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The History of Cocaine

  • Writer: FibonacciMD
    FibonacciMD
  • 5 minutes ago
  • 5 min read

From ancient rituals to modern medicine, this historical overview traces the fascinating journey of a powerful stimulant once hailed as a medical marvel.

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By Stuart M. Caplen, MD


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Cocaine is an addictive stimulant derived from the coca plant, named Erythroxylum coca.  It is thought to have been used for centuries in South America, as chewing the leaves was known to increase energy and produce a feeling of exhilaration.  Its use was incorporated into Inca religious and cultural ceremonies.  The coca leaf is believed to have reached Europe in the 1500s.  In 1860, Albert Niemann, a German chemist, isolated the alkaloid we now call cocaine from coca leaves.  He noted that tasting it made his tongue feel numb, and in fact cocaine does have local anesthetic properties.


Cocaine can cause the immediate effects of euphoria and increased energy.  The psychological effects are short-lived, from about 5 to 30 minutes, but the physiological effects, such as a rapid heart rate and increased blood pressure, last longer.  Long-term use can lead to addiction, irritability, paranoia, cognitive impairment, and even psychosis.  Heart attacks, seizures, and strokes are among the other adverse events that can occur with cocaine.  A withdrawal syndrome may occur when addicted individuals stop using cocaine abruptly.


Cocaine in Wine

In the 1860s, Angelo Mariani, a French chemist, created a tonic containing Bordeaux wine and coca leaves.  He then marketed and sold it as Vin Mariani, which was endorsed by Pope Leo XIII.

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Local Anesthetic

In 1884, Carl Koller, an Austrian ophthalmologist, experimented with cocaine as a local anesthetic for cataract surgery and found it completely numbed the eye’s surface.  The anesthetics ether and chloroform could not be used, as they could cause vomiting, which was not acceptable while performing eye surgery.  Prior to Koller’s discovery, cataract surgery was a painful procedure done without anesthesia.  Soon after, pharmaceutical companies started marketing cocaine, but a problem soon became apparent when some patients died from cocaine overdose during surgery. 


Sigmund Freud

In 1884, Sigmund Freud wrote an article about cocaine called  “Über Coca,” which he described as saying it was a “song of praise to this magical substance.”  He believed its use might be a fertile area for medical research.  He himself later became addicted to cocaine which he had used to treat his own depressive symptoms.


Patent Medicines


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By the late 1890s, cocaine, due to its energizing effects and local anesthetic properties, could be found in many patent medicines, including toothache drops.  The most famous of the health tonics created at that time was Coca-Cola, which was invented by American pharmacist John Stith Pemberton and contained cocaine and a sugar-filled syrup.  Cocaine was eventually removed from Coca-Cola around 1903, when they started to use de-cocainized coca leaves in the formulation.


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Cocaine Becomes a Problem

In the late 1800s, the medical literature was filled with articles about cocaine, and in addition to its inclusion in patent medicines, physicians were prescribing it for various maladies.  From 1900 to 1907, U.S. coca leaf imports tripled, and it was estimated that by 1902, there were an estimated 200,000 cocaine addicts in the U.S. 


In 1906, The Pure Food and Drug Act became federal law and required the presence and amount of 11 dangerous ingredients, including cocaine, heroin, and alcohol, to be properly labeled on consumer products.  It did not, however, ban these substances. 


The Harrison Narcotics Tax Act, passed in 1914, was in response to growing concerns about narcotic and cocaine use in the U.S.  It regulated and taxed the production, importation, and distribution of opiates and coca products and essentially banned the nonmedical use of those substances.


Crack Cocaine


Crack Cocaine
Crack Cocaine

Cocaine that is injected or smoked has a quicker onset of action and produces a more pronounced high than cocaine that is inhaled through the nose or taken orally. This is due to direct introduction of the drug into the bloodstream or its absorption by the lungs. Snorting cocaine powder or allowing it to dissolve in the mouth causes constriction of blood vessels and limits systemic uptake. 


In the late 1970s, “crack” cocaine was created, by solidifying cocaine powder with a mixture of ammonia or sodium bicarbonate and water. The resulting substance was then broken into small chunks that could be smoked or sprinkled on a cigarette.  It is called crack due to the crackling sound it makes as it is heated.  The price of cocaine decreased dramatically and in the 1980s an epidemic of cocaine abuse followed. Cocaine usage peaked in the United States in the early 1980s with an estimated 10.4 million users.


In the 1970s, freebasing also became popular, which involved adding ether to cocaine powder and heating it to produce very pure cocaine.  Ether is flammable, and in combination with an open flame it could cause burns or explosions.


Cocaine on Money

In 1996, researchers examined U.S. dollar bills from 14 cities and found traces of cocaine on 79% of them (0.1 micrograms) and in higher amounts (1 microgram) on 54%.  The authors felt that this indicated widespread use of cocaine in the country.  However, contamination of so much currency was thought to be too great to only be from those involved in the drug trade.  It was postulated that circulation of cocaine-laden bills contaminated ATMs and money-counting machines in banks and businesses, which then spread cocaine to other currency.


Medical Cocaine Today

While medical cocaine is still available, it is rarely used.  This is due to its addictive potential, the availability of other medicines that can be used as topical anesthetics and vasoconstrictors, and the finding that even therapeutic amounts can cause coronary artery vasoconstriction, which could potentially precipitate a heart attack.   


Editor’s Note- the heartache that I have witnessed what comes following any patient that presents with severe stroke, tachycardia, shortness of breath or heart attack certainly makes the use of recreational cocaine just not worth it.

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