Physicians learn about cocaine as a local anesthetic. It was the first local anesthetic discovered in the 1800’s and it is the only naturally occurring local anesthetic (cocaine is derived from the leaves of the coca plant). All other local anesthetics are synthetically derived. Local anesthetics belong to two groups: esters and amides. The difference between these two groups has to do with their potential for adverse effects and their metabolism.
Cocaine is an ester. An enzyme (plasma cholinesterase) cleaves the ester linkage, which is the reason this category of drugs has such a short half-life and hence a short duration of action.
How does cocaine work?
- As a local anesthetic it blocks nerve conduction by impairing the propagation of the action potential.
- It also interacts directly with specific receptors on the sodium channels of cells, preventing sodium influx.
- It increases the level of dopamine in the areas of the brain controlling pleasure.
- It blocks norepinephrine and serotonin reuptake in the central nervous system.
What are the effects of cocaine that makes it so tempting?
- Increased energy.
- Increased feeling of happiness.
- Increased mental alertness.
What are the negative consequences of prolonged use and overdose of cocaine?
- Cocaine as an illegal drug is a highly addictive stimulant
- It stimulates the heart to increase heart rate and blood pressure
- May cause hypertensive crisis and cardiac arrest
- Chest pains
- Irregular breathing
- Nausea and vomiting
- Increased body temperature
Given these dreary facts about cocaine, why would anyone want to even try it? Are there some personalities that are more prone to engage in risky behavior? The psychology behind why some people use cocaine is beyond the scope of this blog. What should be brought home to readers is that cocaine can produce physical and psychological dependence, which explains why it is so difficult for many to stop using.
I will also refrain from discussing the various routes that can be used to get cocaine into the blood stream; however, suffice it to say that man can be extremely ingenuous when they want something badly.
Tennis has a very strict policy on the use of drugs that they have deemed as banned substances. Players get tested periodically and recent literature points to the fact that the ITF is trying to increase the frequency of testing. Today’s big announcement was that Daniel Evans had tested positive for cocaine; however, he is not the only tennis player that has tested positive. Martina Hingis and Richard Gasquet, prominent tennis stars, have also tested positive. While I do not condone drug use, I want to say that tennis players are humans and subject to all the weaknesses and frailties of being human.
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