Medical Matters: Cocaine has been in the news of late. The drug was instrumental in the downfall of British TV stars John Leslie and Angus Deayton. Use of the recreational drug is widespread, it seems, in the entertainment and music industries. The song Cocaine was a hit for Eric Clapton and was written at a time when the white powder was seen as a glamour substance with creative benefits.
When your day is done, and you got to run, cocaine.
She don't lie, she don't lie, cocaine.
- J.J. Cale 1976
J.J. Cale's lyrics refer to some of the effects cocaine has on the brain; it produces pleasant feelings of euphoria with the taker experiencing a huge rush of energy and optimism. Increased self esteem and sex drive are other immediate effects. However, these mostly pleasant feelings become diminished 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 become obsessed with apparently deep, philosophical issues.
Cocaine is the main active chemical in the leaves of Erythroxylon coca, a shrub which grows in South America and South-East Asia. Some of the indigenous tribes of South America are thought to have chewed coca leaves, which reportedly reduced fatigue and allowed then to accomplish more work.
The drug was introduced into European medicine in the 19th century when a French doctor, Angelo Mariani, began prescribing and selling medicines which included a generous helping of coca leaves.
An advertisement in the British Medical Journal in 1906 - extolling the virtues of Savars Coca wine, which contained half a gramme of pure cocaine per fluid ounce - showed how little was known about the dangers of the drug at that time.
In 1886, John Pemberton, a pharmacist in Atlanta, adopted Mariani's idea and produced a medicine called "Pemberton's French wine coca", which contained cocaine and cola nut extract. However, it was not until he diluted it with carbonated water that its popularity with the general public really grew. "Coca-Cola" was thus born as a refreshing and invigorating drink; the cocaine was removed in 1904 and replaced by caffeine because of concerns for public safety.
While cannabis remains the most popular illegal drug throughout Europe, cocaine use among young adults is on the increase according to recent research. The 2002 annual report on the state of the drugs problem in the EU shows a fivefold increase in cocaine use in people between the age of 16 and 29 compared with 1996.
Despite its trendy image and the belief amongst some users that it is "cleaner" and less addictive than other drugs, regular use can literally destroy the body.
Cocaine powder is snorted into the nostrils causing the 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 begins to disintegrate and a hole appears between the two nasal passages. A tell-tale sign of repeated cocaine use is a red, running stuffed-up nose, which is 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 cause blood vessels to narrow. This leads to a sudden and large rise in blood pressure. Again this is not permanent, but it can lead to 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 the blood between the inner and outer linings of the aorta. This false passage can easily burst (an aortic dissection) leading to a tearing pain in the chest or back. Research in the US has found that over one third of patients with the potentially fatal condition had been using cocaine.
Cocaine and alcohol are synergistic in the body; 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. Regular high-dose users of cocaine develop bouts of uncontrolled behaviour, with impaired judgment, impulsiveness and hyper sexuality. The user loses insight and may become briefly violent.
Muscle twitching and fits are a risk, especially in adolescents who smoke crack, a highly addictive form of the drug. And those withdrawing from cocaine experience unpleasant crawling feelings under the skin - "cocaine bugs" or "snow bugs" - which they describe as biting, creeping, burning or itching.
All in all, cocaine has the potential to cause death and disability and certainly does not deserve its reputation as a "clean" drug. We have seen its ability to destroy lives in the entertainment world. In the words of the songwriter, cocaine may not lie but neither does its reputation tell the whole truth about its toxicity and destructiveness.
mhouston@irish-times.ie