Cocaine Abuse

Are you confused? Did we make your heads hurt? 

You should have seen the writers when they were first planning the story. If Meredith wasn't dark and twisty, then she wouldn't have slept with Derek. Then, Addison and Derek would have gotten back together and stayed married. So Meredith's actually engaged to Alex, who winds up cheating on her with April, who is Meredith's best friend instead of Cristina? But then she and Cristina are meant to be best friends no matter what, so in the end, we see that beginning to form and –

Nope. Can't try to figure it all out again. Heads will hurt.

BUT! Who would have thought – Lexie overdoses on cocaine?!

Cocaine derives from a plant (Erythroxylon coca) native to Peru, Bolivia, Mexico, the West Indies, and Indonesia.

The ancient Incas of Peru believed the plant was a gift from the gods, chewing the coca leaves as an endurance enhancement. History shows that the drug started to be used medicinally around the year 1596. William Halsted, one of the pioneers of surgery, used cocaine to perform the first nerve transplant in 1884. Interestingly enough, Dr. Halsted was also one of the first reported physicians to be dependent on the drug. Similar to Halsted, Freud also shared a dependency while advocating cocaine's uses for conditions such as asthma, wasting diseases, and syphilis. However, due to cocaine's addictive properties, the drug was banned for non-prescription use by the Harrison Narcotics Act of 1914.

The Drug Abuse Warning System (DAWN) gives the following statistics on cocaine abuse:

- Besides alcohol and tobacco, cocaine is the most common cause of drug-related emergency room visits in the United States.
- Patients with cocaine toxicity often come into the ER with other drugs present in their system; the combined use of cocaine and alcohol signals the liver to produce a third substance called cocaethylene. This combination increases cocaine's euphoric effects and may be the major cause of drug-related deaths).
- In 2005, cocaine was associated with 31% of ER visits related to drug misuse and abuse.
- The 2006 National Survey on Drug Use and Health found that 35.3 million Americans older than twelve years old have used cocaine at least once.

How is cocaine abused?

Cocaine is usually snorted, injected, or smoked. Abusers snort the powder form through the nose where it can be absorbed through the nasal tissues while injecting the drug involves using a needle to directly access blood vessels. When people smoke cocaine, they inhale the drug's vapor into the lungs, feeling the effects of the drug almost as quickly as when one injects it. Regardless of the route, each method can rapidly lead to addiction and serious health problems.

Abusers experience a more intense "high," the faster they can absorb the drug into their bloodstream. The drug's main effects include increased energy, reduced fatigue, and mental alertness. However, the more intense high also causes the sensations to not last as long. For example, experts assume that snorting cocaine produces a high that ranges from 15 to 30 minutes while injecting/smoking only lasts for 5 to 10 minutes. Due to this shorter duration, abusers will often immediately use again at an even higher dose.

A powerful nervous stimulant, cocaine can affect nearly every organ in the body.

First, cocaine increases the amount of dopamine and serotonin in the "pleasure center" of the brain, causing excess amounts to build up and produce the euphoria associated with the use of the drug. However, this excessive dopamine also disrupts normal communication processes within the brain, leading to long-term systemic changes and addiction.

Other adverse effects cocaine imposes on the body include:

- Constricting blood vessels.
- Dilating pupils.
- Increased temperature, heart rate, and blood pressure.
- Headaches.
- Gastrointestinal problems such as pain and nausea.
- Decreased appetite, leading to malnourishment.
- Irritability, restlessness, and anxiety.
- Severe paranoia.
- Acute cardiovascular or cerebrovascular emergencies.

Also, depending on the method of administration, the effects of cocaine may vary. For example, repeated snorting may lead to frequent nosebleeds, the loss of the sense of smell, difficulty swallowing, a chronic runny nose, and hoarseness. If one injects cocaine, the abuser is at a much higher risk for allergic reactions and contracting HIV/AIDS or other blood-borne diseases.

Excessive doses of cocaine can potentially be fatal.

Similar to Lexie, an overdose of cocaine may present as cardiac arrest from a heart attack due to the insufficient blood flow to keep up with the heart. Other ways that an overdose can occur include a stroke, seizures, fever, infection, kidney failure, liver hepatitis, pneumonia, and clotting of the veins.

There is no definitive treatment for a cocaine overdose – management is mostly supportive and tailored to the patient's symptoms. For example, due to her heart stopping more than once, Lexie sustained enough cardiovascular damage to need a pacemaker. And even though Meredith and Cristina performed an emergency thoracotomy on Lexie at the end of the episode, that indication is seldom done.

Currently, no FDA-approved medications exist for treating cocaine addiction. However, the development of a treatment remains one of the top priorities for the National Institute on Drug Abuse.

For more information on cocaine's effects on the body, please visit:

http://www.nlm.nih.gov/medlineplus/cocaine.html

http://www.drugabuse.gov/publications/infofacts/cocaine