1. STIMULANTS
In this chapter you will explore:
Historical aspects of stimulant use,
Methods of administering stimulants,
Physical and psychological effects triggered by stimulant use,
Side effects caused by stimulant use,
The effects of chronic stimulant use,
Resulting effects of stimulant overdose,
Results that occur from stimulant withdrawal,
Distinctive features of stimulant use.
STIMULANTS
A stimulant increases the functioning of the central nervous system. The nervous system works
in a hierarchial manner. This means stimulants arouse the central nervous system directly or
indirectly by stimulating the lower parts of the central nervous system; especially the
sympathetic division of the system.8 This is why stimulants are often called sympathomimetics.
They mimic the effects of the sympathetic nervous system.
Stimulants are used by people to produce alertness, decrease fatigue and to prolong physical
work. They elevate mood and enhance self-confidence. The effects of the drugs in the stimulant
classification are similar to one another. The difference in their effects results from the
individual's mental state, drug dosage, and potency. All stimulants increase blood pressure, heart
rate and body temperature. The body temperature is elevated by the effect caused by increasing
muscle activity and constricting the blood vessels. This results in decreased heat loss, increased
heart rate and elevated blood pressure. Examples of drugs in this classification include caffeine,
nicotine, amphetamines and cocaine. Psychological dependence and tolerance are risks
associated with stimulant use.
Caffeine
History. Caffeine is our national non-alcoholic drink. It is present in a number of plants including
coffee beans, tea leaves, and cacao beans. It is found in coffee, tea, soft drinks, candy bars, and
in over-the-counter pain killers.
The coffee bean is native to Ethiopia. It appears to have been first ingested by chewing the bean.
The practice of making a drink from the coffee bean began in Arabia. One of the plants earliest
cultural uses was in religious observances and was often used by people to stay attentive during
the long nights they spent in prayer. Tea use began in China. In some countries caffeine is also
sold in tablet form as an anti-fatigue compound.

2. Methods of Administration. The drug is usually ingested in a
beverage but it can be consumed in tablet form, as a suppository
or injected.
Effects. There is a great deal of variation in the amount of caffeine
that is found in over- the-counter medications. Caffeine initially
produces a mild stimulation. The initial effects of caffeine occur
within 15–60 minutes; a maximum effect occurring within two
hours. The duration of effects can last from seven to eight hours.4
Alertness may be increased and performance of uncomplicated
tasks may be improved. The consumption of 150–250 milligrams will produce arousal. In
amounts ranging between 200–300 milligrams, fatigue is relieved and the amount of physical
work an individual can perform is prolonged. In doses of 200 to 400 milligrams marked
stimulation of the nervous system may occur.9 Caffeine can function as a performance aid in
athletic endurance sports when three to five cups of coffee are taken one hour before a contest.
Two to three cups of coffee a day can increase the basic metabolic rate between three and five
percent. This enhanced metabolic effect lasts up to four hours. Caffeine also causes the release of
fatty acids in the blood which spares the muscles from using the muscle sugar glycogen. This
further improves performance in endurance events.
Chronic Use. Chronic use leads to the development of tolerance and psychological dependence.
Caffeine is similar to other stimulants in that the beneficial stimulating effect is followed by a
rebound effect which ranges from mild fatigue to varying levels of depression. Headache,
diarrhea and fatigue are also associated with this rebound effect.
Overdose. The International Olympic Committee has stated that 600 mg (approximately four to
five cups of coffee) of caffeine taken in 30 minutes produces a blood doping infraction because
at this level caffeine improves performance in endurance activities. If caffeine is consumed at
this level, irregular heartbeat, tinnitus (ringing in the ears), nervousness, diarrhea, restlessness,
insomnia, anxiety, delirium, headache, upset stomach and peptic ulcers can result.19
Psychological effects caused by an overdose include insomnia and anxiety. Caffeine overdose is
treated with antipsychotics, and medications to reduce blood pressure and heart rate.
Anticonvulsant drugs may be given to combat convulsions associated with caffeine overdose.
Side Effects. Caffeine can have a powerful diuretic effect. Although therapeutic caffeine use can
enhance attention span higher doses actually hampers performance of tasks that require
concentration and critical analysis. Caffeine causes muscle tremors which hinders performance
in activities that require fine muscle control. This includes any activity that demands delicate
coordination and accurate timing such as riflery and archery. Heartburn is one of the common
side effects of caffeine use and is one of the major reasons why many people stop drinking
caffeine beverages.
