Increase In Cocaine Use Research Articles

Cocaine-Induced Coronary Syndromes: Unraveling the Complex Pathophysiology and Clinical Implications

Cocaine-induced coronary syndromes represent a significant public health concern, with complex pathophysiology and high morbidity and mortality rates. This article provides a comprehensive overview of the epidemiology, pathophysiology, clinical manifestations, diagnosis, management strategies, prognosis, and complications associated with cocaine-induced coronary syndromes. Epidemiological data suggest a notable increase in cocaine use globally, with significant implications for cardiovascular health. The pathophysiology of cocaine-induced coronary syndromes involves multifaceted mechanisms, including vascular dysfunction, myocardial ischemia, atherosclerosis, and thrombosis. Clinical manifestations range from asymptomatic electrocardiographic changes to life-threatening acute myocardial infarction, posing diagnostic challenges for healthcare professionals. Management strategies encompass a multidisciplinary approach, including pharmacological interventions, revascularization procedures, and behavioral interventions aimed at addressing both acute cardiovascular events and underlying substance abuse disorders. Despite advancements in medical therapy and preventive measures, the burden of cocaine-induced coronary syndromes remains substantial, highlighting the need for collaborative efforts to mitigate the impact of cocaine-related cardiovascular complications on public health and clinical practice.

Convergent abnormalities in striatal gene networks in human cocaine use disorder and mouse cocaine administration models.

Cocaine use disorder (CUD) is an intractable syndrome, and rising overdose death rates represent a substantial public health crisis that exacts tremendous personal and financial costs on patients and society. Sharp increases in cocaine use drive the urgent need for better mechanistic insight into this chronic relapsing brain disorder that currently lacks effective treatment options. To investigate the transcriptomic changes involved, we conducted RNA sequencing on two striatal brain regions that are heavily implicated in CUD, the nucleus accumbens and caudate nucleus, from men suffering from CUD and matched controls. Weighted gene coexpression analyses identified CUD-specific gene networks enriched in ionotropic receptors and linked to lowered neuroinflammation, contrasting the proinflammatory responses found in opioid use disorder. Integration of comprehensive transcriptomic datasets from mouse cocaine self-administration models revealed evolutionarily conserved gene networks in CUD that implicate especially D1 medium spiny neurons as drivers of cocaine-induced plasticity.

Characteristics and circumstances of cocaine-related completed suicide in Australia, 2000–2021

BackgroundThere has been a substantial global increase in cocaine use and associated harms. The current study aimed to: 1. Determine the case characteristics and circumstances of death of cocaine-related suicide in Australia 2000–2021; and 2. Determine the toxicological profiles of cases. MethodsRetrospective study of cocaine-related death in Australia, 2000–2021, retrieved from the National Coronial Information System (NCIS). Suicide intent was based upon the NCIS code for “Intentional Self-harm”, derived from case circumstances and coroners’ conclusions. Sex comparisons were made for all major variables. ResultsA total of 157 cases were identified, 82.2% male, 79.5% employed, with a mean age of 32.3 years. Concerns for mental health were documented in 65.6%, a previous suicide attempt in 21.0%, a history of substance use treatment and/or negative consequences of substance use in 45.9% and injecting drug use in 14.6%. Manner of death amongst both sexes was predominantly by physical means (82.8%). Written intent was documented in 29.3%. Intense agitation prior to the incident was noted in 28.0% and conflict in 24.8%. The median blood cocaine concentration was 0.060 mg/L (range 0.007–5.500). Other drugs were present in 95.5%, most commonly alcohol (63.1%) with a median concentration of 0.140 g/100 ml. Psychostimulants other than cocaine were present in 31.2%. ConclusionsThe ‘typical’ cocaine-related suicide case was a male, aged in their early thirties, who was highly likely to be employed. The majority of cases used physical means, and a substantial minority were highly agitated and engaged in conflict prior to the fatal incident.

