Cocaine Addiction Treatment Information

Cocaine is a powerfully addictive stimulant with a long history of use and was even an ingredient in tonics and elixirs developed in the 1900s. Within Canada, cocaine is a Schedule I drug under the Controlled Drugs and Substances Act. There are two chemical forms of cocaine that are abused, the water-soluble hydrochloride salt and the water-insoluble base or freebase cocaine. Drug users can inject or snort the hydrochloride salt, or the base form of cocaine is processed with ammonia or sodium bicarbonate and water. The drug is then heated to remove the hydrochloride, and it produces a smokable substance referred to as crack cocaine

Cocaine is made from the leaves of the coca plant that is native to parts of South American. As a street drug, cocaine looks like a fine, white crystal powder. Street dealers often mix the powder with cornstarch, talcum powder, or flour to increase profits. Other drugs like amphetamines or even synthetic opioids are added, and this increases the risk of overdose. Cocaine is a naturally occurring alkaloid that is found in over 200 distinct species of Erythroxylum, and only two, Erythroxylum coca and Erythroxylum novogranatense, contain significant amounts of cocaine. Within South America are two different varieties that are cultivated.

The production of illicit natural cocaine involves three different steps. The first step involves the extraction of crude coca paste from the coca leaf, followed by purification of coca paste to coke base and finally, conversion of coke base to cocaine hydrochloride. Overall, there is no one method for obtaining coca paste, coke base, or cocaine hydrochloride. Drug cartels worldwide have used numerous procedural variations, especially with the inclusion of alternate chemicals. Typically, illicit natural cocaine has a purity that varies from 80 to 97%, but this changes at the street level. When pharmaceutical cocaine was used, the purity level was around 99.5%.

According to the Drug Enforcement Administration, the coca leaves are grown in Bolivia, Peru, and Columbia. The manufacturing takes place in jungle labs—Columbia produces roughly 90% of the cocaine powder that reaches the United States. Most cocaine that enters the United States comes through Mexico. As of 2021, fentanyl’s presence in the cocaine supply remains a serious concern for law enforcement and public health officials.

How Does Cocaine Affect the Body and Mind, and How is it Used?

When cocaine is used, it stimulants the brain’s mesolimbic dopamine system, which is the brain’s reward pathway. Also, the particular circuits of this part of the brain regulate emotion and motivation. Typically, dopamine is naturally released; however, drug abuse interferes with the normal communication process. Cocaine binds to the dopamine transporters blocking the removal of dopamine, causing it to build up, amplifying the rewarding feeling and causing the euphoria. The use of cocaine causes changes within the brain, such as affecting pathways that respond to stress.

According to research as cited by the National Institute on Drug Abuse, because of how cocaine affects how the brain responds to stress, stress contributes to cocaine relapse. Research has suggested that cocaine elevates stress hormones within the body, and this increases the sensitivity to the drug. However, the effects of cocaine differ in intensity depending on the manner that which the drug is used. For example, when cocaine is smoked or injected, the onset of the effects is immediate. When the drug is snorted, the effects are felt quickly but not as intense as the other two methods.

Cocaine affects the body by causing dilated pupils, elevating heart rate, and causing upset stomach and headaches. Overall, it speeds up activity within the brain and stimulates the central nervous system increasing energy. The drug also causes restlessness, anxiety, increased blood pressure, respiration, temperature, and many other conditions. Because of how cocaine increases dopamine levels unnaturally, cocaine users suffer intense crashes when the drug wears off. The intense feelings of anxiety, guilt, and remorse cause the person to want to use cocaine again, thus starting a cycle of abuse.

Additionally, cocaine reduces the body’s ability to need sleep and food because of the intense lows and highs, and most heavy cocaine users will binge for hours or days. Generally, cocaine use will result in cardiovascular problems, respiratory problems, and liver damage and lead to other diseases or infections. Someone struggling with cocaine addiction should take steps to receive proper treatment beginning with detox, residential treatment, or inpatient care.

What are the Street Names and Legal Status of Cocaine in Canada?

According to the Canadian Centre on Substance Use and Addiction, cocaine is a Schedule I drug under the Canadian Controlled Drugs and Substances Act. Anyone caught in possession of the drug could face up to seven years in prison, while trafficking and production can result in life imprisonment. Driving while impaired by cocaine is a criminal offence under the Criminal Code of Canada. In 2016, 2,440 kilograms of cocaine were seized by law enforcement, which was an increase of 45% from the previous year.

