Sure, it stains your teeth, and you when you spit it out on the footpath it leaves a big red mark, like a blood stain, but betel leaf chewing is a popular pastime on the streets of Burma. It acts as an appetite suppressant and is said to get rid of parasites. Putting it together is like making a salad: a street vendor who sells the stuff takes a leaf, coats it with lime paste and puts in a pinch of cloves, aniseed, cardamom and betel nuts. Kava is not to be confused with the Spanish bubbly of a similar name.
The effect of this kava depends, of course, on how much you consume. A crop native to the western Pacific, kava comes from the root of a pepper plant. Voyagers, chroniclers, and conquistadores sent word to Europe about this miracle plant. But commercial motivations prevailed. The Spanish instead sought to profit from coca, taxing and trading the leaf while rationing it to the laborers who claimed it boosted their strength , alleviated their hunger, and relieved their pain.
This discovery would lead to an entirely new use for the coca leaf: as the raw ingredient for cocaine—a far more potent drug in its own right. Then its medical indications expanded in the late s, when it was touted as a panacea. Explorer Ernest Shackleton and his team brought cocaine to Antarctica as a purported remedy for snow blindness and a stimulant during the arduous trek to the South Pole. In the U. The substance was mixed into numerous drinks, such as wine and Coca-Cola , which is still flavored with decocainized coca leaves.
At the turn of the 20th century, much of the world was gripped by a moral panic about drugs. Worldwide controls such as the International Opium Convention in soon followed, leading to a decline in the coca planting industry. The Single Convention on Narcotic Drugs —perhaps the most influential document to shape global drug policy—called for the destruction of coca plants and the abolition of coca chewing within 25 years.
The document classified both cocaine and coca leaves as Schedule I drugs, meaning they are liable to be abused and must be strictly controlled. Then, as now, governments of Andean countries have rejected the nearly worldwide ban on coca. They argue that Indigenous peoples have been safely consuming coca for thousands of years. They seek to distinguish the leaf from its infamous powdery extract because, in fact, the two are strikingly different. Coca leaves contain between 0.
Transforming the leaves into cocaine involves a multistep process of dissolution, extraction, and purification using some combination of lime in the form of cement mix , sulfuric acid, kerosene , gasoline, ammonia , hydrochloric acid, acetone the active ingredient in paint thinner , and other dangerous chemicals.
Still, though some coca planted in Peru is used for traditional and medicinal purposes, a shocking In addition, the legal market furnishes the justification for the existence of the illegal market.
In this condition, the patient demonstrates hypervigilance, paranoid delusions, for example of persecution, injury, death, poisoning, witchcraft or infidelity, auditory and olfactory hallucinations, insomnia, and aggression, including attempted suicide, homicidal attack and sudden assault. In this state some smokers have died from an overdose, have committed suicide, or have been killed in an accident or during a fight.
If the psychotic patient is taken to hospital, conventional treatment, including detoxification, antipsychotic medication and psychotherapy, may bring about a recovery in a matter of weeks or months. The different phases of mental disorder are associated with various physical disorders.
During euphoria, dysphoria and hallucinosis the subject is usually thin, pale and shaky, sweats profusely, and has dilated pupils, high blood pressure, a rapid pulse, increased temperature and rigid muscles. Common complications are malnutrition, immunodeficiencies, dental, skin, respiratory, intestinal, hepatic and meningeal infection, tuberculosis, pneumonia and other respiratory disorders and cocaine-induced epilepsy.
Serious coca-paste intoxication can lead to indifference, inactivity, fever, lack of co-ordination, asthma, automatism, cardiac arrythmias, stupor, collapse, convulsions, neurogenic hyperventilation, respiratory arrest, cardiac arrest and death.
The somatic and psychological disorders observed in the coca-paste smokers under study when they were admitted to medical and psychiatric care are set out in tabular form below:. Coca-paste smoking has had a serious social impact on the patients under study. They have become so dependent on the drug that they have practically no other interest in life.
They are inefficient at their jobs and experience marital problems, and the students fail courses or drop out of school. If they have a job, they are frequently absent from work because they do not feel well or because they spend time on procuring the drug. They need money to buy the coca paste, spend all their salary and resources and, when funds become scarce, resort to swindling, theft, non-payment of debts or drug-peddling.
Most coca-paste abusers have psychopathological disturbances before they become addicted to drugs, but some of these young people had been healthy and respected middle-class students, professionals or employees before they began smoking coca paste.
It was hard to credit the extremes of social degradation to which people could fall, especially those who had been good students, efficient professional workers or successful business people. Soon after the first paper on this study was published, Peruvian investigators confirmed the results and added their own observations [ 3 ] , [ 11 ].
