In the late 1970s the use of cocaine by
championship athletes associated the drug with manliness and power.
Cocaine became the media’s powdery star with stories of its use by the
famous, its increasing expense and its description as the caviar or champagne of
drugs. In July 1981 Time
magazine showed a champagne glass full of sparkling white powder with the
headline “HIGH ON COCAINE- a drug with status- and menace”.
The net effect of the article was a positive and alluring image of
cocaine. In New
York magazine (1978) cocaine was referred to as “the drug of choice”
and “every bit as enjoyable as Freud claimed”1. “Cocaine
is God’s way of telling you that you’ve made too much money.” –Manager
of a rock ‘n’ roll band 3.
Cocaine is highly addictive - once a person has used cocaine the urge to use it again is almost irresistible, and in this respect it is one of the most insidious 'recreational' drugs around. However, despite the feelings of overwhelming ecstasy it brings, cocaine never produces satisfaction. The user is left with an overwhelming craving to experience the joy of cocaine over and over again, which leads to tolerance and an ever-increasing dose. Laboratory research has shown that given an option, animals prefer cocaine to food, water and even sex. If given free access to it, they continue to take the drug until they overdose and die. The same, unfortunately, is true for humans as well. For this reason cocaine is classified as an illegal substance in most countries of the world.
The combination of cocaine
with alcohol is substantially more toxic than either substance on their own
Twelve
million Americans combine ethanol with cocaine to produce a pronounced and
prolonged euphoria. However it is
known that the combination of these to drugs is substantially toxic.
This may be a result of cocaethylene,
detected in the serum of emergency patients.
Cocaethylene is a cocaine metabolite,
formed in the liver only in the presence of ethanol.
It is pharmacologically active and depresses the myocardium causing
cardiotoxicity8. The cardiovascular effects of cocaine are complex. These include sympathomimetric and
local anesthetic effects. Low
doses of cocaine cause the sympathomimetric effects to predominate, but
tolerance develops. Whereas for
high doses the local anesthetic effects predominate causing potential
cardiovascular collapse and sudden death.
Strategy for the treatment
of cocaine abuse
Improvements
in the treatments for drug abuse are continually improving.
For twenty-five years methadone was the
only treatment for opiate dependence9.
Now LAAM, buprenorphine
and naloxone are being used as treatments9.
Similarly for alcohol dependence, disulfiram,
nactrexone and shortly amprosate
are prescibed9. However
the treatment of cocaine abuse poses a more difficult challenge for addition
pharmacotherapy. Potential
treatments in the future may be based on immunopharmacotherapeutic
agents that can suppress the effect of cocaine on behavioral and
locomotive actions. A second-generation
vaccine also protects against the psychoactive effects of cocaine10.
Similarly a catalytic monoclonal antibody (mAB)
is under development to bind and degrade cocaine-by hydrolysing the benzoate
ester of cocaine11.
The
actual mechanism whereby cocaine produces euphoria is still unknown.
Sigma 1 receptors are unique endoplasmic reticulum proteins that bind
certain steroids, neuroleptics and psychotropic drugs.
Sigma 1 receptors form a trimeric complex with
ankyrin B and IP2Rtype 3 in NG-108 cells, which regulate Ca2+
signaling and may represent an active site for the binding of cocaine and
neurosteroids12.