Crack cocaine is commonly smoked in a pipe with a metallic filter made from a steel wool scouring pad. We report an unusual complication of smoking crack cocaine: the aspiration and ingestion of a Brillo pad filter. A 34-year-old female presented 7 h after drinking beer and smoking crack. She was concerned that she might have inhaled the "screen" from her crack pipe, a piece of Brillo pad the size of her fingertip. She complained of "burning" in her throat, a foreign body sensation, and change in her voice, but no dyspnea, dysphagia, or abdominal pain. On physical examination, she was afebrile with a pulse of 105 beats/min and respiratory rate of 24 breaths/min. She was tearful and spoke in a whisper. There were no visible oropharyngeal burns and the lungs were clear to auscultation, but she had intermittent inspiratory stridor. The O2 saturation was 96%, and the ethanol concentration was 100 mg/dl. No foreign body or burn was seen on indirect laryngoscopy. A lateral neck x-ray study showed a normal epiglottis and no foreign body. Chest x-ray studies were unremarkable. Fiberoptic laryngoscopy showed left posterior arytenoid edema and swelling. An abdominal x-ray study revealed a foreign body in the right lower quadrant consistent with the Brillo pad filter. The next morning, the patient was asymptomatic and was discharged, recovering without sequellae. While crack pipe screen aspiration is a rarely reported event, physicians should be aware of the potential for foreign body aspiration and ingestion by this mechanism.
Crack cocaine, commonly known simply as crack, and also known as rock, is a free base form of the stimulant cocaine that can be smoked. Crack offers a short, intense high to smokers. The Manual of Adolescent Substance Abuse Treatment calls it the most addictive form of cocaine.
Crack cocaine first saw widespread use as a recreational drug in primarily impoverished neighborhoods in New York City, Philadelphia, Baltimore, Washington, D.C., Los Angeles, San Francisco, and Miami in late 1984 and 1985; this rapid increase in use and availability was named the "crack epidemic", which began to wane in the 1990s. The use of another highly addictive stimulant drug, crystal meth, ballooned between 1994 and 2004.
Purer forms of crack resemble off-white, jagged-edged "rocks" of a hard, brittle plastic, with a slightly higher density than candle wax. Like cocaine in other forms, crack rock acts as a local anesthetic, numbing the tongue or mouth only where directly placed. Purer forms of crack will sink in water or melt at the edges when near a flame (crack vaporizes at 90 °C, 194 °F).
Crack cocaine sold on the streets may be adulterated (or "cut") with other substances mimicking the appearance of crack to increase bulk. Use of toxic adulterants such as levamisole, a drug used to treat parasitic worm infections, has been documented.
Crack cocaine is frequently purchased already in rock form, although it is not uncommon for some users to "wash up" or "cook" powder cocaine into crack themselves. This process is frequently done with baking soda (sodium bicarbonate), water, and a spoon. Once mixed and heated, the bicarbonate reacts with the hydrochloride of the powder cocaine, forming free base cocaine and carbonic acid (H2CO3) in a reversible acid-base reaction. The heating accelerates the degradation of carbonic acid into carbon dioxide (CO2) and water. Loss of CO2 prevents the reaction from reversing back to cocaine hydrochloride. Free base cocaine separates as an oily layer, floating on the top of the now leftover aqueous phase. It is at this point that the oil is picked up rapidly, usually with a pin or long thin object. This pulls the oil up and spins it, allowing air to set and dry the oil, and allows the maker to roll the oil into the rock-like shape.
Crack vaporizes near temperature 90 °C (194 °F), much lower than the cocaine hydrochloride melting point of 190 °C (374 °F). Whereas cocaine hydrochloride cannot be smoked (burns with no effect), crack cocaine when smoked allows for quick absorption into the blood stream, and reaches the brain in eight seconds.
Crack cocaine can also be injected intravenously with the same effect as powder cocaine. However, whereas powder cocaine dissolves in water, crack must be dissolved in an acidic solution such as lemon juice (containing citric acid) or white vinegar (containing acetic acid), a process that effectively reverses the original conversion of powder cocaine to crack. Harm reduction and public health agencies may distribute packets of citric acid or ascorbic acid (Vitamin C) for this purpose.
