Cocaine Metabolite

[Nico Sadiq]

Zawnis a writer who covers medical, legal, and social justice topics. Her work has been published in dozens of publications and websites. She lives with her husband, daughter, six tortoises, a dog, and 500 orchids. In her spare time, she runs a local maternal health nonprofit.

Dr. Deborah Weatherspoon is a former university nursing educator and has authored multiple publications. She has also presented at national and international levels about medical and leadership issues.

Beth lives in London and works as a freelance writer on a range of projects. Along with writing regular articles for Medical News Today, she writes for the Horniman Museum, an anthropology museum in South London. This involves recording minutes for conferences, blogging for their website, and documenting their process of curating art exhibitions. She loves theatre, yoga, and cycling in her spare time.

Kathleen lives in Western New York where she works as a Family Nurse Practitioner in the Psychiatric setting. She is married with three adult sons and a beautiful new daughter-in-law. In addition to numerous articles, Kathy is the author of the e-book Hepatitis C Quick Start: A Guide for the Clinician, for which she is presently working on a second edition. She loves trying new recipes, taking and editing photos, and enjoying long walks with her dog around the neighborhood.

Cocaine has a shorter half-life than many other drugs, which means that the body metabolizes it fairly quickly. Within a few hours, the dose is half that of the initial dose. And within a few days, the body has completely eliminated cocaine.

This means that a person will enter withdrawal shortly after stopping cocaine and that a blood, saliva, or urine test will only show the presence of cocaine for a few days. Because cocaine can linger in the hair longer, a hair test may be positive for months or years.

Cocaine has a short half-life of around 1 hour. This means that, within an hour of taking a dose, the body will have metabolized half of the original dose. Within a few days, the body metabolizes all of the cocaine, and it is no longer in the system at all. Other sources, however, state that the initial half-life can be several hours.

The half-life of cocaine determines how quickly a person will stop feeling high or begin feeling withdrawal symptoms. New cocaine users may find that the high weakens within a couple of hours, while habitual cocaine users may already begin feeling withdrawal within a few hours after their last dose.

This is because drug tests look for cocaine metabolites. These are the chemicals the body produces when breaking down cocaine. A person may no longer be feeling high. However, they can still test positive on a drug test due to these cocaine metabolites.

Whether a person tests positive for cocaine depends on several factors, including the type of drug test. The metabolite cutoff level will also determine the odds of a positive test. Different manufacturers determine different cutoffs. Smaller cutoff numbers mean a person is more likely to get a positive result.

This window is just a few hours for cocaine itself and 5.5 to 7.5 hours for cocaine metabolites. Therefore, a blood cocaine test is really just a test to measure if someone is currently under the influence of cocaine, not whether they have recently used it.

Hair cocaine testing poses some reliability issues. People with short hair or who cut their hair, for instance, can expect a shorter positive testing window since they may cut out the portions of the hair that will test positive.

The process by which the body metabolizes cocaine helps break it down. The metabolites created by the metabolization process travel to the urine, hair, saliva, and bloodstream, eventually leaving the body.

Cocaine metabolism begins when a chemical in the blood plasma called plasma butyrylcholinesterase (BChE) breaks down cocaine into a chemical called ecgonine methyl ester (EME). Next, enzymes break cocaine down into benzoylecgonine. This is the chemical most cocaine tests look for.

A person who needs to know how quickly cocaine leaves the body may need help for their cocaine use. This is because cocaine exits the body quickly, and a person who is unable to abstain for a few days or who has concerns about withdrawal may have an addiction.

People concerned about cocaine drug testing should avoid cocaine for as long as possible. It is also important to consider that, if cocaine may interfere with a drug test for work or school, this could be a sign that a person has become dependent on cocaine and needs treatment.

