Cocaine
Introduction and statistics:
Cocaine is known by the street names coke, C, snow, flake, and blow. In North America,
addiction to and abuse of cocaine are serious health issues. According to the NSDUH, an
estimated 1.5 million Americans were either dependent on cocaine or had abused it within the
previous 12 months in 2012. According to the same survey, there are an estimated two million
current users of cocaine (those who have used it within the last month), and an estimated 567,000
current users of crack. When it comes to age groups, adults between the ages of 18 and 25 have
the highest rate of cocaine use.
The highly addictive drug cocaine can be smoked, injected, sniffed, or snorted. The material
utilized is an extract from the leaves of the Erythroxylon coca bush, which is mainly grown in
Bolivia and Peru.
It is commonly supplied as freebase (rock) or powdered hydrochloride salt. Cocaine in powder
form is easily dissolved in water and can be taken orally or intravenously. Freebase is a
processed form of cocaine that is suitable for smoking because it has not been neutralized by an
acid to create the hydrochloride salt. The sound that is produced when the mixture is smoked is
referred to as the "crack." Cocaine users experience euphoria and energy, but excessive use can
lead to strange and violent behavior.
Patterns of Use:
1. Cocaine is commonly used through methods such as snorting, smoking (crack cocaine),
injecting, oral ingestion, and topical application.
2. Snorting cocaine results in rapid absorption through the nasal mucosa, leading to a short-
lived but intense high and potential nasal complications.
3. Smoking crack cocaine delivers a quick and intense euphoria, with associated risks of
respiratory issues and infections.
4. Injecting cocaine intravenously provides an almost instant and powerful high but comes
with elevated risks of cardiovascular complications and infections.
5. Oral ingestion and topical application are less common methods, with oral use resulting
in a slower onset of effects and potential gastrointestinal complications.
Mechanism of action:
Cocaine addiction is a widespread problem that has extensive ramifications that go beyond the
immediate sense of euphoria felt by users. The addictive nature of it is rooted in an intricate
mechanism of action.
Cocaine functions by impeding the reuptake of neurotransmitters, specifically dopamine, within
the reward pathways of the brain. This disturbance results in a buildup of dopamine, inducing
profound sensations of pleasure and euphoria. However, the duration of these effects is brief,
which leads individuals to pursue frequent and increasing amounts of the substance in order to
sustain the desired sensations. This ultimately creates a pattern of reliance and addiction.
General health Complications:
Several potentially severe medical complications are associated with cocaine use. Among the
most frequent complications are cardiovascular effects, including disturbances in heart rhythms
(ventricular fibrillation), heart attacks, strokes, and hypertension. Cocaine abuse may cause chest
pain and respiratory failure, headaches, seizures, and
gastrointestinal problems, including abdominal pain and nausea.
Different routes of cocaine use can produce varying adverse
effects. Persons who inject cocaine will exhibit needle tracks
(venipuncture sites) on various parts of the body, most commonly
on the forearm. Intravenous cocaine users may experience allergic
reactions, either to the drug or some additive in street cocaine. In
severe cases, such reactions can result in death. IV drug users are
also susceptible to sub-acute bacterial endocarditis (SBE) and
should take prophylactic antibiotics as a precautionary measure.
Long-term effects of snorting cocaine include nosebleeds, problems with swallowing,
hoarseness, loss of sense of smell, and an overall irritation of the nasal mucosa, which can lead to
a chronically inflamed, runny nose.
Because cocaine has a tendency to cause loss of appetite with resulting decreased food intake,
many chronic cocaine users experience significant weight loss and malnourishment. In addition,
there is a potentially dangerous interaction between cocaine and alcohol. When taken in
combination, the body converts the two drugs to coca-ethylene, which has a longer duration of
action in the brain and is more toxic than either drug alone. The mixture of cocaine and alcohol
is a common two-drug combination cause of drug-related death.
Dental and Orofacial Complications:
Cocaine consumption can directly and negatively impact the tissues in
the mouth, resulting in a wide range of complications. Vasoconstriction
caused by cocaine decreases blood flow to the oral tissues, which
negatively affects the health of the gums and teeth. The reduced blood
supply leads to a higher susceptibility to dental caries, periodontal
disease, and eventual tooth extraction. Dental professionals often come
across patients who have dental problems caused by cocaine use,
requiring a careful and thorough approach.
Cocaine addiction not only causes obvious dental problems, but also presents specific risks to the
mouth and face. Bruxism, also known as teeth grinding, is a prevalent consequence of cocaine
consumption, leading to the erosion of tooth enamel, discomfort in the jaw, and disorders in the
temporomandibular joint. The drug's stimulant properties can also result in heightened oral
activity, characterized by repetitive movements of the tongue and lips. This can contribute to the
formation of oral sores and lesions.
Dental management of cocaine addiction patients:
Chronic cocaine users should not be given local anesthesia containing epinephrine because the
vasoconstrictive effects of epinephrine may lead to an acute hypertensive crisis. It is of
paramount importance that the dentist be informed if the patient has used cocaine before the
dental appointment. Although most cardiovascular effects of cocaine diminish a few hours after
use, the blood pressure can remain elevated. Even if the patient states that he or she has stopped
using the drug, it is imperative to check the blood pressure before initiating treatment.
Dentists play a vital role in identifying and managing cases of cocaine addiction, given the
distinct difficulties associated with this condition. It is crucial to collaborate with addiction
specialists and healthcare professionals in order to address the wider aspects of addiction and
help individuals on their path to recovery. Dental interventions encompass not only the treatment
of immediate oral health issues but also the provision of education and assistance to aid
individuals in maintaining optimal oral hygiene throughout their recuperation.
References:
1. Stefanac, S. J., & Nesbit, S. P. (2024a). Diagnosis and treatment planning in Dentistry.
Elsevier.
2. Nassar, P., & Ouanounou, A. (2020). Cocaine and methamphetamine: Pharmacology and
dental implications. Canadian Journal of Dental Hygiene, 54(2), 75.
3. Canadian Centre on Substance Use and Addiction. Changes in stimulant use and related
harms: Focus on methamphetamine and cocaine. CCENDU Bulletin. Ottawa ON: CCSA;
2019.
4. Melo, C. A. A., Guimarães, H. R. G., Medeiros, R. C. F., Souza, G. C. de A., Santos, P.
B. D. dos, & Tôrres, A. C. S. P. (2022). Oral changes in cocaine abusers: an integrative
review. Brazilian Journal of Otorhinolaryngology, 88(4), 633–641.
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