Medical implications:The extent to which cocaine use has increased in this country is reflected in figures published yesterday by the National Advisory Committee on Drugs (NACD), which show a three- to four-fold increase in people seeking treatment for cocaine addiction over a five-year period.
The increase in cocaine-positive road safety tests from nine in 2002 to 86 in 2005 is a worrying trend, with implications that go beyond the health of the individual drug-user.
Cocaine hydrochloride is the active chemical in the leaves of erythroxylon coca, a shrub that grows primarily in South America. The drug is available in two forms: cocaine powder and crack cocaine.
The initial attraction of cocaine as a recreational drug is the pleasant feelings of euphoria it induces, leading to a huge rush of energy and optimism. Increased self-esteem and sex drive are other immediate effects. However, these mostly pleasant feelings become diminished with successive doses. The cocaine-user needs progressively larger doses to achieve the same degree of euphoria; the high doses bring toxic side effects, including paranoia and hallucinations. Regular users experience disordered thought patterns in which they lose insight and develop uncontrolled and impulsive behaviour which can lead to violence.
Cocaine powder is snorted into the nostrils causing the blood vessels in the lining of the nasal passages to shrink. Repeated doses lead to a loss of blood supply to the septum, the wall dividing the nostrils. Eventually this wall begins to disintegrate and a hole appears between the nasal passages. A tell-tale sign of repeated cocaine use is a red, running, stuffed up nose.
Cocaine powder may also be made into a solution and injected into the body, leading to the risk of an allergic reaction either to the drug itself or to an adulterant such as lignocaine (a local anaesthetic) or caffeine. Long-term injecting may result in abscess formation and hepatitis.
Once it gets into the body, cocaine releases large amounts of the stress hormone noradrenaline, which cause blood vessels to narrow. This leads to a sudden and large rise in blood pressure, putting the person at risk of a heart attack or stroke.
The constriction of vessels supplying the kidney may cause renal failure with the need for long-term dialysis.
The body's main blood vessel, the aorta, is damaged by long-term use of cocaine. A surge in pressure forces the blood between the inner and outer linings of the aorta. This false passage can easily burst, (an aortic dissection), leading to a tearing pain in the chest or back. It can be fatal.
Cocaine and alcohol are synergistic in the body; drinking makes the cocaine last longer because of the way the two interact in the liver. Liver damage is more common when alcohol and cocaine are used together, and the risk of sudden death is 18 times greater than when cocaine is used on its own.
Those communities with an established history of problem drug use appear to be disproportionately affected. There is an urgent need for a public information campaign outlining the risks and harms of cocaine use and the availability of effective treatments.