Is your patient using cocaine?

[Complications related with cocaine abuse that required hospital admission]

INTRODUCTION

Although cocaine abuse is an increasingly important medical problem, many manifestations of its toxicity are not well understood. The aim of this study is to review the most serious clinical manifestations related to cocaine abuse.

PATIENTS AND METHOD

We reviewed the medical records of all patients over 16 years of age admitted to the hospital from January 1994 to December 2005 where cocaine abuse was recorded in their clinical history.

RESULTS

A total of 170 patients, with 188 episodes and 268 pathologic manifestations related to cocaine abuse were included. Thirty two out of the 170 patients (18.8%) were females. Mean age was 33 +/- 11 years, with no significant difference between males and females. A total of 88.8% were smokers, 70% had alcohol abuse and 67.3% had other illegal drug abuses. The more frequent reason for their hospitalization was: pulmonary infection (29.6%), bronchial hyperreactivity (14%), acute psychotic attack related to drugs (12%), ischemic heart disease (10%), infectious endocarditis (7.8%), cerebrovascular disease (8.6%), seizures (6.2%) and severe abdominal complications (2.3%). Eight patients died (6.25%). The association with cocaine was only suspected in 46% of the toxic manifestations.

CONCLUSIONS

Several clinical manifestations are associated to cocaine abuse and its consumption causes potentially fatal complications. The integral treatment of these patients could be improved if these complications are kept in mind.

Psychiatry in orthodontics. Part 2: Substance abuse among adolescents and its relevance to orthodontic practice

Substance abuse by adolescents is a serious problem that will touch every orthodontic practice. Recent data show that 40% of tenth graders in the United States will use an illicit drug at some time, and 18% will do so in a 30-day period. These are significant figures that should impact orthodontic diagnosis and treatment planning. The nature of orthodontic treatment is unique in that the orthodontist will see relatively healthy adolescent patients on a monthly basis over a period of years. The orthodontist is in a prime position to recognize potential substance abuse problems and make referrals. This article discusses various types of substance abuse, diagnosis, options for referral, and orthodontic implications.

Recreational drugs

The war against substance abuse continues in today's society and the sports world often seems to be in the middle of all the attention, especially among the media. New recreational drugs arrive on the scene from time to time, much like GHB, but the predominant substances of abuse continue to be marijuana, cocaine, and alcohol. As research evolves in efforts to stay current and determine any potential performance effects of new substances, the literature has changed very little regarding the more common recreational drug and their effects on athletic participation. New studies are emerging comparing recreational drug use among athletes versus nonathletes. Findings include differences among these groups regarding individual sports, team sports, contact versus noncontact sports, and gender-specific sports. Higher risk-taking behavior contribute to these findings and is known to be more prevalent among an athletic population. Overall, illicit drug use in America in 1996 remained about the same as in 1995 after rising steadily since the early 1990s. About 13 million Americans used drugs at least monthly in 1996, up slightly from 12.8 million in 1995. Teenage drug and alcohol use fell to 9% in 1996, down from 10.9% in 1995. Attempts to recognize the early signs of substance abuse and identify those athletes "at risk" of experimenting with elicit drugs are paramount to the optimal treatment response program. The preparticipation examination remains the best initial format for establishing a sound physician-patient relationship. A thorough history including risk factors, family history, and personnel tendencies toward substance abuse should be obtained followed by an ongoing relationship between the athlete and his team physician. The better rapport between the athlete and team physician, the higher likelihood of early recognition of a developing substance abuse problem. Likewise, the earliest intervention usually leads to the most optimal treatment response.