Withdrawal. Withdrawal from caffeine includes effects such as headache, diarrhea, irregular
heartbeats, and psychological complaints including anxiety, irritability, mood changes, sleep
disturbances and fatigue. The withdrawal is not long lasting and no permanent effects have been

3. reported.
Unique Aspects. Caffeine's ability to increase heart rate makes it useful in the treatment of heart
failure. Caffeine relaxes the smooth muscles of the bronchial tubes of the lungs. This makes it
valuable in the treatment of asthma—both in preventive and emergency situations. Its ability to
constrict blood vessels in the brain makes it effective in the treatment of severe headaches
(migraine). Caffeine has also been helpful in counteracting the effects of barbiturate overdose.
Nicotine
History. Nicotine, the active ingredient in tobacco was isolated by a French chemist by the name
of Nicot and the drug was named after him. Nicotine is the principal active ingredient in tobacco.
A number of varieties of exist and include bright, burley and Turkish tobaccos. Most of our
cigarettes contain a mixture of these various types of tobacco. Prior to the introduction of the
pipe or cigarette in Europe chewing was the preferred way to use tobacco. It was smoked in
pipes and used as snuff by the Native American Indians. Pipe smoking was used for ceremonial
purposes, but it was also for preventing hunger and as a medicine. The rapid acceptance of pipe
smoking among the aristocrats of Europe helped spread the popularity of tobacco use.
The spread of tobacco use across Europe was
strongly opposed by the church and several
national governments. In the 1500–1600s the
death penalty was imposed in Germany, China,
and Turkey for anyone convicted of using
tobacco products. Castration was the sentence for
tobacco use in Russia. Public health officials
discouraged tobacco use by campaigning against
the use of chewing tobacco because it contributed
to the spread of tuberculosis. The introduction of the cigarette provided a sanitary and
inexpensive alternative to chewing tobacco and created a change in the pattern of tobacco use.
Most of the early pipe and cigar smokers were men. However, women quickly adopted the
tobacco habit with the introduction of cigarette smoking.
The health hazards of smoking have been widely publicized. The effect of public notices have
resulted in a restriction placed on advertising and the banning of smoking in public areas
including elevators, hospitals, theaters, restaurants and aircraft.
Methods of Administration. Nicotine is usually inhaled (smoking), snorted or chewed. It has also
been used as a tincture like tea.

4. Effects. Over four thousand chemicals are found in tobacco in addition to nicotine. Some of these
include acetone, carbon monoxide, ammonia, acids, insecticides, tar, and radioactive substances.
The active ingredient in cigarette smoke is nicotine. The nicotine is a powerful agent that
modifies behavior. Nicotine that is injected intravenously is more potent than intravenous
cocaine in terms of its "reward" potential for the user. When nicotine is smoked it takes
approximately seven seconds to reach the brain. Approximately 60 milligrams of nicotine can
produce a lethal dose. The average cigarette delivers between 0.05 and 2.5 milligrams of nicotine
to the smoker. The smoker who inhales gets approximately 90% of the nicotine in their
bloodstream as compared to 20% to 50% for the person who does not inhale.
Nicotine is a highly toxic compound that has also been used as an insecticide. Nicotine is a
curious drug because it causes both stimulation and depression of the nervous system. It
increases respiration by stimulating the receptors in the carotid artery that monitors the brain's
need for oxygen.1 Its depressant effect causes fluctuations in blood pressure. The depth of
inhaling and the frequency of puffing will determine the amount of nicotine reaching the
bloodstream. Tobacco smoke also contains acetaldehyde which is produced when the liver first
breaks down alcohol. Acetaldehyde is more potent than alcohol and produces a sedative effect in
the tobacco user.
Nicotine affects the part of the brain that directly controls swallowing, blood pressure,
respiration and vomiting. Nicotine is also an activator of the sympathetic nervous system and the
organs affected by the sympathetic nervous system. This effect causes the release of the
neurotransmitters norepinephrine and can induce skeletal muscle tremors, increased blood flow
to the heart, and elevated heart rate and blood pressure.

