If you snort, smoke or inject cocaine or care about someone who does, you more than likely have some unanswered questions about the nature and effects of this powerful drug.

Cocaine is a powerfully addictive stimulant that causes dramatic changes in the brain and behavior. Once regarded as the status and power drug of the ’80s and early ’90s “me generation,” cocaine-in its various forms continues to wreak havoc on the lives of millions of Americans and their families.

With the possible exception of sucking and chewing coca leaves, as do natives of the high plains and mountainous regions of South and Central America, there is no safe way to use cocaine. It is proven to have a powerful effect on the brain and behavior and has high addictive potential.

Cocaine, more than any other drug of abuse, has direct and immediate access to the brain’s pleasure center. It causes disruption in the delicate chemistry that regulates mood, pleasure and survival drive.

Before the cocaine epidemic of the late ’70s and early ’80s, the drug was believed to be safe and not addicting. This was due, in part, to the belief that in order for a drug to be addictive, a user had to suffer withdrawal symptoms when it was withheld.

In other words, addiction was synonymous with withdrawal symptoms. Learning the truth about cocaine’s powerful addiction potential has been a costly and painful lesson to millions of users and their families, and to our nation.

How cocaine-induced brain changes result in changes in thinking, attitudes, self-destructive behavior and lifestyle has led neuroscientists to understand that addiction is a multifaceted brain disease which produces dramatic changes in one’s thinking, feeling and behavior.

What Is Cocaine?

Crack cocaine is derived from cocaine hydrochloride by taking powder cocaine, adding ammonia or baking soda and heat to remove the hydrochloride, and changing the ph from an acid to its base alkaline form. This process makes the drug combustible, so it can be easily smoked. The resulting product is then broken into small pieces, or rocks, that can fit into a small pipe, or that can be packed into a cigarette or cigar.

When crack is smoked, it is quickly absorbed into the blood through the lungs. It travels via the pulmonary vein to the heart, then up the carotid artery to the brain. It takes less than five seconds for the entire dose to reach the pleasure center.

For veteran users, just seeing the crack pipe approaching their lips accelerates this process, due to their learned anticipation of the cocaine effect. Because cocaine reaches the brain so rapidly, and before it reaches the liver, the enzymes designed to protect the brain and body from toxins like cocaine cannot do so. The resulting “high” is immediate, intense and very compelling and addictive.

The addiction potential of any psychoactive drug is greatly increased when the way that it is used, or its delivery, can more rapidly send it to the reward center of the brain. Nicotine is a good example. No one gets addicted to, or abuses, nicotine patches or gum. The delivery of nicotine via this method is too slow to produce what is commonly called a “high” or rush. However, as we have learned, when nicotine is smoked in cigarettes it’s an entirely different matter.

When a drug is smoked, the psychoactive effects, addiction potential and harmful consequences are greatly increased.

How Is Cocaine Used?

The main ways of using cocaine are:

  • chewing
  • snorting
  • injecting
  • inhaling

Snorting is the most common way to use cocaine hydrochloride (powder cocaine). When snorted into the nose, cocaine and its other constituents are slowly absorbed into the blood stream through the mucus membranes in the nasal and sinus cavities. The cocaine enters the blood stream and must circulate through the body and liver, where it is metabolized. Consequently, cocaine reaches the so-called “pleasure center” of the brain slowly and in a relatively small dose.

In contrast, injecting cocaine quickly releases the drug directly into the bloodstream, and heightens the intensity of its effects. Smoking involves inhaling cocaine vapor or smoke into the lungs, where absorption into the bloodstream is as rapid as by injection. The drug can also be rubbed onto mucous tissues, like the gums. Some users dissolve cocaine powder, combining it with heroin, and inject it. This combination is known as a “speedball.”

The “high” from cocaine is determined by the volume of the drug and by the speed at which it arrives at its targets in the brain. Users describe a cocaine euphoria that peaks in 10 to 20 minutes.

Mark S. Gold, M.D. contributed to this article.