Even when used this way, some of the used cocaine may be absorbed through oral or nasal mucosa and give systemic effects. In this scenario dissolved cocaine is soaked into a ball of cotton wool, which is placed in the nostril for the 1. If vasoconstriction is desired for a procedure (as it reduces bleeding), the anesthetic is combined with a vasoconstrictor such as phenylephrine or epinephrine. Cocaine has since been largely replaced in Western medicine by synthetic local anesthetics such as benzocaine, proparacaine, lidocaine, and tetracaine though it remains available for use if specified. The major disadvantages of this use are cocaine's intense vasoconstrictor activity and the potential for cardiovascular toxicity. Between one and three percent of people in the developed world have used cocaine at some point in their life. Use is highest in North America followed by Europe and South America. With further processing crack cocaine can be produced from cocaine. This results in greater concentrations of these three neurotransmitters in the brain. After a short period of use, there is a high risk that dependence will occur. Physical symptoms may include a fast heart rate, sweating, and large pupils. Mental effects may include loss of contact with reality, an intense feeling of happiness, or agitation.
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