Effects Of Cocaine Use Research Articles

Cocaine related chest pain: are we seeing the tip of an iceberg?

The recreational use of cocaine is on the increase. The emergency nurse ought to be familiar with some of the cardiovascular consequences of cocaine use. In particular, the tendency of cocaine to produce chest pain ought to be in the mind of the emergency nurse when faced with a young victim of chest pain who is otherwise at low risk. The mechanism of chest pain related to cocaine use is discussed and treatment dilemmas are discussed. Finally, moral issues relating to the testing of potential cocaine users will be addressed.

Primates exposed to cocaine in utero display reduced density and number of cerebral cortical neurons.

This study examined the effects of cocaine use during the second trimester of pregnancy on cerebral neocortical volume and density, and total number of neocortical neurons and glia in offspring. We also evaluated the extent of postnatal recovery of cytoarchitectural abnormalities previously observed in the neocortex of two-month-old primates born from cocaine-treated mothers (Lidow [1995] Synapse 21:332-334). Pregnant monkeys received cocaine orally (20 mg/kg/day) from the 40th to 102nd days of pregnancy (embryonic day [E]40-E102). On E64 and E65, the animals were injected with [(3)H]thymidine. Cerebral hemispheres of the offspring were examined at three years of age. We found a reduction in the neocortical volume and density and total number of neocortical neurons. The observed reduction in neuronal number within the neocortex was not accounted for by the increase in the number of neurons in the white matter of cocaine-exposed animals, because the number of these "extra" neurons was equal to only half that of missing neurons. We detected no significant changes in the number of neocortical glia. The cytoarchitectural abnormalities in the neocortex of prenatally cocaine-exposed three-year-old monkeys closely resembled previously described neocortical abnormalities in similarly exposed two-month-old animals: the neocortex lacked a discernible lamination; the majority of the cells labeled by [(3)H]thymidine injected during neocortical neurogenesis did not reach their proper position within the cortical plate. Therefore, postnatal maturation is not associated with significant improvement in neocortical organization in primates prenatally exposed to cocaine. There was, however, a postnatal recovery of low glial fibrillary acidic protein (GFAP) immunoreactivity previously observed in 2-month-old cocaine-exposed animals.

Spontaneous coronary artery dissection associated with cocaine use: A case report and brief review

Isolated, spontaneous dissection of the coronary arteries in the absence of trauma is an unusual but well-documented occurrence. Fewer than 50 cases have been reported in males in the English language literature, and only one case, nonfatal, was associated with cocaine use. We present the second overall and the first fatal case of cocaine-associated spontaneous coronary artery dissection and a brief review of the literature on coronary dissection and the cardiovascular effects of cocaine use. The mechanism of cocaine's toxicity on the heart and vasculature is complex, multifactorial, and predominantly related to cocaine's adrenergic properties. The increased arterial blood pressure from cocaine's inotropic and chronotropic effects combined with its direct vasoconstrictive effect leads to increased shear forces on the coronary endothelium. This elevated stress may be responsible for the formation of an intimal tear and the subsequent dissection of the coronary artery. If the dissected portion of the arterial wall is displaced enough to significantly occlude the true lumen, infarction can result. In light of this possibility, coronary artery dissection must be considered in young patients presenting with symptoms of cardiac ischemia and a history of cocaine use.

Longitudinal application of the medical outcomes study 36-item short-form health survey with not-in-treatment crack-cocaine users.

The Medical Outcomes Study SF-36 has been used infrequently with substance abusers. The objectives of this study were to use the SF-36 to assess changes in the health status of crack-cocaine users over time, to determine the characteristics of users who change, to assess the influence of frequency of crack use on SF-36 health status, and to determine the utility of the SF-36 with crack users. A multilevel model was used to analyze data that were collected every 6 months over a 2-year period. The sample consisted of 439 not-in-treatment crack-cocaine users. The SF-36 was administered at baseline and follow-up interviews. Data on the frequency of crack-cocaine use were also collected. On average, SF-36 health status remained fairly static during the study although statistically significant increases in scores occurred on the social functioning and role-emotional subscales. Variation in subjects' health trajectories occurred but was not, for the most part, explained by individual characteristics. Frequency of crack use was negatively related to scores on the physical functioning, social functioning, and mental health subscales. Most subscales did not reflect what are commonly recognized to be the health-compromising effects of cocaine use, raising questions about the use of the SF-36 with illicit drug users. Changes in crack users' SF-36 health status were uncommon. Frequency of crack use was negatively associated with health status. Several SF-36 subscales may be helpful in studies involving illicit drug users in which limited assessments of health status are needed.

