The Cocaine-Addicted Patient

  • Alan D. KayeEmail author
  • Julia L. Weinkauf


Cocaine (benzoylmethylecgonine, C17H21NO4), a natural alkaloid, is derived from Erythroxylon coca, a plant indigenous to parts of South America, Mexico, the West Indies, and Indonesia. It is a pharmacologically diverse drug with local anesthetic, central nervous system stimulant, and sympathomimetic properties. As a readily available herb, it has been used and abused for over 5,000 years. Initially ingested by the Andean people to treat high-altitude fatigue in South America, it had application also as a topical local anesthetic, for spinal anesthesia, and as a dilator of the pupil for cataract surgery [1]. In 1914, the Harrison Narcotic Act limited its medical use in the United States. Over the past 20 years, the abuse of cocaine has grown enormously because of ubiquitous availability and reduction in cost (When adjusted for inflation, cocaine is now approximately 20% of the 1980s street price) [2].


Minimum Alveolar Concentration Street Price Chronic Cocaine Uterine Blood Flow Central Nervous System Stimulant 
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  1. 1.
    Katzung BG. Drugs of abuse, Basic and clinical pharmacology. 10th ed. New York, NY: McGraw-Hill companies; 2007. p. 518–23.Google Scholar
  2. 2.
    Borden D. Editorial “Yes, the drug war really is still failing, DEA and ONDCP”. Accessed 11 Apr 2010.
  3. 3.
    US Department of Health and Human Services. National survey on drug use and health. Washington DC: US Department of Health and Human Services; 2008. Figures 2.1, 2.6.Google Scholar
  4. 4.
    Brookoff D, Campbell EA, Shaw LM. The underreporting of cocaine-related trauma: drug abuse warning network reports vs hospital toxicology tests. Am J Public Health. 1993;83(3):369–71.PubMedCrossRefGoogle Scholar
  5. 5.
    Feinstein L, Schmidt K. Cocaine users present unique anesthetic challenges: part 1. Anesthesiol News. 2010;36-2:8–9.Google Scholar
  6. 6.
    Pendergrast M. For god, country, and coca-cola. New York, NY: Charles Scribner’s Sons; 1993. p. 32–3. 90–91, 355–56.Google Scholar
  7. 7.
    Hertting G, Axelrod J, Whitby LG. Effect of drugs on the uptake and metabolism of H3-norepinephrine. J Pharmacol Exp Ther. 1961;134:146–53.Google Scholar
  8. 8.
    Jatlow PI. Drug of abuse profile: cocaine. Clin Chem. 1987;33:66B–71.PubMedGoogle Scholar
  9. 9.
    Bernards CM, Artru A, Visco E, et al. Chronic cocaine exposure alters carbon dioxide reactivity but does not affect cerebral blood flow autoregulation in anesthetized dogs. J Trauma. 2002;52:912–21.PubMedCrossRefGoogle Scholar
  10. 10.
    Lange RA, Hillis LD. Cardiovascular complications in cocaine use. N Engl J Med. 2001;345(5):351–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Hollander JE, Hoffman RS. Cocaine-induced myocardial infarction: an analysis and review of the literature. J Emerg Med. 1992;10:169–77.PubMedCrossRefGoogle Scholar
  12. 12.
    Meisels IS, Loke J. The pulmonary effects of free-base cocaine: a review. Cleve Clin J Med. 1993;60:325–9.PubMedGoogle Scholar
  13. 13.
    Jatlow P, Barash PG, Van Dyke C, et al. Cocaine and succinylcholine sensitivity: a new caution. Anesth Analg. 1979;58:235–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Chestnut DH. Substance abuse. In: Obstetric anesthesia: principle and practice, 3rd ed. New York, NY: Elsevier Mosby; 2004.Google Scholar
  15. 15.
    O’Brien CP. Drug addiction and drug abuse. In: Hardman JG, Limbird LE, editors. The pharmacological basis of therapeutics. New York, NY: McGraw-Hill; 2002. p. 621–42.Google Scholar
  16. 16.
    Ndikum-Moffor FM, Schoeb TR, Roberts SM. Liver toxicity from norcocaine nitroxide, an N-oxidative metabolite of cocaine. J Pharmacol Exp Ther. 1998;248:413–9.Google Scholar
  17. 17.
    Harris DS, Everhart ET, Mendelson J, Jones RT. The pharmacology of cocaethylene in humans following cocaine and ethanol administration. Drug Alcohol Depend. 2003;72:169–82.PubMedCrossRefGoogle Scholar
  18. 18.
