Health care Research in Europe

Written by Alejandro Andión


Erythroxylum is a genus of flowering plants of the erythroxylaceae family, native to the steep foothills of the Amazonian Andes. The species of this genus are originally cultivated in the Andes of Bolivia, Colombia, Ecuador, Chile, Peru, and western areas of northwestern Argentina, but also grow wild. Coca grows properly in the hot and humid lands of the Andes (Yunga’s region or high jungle), in an altitude range that goes from 500 to 2000 meters above sea level. However, high altitude crops outside this range are possible in certain regions. It even grows under the shade of large trees in tropical regions. (1)

The coca plant has always played an important role in Andean cultures, both for ritual purposes in the relationship between humans and nature, as a psychoactive agent to induce ceremonial trances, as an energy for work, for bartering between products, as digestive, and for analgesic and curative purposes in medical interventions. It has been used in all these aspects for thousands of years by Andean cultures such as the Chibcha, Aymara and Quechua nations. The coca plant became known throughout the world for its alkaloids, from which cocaine hydrochloride (also called coca or cocaine) is obtained through a chemical process discovered in Europe in the 19th century, a substance that is a powerful stimulant of the central nervous system and with a high tendency to cause dependence. (1)

In Bolivia and Peru, the traditional forms of use and consumption of the coca leaf, as well as its cultivation, are legal by each government up to a certain amount in tons and hectares, precisely to avoid the production of cocaine. This plant is appreciated by most of the indigenous population of each country, especially in rural areas to perform rituals of gratitude to Mother Nature. Coca is harvested up to three times a year manually in the Bolivian Yungas area (in the Department of La Paz, Bolivia), it is harvested 4 times a year in the Chapare of the Department of Cochabamba (Bolivia) and up to six times in the Upper Huallaga (Peru). In Colombia, the cultivation of coca leaf is prohibited in all its forms by the state if it exceeds 20 units or plants, even so, the indigenous people in the reservations of the Sierra Nevada de Santa Marta and in the Department of Cauca they cultivate certain quantities for their religious rituals. The leaves are plucked by the petiole and dried in the sun for later sale and marketing. The same plant can be harvested for ten years. (1)

The coca leaf has medicinal effects as a digestive, either alone or combined with other substances (as an infusion) and as a local analgesic through its use in plasters. On the other hand, coca leaf infusion is an excellent palliative for altitude sickness for people who are not used to living in the high Andean areas, so that “coca tea” is always offered to tourists in tourist hotels. (1)

Also, it is used in traditional medicine for colds, coughs, and inflammation of the throat.
Its content in vitamins and certain trace elements mean that coca infusion constitutes a nutritional complement to the daily diet. Studies from Harvard University maintain that in 100 grams of coca you can have almost two grams of potassium that are necessary for the balance of the heart and are also attributed slimming properties. Knowing that these tisanes are so rich in these nutrients, they become food and medicine. (1)

Depending on its location, this plant differs in its characteristics depending on the cultivation area. As its geographical extension is so wide, there are differences between the different species of Erythroxylum used for the same purpose. They are the following:
• Erythroxylum coca var.coca: Also called Bolivian coca. It extends from Ecuador to Bolivia, on both sides of the mountain range. This plant is a shrub that grows up to 2.5 m in height, with woody stems and ellipsoidal, medium-sized, very fragrant, intense green leaves. Its flowers are tiny and white. Its fruits, red in colour, have no pulp as they are like ovoid seeds and measure about 1 cm long. (1)
• Erythrixylum coca var.ipadu: Also known as Amazonian coca, is closely related to Erythroxylum coca var. coca, from which it originated relatively recently. E. coca var. ipadu does not escape cultivation or survive as a feral or wild plant like E. coca var. coca.
Unlike the other species of coca which are propagated through seeds, E. coca var. ipadu, which rarely produce seeds, is propagated through stem cuttings which remain viable for several weeks if kept moist. Since Amazonian coca is vegetatively propagated, entire plantations may be populated from the same clone. E. coca var. ipadu is specially adapted to the shifting agriculture of semi-nomadic Amazonian peoples. Since cuttings of E. coca var. coca do not easily root, it is likely that E. coca var. ipadu has been artificially selected for its ease of vegetative propagation. In contrast to the Andean E.coca var. coca, Amazonian E. coca var. ipadu is typically a weaker plant evidenced by the fact that after a few years plants lose their vigor and easily fall prey to disease or insect infestation. Overharvesting can speed up this process. (1)
• Erythroxylum novogranatense var.novogratense: Also called Colombian coca, the species is native to the arid Andean regions of Colombia. It is an evergreen shrub or small tree, taller than the previous ones, up to about 3 m, with leaves on an about 0.5 cm long petiole, alternate, obovate-elliptic, 2-6 cm long and 1-3 broad cm, bright green. The flowers are axillary, hermaphrodite, solitary or in groups, produced practically in continuation, with five yellowish-white petals. The fruits are oblong drupes, red when ripe, about 0.8 cm long and 0.3 cm of diameter, containing a single oblong seed. (2)
• Erythroxylum novogranatense var. Truxillense: Also called coca de Trujillo. It grows in the western part of Peru and Ecuador and differs from the previous one by the absence of the longitudinal lines on the leaves on the sides of the central vein, present in the species. It reproduces by seed that has a short duration of germination, about three weeks. (2)

