The mechanism of action of cocaine

Cocaine modifies the action of dopamine in the brain. The dopamine rich areas of the brain
are the ventral tegemental area, the nucleus accumbens and the caudate nucleus – these
areas are collectively known as the brain’s ‘reward pathway’. Cocaine binds to dopamine
re-uptake transporters on the pre-synaptic membranes of dopaminergic neurones. This
binding inhibits the removal of dopamine from the synaptic cleft and its subsequent
degradation by monoamine oxidase in the nerve terminal. Dopamine remains in the
synaptic cleft and is free to bind to its receptors on the post synaptic membrane, producing
further nerve impulses. This increased activation of the dopam .

Characteristics of cocaine-dependent patients who attempt suicide.

Roy A.

Psychiatry Service, Department of Veterans Affairs, New Jersey Healthcare System, 385 Tremont Ave., East Orange,

NJ 07018, USA.

Abstract

OBJECTIVE: Although suicidal behavior is frequent among cocaine-dependent patients, it has been little studied.

Therefore, the author examined the characteristics of cocaine-dependent patients who had attempted suicide.

METHOD: Cocaine-dependent patients who had attempted suicide (N=84) were compared with cocaine-dependent

patients who had never attempted suicide (N=130) on clinical, personality, psychiatric, and physical variables.

RESULTS: Significantly more of the patients who had attempted suicide were female and had a family history of

suicidal behavior; they reported significantly more childhood trauma and were significantly more introverted, neurotic,

and hostile. They had also had significantly more comorbidity with alcohol and/or opiate dependence, major

depression, and physical disorders.

CONCLUSIONS: The clinical implications are that family, childhood, personality, psychiatric, and physical risk factors

contribute to suicidal behavior in cocaine-dependent patients. Comorbidity appears to be an important determinant of

suicidal behavior.

The sole source of opium is the opium poppy (Papaver somniferum). The psychological and
healing effects of opium have been known for around 4,000 years.
By incising the head of the opium poppy, farmers can extract its sticky brown sap from the
egg shaped bulb. The raw opium sap contains 7-15 per cent morphine, which easily can be
precipitated from the poppy sap after simple boiling. Raw opium has a characteristic odour
which is strong and pungent.

Opiate receptors in the brain induce high physiological addiction and lasting psychological
dependence. Regular use results in increased tolerance and the need for greater quantities
of the drug.

Use of opium in Western countries has decreased substantially but it is still widely used
among highland ethnic minorities in China, Laos, Cambodia, Myanmar, Thailand and
Vietnam both for recreational and medical purposes.

Can produce intense euphoria, a heightened state of wellbeing, enhanced imagination and
speech. Soon after, respiration slows down, imagination diminishes and the thinking process
becomes confused. Lethargy, relaxation and deep sleep usually follow.

Administration is usually by smoking but it can also be chewed and cooked with food for
digestion. Particularly in countries of origin, it can be drunk as an infusion.

An opium pipe has a long thick stem with a bowl at one end. The opium ‘pellet’ is placed
into the bowl , heated and the smoke is inhaled.

Sediment or the ‘dross’ left in smoking implements can contain up to 8 per cent morphine,
is often used again and is known as blackwater opium. This form of opium still remains
popular in particular Asian countries i.e. Vietnam, Cambodia.

Smoking puts more of the active ingredients of opium into the blood stream faster, by the
way of the lungs, so the drug begins to reach the brain in about 7 seconds.

Long term use results in decreased mental and physical capacities with loss of appetite and
body wasting.

Withdrawal symptoms, similar to those of morphine, include agitation, irritability, anxiety,

restlessness, insomnia, and abdominal and muscle pain.