Wednesday, February 20, 2019

Cocaine Addiction

Ruwan M Jayatunge M.D.
Cocaine, also known as benzoylmethylecgonine or coke, is a strong stimulant mostly used as a recreational drug (Pomara et al., 2012). It is a crystalline alkaloid found in the Erythroxylum cocacoca and Erythroxylumnovogranatense plant species ( Karila  et al.,2011).  Pure cocaine is originally extracted from the leaf of the Erythroxylon coca bush.

There are basically two chemical forms of cocaine: the hydrochloride salt and the freebase.” The hydrochloride salt, or powdered form of cocaine, dissolves in water and, when abused, can be taken intravenously (by vein) or intranasally (in the nose). Freebase refers to a compound that has not been neutralized by an acid to make the hydrochloride salt. The freebase form of cocaine is smokable (NIDA).

Cocaine   leads to the rapid accumulation of catecholamines and serotonin in the brain due to prevention of their re-uptake into the neuron that released the neurotransmitter (Shorter &, Kosten, 2011).  Cocaine is believed to work by blocking the dopamine transporter (DAT) and thereby increasing the availability of free dopamine within the brain (Ritz et al., 1987).

Cocaine addiction is an important public health problem worldwide (Haas et al., 2009).   According to the recent studies, 0.3–0.5% (or 14–21 million people) of the global population aged 15–64, are estimated to be cocaine users (Degenhardt & Hall, 2012).  Cocaine addiction is rapidly progressive and associated with severe medical, psychiatric, and psychosocial consequences (Dackis &, O’Brien, 2001).

The effects of chronic cocaine abuse have been widely described in the literature. The chronic use of cocaine is also associated with major medical, neurological, and neuropsychiatric complications (Bolla et al., 1998).  Common complications include nasal septal perforation, saddle-nose deformity, and palatal perforation (Vilela et al., 2002).  Cocaine snorting may cause significant local ischemic necrosis and the destruction of nasal and midfacial bones and soft tissues, leading to the development of a syndrome called cocaine-induced midline destructive lesion (Colletti et al., 2013).

 Cocaine abusers have specific dysfunction of executive functions (decision making, judgment) and that this behavior is associated with dysfunction of specific prefrontal brain regions, the orbitofrontal cortex, and anterior cingulate gyrus (Bolla et al.,1998). Cocaine produces its psychoactive and addictive effects primarily by acting on the brain’s limbic system, a set of interconnected regions that regulate pleasure and motivation (Nestler, 2005). 

Cocaine can induce anxiety and panic in humans (Goeders, 2002). Cocaine-induced paranoia is a common experience among chronic users (Brady et al., 1991). Chronic cocaine users have reported   cocaine withdrawal related depression, which may be a neurophysiologic response to the elimination of cocaine from the CNS. (Bolla et al., 1998).

Cocaine has cardiovascular effects, including disturbances in heart rhythm and heart attacks; such respiratory effects as chest pain and respiratory failure; neurological effects, including strokes, seizure, and headaches; and gastrointestinal complications, including abdominal pain and nausea.  Cocaine use in pregnancy can lead to spontaneous abortion, preterm births, placental abruption, and congenital anomalies (Malek, 2012).

 Development of effective treatments for cocaine dependence is necessary to reduce the impact of this illness upon both the individual and society (Shorter &, Kosten 2011). Some treatment approaches, such as cognitive behavioral therapy (CBT) and medications have shown promise in successfully treating cocaine dependence (Penberthy et al., 2010).  CBT is focused on helping cocaine-addicted individuals abstain—and remain abstinent—from cocaine and other substances (NIH). Furthermore CBT has shown to be effective for decreasing cocaine use and preventing relapse.

Cocaine Detoxification (Medical Detoxification) also helps in treatment. Cocaine Detoxification is a process that systematically and safely withdraws people from addicting drugs, usually under the care of a physician. In addition Therapeutic communities (TCs), or residential programs, offer another alternative to persons in need of treatment for cocaine addiction. TCs usually require a 6- or 12- month stay and use the program’s entire “community” as active components of treatment. Schierenberg and colleagues (2012) suggested Contingency Management (CM), a promising behavior therapy using operant conditioning, is evaluated for the treatment of cocaine dependence.

Bolla ,K.I., Cadet, J.L., London, E.D.(1998).The neuropsychiatry of chronic cocaine abuse. J Neuropsychiatry Clin Neurosci.  ;10(3):280-9.

Brady, K.T., Lydiard, R.B., Malcolm, R., Ballenger, J.C.(1991).Cocaine-induced psychosis.J Clin Psychiatry.  ;52(12):509-12.

Colletti, G., Allevi, F., Valassina, D., Bertossi, D., Biglioli, F.(2013).Repair of cocaine-related oronasal fistula with forearm radial free flap.J Craniofac Surg.  ;24(5):1734-8.

Dackis, C.A., O’Brien, C.P.(2001).Cocaine dependence: a disease of the brain’s reward centers.J Subst Abuse Treat. ;21(3):111-7.

Degenhardt, L., & Hall, W.(2012). Extent of illicit drug use and dependence, and their contribution to the global burden of disease. Lancet, 379(9810), 55–70.

Goeders, N.E.(2002).Stress and cocaine addiction.J Pharmacol Exp Ther. ;301(3):785-9.

Haas, C., Karila, L., Lowenstein, W.(2009).[Cocaine and crack addiction: a growing public health problem].Bull Acad Natl Med. ;193(4):947-62; discussion 962-3.

Karila, L. , Reynaud, M., Aubin, H.J., Rolland, B., Guardia, D., Cottencin, O, Benyamina, A.(2011).Pharmacological treatments for cocaine dependence: is there something new? Curr Pharm Des. ;17(14):1359-68.

Malek, A. (2012) Effects of Prenatal Cocaine Exposure on Human Pregnancy and Postpartum. Pharmaceut Anal Acta 3:191.

Nestler, E.J.(2005).The neurobiology of cocaine addiction.Sci Pract Perspect.  ;3(1):4-10.

Penberthy, J.K., Ait-Daoud, N., Vaughan, M., Fanning, T.(2010).Review of treatment for cocaine dependence. Curr Drug Abuse Rev.  ;3(1):49-62.

Pomara, C., Cassano, T., D’Errico, S; Bello, S; Romano, AD; Riezzo, I; Serviddio, G (2012). “Data available on the extent of cocaine use and dependence: biochemistry, pharmacologic effects and global burden of disease of cocaine abusers.”. Current medicinal chemistry 19 (33): 5647–57.

Ritz, M.C., Lamb, R.J., Goldberg, S.R., Kuhar, MJ.(1987).Cocaine receptors on dopamine transporters are related to self-administration of cocaine.Science.  4;237(4819):1219-23.

Schierenberg, A., van Amsterdam, J., van den Brink, W., Goudriaan, A.E.(2012).Efficacy of contingency management for cocaine dependence treatment: a review of the evidence. Curr Drug Abuse Rev.  ;5(4):320-31.

Shorter, D., Kosten, T.R.(2011).Novel pharmacotherapeutic treatments for cocaine addiction.BMC Med.   3;9:119.

Vilela, R.J., Langford, C., McCullagh, L., Kass, E.S.(2002).Cocaine-induced oronasal fistulas with external nasal erosion but without palate involvement.Ear Nose Throat J.  ;81(8):562-3.

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