Their description of the natural course of coca-paste dependence was based on information obtained from patients in psychiatric hospitals. Their clinical and sociological observations tallied very closely with those summarized above and confirmed that most patients would develop an intense dependence after six months of coca-paste smoking, characterized by psychological paranoia, stupor and cerebral disorders [ 3 ]. Another author [ 15 ] was particularly interested in the jargon used by coca-paste smokers and described the natural history of dependence, based on Colloquial descriptions by smokers and observations made on 24 hospital patients [ 1l ].
Two researchers working in Bolivia [ 8 ] found that coca-paste smoking accelerated the thinking process and led to obsessiveness and a marked compulsion to use the drug; they reported that they almost immediately began to have paranoid thoughts, which were accompanied by intense anxiety. In 35 per cent of the cases, senso-perceptive disturbances were documented. They also found that 80 per cent of the patients resorted on impulse to criminal acts such as theft or fraud to enable them to buy the drug.
Coca-paste smoking was highly addictive, producing a psychological dependence that could lead individuals to delinquency, ill-health and imprisonment. Recently coca-paste bazuco Smoking has been reported in many parts of Colombia. In , more than 1, cases were reported to the Ministry of Health [ 9 ]. The social repercussions of coca-paste smoking are not limited to family and neighbours. Coca paste has become the main illicit drug exported by drug traffickers from Peru [ 18].
The enormous profits derived from this huge-scale illegal business give traffickers an extraordinary means of setting up legitimate businesses as "cover" and a considerable capacity for corruption and for maintaining rapid communication, as well as for procuring sophisticated equipment for hiding the drug. Coca-paste smuggling can have a demoralizing effect on certain sectors of society. Cases have been repeatedly brought to courts of law in which judges, lawyers, congressmen, physicians, politicians, police officers and civil servants had accepted bribes or had become members of an illegal international drug-trafficking organization [ 19 ].
Similar events have been reported in Argentina [ 20 ] , Bolivia [ 21 ] , Colombia [12, 22] and Ecuador [ 23 ]. The loss in manpower and efficiency from illness, addiction, delinquency, imprisonment, absenteeism and Sloppy work habits has been considerable. In order to verify the effects of coca-paste smoking, the author undertook in a study of a group of eight healthy middle-class Peruvian males, between 20 and 25 years of age, who smoked Coca-paste.
All were volunteers, and none reported any previous organic, mental or nervous disorder. They took part in a smoking session at which they were under observation and stopped when they had had enough. Some showed anxiety or changes in mood. Others became withdrawn and between cigarettes would come out of their isolation only to complain of their depressed mood. A few subjects became garrulous, active and playful when they were smoking, but between cigarettes showed some hostility and moody ambivalence.
The latter smoked very quickly to begin with and then voiced a desire to stop but were unable to do so, experiencing extreme dysphoria at the end of the session. While smoking, all the subjects showed an increased pulse rate, blood pressure and respiration.
In some cases the body temperature rose. All of the subjects had dilated pupils, many became shaky and showed increased muscle tone with profuse perspiration. All of them expressed a strong desire for alcohol, which they claimed was necessary to calm them down. Blood was taken from the veins of the forearm at minute intervals during the smoking session.
Two tests were carried out, using liquid gas chromatography and a nitrogen-sensitive detector. It was also found that the subjects became dysphoric when the concentration of cocaine in the blood was still high [ 4 ]. Even though the amount of coca paste used by the subjects of this study was very small compared with the quantities smoked under illegal conditions by heavy smokers, the following two findings were documented:. Coca-paste smoking produced physiological and psychological changes, including euphoria, dysphoria and paranoid behaviour;.
Coca-paste smoking gave rise to rapid and elevated levels of cocaine in the blood, similar to those found after intravenous injection. As it was difficult to administer psychological tests while repeatedly taking blood from the volunteers for this study, another series of examinations was performed in without blood Samples [ 5 ] , the main purpose of this being to measure the psychological changes in individuals while they were under the influence of coca paste.
Six healthy male volunteers, aged from 19 to 35 years, were examined after they had signed informed consent forms.
The subjects were placed in two rooms. In one room they were examined every two minutes by a psychiatrist who marked up the linear and behavioural scales. The psychiatrist did not know what substance was being smoked.
In the other room, two physicians performed periodical medical examinations, distributed the cigarettes tobacco only or coca paste with tobacco and observed the physical changes. None of the subjects knew whether the cigarettes were tobacco only or paste with tobacco. The physiological changes noted in previous research [ 4 ] were verified in all subjects. The BPRS test showed considerable sensitivity to placebo smoking. EDES and the RHS tests showed significant swings between euphoria and dysphoria during the different phases of the smoking sessions.
