Cocaine is an illegal, mood-altering drug. It is a fine white powder consisting of cocaine hydrochloride from the leaves of the coca shrub and other compounds. The shrub is indigenous to Peru and Bolivia. There are an estimated five million users of cocaine in the United States. Use of the drug can lead to serious physical and/or psychological problems, sometimes resulting in death.
Surgeons used cocaine as a local anesthetic over a century ago. Today, except in certain kinds of nose and throat surgery, the use of cocaine in surgery has been replaced by synthetic, local anesthetics. The use of cocaine as an illegal stimulant of the central nervous system, however, has grown to alarming proportions in recent years, prompting drug enforcement officials to redouble their efforts in combating the growth, importation, distribution, and sale of the drug.
Cocaine gained widespread acceptance in the 1970's when it was viewed as a harmless "recreational" drug that produced the desired "high" without the danger of addiction or typical drug-related side effects. Many persons in the public eye-movie stars and sports heroes, for example-were users of cocaine. It quickly became fashionable in other sectors of society, especially among those who could easily afford its once high price. Before the price came down, cocaine use was directly associated with wealth and success. Those who used the drug claimed that the cocaine rush not only produced the intended euphoric "high," but also resulted in higher levels of performance in whatever activity they happened to be engaged in.
Addiction. Since the 1970's and early 1980's, scientific research and painful experience have demonstrated that cocaine, far from being a harmless recreational drug, is not only highly addictive, but also very dangerous, even potentially lethal. Further, the much-touted euphoria and elevation of performance levels have turned out to be either transitory or illusory.
According to research done by the American Council for Drug Education, cocaine affects the same part of the brain that reinforces basic instinctual drives such as hunger, thirst, and sexual desire. This is the brain's "reward center." Cocaine causes the release of a neurotransmitter called dopamine in the brain's nerve endings. When the level of dopamine increases, the reward center is falsely notified that a basic need has been satisfied; the reward center then provides the pleasure response or euphoric high. With the repeated use of cocaine, the reward center is "reprogrammed," thus encouraging the user to obtain and use more cocaine to supplant survival-oriented drives.
Once a person's brain has accepted cocaine as necessary to basic survival, that person is addicted, and the drive to obtain and use cocaine takes precedence over important areas of life, such as nutrition, sleep, sex, and career. According to the American Council for Drug Education, cocaine addiction is characterized by four major features: cravings and compulsions to obtain and use the drug; inability to limit or control use; continued use despite adverse consequences; and denial that the problem exists.
Of the many serious problems associated with cocaine addiction, one of the more apparent ones is the "crash" that follows the "high." Though the level of dopamine initially rises when a person takes cocaine, producing the "high," it soon falls off, dropping to a level below normal and producing the "crash." With repeated use of the drug, an overall depletion of dopamine levels occurs and chronic depression sets in, a familiar state in the person who is addicted to cocaine. The addict requires ever-increasing amounts of the drug to attain the desired high. Eventually, however, the addict's tolerance reaches a level so high that no amount of cocaine will produce euphoria.
Side effects of cocaine use can include a substantial drop in weight because of loss of appetite. Addicts who inhale cocaine often develop sensitive and ulcerated nasal membranes. This can even lead to a perforation of the nasal septum. Addicts who inject cocaine intravenously are also at greater risk for contracting infectious diseases, such as AIDS, due to the habit of sharing needles and syringes. Among the psychological effects are irritability, sleeplessness, paranoid thoughts, and possible full-blown, paranoid psychosis.
Persons who lack the enzyme cholinesterase have an extreme sensitivity to cocaine and can be poisoned by very small amounts. Cocaine deaths are usually caused by severe disturbances of the heart rhythm (ventricular fibrillation), heart attack (myocardial infarction), repeated convulsions, or depression of the respiratory center in the brain.
Crack. A form of cocaine, known by its street name of "crack" or "rock," has emerged as an even greater menace than cocaine in its more familiar powdered form. Crack is freebase cocaine, a smokable form of the drug, that has been extracted ("freed") from the hydrochloride salt of cocaine and formed into pellets using baking soda and water. The name comes from the cracking sound the drug makes when heated and smoked.
Cocaine taken in this way is rapidly and efficiently absorbed into the bloodstream. It reaches the brain in 8 to 10 seconds and, in this concentrated form, produces a very rapid and intense high. The high lasts only a few minutes, however, so the user requires another dose very soon to sustain the high. Repeated doses of the highly concentrated form of the drug cause the user to become addicted very quickly.
With crack, all the medical and psychological problems produced by powdered cocaine are magnified. The extremely high levels of cocaine in the blood greatly increase the possibility of serious toxic reactions, such as high blood pressure, irregular heartbeat, fever, and potentially fatal brain seizures. Among serious respiratory problems suffered by crack smokers are wheezing, chest congestion, chronic cough, and impairment of lung function. Psychological consequences often include radical changes in personality and behavior, which can range all the way from irritability and withdrawal to paranoid reactions and suicidal behavior.
Hospitalization - Admission Procedures
The procedures you follow on admission to a hospital vary from one hospital to another, but basically the process is the same in most institutions in the United States.
Care of the Dying - Role of Friends
The friend can show appreciation of the work being done by the family and offer to stay with the patient if the family needs a little time away from home.
Care of the Dying - Death of an Older Child or an Adolescent
From the age of three years onward, a child begins to understand the concept of death and dying. The dying child feels protective toward his or her parents. Although the child desperately needs to talk about what is going to happen, he or she may never get close to the subject. The child may attach himself or herself to a nurse or physician while still relying on the parents. By doing this, the child is sharing the emotional responsibility. The parents may find this difficult to accept, but must realize that someone else can perhaps give more help by listening dispassionately to the child's fears and anxieties.
