Cocaine is one of the most frequent causes of medical complications of drug abuse. Its actions include blockade of reuptake of catecholamines and dopamine by the neurons, release and/or blockade of the reuptake of serotonin, and centrally mediated neural sympathetic activation. In addition to stimulating the sympathetic nervous system, cocaine also has a local anesthetic effect due to blockade of fast sodium channels in neural tissue and the myocardium. Cocaine may be injected intravenously, smoked, snorted, or orally ingested. Its half-life is approximately 60 min. After intravenous injection or smoking there is a rapid onset of CNS manifestations; the effects may be delayed 30 to 60 min after snorting, mucosal application or oral ingestion. The duration of cocaine effect is dependent on the route of administration, and is usually about 90 min after oral ingestion. Acute cocaine intoxication usually resolves after about 6 hours, but some manifestations, such as myocardial infarction and stroke, may occur many hours after use, and a cocaine “crash” syndrome may last for several days after cocaine binging.
Most of the toxic manifestations of cocaine are due to excessive central and sympathetic nervous system stimulation. CNS stimulation causes behavioral changes, mood alterations, and psychiatric abnormalities. Autonomic stimulation causes cardiovascular system abnormalities, such as alterations in blood pressure, heart rate, arrhythmias, and hyperthermia. Some of these manifestations, especially in the CNS and cardiovascular system, can be lifethreatening. In moderate doses, cocaine produces arousal and euphoria, but also anxiety and restlessness. Acute intoxication may result in severe psychiatric disturbances, such as acute anxiety, panic attacks, delirium, or acute psychosis. Chronic cocaine intoxication can produce paranoid psychosis similar to schizophrenia. Headache is quite common in cocaine users, and has been reported in 13 to 50% of the users surveyed. In some patients the headaches were triggered by cocaine, whereas others reported them in association with cocaine withdrawal. Some patients experienced migraine headaches. In some instances, headaches may be induced by hypertension. Persistent headaches, despite normalization of blood pressure, should raise concern about a possible stroke.
Stroke and transient neurologic defects
A variety of neurologic signs have been reported in patients with cocaine intoxication, among them dizziness, vertigo, tremor, blurred vision. Transient hemiparesis has also been observed, and may be the result of cerebral vasospasm. Strokes are being increasingly recognized in cocaine abuse, particularly in young patients. Among the patients with strokes, about 50% have cerebral hemorrhage, 30% subarachnoid hemorrhage and 20% ischemic stroke. This distribution differs from the one found in the general population, where ischemia and not hemorrhage accounts for the majority of strokes. The mechanism of stroke is thought be an acute elevation of blood pressure induced by increased sympathetic activity, which may cause rupture of cerebral aneurysm; or vasospasm or cerebral vasoconstriction. Chronic cocaine abuse has been associated with acute dystonic reactions which in some cases have been precipitated by neuroleptics, and in other without neuroleptics. Acute dystonia was reported after cocaine use as well as during cocaine withdrawal.
Seizures are seen in about 1.4% of cocaine abusers admitted to a hospital. They are usually generalized, tonic-clonic in character, and may occur soon after taking cocaine, or after a delay of several hours. Children can have seizures as a first manifestation of cocaine exposure. The mechanism of cocaine-related seizures may be its local anesthetic properties.
Toxic encephalopathy and coma
Often patients present after several days of a cocaine binge; at first they may experience severe anxiety, hyperactivity, and paranoia which last for about 6 to 8 hours, and then they may become hypersomnolent and depressed. This latter phase can last 2 to 3 days. Other complications associated with cocaine abuse are frontal sinusitis and brain abscess after chronic cocaine snorting. Cocaine snorting is also associated with atrophy of nasal mucosa, necrosis, and perforation of the nasal septum.
Are you affected by cocaine addiction? Treatment for cocaine addiction can be initiated by a medical professional and may involve admission to an inpatient or outpatient drug rehabilitation program with continuing after care and counselling for a long as is recommended by your care giver.