However, in 2017, cocaine-related drug offences in Canada continued to decline for the fifth consecutive year. Yet, the regions of Canada that saw increases in cocaine-related offences were Yukon, Nova Scotia, Newfoundland and Labrador. Common street names include the following: blow, coca, coke, crack, flake, snow, and soda cot. According to the Drug Enforcement Administration, Columbia remains the primary source for the majority of cocaine seized and analyzed in the United States. In 2018, roughly 90% of the cocaine that was tested was of Columbia origin. According to the 2019 Analyzed Drug Report, the main controlled substances identified in Canada were cocaine and methamphetamine.

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The History of Cocaine in Canada

Cocaine has a history going back over 4,000 years and has been used as medicine and stimulant in Columbia, Peru, and Bolivia. In the sixteenth century, European travellers made note of its existence, and South American inhabitants would chew the coca leaves as it was believed it would elevate mood, help with digestion, and suppress appetite. By the mid 19th century, coca grew and had been restricted to the area of its natural habitat. Coca did not make its way to the western world and was used in western medicine until the late 19th century. Within the United States, it was first considered a safe stimulant and nerve tonic. However, within roughly 30 years of coca being used this way, its addictive and destructive properties became apparent.

Within Canada and the United States, cocaine reappeared in the 1970s and was considered a high-status expensive drug with no serious consequences. However, by the 1980s, the price began to drop, causing millions of people to become addicted to drugs. Although, street prices of cocaine in Canada are higher than they are in South American and East Asian countries. Between 1997 and 2001, the street price of the drug fell by almost thirteen US dollars a gram.

Overall, cocaine has been a popular drug in Canada since the early 20th century. Since the 1970s, the Canadian media has highlighted the cocaine-related drug problems occurring within the United States. The cocaine that Canadians were using during the early 1970s was coming from Europe and the United States. However, in 1972, Canadian authorities noted large amounts of cocaine were being imported via Toronto, Montreal, and Vancouver, coming from South America. The cocaine that was entering Canada from the South American market was coming via Los Angeles, Chicago, New York, Miami, and other large urban centers.

Unfortunately, Canadian media at the time were misinforming the public by only highlighting cocaine as being an American problem. Yet, Americans and Canadians were smuggling cocaine into Canada, and 100% of the cocaine coming into Canada and the United States was smuggled in from Latin America. During the 1970s and on, cocaine was just as much a Canadian problem as it was an American problem. According to the 2019 Global Drug Survey Key Findings, Canada ranked second in the world for cocaine use, and the price of cocaine in Canada compared to the rest of the world was $85 per gram.

Additionally, as mentioned above by the Canadian Centre on Substance Use and Addiction, in 2017, cocaine-related drug offences in Canada continued to decline for the fifth consecutive year. From 2016 to 2017, cocaine offences dropped 35% in Nunavut, 16% in British Columbia, and 15% in Alberta. However, they increased 71% in Yukon, 37% in Nova Scotia, and 23% in Newfoundland and Labrador. In 2014, cocaine was responsible for the highest costs to the criminal justice system at under $1.9 billion. In 2014, only 2% of the Canadian population was using cocaine, but it was associated with over 20% of all substance use attributable to criminal justice costs 2014. As of 2021, the possession of cocaine in Canada is illegal, and it remains a Schedule 1 drug; however, the sale, transport, and cultivation of cocaine in Canada are legal medically.

What are the Short-Term and Long-Term Effects of Cocaine?

The effects of cocaine are felt almost immediately after a single use and can disappear within minutes or hours, depending on the method of use. Even a small amount of cocaine causes the user to feel euphoric, energetic, talkative, and mentally alert. However, the duration of these effects depends on the route of administration—the faster the drug is absorbed, the more intense the high. According to the National Institute on Drug Abuse, the effects of snorting cocaine may last 15 to 30 minutes, while the effects of smoking cocaine may last only 5 to 10 minutes.

According to Health Canada, the short-term mental effects include the following:

• Paranoid thinking
• Panic
• Anxiety
• Feeling happy and mentally alert
• Having more energy

The moderate and severe physical effects include the following:

• Dry mouth
• Restlessness
• Dilated pupils
• A heightened sense of sight and sound
• A temporary decrease in the need for food and sleep
• Tremors
• Dizziness
• Violent behaviour
• Nausea and vomiting
• Rapid breathing

Cocaine causes a state of euphoria that is accompanied by a large burst of energy. The prolonged use of cocaine does lead to more serious and harmful effects. Some of the long-term effects include the following:

• Sleep disturbance
• Weight loss
• Tolerance of the drug
• Depression
• Nasal damage
• Cardiovascular problems
• Kidney failure
• Hallucinations
• Seizures
• Memory disruptions

Repeated exposure to cocaine causes the brain to adapt so that the reward pathways become less sensitive to natural reinforcers. The regular use of cocaine increases the tolerance to higher doses, and more frequent use of cocaine is needed to produce the same level of pleasure and relief from withdrawal. Increased tolerance to cocaine increases the risk of cocaine toxicity—increasing doses, and higher frequency of use cause more severe adverse psychological or physiological effects.

