Side Effects of Cocaine Addiction: Extending Beyond the Mental Health Concerns

The Physiological Consequences of Cocaine Consumption

Cocaine is classified as a potent stimulant, affecting the sympathetic nervous system. It blocks the reuptake of catecholamines, increasing norepinephrine activity and overstimulating the adrenergic system (Riezzo et al., 2012). The detrimental physiological effects of cocaine consumption lie directly within the metabolization of noradrenaline and norcocaine (Riezzo et al., 2012). The result is mitochondrial dysfunction and oxidative stress, causing structural changes to vital organs including the brain, heart, liver, and kidneys.

Acute Physiological Impacts of Cocaine Use

One of the most significant physiological effects of cocaine use is its impact on the cardiovascular system. Acute effects notably studied on the heart include electrocardiographic abnormalities, hypertension, and myocardial infarction (MI). Prolonged sympathetic nervous system activity and blocked potassium and sodium channels stimulate abnormal cardiovascular profiles (Park, 2019).

Coronary events occur within minutes to hours after cocaine use. Cocaine binds to norepinephrine transporters, increasing its effects. This also blocks the reuptake of norepinephrine, triggering tachycardia and hypertension. Cocaine specifically induced hypertension through increasing vasoconstriction. These events together result in acute vessel damage, blood clots, and acute damage to the heart muscle (Park, 2019).

Acute MI from cocaine is multifaceted. The sympathomimetic effects of cocaine produced similar effects to a local anesthetic in low doses, increasing blood pressure, heart rate, and myocardial oxygen demand. In high doses, the anesthetic effects caused a decrease in left ventricular contractility and prolonged QRS and QT intervals on ECG. Vasoconstriction and thrombosis reduce myocardial oxygen and the inverse of supply and demand results in an MI (Park, 2019).

Chronic Health Implications of Prolonged Cocaine Use

Chronic cocaine use disrupts the adrenergic system, resulting in vasospasms through stimulation of the coronary arteries. The result is significant coronary atherosclerosis, specifically noted in younger chronic cocaine users. This highlights that coronary health conditions including coronary heart disease result from prolonged cocaine use (Patrizi, n.d.).

One study accentuated the likelihood of developing plaque burden from chronic cocaine use. Though the total plaque volume between chronic cocaine users and non-cocaine users was statistically similar, the left anterior descending artery (LAD) plaque volume yielded significantly higher volumes in the chronic cocaine group. Levels in this group showed 154.6 + 127.7 mm3 for LAD volume, whereas the non-cocaine group yielded 72.5 + 70.0 mm3 (Long-Term Cocaine Use Is Associated With Increased Coronary Plaque Burden – a Pilot Study, 2020). The results showed that sublingual atherosclerosis occurs during chronic cocaine use, and continued ingestion of the substance will result in further atherosclerosis burden.

Cognitive and Psychological Impairments: An Examination of Cocaine-Induced Psychosis

Numerous studies have compared cocaine use and the induction of psychological impairments, including the development or presence of a psychotic disorder. Dopamine levels cortically within the brain are the root cause of hallucinations, paranoia, and suspiciousness when referring to CIP. CIP is short-term and occurs in both early use and chronic use. A separate condition known as cocaine-induced psychotic disorder (CIPD) involves auditory and visual hallucinations that occur long-term (Sasiadek et al., 2021).

Both psychotic disorders and CIP/CIPD have been linked to dysfunction in dopaminergic activity. Novel psychoactive substances (NPS) are desired for their dopaminergic activity, creating euphoric and stimulating effects. The reward system reacts by signaling the urge to continue taking more cocaine until there is no supply left. Dopamine itself holds no value in this case, as it does not cause fatal reactions. The effects of the cocaine ingested cause adrenergic toxicity within the cardiovascular system (Dawson & Moffatt, 2012). Left untreated, the toxicity will become fatal.

Cocaine-induced psychosis is not solely attributed to elevated dopamine levels. During a cocaine overdose, altered mental status is accompanied by tachycardia, seizures, and hyperthermia. CIP manifesting specifically during overdose episodes does not always occur during regular use. A thorough patient history is crucial to differentiate CIP from other substance-induced psychoses, such as delirium tremens (DTs), to ensure accurate diagnosis and treatment (Cocaine Toxicity – StatPearls, 2023).

