Medical Problems

1. Medical problems resulting from adulterants and administration

small intestinal ischemia, necrotizing enterocolitis, inflammation of nasal mucosa, necrosis, perforation of the nasal septum, paralysis of the pharynx and larynx, aspiration pneumonia, optic atrophy, osteolytic sinusitis, pnuemomediastinum and emphysema, granulomatous pneumonitis, pulmonary edema, burns, skin abscesses, phlebitis, deep vein thrombosis, cellulitis, septic emboli, pulmonary abscesses, bacterial endocarditis, ophthalmological infections, fungal cerebritis, hepatitis, tuberculosis, rhabdomyolysis and its complications, acute renal failure, headaches, and sexually transmitted diseases, including HIV transmission during administration by injection.

2. Medical problems resulting from stimulant abuse

sinus tachycardia, ventricular premature contractions, ventricular tachycardia and fibrillation, myocardial infarction or arrhythmia, seizures, status epilepticus, cerebral hemorrhage, cerebral vascular accident, transient ischemia attacks, hyperpyrexia, respiratory paralysis or arrest, migraine-like headaches, weight loss, dehydration, nutritional deficiencies, endocrine abnormalities, organic mental disorders to include intoxication, delirium, delusional disorder, and withdrawal

3. Disorders from: COCAINE, AMPHETAMINE, SIMILARLY-ACTING SYMPATHOMIMETICS

A. Delirium--may develop within 24 hours after stimulant use. Often the patient is aggressive or violent and may need to be restrained. Delirium usually appears within an hour of substance use and is finished in about six hours. When the stimulant is taken intravenously, the onset of delirium is immediate. On rare occasions, it follows a period of "intoxication." When the other pharmacological effects of the drug have worn off, the delirium disappears completely. The criteria for diagnosing delirium include: delirium developing within 24 hours after stimulant use (assuming that the delirium is not due to any other physical or mental disorder).

B. Delusional Disorder--These disorders are characterized by rapidly developing ideas of persecution shortly after cocaine or an amphetamine is used. The patient often has a distorted body image and people's faces may look strange to him. At first, he may be merely suspicious and curious, and feel pleasure from the drug, but later this turns to aggression or violence against his "enemies." Hallucinations about bugs, snakes, or vermin crawling under the skin may lead to scratching and extensive scarring of the skin. Such delusions may last for a week or longer, but sometimes last for more than a year. The diagnostic criteria for these delusional disorders include an organic delusional syndrome that develops shortly after the drug is used, rapidly developing delusions of persecution as the predominant clinical sign, and the absence of any other physical or mental disorder that could produce the delusions. Cocaine, either smoked or taken intranasally, is currently a common cause of mental illness.

C. Intoxication--is identified by the recent use of a stimulant, and behavioral changes to include fighting, grandiosity, psychomotor agitation, impaired judgement, and impaired social or occupational functioning. Physical signs of amphetamine intoxication include at least two of the following within an hour of use: tachycardia, dilated pupils, elevated blood pressure, excess perspiration or chills, and nausea and vomiting. The list is identical for cocaine except that visual and tactile hallucinations are also included.

Chronic intoxication produces marked weight loss, hallucinations, paranoid delusions, compulsive stereotyped behavior such as sorting objects into neat piles. If cocaine is combined with alcohol, the withdrawal symptoms will be more severe, and the risk of death from heart attack or stroke increases. Alcohol and cocaine in combination are metabolized by the liver to cocaethylene which produces a more intense high, and consequently more severe withdrawal symptoms.

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