    Wang Z, Fermini B, Nattel S. Mechanism of flecainide’s rate-dependent actions on action potential duration in canine atrial tissue. J Pharmacol Exp Ther. 1993;267:575–81.PubMedGoogle Scholar
  19. 19.
    Bauman JL, Grawe JJ, Winecoff AP, Hariman RJ. Cocaine-related sudden cardiac death: a hypothesis correlating basic science and clinical observations. J Clin Pharmacol. 1994;34:902–11.PubMedGoogle Scholar
  20. 20.
    Afonso L, Mohammad T, Thatai D. Crack whips the heart: a review of the cardiovascular toxicity of cocaine. Am J Cardiol. 2007;100(6):1040–3.PubMedCrossRefGoogle Scholar
  21. 21.
    Lucena J, Blanco M, Jurado C, Rico A, Salguero M, Vazquez R, et al. Cocaine-related sudden death: a prospective investigation in south-west Spain. Eur Heart J. 2010;31(3):318–29. Epub 2010 Jan 12.PubMedCrossRefGoogle Scholar
  22. 22.
    Kimura S, Bassett AL, Xi H, Myerburg RJ. Early after-depolarizations and triggered activity induced by cocaine. Circulation. 1992;85:2227–35.PubMedGoogle Scholar
  23. 23.
    DeWitt CR, Waksman JC. Pharmacology, pathophysiology and management of calcium channel blocker and beta-blocker toxicity. Toxicol Rev. 2004;23:223–38.PubMedCrossRefGoogle Scholar
  24. 24.
    Charbit B, Samain E, Merckx P, Funck-Brentano C. QT interval measurement. Anesthesiology. 2006;104:255–60.PubMedCrossRefGoogle Scholar
  25. 25.
    Khan IA, Long QT. Syndrome: diagnosis and management. Am Heart J. 2002;143:7–14.PubMedCrossRefGoogle Scholar
  26. 26.
    Chvilicek JP, Hurlbert BJ, Hill GE. Diuretic-induced hypokalaemia inducing torsades de pointes. Can J Anaesth. 1995;42:1137–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Solaini L, Gourgiotis S, Salemis NS, Koukis I. Bilateral pneumothorax, lung cavitations, and pleural empyema in a cocaine addict. Gen Thorac Cardiovasc Surg. 2008;56(12):610–2.PubMedCrossRefGoogle Scholar
  28. 28.
    Averbach M, Casey KK, Frank E. Near-fatal status asthmaticus induced by nasal insufflation of cocaine. South Med J. 1996;89(3):340–1.PubMedCrossRefGoogle Scholar
  29. 29.
    Gotway MB, Marder SR, Hanks DK, Leung JW, Dawn SK, Gean AD, et al. Thoracic complications of illicit drug use: an organ system approach. Radiographics. 2002;22:S119–35.PubMedGoogle Scholar
  30. 30.
    Restrepo CS, Carrillo JA, Martínez S, Ojeda P, Rivera AL, Hatta A. Pulmonary complications from cocaine and cocaine-based substances: imaging manifestations. Radiographics. 2007;27(4):941–56.PubMedCrossRefGoogle Scholar
  31. 31.
    Herrine SK, Park PK, Wechsler RJ. Acute mesenteric ischemia following intranasal cocaine use. Dig Dis Sci. 1998;43(3):586–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Lingamfelter DC, Knight LD. Sudden death from massive gastrointestinal hemorrhage associated with crack cocaine use: case report and review of the literature. Am J Forensic Med Pathol. 2010;31(1):98–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Nalbandian H, Sheth N, Dietrich R, Georgiou J. Intestinal ischemia caused by cocaine ingestion: report of two cases. Surgery. 1985;97(3):374–6.PubMedGoogle Scholar
  34. 34.
    Abramson DL, Gertler JP, Lewis T, Kral JG. Crack-related perforated gastropyloric ulcer. J Clin Gastroenterol. 1991;13(1):17–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Johnson BA, Dawes MA, Roache JD, Wells LT, Ait-Daoud N, Mauldin JB, et al. Acute intravenous low- and high-dose cocaine reduces quantitative global and regional cerebral blood flow in recently abstinent subjects with cocaine use disorder. J Cereb Blood Flow Metab. 2005;25(7):928–36.PubMedCrossRefGoogle Scholar
  36. 36.