Additionally, cocaine damages many of the organs in the body and is linked to an increased risk of stroke, seizures, neurological problems, movement disorders, and cognitive difficulty. Cocaine use causes lung, nose, and breathing problems. Someone who regularly snorts cocaine develops nose and sinus problems like losing the sense of smell, nosebleeds, sinus infections, and developing a hole in the wall between the nostrils. Cocaine also stresses the heart and can cause an irregular or fast heartbeat. Cocaine users also experience stomach problems like abdominal pain, nausea, vomiting, appetite changes, bowel perforation, and decay.

Cocaine Overdose and the Risk of Contracting HIV and Hepatitis C

In the event of a cocaine overdose, it is important to seek immediate medical attention. A cocaine overdose occurs when a toxic amount is taken, whether snorted, smoked or injected. The risk of overdose is always prevalent because the quality or purity of cocaine cannot always be tested. For example, many of the overdose deaths in Canada are connected to cocaine that is laced with fentanyl. According to the Canadian Public Health Info Base, between January 2016 and June 2020, there were 17,602 apparent opioid toxicity deaths.

Additionally, western Canada continues to be the most impacted region of the country since 2016. Between January and June 2020, 86% of all opioid toxicity deaths occurred in British Columbia, Alberta, and Ontario. Males accounted for the majority of accidental apparent opioid toxicity deaths and individuals aged 20 to 49 years old. Available information coming from six provinces and territories indicated a 65% increase in the number of deaths involving stimulants from April to June 2019 compared to January to March 2020.

Approximately 98% of those were accidental, meaning the individual did not know they were taking a lethal dose. Also, 70% of the identified apparent stimulant toxicity deaths from January to June 2020 involved cocaine, while 48% involve methamphetamines. Overall, cocaine overdose is a life-threatening condition that requires immediate medical attention. Overdose can occur after a single dose of cocaine, or it could take a large amount of the drug. Cocaine is unpredictable because the amount to cause an overdose varies depending on the individual and what drugs are laced into the cocaine.

The effects and signs of a cocaine overdose include the following:

• Delusions
• Hallucinations
• Headache
• Paranoia
• Rapid heart rate
• Feeling as though your head may explode
• Feeling like your heart could burst out of your chest
• Overheating
• Feeling dehydrated

The best thing to do for anyone that is experiencing a cocaine overdose is to seek immediate medical attention. When admitted to the hospital, medical professionals may administer benzodiazepines to counter the effects of the cocaine. Also, attendants may begin to cool the body down to prevent muscle cell deterioration, and acetaminophen could be used to bring down the body temperature.

Along with the risk of an overdose, there is an increased risk of contracting HIV and hepatitis C through sharing drug paraphernalia and risky sexual behaviour. According to the National Institute on Drug Abuse, studies that examine patterns of HIV infection and progression demonstrated that cocaine use accelerates HIV infection along with impairing immune cell function. Per an article written for Arteriosclerosis, Thrombosis, and Vascular Biology, the authors suggest that HIV infection, cocaine use, and hepatitis C virus infection are important non-traditional risk factors for cardiovascular disease.

Cocaine Addiction and Cycle of Addiction

Cocaine addiction becomes a complex problem that leads to physical and psychological dependence, tolerance, and even withdrawal symptoms. Cocaine is a highly addictive drug, and when someone is addicted, their ability to resist urges becomes impaired, making it much harder to quit. Anyone who uses cocaine is at risk of becoming addicted to it. The signs of cocaine addiction include the following:

• Tolerance and requiring large amounts
• An inability to stop using cocaine
• Withdrawal symptoms
• Desire to keep using despite consequences
• Negative impact on the quality of life
• Psychosis and hallucinations
• Irritability and anxiety
• Binge sessions

Generally, the phases of cocaine addiction involve initial use, abuse, tolerance, dependence, addiction, and relapse. There are many reasons why someone begins to struggle with addiction. The underlying factor could include family or work stress, personal injury, emotional distress, environment, or a history of physical or emotional abuse. However, not every addiction begins with a painful event as many people became addicted through recreational drug use or early experimentation with drugs. According to the Mayo Clinic, drug addiction can start with the experimental use of a recreational drug in social situations as it becomes more frequent for some people.

