Routes of administration

Oral

A spoon containing baking soda, cocaine, and a small amount of water. Used in a "poor-
man's" crack-cocaine production

Many users rub the powder along the gum line, or onto a cigarette filter which is then smoked,
which numbs the gums and teeth - hence the colloquial names of "numbies", "gummers" or
"cocoa puffs" for this type of administration. This is mostly done with the small amounts of
cocaine remaining on a surface after insufflation. Another oral method is to wrap up some
cocaine in rolling paper and swallow it. This is sometimes called a "snow bomb."

Coca leaf

Coca leaves are typically mixed with an alkaline substance (such as lime) and chewed into a
wad that is retained in the mouth between gum and cheek (much in the same as chewing
tobacco is chewed) and sucked of its juices. The juices are absorbed slowly by the mucous
membrane of the inner cheek and by the gastrointestinal tract when swallowed. Alternatively,
coca leaves can be infused in liquid and consumed like tea. Ingesting coca leaves generally is
an inefficient means of administering cocaine. Advocates of the consumption of the coca leaf
state that coca leaf consumption should not be criminalized as it is not actual cocaine, and
consequently it is not properly the illicit drug. Because cocaine is hydrolyzed and rendered
inactive in the acidic stomach, it is not readily absorbed when ingested alone. Only when
mixed with a highly alkaline substance (such as lime) can it be absorbed into the bloodstream
through the stomach. The efficiency of absorption of orally administered cocaine is limited by
two additional factors. First, the drug is partly catabolized by the liver. Second, capillaries in
the mouth and esophagus constrict after contact with the drug, reducing the surface area over
which the drug can be absorbed. Nevertheless, cocaine metabolites can be detected in the
urine of subjects that have sipped even one cup of coca leaf infusion. Therefore, this is an
actual additional form of administration of cocaine, albeit an inefficient one.

Orally administered cocaine takes approximately 30 minutes to enter the bloodstream.

Typically, only a third of an oral dose is absorbed, although absorption has been shown to
reach 60% in controlled settings. Given the slow rate of absorption, maximum physiological
and psychotropic effects are attained approximately 60 minutes after cocaine is administered
by ingestion. While the onset of these effects is slow, the effects are sustained for
approximately 60 minutes after their peak is attained.

Contrary to popular belief, both ingestion and insufflation result in approximately the same
proportion of the drug being absorbed: 30 to 60%. Compared to ingestion, the faster
absorption of insufflated cocaine results in quicker attainment of maximum drug effects.
Snorting cocaine produces maximum physiological effects within 40 minutes and maximum
psychotropic effects within 20 minutes, however, a more realistic activation period is closer to
5 to 10 minutes, which is similar to ingestion of cocaine. Physiological and psychotropic
effects from nasally insufflated cocaine are sustained for approximately 40 – 60 minutes after
the peak effects are attained.[42]
Mate de coca or coca-leaf infusion is also a traditional method of consumption and is often
recommended in coca producing countries, like Peru and Bolivia, to ameliorate some
symptoms of altitude sickness. This method of consumption has been practiced for many
centuries by the native tribes of South America. One specific purpose of ancient coca leaf
consumption was to increase energy and reduce fatigue in messengers who made multi-day
quests to other settlements.

In 1986 an article in the Journal of the American Medical Association revealed that U.S.
health food stores were selling dried coca leaves to be prepared as an infusion as “Health Inca
Tea.”[43] While the packaging claimed it had been “decocainized,” no such process had
actually taken place. The article stated that drinking two cups of the tea per day gave a mild
stimulation, increased heart rate, and mood elevation, and the tea was essentially harmless.
Despite this, the DEA seized several shipments in Hawaii, Chicago, Illinois, Georgia, and
several locations on the East Coast of the United States, and the product was removed from
the shelves.

Insufflation

Insufflation (known colloquially as "snorting," "sniffing," or "blowing") is the most common

method of ingestion of recreational powdered cocaine in the Western world. The drug coats
and is absorbed through the mucous membranes lining the sinuses. When insufflating cocaine,
absorption through the nasal membranes is approximately 30–60%, with higher doses leading
to increased absorption efficiency. Any material not directly absorbed through the mucous
membranes is collected in mucus and swallowed (this "drip" is considered pleasant by some
and unpleasant by others). In a study[44] of cocaine users, the average time taken to reach peak
subjective effects was 14.6 minutes. Any damage to the inside of the nose is because cocaine
highly constricts blood vessels – and therefore blood and oxygen/nutrient flow – to that area.