5. Nicotine also stimulates the release of the neurotransmitter dopamine. This release helps the
smoker associate smoking with pleasurable sensations and helps reinforces the craving for
tobacco. The relaxing sensation is also reinforced through the psychological belief that smoking
relaxes a person. This placebo effect produces a relaxation that many smokers say they sense
when they smoke. Chronic Use. Chronic nicotine use is related to tooth discoloration, tooth
decay and gum diseases, such as gingivitis. Bronchitis, emphysema, cancers of the mouth, throat,
digestive system and lungs are all associated with tobacco smoking and the chewing of tobacco
products.16
Nicotine helps deaden taste buds, and depresses appetite by slightly increasing blood sugar. Its
use can inhibit hunger contractions in the stomach for up to an hour. These effects may explain
the reason for the decrease in appetite described by many smokers. The body's metabolism may
decrease as much as 10% once the smoker quits. This may account for the weight gain often
associated with people who have quit smoking.2
Physically, smoking has some very direct effects
on the efficiency of oxygen absorption. The
carbon monoxide in tobacco smoke is more
readily absorbed by the hemoglobin molecules in
the red blood cells than is oxygen. The interaction
of oxygen and carbon monoxide produces

6. carboxyhemoglobin. This form of hemoglobin cannot carry oxygen. Therefore, less oxygen is
circulated in the blood when you smoke. The tar found in the residue of cigarette smoke coats the
lining of the air sacks in the lungs, further decreasing the amount of oxygen delivered to the body
and brain. These factors combine to cause the classic smoker's shortness of breath. The tars and
radioactive substances in cigarette smoke also combine to produce one-third of all cancer deaths.
Chronic smoking contributes to increased chances of heart disease by inhibiting the production
of a cholesterol removing enzyme and interferes with its ability to clear excess cholesterol from
the artery walls and deliver it to the liver where it is metabolized into bile and eliminated from
the body through the digestive tract.
Overdose. One of the results of nicotine overdose is its effect on blood pressure. Low to medium
doses raises heart rate and blood pressure but increasing the amount often leads to a reduction in
blood pressure. This characteristic feature of nicotine poses problems for individuals with
coronary artery disease or who are using medications to control blood pressure.
Side Effects. The initial effect of nicotine on the brain causes first time smokers to feel dizziness,
nausea and often causes them to vomit. Nicotine reduces blood flow to the extremities of the
body and can reduce the strength of the heartbeat. It also irritates the lining of the lungs and
slows down the functioning of the cilia which helps clean the lungs of foreign particles.
Passive, secondhand or sidestream smoke has received a great deal of attention recently.
Breathing the air in close proximity to a person who is smoking has been documented to cause a
detrimental effect on the nonsmoker.31 This smoke has higher concentrations of carbon
monoxide, nicotine and ammonia than does inhaled smoke. This effect can be particularly
harmful to young children whose immature liver and excretory systems cannot effectively screen
out these substances.
Withdrawal. Withdrawal symptoms include irritability or anger, decreased alertness and
increased aggressiveness. Insomnia, drowsiness, hunger, muscle tremors and a craving for
tobacco also occur. The individual will experience a decrease in both heart rate and blood
pressure after withdrawal from nicotine. The first symptoms will appear within two hours and
the symptoms will intensify for up to 24 hours. The symptoms will gradually decline over a
period of time ranging from 10 days to several weeks. Some people report symptoms one month
after stopping smoking, and 75% of smokers who have stopped have reported cravings for up to
six months.15
Unique Aspects. It is now well established that smoking has been linked to coronary artery
disease, lung cancer, bronchitis, emphysema, duodenal ulcers and allergies. Smoking statistically
is related to more deaths than illicit drugs, alcohol, all accidents, homicides and suicides
combined. The smoking habit is acquired early in life. It appears to be a coping behavior that
produces a positive self-concept, allows an individual to demonstrate autonomy, and relates to
our perception of being tough, accepted by peer groups and independent. Peer influence, social
conformity, a positive family attitude toward smoking, stress, and inadequate personal coping
skills help students increase the likelihood of their smoking. Twenty–seven percent of high
school students and 16% of junior high school students smoke seven or more cigarettes a day. It
is estimated that 83% of the population will try smoking by the age of 25.27

7. Nicotine seems to be able to act as an antagonist to counteract the sedative effect produced by
alcohol, and also potentiates caffeine effects. This reduces the amount of caffeine needed to
produce a stimulating effect. Nicotine interacts with oral contraceptives. This interaction
increases the possibility of strokes and embolisms in female tobacco users. Nicotine crosses the
placental barrier and easily enters the fetal bloodstream. Cigarette smoking for women also
increases the chances for cervical cancer, miscarriages, early menopause and osteoporosis.
