Cocaine and Other Sympathomimetics

Cocaine, a naturally occurring plant-derived alkaloid, has been used for centuries as a medicinal product. For thousands of years in South America, the leaves of the coca plant (Erythroxylon coca) have been chewed for treatment of various ailments. In 1860, the pure alkaloid form was isolated and became a popular constituent of various beverages, pharmaceuticals, and therapeutic tonics, but it was banned from these products in the United States in 1914. At the peak of the cocaine epidemic in the early 1990s, it was estimated that 5 million people used cocaine regularly in the United States. The drug is still popular, with up to 1.6 million current users of cocaine reported as of 2009. This is a decrease from 2.3 million users in 2003, but the consequences of recreational cocaine use are still profound. Cocaine is implicated in violent deaths and was detected in 25% of autopsies of fatal injuries in adults aged 15 to 44 years. In 2009, 39% of drug misuse deaths were due to cocaine. According to the Drug Abuse Warning Network, there were more than 423,000 cocaine-related emergency department (ED) visits representing 52% of drug abuse or misuse cases. As of 2009, cocaine ranked within the top three causes of illicit drug–related deaths at various cities across the United States. Amphetamines are stimulants originally designed for use as decongestants and dietary aids that became popular as recreational drugs in the mid-20th century. By modification of the amphetamine molecule, illicit “designer” amphetamines are inexpensively produced. The enhanced effects from these alterations add to the popularity of drugs such as 3,4-methylenedioxymethamphetamine (MDMA) and methamphetamines. Cocaine, amphetamines, and derivatives of amphetamines are called sympathomimetics (Box 154-1). These agents cause central nervous system (CNS) stimulation and a cascade of adrenergic physiologic effects. As of 2009, there were 502,000 methamphetamine current users in the United States.