Powder form is frequently rubbed along the gums and absorbed orally. The coca leaf is chewed like betel nut for its effect. The base form known as ‘freebase’ as well as a cheaper adulterated form called ‘crack’ is vaporized and then smoked. Insufflation is better termed as snorting or sniffling among drug users, where the fine powder is inhaled through the nose directly. Injection gives the quickest rush; when combined with heroin (known s speedball) it is highly lethal. Practice of anal and vaginal insertions (plugging) have also been reported.

Cocaine exerts its effects on the brain through the mesolimbic pathway where it stimulates the release of dopamine, the chief neurotransmitter responsible for experiencing reward. Cocaine also increases other neurochemicals noradrenaline and serotonin. It offers a sense of euphoria, physical vigor and amplified energy. The subjective proficiency and self-esteem get significantly raised too. However, in higher doses it leads to agitation, irritability, impaired judgment, impulsive and dangerous sexual behavior, and extremes of aggression.

The behavioral effects of cocaine appear almost immediately and usually last for a short time (20 to 40 minutes). The user needs to take frequent and larger doses in order to continue experiencing these euphoric effects. Oral use takes the longest to act, injectable, the least. Cocaine produces such euphoria that the brain can develop dependence with one use.

Following the ‘high’ of cocaine intoxication, the crash of depression is 
associated with irritability, anxiety, sadness, fatigue, lack of
 drive and excessive sleeping. Usually all these symptoms subside 
in 14 to 18 hours but with heavy use this can last for weeks. 
Sometimes the depression may progress to suicidal intent. Unpleasant dreams are quite common along with slowing of thought. People who take cocaine truly know the intensity and severity of the withdrawal. They tend to medicate themselves with alcohol and sleeping pills but this only complicates the condition and then makes it poly-substance dependence.

Cocaine users do not come voluntarily for treatment. Well known as the ‘rich man’s drug’ and used by the elite, cocaine is getting more popular as affordability and accessibility is increasing. The exaltation experience with cocaine is too positive, and the negative effects though troublesome, seem too minimal to warrant a search for treatment. Medications help control the withdrawal. On a broader treatment perspective, the family and friends circle; all need to get involved in the management to restore a drug free life. Hospitalization, with pharmacotherapy and psychotherapy can assist detoxification and help attain abstinence. Substance dependence is an illness. People with diabetes, cancer and cardiac conditions get sympathy and understanding from their loved ones; sadly this is not the case with a drug like cocaine. Here the best and foremost person who can help oneself is oneself. It makes sense to do it sooner than later.