Effects Of Cocaine Use On Health

Crack and cocaine can damage your health in many ways and in some instances, these can be fatal. Some of these risks can be increased by the way that the drug is used and also by the route of use. The bottom line is that there is no safe way to use them.

Effects on the heart:

Heart failure can happen to anyone taking crack or cocaine, it does not matter how much they are taking or how long they have been using for. People who already have heart disease or heart defects are at an even greater risk if they use the drug. Some American studies have shown that around 25% of all heart attacks in people between the ages of 18 – 45 are down to frequent cocaine use. When taking crack or cocaine, you can increase the risk of having a possible heart attack by 23 times in the hour after use, especially if alcohol has been used in conjunction.

The increased risk of heart attack can come from a number of factors including:

Increased adrenaline (released because of cocaine use)
High blood pressure (increased heart rate caused by adrenaline)
Constricted blood vessels (cocaine releases endothelin which constricts blood vessels)
Hardening of the arteries (caused by cocaine use)
Weakened heart (congestive heart failure)
Arrhythmia (erratic heartbeat)
Ashen grey skin (poorly oxygenated blood)
Current heart problems (Made worse by cocaine)
Other drugs that may be used in conjunction with cocaine such as Viagra and alcohol (can increase the stress upon the heart)

Sodium Bicarbonate (used to ‘wash’ cocaine to turn it into crack) may have some effect on the heart putting it under further stress. And cocaethylene, a chemical that is produced in the liver when using crack/cocaine and alcohol together, also exerts more pressure on the cardiovascular system, than if cocaine were just taken on its own.

Strokes and Seizures:

Strokes are thought to be caused by the constriction of blood vessels and the repeated increase in blood pressure. These combined factors can sometimes cut off the blood supply to parts of the brain and also in some cases cause delicate blood vessels to break (causing bleeding in the brain). Blackouts and seizures mat also be caused by the above coupled with high body temperatures.

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Respiratory System:

Taking crack or cocaine can cause many lung problems. These problems are not just isolated to smoking crack as injecting crack or cocaine can also cause lung problems. Some of the problems that are associated with the use of crack or cocaine include:

Pulmonary edema – Build up of fluid in the lungs
Pulmonary haemorrhage – Bleeding in the lungs
Pulmonary barotraumas – Air escaping lungs (by holding in crack smoke)
Foreign bodies in lungs – Poor pipes, no gauze’s used
‘Crack Lung’ – Cough, shortness breath, fever, inflamed lungs

Crack use can affect the cilia (small hairs) that line the main tubes of the lungs. These help to clean the lungs and prevent infections, which in turn leads to crack and cocaine users being more susceptible to bronchitis, pneumonia, pleurisy etc (this can be made worse by the impaired immune system).

Tuberculosis may be a new risk factor for crack and cocaine users as there is emerging evidence from the USA (University of Texas-Houston Health Science Centre) that is suggesting that there is increased chance of catching TB. This is probably due to impaired immune systems, long spells within enclosed environments (crack houses etc), poor diet and reluctance to present for medical interventions. The symptoms of TB are similar to those of someone heavily using crack or cocaine so may not be identified. The only sure way of sure diagnosis is through a chest x-ray or skin test.

Damage to the lungs may also be caused by deep inhaling ammonia (freebase rocks).

Liver Damage:

If alcohol is used in conjunction with cocaine then the stress upon the liver will become increased as a liver toxic substance called cocaethylene is produced. If users are Hep C positive then the stress exerted upon the liver could have more serious consequences.

Immune System:

Crack and cocaine impair the immune system by damaging CD4 T Cells (they don’t work as effectively as they should). This cell helps fight off infections throughout the body. Prolonged use can lead to a depletion in vitamins (particularly C and E) minerals and amino acids (the building blocks for neurotransmitters). Poor diet and unhealthy lifestyle can also contribute to a poor immune system. This should recover once the client has stopped using crack or cocaine.

Excited Delirium:

Excited delirium (agitated delirium) is thought to be caused by the build up of dopamine in certain areas of the brain after repeated binges of crack or cocaine. The symptoms of ED include (below) and may be followed by a heart attack (some deaths in custody are now being attributed to excited delirium especially following restraint):

Bizarre or violent behaviour (incoherent shouting)
Hyperactivity (lots of energy)
Hypothermia (inability to regulate body temperature)
Extreme paranoia

Pregnancy:

Crack or cocaine use is definitely not advisable during pregnancy as taking any substance during this time could have an adverse effect. Many of the studies regarding issues such as ‘crack baby syndrome’ have now been shown to be overblown and more to do with public and professional reactions to crack being used during pregnancy than factual evidence.

However, crack and cocaine use during pregnancy MAY cause:

Miscarriage (high blood pressure)
Low birth weight (under nourishment)
Premature birth
Disturbed behaviour in new-born babies (possibly high adrenaline levels)

Cocaine can be passed on to the child through breast milk so it is advisable that if clients continue to use after the birth of their child that they bottle-feed.

It is vitally important that if someone has used when they are pregnant that they receive proper medical attention and look after themselves during the course of the pregnancy. Avoiding proper medical care, not eating properly, smoking cigarettes and drinking alcohol can all have a major effect upon the health of the baby during pregnancy.

