Cocaine intoxication – rapidly growing epidemic in federal capital

Over 100 cases reported in last three months

Islamabad

Among alcohol and not including tobacco-related illnesses, cocaine has been emerging as the most common cause of drug-related emergencies in the federal capital and the rapidly increasing number of cocaine patients being reported in emergency and critical care units of both public and private sector hospitals is a big concern for the health professionals serving in the twin cities of Islamabad and Rawalpindi.

Most of the addicts and abusers of cocaine have been reported at private healthcare facilities in recent past and majority of them are from elite class in the federal capital from 17 to 45 years of age.

Well over 100 cases of cocaine addicts have been reported at emergency departments of private hospitals in the federal capital in last three months of which eight patients were in need of admission to the intensive care units, while one patient expired of cocaine overdose causing massive brain hemorrhage.

According to Intensive Care Consultant at Holy Family Hospital in Rawalpindi Dr. Muhammad Haroon, who helped ‘The News’ in collecting data on increasing number of cocaine related emergencies, the cocaine intoxication is emerging as a new epidemic in this part of the country and its abuse should be controlled well in time.

Studies reveal that people who suffer from cocaine toxicity may require immediate medical treatment in order to stop the deadly effects of the drug and to avoid serious damage to the heart, liver, kidneys or other organs. If left untreated, cocaine toxicity has the potential to cause fatal side effects including heart attack, stroke or other serious health complications.

Cocaine overdose, when left untreated, can lead to stroke, respiratory failure, heart failure or cerebral hemorrhage and all of these conditions can cause death of the addict.

Cocaine is also known as ‘crack’ and ancient Incas of Peru believed cocaine to be a gift from the gods has emerged as a modern day curse to human society, said Dr. Haroon.

He said the use of cocaine has a history of thousands of years, with a duality of effects noted throughout the centuries. Knowledge of its mind-altering function dates to at least 2000 BC. For centuries, indigenous mineworkers in Andean countries have used cocaine derived from the chewing of coca leaves as an endurance-enhancement agent, he said.

He added in 1884, William Stewart Halsted performed the first nerve block using cocaine as the anesthetic. Halsted subsequently became the first cocaine-impaired physician on record. That same year, Sigmund Freud published the essay ‘Uber Coca’ in which he advocated the use of cocaine in the treatment of asthma, wasting diseases, and syphilis. In 1885, John Styth Pemberton registered French Wine Cola in the United States. The popular product, which contained 60 mg of cocaine per 8-oz serving, was later renamed now a popular cold drink, said Dr. Haroon.

He added after taking cocaine a person feels elevation in mood, a gush of emotions and joy, light headedness, and clouding of pain along with euphoria pleasure. Common central nervous system manifestations include euphoria, anxiety, agitation, psychosis, and delirium. Rarely, cocaine-induced ischemic cerebral infarction is mistaken for a psychiatric condition. Seizures are generally short-lived and self-limited unless there is ongoing drug absorption. Several mechanisms are likely responsible for more serious central nervous system complications. A sudden rise in blood pressure may cause intracerebral hemorrhage, a type of stroke caused by bleeding within the brain tissue and subarachnoid hemorrhage, particularly in association with an underlying aneurysm or arteriovenous malformation, explained Dr. Haroon.

He added that vasospasm, vasculitis, myocardial infarction with cardiac arrhythmias, and increased platelet aggregation may further trigger ischemic events. In most cases, the time interval between drug abuse and the cerebrovascular event is less than three hours. Cardiovascular manifestations include chest pain, acute coronary syndrome, sudden death, arrhythmias, heart failure, pulmonary hypertension, endocarditis, and aortic dissection, said Dr. Haroon.

He added the cocaine abuse may cause a disorder of lungs, pulmonary edema and alveolar hemorrhage. Not uncommonly, crack cocaine causes an acute pulmonary syndrome characterized by dyspnea (difficult or laboured breathing) and hemoptysis (coughing up of blood or blood stained mucus). The severity of respiratory complications ranges from mild dyspnea to severe respiratory failure requiring intubation and mechanical ventilation. Another severe manifestation of cocaine abuse is rhabdomyolysis in which there may be concurrent hyperthermia, tachycardia, muscle rigidity, disseminated intravascular coagulation, hepatic dysfunction, and kidney failure, said Dr. Haroon.

He explained that cocaine-induced hyperthermia resemble infections. Rare cocaine-associated complications include ischemic colitis, renal infarction, nasal septal perforation, and localized areas of skin necrosis due to subcutaneous injection. Intranasal use of cocaine has been associated with sinusitis and botulism. In addition, cocaine increases the likelihood of violent fatal injuries. Treatment of cocaine intoxication starts with the resuscitation and treatment of seizures, hyperthermia, and agitation, he said.

Dr. Haroon said the concerned government authorities should take immediate steps to stop spread of cocaine use before it gets out of control.