Cocaine Abuse, Its Effect and Management

Cocaine Abuse, Its Effect and Management

It is obtained from the leaves of Erythroxylum coca, which grows in South America, India, Java, etc. It is a colorless, odorless, crystalline substance with bitter taste. It is used as local anesthetic. It is also known as coke, snow, - Cadillac and white lady. Crack is prepared by combining cocaine with baking soda and water, which is suitable for smoking.


Action:

It desensitizes the terminal nerves and causes vasoconstriction at the site of application. It stimulates the cortex for a short time, followed by depression. Similar but less marked effect is seen on the spinal cord.

Absorption and Excretion:

It is rapidly absorbed from the mucous membranes and from the subcutaneous tissues. The usual routes of intake are by application to the nasal mucous membrane (snorting), and by the i.v. route. It is also smoked. It is rapidly hydrolyzed to benzoylegonine and other derivatives by blood cholinesterase’s. It appears almost immediately in the urine. It is destroyed in the liver and is excreted in the urine within twenty-four hours in its metabolized forms.

Sings and Symptoms:

When inhaled, the onset of action is within one to three minutes; when used i.v., or smoked it acts in seconds and peak action is in three to five minutes; when applied topically to the nasal mucosa, it peaks in 20 to 30 minutes; when ingested orally it peaks within sixty to ninety minutes. Its action is short, and as such it has to be taken every one-fourth to one hour to maintain a high.

(1) Stage of Excitement:

There is bitter taste, dryness in the mouth, dysphagia, feeling of well-being and loss of depression and fatigue. The patient may be excited, restless and talkative, but this passes into a calm, dull condition. The pulse is rapid, blood pressure falls, respirations rapid and deep, pupils dilated, headache, pallor of the skin, cyanosis, sweating, and the temperature is raised. The reflexes are exaggerated, and there may be tremors or convulsions.

Occasionally, the patients may have hallucinations and become maniacal. There is often a feeling of tingling or numbness in the hands and feet, and a numb feeling at the place where the drug has touched, e.g. nose and back of throat, when it has been sniffed. With spinal anesthesia there is an occasional case of post-anesthetic myelitis, which leads to permanent symptoms of cord degeneration.

(2) Stage of Depression:

Within an hour or even less, respirations become feeble, profuse perspiration, collapse, convulsions and death occurs. Death is due to respiratory failure, cardiac failure, or vascular collapse. Sudden death may occur following i.v.. injection, smoking and also by snorting, due to cardiac arrhythmias due to direct action on myocardium, and cardiopulmonary arrest.

Large doses or a "binge" may result in anxiety and panic leading to paranoia. A combination of cocaine and heroin taken by injection is known as "speedball".

Fatal Dose:

One to one-and-half g. orally. Procaine is about half as toxic as cocaine; butacaine is twice and dibucaine five to ten times.

Fatal Period:

Few minutes to few hours.

Treatment:

  1. If it has been taken by mouth, gastric lavage should be performed with warm water containing potassium permanganate, charcoal or tannic acid.
  2. If applied to the nose or throat, wash-out the mucous membrane with water.
  3. If injected apply a ligature above the part.
  4. Convulsions should be controlled with chloroform or short-acting barbiturates.
  5. Amyl nitrite is antidote and is given by inhalation.
  6. Airway and circulatory stabilization.
  7. Thiamine hundred mg. i.v.
  8. Naloxone hydrochloride two mg. i.v.
  9. The symptoms should be treated on general lines.

Cocaine Habit:

It is also known as cocainism, cocainophagia or cocainomania. Chronic abusers can tolerate ten grams a day. It causes digestive disturbances, anorexia, salivation, tachycardia, tachyapnoea and insomnia. The face is pale, eyes sunken, pupils dilated, and the gaze 'shifty'.

The tongue and teeth are black. Over a period of time, the addict loses interest in family, friends, food, sexual activity, etc. and appears emaciated and physically exhausted. Sometimes, a manic, paranoid or depressive psychosis develops. Complications include persistent rhinitis, nasal erosions, sinusitis, chronic cough,bronchitis, etc.

The snuffing habit leads to ulceration of the nasal septum, but perforation is very rare. Degeneration of central nervous system occurs, and the patient may become violent, aggressive and suffer from hallucinations, convulsions, delirium and insanity. Magnan's symptom or cocaine bugs is characteristic, in which there is a feeling as if grains of sand are lying under the skin or some small insects are creeping on the skin giving rise to itching sensation (tactile hallucination).It is a drug of addiction and causes lowering of moral tone and loss of decency and self-respect. The cocaine substitutes are not habit forming.

The Circumstances of Poisoning:

It is rarely used for homicide or suicide. The common names of substances used by addicts are: crack, pasta, bazooka, and speed-ball.-Accidental cases occur from addiction, hypodermic injection and from urethral, vesicle and rectal injection. It is believed to he an aphrodisiac and to increase the duration of sexual act by paralyzing sensory nerves of glans penis. Prostitutes sometimes inject cocaine solution into vagina to produce local constriction.

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