Cocaine abuse ‘on upward trajectory’, say doctors

Use of drug ‘higher than Celtic Tiger levels’ and set to rise further, say specialists

Doctors say they are increasingly treating patients for health problems caused by cocaine, though cannabis remains the main illicit drug that is abused.

Consultant psychiatrist Prof Brendan Kelly, speaking after the publication of a report from the Health Research Board finds young people are drinking less but taking significantly more cocaine, notes a steady rise in cocaine use among young and middle-aged patients. “It’s not just professionals as it used to be, it’s right across the population. People tend to use it weekly or twice-weekly, often in social gatherings. Certain groups think cocaine use is acceptable, when in fact it is very harmful.”

Prof Kelly lists the very many harmful effects he sees in patients — mood swings, paranoia, irritability, social difficulties and disturbances within the family. “It is also associated with insomnia and over-confidence, but these things have rebound effects that more than outweigh any perceived benefit.”

Prof Kelly points out that alcohol accounted for more psychiatric admissions than illegal drugs in 2018. By 2019, alcohol and illegal drugs were running neck and neck and in 2020, illegal drugs overtook alcohol as the main source of psychiatric admission.

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Asked what advice he would give to worried parents, Prof Kelly said the most important thing is to talk to children about what substances they might be using. “Be sure to talk to them in understanding and initially non-judgemental ways, and probe gently to understand where the motivation for change might come from.”

North Dublin GP and associate professor of general practice in UCD Ray Walley likens cocaine abuse to “plugging into an electricity circuit that quickens you up to the point that things start to go wrong”.

Short-term physical effects include agitation, a decreased need for food or sleep, increased heart rate and a feeling of hotness, he says. The psychological effects include anxiety, panic and paranoia.

In the long term, Dr Walley says, cocaine abuse can lead to cardiovascular problems such as clots, stroke and angina, along with increased blood pressure and an irregular heartbeat that can result in sudden death. “There is also the general degradation of the human being, the difficulty in remembering things and in making choices, how ratty you become.”

One patient, still in his early 30s, suffered heart damage caused by taking cocaine, leading to myocardial infarction.

But Dr Walley also makes the point that, despite the headlines about cocaine use among young people, cannabis remains the drug that is most widely abused.

“Cannabis gets overlooked in all the talk about illegal drugs, but in my decades of experience it is the biggest cause of presentations for any drug. My experience also tells me that it is a gateway drug for others, though this is hard to prove scientifically.”

Consultant child and adolescent psychiatrist Prof Bobby Smyth pointed to the finding by the Health Research Board that drug poisonings have fallen 60 per cent in the last decade. “There tends to be a lot of nihilism and hopelessness around drug problems in Ireland but this is certainly good news.”

Cocaine use — “which tends to be related to the amount of money sloshing around in people’s pockets” — now exceeds Celtic Tiger levels, he said.

While cannabis remains the dominant driver of demand for addiction treatment, cocaine is “on an upward trajectory and it is difficult to know where this will stop”.

He added: “There is a complacency, and a normalisation of use around drugs like cannabis and cocaine among sectors of the population, that is a worry.”

Paul Cullen

Paul Cullen

Paul Cullen is Health Editor of The Irish Times