Cocaine medical applications

When cocaine hydrochloride was first isolated in the late 1880s it revolutionized sur-gery and was widely prescribed for a time. Now, in the 1980s, its medical application is limited, but its popularity as a recreational drug is growing by leaps and bounds. On the black market, this ounce of pure, pharmaceutical cocaine would be worth itpwards of 2000. (leremy Bigwood)... 

Many studies have examined the efficacy of a variety of psychosocial treatments for alcohol, cocaine, and opioid use disorders, alone and in conjunction with pharmacotherapy. However, only a handful of studies have explored how these two treatment approaches may interact. More research is needed to further explore the ways in which psychosocial interventions may be used in conjunction with pharmacotherapy to optimize outcomes for both treatments. Providing encouragement for abstinence, greater treatment retention, medication adherence, and coping with medication side effects are some potential applications of psychosocial therapies. 

Psvchopharmaceutieals are medications that can affect the behavior and subjective state of man and are used therapeutically on account of these psychotropic effects. Apart from psychopharmaceuticals, there are man) other substances with psychotropic action, such as alcohol, nicotine, cocaine and heroin, which are characterized as social or addictive products and have no generally recognized therapeutic applications in Western medicine. Analgesics and members of other drug classes also have direct or indirect actions on subjective state and behavior but are not considered to be psychopharmaceuticals because they are not used primarily for their psychotropic effects. 

Cocaine is used medically by otorhinolaryngologists and plastic surgeons as an epinephrine cocaine mixture. Solutions for topical application are typically less than 4% cocaine hydrochloride. In the U.S. cocaine is a scheduled drug under the federal Controlled Substances Act of 1970. Refined cocaine, in the form of the base or hydrochloride salt, is self-administered by many routes, including snorting, smoking, genital application, and by injection. 

Probably all commonly used local anesthetics have produced fatal accidents. These depend not only upon the absolute dose, but also on the rate of absorption, on idiosyncrasy, and on other conditions. The Local Anesthetic Committee of the American Medical Association has made recommendations that should minimize the accidents. The following are the most important. Procaine appears the safest of the more widely used local anesthetics and may be employed for subcutaneous and submucosal injections, but the concentration should not exceed 1%. Cocaine and butyn should not be injected under the skin or mucous membranes but restricted to surface application. The total quantity of cocaine should not exceed 0.06 to 0.1 g (1 to 1 1/2 grains). The patient should be recumbent if the operation permits. With nervous patients, it is advisable to inject morphine 15 min before the local anesthetic and to delay the start of the operation until 20 min after the injection of the local anesthetic. Urethral injections are especially dangerous, and should be avoided if there is trauma or stricture. 

Supercritical phase extraction is the chosen method for extracting drugs, including opiates, cocaine, and methadone from a solid matrix such as hair. In its present state, supercritical phase extraction can be used with these three groups of drugs. In the near future, however, it is probable that this method will be applicable to other drugs and even to other medical substances. At that time, SFE will probably become the reference method for hair analysis. 

A forensic toxicologist receives a postmortem blood sample and performs a routine screening analysis followed by GCMS to confirm the presence of cocaine and its metabolites. The toxicologist also performs a quantitative analysis for these analytes. He writes his report and sends it through the laboratory system. The report arrives on the desk of the medical examiner. Identify at least 3 levels of peer review that would have occurred in this example. Hint Much of the applicable peer review would have occurred offstage and in the past.)... 

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