Regarding the content of the best-known alkaloid of these plants, cocaine, these varieties also differ from each other. The one that contains the highest percentage of cocaine is Colombian coca with 0.77%, followed by coca from Trujillo with 0.72%, then there’s Bolivian coca with 0.63% and finally Amazonian coca with 0,25%. These percentages are average. (1)


The coca plant has a high content of carbohydrates, proteins, and fats, it is also a very important source of vitamins (A, B1, B2, B3, B5, B6, B9, C and E) and minerals (Calcium, Copper, Iron, Magnesium, Manganese, Phosphorus, Potassium, Sodium and Zinc). (3)
In addition to all the above, this plant is known for its content of tannins and alkaloids, of which it has 14. These alkaloids are listed below along with their possible benefits for the human body. (3)
• Cocaine: It is the metal ester of the benzoyl egnonine, it has anesthetic and analgesic properties.
• Egnonin: It is a carboxylated derivative of atropine, it has properties to metabolize fats and carbohydrates.
• Pectin: It is absorbent and antidiarrheal, together with vitamin E, it regulates the production of melanin for the skin.
• Papain: This protease (which papaya contains in greater proportion) is very similar in its structure to animal cathepsin, it is a ferment that speeds up digestion.
• Hygrine: It excites the salivary glands when there is oxygen deficiency in the environment.
• Globulin: It is a cardiotonic that regulates the lack of oxygen in the environment, improves blood circulation, prevents “soroche” (altitude sickness).
• Pyridine: Accelerates the formation and functioning of the brain, increases blood supply to the pituitary and glands.
• Quinoline: Prevents the formation of dental caries along with phosphorus and calcium.
• Conina: anesthetic.
• Cocamine: analgesic.
• Reserpine: Regulates blood pressure in hypo and hypertension and helps the formation of bone cells.
• Benzoin: Therapeutic properties for gastritis and ulcers.
• Inulin: Refreshes and improves the functioning of the liver, the secretion of bile and its accumulation in the gallbladder, it is diuretic, it helps to eliminate non-physiological harmful and toxic substances. It is a polysaccharide that produces an increase in blood cells
• Atropine.

These 14 alkaloids, the amino acids they contain, the acids and vitamins A, B1, C and E, tyramine, niacin and riboflavin, make it the most complete plant in the universe in non-protein nitrogen, which is what eliminates toxins and pathologies of the human body and provides two properties of solubility and hydration, obtaining optimal combinations with medicinal fruits. (3)

Of all the benefits of this plant, the most obvious and those with the most scientific evidence are the following:
Reduction of altitude sickness: The relationship between coca and altitude is direct, not only because this plant only develops at high altitudes, but also because it produces an adaptation to it and may be indicated in the treatment of altitude sickness. Anthropological observations show that, in places with a low percentage of oxygen, such as the Andean highlands, chewing coca leaves provides a benefit through adaptation to the environment. Even the updated WMS (Wilderness Medicine Society) guidelines include coca in the other options section for the treatment and prevention of acute altitude-related conditions, including the prevention of high-altitude-related cerebral edema. (4)

Increased energy: It is postulated that the coca leaf acts at two levels, initially it increases the heart rate during submaximal effort and later it can prolong the resistance to physical exercise. In this way, the use of coca leaves increases working time and reduces the feeling of fatigue. Other studies suggest that it reduces muscle fatigue caused by extreme exercise.

Recent studies have shown that chewing coca induces biochemical changes in the metabolism of carbohydrates, improving physical activity in high altitude areas. In the first moments of exercise, carbohydrates are the first source of energy. The coca leaf inhibits glycolysis at the level of pyruvate dehydrogenase, producing glucose and pyruvate accumulation, so that the energy required for exercise is obtained from the beta-oxidation of fatty acids. A study concludes that chewing coca leaf provides a beneficial effect during physical exercise, especially for prolonged periods. In this sense, it has been proposed to include the coca leaf within the group called adaptogens and its usefulness in training programs for elite athletes. (4)

Psychic effects: It has been collected in the literature that the coca leaf has a therapeutic application for stress, accompanied or not by irritability, sleep disorders and/or prolonged exhaustion of mental resources. It has been recommended for the treatment of depression, stress, and irritability.

