The cocaine-addicted patient

Cocaine (benzoylmethylecgonine, C17H21NO4), a natural alkaloid, is derived from Erythroxylon coca, a plant indigenous to parts of South America, Mexico, the West Indies, and Indonesia. It is a pharmacologically diverse drug with local anesthetic, central nervous system stimulant, and sympathomimetic properties. As a readily available herb, it has been used and abused for over 5,000 years. Initially ingested by the Andean people to treat high-altitude fatigue in South America, it had application also as a topical local anesthetic, for spinal anesthesia, and as a dilator of the pupil for cataract surgery [1]. In 1914, the Harrison Narcotic Act limited its medical use in the United States. Over the past 20 years, the abuse of cocaine has grown enormously because of ubiquitous availability and reduction in cost (When adjusted for inflation, cocaine is now approximately 20% of the 1980s street price) [2].