher volumes used to combat fatigue (rather than increase euphoria) by long-term users, is the risk of ill effects or damage caused by the compounds used in adulteration. Cutting or "stepping on" the drug is commonplace, using compounds which simulate ingestion effects, such as Novocain (procaine) producing temporary anesthaesia as many users believe a strong numbing effect is the result of strong and/or pure cocaine, ephedrine or similar stimulants that are to produce an increased heart rate. The normal adulterants for profit are inactive sugars, usually mannitol, creatine or glucose, so introducing active adulterants gives the illusion of purity and to 'stretch' or make it so a dealer can sell more product than without the adulterants.^{[citation needed]} The adulterant of sugars therefore allows the dealer to sell the product for a higher price because of the illusion of purity and allows to sell more of the product at that higher price, enabling dealers to significantly increase revenue with little additional cost for the adulterants. A study by the European Monitoring Centre for Drugs and Drug Addiction in 2007 showed that the purity levels for street purchased cocaine was often under 5% and on average under 50% pure.^[122]

Society and culture

Legal status

The production, distribution and sale of cocaine products is restricted (and illegal in most contexts) in most countries as regulated by the Single Convention on Narcotic Drugs, and the United Nations Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances. In the United States the manufacture, importation, possession, and distribution of cocaine is additionally regulated by the 1970 Controlled Substances Act.

Some countries, such as Peru and Bolivia permit the cultivation of coca leaf for traditional consumption by the local indigenous population, but nevertheless prohibit the production, sale and consumption of cocaine. In addition, some parts of Europe and Australia allow processed cocaine for medicinal uses only.

Interdiction

In 2004, according to the United Nations, 589 tonnes of cocaine were seized globally by law enforcement authorities. Colombia seized 188 t, the United States 166 t, Europe 79 t, Peru 14 t, Bolivia 9 t, and the rest of the world 133 t.^[123]

Usage

According to a 2007 United Nations report, Spain is the country with the highest rate of cocaine usage (3.0% of adults in the previous year).^[124] Other countries where the usage rate meets or exceeds 1.5% are the United States (2.8%), England and Wales (2.4%), Canada (2.3%), Italy (2.1%), Bolivia (1.9%), Chile (1.8%), and Scotland (1.5%).^[124]

Europe

Cocaine is the second most popular illegal recreational drug in Europe (behind cannabis). Since the mid-1990s, overall cocaine usage in Europe has been on the rise, but usage rates and attitudes tend to vary between countries. Countries with the highest usage rates are: The United Kingdom, Spain, Italy, and Republic of Ireland.

Approximately 12 million Europeans (3.6%) have used cocaine at least once, 4 million (1.2%) in the last year, and 2 million in the last month (0.5%).

About 3.5 million or 87.5% of those who have used the drug in the last year^[when?] are young adults (15–34 years old). Usage is particularly prevalent among this demographic: 4% to 7% of males have used cocaine in the last year in Spain, Denmark, Republic of Ireland, Italy, and the United Kingdom. The ratio of male to female users is approximately 3.8:1, but this statistic varies from 1:1 to 13:1 depending on country.^[125]

In 2014 London had the highest amount of cocaine in their sewage out of 50 European cities.^[126]

North America

United States

Cocaine is the second most popular illegal recreational drug in the United States (behind cannabis)^[127] and the U.S. is the world's largest consumer of cocaine.^[128] Cocaine is commonly used in middle to upper class communities and is known as a "rich man's drug". It is also popular amongst college students, as a party drug. A study throughout the entire United States has reported that around 48 percent of people who graduated high school in 1979 have used Cocaine recreationally during some point in their lifetime, compared to approximately 20 percent of students who graduated between the years of 1980 and 1995. ^[129] Its users span over different ages, races, and professions. In the 1970s and 1980s, the drug became particularly popular in the disco culture as cocaine usage was very common and popular in many discos such as Studio 54.

