The effects of cocaine on the cardiovascular system can be grouped into acute and chronic processes. Cocaine use can cause one or more of several acute, life-threatening cardiovascular effects. The most common is myocardial ischemia or infarction (e.g. a heart attack). Cocaine can induce a heart attack through one of several mechanisms. First, cocaine causes arterial (including coronary artery) vasoconstriction, which can lead to coronary vasospasm. Second, cocaine activates platelets, which increases the risk of thrombosis (including coronary thrombosis). Third, cocaine use produces an adrenergic surge which induces tachycardia (high heart rate) and hypertension. High heart rate and hypertension both increase myocardial oxygen demand, which can cause supply-demand mismatch and precipitate myocardial ischemia or infarction. Fourth, vasospasm or stress associated with cocaine use can also precipitate coronary artery plaque rupture (the mechanism underlying most classic heart attacks). Two thirds of heart attacks due to cocaine occur within three hours of cocaine use; the risk of a heart attack is 24-fold higher than normal in the first sixty minutes after using cocaine. Cocaine has several other potentially devastating acute effects, including stroke, aortic dissection (e.g. dissection of the major artery connecting the heart to the rest of the body), life threatening heart arrhythmias, and myocarditis which can also occur with chronic use. Chronic cocaine can result in accelerated atherogenesis (i.e. accelerated plaque buildup in the coronary arteries), hypertrophy of the left ventricle, dilated cardiomyopathy, aortic aneurysms, and coronary aneurysms.
Patients who are acutely intoxicated with cocaine and present with chest discomfort should be referred to an emergency room immediately for evaluation. They should undergo a chest-x-ray, an electrocardiogram, blood work to evaluate for evidence of a heart attack and non-myocardial muscle breakdown (e.g. rhabdomyolysis), and to assess kidney function, white and red blood cell counts, and liver function. Cocaine intoxication is diagnosed if and when patients report recent cocaine use and through serum and urine toxicology screens (which should be performed immediately as well). If a clinician suspects that a patient is acutely intoxicated with cocaine, treatment should not be withheld while waiting for the results of the toxicology screen. Patients with acute cocaine intoxication and symptoms concerning for cerebrovascular or other cardiovascular sequelae of cocaine intoxication may also need additional imaging to assess for evidence of damage to the heart, aorta, or other blood vessels.
In terms of treatment, these patients should receive benzodiazepines to help mitigate the adrenergic surge. If chest pain due to myocardial ischemia is suspected, sublingual nitroglycerin should be administered. Ongoing ischemic symptoms, as well as hypertension and tachycardia (drivers of myocardial oxygen demand) should be treated with calcium channel blockers (i.e. diltiazem or verapamil). Beta blockers should ideally be avoided until there is no cocaine remaining in the patient’s system. If beta blockers must be used, we recommend using either labetalol or carvedilol, which are non-selective inhibitors of both alpha and beta receptors (note: other beta blockers that are selective for beta receptors are contraindicated due to a theoretical risk that selective beta blockade could lead to unopposed alpha-mediated arterial vasoconstriction, which could precipitate marked hypertension and even peripheral and splanchnic ischemia). Alternative, and highly effective, agents for treatment of hypertension include IV nitroglycerin (which should also be used if the patient has chest pain) and IV nitroprusside. Phentolamine, an alpha blocker, can be used for refractory hypertension. Patients presenting with chest pain should also receive a full dose chewable aspirin (325 mg) and 80 mg of atorvastatin (if available). Patients with ECG changes consistent with myocardial ischemia or infarction and/or elevated blood levels of cardiac biomarkers should be managed identically to patients with non-cocaine induced myocardial ischemia and infarction
As a result, Volkow coined the phrase “hijacking the brain” because of how cocaine (and all addictive drugs) fool the brain by producing reward for self-destructive behavior. In clinical settings, cocaine addicts can accurately describe the particular stimulus that “hijacks” their brain, which they experience as intense wanting, anticipatory pleasure, desire and motivation to use. When this occurs, relapse is usually just a matter of time. “I’m not addicted to cocaine, I only used it on pay days.” –Darien, 37, Former CPA
We have established what happens when addicted persons are triggered by external drug cues. But what about non-addicted people who have tried cocaine a few times, but have not crossed the line to addiction? The findings from Cox et al, have demonstrated that after initial doses of cocaine, non-addicted persons produce the same drug cue responses in the ventral striatum that occurs among addicted persons. This evidence demonstrates that initial, occasional cocaine use results in a Pavlovian response, in which preoccupation with cocaine-induced euphoria, a narrowing of interests, and increased susceptibility to addiction occur.
The infralimbic cortex and accumbens shell appear to be recruited by extinction learning because inactivation of these structures prior to extinction training did not alter cocaine seeking. Together, these findings suggest that a neuronal network involving the infralimbic cortex and accumbens shell is recruited by extinction training to suppress cocaine seeking…Interestingly, however, if prefrontal cortex is electrically stimulated during abstinence, cocaine seeking is reduced in the first extinction session (Levy et al., 2007), suggesting that electrical stimulation of prefrontal cortex may mimic extinction training and/or that extinction training enhances activity in prefrontal cortex.
Cocaine users are more likely than non-users to suffer from HIV, Hepatitis, sexually transmitted and other diseases according to a recent study by the McLean Hospital Alcohol and Drug Abuse Research Centre in Belmont Massachusetts.
The study found that cocaine impairs the human body's immune defence system for at least four hours.
This weakened immune defence system makes it more likely that an infection like HIV or the common cold can take hold.
The study involved 30 participants with a history of cocaine use that had used cocaine at least once within the past month.
The research suggesting the compromised immune system for cocaine users could help to explain the known high incidence of infectious diseases amongst drug users.
(Source: Journal of Clinical Endocrinology & Metabolism, 2003, pages 1188-1193)
This research confirms other scientific research that indicates that illicit drugs suppress the human immune system.
Past scientific research has disclosed that cannabis use also suppresses the human immune system making users more susceptible to infections (see our web site at www.daca.org.au).
As well, cocaine use can prove fatal.
Infections like HIV and Hepatitis have serious health problems so programs that maintain illicit drug use should be replaced by rehabilitation to a drug free condition.
The Metropolitan Police in the United Kingdom have come up with a unique way of showing the health damage from the use of illicit drugs.
In a series of before and after photos of young women that used cocaine the severe aging is clear.
The damaged faces of the women are shown at the police web site and have been produced on posters, beer mats and nightclub flyers.
The shocking images showing the degenerative effects of drug use indicate that drug use can prematurely age young women in as little at 3 years of drug use.
One teenager looks 20 years older after using cocaine.
(Drug damage images are at www.met.police.uk/drugs/crackdown.htm)
All illicit drug users suffer physical harm and damaged looks are one of the health consequences.
However premature aging from using illicit drugs means rising health costs to the community as medical conditions normally associated with aging are brought forward to an earlier stage in life.
Cannabis is known to suppress the human immune system and to cause cancer so the health risks extend beyond aging.
By using our courts to divert illicit drug users into detoxification and rehabilitation we can help users to avoid these future health burdens and save costs to the community.
These premature aging images MUST be used by Australian governments as part of their drug prevention education campaigns to turn teenagers away from future drug use.
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Presentations, Statements & Conference Resources from WFAD 2018 Forum