Drug abuse in pregnancy: Marijuana, LSD, cocaine, amphetamines, alcohol, and opiates
Hung N. Winn, Frank A. Chervenak, Roberto Romero in Clinical Maternal-Fetal Medicine Online, 2021
Cocaine is a stimulant drug derived from the coca plant, Erythroxylon coca. Cocaine use in pregnancy was widely publicized in the 1980s with reports of the urban phenomenon of “crack babies” flooding maternity wards and burdening society. While harm from cocaine to multiple organ systems is clear, and much of the risk in pregnancy is known, there are numerous confounders that make effects directly attributable to cocaine difficult to isolate; the mania of the media blitz may be unfounded (20,21). A retrospective study of 139 cocaine-abusing women revealed concomitant use of other drugs such as alcohol, tobacco, marijuana, diazepam, heroin, and methadone to occur in 92.8% of users (20). Cocaine use has increased, but its use still pales when compared with that of marijuana and alcohol. In the United States, 1.5million persons over the age of 12 met the criteria for the abuse or dependence of cocaine or crack cocaine over the past year (1).
Critical Review of Evidence for Neonatal Cocaine Intoxication and Withdrawal
Richard J. Konkol, George D. Olsen in Prenatal Cocaine Exposure, 2020
Cocaine may be ingested, snorted, smoked, or taken intravenously. Average peak venous plasma concentrations range from 200 to 600 ng/ml, while peak arterial concentrations are several times higher than venous after smoking.24 It is the high arterial concentrations that are presented to the uterus and placenta for tissue uptake of cocaine, while venous plasma levels are reported in the literature. Under controlled situations, euphoria and cardiovascular effects are reported at plasma concentrations above 80 to 100 ng/m1.69 Among coca leaf chewers, plasma concentrations range from 10 to 150 ng/ml, and clinically are associated with anorexia and a hyper alert state.70 When intranasal cocaine solutions were used during medical procedures, the peak plasma concentration ranged from 120 to 475 ng/m1.71 Individual South American cocaine paste smokers maintain their plasma cocaine levels between 250 and 900 ng/ml 72 In patients presenting with cocaine-associated seizures and strokes, the plasma concentrations ranged from 1 to 1700 ng/ml with a median concentration of 34 ng/m1;73 seventy-five percent of the patients had plasma cocaine levels below 100 ng/ml. Among chronic cocaine users enrolled in a methadone maintenance program, the average plasma cocaine concentration was 19 ng/m1.74 Lethal plasma levels of cocaine, inferred from autopsy data, indicate the average plasma concentration of cocaine found in cocaine related deaths is 5300 ng/ml, with a range of 900 to 21,000 ng/m1.75
Stimulants
David J. George in Poisons, 2017
Cocaine can produce euphoria, energy, talkativeness, mental alertness, and a decreased need for food and sleep. These characteristics can overshadow the likelihood of extreme negative cardiovascular and behavioral effects. The intensity and duration of these effects depend on how much cocaine is administered and the route of administration. After smoking, effects may last up to 10 min, and perhaps up to 30 min after snorting. This short duration of action necessitates frequent dosing and often extends into binging. Cocaine can significantly elevate body temperature, heart rate, and blood pressure. These effects become more pronounced with increasing doses that can also trigger irritability, paranoia, violent aggressive behavior, and other manifestations of neurotoxicity. Cardiovascular effects can include arrhythmias and malignant hypertension. Cocaine-related deaths are often the result of cardiac arrest or seizures followed by respiratory arrest. Sudden deaths can occur after the first use of cocaine or unexpectedly at any point during future use.
Substance use disorders: diagnosis and management for hospitalists
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Ahmed K. Pasha, Arnab Chowdhury, Sanah Sadiq, Jeremiah Fairbanks, Shirshendu Sinha
Cocaine is a powerful stimulant drug that is derived from the leaves of the Erythroxylum coca plant native to South America. Common street names of this drug include: Blow, Coke, Crack, Rock or Snow. Cocaine has also been combined with other psychoactive drugs that include opioids and stimulant amphetamines. Illicit cocaine is available in two forms: Cocaine salt and Cocaine base (crack, free base). Users can snort cocaine salt through the nose or rub it into their gums. Cocaine base can be heated to produce vapors that are inhaled into the lungs. The water-soluble form of cocaine can be injected intravenously as well. Cocaine’s effect occurs almost immediately and dissipates quickly in a few minutes to an hour. As per the results of a national survey on drug use and health in 2016, there were an estimated 1.9 million people aged 12 or older (corresponding to 0.7% of the population older than 12 years) who currently used cocaine. This estimate was similar to the estimates of cocaine users between 2007 and 2015 but lower than the estimates from 2002 to 2006 [33,34].
Long-term cocaine use is associated with increased coronary plaque burden – a pilot study
Published in The American Journal of Drug and Alcohol Abuse, 2020
Doris Hsinyu Chen, Márton Kolossváry, Shaoguang Chen, Hong Lai, Hsin-Chieh Yeh, Shenghan Lai
Cocaine is an addictive stimulant that is sourced from the Erythroxylon coca plant. It is categorized as a Schedule II drug and can be prescribing for medical purposes such as local anesthesia during surgery (1). The short-term physical effects of cocaine include sensitivity to environmental factors, increased energy, and mental alertness. The effects vary depending on the amount and route of exposure. There is a wide range of physiological effects from increased heart rate to narrowing of blood vessels. Long-term use can lead to negative health consequences such as cardiovascular problems, coma, and seizures (2,3). Even though the rates of cocaine use have remained steady over the past decade, cocaine is still a widely used substance in the United States. The National Survey on Drug Use and Health found that 5.5 million people used cocaine in 2018 (4).
The Scheduling of Kratom and Selective Use of Data
Published in Journal of Psychoactive Drugs, 2018
O. Hayden Griffin, Megan E. Webb
Comparisons of drug seizure data are somewhat difficult. Clearly, much more marijuana was seized than kratom, but one would expect this, considering that marijuana is the most consumed recreational drug in the U.S. behind alcohol. The amount of kratom compared to cocaine, heroin, and methamphetamine may seem compelling on its face, but when it is analyzed in more detail, these results appear more mundane. Cocaine and heroin enter the U.S. as powder that is meant to be snorted, smoked, or injected, and methamphetamine is either in crystal or powder form that can be administered in any one of the three aforementioned routes. Kratom can be ingested in a variety of forms, but the drug can be frequently imported as plant matter. Thus, kratom seems likely to naturally weigh more than many other types of drugs. While the DEA did claim, in its initial intent to schedule, that the amount of kratom seized represented 12 million doses of the drug, it is hard to take this claim at face value for two reasons. First, the DEA gives no indication of what types of kratom (e.g., plant material, powder, capsules) were seized to produce this many doses. The second reason is that, considering how novel kratom is to the U.S. and without any real indication of how widespread kratom use is in the U.S., 12 million doses seems a rather ambitious amount for people who are attempting to sell kratom in the U.S.
Related Knowledge Centers
- Central Nervous System
- Coca
- Erythroxylum Coca
- Hydrochloride
- Stimulant
- Euphoria
- Tropane Alkaloid
- Recreational Drug Use
- Reward System
- Local Anesthetic