Rehab 4 Addiction

Today, cocaine is used almost solely for recreational purposes.

Despite its increasing potency in recent years, cocaine has a substantially large illegal market and thus almost all street cocaine samples contain impurities.

It is estimated that on average, street cocaine in Europe is between 53% and 68% pure. In the United States, purity ranges from 20% to 65%.

However, it is not uncommon for “cocaine” samples to contain no cocaine at all.

The impurity of street cocaine is due to a practice called “cutting”.

What is cutting?

Cutting

Cutting involves mixing cocaine with other substances, either to intensify its effects or maximise profits by adding weight and selling less pure cocaine for more money.

“Adulterants” are added to intensify cocaine’s effects, whilst “diluents” are added to increase profit.

Both adulterants and diluents can be very dangerous for different reasons that will be explored further below.

What adulterants and diluents distributors choose to use varies, and typically depends on:

  • The manufacturing process
  • Where it takes place
  • How many people have handled it

Cutting agents can alter the properties of cocaine to make snorting, smoking, or injecting more convenient and easier for users.

It is important to note that even small, sub-perceptual amounts of cocaine can be dangerous and potentially quite harmful, irrespective of its purity level.

That said, some familiarity with the dangers associated with commonly used cutting agents can help to prevent serious harm, including overdose and death.

The variation in and unpredictability of adulterants and diluents that are added to cocaine makes it significantly more dangerous.

What is cocaine?

What is cocaine

Cocaine is a powerful, addictive, psychomotor stimulant drug derived from the leaves of the coca plant.

At present, cocaine is classified as a Class-A drug in the UK and a schedule II drug in the US.

Schedule II classification in the US means that, although cocaine is considered to have some medical uses, it has a high potential for abuse.

Taking cocaine initiates feelings of intense euphoria and heightened alertness, lasting anywhere between 30 and 45 minutes and decreasing in intensity as time passes.

The positive effects of cocaine use include:

  • Intense pleasure
  • Enhanced confidence
  • Reductions in social anxiety
  • Improved mood 
  • High energy

However, these are heavily outweighed by the negative side-effects, including:

Cocaine’s pleasant short-term side effects are caused by increased concentrations of the neurotransmitter dopamine.

The imbalance of this chemical is what encourages the regular use of and ultimately addiction to cocaine.

Types of cocaine 

Types of cocaine

Pure cocaine comes in a hydrochloride salt form, but pure cocaine is usually neutralised with the use of a solvent, which turns it into a flaky white powder.

This powdered form of cocaine is the most prominent and most popular form of cocaine, and likely the type that you will be familiar with.

Powdered cocaine is typically snorted or ingested orally, but it can also be dissolved in water for intravenous use.

Cocaine also comes in a freebase crystal form known as “crack”. Unlike powdered cocaine, crack is almost always smoked.

According to the Drug Enforcement Administration (DEA), crack cocaine is between 75% and 90% pure as a consequence of the manufacturing process.

It is widely thought that crack cocaine is more addictive than the powdered form because of its rapid onset, short duration, and especially intense effects.

However, research on this matter has so far been inconclusive.

Common cocaine cutting agents

Common cutting agents

Agents used to cut cocaine may include a range of different materials and substances.

The primary objective of diluents is to deceive buyers by making it appear as though there is more cocaine than there actually is.

The most commonly used diluents include:

  • Boric acid
  • Creatine
  • Laundry detergent
  • Mannitol
  • Benzocaine
  • Lidocaine
  • Novacaine
  • Procaine
  • Tetracaine 

The diluents listed above are mainly used because they, like cocaine, come in white powder form.

This makes it very difficult for buyers to determine how pure the product is, and whether or not any diluents have been added.

The local anaesthetics listed above (benzocaine, lidocaine, novocaine, procaine and tetracaine) are added because they have a numbing effect like that of cocaine. They also have a similar taste.

In general, diluents are not seriously harmful or dangerous. That said, they are certainly not good for you and continued, long-term ingestion may cause serious health complications.

For instance, laundry detergent contains ingredients that are poisonous, including the corrosive acid benzalkonium chloride.

Detergent poisoning can negatively affect the functioning of one’s:

  • Blood
  • Eyes
  • Ears
  • Nose
  • Throat
  • Gastrointestinal system
  • Heart
  • Lungs
  • Skin.

Boric acid can also cause considerable harm. Associations have been made between chronic use of boric acid and kidney damage. In large enough doses, boric acid can even cause death.

