Cocaine is NOT an Opiate - It is a Schedule II Stimulant
Cocaine is classified as a Schedule II controlled substance under the Controlled Substances Act, but it is a central nervous system (CNS) stimulant, not an opiate. 1
Drug Classification
Cocaine belongs to the CNS stimulants category, alongside amphetamines, methamphetamine, and methylphenidate (Ritalin), not to the opioid class. 1
Opioids include drugs like morphine, codeine, methadone, heroin, fentanyl, oxycodone, and hydrocodone - cocaine is pharmacologically distinct from these agents. 1
Mechanism of Action
Cocaine functions as a sympathomimetic agent by inhibiting catecholamine reuptake (particularly dopamine, norepinephrine, and serotonin), stimulating central sympathetic outflow, and increasing the sensitivity of adrenergic nerve endings to norepinephrine. 2, 3
Cocaine also acts as a local anesthetic by inhibiting voltage-gated sodium channels, which is completely different from opioid receptor agonism. 3, 4
The excess dopamine availability in the synaptic cleft mediates cocaine's pleasurable effects and contributes to its addictive potential - a mechanism fundamentally different from opioid drugs that work through mu, delta, and kappa opioid receptors. 3
Clinical Distinction from Opioids
Neonatal withdrawal from cocaine exposure does not produce a clearly defined abstinence syndrome like opioid withdrawal does, with neurobehavioral abnormalities (irritability, hyperactivity, tremors) typically appearing on postnatal days 2-3 rather than the classic opioid withdrawal pattern. 1
Cocaine toxicity presents with sympathomimetic effects including hypertension, tachycardia, hyperthermia, and seizures - the opposite of opioid toxicity which causes respiratory depression, miosis, and sedation. 5, 4
Schedule II Classification
- Cocaine is classified as Schedule II because it has accepted medical use (as a topical anesthetic for certain procedures) but high potential for abuse and severe psychological or physical dependence. 1