Cocaine Use

Medical Complication from Use

There are enormous medical complications associated with cocaine use. Some of the most frequent complications are cardiovascular effects, including disturbances in heart rhythm and heart attacks; such respiratory effects as chest pain and respiratory failure; neurological effects, including strokes, seizures, and headaches; and gastrointestinal complications, including abdominal pain and nausea.

Cocaine use has been linked to many types of heart disease. Cocaine has been found to trigger chaotic heart rhythms, called ventricular fibrillation; accelerate heartbeat and breathing, and increase blood pressure and body temperature. Physical symptoms may include chest pain, nausea, blurred vision, fever, muscle spasms, convulsions, and coma.

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Cocaine Route of Administration

Different routes of cocaine administration can produce different adverse effects. Regularly snorting cocaine, for example, can lead to loss of sense of smell, nosebleeds, problems with swallowing, hoarseness, and an overall irritation of the nasal septum, which can lead to a chronically inflamed, runny nose. Ingested cocaine can cause severe bowel gangrene, due to reduced blood flow.

And, persons who inject cocaine have puncture marks and “tracks,” most commonly in their forearms. These users may also experience an allergic reaction, either to the drug or to some additive in street cocaine, which can result, in severe cases, in death. Because cocaine has a tendency to decrease food intake, many chronic cocaine users lose their appetites and can experience significant weight loss and undernourishment.

Research has revealed a potentially dangerous interaction between cocaine and alcohol. Taken in combination, the two drugs are converted by the body to cocaethylene. Cocaethylene has a longer duration of action in the brain and is more toxic than either drug alone. While more research needs to be done, it is noteworthy that the mixture of cocaine and alcohol is the most common two-drug combination that results in drug-related death.

Mother and child

Cocaine during pregnancy

Cocaine use during pregnancy can affect a pregnant woman and her baby in many ways. During the early months of pregnancy, cocaine may increase the risk of miscarriage.

Later in pregnancy, it may trigger preterm labour (labour that occurs before 37 completed weeks of pregnancy) or cause the baby to grow poorly. As a result, cocaine-exposed babies are more likely than unexposed babies to be born prematurely and with low birth weight.

Premature and low-birth-weight babies are at increased risk of health problems during the newborn period, lasting disabilities such as intellectual disabilities and cerebral palsy, and even death. Cocaine-exposed babies also tend to have smaller heads, which generally reflect smaller brains and an increased risk of learning problems (1).

Some studies suggest that cocaine-exposed babies are at increased risk of birth defects involving the urinary tract and, possibly, other birth defects (2, 3).

Cocaine may cause an unborn baby to have a stroke, which can result in irreversible brain damage and sometimes death.

Cocaine use during pregnancy can cause placental problems, including placental abruption. In this condition, the placenta pulls away from the wall of the uterus before labour begins. This can lead to heavy bleeding that can be life-threatening for both mother and baby. The baby may be deprived of oxygen and adequate blood flow when an abruption occurs. Prompt cesarean delivery, however, can prevent most deaths but may not prevent serious complications for the baby caused by lack of oxygen.

After birth, some babies who were regularly exposed to cocaine before birth may have mild behavioural disturbances. As newborns, some are jittery and irritable, and they may startle and cry at the gentlest touch or sound (4). These babies may be difficult to comfort and may be withdrawn or unresponsive. Other cocaine-exposed babies “turn off” surrounding stimuli by going into a deep sleep for most of the day. Generally, these behavioural disturbances are temporary and resolve over the first few months of life (4).

Cocaine-exposed babies may be more likely than unexposed babies to die of SIDS. However, studies suggest that poor health practices that often accompany maternal cocaine use (such as the use of other drugs and smoking) may play a major role in these deaths (5).

Long-term Outlook for Babies

Most children who were exposed to cocaine before birth have normal intelligence (6). This is encouraging, in light of earlier predictions that many of these children would be brain-damaged. A 2004 study at Case Western Reserve University found that 4-year-old children who were exposed to cocaine before birth scored just as well on intelligence tests as unexposed children (6). However, the Case Western and other studies suggest that cocaine may sometimes contribute to subtle learning and behavioural problems, including language delays and attention problems (6, 7, 8, 9). A good home environment appears to help reduce these effects (6, 8, 9). A recent study also suggests that cocaine-exposed children grow at a slower rate through age 10 than unexposed children, suggesting some lasting effects on development (10).

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1.  Bateman, D.A., Chiriboga, C.A. Dose-Response Effect of Cocaine on Newborn Head Circumference. Pediatrics, volume 106, number 3, September 2000, p.e33.

2. Vidaeff. A.C., Mastrobattista, J.M. In Utero Cocaine Exposure: A Thorny Mix of Science and Mythology. American Journal of Perinatology, volume 20, number 4, 2003, pages 165-172.

3. Reproductive Toxicology Center. Cocaine. Last updated 12/1/05.

4. Bauer, C.R., et al. Acute Neonatal Effects of Cocaine Exposure During Pregnancy. Archives of Pediatric and Adolescent Medicine, volume 159, September 2005, pages 824-834.

5. Fares, I., et al. Intrauterine Cocaine Exposure and the Risk for Sudden Infant Death Syndrome: A Meta-Analysis. Journal of Perinatology, volume 17, number 3, May-June 1997, pages 179-182.

6. Singer, L.T., et al. Cognitive Outcomes of Preschool Children with Prenatal Cocaine Exposure. Journal of the American Medical Association, volume 291, number 20, May 26, 2004, pages 2448-2456.

7. Linares, T.J., et al. Mental Health Outcomes of Cocaine-Exposed Children at 6 Years of Age. Journal of Pediatric Psychology, volume 31, number 1, January-February 2006, pages 85-97.

8. Lewis, B.A., et al. Prenatal Cocaine and Tobacco Effects on Children’s Language Trajectories. Pediatrics, volume 120, number 1, July 2007, pages e78-e85.

9. Bada, H.S., et al. Impact of Prenatal Cocaine Exposure on Child Behavior Problems through School Age. Pediatrics, volume 119, number 2, February 2007, pages e348-e359.

10. Richardson, G.A., et al. Effects of Prenatal Cocaine Exposure on Growth: A Longitudinal Analysis. Pediatrics, volume 120, number 4, October 2007, pages e1017-e1027

Source: The March of Dimes; Pregnancy and Illicit Drugs

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