The addition of local anaesthetics in cocaine can cause:

  • Confusion
  • Drowsiness
  • Blurred vision
  • Respiratory issues
  • Methemoglobinemia (abnormal levels of haemoglobin in the bloodstream)
  • Cardiovascular issues (arrhythmia) 
  • Convulsions
  • Seizures 
  • Brain damage

Cocaine adulterants

Cocaine adulterants

Other stimulant drugs are also added to cocaine to intensify the drug’s effects, making them more noticeable despite the high level of impurity.

Other drug types such as analgesics, amphetamines, calcium-channel blockers, antihistamines, and anthelmintics are frequently detected in cocaine samples also.

The most commonly detected adulterants in cocaine samples include:

  • Levamisole
  • Caffeine
  • Methylphenidate
  • Amphetamine 
  • Methamphetamine
  • Diltiazem
  • Hydroxyzine 
  • Fentanyl
  • Carfentanil
  • Aspirin
  • Phenacetin
  • Paracetamol

Dangers of cocaine adulterants

Dangers

Levamisole, a medication used to treat parasitic worm infections in veterinary medicine, is detected in cocaine samples more than any other adulterant.

Levamisole is reportedly present in up to 70% of cocaine samples.

Levamisole is used more often than other adulterants because it is inexpensive, and its active metabolite, aminorex, has very potent stimulant-like properties.

Levamisole was once available for human use, however, it was pulled from the market due to an array of associated health complications.

Levamisole can cause a life-threatening condition called agranulocytosis, in which the body becomes unable to produce enough of a particular type of white blood cell called neutrophils.

Agranulocytosis can severely compromise a person’s immune system, leaving them susceptible to deadly infections from otherwise innocuous cuts.

Levamisole can cause:

  • Joint stiffness
  • Lesions of the skin
  • Skin necrosis
  • Seizures 

Methamphetamine, like cocaine, is a potent stimulant. Cutting cocaine with methamphetamine can cause an array of health complications. These may include:

  • Palpitations
  • Chest pain
  • Hypertension
  • Arrhythmia
  • Stroke
  • Seizures
  • Heart attack
  • Coronary artery disease
  • Acute coronary syndrome
  • Cardiomyopathy
  • Brain damage 
  • Psychosis 

The presence of methamphetamine and/or amphetamine in cocaine also increases the likelihood of accidental overdose.

The opioid fentanyl, reported to be up to 100 times more powerful than heroin, is also commonly detected in cocaine samples.

Fentanyl is added to cocaine by distributors because it is very inexpensive to manufacture, cheap to purchase, and it is incredibly potent.

The presence of fentanyl in cocaine has been associated with an increasing number of deaths in recent years. Unfortunately, fentanyl can be lethal in doses as little as 2 milligrams.

Treatment for cocaine addiction

Treatment

Because cocaine has a short half-life, completely stopping use can be one of the most effective initial steps to take.

However, it is not recommended to detox in such a manner by oneself. Home detox can be dangerous, particularly in the case of severe cocaine use disorder.

Instead, individuals are encouraged to attend residential rehab where expert medical care is guaranteed, detoxification complications mitigated, and withdrawal symptoms appropriately addressed.

Detoxification, which typically lasts about a week, is just the starting point of treatment and recovery.

Residential rehab for cocaine addiction 

Residential rehab

Residential rehab, sometimes referred to as inpatient treatment, is widely regarded as the best option for people with cocaine addiction.

Residential rehab requires patients to live at a rehab centre for the duration of their treatment programme.

Patients that enter residential treatment centres enjoy the structure and stability of a facility monitored by trained professionals who provide expert medical care and assistance 24 hours a day.

Once admitted, patients undergo medical assessments, and an individualised treatment programme is quickly devised to meet each individual’s specific requirements.

Treatment programmes typically include therapy treatments that specialise in the management of withdrawal symptoms and address any underlying issues or co-occurring disorders that often accompany addiction.

Evidence-based therapy treatments available to patients at residential rehab include:

Inpatient cocaine rehab is especially recommended for individuals who may have tried and failed to recover from addiction in the past, or people who may be experiencing suicidal ideation.

References 

https://www.sciencedirect.com/science/article/abs/pii/S0196064488800787 

https://www.researchgate.net/publication/258111672_Identification_of_Levamisole_Impurities_Found_in_Illicit_Cocaine_Exhibits 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498128/#bib9 

https://www.dea.gov/resources/facts-about-fentanyl

boris

Boris is our editor-in-chief at Rehab 4 Addiction. Boris is an addiction expert with more than 20 years in the field.  His expertise covers a broad of topics relating to addiction, rehab and recovery. Boris is an addiction therapist and assists in the alcohol detox and rehab process. Boris has been featured on a variety of websites, including the BBC, Verywell Mind and Healthline.