Cocaine abuse begins when the person begins to use the drug despite the consequences and uses the drug in a harmful way. Substance abuse leads to tolerance as cocaine causes changes in the brain that result in this tolerance. Following tolerance is the mental and physical dependence, or compulsive drug use despite harmful consequences as defined by the National Institute on Drug Abuse. Addiction is characterized by an inability to stop using a drug and failing to meet responsibilities and obligations in life. After someone becomes addicted to the drug, they then struggle with chronic relapse.

For example, it is not uncommon for someone addicted to cocaine to remain sober for a couple of weeks or months and then relapse. Unfortunately, this pattern continues until they receive the treatment they need. According to the Canadian Centre on Substance Use and Addiction, the percentage of cocaine use in the Canadian population is low at approximately 2%. The rate of past year cocaine use in older youth aged 20 to 24 is increasing. Also, despite the low prevalence of consumption, cocaine is responsible for the highest costs to the criminal justice system of any substance in Canada following alcohol.

Cocaine Addiction Treatment in Canada

According to a Substance Use Treatment in Canada report, 1 in 206 Canadians were in treatment for substance use. Approximately 62% of treatment admissions and 38% were female. Alcohol is the single most frequently reported problem substance among individuals accessing treatment, followed by cocaine and cannabis. Treating cocaine addiction should involve a well-rounded process that begins with detox, followed by inpatient or outpatient treatment and effective aftercare support.

According to the National Institute on Drug Abuse, behavioural treatments for cocaine addiction have proven effective in residential and outpatient settings. However, prior to behavioural therapy, the first step is detox. Cocaine detox typically lasts a few days, but this is different for each person as it depends on other drug use, underlying medical issues, and the severity of withdrawal symptoms. The initial crash from cocaine addiction occurs within 24 hours. Early withdrawal symptoms include:

• Lack of energy and motivation
• Increased hunger
• Irritability
• Anxiety
• Extreme depression and fatigue
• Anxiety
• Paranoia
• Low energy
• Cravings
• Changing moods

However, detox should not be considered the only approach taken as it will not address underlying issues with proper counselling and therapy. NIDA notes that one form of behavioural therapy that is showing positive results with cocaine addiction is contingency management or motivational incentives. Cognitive-behavioural therapy is also effective, especially for preventing relapse. Cognitive-behavioural therapy helps someone develop critical skills that support long-term sobriety. These therapies are also used in conjunction with other treatments like holistic or experiential drug rehabilitation.

Therapeutic communities or residences for aftercare support are also a good option and have been effective for people recovering from cocaine addiction. Even community-based recovery groups are an effective choice because it helps the individual remain connected to other sober people during recovery. Participants benefit from the supportive fellowship and from sharing with those experiencing common problems and issues.

Cocaine Addiction Statistics in Canada

According to the Canadian Centre on Substance Use and Addiction report mentioned above, approximately 2.5% of Canadians aged 15 and older reported using cocaine during the past year in 2017. When compared to 2015, this was an increase from 1.2%, but a significant increase from 0.9% in 2013. Among adults aged 25 and over, approximately 2.2% reported past-year cocaine use in 2017, and this was an increase from 0.6% in 2013. The rates of past year cocaine use among youth aged 15 to 19 have remained steady between 2013 and 2015.

However, past year cocaine use among young adults aged 20 to 24 has significantly increased from 3.3% in 2013 to 6.2% in 2017. The report also indicates a significant increase in cocaine consumption by men in Canada from 1.3% in 2013 to 3.7% in 2017. The consumption of cocaine among women has not changed significantly between 2013 and 2017. In 2015, the annual prevalence of cocaine use among the Canadian population was relatively high at 1.47% compared to the global estimate. Although, the rates in Canada remain lower than in the United States, England, and Australia.

According to an opioid and stimulant related harms report for Canada, nearly 90% of poisoning hospitalizations involving opioids or stimulants occurred in British Columbia, Alberta, and Ontario in 2020. The western provinces and the territories continue to be the most impacted regions of Canada. Most accidental stimulant related poisoning hospitalizations occurred among men and among individuals aged 20 to 49 years old. Also, 57% of stimulant related poisoning hospitalizations involved cocaine, and 58% involve other psychostimulants. Approximately 65% of stimulant related poisoning hospitalizations involved non-stimulant polysubstance use.

Additionally, information gathered for Statista showing the percentage of Canadians who used cocaine/crack in their lifetime indicated that 19.2% of residents in British Columbia had used these drugs. After British Columbia, 11.7% of Nova Scotia residents, 10.8% of Quebec, 10.2% of Alberta, and 9.63% of Manitoba residents had used cocaine and or crack cocaine in their lifetime.