“Crack”, is a street name that has been given to cocaine that has been processed from cocaine hydrochloride to a ready-to-use free base for smoking. Rather than requiring the more volatile method of processing cocaine using ether, it is processed with ammonia or sodium bicarbonate (baking soda) and water heated to remove the hydrochloride, thereby producing a form of cocaine that is available for smoking. Crack is a mixture of cocaine and other ingredients, to make it smokable. The additives also ‘stretch’ the cocaine (induce a longer-lasting high) and increase a dealer’s profit. The term “crack” originates from the sound heard when the mixture is heated, presumably from the sodium bicarbonate.
Usage of Crack Cocaine
Injection or ingestion of crack occurs, but it is rare. Smoking crack is the most common way of consuming it, due to the rapid and potent absorption of cocaine that can intoxicate within seconds. Smoking crack delivers a large quantity of cocaine into the lungs, producing effects comparable to that of intravenous injection. These effects are felt almost immediately, very intense but are short-lived. Cocaine is the most potent stimulant of natural origin, and it is a bitter addictive anesthetic (pain blocker) that is extracted from the leaves of coca shrub (Erythroxylon coca), indigenous to the Andean highlands of South America. Crack, as it is processed cocaine is highly addictive, and the desire to smoke more (in terms of frequency and amount) increases quickly, resulting in binge use.
The risks associated with the use of cocaine are great, whether the drug is ingested by snorting, injecting or smoking. Evidence suggests that users who smoke or inject cocaine may even be at a higher health risk than those who snort it. Compulsive cocaine use may develop even more rapidly if the substance is smoked rather than snorted. Excessive doses of crack cocaine may lead to death from cerebral hemorrhage (bleeding into the brain), stroke, heart failure, respiratory failure, or kidney failure.
Crack Cocaine Overdose
There is no specific antidote for a cocaine overdose. Treatment for crack overdose is dependent on the severity of the symptoms of overdose. Heart functioning and respiration are the primary concerns with prolonged and strenuous resuscitation efforts. Sedatives are frequently deployed as a de-escalation for elevated vital signs and psychological calming. As a method of cooling the body, injections and IV therapy are common.
Fentanyl is a potent, synthetic opioid analgesic- excellent for the control of serious pain, but also with great abuse potential. Fentanyl is 50-100 times more potent than heroin, and an amount equivalent to the size of a rice grain can kill. Fentanyl may be smoked, snorted, injected or used orally. No method of the use of fentanyl is safer than the other. Fentanyl can be severely harmful or even fatal, with death usually resulting from respiratory failure. Having such huge potency, Fentanyl administration is frequently reserved for patients that are already opioid-tolerant – those that have already grown tolerant to a therapeutic dose of some other opiate. In its prescription form, fentanyl is known by names such as: Sublimaze, Duragesic, Actiq, Durogesic, Subsys, Nasalfent, Lazanda, and Fentanyl citrate. Anyone who uses fentanyl and does not have an opioid tolerance is risking his/her health. In other words, a first time user who decides to “experiment” or use Fentanyl recreationally places himself/herself in extreme danger of overdose. A potentially lethal dose of fentanyl could be the size of just a grain of salt. The minimum lethal dosage of fentanyl is estimated to be around 250 micrograms.
In the United States in 2017, fentanyl was responsible for 59 percent of opioid-related deaths, compared to 14.3 percent in 2010. The street names for illegally used fentanyl include China Girl, China White, Apache, Dance Fever, Goodfella, Murder 8, Friend, Tango & Cash, Serial Killer, Drop Dead, Shine, TNT, Percopop, and Jackpot. The illegally made fentanyl, mostly associated with the overdose, are made in laboratories. This synthetic fentanyl is sold illegally as a powder, dropped onto blotter paper, made into pills to look like prescription drugs, and put in nasal sprays or eye drops.
The short-term effects of Fentanyl are:
- Reduced feeling of pain
Those seeking the above effects will often abuse Fentanyl by taking it without prescription, using high doses or mixing with other drugs; all of which can turn fatal.
