Cocaine

Originally located in South and Latin America. Cultivated mainly in Colombia, Peru and Bolivia.

Cultivation: area under cultivation in Peru 1978: 17,800 ha, 1984: 63,000 ha, 1988: 190,000 ha, 1989: 250,000 ha, and the trend is still rising. Bolivia: increase in the area under cultivation from 70,000 ha in 1980 to 120,000 ha in 1986 (80% of the gross national product).

Raw material: Erythoxylon coca leaves, 3-4 harvests/year with 300 g of fresh leaves/harvest. Annual yield: about 1 tonne/hectare.

Preparation: Raw leaves are soaked in water and soda/lime, the cocaine is extracted with mineral oil and re-extracted with sulphuric acid: 1000 kg coca leaves make 5 kg "coca paste". Further, partly quite complex cleaning leads to cocaine hydrochloride with 90% active ingredient. 2 kg coca paste provide 1 kg pure cocaine.

After application and resorption via the nasal mucosa (sniffing), the onset of action occurs after 3 minutes, with intravenous injection or smoking after approx. 6 seconds. The effect lasts approx. 30 minutes.

Centrally arousing and euphoric, "making the unbearable bearable". Physical performance reserves can be exploited to the point of exhaustion.

Initial stage: Depression is driven away, urge to be active, fantasies of omnipotence, reduction of inhibitions, urge to talk increase.

After the initial stage, intoxication stage with anxiety-tinged experiences, tactile sensory illusions (skin tingling "cocaine animals"), flashes of light ("snow lights").

The intoxication ends after 1-2 hours in a depressive stage with headaches, vomiting and the need to sleep with simultaneous inability to sleep. Need for a new dose to escape this state.

First important local anaesthetic, which is used in salt form, as Cocainum hydrochloricum, according to BtMVV only as a local anaesthetic on the eye (simultaneously causes mydriasis).

Crack, as practically pure cocaine, only works for 2-20 minutes and is immediately followed by a post-rush, so there is a rapid risk of relapse due to psychological dependence.

Strong acute effects: hyperhidrosis, heart failure, respiratory arrest, cerebral hemorrhage, stroke.

Long-term effects: exhaustion, loss of vision, paranoid and schizophrenic states, personality alterations.

Long-term abuse can lead to scleroderma-like skin changes, and overall, long-term use can lead to a range of autoimmune symptoms that can be categorized into three overlapping clinical pictures:

• Cocaine-induced midline destructive lesions (CIMDL/no other organ involvement/BurgMR et al. 2015)
• Cocaine/levamisole vasculopathy/vasculitis (syn: levamisole/cocaine-induced (LAC) vasculopathy/vasculitis)
• Cocaine-induced vasculitis/vasculopathy (CIV)

History: 5000 years ago "sacred plant" of the Incas, at the time of the Spanish miners and slaves were paid with coca leaves. From 1884 used for local anesthesia, especially for minor eye operations (ophthalmologist Carl Koller), from 1899 also for conduction anesthesia; replaced from 1905 by fully synthetic products such as procaine. Since 1886 an ingredient of "Coca-Cola", from 1906 no cocaine was added.

Used in Germany well into the 20th century as a legal party drug, especially by artists.

1. Attoussi S et al. (1998) Cocaine-induced scleroderma and scleroderma renal crisis. South Med J 91: 961-963
2. Burg MR et al (2025) Occlusive cutaneous vasculopathies: rare differential diagnoses. J Dtsch Dermatol Ges 23:487-506.
3. Castro-Villamor MA et al. (1999) Cocaine-induced severe angioedema and urticaria. Ann Emerg Med 34: 296-297
4. Di Paolo N et al. (1997) Kidney vascular damage and cocaine. Clin Nephrol 47: 298-303
5. Haustein UF, Ziegler V (1986) Scleroderma and scleroderma-like diseases caused by environmental pollutants. Derm Profession Environment 34: 61-67
6. Hofbauer GF (1999) Urticarial vasculitis following cocaine use. Br J Dermatol 141: 600-601
7. Nelson LM (1995) Fixed drug eruptions; a report of two cases, one caused by niacin, the other by cocaine. Calif Med 82: 127-128
8. Paraiso PG et al. (2003) Middle facial necrosis secondary to cocaine abuse. An Otorrinolaringol Ibero Am 30: 389-396
9. Strong DH et al. (2003) Eosinophilic "empyema" associated with crack cocaine use. Thorax 58: 823-824