The fetus cannot metabolize nicotine or carbon monoxide as efficiently as does the mother. This
can affect the fetus's nervous system, cause spontaneous abortions, or low birth weight. Studies
have shown that passive smoking can hinder lung development in children. Children born to
parents who smoke are more likely to develop bronchitis and pneumonia during the first year of
life than are children of nonsmokers. Nicotine is also secreted in breast milk thus has the ability
to affect the nursing child.
Smokeless Tobacco
There is a false perception by many that smokeless tobacco is less dangerous than tobacco
smoking and therefore is a safe alternative to smoking tobacco. The use of this form of tobacco is
especially popular with adolescent males between the ages of 18 to 30 years of age. There are a
variety of techniques for using smokeless tobacco. Dipping is performed by placing a pinch of
powdered tobacco called snuff between the cheek and gum. Chewing consists of placing leaf
tobacco called a wad or chaw on the inner cheek. A chaw is a ball of leaf or plug tobacco. The
decreased saliva production that long term tobacco chewing causes can result in less protection
for the teeth against infections and cavities.

8. Persistent use of smokeless tobacco reduces the sense of taste and smell, contributes to bad
breath and tooth discoloration. The sweeteners, flavorings, and additives including sugars, and
fluoride helps contribute to the staining and eroding of the tooth enamel.
Leukoplakia results from the continued contact of smokeless tobacco with the gums.
Leukoplakia begins with an irritation and a reddening of the gums. As the disease progresses the
gums recede, become wrinkled and form white lesions. There is a strong possibility of the
development to oral cancers with continued smokeless tobacco use. The risk of cancer varies
depending on the frequency, duration and the placement of the tobacco in the mouth.
Amphetamines
History. Amphetamines were introduced into American medicine in the 1930s to produce
wakefulness, self-confidence and euphoria. Its use as a prescribed medication for weight control
reached its peak in 1967. Its use was restricted in 1970 to the treatment of narcolepsy,
hyperkinetic behavior, and for short-term weight loss. The drug was used by the militaries of The
United States, England, Germany and Japan in World War II to counteract fatigue and enhance
aggressiveness. Following World War II, the drug companies in Japan dumped amphetamines
onto the civilian market. No prescription was required to purchase the drug at that time. The
United States military used the drug for the same reason during the Korean Conflict. The most
common examples of amphetamines include Benzridrine, Dexidrine and Methamphetamine.
Methods of Administration. Amphetamines can be taken as a tablet, inhaled or injected.
Effects. Amphetamines are similar to our body's own neurotransmitter noradrenalin and
dopamine. Amphetamines cause norepinephrine to seep from its presynaptic storage sites and
artificially places the body in a state of stress. This results in a stimulation of the adjacent
neuron. Amphetamines block the re-absorption of dopamine and norepinephrine causing a
continuous stimulation of the nervous system. Such successive stimulation can induce a situation
called behavior stereotype in which the individual continuously performs a given task such as
repeating phrases of music, a task, or repeatedly cleaning the same object.6
At low to moderate doses users report the feelings of self-confidence, increased alertness and the
ability to concentrate, loss of fatigue and mood elevation. The amphetamines and cocaine also
have the ability to magnify the pleasure experienced in many activities. The "rush" or euphoria
activates the brain's pleasure center with effects lasting from four to 14 hours.3 Performance may
be enhanced in tasks that demand physical activity or are boring and monotonous. Performance
involving intellectual tasks may be worsened.13 Amphetamines and cocaine suppress appetite
and delay the onset of sleep. The strong sense of well-being that amphetamines and cocaine
produce increases the likelihood of psychological dependence and tolerance.
Chronic use. In many cases amphetamine's effect of suppressing appetite causes users to neglect

9. good nutritional habits. This results in dietary deficiencies and malnutrition. The users must also
contend with the effects of the lack of sleep and psychosis. The physical complications
associated with long-term amphetamine use include anorexia, vomiting, heart irregularities, chest
pain, diarrhea, convulsions and coma, physical weakness, and insomnia. Psychological and
behavioral effects of chronic use include mental confusion, irritability, anxiety, delusions, panic
states suicidal and homicidal tendencies.1 The exact effect of amphetamines on brain function is
still unclear. Evidence suggests that prolonged amphetamine use can cause physical damage to
the cells of the brain. An individual may use amphetamines for extended periods that can last for
days to get a continuous effect. Psychosis and bizarre behavior may be very severe during this
time. This run is usually followed by a rebound that causes sleep, depression and excessive
eating.