Fentanyl Side Effects
Fentanyl affects everyone differently. The experienced effects depend on the size of the individual, weight, the amount taken, overall state of health, whether the fentanyl is combined with other drugs, and whether the person is used to taking opioids. The side effects of Fentanyl include:
- Stiff or rigid muscles
- Slow breathing rate
- Dry mouth
- Difficulty in concentrating
- Altered heart rate
- Tight feeling in the throat
- Itching skin
- Constricted pupils
The high potency of fentanyl greatly increases the risk of an overdose, especially if the drug user is unaware that a powder or pill contains it. The person can consequently underestimate the dose of the opioid, thereby resulting in an overdose. The following are the signs and symptoms of Fentanyl overdose:
- Extreme fatigue
- Cardiac arrest
- Difficulty swallowing
- Severe confusion
- Severe sleepiness
- Dizziness and fainting
- Shallow, difficult breathing/respiratory arrest
- Cold, clammy skin
- Trouble talking or walking
- Obtundation (altered level of consciousness)
- Non-responsiveness to painful stimuli
Naloxone is a medicine that can be administered to a person to reverse a fentanyl overdose. Due to the potency of fentanyl, multiple doses of Naloxone might be necessary to wear it off.
Several states in the United States have shown a growing number of recorded cases in which fentanyl is found to be used to lace cocaine. Some states are witnessing an increase in the number of deaths due to overdose, associated with both cocaine and fentanyl. In Connecticut, the number of fatal doses involving cocaine and fentanyl rose by 420 percent in three years. The number of fentanyl-laced cocaine samples that were seized in Massachusetts tripled in just a year. The Drug Enforcement Administration reported that seven percent of all the seized cocaine in New England was noticed to have contained fentanyl, more than double from 2016. In just a single weekend in June 2018, 15 people in Philadelphia overdosed on crack cocaine laced with fentanyl, and most told doctors after being revived that they were just using crack cocaine and had no prior idea it included an opioid. The nature of crack cocaine makes its use dangerous. The constituent ingredients are unknown to the user, as in their quantity and potential for toxicity.
Cocaine-related deaths rose by 52 percent across the country from 2015 to 2016. At the beginning of 2016, 37 percent of cocaine-related deaths due to overdose in New York City involved fentanyl. By the end of the year 2016, fentanyl had involvement in almost half of all overdose deaths in New York City. The combination of cocaine and fentanyl has been a considerable driving force of the rising death toll since 2015, and opioid-naïve cocaine users are at an exceedingly high risk of unintentional overdose on an opioid. If your laced cocaine contains just two milligrams of fentanyl, there is a high probability that you will not wake up from it.
It is not the intention of every crack user to have their cocaine laced with fentanyl, but those who purposely combine the two drugs do so for the purpose of “speedballing” as seen in the case of heroin and cocaine combination. Cocaine is a stimulant, while opioid is a depressant, and both provide a sense of euphoria. The idea of combining them is to get a greater high with the rush from cocaine and for the depressant effect of the opioid to minimize jumpiness and anxiety. The practice of combining both has been in existence for a long time with cocaine and heroin, but it is very dangerous with fentanyl because of its high potency. Cocaine can disguise the dangerous side effects of fentanyl abuse, and mask an overdose even while it is occurring. A person can even go into respiratory failure from the intake of fentanyl but not know until the effects of the cocaine wear off.
Cocaine and fentanyl are drugs that are chemically opposite in nature. The two drugs are consumed by two totally different demographics. Cocaine is known for its quick, energizing and euphoric effects, and thereby used in party scenes. On the other hand, fentanyl is a synthetic opioid drug, known for an intense high that relaxes and numbs the body, often used as alternatives to prescription painkillers and even heroin. Cocaine, being a “party drug” is not usually mixed with an opioid. Fentanyl-laced cocaine, has an entirely new population exposed to the addictive properties of opioids, without them even knowing. There is a risk of tolerance, abuse, dependency, and addiction associated with the use of fentanyl. Remember that a Detox in Scottsdale is always recommended before entering treatment.
There is evidence that much of the current mixing of cocaine and fentanyl is actually accidental. Researchers are finding that rather than an intentional combination, the mixing of cocaine with fentanyl may be due to poor packaging and the contamination of illicit drugs. Some experts, with the inclusion of doctors and law enforcement officers still believe that lacing cocaine with fentanyl (an opioid) is an intentional act, thereby suspecting the drug cartels for such act; in order to get occasional and recreational cocaine users hooked up on opioids, in a bid to extend the market. The truth behind it being an intentional act from the drug cartels cannot be proven.
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