Economics

Because of the drugs potential for addiction and overdose, cocaine is generally treated as a 'hard drug', with severe penalties for possession and trafficking. Demand remains high, and consequently black market cocaine is quite expensive. Unprocessed cocaine, such as coca leaves, are occasionally purchased and sold, but this is exceedingly rare as it is much easier and more profitable to conceal and smuggle it in powdered form. The scale of the market is immense: 770 tonnes times $100 per gram retail = up to $77 billion.^{[citation needed]}

Production

Until 2012, Colombia was the world's leading producer of cocaine.^[130]^[131] Three-quarters of the world's annual yield of cocaine has been produced in Colombia, both from cocaine base imported from Peru (primarily the Huallaga Valley) and Bolivia, and from locally grown coca. There was a 28% increase from the amount of potentially harvestable coca plants which were grown in Colombia in 1998. This, combined with crop reductions in Bolivia and Peru, made Colombia the nation with the largest area of coca under cultivation after the mid-1990s. Coca grown for traditional purposes by indigenous communities, a use which is still present and is permitted by Colombian laws, only makes up a small fragment of total coca production, most of which is used for the illegal drug trade.

An interview with a coca farmer published in 2003 described a mode of production by acid-base extraction that has changed little since 1905. Roughly 625 pounds (283 kg) of leaves were harvested per hectare, six times per year. The leaves were dried for half a day, then chopped into small pieces with a strimmer and sprinkled with a small amount of powdered cement (replacing sodium carbonate from former times). Several hundred pounds of this mixture was soaked in 50 US gallons (190 L) of gasoline for a day, then the gasoline was removed and the leaves were pressed for remaining liquid, after which they could be discarded. Then battery acid (weak sulfuric acid) was used, one bucket per 55 lb (25 kg) of leaves, to create a phase separation in which the cocaine free base in the gasoline was acidified and extracted into a few buckets of "murky-looking smelly liquid". Once powdered caustic soda was added to this, the cocaine precipitated and could be removed by filtration through a cloth. The resulting material, when dried, was termed pasta and sold by the farmer. The 3750 pound yearly harvest of leaves from a hectare produced 6 lb (2.5 kg) of pasta, approximately 40–60% cocaine. Repeated recrystallization from solvents, producing pasta lavada and eventually crystalline cocaine, were performed at specialized laboratories after the sale.^[132]

Attempts to eradicate coca fields through the use of defoliants have devastated part of the farming economy in some coca growing regions of Colombia, and strains appear to have been developed that are more resistant or immune to their use. Whether these strains are natural mutations or the product of human tampering is unclear. These strains have also shown to be more potent than those previously grown, increasing profits for the drug cartels responsible for the exporting of cocaine. Although production fell temporarily, coca crops rebounded in numerous smaller fields in Colombia, rather than the larger plantations.

The cultivation of coca has become an attractive, and in some cases even necessary, economic decision on the part of many growers due to the combination of several factors, including the persistence of worldwide demand, the lack of other employment alternatives, the lower profitability of alternative crops in official crop substitution programs, the eradication-related damages to non-drug farms, and the spread of new strains of the coca plant.

Estimated Andean region coca cultivation and potential pure cocaine production^[133]
	2000	2001	2002	2003	2004
Net cultivation km² (sq mi)	1,875 (724)	2,218 (856)	2,007.5 (775.1)	1,663 (642)	1,662 (642)
Potential pure cocaine production (tonnes)	770	925	830	680	645

The latest estimate provided by the U.S. authorities on the annual production of cocaine in Colombia refers to 290 metric tons. As of the end of 2011, the seizure operations of Colombian cocaine carried out in different countries have totaled 351.8 metric tons of cocaine, i.e. 121.3% of Colombia’s annual production according to the U.S. Department of State’s estimates. ^[134]^[135]

Synthesis

Synthetic cocaine would be highly desirable to the illegal drug industry, as it would eliminate the high visibility and low reliability of offshore sources and international smuggling, replacing them with clandestine domestic laboratories, as are common for illicit methamphetamine. However, natural cocaine remains the lowest cost and highest quality supply of cocaine. Actual full synthesis of cocaine is rarely done. Formation of inactive enantiomers (cocaine has 4 chiral centres – 1R, 2R, 3S, and 5S – hence a total potential of 16 possible enantiomers and diastereoisomers) plus synthetic by-products limits the yield and purity. Names like "synthetic cocaine" and "new cocaine" have been misapplied to phencyclidine (PCP) and various designer drugs.

Trafficking and distribution

Cocaine smuggled in a charango, 2008

Organized criminal gangs operating on a large scale dominate the cocaine trade. Most cocaine is grown and processed in South America, particularly in Colombia, Bolivia, Peru, and smuggled into the United States and Europe, the United States being the world's largest consumer of cocaine,^[128] where it is sold at huge markups; usually in the US at $80–$120 for 1 gram, and $250–300 for 3.5 grams (⅛ of an ounce, or an "eight ball").