Overdose. High levels of amphetamine use can result in irritability, fear, suspicion, confused
behavior, and a psychosis. Psychosis is a psychotic-like state in which the individual experiences
confusion, suspiciousness, delusional thinking and visual hallucinations during use.35 This druginduced psychosis clears up within days of the last dose, but after-effects may last for weeks or
months. Heavy use causes a rebound effect in which the extreme stimulation of the central
nervous system is followed by a lethargic depressed state. Amphetamine-induced depression can
last months. Death from overdose is occasionally reported and usually results from a brain
hemorrhage.
Side effects. Insomnia, anxiety, irritability, and hostility occur during periods of initial
amphetamine use. Hypomania (repetitive foot tapping) and formication (the sensation that bugs
are crawling over the skin) may occur. Insomnia and malnutrition are also possible side effects.
Amphetamine use is often combined with the use of depressants such as alcohol, barbiturates,
heroin and hallucinogens such as LSD. These substances reduce or counteract the side effects of
amphetamine use and helps the drug user sharpen the amphetamine effects.
Withdrawal. The initial withdrawal symptoms begins several hours after drug stoppage.
Withdrawal symptoms include muscle weakness, fatigue, diarrhea, chest pain and irregular heart
beats. Psychological effects include confusion, irritability, anxiety, delirium, paranoid
hallucinations and depression. Depression peaks two to three days after the last dose, but the
symptoms may last for approximately four days. The individual gradually develops
hallucinations, and vague suspicions that can turn into delusions. If these delusions are prolonged
the user feels agitated and confused and violent.
A rebound effect results from the depletion of norepinephrine and dopamine. This creates an
anxiety and a craving for amphetamines. The fatigue and depression can last for months after
stopping the use of amphetamines.29 Also, compulsive eating and extended periods of sleep may
occur. The extended sleep may be the result of the body catching up for the depression of REM
sleep during the period of amphetamine use. Withdrawal after extended use called amphetamine
runs causes severe depression accompanied by suicidal thoughts. The feelings of fatigue and
lethargy may last for long periods of time, this is thought to be due to the depletion of dopamine
during the period of amphetamine use. The long term effect of dopamine depletion by
amphetamines on the body is still unknown.

10. Unique Aspects. One of the beneficial uses of amphetamines occurs in the treatment of asthma
and other breathing disorders. Amphetamines are effective in relieving asthmatic symptoms
because they act as bronchial dilators and relax the bronchial muscles. Amphetamines were also
prescribed as a short-term appetite suppressant for people with weight problems. It was also used
as a remedy for fatigue, and to treat narcoleps who may have numerous sleeping bouts.
The prescribing of amphetamines such as Ritalin to treat hyperkinetic disorders (in which a child
acts restless, impulsive, has a short attention span, and displays disruptive behavior) should also
be mentioned. Its use tends to cause better control of the individual's muscle coordination and
enhances the ability to concentrate and screen out surrounding distractions. Today in many
countries amphetamine use is limited to treating narcolepsy and hyperkinetic disorders.
Cocaine
History. Cocaine has been used for thousands of years in Peru, Bolivia, and Columbia to combat
fatigue, hunger, and to induce pleasurable sensations. The plant does have some nutritional
value. Two ounces of coca leaves contains the RDA of vitamins and also has some essential
minerals.
The South American Indians chew the coca leaves by rolling it into a ball and keeping it in the
mouth. Modern natives mix cocaine leaves with lime and chew them.34 The interaction of
chewing the leaves, mixing them with the lime and saliva releases the cocaine. This practice
helps maintain the stimulant effects for an extended amount of time.
Cocaine is valuable at high altitudes where fatigue, the lack of oxygen, cold and limited
availability of food contribute to the rapid onset of fatigue. It is used in religious ceremonies and
as a medium for trade. Interestingly, cocaine also became a measure of time or distance. The
cocatá was a measure of time; 40 minutes or a distance of two to three kilometers. This was the
time or the distance a person could walk while experiencing the effects of cocaine.
