Physical effects of cocaine may include

- dilated pupils

- rapid heartbeat

- hyperthermia (high body temperature)

- reduced fatigue

- euphoria

- increased energy

Chronic use of cocaine can lead to a variety of health effects; for example, if the drug is snorted on a regular basis, the individual may suffer from nosebleeds and a chronically runny nose, as well as the loss of the sense of smell. An oral intake of cocaine on a regular basis can lead to severe bowel gangrene caused by reduced blood flow. Frequent injections of cocaine can sometimes cause severe allergic reactions. If shared needles are used, the individual is at risk for contracting the human immunodeficiency virus (HIV), hepatitis, and other bloodborne infections.

Possible serious health effects of the use of cocaine may include

- strokes

- heart attack

- acute kidney failure

- respiratory failure

- seizures

- tardive dyskinesia

Psychological effects of the long-term abuse of cocaine may include the following symptoms:

- paranoia

- auditory hallucinations

- restlessness

- delusions

- irritability and mood disturbances

- addiction

- suicidal or homicidal behavior

- panic attacks

In large amounts, cocaine can induce a psychotic state that is similar to and sometimes indistinguishable from schizophrenia. Some users become aggressive and violent and may harm others.

According to Nnadi and his colleagues in 2005 in the Journal of the National Medical Association, if patients overdose on cocaine, special care should be taken:

Acute agitation in cocaine overdose can manifest as garrulousness, excitement, restlessness, and confusion. Patients with suspected overdose of cocaine should be transported urgently to the nearest emergency department using advanced life-support ambulance, when possible. The patients' family, ambulance service personnel, law enforcement officers and physicians need to be aware that attempts to control cocaine agitation with physical restraints and neck hold can result in lethal complications.

They also note that suicide is a high-risk complication in cases of patients who abuse cocaine: "Cocaine exacerbates suicidal and omnipotent fantasies, making the prevention of self-harm an important treatment focus. Suicidal intent is a common psychiatric complaint related to cocaine presentation in the emergency room."

According to Dr. Karch, most deaths (60 percent) of cocaine abuse among long-term users are a direct result of chronic toxicity, while homicides represent about 20 percent of the deaths of cocaine abusers, and suicide represents less than 10 percent of deaths. The other cocaine-related deaths are caused by stroke, excited delirium, myocardial infarction (heart attack), and sudden cardiac death.

Karch describes excited delirium in this manner: "This syndrome is comprised of four elements that occur in sequence--hyperthermia, psychotic agitation, respiratory arrest, and death." He adds that "hyperthermia is the result of dopamine receptor changes in the brainstem, while the psychotic behaviour results from up-regulation of kappa-2 receptors in the amygdala."

Deaths from strokes and excited delirium are relatively rare among cocaine abusers, but deaths that result from cardiac causes are common and may constitute the majority of all cocaine-related deaths.

Many individuals who abuse or are dependent on cocaine are also heavy users of alcohol, particularly those who are users of powdered cocaine. In one study in the United Kingdom that compared the users of powdered cocaine to those who abused crack cocaine, reported in Alcohol and Alcoholism in 2006, the researchers found that although heavy drinking was common among both groups, there were more frequent occurrences of heavy drinking among the powdered cocaine users. In contrast, the users of crack cocaine were more likely to have problems with other illicit drugs and to have both psychological and physical health problems, as well as criminal issues.

Said the researchers, "The differences in alcohol consumption patterns confirm the importance of differentiating between use of cocaine powder and crack cocaine."

The use of alcohol and cocaine at the same time presents a health risk because the two drugs together cause the formation of the substance cocaethylene in the body. This substance increases the euphoric qualities of cocaine, while it also escalates the risk for sudden death.

Because of its addicting effects, cocaine is often associated with crimes, including drug dealing, burglary, and prostitution. In a report on those inmates who tested positive for powdered cocaine in 2003, researchers found that 30 percent of all the male arrestees and more than one-third of females (35.3 percent) tested positive. The inmates were also asked about their use of cocaine in the past week, month, and year, as well as the average number of days they had used cocaine in the past 30 days. Males were somewhat heavier abusers of cocaine than females; for example, 9.6 percent of the males reported using cocaine in the past 30 days, compared to 7.2 percent of the females.

References:

1)         Gossop, Michael, Victoria Manning, and Gayle Ridge. "Concurrent Use of Alcohol and Cocaine: Differences in Patterns of Use and Problems among Users of Crack Cocaine and Cocaine Powder." Alcohol and Alcoholism 41, no. 2 (2006): 121-125.

2)         Johnston, Lloyd D., et al. Monitoring the Future: National Survey Results on Drug Use, 1975-2004. Vol. 2, College Students and Adults Ages 19-45. Bethesda, Md.: National Institute on Drug Abuse. National Institutes of Health, 2005.

3)         Karch, Steven B., M.D. "Cocaine: History, Use, Abuse." Journal of the Royal Society of Medicine 92 (August 1999): 393-397.

4)         National Institute on Drug Abuse. Epidemiologic Trends in Drug Abuse. Vol. 1, Proceeding of the Community Epidemiology Work Group: Highlights and Executive Summary. Bethesda, Md.: National Institutes of Health, June 2005.

5)         Nnadi, Charles U., et al. "Neuropsychiatric Effects of Cocaine Use Disorders." Journal of the National Medical Association 97, no. 11 (November 2005): 1,504-1,515.

6)         Office of National Drug Control Policy, Predicting Heavy Drug Use. Publication no. NCJ 208382. Washington, D.C.: Executive Office of the President, 2004.

7)         Shanti, Christina M., M.D., and Charles E. Lucas, M.D. "Cocaine and the Critical Care Challenge." Critical Care Medicine 31, no. 6 (2003): 1,851-1,859.

8)         Spillane, Joseph F. Cocaine: From Medical Marvel to Modern Menace in the United States, 1884-1920. Baltimore, Md.: Johns Hopkins University Press, 2000.

9)         Substance Abuse and Mental Health Services Administration. Overview of Findings from the 2004 National Survey on Drug Use and Health. Washington, D.C.: Department of Health and Human Services, September 2005.

10)       Zickler, Patricia. "Modafinil Improves Behavioral Therapy Results in Cocaine Addiction." NIDA Notes 20, no. 5 (2005): 1, 11.

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