Caribbean and Mexican routes

Cocaine shipments from South America transported through Mexico or Central America are generally moved over land or by air to staging sites in northern Mexico. The cocaine is then broken down into smaller loads for smuggling across the U.S.–Mexico border. The primary cocaine importation points in the United States are in Arizona, southern California, southern Florida, and Texas. Typically, land vehicles are driven across the U.S.-Mexico border. Sixty five percent of cocaine enters the United States through Mexico, and the vast majority of the rest enters through Florida.^[136]

Cocaine traffickers from Colombia, and recently Mexico, have also established a labyrinth of smuggling routes throughout the Caribbean, the Bahama Island chain, and South Florida. They often hire traffickers from Mexico or the Dominican Republic to transport the drug. The traffickers use a variety of smuggling techniques to transfer their drug to U.S. markets. These include airdrops of 500 to 700 kg (1,102 to 1,543 lb) in the Bahama Islands or off the coast of Puerto Rico, mid-ocean boat-to-boat transfers of 500 to 2,000 kg (1,102 to 4,409 lb), and the commercial shipment of tonnes of cocaine through the port of Miami.

Chilean route

Another route of cocaine traffic goes through Chile, this route is primarily used for cocaine produced in Bolivia since the nearest seaports lie in northern Chile. The arid Bolivia-Chile border is easily crossed by 4x4 vehicles that then head to the seaports of Iquique and Antofagasta. While the price of cocaine is higher in Chile than in Peru and Bolivia, the final destination is usually Europe, especially Spain where drug dealing networks exist among South American immigrants.

Techniques

Cocaine is also carried in small, concealed, kilogram quantities across the border by couriers known as “mules” (or “mulas”), who cross a border either legally, for example, through a port or airport, or illegally elsewhere. The drugs may be strapped to the waist or legs or hidden in bags, or hidden in the body. If the mule gets through without being caught, the gangs will reap most of the profits. If he or she is caught however, gangs will sever all links and the mule will usually stand trial for trafficking alone.

Bulk cargo ships are also used to smuggle cocaine to staging sites in the western Caribbean–Gulf of Mexico area. These vessels are typically 150–250-foot (50–80 m) coastal freighters that carry an average cocaine load of approximately 2.5 tonnes. Commercial fishing vessels are also used for smuggling operations. In areas with a high volume of recreational traffic, smugglers use the same types of vessels, such as go-fast boats, as those used by the local populations.

Sophisticated drug subs are the latest tool drug runners are using to bring cocaine north from Colombia, it was reported on 20 March 2008. Although the vessels were once viewed as a quirky sideshow in the drug war, they are becoming faster, more seaworthy, and capable of carrying bigger loads of drugs than earlier models, according to those charged with catching them.^[137]

Sales to consumers

Cocaine adulterated with fruit flavoring

Cocaine is readily available in all major countries' metropolitan areas. According to the Summer 1998 Pulse Check, published by the U.S. Office of National Drug Control Policy, cocaine use had stabilized across the country, with a few increases reported in San Diego, Bridgeport, Miami, and Boston. In the West, cocaine usage was lower, which was thought to be due to a switch to methamphetamine among some users; methamphetamine is cheaper, three and a half times more powerful, and lasts 12 to 24 times longer with each dose.^[138]^[139] Nevertheless, the number of cocaine users remain high, with a large concentration among urban youth.

In addition to the amounts previously mentioned, cocaine can be sold in "bill sizes": for example, $10 might purchase a "dime bag," a very small amount (0.1–0.15 g) of cocaine. Twenty dollars might purchase 0.15–0.3 g. However, in lower Texas, it is sold cheaper due to it being easier to receive: a dime for $10 is 0.4g, a 20 is 0.8–1.0 gram and an 8-ball (3.5g) is sold for $60 to $80, depending on the quality and dealer. These amounts and prices are very popular among young people because they are inexpensive and easily concealed on one's body. Quality and price can vary dramatically depending on supply and demand, and on geographic region.^[140]

The European Monitoring Centre for Drugs and Drug Addiction reports that the typical retail price of cocaine varied between €50 and €75 per gram in most European countries, although Cyprus, Romania, Sweden and Turkey reported much higher values.^[141]

