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well-being. Chemically, cocaine is benzoylmethylecgonine. Cocaine may be used
by injection, inhalation (in the form of cocaine alkaloid or “crack”), nasal
insufflation, and rarely, ingestion. In making crack, street cocaine (which is in the
form of cocaine hydrochloride) is converted to cocaine alkaloid by removal of the
salt moiety. This reaction is accomplished by mixing the cocaine with water and
sodium bicarbonate. The crack is then separated from the water by filtration and
drying. The paste hardens and is cut into chips that resemble soap. It is then
smoked in a pipe or sprinkled onto a cigarette or joint. A small piece, called a
quarter rock, produces a 20- to 30-minute high when smoked in a water pipe.
Although oral ingestion is uncommon, there are two circumstances under
which cocaine may be ingested in toxic quantities: the “body packer” and the
“body stuffer.” In the body packer, large quantities of cocaine are enclosed in
plastic and ingested in an attempt to smuggle the drug, usually across
international boundaries. In the case of the body stuffer, the person in fear of
being found with the substance suddenly ingests cocaine. Body stuffers are
typically at greater risk of cocaine intoxication because they do not take sufficient
care to guarantee that the cocaine does not leach from the bag.
Cocaine is reportedly used by up to 15% of women during pregnancy. Infants
exposed to cocaine in utero are often preterm, small for age, irritable, and show
neurodevelopmental delay. Beyond the postnatal age, passive cocaine exposure in
infants and toddlers can cause severe intoxication, including the development of
convulsions.
The relief from fatigue that occurs with cocaine use results from central
stimulation that masks the sensation of fatigue. Cocaine potentiates the excitatory
and inhibitory responses of sympathetically innervated organs to norepinephrine
and epinephrine by blocking the reuptake of catecholamines at adrenergic nerve
endings. This explains why cocaine, unlike other local anesthetics, produces
vasoconstriction and mydriasis. Cocaine is still occasionally used as a local
anesthetic for ophthalmologic or otorhinolaryngologic procedures due to its
ability to block the initiation or conduction of the nerve impulse after local
application. It also can be used as a topical anesthetic for laceration repair in the

form of TAC (tetracaine, adrenaline, cocaine), although this formulation has
largely been replaced by the less toxic combination of lidocaine, epinephrine, and
tetracaine.
Although fatalities have been associated with cocaine doses as low as 30 mg, 1
to 2 g is generally the lethal dose in adults. Ingested cocaine is less toxic than that
taken by other routes because of its slower absorption by this route. The
elimination half-life of cocaine is approximately 1 hour. Cocaine metabolism is