The leaves were transported to Europe but never became popular because the long voyage
reduced the cocaine content to a point that it was worthless. Wide use outside South America
occurred in the late 1850s when cocaine was isolated from the coca plant, thus making it easy to
store and transport. It was a popular anesthetic at that time. The invention of the hypodermic
needle further increased its use. Sigmund Freud experimented with cocaine to treat depression
and to ease the withdrawal from opiate addiction. Sir Arthur Conan Doyle had his character,
Sherlock Holmes, use a seven percent solution of cocaine and morphine.17 During the 1800s it
was used in the United States in patent medicines to help cure hay fever, whooping cough,
asthma and bronchitis.
Cocaine was made into an concentrated extract in the 19th century. It was sold as a medicinal
drug which would free the body of fatigue, lift the spirits, and cause a sense of well-being. In the
1890s it was used in the United States as a local anesthetic for eye surgery and as a nerve tonic.
Dr. J.C. Pemberton created Coca-Cola™ from the extract of cocaine and the cola bean.

11. Decocainized leaves are still used as a flavoring agent in the beverage today.
Cocaine was the first medically used local anesthetic. In the 1960s cocaine became the
alternative for amphetamine use because government regulations resulted in a limiting the
availability of amphetamines. Cocaine's use peaked in the 1980s. Present use has leveled off or
declined compared to 1970s levels. Less than one percent of the cocaine is used for medical use
with the remaining 99% being used recreationally.22
Methods of Administration. The drug can be chewed, snorted, inhaled or injected.
Effects. Cocaine is a powerful short-acting central nervous system stimulant that produces both
stimulation similar to amphetamines or adrenalin and an anesthetic effect.36 Cocaine is a very
potent reinforcer. This means cocaine has an overwhelming influence on the brain's pleasure
center which leaves the user feeling competent, energetic and self-confident. The perception of
increased energy is brought about by altering the perception of fatigue by stimulating the central
nervous system thereby masking the fatigue.26 Tolerance develops within hours or days to
cocaine. This rapid development of tolerance allows the user to move from the average dose of
300 milligrams to increased amounts in the same day (up to 30 grams or more).
Cocaine releases the neurotransmitter dopamine and norepinephrine and prevents their re-uptake
thus depleting these neurotransmitters and causing depression and a craving for the drug.28 This
effect results in pleasurable sensations and stimulates the nervous system. The brain's reward
system reacts by requiring less stimulation. Animals with unlimited access to cocaine are most
likely to select the drug in place of sex, food, or water and often use it to the point of death. It is
an excellent anesthetic and constrictor of mucous vessels of the ears, nose, and throat. If taken
when the user is in a relaxed state, and in small to moderate doses fatigue is almost totally

12. eliminated for the period of time the person is under the influence of the drug and motor
coordination is improved. Users also experience a strong sense of self- confidence. It functions
as a sexual stimulant by delaying male and female orgasms and culminates in orgasms that are
said to be extraordinary. However, long-term use has shown to decrease the ability to have an
orgasm without cocaine and can lead to impotence in both men and women.21
The effects on the neurotransmitters produces a rapid high and sense of wellbeing which is
followed by a prolonged low when the drug is metabolized. This rebound effect leaves the
individual craving the drug; anxious, tired, mentally dull, tense and depressed.24 Over a period
of time the drug is often taken to maintain a feeling of being normal. This is due to the dopamine
depletion. The rapid tolerance that develops in one to two hours to the euphoric effects of the
drug is called tachyphylaxis. This rapid development of tolerance motivates the user to increase
the dosage to maintain the euphoric effects and may be one of the mechanisms that lead to
cocaine binging.5
Cocaine is used in four forms. Coca paste is formed when sulfuric acid, kerosene, and methanol
are mixed with the coca leaves. These chemicals convert cocaine to cocaine sulfate and it is
collected as a paste. At this point it can be ingested or smoked. Cocaine is also converted to
cocaine hydrochloride and sold as cocaine powder. The most common way that cocaine powder
is used in the United States is by inhaling or snorting the drug.
More intense effects can be obtained by converting the cocaine to freebase. Solvents such as
ether are used to create freebase cocaine. The freebase is heated changing the water-soluble base
into a water insoluble base that is often over 90% pure. It floats to the top and is drained off with
an eyedropper. It is then dried and crushed into a powder for smoking or it can be injected.
Cocaine hydrochloride can be mixed with bicarbonate soda (baking soda) and water, heated and
then mixed with cold water. This hardens it into solid pieces called crack.18 It is also formed
into three-inch sticks called teeth, french fries, or can be pressed into pills.
