Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

198 III. SUBSTANCES OF ABUSEcates that crack may induce ischemic events, causing intestinal ruptures insome people (Muniz & Evans, 2001).Gastroenterological exposure to cocaine has been studied among drugsmugglers, among whom a 58% mortality rate has occurred when swallowedcocaine packets have ruptured (McCarron & Wood, 1983), or among thosewho swallow cocaine for other reasons. If a packet ruptures, causing severecocaine intoxication, immediate laparotomy for removal of the packets is thebest treatment option (Schaper, Hofmann, Ebbecke, Desel, & Langer, 2003).The treatment for those who swallow cocaine may be less clear, but each grouprequires medical attention.Complications of intranasal administration include loss of sense of smell,atrophy and inflammation, and necrosis and perforation of the nasal septum.Snorting cocaine may anesthetize and paralyze the pharynx and larynx, causinghoarseness and predisposing the person to aspiration pneumonia (Estroff &Gold, 1986). Recurrent snorting of cocaine may result in ischemia, necrosis,and infections of the nasal mucosa, sinuses, and adjacent structures.In terms of pulmonary effects, pneumomediastinum and cervical emphysemahave been reported after smoking cocaine due to alveolar rupture withprolonged deep inspiration and Valsalva’s maneuver (Aroesty, Stanley, &Crockett, 1986). Other respiratory complications of inhaling or smokingfreebase cocaine include abnormal reductions in carbon monoxide diffusingcapacity (Itkonen, Schnoll, & Glassroth, 1984), granulomatous pneumonitis(Cooper, Bai, Heyderman, & Lorrin, 1983), pulmonary edema (Allred & Ewer,1981), thermal airway injury, pulmonary hemorrhage, hypersensitivity reactions,interstitial lung disease, obliterative bronchiolitis, asthma, and persistentgas-exchange abnormalities (Laposata & Mayo, 1993). Respiratory manifestationsinclude shortness of breath, cough, wheezing, hemoptysis, and chest pains.Severe respiratory difficulties have been reported in neonates of abusing mothers.Inhalation of hot cocaine vapors may also result in bilateral loss of eyebrowsand eyelashes (Tames & Goldenring, 1986), and preparation of freebasecocaine with solvents such as ether may result in accidental burns and explosions.Complications of intravenous cocaine use are multiple and include skinabscesses, phlebitis and cellulitis, and septic emboli resulting in pneumonia, pulmonaryabscesses, subacute bacterial endocarditis, ophthalmological infections,and fungal cerebritis (Wetti, Weiss, Cleary, & Gyori, 1984). Injected talc and silicatemay cause granulomatous pneumonitis with pulmonary hypertension, as wellas granulomata of the liver, brain, or eyes (Estroff & Gold, 1986). Hepatitis B,hepatitis C, and delta agent are all too frequently by-products of intravenous drugabuse. In the past several years, concomitant with the increase in HIV infection,there has been an increase in pneumonia, endocarditis, tuberculosis, and hepatitisdelta and other sexually transmitted diseases in drug users (see Chapter 19 onHIV and addictions for more information on cocaine and HIV/AIDS).