Prior to insufflation, cocaine powder must be divided into very fine particles. Cocaine of high
purity breaks into fine dust very easily, except when it is moist (not well stored) and forms
"chunks," which reduces the efficiency of nasal absorption.

Rolled up banknotes, hollowed-out pens, cut straws, pointed ends of keys, specialized spoons,
long fingernails, and (clean) tampon applicators are often used to insufflate cocaine. Such
devices are often called "tooters" by users. The cocaine typically is poured onto a flat, hard
surface (such as a mirror, CD case or book) and divided into "bumps", "lines" or "rails", and
then insufflated.[45] As tolerance builds rapidly in the short-term (hours), many lines are often
snorted to produce greater effects.

A study by Bonkovsky and Mehta[46] reported that, just like shared needles, the sharing of
straws used to "snort" cocaine can spread blood diseases such as Hepatitis C.[47]

In the United States, as far back as 1992 many of the people sentenced by federal authorities
for charges related to powder cocaine were Hispanic American; more Hispanics than non-
Hispanic White and non-Hispanic Black people received sentences for crimes related to
powder cocaine.[48]

Injection
Drug injection provides the highest blood levels of drug in the shortest amount of time.
Subjective effects not commonly shared with other methods of administration include a
ringing in the ears moments after injection (usually when in excess of 120 milligrams) lasting
2 to 5 minutes including tinnitus & audio distortion. This is colloquially referred to as a "bell
ringer".[49] In a study[44] of cocaine users, the average time taken to reach peak subjective
effects was 3.1 minutes. The euphoria passes quickly. Aside from the toxic effects of cocaine,
there is also danger of circulatory emboli from the insoluble substances that may be used to
cut the drug. As with all injected illicit substances, there is a risk of the user contracting
blood-borne infections if sterile injecting equipment is not available or used.

An injected mixture of cocaine and heroin, known as “speedball” is a particularly dangerous

combination, as the converse effects of the drugs actually complement each other, but may
also mask the symptoms of an overdose. It has been responsible for numerous deaths,
including celebrities such as John Belushi, Chris Farley, Mitch Hedberg, River Phoenix and
Layne Staley.

Experimentally, cocaine injections can be delivered to animals such as fruit flies to study the
mechanisms of cocaine addiction.[50]

Inhalation

See also: Crack cocaine

Inhalation or smoking is one of the several means cocaine is administered. Cocaine is smoked
by inhaling the vapor by sublimating solid cocaine by heating.[51] In a 2000 Brookhaven
National Laboratory medical department study, based on self reports of 32 abusers who
participated in the study,"peak high" was found at mean of 1.4min +/- 0.5 minutes.[44]

Smoking freebase or crack cocaine is most often accomplished using a pipe made from a
small glass tube, often taken from "Love roses," small glass tubes with a paper rose that are
promoted as romantic gifts.[52] These are sometimes called "stems", "horns", "blasters" and
"straight shooters". A small piece of clean heavy copper or occasionally stainless steel
scouring pad – often called a "brillo" (actual Brillo pads contain soap, and are not used), or
"chore", named for Chore Boy brand copper scouring pads, – serves as a reduction base and
flow modulator in which the "rock" can be melted and boiled to vapor. Crack smokers also
sometimes smoke through a soda can with small holes in the bottom.

Crack is smoked by placing it at the end of the pipe; a flame held close to it produces vapor,
which is then inhaled by the smoker. The effects, felt almost immediately after smoking, are
very intense and do not last long – usually five to fifteen minutes.

When smoked, cocaine is sometimes combined with other drugs, such as cannabis, often
rolled into a joint or blunt. Powdered cocaine is also sometimes smoked, though heat destroys
much of the chemical; smokers often sprinkle it on cannabis.

The language referring to paraphernalia and practices of smoking cocaine vary, as do the
packaging methods in the street level sale.
Cocaine hydrochloride for medical use.

