Original subtitles

Cocaine is one of the most widely used drugs in the entire world.

While the indigenous peoples of South America have been using the coca leaf

for medicinal and stimulative purposes for thousands of years,

it was the refinement and purification of the cocaine

alkaloid inside the leaf that led to the drug we know of today.

In today's video, with the help of the cadavers

here in the lab, we're going to discuss what cocaine does to the body,

as well as the mass destruction it leaves in its wake.

It's going to be an important one.

Let's do this.

Cocaine can be consumed in various forms.

It can be swallowed, smoked, injected intravenously

or snorted through the nose in what's known as nasal insufflation.

But once it gets into the bloodstream, the effects on the nervous

and endocrine system are essentially going to be the same,

although the timing in terms of the onset and duration of the effects

are going to be different.

However,

there are unique consequences to the body depending on how it was consumed.

Intravenous administration can come with a risk of infection

as well as permanent damage to blood vessels.

Smoking can come with tooth decay, abscesses and lung damage.

Our focus today is primarily

going to be on nasal

insufflation, considering that's the most common form of consumption,

and that can come with severe consequences for the nasal passageways.

You are looking at a midsagittal view of the head, which allows us

to see the internal anatomy of the nasal cavity.

And you're going to notice, if you look closely,

that there are three projections in this nasal cavity.

These are the superior, middle and inferior, conchae.

Or sometimes you'll also hear them be referred to as turbinates.

And between them are going to be passageways

The air will actually travel through as it's going into the body.

But covering these cocci is going to be mucosal membranes,

and these mucosal membranes are highly vascular

and they act to warm up the air as well as humidify it.

As the air travels through goes down the nasal pharynx

and into the lower respiratory tract.

This is going to be the nasal septum

and it divides the left and right aspects of the nasal cavity.

And it's actually a combination

of cartilage, which is this portion here and bony tissue,

but it would also be covered in mucosal membranes.

And this would actually be more vascular than the conchae would be.

And it's this vascularization that's going to be most important

and interesting to us for our conversation today, because the effect that cocaine

has on the blood vessels inside of the nasal cavity

can really only be described as utterly destructive.

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Cocaine is a vasoconstrictor, and that means it causes blood vessels

to get smaller.

And this is actually why it's still used medicinally in certain

and very specific circumstances to this day.

But when cocaine is snorted, it is going to coat the mucosal membranes

and get absorbed by the blood vessels inside.

Now, undoubtedly, some of the cocaine will make its way

into the nasopharynx and down into the lower respiratory tract.

But this is still going to be the primary route of absorption.

And this actually takes time to occur.

And this is why snorting cocaine is one of the slowest acting forms of consumption.

Whenever anything abnormal enters the nasal passageway,

the mucosal membrane responds by producing mucous.

Just think of allergens.

But the mucus is meant to stop whatever it is from getting deeper into your body.

And cocaine is no different.

So if someone is using cocaine multiple times over the course of,

say, a day or an evening, there's going to be a progressive buildup

of mucus inside of the nasal cavity

until it gets to the point where there is a complete blockage.

And this will actually prevent them from continuing

to use the cocaine, which is why you often hear users

snorting.

And as it's been described to me, this serves two primary purposes.

The first is they're desperately trying to unblock

the nasal passageways so they can consume more cocaine.

But they also are kind of hoping that there's cocaine in the mucus, that

by snorting, it's somehow going to get freed up and get into their system.

When the blood vessels are constricted, that means nutrients and namely oxygen

isn't able to get to the nasal mucosa, the nasal septum,

and even the bony tissue underneath both of them.

And considering the nasal septum, which is partly cartilaginous, already

has a limited blood supply, it's possible

to develop a septal perforation — a hole inside of that nasal septum

— in a matter of weeks

with consistent cocaine usage, although that also can take longer.

And it's important to note

this is a permanent hole that can only be repaired surgically.

For chronic users, the situation only gets worse.

The bones of the skull can begin to degenerate.

Midfacial Osteomyelitis is a potential consequence of long term usage.

So this right here is the Vomer, and just above it is the Ethmoid.

And behind it, this right here is called the Sphenoidal

Sinus and it belongs to a bone called the Sphenoid.

All of these, including other bones such as the Maxilla, which we can't see

here, can degenerate and house bacterial infections.

So essentially a giant hole starts to form in the center of the skull.

Once cocaine gets to the bloodstream, it will make its way to the heart,

which will then pump it and distribute it all throughout the body.

Once it gets to the brain,

it has to pass through what's known as the blood-brain barrier.

The blood-brain barrier essentially exists to prevent harmful substances

from interacting with the brain tissue.

It does this through tight cellular junctions and mechanisms.

Cocaine is highly lipophilic, which means that it dissolves into fats and oils.

And unfortunately,

this type of lipophilicity also means that it relatively easily gets through

the blood-brain barrier through passive diffusion, which you can just think of it

naturally making its way through without any energy requirements.

Although mouse studies have also shown that cocaine can be actively transported.

This is where energy is actually being used

to also push it through the blood-brain barrier,

making it even easier to get into the brain tissue.

