Cocaine abuse and acquired immunodeficiency syndrome: a tale of two epidemics

Article Abstract:

In the 1980s, the country was faced with two major epidemics. Cocaine abuse and the acquired immunodeficiency syndrome (AIDS). The two are similar in that they both affect small populations, increase health care costs, and have associated secondary illnesses. AIDS is primarily a health issue and has gained wide support from federal agencies which have collaborated with health-care agencies to improve the understanding of AIDS in just a few years. Increased research has led to improved methods of diagnosis, prevention and education. Governmental regulations have been modified to accept new drugs for the treatment of secondary diseases caused by AIDS. The dissemination of scientific information in journals and newspapers has been substantial. In contrast, progress in the understanding of cocaine addiction has been slow. The drug problem is primarily governed by the National Institute on Drug Abuse, which focuses on the 'war on drugs' with very little attention paid to related health issues. In confronting cocaine addiction, there are very few experienced health-care professionals. Less than 30 fellowships are offered by medical institutions in the US for the study of cocaine addiction. This lack of research has prevented the development of medical expertise for dealing with cocaine addiction. A recent article in the New England Journal of Medicine by Ettinger and Albin (a review appears in the December 1989 issue of The American Journal of Medicine), addressed one potential health problem facing cocaine addiction, the effect of cocaine use on the lungs. These researchers provided an excellent source of information regarding health issues related to cocaine addiction. Once the focus of issues surrounding the AIDS epidemic moved away from behavior and social groups to health, advancements were made. When the health problems of cocaine addiction move into the spotlight, basic questions regarding health issues will be answered. (Consumer Summary produced by Reliance Medical Information, Inc.)

Laws, regulations and rules, Drug addicts, Drug abusers, AIDS (Disease), editorial

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Pulmonary infarction associated with crack cocaine use in a previously healthy 23-year-old woman

Article Abstract:

Cocaine use may cause ischemia, or insufficient blood supply to tissues or organs. A case is described of a 23-year-old woman who used 'crack' cocaine and subsequently developed pulmonary infarction, or death of lung tissue due to cessation of blood supply. The patient was admitted to the hospital after three days of pain in the chest. She reported recent use of crack cocaine, but had no history of intravenous drug abuse. Diagnostic tests revealed abnormalities in blood flow and blood vessel obstruction (blockage) in the right lower lung. She was treated with heparin, a drug that prevents the coagulation of blood. The patient began to spit up blood, and the heparin was discontinued. Surgery revealed that 20 percent of the lower lobe of the right lung was infarcted, or decayed due to lack of blood supply. The dead lung tissue was removed, and the patient recovered. Cocaine may cause vasospasm, or transient constriction of blood vessels, leading to diminished blood flow and insufficient blood supply to tissues. This drug may also promote thrombosis (the formation of blood clots) by causing damage to the endothelial cells lining the vessels, or by creating conditions that enhance blood coagulation. Cocaine has also been reported to cause widespread bleeding of alveoli (the gas-exchanging units of the lungs), accumulation of cells and fluids in lung tissue, impaired breathing, vasospasm, and overgrowth of the blood vessels supplying the lungs. In this case, cocaine may have caused vasospasm and a localized blood clot, which led to insufficient blood supply and tissue death in a portion of the lung. (Consumer Summary produced by Reliance Medical Information, Inc.)

Lungs, Ischemia, Infarction, Pulmonary circulation

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A review of the respiratory effects of smoking cocaine

Article Abstract:

Smoking cocaine, crack or freebase can produce many adverse effects, particularly lung complications. Pulmonary edema is a potentially fatal accumulation of fluid in the lungs which causes breathing difficulties, rapid heart beat and low blood pressure. Smoking cocaine irritates the lungs and can result in a hypersensitivity phenomena, a reaction which resembles asthma. Pulmonary hemorrhage, or bleeding in the lungs, may be caused by the ability of cocaine to constrict blood vessels; pulmonary hemorrhage damages lung tissue and the epithelial cells lining the lungs. Pulmonary barotrauma can be produced by a maneuver commonly used by cocaine smokers to enhance the drug's effects. The resulting changes in pressure within the lungs can lead to pneumothorax (air leaks out of the lungs and into the thorax). Bronchiolitis, the swelling of the bronchiole level of the air passages, is a potential cause of respiratory failure, but is rarely reported. Abnormal findings on pulmonary function tests are noted after smoking cocaine. The mechanisms responsible for these lung complications and the influence of tobacco and other adulterants on these cocaine effects are not understood. (Consumer Summary produced by Reliance Medical Information, Inc.)

Lung diseases, Pulmonary edema

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