The coca leaf elevates mood from its first consumption, unlike synthetic antidepressants, which may take between a month and three months to arrive produce to its maximum effect. Some authors have proposed the coca leaf as a fast-acting antidepressant medication. (4)

Anesthetic effects: Cocaine was the first anesthetic used in the clinic. In 1884 the ophthalmologist Carl Köller demonstrated that reversible corneal anesthesia could be produced by administering cocaine. Since then, a significant number of derivatives have been synthesized, the first of which was procaine, in 1905. Cocaine shares its mechanism of action with all its derivatives: decreased permeability of membranes to Na+ ions, resulting in nerve conduction blockade. It is only allowed to be used in topical anesthesia.

The anesthetic effects of the coca leaf have been demonstrated in many experimental studies. Both cocaine and two fractions of an ethanolic extract of leaf (one with cocaine and one without) produces local anesthesia in rats when the tail is stimulated with electric shock. Other observations have shown improvement of toothache in relation to dental caries and by oral thrush during coca leaf chewing. (4)

Digestive and metabolic effects: It has been observed that the use of coca leaf can have beneficial effects in the treatment of abdominal pain of multiple aetiologies, such as irritable colon, bloating, spastic colon, inflammatory bowel disease, etc. It seems that the coca leaf relaxes the smooth muscles of the digestive tract, restoring a physiological tone.

In addition, as a local anesthetic, it also influences the symptomatic improvement of abdominal pain. According to some authors, this effect is superior to belladonna, atropine and other agents that block the parasympathetic nervous system, without producing the unpleasant side effects that can appear with the use of these substances.

In a study with coca leaf for the treatment of abdominal pain of different etiologies on 250 patients, it was observed that it improved pain due to indigestion, acute gastritis, peptic ulcer, gastroenteritis, ulcerative colitis and chronic constipation.

In people who suffer from abdominal pain and in turn consume coffee, it can cause exacerbations. In addition, coffee is irritating to the gastric mucosa.

Coca leaf has been proposed to replace coffee as an alternative central nervous system stimulant and for its activity against abdominal pain.

It has also been proposed as a coadjuvant therapy in body weight loss programs, especially in those who perform physical exercise, since, by inhibiting the glycogenesis, favors the elimination of fatty acids, in addition to increasing the time of resistance to exercise and reducing the effects of fatigue. (4)


In this section, some relevant studies and works with respect to this plant will be cited.
Published: May 1, 1978.
Authors: A T Weil.
Study title: Coca leaf as a therapeutic agent.

Published: Mar-May 3, 1981.
Authors: A T Weil.
Study title: The therapeutic value of coca in contemporary medicine
These first two studies highlight the beneficial effects of the coca plant as a treatment for gastrointestinal ailments and motion sickness, as a fast-acting antidepressant medication, as a substitute stimulant for coffee in certain cases, and as an adjunct in programs of weight reduction and physical fitness.

Published: October 23, 2015.
Authors: Amy Sue Biondich , Jeremy D Joslin.
Study title: Coca: High Altitude Remedy of the Ancient Incas.
This present work explores the role of coca throughout the history of the Andean peoples and explores whether this ancient remedy has a place in modern medicine. A focused summary of research articles with relevance to the field of wilderness medicine is also included to better provide the reader with lessons not only from history but also from another culture.

Published: August 25, 2010.
Authors: V Casikar, E Mujica, M Mongelli, J Aliaga, N Lopez, C Smith, F Bartholomew.
Study title: Does chewing coca leaves influence physiology at high altitude?
The aim of this study was to investigate the effects of chewing coca leaves on biochemical and physiological parameters. The experimental findings of this study suggest that chewing coca leaves is beneficial during exercise and that the effects are felt over a prolonged period of sustained physical activity.

Published: May 20, 1984.
Authors: J A Bedford, C E Turner, H N Elsohly.
Study title: Local anesthetic effects of cocaine and several extracts of the coca leaf (E. coca)
Cocaine and several different fractions of a crude ethanol extract of the coca leaf (E. coca) were subjected to a local anesthetic screen using rat tail withdrawal from electric shock. Following an intradermal injection of 0.1 ml of a 2.0% (w.v) solution of cocaine HCl, an immediate response was observed. Two of the coca fractions also produced some local anesthesia. An alkaloidal fraction, containing an equivalent amount of cocaine, produced a maximum effect that was approximately 20% less than that observed with cocaine. The only other fraction producing any effect, a water-soluble cocaine-free fraction, showed a maximum response that was approximately 30% of that observed with cocaine.