Illicit drug use in Reykjavik by wastewater-based epidemiology

Estimation of illicit drug use on a community level by wastewater-based epidemiology (WBE) is both an objective and reliable way to establish near real-time results. Wastewater samples were collected at eleven timepoints in Reykjavik from 2017 to 2020. The use of commonly abused illicit drugs in Iceland (amphetamine, methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA), cocaine, and cannabis) was estimated. Solid phase extraction and ultra-high performance liquid chromatography coupled to tandem mass spectrometry was used for analysis. Estimated amphetamine and methamphetamine use showed signs of an increase from 2017 to 2020 with amphetamine being the dominant stimulant on the market. MDMA use remained stable from 2017 to 2020. Results showed a large increase in cocaine use from 2017 to 2019 but interestingly, a marked decrease in 2020 during the COVID-19 pandemic. Cannabis use was stable from 2017 to 2019 but showed signs of an increase during the pandemic in 2020. Results by WBE corresponded with data based on two other indicators of drug use, seizure data and driving under the influence cases. Both temporal and spatial trends in illicit drug use were successfully estimated by using WBE, complimenting other indicators which provided a comprehensive picture of drug abuse in Reykjavik.

Long-term cocaine use is associated with increased coronary plaque burden – a pilot study

ABSTRACT Background: There is a lack of research regarding whether prolonged use of cocaine would lead to increase of coronary plaque burden. Objectives: To study the effects of cocaine use on the coronary artery plaque volume. We hypothesize the longer the cocaine use, the greater the plaque burden. Methods: We used coronary computed tomography angiography to evaluate plaque volumes. The study included chronic (N = 33 with 27 HIV+) and non-cocaine users (N = 15 with 12 HIV+). Chronic cocaine use was defined as use by any route for at least 6 months, administered at least 4 times/month. The Student’s t-test was used to compare the plaque volumes between chronic and non-cocaine users. Multivariable regression analysis adjusted for age, sex, body mass index, HIV status, cigarette smoking, diabetes, and total cholesterol was performed to determine the relationship between years of cocaine use and plaque volumes. Results: The total plaque volumes between groups showed no difference (p = .065). However, the total left anterior descending artery (LAD) plaque volume in the chronic cocaine group was significantly higher than that in the non-cocaine group (p = .047). For each year increase in cocaine use, total plaque volume and total LAD plaque volume increased by 7.23 mm3 (p = .013) and 4.56 mm3 (p = .001), respectively. In the multivariable analyses, both total plaque volume and total LAD plaque volume were significantly associated with years of cocaine use (p = .039 and 0.013, respectively). Conclusion: Prolonged cocaine use accelerates the development of sub-clinical atherosclerosis.

Hyperbaric medicine in Rijeka 25 years after the publication of the first Croatian list of indications for hyperbaric oxygenation

Argentina is facing an increase in cocaine use by adolescents and young adults from every socioeconomic background. It is calculated that up to 10% of all cocaine passing through this country is locally sold and consumed. Nevertheless, local information describing common cocaine-related neurological events is scarce. From August 1988 to March 1993, 13 patients were evaluated with neurological disease associated with cocaine abuse. Among these 13 patients (Table 1), the mean age was 29; 70% were men. Patients most commonly used the nasal route (snorting). Concomitant abuse of other intoxicants, especially alcohol, was frequent (85%). The major neurological complications included one or more seizures (n = 7), ischemic stroke (n = 2) (Fig. 1-2), hemorrhagic stroke (n = 2) associated with arteriovenous malformation (Fig. 3a-b), memory disturbances (n = 1) and paroxysmal dystonia (n = 1). Psychiatric complaints were present in all patients. Mortality was not observed. There was no correlation between the appearance of complications and the amount of cocaine used, or prior experience with this drug. Only one of the 7 patients with seizures had a previous history of seizures. All had generalized tonic-clonic seizures, and one had concomitant absence episodes. Cocaine modulates central neurotransmitters and has direct cerebrovascular effects. The neurological complications appear to be related to cocaine hyperadrenergic effects, striatal dopaminergic receptor hypersensitivity and perhaps vasculitis. Structural changes in the brain of long-term cocaine abusers could explain the persistence of neurologic symptoms after drug withdrawl.