Diminished Acoustic Startle in Chronic Cocaine Users

Chronic cocaine use has been shown to produce neurochemical alterations which persist after acute withdrawal. This study assessed the effects of cocaine use on the acoustic startle response and sensorimotor gating using prepulse inhibition (PPI) of startle. Nine male control subjects (mean age = 41.6) and 15 male cocaine users (mean age = 43.2) were tested, the latter after heavy cocaine use ranging from 4 to 27 years (mean age = 16.7). Cocaine users had been cocaine free for four days to six months (mean = 17 days) at testing. Cocaine users exhibited a 68% reduction in startle amplitudes (F = 7.4; df = 1,22; p < .01) compared to controls. There were trends towards increased PPI in cocaine users under certain conditions; however, there were no significant main effects. These results indicate that chronic cocaine use produces impairment of the startle response which persists after cessation of cocaine use. These findings may reflect changes in the dopaminergic system resulting from chronic cocaine use.

Cocaine and development: clinical, behavioral, and neurobiological perspectives--a symposium report.

THE objective of the Symposium is to present new data concerning the developmental effects of cocaine in humans and in animal models. In so doing, the Symposium will identify new clinical and preclinical findings which, together with many decades of experience, will expand our understanding of the mechanisms by which cocaine produces neurobehavioral alterations. The ultimate objective being to understand the biological consequences of cocaine use during pregnancy and to draw attention to the problems associated with substance abuse in pregnancy.

Studies of Prenatal Cocaine Exposure: Assessing the Influence of Extraneous Variables

Using data from a longitudinal study of prenatal cocaine exposure, we demonstrate that women who use cocaine during pregnancy differ in demographic, substance use, and environmental characteristics from women who do not use cocaine. Each of these characteristics affects the child's development independent of cocaine exposure, and it is not appropriate to draw conclusions regarding the effects of cocaine use per se without taking into consideration the ways in which women who use cocaine differ from women who do not use. We present statistical examples where the effect of prenatal cocaine use was not significant after control for extraneous variables and examples where the effects remained significant after control. Thus, it is necessary to identify which variables are extraneous variables and to explore the effects of these variables on the findings. Failure to control for these variables can lead to inaccurate conclusions regarding the effects of prenatal cocaine exposure.

Cocaine use and high-risk sexual behavior among STD clinic patients.

Crack-smoking sexually transmitted disease (STD) patients are at high-risk for contracting HIV. To examine the effects of cocaine use and other correlates on high-risk sexual behavior among STD clinic patients. This was a cross-sectional study of 1,490 consecutive patients attending three Los Angeles County STD clinics between 1992 and 1994. Logistic regression analysis found high-risk sexual activity was associated with being a male and being of younger age. Among women, high-risk sexual behavior was associated with crack cocaine use and a perceived need for help. Among the men in the study, ethnicity (being black) and having an arrest history were associated with high-risk behavior. Effective intervention strategies should address cocaine use among STD patients and provide them with referrals to drug treatment.

Psychiatric symptom severity in cocaine-dependent outpatients: demographics, drug use characteristics and treatment outcome

Psychiatric symptom severity and associated characteristics were assessed in 185 individuals seeking outpatient treatment for cocaine dependence. The sample was divided into groups of low, medium and high psychiatric symptom severity based on Addiction Severity Index psychiatric composite scores. Patients with high symptom severity reported poorer pre-treatment functioning and more adverse consequences of cocaine use than the lower severity groups. Relationships between psychiatric severity and treatment outcome variables were assessed in a subset of 123 patients who received one of three 24-week psychosocial treatments for cocaine abuse: (i) behavioral treatment with a voucher-based incentive program; (ii) the same behavioral treatment without vouchers; (iii) or drug abuse counseling. Psychiatric symptom severity failed to influence treatment outcome with any of these treatments. Thus, in this study the authors found no evidence to indicate that high psychiatric severity predicts poor response to psychosocial treatment for cocaine abuse.

Cocaine-Associated Myocardial and Mesenteric Ischemia: A Case Report and Review of the Literature

Despite the increasing incidence of cocaine abuse and its known vasoactive properties, the vascular consequences of cocaine use are incompletely defined. Cocaine-related myocardial ischemia has been described and is thought to occur secondary to vasospasm. Infrequently reported cases of cocaine-related visceral ischemia have been attributed to vasoconstriction. We report here the first described case of serial infarctions in distinct vascular beds, myocardial and mesenteric. The case report and review of the literature support the concept of a diffuse, severe, and potentially lethal vasoconstrictive effect of cocaine.