Published: October 15, 1993.
Authors: J A Nathanson , E J Hunnicutt, L Kantham, C Scavone.
Study title: Cocaine as a naturally occurring insecticide
Although cocaine has a fascinating and complex medicinal history in man, its natural function in plants is unknown. The present studies demonstrate that cocaine exerts insecticidal effects at concentrations which occur naturally in coca leaves. Unlike its known action on dopamine reuptake in mammals, cocaine’s pesticidal effects are shown to result from a potentiation of insect octopaminergic neurotransmission. Amine-reuptake blockers of other structural classes also exert pesticidal activity with a rank order of potency distinct from that known to affect vertebrate amine transporters. These findings suggest that cocaine functions in plants as a natural insecticide and that octopamine transporters may be useful sites for targeting pesticides with selectivity toward invertebrates.


Coca leaf is the raw material for the manufacture of the drug cocaine, a powerful stimulant and anaesthetic extracted chemically from large quantities of coca leaves. Today, since it has mostly been replaced as a medical anaesthetic by synthetic analogues such as procaine, cocaine is best known as an illegal recreational drug. The cultivation, sale, and possession of unprocessed coca leaf (but not of any processed form of cocaine) is generally legal in the countries such as Bolivia, Peru, Chile, and Argentine Northwest where traditional use is established, although cultivation is often restricted in an attempt to control the production of cocaine. In the case of Argentina, it is legal only in some northwest provinces where the practice is so common that the state has accepted it.

The prohibition of the use of the coca leaf except for medical or scientific purposes was established by the United Nations in the 1961 Single Convention on Narcotic Drugs. The coca leaf is listed on Schedule I of the 1961 Single Convention together with cocaine and heroin. The Convention determined that “The Parties shall so far as possible enforce the uprooting of all coca bushes which grow wild. They shall destroy the coca bushes if illegally cultivated” (Article 26), and that, “Coca leaf chewing must be abolished within twenty-five years from the coming into force of this Convention” (Article 49, 2.e).

Since the 1980s, the countries in which coca is grown have come under political and economic pressure from the United States to restrict the cultivation of the crop to reduce the supply of cocaine on the international market.
Article 26 of the Single Convention on Narcotic Drugs requires nations that allow the cultivation of coca to designate an agency to regulate said cultivation and take physical possession of the crops as soon as possible after harvest, and to destroy all coca which grows wild or is illegally cultivated. The effort to enforce these provisions, referred to as coca eradication, has involved many strategies, ranging from aerial spraying of herbicides on coca crops to assistance and incentives to encourage farmers to grow alternative crops.

The primary organization authorized to purchase coca leaves is ENACO S.A., headquartered in Peru. Outside of South America, most countries’ laws make no distinction between the coca leaf and any other substance containing cocaine, so the possession of coca leaf is prohibited. In South America coca leaf is illegal in both Paraguay and Brazil.

Its use is prohibited in Europe, and the coca leaf has no distinction with cocaine, therefore it is not allowed as food, or for human or animal consumption.

This prohibition is exercised to limit the circulation of cocaine, one of the alkaloids of the coca plant.
Even so, there are products that are made with coca leaves that are allowed in Europe, such as coca blue, a drink made with Bolivian coca leaves from which the alkaloid cocaine has been removed, which is why it is allowed to be sold. (1)

1. Wikipedia, La enciclopedia libre.

2. Pietro Puccio (Author), Anna Franke (Translator). (September 17, 2018). Erythroxylum novogranatense.

3. Mama Coca Home, Asociación Chamánica y Ecológica de Colombia. (February, 2002). La coca no es cocaína.

4. Ruth Velarde Alonso, Ester Risco Rodríguez. (February 2, 2016). Potencial de la hoja de coca en la medicina actual.

5. A T Weil. (May, 1978). Coca leaf as a therapeutic agent.

6. A T Weil. (Mar-May, 1981). The therapeutic value of coca in contemporary medicine.

7. Amy Sue Biondich , Jeremy D Joslin. (October 23, 2015). Coca: High Altitude Remedy of the Ancient Incas.

8. V Casikar, E Mujica, M Mongelli, J Aliaga, N Lopez, C Smith, F Bartholomew. (August 25, 2010). Does chewing coca leaves influence physiology at high altitude?.

9. J A Bedford, C E Turner, H N Elsohly.( May, 1984). Local anesthetic effects of cocaine and several extracts of the coca leaf (E. coca).

10. J A Nathanson , E J Hunnicutt, L Kantham, C Scavone. (October 15, 1993). Cocaine as a naturally occurring insecticide.