Cocaine Fact Card
- Benzoylmethylecgonine, Methylbenzoylecgonine
- Synonyms for Cocaine Salt:
- Cocaine Hydrochloride, Powder Cocaine
- Synonyms for Cocaine Base:
- Freebase Cocaine, Crack Cocaine, Coca Paste
- Brand Names:
- Goprelto (Cocaine Hydrochloride Solution)
- Street Names for Cocaine Salt:
- Coke, Blow, Flake, Powder, Rock, Shale, Snow, White, Yay, Yayo, Lines (Single Doses), Bumps (Single Doses)
- Street Names for Cocaine Base:
- Freebase, Base, Crack, Hard, Rock
What is cocaine?
Cocaine, commonly known as coke, is a potent CNS stimulant, anorectic, and local anesthetic, notorious for its high potential for addiction and abuse. Cocaine is naturally occurring, derived from the leaves of the coca plant, grown in various regions of South America. Cocaine is found primarily in its illicitly manufactured street forms: cocaine salt, commonly known as powder cocaine — and cocaine base, commonly known as crack cocaine or freebase. All forms of cocaine were illegal in the United States until 2017, when the FDA approved a new prescription form of cocaine, with a very limited medical application.
Cocaine Salt (Powder Cocaine)
Cocaine salt is a form of cocaine that has been combined with an acid to form its hydrochloride salt: cocaine hydrochloride. Cocaine salt is commonly found on the street in the form known as powder cocaine. This form is purchased by end users in the form of small, white to off-white, soft rocks, which are converted to powder by cutting with a razor blade or by crushing. The powder is then snorted using a small straw, rolled currency, or even a key that has been dipped into the bag of powder. The powder might also be liquefied and injected.
Cocaine salt can also be found in the form of an aqueous solution. In 2017, the US FDA approved a new drug consisting of a solution of 4% cocaine hydrochloride salt, marketed under the brand name Goprelto. The drug was approved under a very limited scope — indicated for the induction of local anesthesia of the mucous membranes when performing diagnostic procedures and surgeries on or through the nasal cavities in adults.
Cocaine Base (Freebase, Crack Cocaine, Coca Paste)
Cocaine base is any form of cocaine that has not been combined with an acid to form the hydrochloride salt, including freebase cocaine, crack cocaine, and coca paste. In these forms, the relevant molecule is identical.  Cocaine base is known to be more potent and addictive than the powder form of cocaine.
Freebase cocaine is powder cocaine that has been processed with ammonia or baking soda into a rock form, which is smoked. More commonly, baking soda is used and the end product is known as crack cocaine — named for the crackling sound it produces when smoked. Freebase produced using ammonia is generally a purer form then crack cocaine and is far less common on the streets. Crack cocaine is notorious for the high risk it poses to users, due to the possibility of dangerous additives being used in its production by street dealers attempting to stretch profits.
Coca paste is the first crude product extracted from the coca leaves during the manufacture of street cocaine. Coca paste is generally not available in the United States. However, it is commonly used in many South American countries, where it is known as pasta and is smoked. Effects are similar to freebase cocaine.
Coca leaves provide the raw material that all forms of cocaine are derived from. Coca leaves are harvested from the coca plant, grown in various Andean regions of South America. In many Andean cultures, the raw coca leaves are commonly chewed for either their stimulant properties, anorectic properties, anesthetic properties, or for other perceived medicinal properties. They are also consumed in the form of a tea. 
Currently, the coca plant is legal only in select Andean regions, where it is considered an important cash crop. In these regions, the unprocessed leaves can be harvested and traded, and are commonly found in some commercial food and beverage products. Coca leaves consumed in their raw form have not been shown to induce the classic signs of addiction and dependence seen with the processed forms of cocaine.
What are the effects of cocaine?
Cocaine is a potent CNS stimulant drug. Effects include a rush of energy and euphoria, rapid heartbeat, perspiration, jaw clenching, teeth grinding, and dilation of the pupils.  Cocaine produces powerful drug cravings that drive users to continue using the drug, continuously seeking more when supply is depleted. In addition, users will typically remain awake for as long as the drug consumption continues. So, cocaine episodes can last for multiple days. However, the exceedingly high cost of cocaine presents a barrier that may cut such episodes short.
Cocaine is also a powerful anorectic. Users will generally avoid food while under its influence. As a result, significant weight loss is common among the cocaine addicted. To lessen cocaine's stimulant effects, "taking the edge off", or to expedite sleep following a cocaine episode, many users turn to sedatives such as benzodiazepines (Xanax) or barbiturates. When potent CNS drugs are combined in such fashions, or when combined with alcohol, results can be unpredictable and at worst fatal. 
Cocaine Abuse and Addiction
Cocaine is sought after for its potent euphoric and stimulant effects, ranking it as the third most popular illicit drug used in the US in 2013, behind marijuana and the illicit use of prescription drugs.  Cocaine is highly addictive, producing powerful drug cravings that cause many addicts to go to great lengths in order to procure more drug when supply is depleted. Cocaine is also extremely expensive, leading to many domestic, social, legal, and financial problems for the cocaine addicted who continuously seek to replenish supply. Cocaine addiction can be extremely difficult to conquer. As a result, many addicts turn to professional sources to help with their recovery.
Urine Testing for Cocaine
Cocaine urine tests target benzoylecgonine, with possible cross-reactivity for unchanged cocaine and the cocaine metabolites ecgonine and cocaethylene. Benzoylecgonine is the prominent metabolite in the urine of those ingesting cocaine.  Cocaine is present as unchanged parent drug in the urine of those ingesting cocaine, but to a much lower degree than benzoylecgonine.  Ecgonine is a metabolite found in the urine of those ingesting cocaine, but only in small concentrations.  Cocaethylene is a metabolite found in the urine of those ingesting cocaine with alcohol (ethanol), but to a much lower degree than benzoylecgonine. 
According to "Disposition of Toxic Drugs and Chemicals in Man" (3rd ed): approximately 35–54% of a cocaine dose is recovered in the urine as the metabolite benzoylecgonine, with approximately 32–49% recovered as the metabolite ecgonine methyl ester, and 1–9% recovered as unchanged cocaine. 
In a study published in the Journal of Analytical Toxicology, eighteen chronic, high-dose cocaine users with reported recent (2.5–63 hours) cocaine use volunteered to provide urine samples for screening over a period of several days. At time of intake, urine concentrations of benzoylecgonine ranged from 630–277,709 ng/mL. The last positive urine sample was observed at 146.8 hours. 
The metabolite cocaethylene only appears in the blood and urine of those combining alcohol (ethanol) with cocaine use.  In addition, the simultaneous presence in urine of the three metabolites cocaethylene (CE), norcocaethylene (NCE), and ecgonine ethyl ester (EEE) is a good marker for the coadministration of cocaine and ethanol.  In a study involving postmortem urine samples positive for cocaine, two cases were positive for the three marker metabolites (CE, NCE, and EEE), indicating the coadministration of cocaine and ethanol. Case 1 yielded a cocaethylene concentration of 39 ng/mL, with a Benzoylecgonine concentration of 6,025 ng/mL. Case 3 yielded a cocaethylene concentration of 255 ng/mL, with a Benzoylecgonine concentration of 8,386 ng/mL.