According to a World Health Organization report, occasional cocaine use is perfectly fine for your health, with no “severe or even minor physical or social problems.”  Surprised?  So was I.  Perhaps it is time to take a closer look at this well-known stimulant, and sort the facts from the fiction. Cocaine or benzoylmethylecgonine is a chemical with a deep and colorful history.  It is extracted from the leaves of the Erythroxylon coca plant.  The leaves of which have been used by native peoples of South American for millennia.  Merely chewing on the leaves or brewing them into a tea provides a mild stimulating effect.  Consumption of the leaves also suppresses feelings of fatigue, pain, hunger and thirst.  South American mummies have even been found buried with coca leaves, with their other treasures.  However, it wasn’t until the mid-1800s that chemists discovered how to extract and condense cocaine directly from the leaves.  It quickly became a popular medication and stimulant used to treat a multitude of ailments. Physiologically, cocaine has diverse effects.  It acts as a vasoconstrictor and is used in certain surgeries to decrease bleeding.  Cocaine also blocks sodium ion channels in nerves providing temporary pain relief and numbness.  Lidocaine and benzocaine are topical painkillers that function similarly to cocaine.  One early researcher, by the name of Karl Koller went so far as to place a cocaine solution onto his eye.  He then proceeded to jab at his own eye with a needle to test the pain killing ability.  According to his records, he felt no pain (though, don’t try it at home). It is the neurological effects that set this chemical apart from other anesthetics.  Cocaine acts by blocking serotonin reuptake inside the brain.  This traps all active dopamine within the space between neurons and causes the dopamine to bind over and over to the neurons.  This overstimulation of neurons causes increased alertness, euphoria, energy, well-being, self-confidence, and motor activity.  The neurons in the voluntary movement centers of the brain are especially affected, inciting a desire to move and be active.  It can also lead to the tell-tale chewing exhibited by chronic users.  All these effects led to cocaine in the early 1900’s being marketed as a productivity drug to help workers get through the day, improving output and decreasing pain and fatigue.  At the time it had a single chemical competitor with similar effects: caffeine.  Interestingly, according to a World Health Organization study; occasional use poses no short or long term health danger.  The danger lies in sustained abuse. All this pain and fatigue relief can come at a price.  For occasional use, the hangover consists of a dysphoric or “down” feeling or lethargy.  With any chemical that works on the brain’s reward pathways addiction can occur.  While not medically dangerous, physical withdrawal symptoms include insomnia, increased appetite, difficulty with motor control, agitation and bad dreams.  Famously, withdrawal may include an itchy or crawling sensation under the skin known as “coke bugs.” Cocaine does have an active/lethal dose ratio of about .065.  In comparison, alcohol’s ratio is about 0.100, making it almost twice as dangerous per active dose, a rather surprising statistic.  The euphoric “high” from a dose of cocaine only lasts 15-30 minutes and the energetic “high” tops out at 60 minutes which leads many users to keep dosing many times to continue the effects.  Cocaine also has a multitude of side effects depending on the method in which you take the drug.  They can include: fever, runny nose, sore throat, reduced attention, insomnia, lethargy and decreased appetite.  Dehydration is also a concern.  Don’t take that to mean there are not serious health concerns with cocaine.  Like all stimulants, they can exacerbate chronic health problems.  Those with heart disease, high blood pressure or prone to stroke can suffer an infarction or aneurism.  Additionally, street drugs can be cut with any number of contaminants that can cause infamous reactions such as, nose bleeds, infection or lung damage.  Over constriction of nasal blood vessels through cocaine dependence and abuse can lead to necrosis of nasal tissue, severe sinus infection and injury.  Also, much like tobacco and other inhaled drugs, lung damage can occur.  Crack cocaine, an inhalant version of cocaine contains substances extremely toxic to the lungs.  Both oral consumption and nasal insufflation (snorting) result in the same amount of active ingredient reaching the brain.  Interestingly, damage due to smoking, injecting or snorting need not be considered side effects, as these methods are unnecessary for optimum chemical delivery.  Swallowing nets the same effects.  Addiction, is a very real danger with cocaine.  Tolerance is built up to the chemical overtime which can lead to abuse and subsequently the danger of overdose, addiction and withdrawal.  A cocaine tolerant individual will begin taking more and more of the chemical to achieve the desired effect.  This can lead to overdose.  Overdose occurs when sodium ion channel disruption, which creates the anesthetic effects, disrupts the function of the heart muscle.  With high doses, this can lead to cardiac arrest. As will all chemicals, benzoylmethylecgonine is neither good nor evil.  When taken, it has specific stimulating effects on the mind and body.  Cocaine is a chemical with an ancient history in human society.  When used correctly it can aid medical doctors, and at one time, it was used to great effect in improving worker productivity and happiness.  Used incorrectly it can be dangerous and addicting.  The importance of being educated on the effects of medicines and chemicals on individuals and society cannot be overstated.  Through better education we can keep the public safer, healthier and chemical dependence free.   Sources WHO/UNICRI (1995)  “WHO Cocaine project” Levinthal, C. F. Drugs, Behavior, and Modern Society, 6th ed., Allyn and Bacon, Boston “Mouse Party” Cohen, Peter; Sas, Arjan (1994). “Cocaine use in Amsterdam in non deviant subcultures”Addiction Research 2 (1): 71–94. Goldacre, Ben (June 2008). “Cocaine study that got up the nose of the US”Bad Science (London: The Guardian). Lowinson, Joyce, H; Ruiz, Pedro. Millman, Robert B. (2004). Substance abuse: a comprehensive textbook (4th ed.). Lippincott Williams & Wilkins. p. 204.