Hair testing for cocaine in living men: an epidemiological study on hair samples collected for various medico-legal purposes

The collection and analysis of hair samples offers higher chances of identifying people addicted to drugs than urine samples. In our study we propose hair analysis as a useful epidemiological indicator to identify the extent of cocaine use in different medico-legal situations: currently the epidemiological trends of substance abuse are estimated indirectly, mainly through large-scale surveys or through medical and crime statistics that may be too generic. We conducted a cross-sectional study, analysing hair samples, collected for various medico-legal purposes, from living men belonging to different categories, in order to complete a previous study conducted in 2016. Of 104 samples collected for different purposes, 55 were positive for drugs (52.88% of total) and, in this group, positivity for cocaine was found in 28 cases (26.92% of total), with a mean concentration of 4.58 ng/mg of hair, and a mean concentration of 0.75 ng/mg of hair of its major metabolite (benzoylecgonine). This datum is in line with the Italian Superior Health Institute reports, which declared a reduction in the use of cannabis and benzodiazepines, but a notable increase in cocaine use. Despite its limitations, this study adds further information to the previous one conducted in the same context, and furnishes an interesting picture of the phenomenon of cocaine addiction in Italy.

Multisite, randomized, double-blind, placebo-controlled pilot clinical trial to evaluate the efficacy of buspirone as a relapse-prevention treatment for cocaine dependence.

To evaluate the potential efficacy of buspirone as a relapse-prevention treatment for cocaine dependence. A randomized, double-blind, placebo-controlled, 16-week pilot trial was conducted at 6 clinical sites between August 2012 and June 2013. Adult crack cocaine users meeting DSM-IV-TR criteria for current cocaine dependence who were scheduled to be in inpatient/residential substance use disorder (SUD) treatment for 12-19 days when randomized and planning to enroll in local outpatient treatment through the end of the active treatment phase were randomized to buspirone titrated to 60 mg/d (n = 35) or placebo (n = 27). All participants received psychosocial treatment as usually provided by the SUD treatment programs in which they were enrolled. Outcome measures included maximum days of continuous cocaine abstinence (primary), proportion of cocaine use days, and days to first cocaine use during the outpatient treatment phase (study weeks 4-15) as assessed by self-report and urine drug screens. There were no significant treatment effects on maximum continuous days of cocaine abstinence or days to first cocaine use. In the female participants (n = 23), there was a significant treatment-by-time interaction effect (χ²₁ = 15.26, P < .0001), reflecting an increase in cocaine use by those receiving buspirone, relative to placebo, early in the outpatient treatment phase. A similar effect was not detected in the male participants (n = 39; χ²₁ = 0.14, P = .70). The results suggest that buspirone is unlikely to have a beneficial effect on preventing relapse to cocaine use and that buspirone for cocaine-dependent women may worsen their cocaine use outcomes. ClinicalTrials.gov identifier: NCT01641159.

Hidden Choices and Missing Numbers

This study works at the intersection of the social construction of drug problems and the social construction of numbers. While others have looked at how the media use numbers and other discursive resources to construct drug problems, this study looks at how researchers select a few numbers from large studies to present to the media in press releases. It focuses on Monitoring the Future, an annual study of drug use among American teens. It examines specifically the choices the principal investigators of the study made about what numbers to publicize during the Crack Scare of late 1985 and 1986, a time when the media were intensely interested in numbers documenting a purported vast increase in cocaine use. It then compares these choices with those the researchers made at other times between 1978 and 2011. Comparisons over time allow us to determine whether the choices about what numbers to publicize in the mid-1980s were unique to that time (and hence reflected the immediate political context) or were similar to choices made at other times as well (and hence reflected routine practices).

