HIV and Alcohol & Drugs

Chemsex

Alcohol

Cocaine

Cocaine, also known as Coke or Crack, is a highly addictive drug that stimulates the central nervous system by speeding up the messages sent between the body and the brain. It reduces appetite, increases energy and provides a euphoric sense of wellbeing.

Historically, cocaine was used as a painkiller in dentistry and for surgical operations on eyes and throats. Leaves of the coca bush have long been chewed and brewed into teas by indigenous people in South America as a stimulant and to suppress appetite.

Legal Status

Cocaine is illegal in New Zealand and is classified as a Class A drug under the Misuse of Drugs Act. This means it attracts the highest penalties.

Manufacturing, importing, supply or dealing cocaine can result in life in jail. Conspiracy to manufacture, import or supply can attract up to 14 years imprisonment. Possession of cocaine can attract up to 6 months imprisonment and/or a $1000 fine.

Appearance

Cocaine commonly comes in the form of a white odorless powder called cocaine hydrochloride (HCI) that has a bitter numbing taste. Various chemicals are used to develop different types of cocaine, and each is used differently.

Cocaine hydrochloride: This is the most common form of cocaine. Cocaine hydrochloride is a purer form of cocaine, though it can sometimes be mixed with other substances, some of which are poisonous. It comes as a powder which is snorted. Regular and heavy snorting can damage the tissue on the inside of the nose.

Freebase: This is the base form of cocaine derived from cocaine hydrochloride which has been treated with ammonia or baking soda. It comes in crystal form and isn’t dissolvable in water, so freebase cannot be injected or sniffed. It is smoked from pipes, or mixed with tobacco or cannabis and provides an almost instant rush. However, the initial high lasts no longer than 5-10 minutes and a craving for a second hit occurs soon after.

Crack cocaine: This is a less pure variety of freebase. Cocaine hydrochloride is mixed with baking soda and water, and then heated to form crystals like rocks which are then smoked. Crack cocaine was initially developed for a poorer market and some people still refer to it today as 'poor man’s cocaine'. Crack cocaine’s impurity is indicated by its colour which will generally range from a yellowish crème to light brown.

Potential consequences of using cocaine

Cocaine users may take many doses to maintain the high, which can cause anxiety, paranoia and a tolerance for the drug, meaning that larger doses have to be taken to achieve a similar high. Although not addictive in the same way as heroin or opiates, users can become psychologically dependent on the transient high which cocaine provides and find that they suffer anxiety, depression or severe tiredness if they stop using the drug.

Longer-term use of both cocaine and crack can cause severe anxiety, clinical depression, psychotic episodes, aggression, weight loss and malnutrition. Both drugs have also been shown to cause potentially fatal heart problems including heart attack, angina, irregular heartbeat, and inflammation and enlargement of the heart.

In common with most other street drugs, users are rarely sold a pure form of cocaine. The drug is often ‘cut’ with other cheaper drugs such as amphetamines (speed), talc or detergents which can be poisonous or cause irritation, leading to infection.

Snorting cocaine can damage the membrane between the nostrils, leading to bleeding and eventual erosion. There have been reports that sharing snorting equipment may permit the transmission of hepatitis C virus. Rubbing cocaine into the gums, vagina, or anus can cause ulceration, which could increase transmission of HIV or other sexually transmitted infections. Sharing injecting equipment also presents a risk for transmission of HIV, hepatitis viruses, and other blood-borne infections.

Cocaine and HIV

Cocaine is not metabolised by the body in the same way as anti-HIV drugs so there does not appear to be cause for concern about interactions between them.

Test-tube studies suggest that cocaine alters the functioning of the immune system in several ways, making immune cells more vulnerable to HIV. Experiments conducted in HIV-infected mice bred in laboratories, found that mice exposed to cocaine had far fewer CD4 cells than mice not given the drug. This suggests that HIV disease may progress faster in regular cocaine users.

However, studies looking at regular cocaine use and disease progression in gay men have produced conflicting results. Some research found no association, but one study found that HIV-positive women who used cocaine were more likely to become ill. Other research has shown that HIV-positive cocaine users are more likely to have hardening of the arteries.

Because drug use may be an indicator of other social issues which may have a negative effect on health – such as poor access to health care, or other health problems – these types of studies can be difficult to interpret.

As with all recreational drugs it is also wise to consider how use could impact on adherence to your HIV treatments. If you are worried about your recreational drug use, then your doctor or healthcare team will be able to refer you to an appropriate source of support.

The above information sourced and edited for New Zealand form contained on www.aidsmap.com
It is intended to support, rather than replace, consultation with a healthcare professional. Please talk to your doctor or another member of your HIV specialist for advice tailored to your situation.

If you find that you can not control your use of alcohol or other drugs, would like to cut back or stop or would like any other support in this area, Body Positive may be able to help.

To talk to us about getting help, please contact us on 0800 HIV LINE

The NZ Drug Foundation has resources on being safer when using alcohol or drugs. They have also released The Level as a straight up guide for people who use drugs.

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