Once cocaine gets into the brain,

and the overall nervous system for that matter, it has profound effects

on three neurotransmitters: dopamine, serotonin and norepinephrine.

Now, neurotransmitters are molecules that act at the synapse,

which is just the connection of two neurons.

The neurotransmitter

will leave the first neuron and enter into what's known as the synaptic cleft.

This is the gap between two neurons.

From there, it'll then bind to that second neuron

and it'll either excite, inhibit or alter a signal.

The neurotransmitter will then be brought back into a neuron,

and that will essentially just stop whatever the effect it was causing.

We call this reuptake, and cocaine interferes with it.

Cocaine blocks

what are known as dopamine, serotonin and norepinephrine transporters.

And by blocking them,

the neurotransmitters stay in the synaptic cleft, continuing to act.

Dopamine is involved with things such as joy

and pleasure and just overall feeling rewarded for different things.

So that means cocaine is going to make you,

or at least in the presence of cocaine, feel very rewarded.

Serotonin does a ton of different things, but it's involved with

mood, sleep, digestion, breathing.

So that means cocaine is going to have an effect on all of those.

Norepinephrine is the primary driver of the sympathetic

nervous system, which is an aspect of the autonomic nervous system.

Now, I discussed

the autonomic nervous system in quite some detail in a previous video,

so I'll go ahead and link that up above for you to check out.

But you could think of the autonomic

nervous system as the automatic nervous system.

It's things you don’t have to think about.

So this is going to be like your “fight or flight” or your “rest and digest”.

Norepinephrine is the driver for the “fight or flight”,

so this can be things like pupil dilation, sweating, the muscles

being engorged with blood, blood going away from the internal organs.

So that means cocaine is going to have an effect on all of that as well.

So based on this, you'll likely understand all the signs and symptoms associated

with cocaine usage, such as lockjaw,

excitability, dilated pupils,

extreme thirst, runny nose,

weight loss, mood swings,

social isolation, risky behaviors, nosebleeds,

a boost in confidence, yes, but talkative habits and changes

in sleeping and eating patterns, and plenty more.

Cocaine is also extremely addictive, and the proposed mechanism

of that addiction is what's known as the dopamine hypothesis of addiction.

And the idea is pretty simple.

With abnormally high levels of dopamine, you’re creating new baseline for dopamine.

And then as the drug wears off and that dopamine goes below the baseline,

that creates a cascade of downstream effects.

This hypothesis of addiction isn't unique to cocaine,

but is also proposed for many other substances.

But there's still some real science

that needs to be done in proving this hypothesis to be true.

And it's likely that dopamine is just going to be one factor

among many other factors when it comes to addiction and dependency.

But it's important to note

that smoking cocaine, as well as intravenous injections,

that's going to actually be more addictive than intranasal consumption,

but insufflation is still highly addictive.

It's also important to note that cocaine doesn't

only bind to dopamine, serotonin and norepinephrine transporters —

it also binds to neurotransmitter receptors, plasma proteins, voltage

gated ion channels and metabolic enzymes all throughout the body.

This means it has a direct effect on the cardiovascular system,

respiratory system, urinary system, even the immune system.

Cocaine also doesn't

last a long time in the body, or at least your perception of it.

That is because you can still feel the effects of cocaine for days afterwards.

But let's say you consume it intranasally.

You can feel the effects of cocaine

from anywhere from 15 minutes up to an hour in some cases,

which is how and why many users will consume

it multiple times over the course of an evening or throughout a party.

And unfortunately, this also then increases the likelihood of an overdose.

Now, whether or not you overdose depends on a variety of factors such as sex,

weight, tolerance, the route of administration.

So did you smoke it?

Did you inject it, or did you insufflate it?

All of these are going to matter

and can even affect the concentration of cocaine in your system.

Regardless, it's surprisingly easy to overdose on cocaine,

especially if you have a preexisting condition

such as cardiovascular disease, for instance.

But overdosing can result in cardiac arrhythmias, heart attacks, seizures,

strokes, high blood pressure, difficulty breathing and even extreme anxiety.

Cocaine is also commonly paired with alcohol and heroin, which

just dramatically increases the chances of an overdose or harm to the body.

When alcohol and cocaine are consumed together, the byproducts of their

consumption are converted by the liver into something called cocaethylene,

which actually has a stronger effect on dopamine, but less of effect on serotonin

norepinephrine.

But it lasts longer in the system than normal cocaine

does and can result in liver failure and seizures.

I've known many people over the years

that use cocaine, and it's just a terrible drug.

Besides all the physical effects that we just discussed, it's extremely expensive

and it just destroys the relationships with friends and family.

If you or a loved one are in need of assistance

when it comes to cocaine dependency or addiction,

We've provided some resources down in the description below for your convenience.

Thanks for watching, everyone.

While this topic isn't necessarily

fun or light hearted, we're hopeful you were able to learn something valuable.

Be sure to click the link in the description

below and begin your AG1 journey today.

And as always, be sure to like, comment, subscribe if you feel so inclined,

and I'll see you in the next video.