Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Lung effects: The direct
effects of smoking cocaine are responsible for most lung and breathing
complications. The large surface area of the lungs and its great blood supply cause rapid and profound brain stimulation known as the head rush.
Smoking the freebase, crack, or paste is done using a glass pipe, water pipes, or cigarettes, which are heated by butane lighters or matches. The residue from the tars, matches, cocaine contaminants, and additives, such as marijuana, often cause chronic bronchitis, chronic coughing, and coughing up black, nonbloody phlegm. These conditions can cause shortness of breath and chest pain.
Utilizing the technique of deep inhalation and
breath holding to maximize the amount of cocaine inhaled and absorbed can
cause the lung to collapse. These cocaine users will complain of sharp chest
pain, often worse with deep breathing, neck pain,
difficult or painful swallowing, and air under the skin in the neck that
feels like Rice Krispies under the skin when touched (subcutaneous emphysema). Though unusual, the user's lungs can fill with fluid (pulmonary edema), causing extreme shortness of breath, sometimes respiratory failure, and death.
In one study of the cocaine abusers who came to an emergency department, 40% complained of chest pain
-- the most common complaint -- and 22% complained of shortness of breath or were unable to breathe.
Cardiovascular (heart, blood vessels) effects: The major effect of cocaine is to stimulate the sympathetic
nervous system. This system is responsible for the "fight or flight response" and is controlled primarily by adrenaline or epinephrine. The
effects include increased heart rate, blood vessel narrowing, and high blood pressure. Angina or the chest pain that is felt with decreased blood supply to the heart and heart attack have
accounted for more reports in medical journals than any other complication of cocaine intoxication. Chest pain associated with cocaine use is now a common problem in
many emergency departments.
Other cardiovascular complications include abnormal
heart rhythms or rapid heart rate, cardiomyopathy or
disease of the heart muscle, or aortic rupture or dissection where there is
weakening of the walls of the aorta. The acute use, despite the amount or
route, causes narrowing of the arteries to the heart and vasospasm resulting
in decreased blood flow to the heart. This causes angina, which can lead to
a heart attack that means death of heart tissue. Chronic use of cocaine,
again regardless of the route, leads to accelerated hardening and subsequent
narrowing of the coronary arteries. Therefore, angina, heart attacks, and
cardiac deaths have been found in young users from 19-44 years of age.
The overstimulation of the sympathetic system with
the rapid heart rate, high blood pressure, and vasospasm also cause abnormal
heart rhythms. Those rhythms may be ventricular tachycardia and ventricular fibrillation and may cause sudden death. Chest pain has been the most common complaint to the emergency department, up to 40% of people; 21% complain of palpitations or the sensation that their hearts are racing or going fast.
Pregnancy effects: Cocaine use during pregnancy can increase the complications of pregnancy and affect the fetus directly. These
abusers may also use other drugs, alcohol, and nicotine, which adversely
affect the pregnancy as well. They have an increased rate of miscarriages and placenta
abruption, in which the placenta separates from the wall of the uterus and results in stillbirth. There is
increasing information that cocaine may cause birth defects with increased
rates of malformation, low birth weights, and behavioral abnormalities.
Infections: The infectious complications related to IV use of cocaine are not unique to cocaine. All IV drug users are at risk for infections such as cellulitis (soft
tissue infection at the injection site), abscesses at the injection sites, tetanus or lockjaw, lung or
brain abscesses, or infection of the heart valves. These are due to nonsterile
techniques of IV injections. Contagious viruses such as hepatitis B, hepatitis C, and HIV (AIDS virus) are transmitted by sharing IV needles. The abuser may complain of pain, swelling, and redness at the injection site or fever. Abusers may also complain of jaundice or turning
yellow, abdominal pain, nausea, vomiting, loss of appetite, or the multitude of complaints that accompany hepatitis and AIDS.
Body packers or stuffers:
People smuggle the processed cocaine across international borders. They often
swallow drug-filled packets or stuff them into body openings such as the
vagina or rectum. The "body packer" or "mule" can carry 50-200 tightly wrapped condoms or latex bags filled with high-grade cocaine hydrochloride. If the containers break or leak, the cocaine can be absorbed by the person's body. Most mules have no symptoms and may be apprehended by an astute official who notices some suspicious behavior. Some will become acutely ill when the packets leak or rupture, resulting in massive intoxication, seizures, and death. A similar problem may occur with "body stuffers." These are cocaine users or traffickers who swallow bags of cocaine when arrested so there is no evidence.