All drugs have a negative effect on the nervous system, but few can match the dramatic impact of cocaine. Cocaine is one of the most potent, addictive, and unpredictable recreational drugs, and thus can cause the most profound and irreversible damage to the nervous system. The high risk associated with cocaine remains the same regardless of whether the drug is snorted, smoked, or injected into the user's bloodstream. In addition to the intense damage cocaine can cause to the liver, intestines, heart, and lungs, even casual use of the drug will impair the brain and cause serious damage to the central nervous system. Although cocaine use affects many components of the body, including vision and appetite, the most significant damage cause by cocaine takes place in the brain and central nervous system

Short-Term Effects

When cocaine is used it interferes with the reabsorption of dopamine, a brain chemical associated with pleasure and movement, producing a euphoric effect. Shortly after cocaine is ingested the user may experience the following symptoms:

• Constricted blood vessels.
  
• Dilated pupils.
  
• Increased body temperature.
  
• Increased heart rate.
  
• Higher blood pressure.

During the euphoric period after cocaine use, which can last up until 30 minutes, user will experience hyperstimulation, reduced fatigue, and mental alertness. However, some users also experience restlessness, irritability, and anxiety.

During a cocaine binge, when the drug is taken repeatedly, users may experience increasing restlessness, irritability and paranoia. For some users this can lead to a period of paranoid psychosis, with auditory hallucinations and a disconnection with reality.

Long-Term Effects

Repeated cocaine use can cause the following health consequences:

• Irregular heart beat.
  
• Heart attack.
  
• Chest pain.
  
• Respiratory failure.
  
• Stroke.
  
• Seizures and headaches.
  
• Abdominal pain and nausea.

Chronic users of cocaine can become malnourished due to the drug's ability to decrease appetite. Each method of taking cocaine can produce specific health effects, including:

• Snorting: Chronically runny nose, nosebleeds, loss of smell, hoarseness, and problems swallowing.

   

• Ingesting: Severe bowel gangrene due to a reduction in the flow of blood to the intestines.

   

• Injecting: Severe allergic reactions. Increased risk for contracting HIV, Hepatitis and other blood-borne diseases.

Overdose

Although cocaine overdose is not common, it can occur and can be fatal. Because cocaine affects the heart and respiratory system, an overdose can cause death, especially when the drug is injected or smoked.

An overdose of cocaine can lead to:

• Irregular heart beat or heart failure.
  
• High blood pressure resulting in a brain hemorrhage.
  
• Repeated convulsions.
  
• Respiratory failure.

Addiction

Cocaine is highly addictive and those who smoke cocaine appear to develop an addiction to the drug more rapidly that those who snort it. However, even those who snort cocaine can find themselves addicted.

Cocaine users report that they are never able to achieve the "high" they felt the first time that they used the drug. A tolerance to the drug is developed so that the euphoric feeling users get is not as intense nor does it last as long.

When cocaine is injected, the euphoric feeling can last from 15 to 30 minutes, but when it is smoked, in may last only five to 10 minutes, causing the user to use more cocaine more often to try to maintain that high.

Withdrawal

When cocaine users stop using cocaine, or when they end a cocaine binge, they immediately experience a "crash" which includes depression, fatigue, lack of pleasure, anxiety, irritability, sleepiness and a strong craving for more cocaine.

Some people experience agitation and extreme suspicion when they quit using cocaine, but cocaine withdrawal usually does not have visible physical symptoms like vomiting, chills and tremors that occur with the withdrawal of other drugs.

Characteristics of Affected Infants

The following are characteristics of cocaine exposed infants:

• Prematurity
• Lowerbirthweight, shorter
• Smaller head circumference
• A piercing cry, which is apparently indicative of neurological dysfunction
• Lower Apgar score
• Irritability and hypersensitivity. The newborn shoots from sleep to screaming and is inconsolable.
• Poorfeeding
• High respiratory and heart rates
• Tremulousness
• Startling responses
• Poor sleep patterns
• Significantly lower scores on two of the dimensions measured by the Brazelton Neonatal Behavioral Assessment Scales (BNBAS): 1) scales related to interactive abilities, and 2) scales related to organizational responses to environmental stimuli. Infants who perform poorly on the BNBAS are considered high risk, especially if performance is poor in more than one of the behavioral dimensions.
• Inability to respond to caregiver. These cocaine exposed infants are largely unable to respond to the human voice and face and are unable to interact with others.
• An increased risk of malformations of the genito-urinary tract. Dr. Chasnoff recommends that these infants should have routine ultra-sound evaluations of their kidneys in order to rule out such defects.
• There is evidence that the use of cocaine shortly before birth can be associated with cerebral infarction (stroke) which damages the brain of the newborn. A CT scan of the brain may be indicated when both the infant and mother test highly positive for cocaine at the time of birth and when there are additional indications to suggest a stroke might have occurred.
• A greater incidence of Sudden Infant Death Syndrome (SIDS). In Dr. Chasnoff's sample, 15% of the infants died of SIDS, more than triple that of heroin or methadone exposed infants.
• Sleep pattern abnormalities associated with apnea and deep sleep, which may be associated with the greater incidence of SIDS
• Visual abnormalities which may be associated with retinopathy or damage to the iris. This is thought to be related either to actual damage caused by the cocaine and/or the premature birth associated with such use.