Researchers found little, if any, lingering effects from occasional use of cocaine. The long-term physiological effects for persistent cocaine use over many years are dramatic, however. Although the kidneys filter out cocaine after each use, the cumulative effect of hundreds of cocaine doses eventually alters the body’s physiology and leads to physical damage. The organ that suffers the most damage is the brain. The more frequently cocaine users ingest the drug, the more frequently the blood vessels in the brain are narrowed and fail to adequately provide needed oxygen. Deprived of oxygen, brain cells die, so frequent cocaine use eventually compromises the brain’s function. Furthermore, as the blood pressure in the millions of tiny constricted blood vessels and capillaries that supply the brain builds, they gradually break, causing hemorrhage. Dr. Thomas Kosten described this phenomenon during congressional testimony in 1999:

If these vessels are blocked for even a few minutes, brain cells die and thinking, feeling, moving and life itself can cease. Cocaine blocks these blood vessels by constricting them and filling them with abnormal clotting cells called platelets. A large blockage like this leads to strokes in some cocaine abusers, and in most abusers the blockages are smaller, but occur in multiple places in the brain. These multiple blockages leave the cocaine abuser’s brain shrunken, discolored and often poorly functioning.

The restriction of blood supply to the brains of long-term cocaine users appears to be permanent. Scientists have recently been able to observe the restricted blood flow in the brains of such individuals. Using an imaging technique called positron emission tomography (PET), scientists can document the flow of blood in the brain tissue. When the researchers compared PET scans of long-term cocaine abusers with PET scans of normal non-cocaine abusers, they found that the abusers had less blood flow in several areas of the brain. When the researchers performed PET scans again ten days after cocaine use had been discontinued, the blood flow deficits remained even though the subjects in the study had stopped using cocaine.

Not only does the cocaine-related brain damage appear permanent, but the constricted arteries are vulnerable to strokes, which in turn can cause paralysis of parts of the body, the complete loss of speech, loss of memory, and even death. The overall effect is similar to greatly accelerating the aging process. Dr. R. I. Herning, a researcher working on the effects of long-term cocaine use, says, “Our data suggest that cocaine abusers in their thirties have arteries that are as constricted as those of normal subjects in their sixties.”

The cardiovascular system can also suffer damage from long-term cocaine use. The heart, in response to blood vessel constrictions, pumps faster and with greater force in order to meet the oxygen requirements of the body. When the heart is forced to sustain these elevated rates and pressures, it is vulnerable to serious, even deadly problems. For example, the heart can begin to beat erratically, which is called ventricular fibrillation. During an attack of fibrillation, little blood is pumped and without immediate treatment, the victim can die. The heart can also race at rates three to four times normal, a condition called tachycardia. Persistent tachycardia can lead to death.

Medical researchers have proven that long-term cocaine use can cause permanent and massive damage to the brain and heart. Understanding the physical damage inflicted on the body by cocaine, however, has been far easier for researchers than understanding the psychological effects of cocaine. Central to this understanding is the question of whether cocaine is addictive or not.

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