- Cocaine : Facts and History
- Types of Cocaine
- Cocaine hydrochloride
- Freebase Cocaine
- Crack Cocaine
- Routes of Administration
- Effects of Cocaine
- Short Term Effects
- Long Term Effects
- How Long Does Cocaine Stay In Your System?
- How Long Does Cocaine Stay In Your Urine?
- How Long Does Cocaine Stay In Your Blood?
- Cocaine Testing
- Types of Tests for Cocaine
- Urine Test for Cocaine
- Hair Test for Cocaine
- Blood Test for Cocaine
- Sweat Patch Test for Cocaine
- Saliva Test for Cocaine and how long does saliva stay in your system
- Reasons for Inaccuracy of Cocaine Test Results
- False Negative Results
- False Positive Results
- Cocaine Withdrawal Symptoms
Cocaine : Facts and History
- Chemically known as Benzylmethylecgonine (chemical formula: C17H21NO4), cocaine is an alkaloid ester derived from the leaves of the coca plant (family Erythroxylaceae), native to the southern part of the United States. 
- It was not until late 19th century that cocaine production was established. After years of utilizing coca leaves to make wines, cocaine was then extracted and first introduced as an anaesthetic drug in 1884. 
This alkaloid was used for curing abdominal pain, tuberculosis, depression and hay fever. 
- Before it was proven to be a cause of addiction itself, the substance was also utilized for management of opiate addiction. Back then, cocaine was sold in various forms such as cigarettes, powder, and even as an injectable. 
- Because of its diverse use, addiction ensued. It was hence added to the list of prohibited drugs, particularly in the Dangerous Drug Act of 1920. 
- With three different forms known, cocaine had been a serious problem, not only in the United States, but worldwide. 
Picture : coca plant
- It is ranked as 3rd among the top recreational drugs used around the world, beaten by only heroin and cannabis. 
- In 1997, around 1.5 million Americans were deemed as cocaine users, based on the survey done by the National Household Survey on Drug Abuse. 
- In 2010, there was a decline in use of cocaine was noted in Europe, similar to the trend observed in Canada and the United States. This was attributed to the financial burden of regular cocaine use and the concomitant decreasing economy. 
Types of Cocaine
- It uses “coke”, “C”, “snow”, “flake” or “blow” as street names.
- Characterized as white and powdery in consistency, it comes in the form of salt, particularly hydrochloride salt, which is quite soluble in water.
- It is usually either sniffed (snorted) or injected.
- This substance cannot be smoked, for it will be destroyed when burned.
- Chemically modified, it is otherwise known as alkaloidal cocaine.
- As base form of cocaine, it is practically insoluble in water.
- This type is administered by smoking, and usually makes the user feel ”high” immediately by being immersed to the brain very quickly.
- It then releases the metabolite methylecgonidine, which is not only cardiotoxic, but also detrimental to the pulmonary and hepatic tissues.
- A modified type of freebase cocaine, it is usually in the form of small crystals or rocks, very hard and brittle, and off-white to brown in color.
- Also used for smoking, it stimulates the brain almost instantly.[9, 10, 11]
Routes of Administration
- “Numbies”, “gummers” and “cocoa puffs” are usually used.
- Cocaine powder is usually rubbed along the gum lines or smoked onto a cigarette filter, numbing the oral cavity.
- This can also be exemplified by snow bombs, wherein a small amount of cocaine is wrapped up in a rolling paper and is swallowed.
- Coca leaves may also be chewed, with its juices absorbed and ingested.
- Once cocaine is orally administered, it will take around 30 minutes before it reaches the bloodstream.
- Also known as snorting, sniffing or blowing, it is the most common method for ingesting recreational cocaine.
- In this route, approximately 30-60% of the alkaloid is absorbed through mucous membranes of the sinuses.
- The average time with which the sniffed cocaine peaks in the blood is estimated to be around 14 to 15 minutes.
- Cocaine injection provides the highest blood levels of drug in the shortest amount of time.
- Within only 3 minutes of administration, symptoms of euphoria can manifest.
- This can be done either by heating the solid drug and inhaling its vapor, or by smoking freebase or crack form using a small glass tube pipe.
- Effects of which may last for only 5 to 15 minutes.
- Otherwise known as plugging, this method uses an oral syringe.
- Dissolved cocaine is withdrawn to the syringe and inserted into the anus or vagina. [9, 12,13]
Picture : mechanism of action of cocaine
Effects of Cocaine
Cocaine is a fast-acting, but short-lived central nervous system stimulant. Effects vary from subtle to extreme, depending on the dose consumed and the purity of the drug ingested. Symptoms can be felt within seconds, peaking within 5 minutes, and wear off after half an hour. 
When cocaine is ingested, it attaches to the dopamine receptor in the brain. It then dysregulates the normal process, thereby causing excessive production of dopamine  and subsequently causing the following:
Picture: Side effects of chronic use of cocaine
Short Term Effects
- Loss of appetite
- Mental alertness and hyperstimulation
- Increased heart rate, blood pressure and temperature
- Constricted blood vessels
- Dilated pupils
- Insomnia [6, 15]
Long Term Effects
- Irritability and mood disturbances
- Restlessness, sleeplessness and sexual dysfunction
- Paranoia and anxiety
- Cardiovascular problems: Heart attacks, irregular heartbeat, heart failures and strokes
- Severe depression
- Diminished sense of smell
- Perforated nasal septum
- Neurological incidents: seizures, fungal brain infections, cerebral hemorrhage
- Pulmonary disorders: lung effusions, asthma exacerbation, respiratory failure
- For intravenous cocaine users: increased risk of hepatitis, human immunodeficiency virus infection, and endocarditis
- Increased risk for Lupus, Goodpasture’s disease, vasculitis, glomerulonephritis, Steven Johnson syndrome. [6,15]
How Long Does Cocaine Stay In Your System?
