Cocaine

Cocaine is initially extracted from the leaves of the coca plant that is found mostly in South America. It goes through several stages of processing and purifying before it reaches the white salt form of powdered cocaine. Cocaine powder can also be dissolved in baking soda or ammonia and water, then boiled until it is solid, dried, and broken into “rocks” as crack cocaine.

As an illegal drug processed through illicit channels, users may not always be clear on what they are getting. Cocaine is not generally pure. In fact, CNN reports that cocaine purity may be under 50 percent in cocaine sold on the street in the United States. Many agents are used to “cut” cocaine, either to stretch the product out and make it go further (thereby increasing profit by selling less for more) or to enhance the effects of the drug. NIDA reports that flour, talcum powder, or cornstarch are common additives used to stretch cocaine, as they are also white powders and may be visibly indistinguishable from the drug itself. Laundry detergent, boric acid, creatine, and laxatives may also be used as cutting agents of cocaine. These products are much cheaper than cocaine and can therefore increase its street profit, as buyers are often unaware of the amount of cocaine actually in the product they are purchasing.

Many of these cutting agents may not have noticeable side effects; however, some can be outright dangerous. Levamisole, a deworming medication used by veterinarians on cattle, was found in nearly 70 percent of seized cocaine samples in 2009, as published by the Mayo Clinic Proceedings. Levamisole can cause a life-threatening immune system disorder called agranulocytosis that kills 7-10 percent of those who contract it, TIME warns.

Cocaine may also be cut with other stimulants like caffeine, methamphetamine, and amphetamine, or local anesthetics, such as procaine, benzocaine, or lidocaine. These substances all have similar methods of action to cocaine and thus enhance both the effects and potential side effects. Cocaine purity is hard to discern, hence taking the drug is a little like Russian roulette. A person can never be exactly sure what is in the drug they are taking. Cocaine may also be intentionally mixed with other drugs, such as heroin in a “speedball,” for an enhanced experience. This is also a dangerous practice that heightens the odds for a negative or even fatal reaction or overdose.

As a stimulant drug, cocaine is often taken to increase euphoria and feel good. It may be mixed with other drugs, like methamphetamine or amphetamines which have similar effects, in order to increase the high. Cocaine is so potent and its associated high is so intense, however, that mixing other stimulants with it can greatly raise the risk for overdose.

Cocaine may also be combined with drugs with opposite effects, such as depressant drugs like opioids, marijuana, or benzodiazepines. This may be done in an attempt to blunt the negative effects of either substance. For example, heroin and opioid drugs can cause sedation, and cocaine enhances wakefulness and energy. When combined, a user may be seeking a relaxing yet alert high. Individuals may seek to mix “uppers” with “downers” to extend the intoxication timeline as well. While mixing cocaine with other drugs may enhance the potential positive effects, the negative effects of all substances are also enhanced, and both short-term and long-term consequences can occur.

The “speedball” (powdered cocaine and heroin, usually injected) and “eightball” (crack cocaine mixed with heroin and smoked) are common drug combinations that can be highly dangerous. Not only are the desired effects amplified, but so are the negative ones, possibly causing blurred vision, impaired motor control, incoherence, mental stupor, cognitive and mental impairment, confusion, and anxiety. The risks of heart attack, aneurism, stroke, and respiratory failure are increased, NIDA for Teens warns.

The mixture of cocaine and heroin is particularly hazardous as these drugs wear off at different rates. Cocaine creates a short-lived high, while the effects of heroin can linger a little longer, which can lead to fatal respiratory distress as the stimulant nature of cocaine wears off, leaving only the depressant effects of heroin.

Marijuana cigarettes may be sprinkled with cocaine for a more stimulating high. This practice can increase the hazards of both drugs, leading to lower inhibitions and increased risk-taking behaviors with potential long-term consequences.

Combining mind-altering substances not only raises the potential for a fatal overdose, but it can also increase the rate of drug dependence and therefore raise the risk for a loss of control over taking the drugs, or addiction. Drug addiction is often a long-term side effect of polydrug abuse that requires specialized care to manage.

The presence of multiple drugs can complicate withdrawal; therefore, it is optimally performed in a medical detox facility where vital signs and mental health can be constantly monitored for safety. A combination of medical and therapeutic methods is ideal in treating polydrug dependence and addiction.