Cocaine (from French: cocane, from Spanish: coca, ultimately from Quechua: kka)[13] is a tropane alkaloid that acts as a central nervous system (CNS) stimulant. As an extract, it is mainly used recreationally, and often illegally for its euphoric and rewarding effects. It is also used in medicine by Indigenous South Americans for various purposes and rarely, but more formally, as a local anaesthetic or diagnostic tool by medical practitioners in more developed countries. It is primarily obtained from the leaves of two Coca species native to South America: Erythroxylum coca and E. novogranatense.[14][15] After extraction from the plant, and further processing into cocaine hydrochloride (powdered cocaine), the drug is administered by being either snorted, applied topically to the mouth, or dissolved and injected into a vein. It can also then be turned into free base form (typically crack cocaine), in which it can be heated until sublimated and then the vapours can be inhaled.[12]

Cocaine stimulates the mesolimbic pathway in the brain.[15] Mental effects may include an intense feeling of happiness, sexual arousal, loss of contact with reality, or agitation.[12] Physical effects may include a fast heart rate, sweating, and dilated pupils.[12] High doses can result in high blood pressure or high body temperature.[16] Onset of effects can begin within seconds to minutes of use, depending on method of delivery, and can last between five and ninety minutes.[12] As cocaine also has numbing and blood vessel constriction properties, it is occasionally used during surgery on the throat or inside of the nose to control pain, bleeding, and vocal cord spasm.[17]

A single dose of cocaine induces tolerance to the drug's effects.[25] Repeated use is likely to result in addiction. Addicts who abstain from cocaine may experience prolonged craving lasting for many months.[26][27] Abstaining addicts also experience modest drug withdrawal symptoms lasting up to 24 hours, with sleep disruption, anxiety, irritability, crashing, depression, decreased libido, decreased ability to feel pleasure, and fatigue being common.[28][15] Use of cocaine increases the overall risk of death, and intravenous use potentially increases the risk of trauma and infectious diseases such as blood infections and HIV through the use of shared paraphernalia. It also increases risk of stroke, heart attack, cardiac arrhythmia, lung injury (when smoked), and sudden cardiac death.[15][29] Illicitly sold cocaine can be adulterated with fentanyl, local anesthetics, levamisole, cornstarch, quinine, or sugar, which can result in additional toxicity.[30][31] In 2017, the Global Burden of Disease study found that cocaine use caused around 7,300 deaths annually.[32]

Coca leaves have been used by Andean civilizations since ancient times.[30] In ancient Wari culture,[33] Inca culture, and through modern successor indigenous cultures of the Andes mountains, coca leaves are chewed, taken orally in the form of a tea, or alternatively, prepared in a sachet wrapped around alkaline burnt ashes, and held in the mouth against the inner cheek; it has traditionally been used to combat the effects of cold, hunger, and altitude sickness.[34][35] Cocaine was first isolated from the leaves in 1860.[15]

Globally, in 2019, cocaine was used by an estimated 20 million people (0.4% of adults aged 15 to 64 years). The highest prevalence of cocaine use was in Australia and New Zealand (2.1%), followed by North America (2.1%), Western and Central Europe (1.4%), and South and Central America (1.0%).[36] Since 1961, the Single Convention on Narcotic Drugs has required countries to make recreational use of cocaine a crime.[37] In the United States, cocaine is regulated as a Schedule II drug under the Controlled Substances Act, meaning that it has a high potential for abuse but has an accepted medical use.[38] While rarely used medically today, its accepted uses are as a topical local anesthetic for the upper respiratory tract as well as to reduce bleeding in the mouth, throat and nasal cavities.[39]

Cocaine eye drops are frequently used by neurologists when examining patients suspected of having Horner syndrome. In Horner syndrome, sympathetic innervation to the eye is blocked. In a healthy eye, cocaine will stimulate the sympathetic nerves by inhibiting norepinephrine reuptake, and the pupil will dilate; if the patient has Horner syndrome, the sympathetic nerves are blocked, and the affected eye will remain constricted or dilate to a lesser extent than the opposing (unaffected) eye which also receives the eye drop test. If both eyes dilate equally, the patient does not have Horner syndrome.[40]

Topical cocaine is sometimes used as a local numbing agent and vasoconstrictor to help control pain and bleeding with surgery of the nose, mouth, throat or lacrimal duct. Although some absorption and systemic effects may occur, the use of cocaine as a topical anesthetic and vasoconstrictor is generally safe, rarely causing cardiovascular toxicity, glaucoma, and pupil dilation.[41][42] Occasionally, cocaine is mixed with adrenaline and sodium bicarbonate and used topically for surgery, a formulation called Moffett's solution.[43]

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