Cocaine was historically useful as a topical anesthetic in eye and nasal surgery, although it is
now predominantly used for nasal and lacrimal duct surgery. The major disadvantages of this
use are cocaine's intense vasoconstrictor activity and potential for cardiovascular toxicity.
Cocaine has since been largely replaced in Western medicine by synthetic local anesthetics
such as benzocaine, proparacaine, lignocaine/xylocaine/lidocaine, and tetracaine though it
remains available for use if specified. If vasoconstriction is desired for a procedure (as it
reduces bleeding), the anesthetic is combined with a vasoconstrictor such as phenylephrine or
epinephrine. In Australia it is currently prescribed for use as a local anesthetic for conditions
such as mouth and lung ulcers. Some ENT specialists occasionally use cocaine within the
practice when performing procedures such as nasal cauterization. In this scenario dissolved
cocaine is soaked into a ball of cotton wool, which is placed in the nostril for the 10–15
minutes immediately prior to the procedure, thus performing the dual role of both numbing
the area to be cauterized and also vasoconstriction. Even when used this way, some of the
used cocaine may be absorbed through oral or nasal mucosa and give systemic effects.

In 2005, researchers from Kyoto University Hospital proposed the use of cocaine in
conjunction with phenylephrine administered in the form of an eye drop as a diagnostic test
for Parkinson's disease.[88]

Toothache Cures and Patent Medicines

Cocaine was first synthesized in pure form by Albert Niemann. In 1860, he extracted pure
cocaine powder from the leaves of Erythroxylum coca (more commonly known as the coca
plant). Soon after it was isolated, cocaine was used to try to cure almost all the illnesses and
maladies that were known to man.

It wasn't long after the isolation of pure cocaine until people became aware of the addictive
potential of the drug. Today, use in medicine had been tempered by experience. Medical use
has been largely restricted to producing local anesthesia. Even in this area, the dangers of
cocaine led to the early development of safer drugs.

One of its first non medical uses was military. In 1883 Theodor Aschenbrandt administered
cocaine to members of the Bavarian army. It was found that the drug enhanced their
endurance on manoeuvre. His positive findings were published in a German medical journal,
which brought the effects of this wonder drug to a wider medical audience, including
Sigmund Freud (see below).

In the USA, cocaine was sold over-the-counter until 1914. It was widely used in tonics,
toothache cures, patent medicines, and chocolate cocaine tablets. Prospective buyers were
advised (in the words of pharmaceutical firm Parke-Davis) that cocaine "could make the
coward brave, the silent eloquent, and render the sufferer insensitive to pain".

When combined with alcohol, it yielded a further potently reinforcing compound, now known
to be cocaethylene. Thus cocaine was a popular ingredient in wines, notably Vin Mariani.
Coca wine received endorsement from prime-ministers, royalty and even the Pope.
One medical use that was found early in the history of cocaine, and which the drug is still
used for today (rarely), is that of a good surface anesthetic. Beginning in the late 1880s
surgical procedures using local anesthetics (numbing a specific area to pain) were starting to
be used instead of general anesthesia (rendering a person unconscious).

This was due to experiments that were conducted by William Halstead, using cocaine.
William Halstead was one of the four founders of The Johns Hopkins Medical School. He is
often referred to as the Father of American Surgery.

Unfortunately William experimented on himself by injecting cocaine, to see if surgery could

be performed using cocaine as a local anesthetic. After experimenting for a time, he became
addicted.

The addiction grew so bad it put his career on the line. He stopped shooting cocaine and
began taking morphine instead. A habit that probably lasted the rest of his life.

Medical use
Besides being an extremely addictive and dangerous narcotic, cocaine has some medicinal
use. Cocaine has been used as a local anesthetic for eye and nasal surgery. Besides being an
anesthetic, it also is a potent vasoconstrictor (constricts the blood vessels around the area
where injected [eye or nose]). The vasoconstriction helps reduce bleeding and the systemic
circulation of cocaine (into the heart, specifically).

More recently, the use of cocaine as an anesthetic for eye and nasal surgery has diminished,
and has been replaced by other local anesthetics. These newer (and safer) local anesthetics
have to be combined with a vasoconstrictor in order to do the same effect as cocaine.

Pharmaceutical grade cocaine is available in a 4% solution for injection. Studies comparing

cocaine to other local anesthetics most often reveal that newer local anesthetics are more
effective in reducing pain during surgeries and safer. It is generally accepted by the medical
community that the use of cocaine for medical procedures should be limited. However, the
need for it to be available is still there.