Administration, routes snorting

Adverse effects of cocaine include constricted peripheral blood vessels, dilated pupils, and increased body temperature, heart rate, and blood pressure. Cocaine induces several immediate euphoric effects, such as hyperstimulation, reduced fatigue, and mental clarity, all of which depend on the administration route. The faster the absorption of cocaine, the more severe the effects. In contrast, faster absorption limits the duration of action. For example, the effect from snorting cocaine may last 15 to 30 minutes, whereas effects from smoking may last 5 to 10 minutes. Increased use can reduce the period of stimulation, as addicted humans may develop tolerance. In rare instances, sudden death may occur on the first use of cocaine or unexpectedly thereafter. 

Opioids are administered in several ways. Opium was most commonly taken recreationally by smoking, but intravenous administration has become most common since the isolation of opium alkaloids and invention of the hypodermic needle. The development of heroin from morphine at the turn of the twentieth century led to more intense euphoric effects and greater risk for addiction. Heroin may also be snorted, or it can be smoked when added to a medium such as tobacco. Medically, opioids are commonly given through oral, subcutaneous, intravenous, transdermal, or rectal routes. 

The most frequent places of estasy use are raves, nightclubs, college campuses, private parties, and private residences. Streets, shopping malls, inside cars, and schools are also common. The predominant route of administration of ecstasy across the country is pills taken orally. However, in parts of the United States, there is an increase in users snorting or injecting ecstasy. In some areas ecstasy is commonly used in mixed beverages. 

For recreational use, cocaine (hydrochloride salt) is often administered by nasal insufflation ( snorting ) or less frequently, intravenously. Cocaine is more volatile when converted from the salt to the freebase therefore freebase cocaine may be inhaled by smoking. This latter route of administration results in a rapid onset of action. It has gained increased popularity owing to the ready availabihty of the freebase cocaine form known as crack. Consequently the number of emergency room admissions related to cocaine toxicity has increased. 

Cocaine is a notorious drug of abuse that is administered via a number of routes of administration, including intranasal (snorting), intravenous, and inhalational... 

A number of reports in the mid to late 1980 s described patients who developed rhabdomyolysis while using cocaine [118-120]. Some of these patients experienced acute renal failure [121-125]. While the exact incidence of acute renal failure secondary to cocaine rhabdomyolysis is unknown, in one reported series it occurred in only three of 211 admissions for cocaine related complications [114]. On the other hand, in another series of nearly 40 patients the incidence of cocaine related acute rhabdomyolysis increased over the period of enrollment from 2 patients in 1985 to 22 patients in 1987 [126]. Several reports of patients with cocaine-induced rhabdomyolysis have clearly defined both the clinical syndrome and the risk factors for the development of acute renal failure and an adverse outcome [123, 126, 127]. Most patients have been previously healthy young males (mean age 30-35 years old and 80-85% male). The cocaine has been smoked, used intravenously, snorted, or taken orally implying that route of administration was not relevant [122,123,126, 127]. In contrast to narcotic related rhabdomyolysis, a history of prolonged coma or stupor is absent. On presentation, the majority of patients are combative and... 

II. Toxic dose. The toxic dose is highly variable and depends on individual tolerance, the route of administration, and the presence of other drugs, as well as other factors. Rapid intravenous injection or smoking may produce transient high brain and heart levels, resulting in convulsions or cardiac arrhythmias, whereas the same dose swallowed or snorted may produce only euphoria. 

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