Two men in a coma in Waterford give the lie to the notion of cocaine as a safe drug, writes Carl O'Brien, Social Affairs Correspondent.
Several times a week the panic, aggression and terror that accompanies cocaine abuse tumbles through the doors of the cramped accident and emergency unit in Cork's Mercy Hospital "It's happening every four or five days, now," says Dr Chris Luke, an A&E consultant. "On a recent Sunday morning we had a man brought in with his girlfriend, off his head, his nose bitten off after a fight, splattering blood everywhere. We have young professionals coming out of ambulances screaming, who need to be shackled with handcuffs on trolleys and administered tranquilisers.
"We have young people in a state of panic with cardiac arrest, severe chest paints, collapsed lungs. It's affecting all classes, on the northside and the southside. You can imagine the chaos it causes in a small A&E unit with lots of sick and older people on trolleys." Most recover with nothing more than a hangover, a crash in mood or stomach pains. Others may suffer longer-term damage, such as kidney, liver or nerve damage. But for a significant number, the consequences are deadly.
John Grey (23) and Kevin Doyle (21) are both in a coma and on life support this weekend after taking cocaine at a house party in Waterford in the early hours of last Sunday morning. In chaotic scenes, five ambulances ferried a total of 15 people to the emergency department of Waterford Regional Hospital. Gardaí suspect some of the partygoers swallowed rather than snorted the cocaine, causing a much more toxic reaction. The families of the two young men are maintaining a bedside vigil this weekend, although there has been no improvement in their condition.
"Where there's life, there's hope," said Grey's mother, Betty. "We don't want to think about the dark side."
One family, however, is already grieving the loss of a loved one from cocaine use. Tina Greaney (26) was found dead by her seven-year-old daughter at her home in Knocknaheeny in Cork.
At her inquest this week, it emerged she drank two glasses of champagne in a friend's house before taking a line of cocaine. The following morning her mother noticed the eldest of her daughter's three children calling to her from an upstairs room. "Nana, my mammy is cold," the child said. She was lying dead at the foot of the stairs, with a blue pallor in her face.
Now, more than ever, the potentially lethal effects of cocaine use are becoming increasingly clear in A&E units and coroner's courts around the country. The number of deaths will not be published until next year, but other indicators show there has been a 10-fold increase in the number of people seeking help for the problem use of cocaine in recent years. There has also been a six-fold increase in the number of cocaine-positive samples detected in post-mortems between 2000 and 2005.
Its sheer prevalence means it is seen as an increasingly normal and acceptable part of a night out in many social circles. Very quickly, it has travelled from an underground sub-culture into the mainstream.
However, few are aware of the drug's very real risks. The fact that 90 or 95 per cent of people may not suffer an major adverse reaction lulls many into a false sense of security over the drug's safety, says Dr Chris Luke.
"A feature of its misuse is that many people are deluded into thinking it's a clean, safe drug. But every now and again someone drops dead or becomes intensely violent, sometimes murderously so," he says.
THE EFFECTS OF the drug on the body are dramatic. Once cocaine enters the bloodstream, the heart begins to race, blood pressure increases and blood vessels become constricted.
In some predisposed people, the artery walls of the heart clamp down and can't pump blood around the body. "It's like what happens to your fingers when they go white after being placed in cold water for too long," says Dr Brian Maurer, a consultant cardiologist at St Vincent's Hospital in Dublin.
In these circumstances, a potentially fatal heart attack or blood clot can follow within a short space of time. Cocaine use can also cause a stroke if blood vessels in the brain burst, causing internal haemorrhaging. If the drug is combined with alcohol, it forms an even stronger substance called cocaethylene, which damages the heart further, increasing the chances of stroke or heart attack (see panel).
The manner in which cocaine is taken can also raise the risk of serious side-effects. Dr Brion Sweeney, a specialist in addiction psychiatry at the Drug Treatment Centre Board, says ingesting - or swallowing - cocaine can be extremely dangerous.
While the hit from cocaine can occur within minutes after being snorted, it can take anything up to an hour or more if it has been swallowed.
"Someone might continue ingesting it because there's no apparent effect," Dr Sweeney says. "Then, a few hours later, it hits. With a large amount like that, you don't need to be a rocket scientist to know what can happen next."
The risk of overdosing can be raised by the chemicals added into cocaine to make it go further. The purity of cocaine varies wildly, according to Johnny Connolly, a researcher with the Health Research Board, thereby elevating the risk for drug users.
At the Forensic Science Laboratory, where all drugs seized by gardaí are sent for testing, the purity of cocaine varies by anything from 75 per cent to 5 per cent.
Dr Daniel O'Driscoll, the head of the laboratory's drugs section, says the most common products used to cut up cocaine are lignocaine (a local anaesthetic), phenacetin (a fever-relieving drug), caffeine (mimicking the stimulation of cocaine) and a variety of sugar-based substances such as mannitol, which is used to correct hydration and low blood sugar.
"They can have different side-effects," says Dr O'Driscoll. "The reality is that what causes the most lethal side-effect is the drug itself."
ONE ISSUE THAT unites all medical experts dealing with cocaine abuse is the need for greater awareness about the drug's risks. A public-education campaign about the very clear risks of cocaine needs to be ramped up, dispelling the myth that it is a clean and problem-free drug, they say. Some point out that initiatives need to be realistic: they mightn't stop people taking drugs, but they should focus on reducing the most harmful ways of taking cocaine, such as combining it with alcohol.
One of the most effective ways of combating abuse of the drug, though, may be through the voices of victims' families. Liz Greaney is one person still struggling to come to terms with her daughter's death.
"What I would say to anyone heading out for a night and thinking of taking drugs [is to] think again and think of the consequences for themselves and for their family and their loved ones, because you can't imagine the devastation it causes so many people," she said this week.
"Tina is gone, she's buried, but the pain of that day is with me, her sister, her brother . . . It's a vicious circle of pain, loss and anger, and all for what? A bit of powder up their nose?"