Monday, September 6
 Editor's note: This is the third of an eight-week series of articles examining the effects of commonly abused substances on athletic performance and overall health. Dr. Gary Wadler, a New York University School of Medicine professor and lead author of the book "Drugs and the Athlete", has also won the International Olympic Committee President's Prize for his work in the area of performance-enhancing drugs in competitive sports. He joined us to address the issue of cocaine and sports performance.

What is cocaine?

Cocaine is a powerful central nervous system (CNS) stimulant prepared from the leaves of the South American coca plant, Erythroxylon coca. Its most common form is as a white crystalline powder known in slang terms as coke, snow or blow. Cocaine in powder form is usually "snorted" into the nostrils or rubbed on the mucous lining of the mouth and lips. It can also be liquefied and injected intravenously.

Cocaine has been used for both recreational and scientific purposes for many centuries. But as its use proliferated in the late 1800s, so did the recognition of cocaine's dangers. In 1906, Congress passed the Federal Pure Food and Drug Act, which regulated the distribution of both cocaine and narcotics. In 1970, the Controlled Substances Act placed cocaine in Category II, underscoring cocaine's strong potential for abuse and dependency.

"Presently, cocaine is used almost exclusively on a recreational basis," says Wadler. "Not only is the recreational use of cocaine illegal, it is highly addictive and is banned by all sports organizations including the NCAA and the International Olympic Committee." In 1985, 17 percent of NCAA student-athletes reported having used cocaine; by 1997, that figure was down to 1.5 percent.

What is crack cocaine?

Cocaine hydrochloride, the cocaine that is "snorted," can be converted to a smokable form in two ways. One method is called freebasing and the other produces a substance that is called crack cocaine, so called because of the cracking sound it makes when heated. "Altering cocaine hydrochloride by freebasing is potentially very dangerous," says Wadler, "because the chemicals used to remove the hydrochloride are highly flammable and freebased cocaine is smoked. Unlike freebased cocaine, the production of crack does not require the use of a volatile solvent (ether)."

What are the effects of cocaine on performance?

Whether snorted, smoked or injected into a vein, cocaine exerts most of its effects directly in the brain and to a lesser extent on the sympathetic nervous system. "Cocaine gains access to the brain fastest when it is smoked," says Wadler. "It produces a sudden, extreme euphoria, even more intense than that experienced with intravenous cocaine, that lasts only five to 10 minutes. Eighty to 90 percent of users, however, snort cocaine, which produces a euphoria that peaks more slowly, taking five to 15 minutes." The few studies that exist suggest that little to no performance gains are incurred from cocaine and its amphetamine-like properties. Cocaine is notable for distorting the user's perception of reality; for example, an athlete may perceive increased performance and decreased fatigue in the face of actual decreased performance in both strength and endurance activities. An increase in heat production combined with a decrease in heat loss associated with cocaine abuse impairs the body's ability to regulate its temperature during physical activity.

What are the adverse physical health effects of cocaine?

"Competitive athletics increases the potential of cocaine's powerful adverse cardiovascular stimulating effects," according to Wadler, "namely, life-threatening abnormal heart rhythms and heart attacks, particularly in cigarette smokers."

The list of adverse health effects of cocaine is long and affects many organ systems of the body. These effects include:

  • Strokes
  • Convulsions and seizures
  • Chronic headaches
  • Tremulousness and twitching
  • Spontaneous abortions
  • Chronic irritation of nasal membranes including perforation of the nasal septum
  • Abnormal vision including blindness
  • Sexual dysfunction
  • Elevated blood pressure and pulse
  • Hepatitis and AIDS in intravenous cocaine abusers
  • Sudden death

What are the adverse mental health effects of cocaine?

With large amounts of cocaine or with repeated administration over time, cocaine users often exhibit bizarre, erratic or violent behavior. Euphoric effects are often displaced by restlessness, extreme excitability, insomnia, paranoia and the unmasking of underlying psychiatric disorders.

Can cocaine be addictive?

Cocaine is more addictive than amphetamines, and withdrawal produces sleep and eating disorders, irritability, lack of motivation and depression as well as a craving for the drug. Experiments with animals suggest that cocaine is perhaps the most powerful drug of all in producing dependence. Rats and rhesus monkeys will forgo food and sleep for cocaine. Similarly, humans will consistently choose intravenous cocaine over a placebo when given the choice in an experimental setting. "Over time, the use of cocaine leads to neurochemical changes in the brain that manifest themselves by an intense craving for increasing amounts of cocaine," says Wadler. "Severe psycho-physiologic dependence can develop in a matter of days to weeks."

While there remains a debate on whether cocaine is physically or psychologically addictive or both, there is no doubt that the drug erodes physical and mental health and can become so central to a person's thoughts, emotions and activities that it dominates all aspects of a user's life. Following withdrawal from cocaine, a craving for the drug can be evoked by circumstances (e.g., people, locations) and objects (white powder, mirrors, razor blades) that cued the individual to memories of euphoria associated with the prior abuse of cocaine. With time, if the cue conditioning is not rewarded and satisfied by using the drug, the craving gradually diminishes. A number of pharmacologic approaches have been employed to diminish the craving for cocaine.

Is cocaine included in drug testing in sports?

Cocaine is universally banned in both professional and amateur sports primarily to protect the health of the athlete and the reputation of the sport. Regardless of the route of administration, most of the cocaine is metabolized to benzoylecgonine, which is readily detected in the urine. "Using a sophisticated technique called GC/MS, cocaine use can be detected up to five days after its use," according to Wadler. "With long-term cocaine use, particularly in those who smoke large quantities of crack, the metabolite can be detected for as long as 22 days after the last cocaine use."