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An Introduction to Substance Use Disorders for Dental Professionals

Course Number: 545


Cocaine is a powerfully addictive stimulant that directly affects the brain. Cocaine was labeled the drug of the 1980s and 1990s because of its extensive popularity and use during that period. However, cocaine is not a new drug. In fact, it is one of the oldest known psychoactive substances. Coca leaves, the source of cocaine, have been chewed and ingested for thousands of years, and the purified chemical, cocaine hydrochloride, has been an abused substance for over 100 years. In the early 1900s, for example, purified cocaine was the active ingredient in most of the tonics and elixirs that were developed to treat a wide variety of illnesses and pain, including dental pain (see Figure 15).

ce545 - Images - Fig 15

Figure 15. Advertisement for medicinal drops to relieve toothache, Lloyd Manufacturing Co., 1885

Courtesy National Library of Medicine

Cocaine is generally sold on the street as a fine, white, crystalline powder known as coke, C, snow, flake, or blow. Street dealers generally dilute it with inert substances such as cornstarch, talcum powder, sugar, or with active drugs such as procaine (a chemically related local anesthetic) or amphetamine (another stimulant). Some users combine cocaine with heroin – in what is termed a “speedball.”

There are two chemical forms of cocaine that are abused: the water-soluble hydrochloride salt and the water-insoluble cocaine base (or freebase). When abused, the hydrochloride salt, or powdered form of cocaine, can be injected or snorted. The base form of cocaine has been processed with ammonia or sodium bicarbonate and water, and then heated to remove the hydrochloride to produce a substance that can be smoked. The term “crack,” which is the street name given to freebase cocaine, refers to the crackling sound heard when the mixture is smoked.45

The National Survey on Drug Use and Health (NSDUH) estimates that in 2022, 5.3 million people age 12 or older were past year users of cocaine, including about 918,000 users of crack cocaine. This accounts for 1.9% of the population being cocaine users and approximately 0.3% being crack users.61

Users generally take cocaine in “binges,” during which the cocaine is used repeatedly and at increasingly higher doses. This can lead to increased irritability, restlessness, panic attacks, and paranoia–even a full-blown psychosis, where the individual loses touch with reality and experiences auditory hallucinations. With increasing dosages or frequency of use, the risk of adverse psychological or physiological effects increases.45