Consumption

World annual cocaine consumption, as of 2000, stands at around 600 tonnes, with the United States consuming around 300 t, 50% of the total, Europe about 150 t, 25% of the total, and the rest of the world the remaining 150 t or 25%.^[142]

The 2010 UN World Drug Report concluded that "it appears that the North American cocaine market has declined in value from US$47 billion in 1998 to US$38 billion in 2008. Between 2006 and 2008, the value of the market remained basically stable."^[143]

Research

In 2005, researchers proposed the use of cocaine in conjunction with phenylephrine administered in the form of an eye drop as a diagnostic test for Parkinson's disease.^[144]

References

^ Freye, Enno (2009). Pharmacology and abuse of cocaine, amphetamines, ecstasy and related designer drugs a comprehensive review on their mode of action, treatment of abuse and intoxication (Online-Ausg. ed.). Dordrecht: Springer. p. 63. ISBN 9789048124480.
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Bibliography

Gootenberg, Paul, ed. (1999). Cocaine: Global Histories. London: Routledge. ISBN 0-203-02646-2.
Madge, Tim (2001). White Mischief: A Cultural History of Cocaine. Madge (Edinburgh: Mainstream Publishing Company). ISBN 978-1-84018-405-1.
Spillane, Joseph F. (2000). Cocaine: From Medical Marvel to Modern Menace in the United States, 1884–1920. Baltimore and London: The Johns Hopkins University Press. ISBN 0-8018-6230-2.

External links

A look at the Evidence for Cocaine in Mummies at the Wayback Machine (archived 22 August 2013)
EMCDDA drugs profile: Cocaine (2007)
Erowid – Cocaine Information — A collection of data about cocaine including dose, effects, chemistry, legal status, images and more.
Slang Dictionary for Cocaine.
Cocaine content of plants
Cocaine – The History and the Risks at h2g2
Cocaine Frequently Asked Questions
U.S. National Library of Medicine: Drug Information Portal – Cocaine
Cocaine Market Data and Value-Havocscope Black Markets at the Wayback Machine (archived 23 March 2011) Data on cocaine trafficking worldwide.

UpToDate Contents

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1. 成人におけるコカイン乱用および依存 cocaine abuse and dependence in adults
2. コカイン乱用による心血管系合併症の評価およびマネージメント evaluation and management of the cardiovascular complications of cocaine abuse
3. コカイン：急性中毒 cocaine acute intoxication
4. コカイン乱用の肺合併症 pulmonary complications of cocaine abuse
5. 違法薬物の急性摂取（体内隠匿による） acute ingestion of illicit drugs body stuffing

English Journal

Enzyme-amplified electronic logic gates based on split/intactaptamers.

Chen J, Zeng L.SourceKey Laboratory of Regenerative Biology, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou 510530, China.
Biosensors & bioelectronics.Biosens Bioelectron.2013 Apr 15;42:93-9. doi: 10.1016/j.bios.2012.10.030. Epub 2012 Oct 17.
A series of enzyme-amplified electronic logic gates (OR, AND, NOR, and NAND) for one-spot simultaneous monitoring of small molecules and proteins has been constructed at the molecular level. This simple but universal system is based on target-induced self-assembly of split aptamer fragments or targe
PMID 23202336

Clinical characteristics as a function of referral status among substance users in residential treatment.

Banducci AN, Dahne J, Magidson JF, Chen K, Daughters SB, Lejuez CW.SourceCenter for Addictions, Personality, and Emotion Research, University of Maryland College Park, Department of Psychology, 1147 Biology Psychology Building, College Park, MD 20742, United States. Electronic address: banducci@umd.edu.
Addictive behaviors.Addict Behav.2013 Apr;38(4):1924-30. doi: 10.1016/j.addbeh.2012.12.015. Epub 2012 Dec 24.
In the United States, substance users who voluntarily (VO) elect to receive treatment and substance users who are court-mandated (CM) to receive treatment typically obtain care within the same facilities. Little is known about the clinical characteristics that differentiate these individuals. The cu
PMID 23380487

Japanese Journal

Label-free Electrochemical Cocaine Aptasensor Based on a Target-inducing Aptamer Switching Conformation