Prospective effects of traumatic event re‐exposure and post‐traumatic stress disorder in syringe exchange participants

AbstractAimDetermine the effect of traumatic event re‐exposure and post‐traumatic stress disorder (PTSD) symptom severity on proximal drug use and drug abuse treatment‐seeking in syringe exchange participants.DesignProspective longitudinal 16‐month cohort study of new syringe exchange registrants enrolled in a parent study of methods to improve treatment engagement.SettingData were collected in a research van next to mobile syringe exchange distribution sites in Baltimore, Maryland.ParticipantsMale and female (n = 162) injecting drug users (IDUs) registered for syringe exchange.MeasurementsTraumatic event re‐exposure was identified each month with the Traumatic Life Events Questionnaire. PTSD symptoms were measured with the Modified PTSD Symptom Scale–Revised, given every 4 months. Outcome measures collected monthly were days of drug use (heroin, cocaine) and drug abuse treatment‐seeking behavior (interest, calls to obtain treatment, treatment participation).FindingsEach traumatic event re‐exposure was associated with about 1 more day of cocaine use after accounting for the previous month's cocaine use [same month adjusted B, standard error = 1.16 (0.34); 1 month later: 0.99 (0.34)], while PTSD symptoms had no effect. Traumatic event re‐exposure increased interest in drug abuse treatment [same month adjusted odds ratios with 95% confidence intervals = 1.34 (1.11–1.63)] and calling to obtain treatment [same month 1.58 (1.24–2.01); 1 month later 1.34 (1.03–1.75)]. Each 10% increase in PTSD symptom severity was associated with persistent increased interest in treatment [same month 1.25 (1.10–1.42); 1 month later 1.16 (1.02–1.32); 2 months later 1.16 (1.02–1.32)] and calling to obtain treatment [same month 1.16 (1.02–1.32)]. Neither traumatic events nor PTSD symptoms were associated with participants receiving treatment.ConclusionsBecoming exposed again to traumatic events among injecting drug users is associated with an increase in cocaine use up to 1 month later, but drug use is not related to post‐traumatic stress disorder symptoms. Both traumatic event re‐exposure and post‐traumatic stress disorder symptoms predict drug abuse treatment‐seeking behavior for up to 2 months.

Palatal perforations secondary to inhaled cocaine abuse. Presentation of five cases

The estimated incidence of complications associated with cocaine abuse is 4.8%. Palatal perforation is a very infrequent condition within the range of complications associated with cocaine abuse. No epidemiological characteristics relating to patient age or gender have been established, and the diagnosis of the disorder requires a detailed clinical history, including antecedents of cocaine abuse. The clinical and radiological studies show palatal bone erosion and perforation of the soft or hard palate. The present study describes five cases of palatal perforation secondary to inhaled cocaine abuse. As a result of the increase in cocaine use in recent years, particularly among young adults, clinicians must be alerted to the need to include this condition when establishing a differential diagnosis.

Progesterone effects on cocaine use in male cocaine users maintained on methadone: A randomized, double-blind, pilot study.

Previously, the authors reported that progesterone treatment attenuated reports of cocaine-induced high in male and female cocaine users. In this pilot clinical trial, the authors tested the safety and efficacy of oral progesterone as a treatment for cocaine dependence in methadone-stabilized male cocaine users. This was a 10-week, randomized, double-blind, placebo-controlled trial. Forty-five male methadone-stabilized cocaine users were randomized to receive placebo (n=15) or progesterone (n=30) for 9 weeks. The progesterone dose was gradually increased from 100 mg to 300 mg twice daily by Week 4 and maintained through Week 10. Treatment retention for the clinical trial was 80%, without significant group differences (log rank=2.4, p=.12). Hierarchical linear modeling estimates of obtaining a cocaine positive urine result across 10 weeks showed a very slight reduction in cocaine use for the progesterone group (Z=-2.89, p<.004). The placebo group showed a slight increase in cocaine use from Week 1 to Week 10 (Z=2.72, p<.007). These slopes significantly differed from each other (Z=-3.83, p<.0001). Overall, the placebo group showed significantly lower probability of having a cocaine positive urine result at treatment's end (Weeks 9 and 10) compared with the progesterone group (0.60 vs. 0.73; U=4837, p<.04). These preliminary findings do not support the efficacy of progesterone in male cocaine users. The efficacy of progesterone in female cocaine users remains to be determined in future studies.

