Madam, - Last week's RTÉ Prime Time special on the devastating social consequences of cocaine misuse in Ireland was a suitably shocking wake-up call. It also neatly illustrated the Hollywood aphorism that "cocaine is God's way of saying you're making too much money".
What the programme did not make clear, however, is that the cocaine epidemic involves more than needles, prostitution and criminality. It primarily affects the "middle classes", who are attending emergency departments here in ever increasing numbers with violent behaviour, chest pains, seizures, and the other common complications of cocaine misuse. Arguably, the greatest immediate public health problem is that healthcare professionals are largely oblivious to the hazards of cocaine.
In the past few weeks in Cork, for instance, "ordinary people" have attended both inner-city emergency departments with collapsed lungs and only the curiosity of older, perhaps more cynical, staff led to confirmation by urine testing of the underlying cocaine misuse. Few medical or nursing undergraduates receive useful education in substance misuse, so many fail to appreciate how often "emergencies" are caused by illicit drug. Compounding the problem is patients' economy with the truth.
It is imperative that we learn the lessons of recent epidemics in North America and the United Kingdom. Staff in every emergency department in this country must routinely consider cocaine and other substance misuse as a cause of hospitalisation. If we fail to look for cocaine misuse - by enquiring and by testing patient's urine - we will continue, negligently in my view, to miss the cause behind dozens of hospital cases every week.
Once we do look, we can begin the process of effectively managing substance misuse. Thereafter, we could look further afield and start to recognise the common thread in so many cases of air rage, unprovoked homicide and sudden death in custody. - Yours, etc.,
L. C. LUKE,
Consultant in Accident
and Emergency Medicine,
Cork University Hospital.