Addiction Treatment Blog

Illness is in part what the world as done to a victim but in a larger part is what the victim has done with his world, and with himself.

Karl Menninger, quoted in ‘Illness as Metaphor’ by Susan Sontag.

Drug abuse is a cause for many serious illnesses, including HIV (AIDS).

From time to time the healthcare professional will encounter an individual with a medical condition who abuses drugs. Although not condoning the taking of these substances, it is desirable that those in a position to advise are able to provide information on whether the drug is liable to exacerbate the condition. The sections below provide brief details which may be helpful in advising those with some of the more common medical conditions. The information given should be used as a guide only. The data available are sparse in most cases and while it is hoped that the details in this chapter will be useful, every patient’s particular circumstances will differ and one should be cautious about extrapolating limited information to all situations in which it could be applicable.

It is difficult to find data in the advisability of drug abuse in those suffering from concomitant medical conditions. The data given here are based upon details of side effects that have been reported in the medical literature and knowledge of drug handling by the body. This information is incomplete because none of the drugs of abuse have been subject to large-scale clinical trials at the doses abused. This is the main mechanism by which side effect profiles of therapeutic drugs are determined. This being the case, most of the data on adverse effects from street drugs are derived from small-scale studies, case reports, surveys and anecdotal evidence. Causality can also be difficult to ascertain because many users employ a variety of drugs simultaneously. Many drug abusers have a poor quality of life due to bad living conditions and/or inadequate nutrition; this may make them more susceptible to various diseases. Read more…

Save for the occasional use of Cocaine he had no vices, and he only turned to the drug as a protest against the monotony of existence.

Dr. Watson describing Sherlock Holmes in ‘The Adventure of the Yellow Face’, Sir Arthur Conan Doyle, 1893.

When cocaine is taken, users hope to experience a 'rush' of exhilaration as the drug reaches the brain.

History

Cocaine occurs naturally in the leaves of the coca plant, Erythroxylum coca, and certain related species which originate from South America, especially Peru, Bolivia and Columbia. The Incas considered the plant a divine gift and reserved its use for the higher echelons of society. Conversely, all levels of society amongst the Andean Indians have used the leaves as a masticatory for thousands of years. The leaves are combined with slaked lime or plant ash to produce an alkaline medium which enables the cocaine base to form a solution in saliva and thus and the circulation. Chewing the leaves helps the Indians tolerate hunger, exposure and fatigue at high altitudes where the working environment can be hostile. Cocaine provides a stimulus to manual labour, therefore, as well as inducing feelings of pleasure. The leaves contain about 1 per cent cocaine.

In about 1860, cocaine was isolated and identified as the active constituent of the coca plant. It was subsequently employed medicinally as a local anaesthetic. Karl Koller was probably the first to use it in humans, when he performed eye surgery in 1884.

When recreational use of cocaine developed outside South America the form developed was a water-soluble extract: crystalline cocaine hydrochloride. This is still probably the form of drug most widely used; it is often mixed with a diluent powder on the street and in the UK is usually known as coke, snow or blow.

Until relatively recently, cocaine was viewed in the UK as an expensive drug, used more by the wealthier sections of the populations. However, the number of abusers at all levels of society has increased. This is probably because cocaine has a reputation as a ‘clean’ drug and the street price has decreased considerably. Other factors influencing the greater demand for the drug may include the increased availability of very pure forms of cocaine such as ‘crack’ and the fact that various forms of the drug can produce rapid-onset, short-lived but intense effects without the need for injection.

‘Crack‘ is a highly pure form of the free base of cocaine (i.e. it is not a salt of cocaine like cocaine hydrochloride). The name is thought to originate from the cracking noises that lumps of free base make when heated up. This noise is probably caused by impurities in the cocaine remaining from the extraction process (e.g. sodium bicarbonate, sodium chloride). ‘Crack’ began to be available on a large scale in the USA in the mid-1980s. Read more…

There are three basic methods for drug administration.

There are three basic methods by which drugs of abuse are taken into the body: by injection, by mouth and via the airways.

Injection

Many drugs are commonly given by intravenous injection including cocaine hydrochloride, heroin, amphetamine and temazepam. The intravenous route affords rapid access to the circulation and thence to the brain, allowing fast onset of intense psychoactive effects. However, bypassing the body’s normal defense mechanisms in the gut carries great risks to health. The subcutaneous route is an alternative which is occasionally used if the intravenous route is not available. Intra-arterial injections are usually only given by mistake when a needle misses a vein. The intramuscular route is only used for anabolic steroids.

Oral Administration

For many drugs the oral route is preferred for convenience – ecstasy, LSD, alcohol and caffeine are all usually taken this way. Read more…

Once the cocaine is in the United States, its distribution and sale comprises another huge business. Typically, each major city is dominated by one or more criminal organization that controls cocaine selling throughout the city. In some cities, such as Los Angeles, pre-existing gangs have taken on much of the distribution and sale of cocaine. In the mid-1980s, highly organized Jamaican gangs became involved in crack dealing in Miami and New York. These so-called posses were known for their extraordinary violence and mobility; gang members moved to cities throughout the country, starting up new crack businesses. Today, it is estimated that approximately 40 of these posses exist, with a membership of 22,000, controlling one-third of the crack trade in America. Although leaders of these drug-dealing organizations can make hundreds of thousands of dollars a year, the street-level dealers who work for them sometimes make barely enough money to survive and support their own drug addictions. A recent study by the Rand Corporation found that street dealers stood a 1-in-70 chance of getting killed, a 1-in-14 chance of severe injury, and a 2-in-9 chance of going to jail. Despite these odds, many inner-city youths are still attracted to drug-dealing and the prospect of rising through the ranks to make “crazy money”. Read more…

The conversion of the coca leaf to the product that is illicitly marketed on the American street as “cocaine” (the quotation marks are included because the product sold on the street often contains more adulterants than pure drug) involves many steps. It begins with the coca plant itself. Erythroxylon coca, an evergreen shrub approximately three feet tall that grows most commonly in the easter foothills of the Andes Mountains. More than 200 strains of alkaloids, the vast majority contain little, if any, cocaine. The bush thrives at elevations between 1,500 and 5,000 feet and generally contains a relatively small amount of active cocaine; the average Peruvian coca leaf contains approximately one-half of 1% cocaine. The bitter taste of the alkaloids probably contributes to the flourishing growth of the coca bush by making the visually attractive bush an uninviting grazing source for the local animal population.

The coca plant can be harvested between six months and three years after its first planting, depending on the strain that has been planted. Once a growing area has been established, the leaves can be harvested several times a year, simply by stripping the leaves off the bushes. The farmers then take the harvested leaves to local processing plants located in the villages, where initial stage of extraction takes place. Here, coca paste is prepared by macerating coca leaves with kerosene, water, sodium carbonate, and sulfuric acid. Between 100 and 200 kilograms of coca leaves are necessary to produce 1 kilogram (2.2 pounds) of coca paste. The conversion of the leaf to paste thus results in an enormous reduction in bulk as well as an increasingly (40%-91%) pure product now worth four times the price of the original leaves. The decreased bulk enables drug traffickers to transport the paste far more easily than they can move massive quantities of coca leaves. Coca paste is converted into cocaine hydrochloride, the snowy white powder sold on the street, by adding a number of chemicals, which may include hydrochloric acid, potassium permanganate, acetone, ether, ammonia, calcium carbonate, sodium carbonate, sulfuric acid, and more kerosene. Read more…