Medical Matters:Coke, snow, gold dust and white lady are just some of the street names of the drug cocaine. Once regarded as an upper class drug, the increase in cocaine use in the Republic has matched our growing affluence, writes Muiris Houston.
One of the most additive of recreational drugs, a cocaine habit can be hard to kick. Regular high-dose users develop short-term bouts of uncontrolled, impulsive behaviour as well as impaired judgment. The initial attraction of the drug is the pleasant feelings of euphoria it induces, leading to a huge rush of energy and optimism. Increased self-esteem and sex drive are other immediate effects.
However, these mostly pleasant feelings diminish with successive doses. The cocaine-user needs progressively larger doses to achieve the same degree of euphoria; the high doses bring toxic side effects, including paranoia and hallucinations.
Regular users experience disordered thought patterns in which they lose insight and may become violent. The sharp increase in violent crime can be directly linked to criminals' cocaine use.
Cocaine is the main active chemical in the leaves of Erythroxylon coca, a shrub that grows in South America and southeast Asia. Indigenous South American tribes are thought to have chewed coca leaves, which reportedly reduced fatigue and increased productivity.
An advertisement in the British Medical Journal in 1906 - extolling coca wine, which contained half a gram of pure cocaine per fluid ounce - showed how little was known about the dangers of the drug at that time. A more benign medical use for cocaine was discovered by an Austrian eye surgeon in 1880. Karl Koller successfully used cocaine at the University of Vienna as a local anaesthetic for eye surgery.
While cannabis remains the most popular illegal drug, cocaine use is on the rise, especially among young adults. The 2006 Annual Report of the European Monitoring Centre for Drugs and Drug Addiction estimates that 10 million European adults have used cocaine. And it found the cost of the drug fell by 22 per cent in 1999-2004.
Latest statistics from the all-Ireland general population drug prevalence survey, show 3 per cent of respondents reported they had used cocaine at least once. A higher proportion of younger people (15-34 years) had used cocaine compared with older respondents (35-64 years).
Data from the national drug treatment reporting system (NDTRS), published by the Health Research Board, shows the number of people reporting cocaine as the main problem drug rose by 262 per cent in 1998-2003. Half of those treated began using the drug before they were 20, and 80 per cent were men.
Attitudes to cocaine have also changed. We live in a world of instant gratification and greater prosperity; cocaine fits perfectly into a Celtic Tiger mindset of "having it all, now". But the increase in its use has not been matched by an awareness of its dangers. Regular use can literally destroy the body.
Cocaine powder is snorted into the nostrils causing blood vessels in the lining of the nasal passages to shrink. Repeated use leads to a loss of blood supply to the septum, the wall dividing the nostrils. Eventually, this wall disintegrates and a hole appears between the two nostrils.
A tell-tale sign of repeated cocaine use is a red, running, stuffed-up nose, due to a reflex widening of the blood vessels following the initial constriction.
Once it gets into the body, cocaine releases large amounts of the stress hormone noradrenaline, which causes blood vessels to narrow. This leads to a sudden and large rise in blood pressure, putting the person at risk of a heart attack or stroke.
The body's main blood vessel - the aorta - is damaged by long-term use of cocaine. A surge in blood pressure forces blood between the aorta's inner and outer linings. This false passage can easily burst (an aortic dissection), leading to a tearing pain in the chest or back. Research shows more than one-third of patients with the potentially fatal condition had been using cocaine.
Cocaine and alcohol are synergistic; drinking makes the cocaine last longer because of the way the two drugs interact in the liver. Liver damage is more common when alcohol and cocaine are used together; the risk of sudden death is 18 times greater than when cocaine is used on its own.
"Snow bugs" is a term used to describe the unpleasant crawling feelings under the skin sometimes felt during withdrawal from the drug. Other withdrawal signs include pain, sleeplessness and occasionally life-threatening convulsions.
All in all, cocaine has the potential to cause death and disability and certainly does not deserve its reputation as a "clean" drug.
Dr Muiris Houston is pleased to hear from readers at mhouston@irish-times.ie but regrets that he cannot answer individual queries.
