Cocaine is a central nervous system stimulant and is commonly known as a “party” drug. There is a good reason for this slang term, as cocaine use leads to increased energy and alertness and can reduce the effects of alcohol, enabling someone to drink more. These effects come with a high cost, however, and cocaine use produces a variety of changes in the brain, some may even be lifelong. In this article, we examine the exact ways that cocaine produces its effects.
How Cocaine Affects The Brain
Cocaine is a very potent stimulant drug, and it affects a variety of neurotransmitters in the brain. Neurotransmitters are chemicals that are responsible for moderating and sending signals throughout the brain. The most direct influence in the case of cocaine is on the neurotransmitter dopamine, however, it also produces changes in the serotonin and norepinephrine neurotransmitter systems. Cocaine promotes the release of dopamine, serotonin, and norepinephrine while also preventing reuptake, a chemical recycling process used in the brain which also maintains steady levels of these neurotransmitters. Because it can prevent reuptake, the levels of dopamine will rise dramatically as it continues to build up instead of being cleared away as it normally would.
Using cocaine will quickly produce a flood of dopamine, serotonin, and norepinephrine while also acting as a local anesthetic, numbing mucus membranes that are directly exposed to it. The flood of the neurotransmitter dopamine is mostly responsible for mental euphoria and to a lesser degree the increased physical energy. Increased serotonin also contributes to euphoria in a minor fashion, and produces elevated mood and sense of well being while using the drug. Norepinephrine is both a neurotransmitter in the brain, as well as a hormone in the blood where it can promote the release of adrenaline. Dopamine and norepinephrine are responsible for increased energy when using cocaine.
Chronic cocaine use and the continuously increased levels of these neurotransmitters causes the brain to undergo a process called downregulation. This process is the brain’s attempt to maintain balance and is a direct response to these heightened levels. Downregulation is the act of the brain “turning down” its sensitivity to these neurotransmitters when they are at higher-than-normal levels for too long. This has the effect of producing tolerance since the brain will now respond less strongly to these neurotransmitters. Finally, prolonged cocaine use may alter the signaling pathways and production of these neurotransmitters, particularly dopamine, and result in long-term changes to the brain’s structure.
The high from snorting cocaine can last around 45 minutes to 1 hour. Cocaine has a very short half-life (studies vary but between 1-2 hours) which means that the body metabolizes and eliminates it quite quickly. This results in plummeting levels of dopamine, serotonin, and norepinephrine that can often feel like a crash, and the longer someone has been doing cocaine the worse this will feel.
The surge of dopamine and norepinephrine produced by cocaine use creates a great rush of euphoria and increased energy. This surge of energy may increase reaction time temporarily as well as create an urge to talk. Also, both male and female sex drive may be enhanced through cocaine use.
There is a strong tendency for people using cocaine to suddenly feel extremely close to those around them. This can result in a feeling of tight-knit camaraderie with others who are around a person when they are doing cocaine. Experiencing an inflated sense of confidence and faith in one’s abilities is very common as well.
The increase in energy produced by cocaine use can result in a variety of hyperactive or even obsessive behaviors. One of the most common behaviors is nonstop talking. This can also include uncharacteristic honesty or openness about things a person may not normally discuss. Foot tapping, pacing, and chain-smoking are very common while someone is high on cocaine. Finally, cocaine tends to increase risk-taking behavior in general so people may be more prone to making very dangerous choices while using cocaine. This can include doing drugs they normally would not, drinking much more than they normally would, and getting into fights.
How Cocaine Affects The Body
The physical effects of cocaine use are primarily due to norepinephrine release, and the subsequent increase in adrenaline that this produces. This has a far-reaching effect on many different body systems and can increase the risk of overdose or death. Being a stimulant, cocaine will speed up and amplify almost every system it affects. Let’s look at each major body system in turn:
Norepinephrine is a very powerful neurotransmitter and hormone, and the release of adrenaline it produces has a massive impact on the cardiovascular system. Adrenaline is a critically important hormone and is most heavily used during the “fight-or-flight” response to boost short term physical and mental performance when facing predators, thereby increasing survivability. This overexertion of the adrenal system can cause heart rate and blood pressure to spike dramatically while also causing arteries to get smaller through vasoconstriction. This reduces the amount of oxygen that is available to tissues and organs and can unnecessarily tax other vital organs such as the liver, kidneys, lungs, and especially the heart itself.
While the drug cocaine itself has little direct effect on the lungs, the route someone chooses to use it may introduce complications. People who smoke cocaine (not crack, but freebase cocaine) can do extensive damage to the entire mouth, esophagus, and bronchioles or alveoli of the lungs. Pulmonary edema, asthma, emphysema, bronchitis, and pneumonia are quite common in people who smoke cocaine. Additionally, people who snort cocaine can do severe damage to the nose and sinuses along with the esophagus. When injecting cocaine, the risk of pulmonary embolism is greatly increased. Some of the most frequently reported issues, where cocaine has played a role, include wheezing, shortness of breath, chest pain, fever, and coughing up black mucus.
While cocaine increases the function of other systems in the body, it actually slows or even stops digestion. This is a direct result of increased adrenaline levels which, in an attempt to increase survival chances, causes the body to redirect blood from digestion towards functional muscles and vital organs like the heart and lungs. That being said, cocaine itself does pass through the digestive tract after being snorted and can inflict damage on its way through the stomach or intestines. One of the more common issues is known as mesenteric ischemia, which is due to decreased blood flow to the intestines resulting in tissue damage and gangrene. This may then progress to bowel perforation and intraperitoneal hemorrhage (intestinal contents leaking into the abdomen), which is extremely dangerous and can be fatal if not immediately treated.
Cocaine has some very serious repercussions on reproduction for both men and women. The highest risk is with women who are pregnant, for both the mother and child, although cocaine reduced the fertility of all chronic users. The way in which fertility is effected differs between sex, so we will take a look at each in turn:
- Male Reproduction: While cocaine hasn’t been implicated in male infertility per se, it has been associated with subfertility in men. This is due to chronic cocaine use (5+ years) resulting in lower sperm counts, lower sperm motility (ability to swim), and a much higher incidence of abnormal sperm in the ones which were present. 1
- Female Reproduction: While comprehensive and controlled human cocaine studies are hard to come by, it is known that cocaine alters hormone levels and regulation. This, coupled with vasoconstriction, may lead to menstrual abnormalities such as very light or absent periods. Furthermore, cocaine has been implicated as a contributor to fallopian tube damage and blockage. Damaged or blocked fallopian tubes is one of the leading causes of infertility in American women today. 2
- During Pregnancy: Cocaine can have a devastating and deadly impact on developing fetuses, possibly resulting in fetal and/or maternal death. Some of the common issues which are attributed to cocaine stem from a reduction in uteroplacental blood flow and circulation due to vasoconstriction. This is most likely responsible for a variety of birth defects such as low birth weight, premature birth, cognitive and behavioral deficits, and a variety of birth defects. Additionally, there is a much higher rate of miscarriage, placental abruption, and intrauterine growth retardation. Cocaine is also passed into the milk of nursing mothers, so even after the child has been born cocaine still poses a risk if the mother is actively using cocaine. Finally, there is a greatly increased risk of sudden infant death syndrome in children born to mothers who used cocaine while pregnant. 3
- Fertility and Sterility: Association of Cocaine Use with Sperm Concentration, Motility, and Morphology
- American Journal of Pathology: Uteroplacental Blood Flow – The Story of Decidualization, Menstruation, and Trophoblast Invasion
- Human Reproduction Update: Reproductive Risks of Cocaine