In general, individuals smoking coca paste reported intense mental changes on the linear and behaviour scales, but each one showed different qualitative and quantitative curves. Euphoria associated with anxiety was confirmed in all subjects when they were "high". Dysphoria and other mood changes were documented in later phases. These changes were much more evident in the group of coca-paste smokers than in the group using a placebo [ 5 ].
Again it must be noted that the amounts of coca paste smoked in this study were relatively small compared with the usual consumption at recreational or heavy sessions. Every precaution was taken to avoid any possibility of severe or psychotic reactions in the subjects who volunteered for the study.
Two years after coca-paste smoking had first been mentioned in the literature on the subject [ 1 ] , this form of drug abuse was reported to be on the increase in Lima [ 24 ].
In the same year, several hundred cases associated with severe psychological disturbances were documented [ 2 ] , [ 3 ] , [ 15 ].
One author reported a large annual increase in the number of excessive users of coca paste admitted to a psychiatric hospital [ 25 ]. Several researchers observed the same trend in general and psychiatric hospitals [ 2 ] , [ 3 ] , [ 6 ] , [ 7 ] , [ 11 ]. These findings corroborated the data on drug seizures reported by the police.
Coca paste was the main drug involved and the amounts seized increased every year [ 16 ] , [ 17 ]. The number of persons apprehended while smoking coca paste in the streets also increased regularly from year to year [ 17 ] , [ 18 ] , [ 26 ]. An indeterminant amount of cocaine was broken down to poorly characterized pyrolytic products in the smoking process.
The biological activity of those products is not well established. Thus, in fact, considerably less than 30 mg of cocaine base was probably delivered to the mouth of the inhaling research subject. Our electrically heated 1-liter flask was, of course, a rather special and not a typical free base pipe, but experience with cocaine pipes brought into the laboratory by research subject volunteers is similar.
Much, perhaps even most, of the cocaine base placed in the pipe does not reach the mouth of the smoker. How much cocaine aerosol actually reaches lung alveoli depends on heating conditions, air flow, number of inhalations, and other things determined largely by the smoker who only reluctantly yields control to the researcher, if cocaine smoking is like other smoking behavior. If all the cocaine not remaining in the pipe was delivered to the lung alveoli and thus probably completely absorbed, cocaine dose could be better estimated.
However, pyrolysis occurs at variable rates during the smoking process. Although breakdown is not completely quantified yet, we have strong evidence that anhydroecgonine methyl ester is one of the major breakdown products under our smoking conditions.
Thus, under the smoking conditions leading to the plasma levels in figures 1 and 2, only a small fraction of the mg of cocaine base in the smoking apparatus actually was delivered to the alveolar surface, where rapid absorption is most likely. The relative percentages of cocaine base delivered, what remains in the pipe, and what is destroyed vary greatly with the smoking conditions encountered with various smoking apparatus. The 10 subjects in the experiment discussed claimed to be experienced and reasonably confirmed cocaine base smokers, exhibited a varied repertoire of smoking styles ranging from very big puffs with very little and brief inhalation to, at the other extreme, maximum and rapid forced inhalation and valsalva maneuver with little or no intermediate puff behavior.
The variability in smoking behavior we have encountered amongst cocaine smokers is much greater than commonly seen in otherwise similar groups of marijuana or tobacco smokers. Inferring what is likely to be happening in the real world of crack smoking from laboratory studies is risky until the range of possible cocaine-smoking behavior in real-life situations is better understood and better described.
Much can be gleaned from what we know of nicotine and THC smoking. The principles that guide the smoking of those drugs and the unresolved problems of researching nicotine and THC smoking apply to cocaine as well. Almeida, M. Natural history of dependence of cocaine basic paste. Rev Neuropsiquiatr , , Diding, N. Machine smoking results compared to human uptake of cigarette smoke.
Flores, A. Drug abuse problems in countries of the Andean subregion. Bull Narc , , Hanna, J. Use of coca leaf in southern Peru: adaptation or addiction. Herning, R. How a cigarette is smoked determines blood nicotine levels. Clin Pharmacol Ther , , Holford, N. Understanding the dose-effect relationship: Clinical application of pharmacokinetic-pharmacodynamic models. Clin Pharmacokin , , Jeffcoat, A.
Cocaine disposition in humans after intravenous injection, nasal insufflation snorting , or smoking. Drug Metab Dispos , , Jeri, F. Coca-paste smoking in some Latin American countries: a severe and unabated form of addiction. Kozlowski, L.
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