Cocaine addiction


Cocaine is a naturally occurring substance from the cocoa plant found in South America, Erythroxylum coca.

Cocaine addiction occurs in about 0.5% of the US population. 


Estimated that more than 36 million individuals in the US have used cocaine at some time.

14.7% of the population 12 years or older have tried cocaine at least one time in their life, with approximately 5.3 million users in the past year and 1.9 million users in the last month.

The second most widely used illegal drug and most common to precipitate an emergency room visit.

Accounts for up to 40% of the emergency department visits for drug misuse or abuse.

Consumption in the form of freebasing and crack.

No effective pharmacologic treatment.

Mechanism of action in the brain includes the inhibition of dopamine reuptake, which accounts for cocaine’s addictive properties, as dopamine is the critical neurotransmitter for reward.

It is more active in the dopaminergic neurons of the ventral tegmental area than the substantia nigra.

Its administration increases metabolism in the substantia nigra, which can explain the altered motor function seen in cocaine-using subjects.

The inhibition of dopamine reuptake by cocaine also inhibits the firing of spontaneous action potentials by the pars compacta.

The mechanism by which cocaine inhibits dopamine reuptake involves its binding to the dopamine transporter protein.

Affects the cardiovascular system by inducing hemodynamic alterations, coronary artery vasoconstriction, hypercoaguability, endothelial dysfunction and direct myocardial and vascular damage.

Cocaine is associated with coronary artery vasospasm and has the potential to cause an acute myocardial infarction.

Its vasospastic effects are mediated by blockade of the presynaptic catecholamine reuptake which results in catecholamine neurologic surge at the postsynaptic receptor site as well as sympathomimetic stimulation:downstream is fact activates Alpha receptors, calcium flux into the vascular smooth muscle, and resultant coronary vasoconstriction.

Acutely increases heart rate, blood pressure.

Its use is linked with cardiac arrhythmias.

Has deleterious cardiovascular and prothrombotic affects that may underlie a wide range of clinical cardiovascular presentations.

In 2007 cocaine emergency department related visits was 550,000, and this number is likely a very significant underestimate due to underreporting, denial and inadequate testing.

Emergency department visits have the highest incidence among those 35 to 44 years of age, followed by 45 to 54 year age group.

Has acute and more chronic presentations that include acute coronary syndromes, heart failure, cardiomyopathies, arrhythmias, and aortic dissection.

Its use is implicated in 1.8% of patients with acute aortic dissection.

Patients with cocaine-related aortic. dissection are relatively young and have additional factors of hypertension and tobacco use, with a higher mortality rate in those with non-cocaine related dissection.

Chest pain is the most common acute presentation of its use and intoxication.

More than 50% of patients presenting to the emergency room are admitted to the hospital.

The use of illicit drugs has increased in the 50-59-year-old population and cocaine is the illicit drug of choice in this age group.

Most common complication is chest pain.

Frequency of coronary events in patients with cocaine induced chest pain has an average frequency of 0.15% for ST elevation myocardial infarction, 0.42% for non-ST elevation myocardial infarction, and 0.22% for coronary vasospasm (Singh V).


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