HUA Mei,TAO Manlan,WANG Ping,ZHANG Yinfeng,WU Zaisheng,CHANG Yanbing,YANG Yunhui
Analytical sciences : the international journal of the Japan Society for Analytical Chemistry 26(12), 1265-1270, 2010-12-10
NAID 10027574853

P-094 局所麻酔薬コカイン投与時の嗅細胞膜電流変化(ポスターセッション,2010年度日本味と匂学会第44回大会)

玉利健悟,竹内裕子,小林正佳,倉橋隆,山本哲朗
日本味と匂学会誌 17(3), 427-430, 2010-12
NAID 110008451378

Related Pictures

★リンクテーブル★

リンク元	「ドパミン」「薬物濫用」「コカイン」
拡張検索	「cocaine user」「cocaine dependence」「cocaine addiction」「cocaine-related disorder」「cocaine hydrochloride」

「ドパミン」

Cocaine
Systematic (IUPAC) name
	methyl (1R,2R,3S,5S)-3- (benzoyloxy)-8-methyl-8-azabicyclo[3.2.1] octane-2-carboxylate
Clinical data
AHFS/Drugs.com	Micromedex Detailed Consumer Information
Pregnancy; category	US: C (Risk not ruled out);
Legal status	AU: Controlled (S8); CA: Schedule I; NZ: Class A; UK: Class A; US: Schedule II; UN: Narcotic Schedules I and III; ℞ (Prescription only);
Dependence; liability	Physical: Yes; Psychological: High
Addiction; liability	High
Routes of; administration	Topical, oral, insufflation, intravenous
Pharmacokinetic data
Bioavailability	Oral: 33%; Insufflated: 60–80%; Nasal spray: 25–43%
Metabolism	Hepatic CYP3A4
Onset of action	Seconds to minutes
Half-life	1 hour
Excretion	Renal (benzoylecgonine and ecgonine methyl ester)
Identifiers
CAS Registry Number	50-36-2
ATC code	N01BC01 R02AD03, S01HA01, S02DA02
PubChem	CID: 5760
IUPHAR ligand	2286
DrugBank	DB00907
ChemSpider	10194104
UNII	I5Y540LHVR
KEGG	D00110
ChEBI	CHEBI:27958
ChEMBL	CHEMBL120901
Synonyms	benzoylmethylecgonine
PDB ligand ID	COC (PDBe, RCSB PDB)
Chemical data
Formula	C17H21NO4
Molecular mass	303.353 g/mol
	SMILES CN1[C@H]2CC[C@@H]1[C@@H](C(OC)=O)[C@@H](OC(C3=CC=CC=C3)=O)C2;
	InChI InChI=1S/C17H21NO4/c1-18-12-8-9-13(18)15(17(20)21-2)14(10-12)22-16(19)11-6-4-3-5-7-11/h3-7,12-15H,8-10H2,1-2H3/t12-,13+,14-,15+/m0/s1 ; Key:ZPUCINDJVBIVPJ-LJISPDSOSA-N ;
Physical data
Melting point	98 °C (208 °F)
Boiling point	187 °C (369 °F)
Solubility in water	HCl: 1800–2500 mg/mL (20 °C)
See also: data page
(what is this?) (verify)

　　[★]

英: dopamine DA DOA 3,4-dihydroxyphenethylamine
同: ドーパミン
化: 塩酸ドパミン, dopamine hydrochloride, ドパミン塩酸塩
商: イノバン、イブタント、カコージンD、カコージン、カタボン、ガバンス、クリトパン、ツルドパミ、ドパラルミン、ドミニン、トロンジン、プレドパ、マートバーン、ヤエリスタ
関: ドパミン受容体、カテコラミン。強心剤

概念

カテコラミンの一つ

生合成

チロシン→L-dopa→ドパミン→ノルアドレナリン→アドレナリン
脳、交感神経、交感神経節、副腎皮質のクロム親和性細胞で産生される

視床下部-下垂体系

視床下部弓状核や脳室周辺の隆起漏斗系ドパミンニューロンで産生される。
下垂体のD2受容体を介してホルモン分泌の調節を受けている。　→ e.g. プロラクチン放出抑制ホルモン(PIF)

ドパミン受容体

D₁受容体

低用量での血管拡張はこの受容体を介して起こる (GOO.249)

D₂受容体

中枢神経系に存在

神経伝達物質の薬理 (GOO.324)

