A Fire in the Brain

A Fire in the Brai

Drug laws, in the U.S. classify cocaine as a narcotic, along with opium, heroin and morphine. Yet the last three are "downers," which quiet the body and dull the senses, while coke is a stimulant, or "upper," similar to amphetamines. It increases the heartbeat, raises blood pressure and body temperature, and curbs appetite. Like a shot of adrenalin, coke puts the body into an emergency state.

Exactly how coke does that is something of a medical puzzle. But like other stimulants, even caffeine, it apparently intensifies the action of body chemicals called neurotransmitters. Firing off one nerve cell after another like a string of firecrackers, these chemicals help send tiny electrical impulses coursing through the nervous system. (By contrast, narcotics tend to suppress these impulses.) As the signals multiply, they inundate the system's peripheral areas, which control such involuntary functions as the pulse and perspiration. They also flood at least three critical parts of the brain itself: the cerebral cortex, which governs higher mental activities like memory and reasoning; the hypothalamus (appetite, body temperature and sleep as well as such emotions as anger and fear); and the cerebellum (walking, balance and other motor activities).

The consequences are inevitable. "Like an overburdened telephone switch board," explains Dr. Walter Riker Jr., chief of pharmacology at New York Hospital-Cornell Medical Center, "the brain cannot handle all the messages. There is too much information flowing in, and the user becomes hyperaroused." With higher doses and chronic use, the alertness and exhilaration so prized by coke's connoisseurs quickly turn into darker effects, ranging from insomnia to full-fledged cocaine psychosis. Even a single overdose can cause severe headaches, nausea and convulsions--indeed, total respiratory and cardiovascular collapse. Says U.C.L.A. Psychopharmacologist Ronald Siegel: "Extreme cocaine dosages light a kind of fire in the brain."

Ignition can occur in various ways. "Snorting," or sniffing the white powder, ensures absorption of the drug into the bloodstream through the mucous membranes. But it also constricts the myriad little blood vessels in these membranes, reduces the blood supply and dries up the nose. With repeated coke use, ulcers form, cartilage is exposed and the nasal septum can be perforated, requiring repairs by plastic surgery. (Savvy users rinse their noses with water after sniffing to wash away the irritants.) To avoid the impurities of street coke and obtain a greater jolt, more users are resorting to freebasing. After dissolving a substantial quantity of coke in an alkaline (basic) solution, they boil the brew until a whitish lump, or freebase, is left. The lump can be purified further by washing it in a strong solvent. Then it is smoked, often in a water pipe. That way a highly concentrated dose is absorbed into the blood even faster via the lungs than through the nasal membranes.

A few users inject a solution of it directly into the bloodstream. "Shooting" is especially perilous. Not only can the high initial dose send the body into a frenzy, but just a little more than a gram of pure coke can be fatal. There is also a great risk of deadly reactions from dirty syringes or contaminants in the coke. Dr. Charles Wetli, deputy chief medical examiner for Florida's drug-plagued Dade County, reports seeing cases where the needle was still in the dead victim's arm.

As lethal as shooting or freebasing may be, in proper hands cocaine can be medically useful. During the 19th century it was widely used as a local anesthetic because of its numbing properties. Since it constricts blood vessels and thus inhibits bleeding, it was particularly helpful during surgery on such sensitive, blood-rich parts of the body as the eye. It is still the anesthetic of choice for surgery on the nose, throat, larynx and trachea.

Unlike such downers as heroin or Quaaludes, cocaine is physically nonaddictive, without strong withdrawal symptoms. Still, it can damage the liver, cause malnutrition and, especially among those with cardiac problems, increase the risk of heart attacks. Equally disturbing, says Siegel, "it is the most psychologically tenacious drug available." Coming down from a high may cause such deep gloom that the only remedy is more cocaine. Bigger doses often follow, and soon the urge may become a total obsession, with all its devastating consequences.

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