Cocaine Uses and Abuses

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Abstract
Cocaine is a time-honored topical anesthetic for intranasal surgery. It combines superb anesthesia with constriction of nasal vasculature and patient euphoria, which facilitates surgery and enhances its tolerability to the patient. Dosages of 200 mg (2 ml of 10% solution) are considered safe and effective for surgical anesthesia. Central nervous system excitability is the predominant toxic reaction followed by convulsions and apnea, which require respiratory support. Intravenous diazepam effectively averts this reaction. Cardiovascular toxicity appears at higher dosages (such as with ingestion for concealment during smuggling) or when epinephrine is concurrently used with cocaine. Cocaine is also damaging to nasal membranes and the nasal septal cartilage, due to its vasoconstrictive effect and the irritative effects of its diluting contaminants. Its major psychological effect is stimulation similar to that of the amphetamines. Prolonged recreational use may lead to paranoia and violent, antisocial behavior, including homicide and suicide.

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