Announcement: New office hours

Starting March 6, 2017 Nationwide Medical Review will observe new office hours:

Monday through Friday:  8am – 7pm EST

Saturday:  9am – 12pm EST

Drug Overview

Important information regarding COCAINE drug use

Cocaine, the most potent stimulant of natural origin, is extracted from the leaves of the coca plant (Erythroxylon coca), which is indigenous to the Andean highlands of South America. Natives in this region chew or brew coca leaves into a tea for refreshment and to relieve fatigue similar to the customs of chewing tobacco and drinking tea or coffee.

Pure cocaine was first isolated in the 1880s and used as a local anesthetic in eye surgery. It was particulary useful in surgery of the nose and throat because of its ability to provide anesthesia as well as to constrict blood vessels and limit bleeding. Many of its therapeutic applications are now obsolete due to the development of safer drugs.

Illicit cocaine is usually distributed as a white crystaline powder or as an off-white chunky material. The powder, usually cocaine hydrochloride, is often diluted with a variety of substances, the most common of which are sugars such as lactose, inositol and mannitol, and local anesthetics such as lidocaine. The adulteration increases the volume and thus multiplies profits. Cocaine hydrochloride is generally snorted or dissolved in water and injected. It is rarely smoked.

“Crack,” the chunk or “rock” form of cocaine, is a ready-to-use freebase. On the illicit market it is sold in small, inexpensive dosage units that are smoked. With crack came a dramatic increase in drug abuse problems and violence. Smoking delivers large quantities of cocaine to the lungs, producing effects comparable to intravenous injection; these effects are felt almost immediately after smoking, are very intense, and are quickly over. Once introduced in the mid-1980s, crack abuse spread rapidly and made the cocaine experience available to anyone with $10 and access to a dealer. In addition to other toxicities associated with cocaine abuse, cocaine smokers suffer from acute respiratory problems including cough, shortness of breath, and severe chest pains with lung trauma and bleeding.

The intensity of the psychological effects of cocaine, as with most psychoactive drugs, depends on the dose and rate of entry to the brain. Cocaine reaches the brain through the snorting method in three to five minutes. Intravenous injection of cocaine produces a rush in 15 to 30 seconds and smoking produces an almost immediate intense experience. The euphoric effects of cocaine are almost indistinguishable from those of amphetamine, although they do not last as long. These intense effects can be followed by a dysphoric crash. To avoid the fatigue and the depression of “coming down,” frequent repeated doses are taken. Excessive doses of cocaine may lead to seizures and death from respiratory failure, stroke, cerebral hemorrhage or heart failure. There is no specific antidote for cocaine overdose.

Acording to the 1993 Household Drug Survey, the number of Americans who used cocaine within the preceding month of the survey numbered about 1.3 million; occasional users (those who used cocaine less often than monthly) numbered at approximately 3 million, down from 8.1 million in 1985. The number of weekly users has remained steady at around a half million since 1983.

[Abstracted from D.E.A. website q.v.]

Drug Effects

Euphoria! Feeling of super-normal well-being and ability. Actually is strong adrenergic and dopamine-ergic drug causing increased energy and athletic ability! Cocaine has a very short plasma half-life & is very addictive which explains why cocaine abusers abuse so frequently and re-abuse so quickly after a “hit.” Aside from the impairment involved, the most severe ill effect is its effect on the heart’s “timing” system…. often causing life-threatening arrhythmias. There have been many documented deaths caused by Cocaine abuse
Incidence of Abuse
Chemical Name
Cocaine Alkaloid, extracted from Coca Plant, Erythroxylon Coca
Forms and Street Names
Cocaine (Hydrochloride): Coke, Flake, Snow, Happy dust, Gold dust, Cecil, C, Freebase, Toot, White girl, Scotty.
Crack Cocaine (base or hydroxide): Crack, Rock, Base, Sugar block. When prepared for inhalation, “free base” cocaine is called “crack.” (because it “crackles.”)
Preferred routes of administration
Most often “snorted.” Sometimes I.V. Inhalation (“smoking”) of “crack” cocaine much more popular & common in recent years. It is poorly absorbed orally — also topically. Marijuana cigarettes laced with cocaine are called Bazookas.
Length of time detectable after user
Usually 2-4 days “B-E” actually has a longer half-life often resulting in very high (100’s of thousands) urine levels.
Metabolite Actually sought in urine
Benzoyl-ecgonine or “B-E”
Confounding drugs (or factors):
None known w/ gc/ms. Some of the various ‘…caine” drugs may confound Immunoassay?
Screening Cut-off:
150 ng/ml
Confirmation GC/MS Cut-of
100 ng/ml
Facts for Verifying M.R.O
MEDICAL USES?? YES! TAC solution (Tetracaine-Adrenalin-Cocaine) is frequently used in the Emergency Room for local anesthesia for laceration repair. Also, topical Cocaine is used in ENT work as topical naso-pharyngeal anesthetic. PASSIVE INHALATION?? NO! “Crack house” or similar claims are NOT VALID CLAIMS! TOPICAL ABSORPTION?? YES! Policemen have tested “positive” after prolonged handling of cocaine powder! HEALTH INCA TEA?? YES! This product, once legally imported from South America, does contain cocaine. It has been illegal for many years and safety-conscious employees should know to avoid it! It is a “WEAK CLAIM” most likely to be tried by the “savvy” Cocaine Abuser. .