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Sunday, December 17, 2017

Crack Cocaine

Overview

Crack is a free base form of the highly addictive stimulant cocaine, and is the most addictive form of cocaine. Crack abuse is common in the U.S, and particularly in more poverty stricken communities, with an estimated one million Americans being considered regular users in 2016.1 Crack cocaine is so addictive due to its close interaction with dopamine production in the brain.

Crack cocaine remains one of the most deadly recreational drugs found today due to its potency, frequency of being cut with dangerous and toxic additives, negative physiological effects, and how easy it is to build a tolerance to it. Overdoses on cocaine are relatively common, with cocaine accounting for 7,000 deaths due to overdose in 2015.2 However, death from cocaine abuse is more common in its sustained damage to the respiratory and cardiovascular system.

Cocaine exhibits short-term effects similar to other stimulants including alertness, euphoria, decreased appetite, and mood shifts. Long term abuse of cocaine can lead to a variety of physiological and mental ailments including infections, body deterioration, cardiovascular problems, depression, anxiety, paranoia, and sustained respiratory damage. There are currently no effective pharmaceutical treatments for cocaine addiction, but many breakthroughs are being made in developing medications that can be used in recovery, and rehabilitation facilities offer extensive resources for recovering from cocaine addiction in a safe, stable, and comfortable manner.  

What is Crack?

Crack is considered the most dangerous and addictive form of cocaine available. Crack holds a reputation for its short-lasting intense feelings of energy and euphoria as well as its potent addictiveness. Stimulants are a class of drugs that include dangerous street drugs like cocaine, common prescription drugs such as Adderall, and even your ordinary cup of coffee.

Crack is a free base form of cocaine, which refers to a method of turning the protonated form of cocaine that is commonly snorted or injected into a deprotonated form that can be effectively smoked. This process is commonly performed under unsafe conditions in home labs or even kitchens and usually incorporates a variety of additives that can provide a higher overall yield, such as sodium bicarbonate. Cocaine is created with the use of coca leaves, and the abundance of coca plants and the high demand of cocaine have created a massive drug trade that runs throughout all of South America to supply the worldwide cocaine addiction.

Crack cocaine addiction has been dropping since its peak through the late 1980s and early 1990s, but is still frequently found in impoverished areas and communities. The National Institute of Drug Abuse estimates around 7,000 deaths attributed to cocaine both in ordinary and free base form in 2015 alone. Deaths from crack can come in the form of overdosing, particularly in those with a hypersensitivity to cocaine, or long-term users who have built up a tolerance to the drug. Death from damage to the central nervous system and the circulatory system from use of cocaine is also common. Crack cocaine is classified as a Schedule II drug by the Controlled Substances Act (CSA), meaning that cocaine has some accepted medical usage under severe restriction, but is not considered safe for use either due to its high potential for abuse.

How Does Crack Addiction Work?

Cocaine’s deadly addictiveness can be attributed primarily to its effectiveness at blocking dopamine transporters in the brain, which traps already released dopamine in the synapse and allows it to bind over and over to dopamine receptors in the synapse, overstimulating the receptors and causing permanent damage to the cell. Dopamine is a neurotransmitter that is colloquially known as the ‘happiness drug’ due to its purpose in producing feelings of well-being and pleasure when released into the brain.

When the body is hurt, the brain produces natural opiates that allow dopamine to be released in the areas of the brain commonly responsible for feelings of pain and stress, which works to reduce overall feelings of pain. However, once dopamine has done its job, it must be taken back out of the synapse to avoid overstimulating the cell. Cocaine disables this preventative measure in the brain. Because the brain isn’t capable of handling such frequent binding of dopamine, dopamine receptors become damaged and make it more difficult to feel pleasure, leading users to use more and more cocaine to chase the fleeting euphoria it once offered them.

Crack is particular addictive because, once smoked, it concentrates in the area of the brain known as the reward pathway, as well as areas controlling movement. These numerous issues compound to create a strong addiction potential for cocaine, which becomes more and more difficult to feed the more it is abused. This deadly self-feeding cycle of addiction is at the root of crack cocaine’s effectiveness at becoming addictive.

Short and Long Term Effects

Crack cocaine is taken by smoking, usually with the use of small glass pipe colloquially known as a crack pipe. Onset of effects peaks around 3-5 minutes.

Users report short-term mental effects such as feelings of:

  • Euphoria
  • Sexual stimulation
  • Mental stimulation
  • Rapid mood shifts

And physical effects such as:

  • Numbness
  • Lowered appetite
  • Increased heart rate
  • Shaking

Repeated long-term use of cocaine leads to physical side effects such as:

  • Diminished cardiovascular health – Cocaine drastically increases heart rate, putting a great deal of strain on the heart with long term use, which can lead to problems such as tachycardia and heart arrhythmia, and can increase risk of heart attack.
  • Weight loss and malnutrition – Crack is an appetite suppressant, which can lead to a dangerously low intake of essential nutrients as well as drastic weight loss. These effects can compound to produce a host of other problems from a weakened immune system, weakness and decay of muscle tissue, lowered cognitive abilities, poor wound healing, and even organ failures.
  • Respiratory damage – The smoke from cocaine can cause severe damage to the lungs, particularly when in the form of crack. Chronic coughing is a common side effect, and can develop into dangerous respiratory ailments such as bronchitis.
  • Increased risk of infections – Frequent usage of crack lowers immune response. This makes the user susceptible to infection and may lead to further complications such as blood poisoning.
  • Insomnia – Due to cocaine’s stimulating effect, a general decay in personal health, as well as frequent interruptions in ordinary circadian activity, cocaine users often experience worsening sleeping problems that can develop into insomnia.