Psychopathological Consequences of Cocaine Use Disorder

A study was conducted on participants who had been using cocaine for at least 7 years and had met the DSM-V criteria for substance dependence. Among them, a psychopathological comorbidity rate of 61.8% was noted. 34.5% of participants presented with mood disorders, 22.7% with anxiety disorders, and 15.5% with psychotic disorders. Cocaine use disorder has been seen to induce more mood and psychiatric disorders than those who were primarily diagnosed with anxiety and other mental health conditions ([Psychopathological Comorbidity in Cocaine Users in Outpatient Treatment], n.d.). This study highlights the psychopathological consequences associated with cocaine use disorder.

Routes of Administration and Their Impact on the Pharmacodynamics of Cocaine

Route administration and how it impacts the pharmacodynamics of cocaine has limited research. A study conducted compared the results of participants receiving cocaine intravenously, intranasally, and smoking through single doses of each. Physiological and behavioral samples were collected before administration and throughout the duration of the cocaine. Blood samples were also collected and analyzed for cocaine concentrations and the metabolite benzoylecgonine (Cone, n.d.). The results were fitted to pharmacokinetic models by nonlinear regression analysis and described as below:

Method of Use

• Smoking
  • Associated with “good” and “liking” the effects
  • Same plasma concentrations as intravenous
• Intravenous
  • Behavior response not as high as smoking, less effective
  • Same plasma concentrations as smoking
• Intranasal
  • Created slower onset of effects with lesser magnitude
  • Lower plasma concentrations than smoking and intravenous

Cocaine Addiction Treatment From Experts at Alta Mira

The adverse effects of cocaine use present significant challenges to both the cardiovascular and neurological systems. Complications such as psychosis, irreversible cardiac weakness, and organ damage can lead to severe and potentially fatal outcomes. Comprehensive care that addresses both the physical and psychological aspects of cocaine use is essential for effective treatment.

At Alta Mira, the expert team employs a multidisciplinary approach to treatment. The four-step treatment approach includes an extensive physiological evaluation, mental health assessments, rigorous neuropsychological testing, and continuous clinical monitoring. This thorough process enables the development of individualized treatment plans for each patient’s needs, ensuring a comprehensive path to recovery.

Cocaine can wreak havoc on the brain and body, but help is available through the cocaine rehab program at Alta Mira, located in Sausalito, CA. Our team accepts patients from all backgrounds and allows them to bring their pets for moral support. To refer a patient, call 866-922-1350.

Alta Mira: Science-backed treatment, world-class care.

Sources:

Cocaine Toxicity – StatPearls. (2023, June 8). NCBI. Retrieved September 6, 2024, from https://www.ncbi.nlm.nih.gov/books/NBK430976/

Cone, E. (n.d.). Pharmacokinetics and pharmacodynamics of cocaine. PubMed. Retrieved September 6, 2024, from https://pubmed.ncbi.nlm.nih.gov/8926741/

Dawson, P., & Moffatt, J. D. (2012, December 03). Cardiovascular toxicity of novel psychoactive drugs: Lessons from the past. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 39(2), 244-252. Retrieved 2024, from https://www.sciencedirect.com/science/article/abs/pii/S0278584612001054

Long-term cocaine use is associated with increased coronary plaque burden – a pilot study. (2020, September 29). NCBI. Retrieved September 6, 2024, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8311667/

Park, T. (2019, January 29). Acute and Chronic Effects of Cocaine on Cardiovascular Health. NCBI. Retrieved September 6, 2024, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6387265/

Patrizi, R. (n.d.). Cocaine and coronary artery diseases: a systematic review of the literature. PubMed. Retrieved September 6, 2024, from https://pubmed.ncbi.nlm.nih.gov/28306693/

[Psychopathological comorbidity in cocaine users in outpatient treatment]. (n.d.). PubMed. Retrieved September 6, 2024, from https://pubmed.ncbi.nlm.nih.gov/24652395/

Riezzo, I., Fiore, C., De Carlo, D., Pascale, N., Neri, M., Turillazzi, E., & Fineschi, V. (2012). Current Medicinal Chemistry, Volume 19, Number 33, 2012, pp. 5624-5646(23). Side Effects of Cocaine Abuse: Multiorgan Toxicity and Pathological Consequences. Retrieved 09 06, 2024, from https://www.ingentaconnect.com/content/ben/cmc/2012/00000019/00000033/art00007

Sasiadek, J., Lowe, D. J.E., Rioux, S.-M., & George, T. P. (2021). Psychotic Disorders. Substance Use Psychosis. Retrieved 2024, from https://www.sciencedirect.com/topics/neuroscience/cocaine-induced-psychosis