Examining links between cocaine use and street‐based sex work in New South Wales, Australia

We examined potential links between cocaine use and street‐based sex work in New South Wales, Australia, following reports of increased cocaine use among injection drug users (IDU). Police data on prostitution and possession/use of cocaine was analysed using time series analysis. Interviews with key informants and IDU were also conducted, and data on cocaine use from ongoing monitoring systems targeted at IDU were analyzed. There was a clear increase in cocaine use among IDU which occurred in 2001. This occurred at the same time as an increase in prostitution offenses. Qualitative data suggested a greater number of primary heroin users were engaging in street‐based sex work, which was driven in part by the increases in cocaine use among this group. Subsequent reductions in cocaine availability led to decreased cocaine use and possession offenses, along with reductions in prostitution offenses.

Cocaine dependence and PTSD: A pilot study of symptom interplay and treatment preferences

Cocaine dependence and posttraumatic stress disorder (PTSD) frequently co-occur. Little is known, however, about patients' perceptions of symptom connectedness and preferences for treatment. This pilot study preliminarily investigated perceptions of symptom interplay and preferences regarding concurrent or sequential models of psychotherapy, therapy format, and treatment modalities. Participants were 23 individuals with current cocaine dependence and PTSD. The majority (95.5%) reported a functional relationship between cocaine use and PTSD symptoms ( p < 0.001). Improvement in PTSD symptoms was typically (63.6%) associated with a decrease in cocaine use ( p < 0.01). Similarly, a worsening of PTSD symptoms was typically (86.4%) associated with an increase in cocaine use ( p < 0.001). In contrast, improvement/deterioration in cocaine use was not significantly related to subsequent improvement/deterioration in PTSD symptoms. This finding suggests that changes in PTSD may be an important risk factor to consider among individuals with cocaine dependence and PTSD. Approximately 41% preferred a concurrent model of therapy in which the cocaine use and PTSD are treated simultaneously in therapy. The findings highlight the functional relationship between these two disorders and have direct implications for treatment interventions.

Was an increase in cocaine use among injecting drug users in New South Wales, Australia, accompanied by an increase in violent crime?

BackgroundA sharp reduction in heroin supply in Australia in 2001 was followed by a large but transient increase in cocaine use among injecting drug users (IDU) in Sydney. This paper assesses whether the increase in cocaine use among IDU was accompanied by increased rates of violent crime as occurred in the United States in the 1980s. Specifically, the paper aims to examine the impact of increased cocaine use among Sydney IDU upon police incidents of robbery with a weapon, assault and homicide.MethodsData on cocaine use among IDU was obtained from the Illicit Drug Reporting System (IDRS). Monthly NSW Police incident data on arrests for cocaine possession/use, robbery offences, homicides, and assaults, were obtained from the Bureau of Crime Statistics and Research. Time series analysis was conducted on the police data series where possible. Semi-structured interviews were conducted with representatives from law enforcement and health agencies about the impacts of cocaine use on crime and policing.ResultsThere was a significant increase in cocaine use and cocaine possession offences in the months immediately following the reduction in heroin supply. There was also a significant increase in incidents of robbery where weapons were involved. There were no increases in offences involving firearms, homicides or reported assaults.ConclusionThe increased use of cocaine among injecting drug users following the heroin shortage led to increases in violent crime. Other States and territories that also experienced a heroin shortage but did not show any increases in cocaine use did not report any increase in violent crimes. The violent crimes committed did not involve guns, most likely because of its stringent gun laws, in contrast to the experience of American cities that have experienced high rates of cocaine use and violent crime.

