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Crack Cocaine

Crack is the street name for powder cocaine that has been baked with a substance, usually baking soda, to form a rock crystal.

While powder cocaine is usually snorted or sometimes injected into a vein, crack cocaine is smoked. The smoking process causes the small rocks to “crack,” hence the name.

Short Term Effects

Cocaine is a stimulates the release of dopamine in the brain.

Under normal circumstances, when we do something that is pleasurable, the brain rewards us by releasing a little spritz of dopamine in a particular neural system called the reward pathway.

The dopamine is released by neurons, exerts its effect, and is collected by the original neurons for another round of release when needed.

Cocaine prevents these neurons from collecting released dopamine.1 This released dopamine, from cocaine use, causes sustained and intensely pleasurable sensations.

Smoking cocaine causes a faster, more intense high than snorting the powder. While the “high” is more intense when cocaine is smoked, it lasts for a shorter period of time. Smoking crack cocaine produces a high for only 5 to 10 minutes while the snorted form may affect the brain for 15 to 30 minutes.

 Short Term Damage

Cocaine can actually change the reward system in the brain.2 Tolerance to crack cocaine develops very quickly. Larger amounts of the drug are required to achieve the same “high.”

Normal life pleasures are no longer as pleasurable because this important neural system has been altered.

Cocaine also causes:

  • Dramatically increased heart rate
  • Blood pressure
  • Vasospasm (profound constriction of the blood vessels)
  • Heart attack
  • Cardiac arrhythmia
  • Stroke

The tragic story of star athlete, Len Bias, is a famous example of the lethal, short term effects of cocaine in an otherwise healthy young man.

Long Term Damage

Addiction to crack cocaine is both a short and long term problem.

Because smoked crack cocaine is so powerfully addictive, users often become addicted in very few doses.

Wealthy and high-earning users can subsidize their use without detection while poor and regular-income earners engage in increasingly risky and even illegal behavior to feed their addiction. These lead to various legal and personal risks.

A longer term issue related to smoking crack cocaine is the damage done to the reward pathway in the brain and the release of dopamine.

Dopamine controls movement, emotion, and behavior.

Many diseases such as Parkinson’s and Huntington’s diseases and schizophrenia involve the dopamine system. Thus it is not uncommon for cocaine abusers to develop symptoms and signs of schizophrenia, particularly psychosis.

Cocaine abusers are prone to severe bouts of paranoia. They become suspicious of nearly everything. Moreover, part of the psychosis usually involves auditory hallucinations (“hearing voices”) and losing touch with reality. When overlaid with illegal activity and pursuit by law enforcement, the situation is extremely dangerous.

Crack CocaineOverdose

When someone is addicted to crack cocaine, the highs last for very brief periods of time and more of the drug is required to reach an ever-diminishing reward.

Therefore the quantity of crack that is used increases, both in concentration and in the number of times it is smoked.

As the frequency and quantity of crack use increases, the risk of serious side effects increases as well.

The risk of heart attack and stroke can occur at virtually any dose of crack cocaine, at any time it is smoked. Higher doses make the effects on the cardiovascular system more intense and more dangerous.

Smoking crack is a form of Russian roulette. Each use is another pull of the trigger and each increased dose is a live round in another chamber.

Symptoms and Signs of Abuse

Since the high of smoking crack lasts only minutes, it is difficult to catch an abuser in the act.

The effects of cocaine on the body last longer than the high itself.

These symptoms are:

  • Dilated pupils, sometimes to the size of pinholes
  • Feverish
  • Anxious
  • Rapid breathing
  • Fast pulse
  • Constricted blood vessels
  • Gastrointestinal complaints because blood is not flowing to the intestines

Since cocaine diminishes appetite, chronic users lose weight and even appear malnourished. They are typically jittery and anxious, even when not actively intoxicated.

Adverse Interactions

Cocaine has similar action to other types of stimulants, such as amphetamines. In fact, both affect the dopamine system in the reward pathway of the brain. Taken together the high is more intense, but so is the destruction of the natural reward pathway.

Cocaine and alcohol combine in the liver to create an especially toxic compound called cocaethylene. Cocaethylene creates even more profound euphoric effects than the cocaine itself3, but the risk of sudden death when using both crack and alcohol together is enormous.4

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  1. Wise RA, Kiyatkin EA. Differentiating the rapid actions of cocaine. Nat Rev Neurosci. Aug 2011;12(8):479-484.
  2. Gu H, Salmeron BJ, Ross TJ, et al. Mesocorticolimbic circuits are impaired in chronic cocaine users as demonstrated by resting-state functional connectivity. Neuroimage. Nov 1 2010;53(2):593-601.
  3. Harris DS, Everhart ET, Mendelson J, Jones RT. The pharmacology of cocaethylene in humans following cocaine and ethanol administration. Drug Alcohol Depend. Nov 24 2003;72(2):169-182.
  4. Randall T. Cocaine, alcohol mix in body to form even longer lasting, more lethal drug. JAMA. Feb 26 1992;267(8):1043-1044.