Karen Revere
Kian Eftekhari
Will Hiesinger

(%)
Tobacco
Cocaine
Heroin
Alcohol
Cannabis
Ever Used (%) Dependence (%) Risk
75.6
16.2
1.5
91.5
46.3
24.1
2.7
0.4
14.1
4.2
* 31.9
16.7
23.1
15.4
9.1
Source: Anthony et al, 1994.
Courtesy of Charles A. Dackis, MD

i.e. Ischemic or Hemorrhagic strokes
-Hemorrhage occurs about twice as frequently as ischemia.
-Hemorrhagic manifestations may be intraparenchymal or subarachnoid hemorrhage.
-Hemorrhage may occur within seconds of cocaine use or may lag cocaine use by as long as 12 hours. In many cases, it occurs within a few minutes.
-Ischemic strokes are likely due to vasospasm, vasculitis, or due to the procoagulant effect of the drug.
-Most cocaine-induced strokes occur in patients younger than 50 years.

The image was obtained 79 minutes from the sudden onset of right-sided weakness and numbness. T2weighted imaging and FLAIR show the lesion as an area of increased signal intensity with a periphery of signal loss (arrows C) and a surrounding rim of increased signal intensity, most likely due to vasogenic edema encasing the hematoma. CT obtained seven hours from symptom onset shows a left thalamic hematoma. Linfante, I,
Lilnas, RH, Caplan, LR, Warach, S,
Stroke 1999; 30:2263. Copyright ©
1999 Lippincott Williams and Wilkins.

Hypertensive intracerebral hemorrhage
-The 30-day mortality from ICH ranges from 35 to 52 percent and one-half of these deaths occur within the first two days.
-Only a small number of patients function independently after the event.

-Neuropsychiatric complications occur in about 40% of cocaine users.
-Psychiatric disturbances include: depression, suicidal ideation, paranoia, violent antisocial behavior, catatonia, and auditory or visual hallucinations.
-A moderate proportion of addicts develop panic attacks.
-The paranoid symptoms are more severe and develop more rapidly with continuous use of cocaine.

-Seizures occur in about 3% of cocaine users.
-The majority of seizures are single, generalized, induced by intravenous or crack cocaine
-Seizures are one of the few complications of cocaine use in which a direct relationship with dose has been shown.
-All routes of administration are associated with seizures, and seizures can be induced in some persons by small quantities of cocaine.

-Stereotyped behaviors
-Acute dystonic reactions (sustained, often painful muscular spasms, producing twisting abnormal postures)
-Choreoathetosis (brief, irregular contractions with twisting and writhing movements) and akathisia (extreme sensation of restlessness)
-Buccolingual dyskinesias ("twisted mouth" or "boca torcida")
-Exacerbation of Tourette's syndrome

-Treatment for cocaine addiction occurs primarily in the outpatient setting, and involves psychosocial treatment.
-Rates for long-term abstinence are less than 50 percent.
-Buprenorphine may be helpful for patients who are co-addicted to opiates.
-Disulfiram, topiramate, tiagabine, and modafinil have shown some promise for cocaine abstinence.
-Peer group self-help programs (such as Cocaine Anonymous) improve outcomes.

2
One of the most interesting findings in cocaine research . . . .
Raclopride binds D
2 receptors in the nucleus accumbens…

D
2 is also seen with morbid obesity, and addiction to alcohol, heroin & methamphetamine
Courtesy of Charles A. Dackis, MD

Modafinil is a Dopamine enhancing drug
Placebo Modafinil
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
1 2 3 4 6 7 8
Longitudinal GEE models showed a significant main effect for cocaine abstinence in the modafinil group (odds ratio = 2.41, 95% CI 1.09-5.31, p = 0.03)
Courtesy of Charles A. Dackis, MD
Dackis et al.. Neuropsychopharmacology 2005