Psychiatric Issues:

Some diagnosed psychiatric disorders can appear to get better with the use of crack or cocaine, this does not mean that the issue has gone away as when the use of crack or cocaine stops these conditions may reappear. It is therefore important that if there has been a psychiatric diagnosis made in the past that they are receiving the appropriate support from mental health professionals. Psychiatric illnesses that may be complicated by the use of crack or cocaine:

Attention Deficit Hyperactivity Disorder (cocaine may act as self medication)
Paranoia / Anxiety disorders (cocaine can make these worse)
Bi-polar (manic depression)
Schizophrenia (dopamine theory may indicate possible medication action)
Depression / suicidal thoughts
Visual and auditory hallucinations
Compulsive and eating disorders
Crack /cocaine induced psychosis

Other Health Issues:

Stomach pains and digestive disorders
Weight loss (usually happens with people using on a daily basis, can become more complicated if combined with an eating disorder)
Kidney damage
Skin problems (poor diet, depletion in vitamins, burns from smoking etc)
Hypothermia (increased body temperature)
Can exacerbate asthma and increase attacks
Complications with epilepsy and sickle cell (increased attacks)

Crack and blood borne viruses

The issue of BBV’s in connection with crack and cocaine use has to a large extent been ignored unless the route of use is injecting and even then important elements are not being addressed. There is a need to challenge this and disseminate information to users who are at risk.

HIV:

HIV can be spread by the sharing of injecting equipment (as with heroin use) and also by the practice of unsafe sex. Some crack and cocaine users may have multiple partners and recent research into crack and the commercial sex industry (Mainliners, 2002) has highlighted that some working girls / boys are willingly having unprotected sex for an increased price to support their habit.

The main transmission route for HIV amongst crack and cocaine users is either through sharing contaminated needles or risky sexual behaviour. There is a tendency generally for risk taking behaviour to increase when taking cocaine, which in itself could increase the likelihood of the above transmission routes.

Recent research from the University of California has discovered that cocaine not only influences risk taking behaviour and consequent possible transmission but it also affects the AIDS viral load in the blood. Cocaine affects HIV in two ways;

Cocaine can double the amount of HIV infected cells
Cocaine can deplete the number of CD4 T-Cells by up to nine times

The above combination can obviously have a dramatic affect upon the health of an individual who is HIV positive and taking cocaine, whether it is on a recreational basis or dependent use.

HCV:

The dangers of contracting Hepatitis C are again not confined to intravenous drug use. If Hep C positive cocaine use itself can exert strain upon the liver, let alone if alcohol is also used and the immune system can be impaired.

Injecting:

As mentioned above cocaine use can increase risk-taking behaviour and anecdotal information suggests that injecting users of cocaine who are fully aware of safer injecting behaviour can ignore this when caught up in the chaos and compulsion of using.

Smoking:

The use of crack can seriously dehydrate the body leading to lips becoming chapped. These can often be picked producing open wounds and the virus transmitted by pipe sharing. Some pipes can also cut the mouth when smoking, again increasing the risk.

Snorting:

When cocaine is snorted on a regular basis damage to nasal mucus membranes can occur causing the nose to bleed. The practice of sharing straws to ‘snort’ is quite common leading to the possibility of blood to blood transmission via the straw.

Dangers of use

There are many dangers associated with the use of crack and cocaine and to understand them better we need to look at how the drug is administered.

Severe Complications:

1) Strokes, including subarachnoid and intracerebral haemorrhage and cerebral infarcts.

2) Numerous cardiovascular complications, for example, myocardial infarction, ventricular arrhythmias and cardiac arrest.

3) Intestinal ischemia.

Chronic Effects:

General – Anorexia, weight loss, malnutrition, dehydration, tremor, psychosis, severe depression and isolated convulsions. Anaesthetic effects on the nerve endings can lead to an increased risk of physical harm and numbness on the mucus membranes of the vagina can lead to an increased risk of tears and therefore a greater risk of contracting HIV/Hep C etc.

Smoking – Haemoptysis, black sputum, chest pains, lung damage, respiratory failure (freebase/ammonia).

Snorting – Loss of smell, increased susceptibility to upper respiratory tract infections, sinusitis, erosions and nasal perforations.

Injecting – Local abscess and the usual infectious conditions associated with IV drug abuse. Danger also occurs from injecting sites becoming anaesthetised, veins collapsing and increased risk-taking behaviour. There is also an increased risk of septicemia due to an impaired immune system.

Ingestion:

In some cases, clients may ingest large amounts of cocaine. This can be intentional due to chasing the high (smoke one, swallow one) and not realising the amount of toxicity building up in the system, due to paranoia (I can’t be caught with these drugs) or unintentional due to packaging bursting whilst inside the body. Large amounts of cocaine in the system can lead to overdose. Also, a few people cannot metabolise cocaine and even small doses remain in their bodies for a long time. In these cases, overdoses may be possible.

If you have a client that you know or fear has ingested a large amount of cocaine then they need to be taken to the accident and emergency services as quickly as possible (within 1 hour of ingesting) and those services informed of your concerns.