Cocaine is bought in portions of grams called quarters and eighths. Cocaine is usually sold on the
streets in one gram packages. The purity of cocaine sold on the street ranges from five to 95%
and the rest is comprised of fillers. The average street dose ranges from 20 to 50 milligrams;
1200 milligrams produces a lethal effect.
Chronic Use. Long term use of cocaine can result in hoarseness, bronchitis, a breakdown of
cartilage in the nose, inflamed tonsils, weight loss, malnutrition, insomnia, digestive disorders,
paranoia, and hallucinations.14 Formication similar to that experienced by amphetamine use
causes a stimulation of the body's nerve endings. The individual feels as if coke bugs are
crawling over them. Most deaths result from brain hemorrhage, blocking the heart's electrical
system, and lung failure. Prolonged use creates a hypersensitive effect in which the individual
overreacts to what was a tolerated dose. Snorting can cause addiction in three to four years.
Smoking can cause addiction in six to 10 weeks. Vitamin B complex and Vitamin C depletion
can also result from long term use. Commonly-experienced psychological effects include
impaired thinking, short temper, panic attacks and paranoia .20 The injection of cocaine also

13. increases the risk of blood infections, hepatitis B, skin abscesses, scarring at the site of infection,
and acquiring HIV infection.
The effects on the fetus and newborn should also be clarified. Miscarriages, stillbirths, and
premature labor during delivery are common among cocaine using mothers.7 If separation of the
placenta from the uterine wall occurs the life of the mother and the fetus are endangered.
Malformed kidneys and genitals have also been reported in the newborns due to the use of
cocaine. After birth, the newborn is often unresponsive and irritable due to the depressing effect
of cocaine withdrawal. Cocaine also interferes with the infant's breathing and can result in
sudden infant death syndrome. Pregnant women and women considering pregnancy should avoid
the drug because of its potential harm to the developing fetus and because of the unknown
contaminants present in cocaine.
Cocaine is commonly used in combination with alcohol, marijuana, barbiturates, tranquilizers,
heroin and hallucinogens. These substances help control the craving for cocaine and the rebound
effect that is causing the depression after the drug is metabolized by the body.
Overdose. Cocaine's stimulating effect constricts blood vessels and increases muscle activity.
Small doses slows the heart, moderate dose increase heart rate and blood pressure and high doses
causes a toxic effect on the heart muscle that can induce cardiac arrest.12 Cocaine increases
muscular activity that produces heat, has a direct affect on the brain's heat regulating center and
causes the peripheral nervous system to constrict; resulting in fever. Paranoia, confusion, stroke,
heart palpitations, slow or halted heart rate, and heart attacks are all possible from cocaine use.
Muscles tremors and convulsions occur due to the depression of brain centers and may induce
death as the result of lack of oxygen to the heart muscle, respiratory paralysis and heart failure.
Approximately 15% of cocaine users experience seizures and still 95% of them continue to use
cocaine following these episodes.25
Cocaine psychosis is a state in which the cocaine user feels anxious, appears to have superhuman
power, and is paranoid to the point that they believe their lives are in danger or someone is going
to steal their drug. Outbursts of anger, rage, seizures, and depression follows.23 The individual
may come out of the psychosis within two to three hours but they will feel depressed for two to
three days. The depression may induce suicide. People often hear and see things that don't exist
within hours if the cocaine is discontinued. The dopamine depletion may be why hallucinogens
and paranoid episodes occur and norepinephrine and serotonin depletion are implicated in why
depression occurs after cocaine use.
An overdose that produces cocaine poisoning is composed of three distinct stages. The initial
stimulation phase causes irritability, tremors, chest pain, cardiac arrhythmias, palpations,
sweating and fever. The second phase involves depression of heart rate and blood pressure,
labored respiration and mental confusion. The third phase involves system failure characterized
by shock, a lack of oxygen, decreased body temperature, respiratory failure, cardiac failure and
death. In extremely high doses the first phase my not be as noticeable as the depression and
system failure phases.

14. The consequences of overdosing often requires stomach pumping to prevent toxic effects and the
use of antagonist drugs to cancel the effects of cocaine on heart rate and blood pressure. The
body is cooled to treat the fever. Antipsychotic drugs, muscle relaxants and anticonvulsant drugs
may be given to reduce the number and severity of the convulsions.
