well-being Chemically, cocaine is benzoylmethylecgonine Cocaine may be used by injection, inhalation (in the form of cocaine alkaloid or “crack”), nasal insufflation, and rarely, ingestion In making crack, street cocaine (which is in the form of cocaine hydrochloride) is converted to cocaine alkaloid by removal of the salt moiety This reaction is accomplished by mixing the cocaine with water and sodium bicarbonate The crack is then separated from the water by filtration and drying The paste hardens and is cut into chips that resemble soap It is then smoked in a pipe or sprinkled onto a cigarette or joint A small piece, called a quarter rock, produces a 20- to 30-minute high when smoked in a water pipe Although oral ingestion is uncommon, there are two circumstances under which cocaine may be ingested in toxic quantities: the “body packer” and the “body stuffer.” In the body packer, large quantities of cocaine are enclosed in plastic and ingested in an attempt to smuggle the drug, usually across international boundaries In the case of the body stuffer, the person in fear of being found with the substance suddenly ingests cocaine Body stuffers are typically at greater risk of cocaine intoxication because they not take sufficient care to guarantee that the cocaine does not leach from the bag Cocaine is reportedly used by up to 15% of women during pregnancy Infants exposed to cocaine in utero are often preterm, small for age, irritable, and show neurodevelopmental delay Beyond the postnatal age, passive cocaine exposure in infants and toddlers can cause severe intoxication, including the development of convulsions The relief from fatigue that occurs with cocaine use results from central stimulation that masks the sensation of fatigue Cocaine potentiates the excitatory and inhibitory responses of sympathetically innervated organs to norepinephrine and epinephrine by blocking the reuptake of catecholamines at adrenergic nerve endings This explains why cocaine, unlike other local anesthetics, produces vasoconstriction and mydriasis Cocaine is still occasionally used as a local anesthetic for ophthalmologic or otorhinolaryngologic procedures due to its ability to block the initiation or conduction of the nerve impulse after local application It also can be used as a topical anesthetic for laceration repair in the form of TAC (tetracaine, adrenaline, cocaine), although this formulation has largely been replaced by the less toxic combination of lidocaine, epinephrine, and tetracaine Although fatalities have been associated with cocaine doses as low as 30 mg, to g is generally the lethal dose in adults Ingested cocaine is less toxic than that taken by other routes because of its slower absorption by this route The elimination half-life of cocaine is approximately hour Cocaine metabolism is