Crack cocaine is commonly used as a recreational drug. Effects of crack cocaine include euphoria, supreme confidence, loss of appetite, insomnia, alertness, increased energy, a craving for more cocaine,and potential paranoia (ending after use).Its initial effect is to release a large amount of dopamine, a brain chemical inducing feelings of euphoria. The high usually lasts from 5 to 10 minutes, after which time dopamine levels in the brain plummet, leaving the user feeling depressed and low. When (powder) cocaine is dissolved and injected, the absorption into the bloodstream is at least as rapid as the absorption of the drug which occurs when crack cocaine is smoked, and similar euphoria may be experienced.
Like other forms of cocaine, smoking crack can increase heart rate and blood pressure, leading to long-term cardiovascular problems. Some research suggests that smoking crack or free base cocaine has additional health risks compared to other methods of taking cocaine. Many of these issues relate specifically to the release of methylecgonidine and its effect on the heart, lungs, and liver.
In crack users, acute respiratory symptoms have been reported, sometimes termed "crack lung". Symptoms include fever, coughing up blood and difficulty breathing. In the 48-hour period after use, people with these symptoms have also had associated radiographic findings on chest X-ray of fluid in the lungs (pulmonary edema), interstitial pneumonia, diffuse alveolar hemorrhage, and eosinophil infiltration.
Crack baby is a term for a child born to a mother who used crack cocaine during her pregnancy. The threat that cocaine use during pregnancy poses to the fetus is now considered exaggerated. Studies show that prenatal cocaine exposure (independent of other effects such as, for example, alcohol, tobacco, or physical environment) has no appreciable effect on childhood growth and development.However, the official opinion of the National Institute on Drug Abuse of the United States warns about health risks while cautioning against stereotyping:
The intense desire to recapture the initial high is what is so addictive for many users. On the other hand, Reinarman et al. wrote that the nature of crack addiction depends on the social context in which it is used and the psychological characteristics of users, pointing out that many heavy crack users can go for days or weeks without using the drug.
A typical response among users is to have another hit of the drug; however, the levels of dopamine in the brain take a long time to replenish themselves, and each hit taken in rapid succession leads to progressively less intense highs. Nonetheless, a person might binge for 3 or more days without sleep, while inhaling hits from a pipe.
Large amounts of crack cocaine (several hundred milligrams or more) intensify the user's high, but may also lead to bizarre, erratic, and violent behavior. Large amounts can induce tremors, vertigo, muscle twitches, paranoia, or, with repeated doses, a toxic reaction closely resembling amphetamine poisoning.
Synonyms used to refer to crack cocaine include atari; base; bazooka; beamers; beemers; bebe; bee-bee; berry; bing; bolo; bomb; boulder; boulders; butter; caine; cane; Casper; Casper the ghost; cavvy; chemical; chewies; cloud; cloud nine; crills; crunch and munch; dip; famous dimes; fan; fish scale; fries; fry; glo; golfball; gravel; grit; hail; hamburger; helper; hubba; ice cube; kangaroo; kibbles and bits; kibbles; krills; lightem; paste; patico; pebbles; pee wee; pony; raw; ready; ready rocks; redi rocks; roca; rock; rooster; rox; Roxanne; scud; Scotty; scramble; scruples; seven-up; sherm; sherms; sleet; snowballs; stones; teeth; tension; top gun; tweak; ultimate; wash; white cloud; work; yahoo; yale; yay; yayoo; yeah-O; yeyo; yeo; and yuck.
Crack smoking ("hitting the pipe"; "puffing"; "beaming up (to Scotty)") is commonly performed with utensils such as pipes ("bowl"; "devil's dick"; "glass dick"; "horn"; "Uzi"); improvised pipes made from a plastic bottle ("Masarati"); water pipes ("bong"; "hubbly-bubbly"); and laboratory pipettes ("demo").
Cocaine is listed as a Schedule I drug in the United Nations 1961 Single Convention on Narcotic Drugs, making it illegal for non-state-sanctioned production, manufacture, export, import, distribution, trade, use and possession. In most states (except in the United States) crack falls under the same category as cocaine.
In Australia, crack falls under the same category as cocaine, which is listed as a Schedule 8 controlled drug, indicating that any substances and preparations for therapeutic use under this category have a high potential for abuse and addiction. It is permitted for some medical use but is otherwise outlawed. 2b1af7f3a8