    Levine SR, Brust JC, Futrell N, Ho KL, Blake D, Millikan CH, et al. Cerebrovascular complications of the use of the “crack” form of alkaloidal cocaine. N Engl J Med. 1990;323(11):699–704.PubMedCrossRefGoogle Scholar
  37. 37.
    Petty GW, Brust JC, Tatemichi TK, Barr ML. Embolic stroke after smoking “crack” cocaine. Stroke. 1990;21(11):1632–5.PubMedCrossRefGoogle Scholar
  38. 38.
    MacEwen C, Ward M, Buchan A. A case of cocaine-induced basilar artery thrombosis. Nat Clin Pract Neurol. 2008;4(11):622–6.PubMedCrossRefGoogle Scholar
  39. 39.
    Dhuna A, Pascual-Leone A, Langendorf F, Anderson DC. Epileptogenic properties of cocaine in humans. Neurotoxicology. 1991;12(3):621–6.PubMedGoogle Scholar
  40. 40.
    Daras M, Koppel BS, Atos-Radzion E. Cocaine-induced choreoathetoid movements (‘crack dancing’). Neurology. 1994;44(4):751–2.PubMedGoogle Scholar
  41. 41.
    Heesch CM, Negus BH, Steiner M, et al. Effects of in vivo cocaine administration on human platelet aggregation. Am J Cardiol. 1996;78:237–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Kugelmass AD, Oda A, Monahan K, Cabral C, Ware JA. Activation of human platelets by cocaine. Circulation. 1993;88(3):876–83.PubMedGoogle Scholar
  43. 43.
    Kuckowski KM, Birnbach DJ, Van Zunder A. Drug abuse in the parturient. Semin Anesth Perioperat Med Pain. 2000;19:216–24.CrossRefGoogle Scholar
  44. 44.
    Birnbach DJ, Stein DJ. The substance-abusing parturient: implications for analgesia and anesthesia management. Baillieres Clin Obstet Gynaecol. 1998;12:443–60.PubMedCrossRefGoogle Scholar
  45. 45.
    Kuckowski KM. Anesthetic implications of drug abuse in pregnancy. J Clin Anesth. 2003;15:382–94.CrossRefGoogle Scholar
  46. 46.
    Kuckowski KM. The cocaine abusing parturient: a review of anesthetic considerations. Can J Anaesth. 2004;51(2):145–54.CrossRefGoogle Scholar
  47. 47.
    Hollander JE. The management of cocaine-associated myocardial ischemia. N Engl J Med. 1995;333:1267–72.PubMedCrossRefGoogle Scholar
  48. 48.
    Hill GE, Ogunnaike BO, Johnson ER. General anaesthesia for the cocaine abusing patient: is it safe? Br J Anaesth. 2006;97:654–7.PubMedCrossRefGoogle Scholar
  49. 49.
    Susskind H, Weber DA, Volkow ND, Hitzemann R. Increased lung permeability following long-term use of free-base cocaine (crack). Chest. 1991;100:903–9.PubMedCrossRefGoogle Scholar
  50. 50.
    Baldwin GC, Choi R, Roth MD, et al. Evidence of chronic damage to the pulmonary microcirculation in habitual users of alkaloidal (“crack”) cocaine. Chest. 2002;121:1231–8.PubMedCrossRefGoogle Scholar
  51. 51.
    Norris KC, Thornhill-Joynes M, Robinson C, et al. Cocaine use, hypertension, and end-stage renal disease. Am J Kidney Dis. 2001;38:523–8.PubMedCrossRefGoogle Scholar
  52. 52.
    Hoffman RS. Cocaine and beta-blockers: should the controversy continue? Ann Emerg Med. 2008;51(2):127–9. Epub 2007 Sep 24.PubMedCrossRefGoogle Scholar
  53. 53.
    McCord J, Jneid H, Hollander JE, et al. Management of cocaine-associated chest pain and myocardial infarction: a scientific statement from the American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology. Circulation. 2008;117:1897–907.PubMedCrossRefGoogle Scholar
  54. 54.
    Battaglia G, Napier TC. The effects of cocaine and the amphetamines on brain and behavior: a conference report. Drug Alcohol Depend. 1998;52:41–8.PubMedCrossRefGoogle Scholar
  55. 55.
    Moreno AY, Janda KD. Immunopharmacotherapy: vaccination strategies as a treatment for drug abuse and dependence. Pharmacol Biochem Behav. 2009;92(2):199–205.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of Anesthesiology, LSU School of MedicineLouisiana State UniversityNew OrleansUSA
  2. 2.Department of AnesthesiologyMount Sinai School of MedicineNew YorkUSA

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