There are a number of ways to measure the length of time cocaine remains detectable in the human body. Results may range from 6 hours to 5 weeks [16, 17], depending on the body mass, metabolic rate, route of administration, amount and frequency cocaine was used [18, 19, 20], and of course, the method of laboratory diagnostics used .
How Long Does Cocaine Stay In Your Urine?
Urine cocaine test can detect relatively recent use, as early as 7 days, to as long as long term exposure of 2 to 3 months.  It may vary in accordance with the route of administration and frequency of use.
The presence of cocaine in the urine is largely dependent on the route by which the substance is ingested. When cocaine is snorted, urine levels would be positive within 4 to 10 hours. When injected, it will take around 20 hours before the substance is detected.  Longest when taken orally, cocaine will only be present in the urine after 24 hours of ingestion. 
Urine cocaine levels are also greatly influenced by the number of times the substance is used. In an occasional user, Benzoylecgonine, a cocaine metabolite, can be noted in the urine approximately 2 to 4 days after ingestion . However, levels of the same metabolite can remain significant for as long as 22 days among heavy/binge users. 
How Long Does Cocaine Stay In Your Blood?
Following intravenous or pulmonary (smoking or sniffing) administration, high cocaine levels in the blood are achieved almost immediately.  This method has a detection window: from 12 hours, for cocaine level determination, to 48 hours, when utilizing the cocaine metabolite benzoylecgonine. 
Five different types of cocaine drug testing are available up to date: tests for urine, blood, hair, saliva and sweat.
Types of Tests for Cocaine
Urine Test for Cocaine
- Although this is the least expensive method used for the determination of the presence of cocaine, the urine cocaine test is fast, accurate and easy to perform. However, results of which can be easily influenced by temperature, time of last intake, and simultaneous intake of other drugs.
- During specimen collection, the urine must be maintained in a temperature within 96 to 99 degrees Farenheit. This will assure accuracy and reliability of urine drug testing. 
- Abstaining from cocaine use for a period of time before the test can also influence results. 
- Concurrent intake of alcohol may increase levels of cocaethylene, another cocaine metabolite; thus, leading to positive cocaine test. 
- A urine ratio of benzoylecgonine to cocaine of less than 100:1 would reflect cocaine use in less than ten hours. 
Picture – cocaine in urine
Hair Test for Cocaine
- It is a more expensive test for cocaine, in comparison to that of the urine. 
- It may have a positive result within 8 hours, or at times, only after 7 to days after cocaine use. The substance can remain on the hair for months, even until the hair is trimmed. 
- Cannot be done by a single hair, the procedure requires a samples of hair around 5 inches long. 
- Results are not affected by periods of abstinence, but can be contaminated by external factors. 
Blood Test for Cocaine
- Among the tests for cocaine, blood testing is the most expensive one.
- It is the least utilized, but the most accurate method of diagnosing presence of cocaine in the system. 
Sweat Patch Test for Cocaine
- The Sweat Patch has 3 components: an absorption pad, a release liner, and a polyurethrane/adhesive layer. 
- During the 2 week patch application along the upper arm, presence of cocaine is determined as the drug is excreted from the body via perspiration. 
- As little as 1-5mg of cocaine would produce detectable levels of cocaine and/or metabolites in sweat. 
- When a Sweat Patch Test is positive, a mass spectrometry screening system, or gas chromatography, is then done for further confirmation. 
- The usage of this test remains relatively controversial due to its accuracy, which is said to be easily affected by surface contamination. 
Picture – sweat patch test for cocaine
Saliva Test for Cocaine and how long does saliva stay in your system
- The test is more expensive than urine, but cheaper than hair or blood examinations.
- It can detect more recent cocaine use, as compared to the other methods of cocaine determination. 
- Cocaine can be significantly found in saliva shortly after nasal, oral and intravenous use, even up to a day thereafter. However, this shall last only for a maximum of 6 hours. 
- Saliva collected must be around 0.5ml, placed in a clean, plastic container, and stored at 2-8 degrees Celsius for up to 7 days. 
- A cutoff concentration of 20ng/ml serves to screen the saliva for presence of the cocaine metabolite benzoylecgonine. 
- Disadvantages of this procedure include: variable nature of saliva pH, influence of collection devices, procedures of drug concentration, and oral contamination. 
Reasons for Inaccuracy of Cocaine Test Results
Diagnostic examinations determining the presence or absence of drugs may generally have a 5 to 10% false positive turnout, and 10 to 15% chance of being false negative. The reasons for which are stated below.
False Negative Results
- Dilute urine due to excessive fluid intake and diuretic use
- Insufficient quantity ingested
- Inappropriate test used
- Elevated urine lactate
- Inefficient handling, or tampering, of specimen [30, 31, 32]
False Positive Results
- Kidney and/or liver disease
- Diabetes Mellitus
- Cold medications
- Quinolone antibiotics
- Tonic Water
- Amoxicillin (still controversial)[33, 34, 35]
Cocaine Withdrawal Symptoms
- When a cocaine user cuts down or quits the drug, a crash follows almost immediately.
- It has no visible physical symptoms like vomiting and shaking, such that seen in the alcohol withdrawal.
- Accompanied by a strong craving for cocaine, symptoms include fatigue, lack of pleasure, anxiety, irritability, sleepiness and agitation.
- Symptoms disappear over time, but can last for months after cessation of drug use.
- Treatment difficulty is recognized. Patients are encouraged to join support group activities. [36, 37]
Picture : prevalance of cocaine use in world
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