The risk of drug swallowing at the point of arrest: An analysis of 24 cocaine-related deaths following police care or custody in England and Wales

The increase in cocaine use in young people has been reflected in an increase in the number of deaths in which cocaine is identified post mortem. This increase is evident in relation to police custody deaths. In the current analysis, 43 drug-related deaths in custody are considered with cocaine identified in 24 of the post mortem examinations. The article examines the characteristics of these deaths, with particular attention paid to the method and related reasons for drug consumption. Crucially, these deaths contrast with national drug mortality data as they generally involve cocaine consumed by swallowing at the point of arrest. A total of 18 of 24 cocaine deaths involved oral ingestion with at least 15 of these possible attempts at drug concealment occurring at the point of arrest. There is likely to be a considerable risk of loss of life among street-level drug dealers who swallow to avoid drug detection; the article examines the risks associated with this behaviour and possible preventative strategies.

Helping your patients beat cocaine addiction

PREVIEWEven though the dramatic increase in cocaine use that began in the 1970s is abating, primary care physicians today can still expect to encounter patients with cocaine intoxication and withdrawal and the health problems that result from long-term use. Among the nearly 3 million current users of cocaine are half a million users of the highly addictive form, crack. Dr Khouzam describes the distinctive clinical characteristics, medical complications, and accompanying psychiatric disorders of patients with cocaine addiction. He also explains the various dimensions of treatment that are required to provide comprehensive care to these patients.

Prevention and Treatment Issues for Pregnant Cocaine-Dependent Women and Their Infants.

The increase in cocaine use among pregnant women has created significant challenges for treatment providers. Drug-dependent women tend to neglect general health and prenatal care. Perinatal management is often difficult due to medical, obstetrical, and psychiatric complications. Research has demonstrated that comprehensive care, including high risk obstetrical care, psychosocial services, and addiction treatment can reduce complications associated with perinatal substance abuse. Research investigating the effectiveness of residential and outpatient treatment for pregnant cocaine-dependent women also suggests that many biopsychosocial characteristics and issues influence treatment outcomes. Homelessness and psychiatric illness require a more intensive level of care, and abstinence is difficult to maintain for many women in outpatient treatment as they continue to live in drug-using environments. To optimize the benefit of comprehensive services, services should be provided within a multilevel model of substance abuse treatment including long- and short-term residential, intensive outpatient, and outpatient settings.

An Australian profile on the use of cocaine

Data collected on cocaine in Australia in the mid to late 1980s, when law enforcement and treatment centres were concerned with possible increases in cocaine use, indicated a low prevalence of use. This article reports findings from the Australian component of the 1993-94 World Health Organization study entitled "Initiative on Cocaine", which provides an updated analysis of cocaine use patterns and consequences. The two components of this study were a "country profile" which summarized existing health, law enforcement and survey data on cocaine use from national, regional and city level records, and a key informant study which consisted of interviews with people from Sydney and Melbourne who were familiar with cocaine use through personal, professional and observational experience. Findings show that the prevalence of cocaine use has remained low among the general population in Australia (around 2%), and few people present to treatment services with primary cocaine problems or are arrested. However, the use of cocaine seems to have increased among inner Sydney injecting drug users. There have also been indications of larger police seizures of cocaine, reflecting a possible increase in availability. Recommendations are made to provide relevant interventions and continually monitor patterns of cocaine use, particularly among at-risk groups.

An Australian profile on the use of cocaine

Data collected on cocaine in Australia in the mid to late 1980s, when law enforcement and treatment centres were concerned with possible increases in cocaine use, indicated a low prevalence of use. This artick reports findings from the Australian component of the 1993–94 World Health Organization study entitled “Initiative on Cocaine”, which provides an updated analysis of cocaine use patterns and consequences. The two components of this study were a “country profile” which summarized existing health, law enforcement and survey data on cocaine use from national, regional and city level records, and a key informant study which consisted of interviews with people from Sydney and Melbourne who were familiar with cocaine use through personal, professional or observational experience. Findings show that the prevalence of cocaine use has remained low among the general population in Australia (around 2%), and few people present to treatment services with primary cocaine problems or are arrested. However, the use of cocaine seems to have increased among inner Sydney injecting drug users. There have also been indications of larger police seizures of cocaine, reflecting a possible increase in availability. Recommendations are made to provide relevant interventions and continually monitor patterns of cocaine use, particularly among at-risk groups.