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Review Paper - Cocaine Abuse

Good information in the field of drug abuse is rare, and it is a delight to be able to recommend a cracking good read on the subject of cocaine abuse.

Elizabeth Warner, of the University of Florida at Tampa, has sourced 144 articles on cocaine using a MEDLINE search of years 1986-1992 and through a manual search of bibliographies of all identified articles. They were case reports, review articles or small series, and no controlled studies of the subject were available.

The overview looks at qualitative descriptions of reported complications, as no quantitative methods have been used. Despite these apparent drawbacks she has written a gripping and informative paper that brings anyone not knowledgeable on the subject right up-to-date with the clinical story, and with methods of screening for cocaine abuse, the incidence of use of cocaine and the chemistry of the major forms of the drug.

In the 18-34 year-old age group in the USA, 7% use cocaine at least monthly, and nearly 1% use the drug more than once a week. Crack cocaine (a free-base form made by heating cocaine with baking soda) is associated with high levels of crime (50% or more where its use is endemic). Europe has seen exponential growth of cocaine use in the last few years, and the problems here begin to parallel those in America.

Medical complications of cocaine use are many and varied - cardiac, gastrointestinal, head and neck, neurological, pulmonary, psychiatric, renal and obstetric, as well as involvement with sudden death through suicide and homicide. This paper brings all this together. There is a small section on treatment of cocaine addiction, without much in the way of hope.

Reference:

Warner, Annals of Internal Medicine, 1993, 119: 226-235.

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