Prolonged QT interval and cocaine use

Cardiovascular consequences of cocaine use are well known, and surveillance for them is common practice in the routine care of cocaine abusers. However, the cardiac electrical abnormalities that arise, although studied in animal experiments, lack correlation with human reports. The case of a 17-year-old girl, who was admitted after a cocaine binge is reported. She was cardiologically asymptomatic, but an admission electrocardiogram was abnormal, with QT interval prolongation. This returned to normal within 24 hours of observation. The literature on the electrophysiologic effects of cocaine on the heart is reviewed.

Lifetime cocaine use and cardiovascular characteristics among young adults: the CARDIA study.

Cocaine is a central nervous system stimulant associated with cardiovascular disease risk factors, morbidity, and mortality. Despite these demonstrated relationships, it has been difficult to assess the long-term cardiovascular consequences of cocaine use. The Coronary Artery Risk Development in Young Adults study provides an opportunity to evaluate the association of lifetime cocaine use with cardiovascular disease risk factors in a randomly sampled biethnic cohort of men and women of varied socioeconomic status, aged 20 to 32 in 1987. More extensive cocaine use experience was associated with being White, older, and less educated, regardless of sex. Higher levels of licit and illicit substance use behavior were reported by those reporting more extensive cocaine experience; however, most cardiovascular disease risk factors such as systolic and diastolic blood pressure, heart rate, hypertension, physical activity, and anthropometric measurements were not related to lifetime cocaine experience. In this age group, the detrimental cardiovascular effects of cocaine may be limited to acute effects. Further studies are needed to determine whether continued exposure is related to cardiovascular disease risk factors later in life.

Cardiovascular Interactions of Desipramine, Fluoxetine, and Cocaine in Cocaine‐Dependent Outpatients

The authors investigated the subacute cardiovascular effects of cocaine use alone and with antidepressants. At study entry, 55 cocaine‐dependent (DSM‐III‐R) patients with cocaine‐positive urines had slightly higher resting heart rates and blood pressures than 36 patients with cocaine‐negative urines, which achieved significance (P &lt; 0.05) for three of eleven parameters. A repeated‐measures analysis of medication‐compliant patients found no significant cardiovascular differences between cocaine‐positive and cocaine‐negative urine conditions for either desipramine (n = 10) or fluoxetine (n = 20). Cocaine use appears to produce minimal subacute cardiovascular effects, which are not accentuated by desipramine or fluoxetine, in physically healthy cocaine‐dependent patients. (American Journal on Addictions 1996; 5:321–326)

Cardiovascular effects of cocaine during pregnancy

Cocaine administration during pregnancy results in major maternal cardiovascular effects that in some cases exceed those observed in the nonpregnant state. Animal studies have shown increases in heart rate and blood pressure and decreases in regional organ blood flow. Fetal effects include arterial hypoxemia, increases in blood pressure and heart rate, and increases in cerebral blood flow that may be related not only to hypertension and hypoxemia, but also to direct effects on cerebral blood vessels. Fetal intestinal blood flow is decreased. These effects may be related to the clinical consequences of cocaine use during pregnancy.

A cocaine negative consequences checklist: development and validation

Awareness of negative consequences of cocaine use is theoretically important for motivation for treatment and relapse prevention. This study reports on the development of an instrument designed to assess cocaine users' self-reported negative consequences of cocaine use. Two samples of cocaine users in treatment for substance abuse completed the Cocaine Negative Consequences Checklist (CNCC). The measure, which is unidimensional in nature with four content area subscales that may be scored, was found to possess excellent reliability across the two samples. The convergent and discriminant validity of the CNCC was supported by the pattern of relationships with other measures of cocaine consequences, cocaine use, the Addiction Severity Index, and with demographic measures. Further research is needed on the utility of this measure in treatment and research.

Is your patient using cocaine?

Preview Cocaine may bring a feeling of euphoria, but the short-lived high often comes with lasting adverse consequences. Because use of the drug is on the rise, primary care physicians should be familiar with its attendant medical complications. How does cocaine affect the heart? The lungs? The nervous system? Which bodily functions does it inhibit? Or enhance? Dr Warner answers these and other questions in this overview of the medical consequences of cocaine use.

