Cocaine-related medical and trauma problems: a consecutive series of 743 patients from a multicentre study in Italy - Introduction

A Special Author Introduction
European Journal of Emergency Medicine
ISSN: 0969-9546 • Frequency: 6/year • Subscribe Now • Journal Website

By Gianluca Quaglio

Cocaine use has been associated with a variety of medical complications, which may involve all major organs or systems. The most common adverse health consequences are psychiatric disorders, cardiovascular medical problems, neurological impairments, and gastrointestinal disorders. Such complications can be associated with acute and chronic cocaine use and may differ according to the route of administration.

Cocaine is the second most used illicit drug in Europe. It is estimated that around 13 million Europeans (3.6%) have used it at least once in their lifetime and that around 4 million Europeans (1.2%) have used the drug in the last year. One of the highest rates of cocaine consumption in Europe is in Italy. It is estimated that around 7% of the Italian general population (15-64 years) have used it at least once in their lifetime. In public centres for drug use the number of patients treated for cocaine as first drug of abuse increased from less than 5% in 2000 to 16% in 2008. In spite of the high treatment costs and specific medical needs associated with cocaine use, in Europe little is known about cocaine-related presentations to hospital emergency departments.

The majority of knowledge of medical problems associated with cocaine use comes from case reports, small observational studies, reports of patients seeking help at drug treatment or rehabilitation centres, and autopsy studies of cocaine users. A small number of retrospective studies tried to summarise hospital visits for cocaine-related medical problems.

This study systematically reviewed and summarised visits to emergency departments for medical problems and trauma complications relating to self-reported cocaine use. Key findings include an apparently small number of patients who presented to emergency departments reporting symptoms associated with cocaine use. Of those who did report symptoms, the most common were psychiatric, although a high number of cardiac and gastrointestinal symptoms were also reported. In addition, cocaine users reported a wide range of other symptoms. Complications secondary to unintentional injury and road accidents were the most frequent trauma complications.

This report is a multicenter study carried out in a huge catchment area, starting from an analysis of more than 1 million visits. Most complaints appear to be a consequence of the hyperadrenergic and dopaminergic effect of the drug. Further prospective studies, focusing on single cocaine users are needed to better establish the true percentage of patients attending emergency departments as consequence of cocaine use.

Although severe medical complications of cocaine use occurred and are well described, it appears that the negative health effects of cocaine are predominantly psychosocial and related to the consequences of addiction per se. The visits of cocaine users to the emergency room setting may be seen as an opportunity for health personnel to alert patients to the negative effects of addiction, and present an opportunity to arrange referral to psychological and treatment services.

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