神経伝達物質	トランスポーター阻害薬	受容体のサブタイプ	選択的作動薬	選択的阻害薬	受容体と共役する分子
ドパミン	cocaine mazindol nomifensine	D₁			G_s
		D₂	bromocriptine	sulpiride domperidone	G_i
		D₃	7-OH-DPAT
		D₄
		D₅			G_s

薬理学

低濃度

D₁受容体に作用して血管拡張→腎血流量↑→GFP↑→Na排出↑→利尿

やや高濃度

β₁受容体に作用→心拍出量↑・心収縮力↑(頻脈はない)・収縮期圧↑・拡張期圧不変

アドレナリン低用量投与と同じ？

高濃度

α₁受容体に作用→血管平滑筋収縮(→収縮期圧↑、拡張期圧↑？？？)

アドレナリン高用量投与と同じ？

ran]]

(PT.218)

中脳に細胞体を持つものが多く、黒質から線条体に至る黒質線条体系と黒質や腹側被蓋野から報酬系の神経核、辺縁系、前頭葉に至る中脳皮質系がある。視床下部やその周辺にもドーパミン作動性線維の細胞体とその終末があり、隆起漏斗系、隆起下垂体系、不確帯視床下部系、脳室周囲系を形成する。黒質線条体系の変性はパーキンソン病をもたらす。ドーパミン誘導体には幻覚剤となるものがある。ドーパミンの分泌増大や脳のD2受容体の増加は精神分裂病（統合失調症）の発病に関与している可能性がある。モルヒネはドーパミンの分泌を促進する。コカインは輸送体によるドーパミンの取り込みを阻害し作用の持続時間を延長する。一部の覚醒剤中毒はドーパミン輸送体の抑制による。

ホルモンの調節

プロラクチンは視床下部でドパミンの産生を促進　←　プロラクチン抑制因子として作用
ドパミンは視床下部でGnRHの分泌を抑制　→　卵巣機能の抑制
ドパミンは下垂体前葉？でD受容体に作用してプロラクチンを抑制　←　抗精神病薬(D2受容体をブロックする)を使うと高プロラクチン血症となる。

循環不全治療薬として

イノバン

下記のような急性循環不全(心原性ショック、出血性ショック)

(1) 無尿、乏尿や利尿剤で利尿が得られない状態　　←　　低濃度で用いれば、腎血流を増加させ尿量の増加が期待できる　→　ドパミン#薬理学
(2) 脈拍数の増加した状態　　←　　高濃度でなければ、頻脈を起こさず心拍出量を増やす。　→　ドパミン#薬理学
(3) 他の強心・昇圧剤により副作用が認められたり、好ましい反応が得られない状態

「薬物濫用」

　　[★]

英: drug abuse, substance abuse
同: 薬物乱用
関: 薬物依存、薬物嗜癖、物質乱用、物質依存症、薬物使用、接着剤吸引

薬物使用が身体に及ぼす効果

濫用 substance abuse：a pattern of abnormal substance use that leads to impairment of occupational, physical, or social functioning(BBS.73)
依存 substance dependence：ub stance abuse puls withdrawal symptoms, tolerance, or a pattern of repetitive use(BBS.73)
離脱 withdrawal：the development of physical or pschological symptoms after the reduction or cessation of intake of a substance(BBS.73)
耐性 tolerance：the need for increased amounts of the substance to achieve the same positive psychological effect(BBS.73)
交差耐性 cross-tolerance：the development of tolerance to one substance as the result of using another substance(BBS.73)

薬物

1. 中枢神経興奮薬(覚醒剤を含む) stimulants　　身体依存はないとされている

カフェイン caffeine
ニコチン nicotine
amphetamines　精神依存有り。身体依存無し

アンフェタミン amphetamine　精神依存有り。身体依存無し。耐性は連用で出現
デキストロアンフェタミン dextroamphetamine Dexedrine
メタンフェタミン methamphetamine Desoxyn speed ice ヒロポン　精神依存有り。身体依存無し。耐性は連用で出現　　←　以前、日本で多く使われた
メチルフェニデート methylphenidate Ritalin
methylene dioxymethamphetamine MDMA ecstasy

