Substance Abuse in WV - West Virginia State Medical Association

Special Issue | Scientific ArticleTable 2able 1whose charts lacked adequate clinicalinformation. There were a reported1,152 positive urine drug screensfor cocaine at CAMC ER in 2006.In total, a randomized 628 chartswere reviewed with 429 meeting thecriteria (n=429). Patients’ electronicmedical records were reviewed.FindingsThe mean age of patientspresenting with cocaine-positive drugscreens in this study was 35 yearswith a range of 18-57 years, with 61%being male and 39% being female.About 21% of patients complainedof drug-related problems, includingdrug abuse and overdose. The mostcommon discharge diagnoses in2006 were psychiatric conditionsand drug-related problems (drugabuse and drug overdose), at30% and 62%, respectively.Of patients presenting withcocaine-positive drug screens, 42%volunteered their histories of drugabuse. Of the total sample reviewed,12% involved a trauma prioritypatient. Furthermore, of the traumapopulation reviewed, the cocainepositivesample involved three timesas many males as females. For thetotal sample, the most commonconcurrently abused drug was THC(41%), followed by benzodiazepines(30%) and opiates (28%) (Table 1).Of the total sample reviewed (429)42 patients (10%) presented to theER in the year prior (2005) withpositive UDS. Similarly, of the totalsample (429) 59 patients (14%) hadreturned to the ER in the followingyear (2007) with positive UDS.Of the population reviewed,40% had some sort of concurrentTable 1. Concurrent DrugsTHC 206*Benzo 150*Opiates 138*ETOH 102*Amine 33**Several patients were using multipledrugs at the same time.Table 2. Psychiatric Diagnosis DiagnosisDepression 41%Bipolar Disorder 28%Anxiety 18%Schizophrenia 8%Unknown 2%Other 2%Borderline Personality 1%psychiatric disorder. Specifically22% had depression, and 15%had bipolar disorder (Table 2).DiscussionCocaine, extracted from theErythroxylum coca plant, is aSchedule II drug because of itshigh potential for abuse. It can,however, be used medically asa local anesthetic. 2 Cocaine is awhite powder that can be inhaledor intravenously injected, while itsderivative, crack, is a rock crystal thatcan be heated and smoked. Users feelthe euphoric effects within minutes ofintake, followed by a dysphoric crash.Various street names forcocaine include “blow,” “snow,”and” nose candy.” 17Kedia et al (2007) found 78%of cocaine abusers were involvedin polydrug abuse situations,defined as concurrent or sequentialabuse of more than one drug withdependence on at least one. 4 Thedrugs most frequently abused withcocaine are alcohol and marijuana. 5National Institute on Drug Abuseresearchers have found thatcocaine and alcohol combine inthe liver to produce cocaethylene,a compound that intensifies theeuphoria while simultaneouslyincreasing the severity of danger. 11Drug abuse is known to fluctuateover time as abusers recover andrelapse repeatedly. Additionally,the estimated level of lifetimedependence on cocaine is 2-3%. 15The morbidity and mortality ratesof cocaine users are attributable toits cardiovascular effects, overdosepotential, suicides and AIDS. 8 In theUnited States, overdose accountsfor 22% of the deaths related tococaine use. 12 Cardiovasculardiseases caused by cocaine includemyocardial infarctions (MI), angina,atherosclerosis, myocarditis,cardiomyopathy, arrhythmias,hypertension, aortic dissection,and endocarditis, etc. 8 The mostcommon complaint patients presentwith is chest pain, which is 40% ofemergency department (ER) visits. 9According to recent studies, up to6% of chest pain is due to MI, 9 whileapproximately 18% is non-cardiacchest pain. 13 Cocaine-induced MI hasthe highest level of incidence withinthe first hour after intake, but can4, 13occur up to four days after use.A study by McCord et al (2008)found that approximately 66% ofcocaine-induced MIs occur withinthree hours of intake, 8 attributable toseveral factors. First, cocaine inhibitsthe reuptake of catecholamines(specifically dopamine), causinghypertension and tachycardia. 12Next, cocaine causes coronaryartery spasm and platelet activation,causing the vascular occlusion7, 12and myocardial infarction.Additionally, cocaine has beenfound to cause rhabdomyolysis,intracranial hemorrhage, stroke,and seizure among other medicalproblems. Another study foundthat 20% of intracranial hemorrhagecases in patients aged 18-49 wererelated to drug abuse becauseof sudden vasospasm. 7The comorbidity of drug abuseand psychiatric disorders is regularlyseen in the literature. Havassyand Arns (1998), for example,found schizophrenia to be the mostcommon psychiatric diagnosis toaccompany drug abuse, followed bybipolar disorder and depression. 4A later study reported that up to72% of patients with a drug usedisorder had at least one concurringpsychiatric disorder; additionally, forcocaine abuse specifically, 20-30% ofpatients have bipolar disorder. 1 Drugabuse has been found to increase therate of suicide by as much as fiveSUBSTANCE ABUSE IN WV | Vol. 1061