Cocaine 97Like other stimulants, cocaine may improve mood, self-confidence, and so-
ciability. Taking the drug for such purposes may be recreational or for self-
medication of psychological distress; for example, a strong association exists
between posttraumatic stress disorder and cocaine use. Cocaine can tempo-
rarily enhance work performance whether the task be manual labor or intel-
lectual concentration. A century ago railroad engineers, dock workers, and
cotton pickers were reported to be using the drug for that purpose, and it also
received experimental military use in that pre-amphetamine era. On an oc-
casional basis cocaine can help accomplish intense intellectual effort, such as
staying awake all night to finish a piece of writing, and on a regular basis,
cocaine can help accomplish dull repetitive tasks requiring close mental atten-
tion. As with other stimulants, steady use can eventually worsen work ability
as a person’s physical reserves are exhausted and as a person becomes emo-
tionally strung out.
For over a century the most popular ways of taking cocaine were by injec-
tion or by inhaling the drug as a snuff. The latter technique inherently pro-
duces sensations of lesser strength than injection does, but a person desiring
more can simply inhale larger quantities of powder.
Drawbacks.Habitually inhaling cocaine powder can cause a runny or con-
gested nose and nosebleeds. Too much inhalation can bring on nasal ulcers
and in exceptional cases can kill tissue and pierce the cartilage in the middle
of the nose. Snorting can cause headaches. Abuse can also damage muscles
(including heart), kidneys, and liver. Cases of heart attack and stroke are
known, as are cases of serious intestinal damage related to problems with
blood flow. Preexisting asthma can be worsened. Rupture of pulmonary air
sacs and lung collapse are possible, though uncommon, results from cocaine
smoking. The drug may bring on a type of glaucoma.
Some undesired effects are similar to those of amphetamine abuse: peevish-
ness, nervousness, combativeness, paranoia, insomnia, and (after a dose wears
off) depression. Typical afflictions include repetitions in movement or speech.
Males may engage in sexual intercourse far longer than usual. Abusers may
cut themselves off from other persons and become suspicious of them. As-
sorted hallucinations may occur, the classic one being “coke bugs” crawling
under the skin. Psychological problems produced by unwise use of cocaine
are so similar to those from other stimulants that some scientists believe sim-
ilar mechanisms must cause the problems. Psychosis can be induced by co-
caine but, as with other stimulants, generally does not continue after the drug
use stops. Smoking cocaine can produce respiratory difficulties reminiscent of
tobacco smoking—difficulties that develop faster than with tobacco because
lungs must deal not only with the “air pollution” but with powerful drug
effects as well. Particles of crack smoke floating in the air and landing on
someone’s eye can damage the cornea.
The amount of drug needed to kill a person varies; depending on a person’s
condition a dose that provides pleasure one day can kill on another. The same
goes for persons sharing a supply: What satisfies one user can cause serious
trouble for another. In rat experiments females are more sensitive to cocaine
than males. Immediate problems in humans may include high blood pressure,
irregular heartbeat, and seizures. The drug promotes rises in pulse rate and