Cocaine

Cocaine is a central nervous system stimulant and tropane alkaloid derived primarily from the leaves of two coca species native to South America: Erythroxylum coca and E. novogranatense.^{[14][15][16][17][18]} Coca leaves are processed into cocaine paste, a crude mix of coca alkaloids which cocaine base is isolated and converted to cocaine hydrochloride, commonly known as "cocaine".^[18] Cocaine was once a standard topical medication as a local anesthetic with intrinsic vasoconstrictor activity, but its high abuse potential, adverse effects, and cost have limited its use and led to its replacement by other medicines.^[19][20][21] "Cocaine and its combinations" are formally excluded from the WHO Model List of Essential Medicines.^[22]

Street cocaine is commonly snorted, injected, or smoked as crack cocaine, with effects lasting up to 90 minutes depending on the route.^[13][23] Cocaine acts pharmacologically as a serotonin–norepinephrine–dopamine reuptake inhibitor (SNDRI),^[7][24][17] producing reinforcing effects such as euphoria, increased alertness, concentration, libido, and reduced fatigue and appetite.^[25]

Cocaine has numerous adverse effects. Acute use can cause vasoconstriction, tachycardia, hypertension, hyperthermia, seizures, while overdose may lead to stroke, heart attack, or sudden cardiac death.^[17][13][26] Cocaine also produces a spectrum of psychiatric symptoms including agitation, paranoia, anxiety, irritability, stimulant psychosis, hallucinations, delusions, violence, as well as suicidal and homicidal thinking.^[27][17] Prenatal exposure poses risks to fetal development.^{[28][29][30][31]} Chronic use may result in cocaine dependence, withdrawal symptoms, neurotoxicity, and nasal damage, including cocaine-induced midline destructive lesions.^{[32][33][34][35][36][37]} No approved medication exists for cocaine dependence, so psychosocial treatment is primary.^[38][39] Cocaine is frequently laced with levamisole to increase bulk.^[40][41] This is linked to vasculitis (CLIV) and autoimmune conditions (CLAAS).^[42][43]

Coca cultivation and its subsequent processes occur primarily Latin America, especially in the Andes of Bolivia, Peru, and Colombia, though cultivation is expanding into Central America, including Honduras, Guatemala, and Belize.^{[18][44][45][46][47]} Violence linked to the cocaine trade continues to affect Latin America and the Caribbean and is expanding into Western Europe, Asia, and Africa as transnational organized crime groups compete globally.^[48][49] Cocaine remains the world’s fastest-growing illicit drug market.^[50][51] Coca chewing dates back at least 8,000 years in South America.^[52] Large-scale cultivation occurred in Taiwan and Java prior to World War II.^[53][54] Decades later, the cocaine boom marked a sharp rise in illegal cocaine production and trade, beginning in the late 1970s and peaking in the 1980s.^[55] Cocaine is regulated under international drug control conventions, though national laws vary: several countries have decriminalized small quantities.^{[56][57][58][59]}