Side Effects. Over a period of time the brain becomes sensitive to cocaine to the point that the
amount of cocaine needed to produce a seizure is lowered. Fillers such as lactose, sucrose,
quinine, inositol (B complex vitamin), mannitol and stimulants such as amphetamines, and
anesthetics cause many of the side effects associated with cocaine use (including nasal irritation,
running nose, increased blood pressure, nervousness, stomach cramps and diarrhea).30 The
muscles controlling breathing are also detrimentally affected. This results in irregular breathing
patterns. As tolerance develops it causes impotence in males and frigidity in females. The use of
cocaine can result in a 50 beat increase in heart rate. Psychological side effects include acting
suspicious, paranoid, being preoccupied with their own thinking processes, psychosis in which
they are out of touch with reality or are hallucinating and hyperactive.
Withdrawal. The withdrawal symptoms begins within 24 hours of the last dosage and can persist
for seven to 10 days. Cocaine withdrawal similar to acute alcohol hangover includes nausea,
vomiting, body chills and insomnia. Blood pressure, heart rate, respiration and body temperature
remain stable but muscle tremors, headaches, agitation and craving for the drug, fatigue or
lassitude, unquenchable hunger and altered sleep patterns are commonly experienced in cocaine
withdrawal. Psychological feelings of withdrawal include paranoia, depression, fatigue, and a
craving for the drug. This craving for the drug may be due to the depletion of the
neurotransmitter dopamine that occurred during the period of drug use. The long term effects of
dopamine depletion is still unknown.
Unique Aspects. The initial physical effects of cocaine causes constriction of blood flow to the
heart and interferes with the electrical signals that control the heart's rhythm. This can cause an
irregular heartbeat or total heart stoppage.
It is used as a local anesthetic in eye, nose, ear and throat surgery. It is also used as a local
anesthetic when examining digestive and respiratory tracts with probing instruments. Cocaine's
anesthetic effect is due to its ability to block the nerve transmission along the axon of neurons.
When it is used as an oral anesthetic, its effect is felt within one minute and these effects last up
to two hours.
Cocaine is also used in England and Canada to relieve the severe pain caused by terminal cancer.
It is a main ingredient in what is called Brompton's Cocktail. It is a mixture of cocaine,
morphine, and gin placed in a syrup solution. It seems to work by enhancing pain relief, clearing
the senses, and by preventing deep sedation of the patient caused by chemotherapy.
Cocaine addiction differs from other addictions in several ways. These include the rapid
tolerance developed and the fact that the sight or smell of the drug triggers cravings. This latter
characteristic is thought to relate to the fact that cocaine may affect the part of the brain where
sight, smell, taste and thought reside.

15. SUMMARY
Stimulants include caffeine, nicotine, amphetamines and cocaine. These substances function in
similar ways to the body's own adrenalin. All stimulants increase the functioning of the central
nervous system and stimulate the action of the sympathetic nervous system. In small therapeutic
doses these substances can have positive effects. They can enhance the performance of tasks that
involve physical activities that are boring and monotonous. However, tasks that require sustained
intellectual concentration, are worsened.
Caffeine relaxes the smooth muscle of the lungs. This makes it useful in the treatment of asthma.
Its ability to constrict blood vessels in the brain makes it effective in the treatment of migraine
headaches.
Nicotine increases heart rate and since it is taken in combination with other chemicals (such as
carbon monoxide) and tars when we smoke, it has few beneficial effects. Smoking suppresses
appetite and produces a positive sense of wellbeing. Nicotine crosses the placental barrier and
affects the fetal nervous system, causing low birth rates and increases the chances of spontaneous
abortions. Smokeless tobacco is not a safe alternative to tobacco smoking. Its detrimental effects
range from tooth discoloration to Leukoplakia and oral cancers.
Amphetamines have been used since the 1800s to produce alertness, self- confidence, and to
reduce fatigue. They have been used successfully in the treatment of hyperkinetic children and
narcolepsy and for short term weight loss.
Cocaine is a stimulant-like substance that produces extreme stimulation and local anesthesia. It
does contain some nutritional value and has been used by the South American Indians for
centuries to relieve fatigue at high altitudes. Cocaine can be used in various forms: as a coca
paste, cocaine hydrochloride, freebase, and as crack. Cocaine is used effectively in operations
involving the ears, nose and throat. It is also used as a local anesthetic when examining the
digestive tract with probing instruments. Long term use of cocaine can result in weight loss,
malnutrition, insomnia, digestive disorders, paranoia, and hallucinations.
REVIEW QUESTIONS:
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18. Created By: Jonathan Sheldon