Long-term use of cocaine also carries several mental side effects including:

  • Severe addiction – Because of cocaine’s addictiveness, both mental and physical addiction are developed very quickly, leading to a complete dependency on the drug.
  • Depression – Due to overstimulation of dopamine receptors, cocaine frequently leads to depression due to the brain’s inability to utilize dopamine effectively.
  • Anxiety – Anxiety is a frequent symptom of drug abuse in general, and is common in meth abuse due to internal factors from the psychological and physical effect of the drug itself, as well as external factors such as pressure family, friends, and work that may all be affected by addiction. This can compound and develop into chronic paranoia.

Other risks posed by cocaine abuse include:

  • Increased risk of HIV – Cocaine has been proven to speed up and assist in the progression of HIV infections. Because cocaine weakens immune response as well as impairs cell functioning, both HIV and Hepatitis infections are allowed to progress much more rapidly than in a healthy individual.
  • Risk of overdose – Crack overdose is a sometimes understated but dangerously frequent occurrence. Because cocaine tolerance is so volatile, and potency can differ between different batches, it is very easy to misjudge the amount you can handle and overdose. Death by heart failure is common, and survival rates of overdoses are low.
  • Additives – Crack purchased on the street is often cut with additives to maximize profits, including many dangerous and toxic additives. Crack is usually cut with common household substances such as sodium bicarbonate and powdered sugar, as well as deadly drugs such as the livestock de-wormer Levamisole and the insecticide boric acid.
  • Pregnancy – Crack usage can lead to a wide variety of difficulties with pregnancy. This includes issues in the mother such as migraines, seizures, and lung damage, as well as both fatal and nonfatal birth defects, premature birth, membrane ruptures, stillbirths, Sudden Infant Death Syndrome, Neonatal Abstinence Syndrome, and various other dangerous abnormalities.

Crack cocaine withdrawal can be a very difficult process to go through, and includes withdrawal symptoms such as:

  • Increased appetite
  • Fatigue
  • Restlessness
  • Depression
  • Loss of concentration
  • Tremors, muscle aches and cramps
  • Insomnia

Methods of Treatment

Pharmacological:

Unfortunately there are currently no accepted forms of pharmaceutical treatment for crack cocaine addiction that are accepted by the FDA for use in the United States. However, research into potential treatments that work on dopamine, GABA, serotonin, and adrenaline is promising. These treatments focus on receptors found in the reward pathway of the brain in order to directly combat cocaine’s effect on the reward pathway. Although no medications specifically for crack addiction treatment are available, treatment through other medications has shown some benefit, such as the use of disulfiram, a drug traditionally used to treat alcohol addiction. Some breakthroughs are also being made in the application of vaccine technology to cocaine addiction, which may be used to aid the immune system in reducing cocaine’s effectiveness on the brain.

Therapeutic:

Other forms of treatment for beer addiction come in the form of psychological and behavioral therapies. These treatments focus on the behaviors and habits that led to addiction in the first place in an attempt to remove the root of addiction. Amongst these forms of treatment, Cognitive Behavioral Therapy (CBT) is one of the most common, and is growing in support from the scientific and clinical communities all the time. Cognitive Behavioral Therapy sees substance abuse such as beer addict as a symptom of a greater psychological issue, and not a cause in and of itself. By utilizing reflective and analytic techniques, an addict is better able to understand what led them to addiction in the first place, change bad habits, and avoid behaviors that may trigger cravings. The twelve-step program is also available as a longestablished method of treating drug and alcohol addiction. The twelve-step program works as a gradual method of guiding principles and pragmatic steps that can be taken to go from the depths of addiction and unhealthy habits to sobriety. These twelve steps are aimed at effectively recovering from compulsive and addictive behaviors, and addressing mental and behavioral problems that led to addiction in the first place. These twelve steps include both internal and external actions aimed at making amends for past mistakes, accepting responsibility for the actions that led to addiction, and moving forward to establish healthy habits and a positive mindset.

Rehabilitation

There are two main types of rehabilitation: inpatient and outpatient. Inpatient rehabilitation refers to programs that require patients to check themselves into a facility where they will undergo all rehabilitation treatment. Although inpatient rehabilitation requires a greater level of commitment, the facilities, environment, and support offered by these facilities are conducive to a stable and effective recovery. Inpatient facilities generally offer services such as psychiatrists, counselors, group therapy, and all of the living facilities necessary for a comfortable stay. The extensive support offered by these facilities, combined with an environment that is focused on self-improvement and wellness is a great combination for providing the motivation to push through the difficulties of withdrawal and to establish good healthy habits to prevent relapsing once you leave. This form of rehabilitation is effective for those who would benefit from a stricter more scheduled recovery in which the outside distractions and temptations of life won’t get in the way of focusing on recovery.

Outpatient rehabilitation is based on the principle of spending only part of your time in recovery programs while offering you the freedom to continue daily living on your own. Generally these programs will require ten to twelve hours of commitment per week spent in a treatment facility participating in similar activities to those done in an inpatient facility such as group therapy, counseling, and even detox. While this does offer easier access to drugs, some may find being able to maintain their normal daily schedule more beneficial. This form of rehabilitation is effective for those who require more freedom and contact with friends and family.

Both forms of rehabilitation are effective solutions at combatting crack cocaine addiction, and there is a variety of different types of both inpatient and outpatient rehabilitation to suit the personal needs of each individual.

References

  1. About Addiction. “Crack Cocaine Statistics.” Substance Abuse Referral Service, About Addiction, 2017, www.about-addiction.com/addiction/drugs-of-abuse/cocaine/crack-cocaine-statistics/.
  2. “Overdose Death Rates.” NIDA, National Institute on Drug Abuse, 6 Jan. 2017, www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates.