complications of cocaine

Last reviewed 01/2018

Cocaine and particularly crack can create a number of physical and mental health problems in high dose users, some of which can be severe.

General:

• user can suffer from general poor health and aches and pains, as well as specific pains in the shoulders and numbness in hands. Nutritional status is often poor and weight loss can result - can sometimes be seen as positive by users, especially if there is weight gain from other treatment, such as methadone mixture or neuroleptics
• many users may be combining cocaine with other drugs such as: heroin, methadone, alcohol, benzodiazepines, amphetamines, ecstasy, ketamine and sildenafil (Viagra) etc. and the additional effects on health of these other substances must be considered

Dermatological complications:

• itching, rashes and eczema
• colour change: grey pallor
• burns: especially to thumbs and mouth

Respiratory complications:

• range of chest problems including breathing difficulties, developing or worsening of asthma, and 'crack lung' - all can be made worse by cigarette or cannabis smoking
• fumes from paint on cans used as pipes, or ammonia which has been used in the preparation of freebase, can cause coughing and lung damage - because cocaine has anaesthetic properties, the user may be unaware of the burning due to ammonia fumes, and this can cause damage to lungs and nasal passages
  • crack can anaesthetise the lungs, which can decrease the user's ability to feel foreign bodies which may enter the lungs during smoking, such as ash, pieces of metal gauze, water vapour and parts of plastic pipes, and also decrease the cough reflex which would remove these foreign bodies
• burns to the lungs can occur due to breathing in the heat from the flame. Risks of this may increase if a burner is used rather than a lighter

Hepatological complications:

• cocaine can exert stress upon the liver and heavy use may lead to increased liver damage, especially if the patient is hepatitis C positive or is a heavy drinker
• acetone is used to recycle the cocaine remaining in the pipe after smoking. It is toxic and can cause liver damage
• when cocaine and alcohol are taken together they produce cocaethylene, which is more toxic to the liver than either substance alone

Renal complications:

• renal artery spasm, thrombosis or embolism can result in renal colic and/or kidney infarction

CNS complications:

• convulsions/seizures can be caused by increased body temperature and constriction of the small blood vessels in the head, but cocaine and its breakdown products also reduce the epileptic threshold
• cocaethylene is especially potent in this regard, and its effect may last for up to 24 hours after ingestion.

The possible complications related to use of cocaine and the cardiovascular disease, and cocaine and mental health problems are described in the menu item below.

Reference:

• (1) RCGP (2004). Guidance for working with cocaine and crack users in primary care