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Pure cocaine was first extracted and identified by the German chemist Albert Niemann in the mid-19th century, and was introduced as a tonic/elixir in patent medicines to treat a wide variety of real or imagined illnesses. Later, it was used as a local anesthetic for eye, ear, and throat surgery and continues today to have limited employment in surgery. Currently, it has no other clinical application, having been largely replaced by synthetic local anesthetics such as lidocaine.
Because of its potent euphoric and energizing effects, many people in the late 19th century took cocaine, even though some physicians recognized that users quickly became dependent. In the 1880s, the psychiatrist Sigmund Freud created a sensation with a series of papers praising cocaine's potential to cure depression, alcoholism, and morphine addiction.
Skepticism soon replaced this excitement, however, when documented reports of fatal cocaine poisoning, alarming mental disturbances, and cocaine addiction began to circulate.
According to information collected in 1902, 92% of all cocaine sold in major cities in the United States was in the form of an ingredient in tonics and potions available from local pharmacies.
In 1911, the Canadian government legally restricted cocaine use, and its popularity waned. The 1920s and '30s saw a marked decline in its use, especially after amphetamines became easily available. Cocaine's return to popularity, beginning in the late 1960s, coincided with the decreased use of amphetamines.
Cocaine in powder form is usually "snorted" into the nostrils, although it may also be rubbed onto the mucous lining of the mouth, rectum, or vagina. To experience cocaine's effects more quickly, and to heighten their intensity, users sometimes inject it.
Cocaine hydrochloride can be chemically altered to remove other substances. The process, called "freebasing," is potentially dangerous because the solvents used are highly flammable. The pure form of cocaine that results ("free base") is smoked rather than snorted. The drug commonly called "crack" is a crude form of free base that has become popular in recent years.
Cocaine's short-term effects appear soon after a single dose and disappear within a few minutes or hours. Taken in small amounts (up to 100 mg), cocaine usually makes the user feel euphoric, energetic, talkative, and mentally alert - especially to the sensations of sight, sound, and touch. It can also temporarily dispel the need for food and sleep. Paradoxically, it can make some people feel contemplative, anxious, or even panic-stricken. Some people find that the drug helps them perform simple physical and intellectual tasks more quickly; others experience just the opposite effect.
Physical symptoms include accelerated heartbeat and breathing, and higher blood pressure and body temperature.
Large amounts (several hundred milligrams or more) intensify users' "high," but may also lead to bizarre, erratic, and violent behavior. These users may experience tremors, vertigo, muscle twitches, paranoia, or, with repeated doses, a toxic reaction closely resembling amphetamine poisoning.
Physical symptoms may include chest pain, nausea, blurred vision, fever, muscle spasms, convulsions, and coma. Death from a cocaine overdose can occur from convulsions, heart failure, or the depression of vital brain centres controlling respiration.
With repeated administration over time, users experience the drug's long-term effects. Euphoria is gradually displaced by restlessness, extreme excitability, insomnia, and paranoia - and eventually hallucinations and delusions. These conditions, clinically identical to amphetamine psychosis and very similar to paranoid schizophrenia, disappear rapidly in most cases after cocaine use is ended.
While many of the physical effects of heavy continuous use are essentially the same as those of short-term use, the heavy user may also suffer from mood swings, paranoia, loss of interest in sex, weight loss, and insomnia.
Chronic cocaine snorting often causes stuffiness, runny nose, eczema around the nostrils, and a perforated nasal septum. Users who inject the drug risk not only overdosing but also infections from unsterile needles and hepatitis or AIDS (acquired immune deficiency syndrome) from needles shared with others. Severe respiratory tract irritation has been noted in some heavy users of cocaine free base.
Some users, however, report that they become more sensitive to cocaine's anesthetic and convulsant effects even without increasing the amount. This theory of increased sensitivity has been put forward to explain some deaths that have occurred after apparently low doses.
Psychological dependence exists when a drug is so central to a person's thoughts, emotions, and activities that it becomes a craving or compulsion. Among heavy cocaine users, an intense psychological dependence can occur; they suffer severe depression if the drug is unavailable, which lifts only when they take it again.
Experiments with animals suggest that cocaine is perhaps the most powerful drug of all in producing psychological dependence. Rats and monkeys made dependent on cocaine will always strive hard to get more.
At present, researchers do not agree on what constitutes physical dependence on cocaine. When regular heavy users stop taking the drug, however, they experience what they term the "crash" shortly afterwards.
Overall, during abstinence, many users complain of sleep and eating disorders, depression, and anxiety, and the craving for cocaine often compels them to take it again. Treatment of the dependent cocaine user is therefore difficult, and the relapse rate is high. Nevertheless, some heavy users have been able to quit on their own