Saliva Drug Analysis
Steven H. Y. Wong, Iraving Sunshine in Handbook of Analytical Therapeutic Drug Monitoring and Toxicology, 2017
Cocaine is obtained from the leaves of Erythroxylum coca and other species grown in South America. Cocaine hydrochloride is used topically as a local anesthetic for mucous membranes of the oral, laryngeal, and nasal cavities. It has also been used in ophthalmology, but has generally been replaced by other agents with fewer toxic side-effects. Cocaine produces CNS stimulation that is manifested by a feeling of well-being and euphoria. Absorption occurs from all sites of application, including mucous membranes, gastrointestinal tract, and the lungs.5 Illicit cocaine is sold as cocaine hydrochloride for oral, intranasal, and intravenous use and cocaine base (“freebase” and “crack”) for smoking. The drug is hydrolyzed by serum esterases, liver and chemical action to two major metabolites, benzoylecgonine and ecgonine methyl ester, plus a number of minor metabolites. After cocaine use, urine contains less than 10% of unchanged cocaine and 30 to 40% each of the two major metabolites. Cocaine metabolite (benzoylecgonine) can be detected in urine at a cutoff concentration of 300 ng/ml by immunoassay and at a cutoff concentration of 150 ng/ml by GC/MS.Detection times of benzoylecgonine in urine after administration of single euphorigenic doses of cocaine vary from 24 to 48 hr. With higher doses or chronic use, detection times are slightly increased.
Convolvulus pluricaulis (Shankhpushpi) and Erythroxylum coca (Coca plant)
Azamal Husen in Herbs, Shrubs, and Trees of Potential Medicinal Benefits, 2022
The plant Erythroxylum coca Lam. (Figure 4.2), commonly known as “Sivadari” in Tamil/Siddha and “coca” or “cocaine plant” in English, belongs to the family Erythroxylaceae. The plant is native to Peru and Bolivia and was introduced in India and cultivated in Kerala, Tamil Nadu, Uttar Pradesh, Bihar, West Bengal, and Assam experimentally (Khare, 2007). The plants are shrubs or small trees of about 5 m (Bhattacharya et al., 2017), which resembles a blackthorn bush (AP, 2014). The branches are straight, and the green-tinged leaves are thin, opaque, oval, and taper towards the ends. An areolated region of the leaf is distinguished by two longitudinal curving lines, one on each side of the midrib and more visible on the underside of the leaf. Inflorescence is axillary clusters. The flower is small, creamy white, hypogynous, petals five, polypetalous, and sepals five. Stamens are two sets of which one set of stamens faces the petals, while the other, generally shorter set, faces the sepals. The filaments are connate, producing a small staminal tube basally. Each petal has a ventral three-lobed, ligule-like nectariferous appendage placed on the claw's tip. The ligules of the five petals are upright and, while not united, overlap to form an erect tube. The ovary is superior, three celled, with one erect ovule in each cell, only one of which is typically viable. Pistil with carpel three and united, ovary three-chambered (Ganders, 1979; AP, 2014). The flowers mature into red berries (AP, 2014).
Sympathetic Neurotransmission
Kenneth J. Broadley in Autonomic Pharmacology, 2017
Cocaine is a local anaesthetic obtained from the leaves of the South American bush, Erythroxylum coca. Its general stimulant action on the CNS and the elevation of mood were recognized by the natives who have chewed the leaves for at least 1500 years. Following its isolation as the hydrochloride in 1855, it has become a major drug of abuse, more recently being smoked as the free base (‘crack’). The central stimulant properties are attributed primarily to the inhibition of dopamine uptake in the brain, which allows increases in extracellular synaptic dopamine levels in certain brain areas. The elevated dopamine levels appear to activate both D1 and D2 receptors. This action, together with a minor inhibition of uptake of noradrenaline and 5-HT, are thought to result in a mixture of inhibition and excitation of neurotransmission in local circuits in the brain leading to the behavioural effects (Woolverton & Johnson 1992). The central stimulant property is associated with vasomotor stimulation of sympathetic nerves resulting in tachycardia and vasoconstriction. A peripheral component of the increase in heart rate and vasoconstriction also arises from the inhibition of noradrenaline uptake, allowing more noradrenaline released from sympathetic nerves to reach the β- and α-adrenoceptors, respectively. The uptake of circulating adrenaline is to a lesser extent also inhibited.
Substance use disorders: diagnosis and management for hospitalists
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Ahmed K. Pasha, Arnab Chowdhury, Sanah Sadiq, Jeremiah Fairbanks, Shirshendu Sinha
Cocaine is a powerful stimulant drug that is derived from the leaves of the Erythroxylum coca plant native to South America. Common street names of this drug include: Blow, Coke, Crack, Rock or Snow. Cocaine has also been combined with other psychoactive drugs that include opioids and stimulant amphetamines. Illicit cocaine is available in two forms: Cocaine salt and Cocaine base (crack, free base). Users can snort cocaine salt through the nose or rub it into their gums. Cocaine base can be heated to produce vapors that are inhaled into the lungs. The water-soluble form of cocaine can be injected intravenously as well. Cocaine’s effect occurs almost immediately and dissipates quickly in a few minutes to an hour. As per the results of a national survey on drug use and health in 2016, there were an estimated 1.9 million people aged 12 or older (corresponding to 0.7% of the population older than 12 years) who currently used cocaine. This estimate was similar to the estimates of cocaine users between 2007 and 2015 but lower than the estimates from 2002 to 2006 [33,34].
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