コカイン cocaine crack freebase　精神依存有り。身体依存無し　精神依存生じやすい。耐性発現殆ど無し　コカ

2. sedatives

alcohol　　精神依存有り。身体依存有り。
barbiturates
benzodiazepines

⇔flumazenil Mazicon Romazicon

3. opioids

morphine　精神依存・身体依存有り　けし
heroin　精神依存・身体依存が強い。耐性発現早い。離脱症状激しい
codeine
pethidine
fentanyl
methadone
l-alpha-acetylmethadol acetate LAMM
buprenorphine Temgesic

4. hallucinogens and related agents

cannabis(marijuana(tetrahydrocannabinol THC,hashish)　精神依存有り。身体依存無し　精神依存軽度。耐性は長期使用で軽度出現　大麻草
lysergic acid diethylamide LSD
phencyclidine PCP angel dust
psilocybin
mescaline

精神依存、身体依存

	精神依存	身体依存
コカイン、アンフェタミン類(アンフェタミン、メチルフェタミン)、大麻	○
麻薬(モルヒネ、ヘロイン、コデイン)、バルビツール酸系(フェノバルビタール、チオペンタール)、アルコール	○	○

「コカイン」

　　[★]

英: cocaine
ラ: cocainum
化: 塩酸コカイン cocaine hydrochloride
関: 薬物濫用、麻薬; コカアルカロイド系製剤

概念

俗名"crack","freebase" (BBS.74)
コカの葉に含まれるアルカロイド。精製するとコカインとなる。
濫用薬物としての分類はstimutans(see. 薬物濫用)
麻酔作用がある　→　エステル型の局所麻酔薬として使われる

構造

作用機序

神経線維の膜の安定化
ドーパミン、ノルアドレナリン、セロトニンの神経終末への取り込みを阻害する (GOO.620)

薬理作用

局所麻酔作用
交感神経興奮作用
中枢神経興奮作用

動態

皮膚からの吸収：悪い
粘膜からの吸収：良好

適応

粘膜の表面麻酔

注意

高血圧症、心疾患、甲状腺中毒症、MAO阻害薬使用時には注意して投与しなければならない (SPC.171)

MAO阻害薬を服用している場合、神経終末部のニューロン内でノルアドレナリン濃度の上昇を期待→コカインはノルアドレナリンのuptake1を抑制→MAO阻害薬の作用が減弱

麻薬としてのコカイン

種類：stimulants
症状：幻覚、性欲亢進、不眠。精神依存強

妊娠中の妊婦がコカインを使用すると、新生児にhyperactivityやgrowth retardationが見られる
虫が体を這うような幻触(tactile hallucination)が見られる("cocaine bugs")

"crack", "freebase"は安価なコカインであり、喫煙により吸入する。精製したコカインは鼻孔から嗅いで吸引する。

「cocaine user」

　　[★]

コカイン使用者、コカイン常習者

関: cocaine abuse、cocaine addiction、cocaine dependence、cocaine-related disorder

「cocaine dependence」

　　[★]

コカイン依存、コカイン依存症

関: cocaine abuse、cocaine addiction、cocaine user、cocaine-related disorder

「cocaine addiction」

　　[★]

コカイン中毒、コカイン嗜癖

関: cocaine abuse、cocaine dependence、cocaine user、cocaine-related disorder

「cocaine-related disorder」

　　[★]

コカイン関連疾患

関: cocaine abuse、cocaine addiction、cocaine dependence、cocaine user

「cocaine hydrochloride」

　　[★] コカイン、塩酸コカイン

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cocaine

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Contents

Uses

Medical

Recreational

Oral

Coca leaf

Insufflation

Injection

Inhalation

Suppository

Adverse effects

Acute

Chronic

Addiction

Dependence and withdrawal

Pharmacology

Pharmacodynamics

Pharmacokinetics

Physical and chemical properties

Appearance

Forms

Salts

Basic

Crack cocaine

Coca leaf infusions

Biosynthesis

N-methyl-pyrrolinium cation

Robert Robinson's acetonedicarboxylate

Reduction of tropinone

Detection in body fluids

History

Discovery

Isolation and naming

Medicalization

Popularization

Prohibition

Prohibition of cocaine in the United States

Modern usage

Society and culture

Legal status

Interdiction

Usage

Europe

North America

United States

Economics

Production

Synthesis

Trafficking and distribution

Caribbean and Mexican routes

Chilean route

Techniques

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Research

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