Stimulatory effects of cocaine and its metabolites on IM-9 human B-lymphoblastoid cells

This study examined the effect of cocaine and its metabolites benzoylecgonine, norcocaine, and cocaethylene on human B-cell proliferation using IM-9 cells. Cells were incubated with 0.01–10 μg/ml of cocaine or metabolite in serum-free medium or medium containing 2% FBS for 24 and 48 h, and [ 3H] thymidine incorporation into DNA was measured using liquid scintillation counting. Results showed incubation with cocaine and metabolites significantly increased IM-9 cell proliferation. With cocaine, maximal stimulation of 148% (compared to drug-free control) occurred at 1.0 μg/ml in serum-free medium at 48 h. Benzoylecgonine and norcocaine showed maximal stimulation at 0.1 μg/ml with 170% and 150% stimulation, respectively. Cocaethylene showed maximal stimulation of 146% at 10 μg/ml. Drug stability was monitored under incubation conditions using high-performance liquid chromatography (HPLC). We have shown that cocaine and its major metabolites have an immunomodulatory effect on B-cell proliferation at concentrations equivalent to serum levels produced during cocaine use in humans. Since the cocaine metabolites also show an immunomodulatory effect, the immune consequences of cocaine use may be significantly prolonged.

Cocaine use in pregnancy in Amsterdam.

To study the effects of cocaine use in pregnancy in Amsterdam, clinical data on cocaine-using pregnant women (n = 21) and their offspring (n = 23) were obtained retrospectively (1987-1994) at the Academic Medical Center, Amsterdam. Infants exposed to cocaine had a median gestational age of 39 weeks and a median birth weight of 3090 g. There were six preterm infants, two small-for-gestational-age infants and five infants with a small head circumference. Three infants had a congenital malformation. One infant (Potter's syndrome) died shortly before birth. One infant had congenital syphilis, four had intracerebral abnormalities on ultrasound and four had abnormal neurologic symptoms in the neonatal period. One infant died after 21 days of life. At follow-up four infants showed abnormal development. In 12 of the 23 infants (52%), one or more possible effects of cocaine were found.

Persistent reduction of immediate early gene mRNA in rat forebrain following single or multiple doses of cocaine

Stimulus-induced expression of immediate early genes (IEGs) is believed to be involved in the transduction of extracellular stimuli into prolonged modifications of cellular function. Previous studies have demonstrated that the IEGs NGFI-A (zif268) and c-fos are each rapidly induced in the caudate putamen (CP) by treatment with the indirect dopamine agonist cocaine. The short-term course of this induction has been well studied. However, the consequences of cocaine use are not limited to immediate pharmacological effects. Withdrawal, especially from prolonged or repeated use, can produce extended physiological and behavioral changes. At the cellular level, these longer-term effects may be mediated by or reflected in changes in the expression of IEGs. For this reason, we have investigated long-term perturbations in IEG expression during withdrawal from intravenously (IV) or intraperitoneally (IP) administered cocaine. Levels of NGFI-A and c- fos were measured in the CP of rats by Northern blot analysis, which confirmed that cocaine-induced increases of NGFI-A and c- fos mRNA lasts for several hours after drug administration. Immediately following this induction, however, there is a prolonged period during which a marked reduction in the relative amount of mRNA for both NGFI-A and c- fos is observed in cocaine-treated animals when compared to matched, vehicle-treated controls. This repression persisted for several hours after a single injection and as long as several days following multiple injections, strongly suggesting a cumulative effect for repeated exposures. Perturbation of IEG expression can affect key cellular processes and, therefore, these changes are likely to play an important role in mediating the long-term neurophysiologic effects produced by use of cocaine.

Aids-Related Knowledge, Beliefs and Risk Behaviors in a Sample of Crack Addicts

This longitudinal study examines male veterans with a history of cocaine dependence and treatment, focusing on the relationship between levels of crack use and HIV-related knowledge, beliefs and risk behaviors. Over half the subjects were African-American and the majority were heterosexual. A survey instrument was administered at one and two years after initiating treatment. HIV serotesting was conducted at each interview which showed the rate of seropositivity to be low at both points. Knowledge about HIV transmission increased significantly over time for the sample, but no differences were significantly related to level of crack use. Few subjects report the use of condoms on a consistent basis, regardless of crack use level. However, both the number of sex partners reported and beliefs about personal susceptibility to HIV infection increased as the level of crack use increased. Our crack-using subjects had not fully internalized their risk of HIV infection or were fatalistic about their ability to change HIV-related risk behaviors. Either of these possibilities presents a significant challenge to education and prevention efforts targeted to crack users. AIDS education efforts in drug treatment programs may need to more strongly emphasize the sexual transmission routes of HIV infection and highlight the effects of cocaine use on sexual practices.