Cocaine use

Cocaine stimulates the brain to release large amounts of the hormone dopamine. Dopamine results in the euphoria commonly reported by cocaine abusers. As a person continues to use cocaine, a tolerance is developed. This means that higher doses and more frequent use are required to maintain the euphoria.

Cocaine is also a very potent constrictor of blood vessels. The result of blood vessel constriction can raise blood pressure, cause heart rhythm abnormalities and restrict the blood flow to areas that are relatively deprived of blood supply. The common mode of use of cocaine, sniffing, exposes the lining of the nasal septum (the wall that separates within the nose between the right and left), called mucosa to the effect of blood vessel constriction. The mucosa has blood vessels running through it that supply the cartilage of the septum which is devoi d of any blood vessels. Any interruption of the delicate blood supply to the cartilage of the nasal septum can cause the cells that make up the cartilage to die.

Cocaine use can cause prolonged periods of blood vessel constriction which significantly reduces the blood flow supplying the essential nutrients and oxygen to the lining and the cartilage of the septum which can result in a hole in the septum. Initially a small hole may not even be noticeable, but with continuing cocaine use, the hole can enlarge and begin to cause problems.

Initially, a slight shitling sound may occur as a result of the passage of an air column through the septa l hole (also called perforation). As the hole enlarges, dryness of the air may cause the appearance of crusting or nose bleeds. Since the septum is the support strut for the external appearance of the nasal bridge, a collapse of the nose can occur which can be both cosmetically deforming and very difficult to repair.

Stopping cocaine use can be very difficult because of a strong physical dependence induced by the drug. When a cocaine user stops using abruptly, he experiences a crash or withdrawal. This results in an extremely strong craving for more cocaine. It also results in fatigue (being tired), loss of pleasure in life, depression , anxiety , irritability, and sometimes paranoia. These withdrawal symptoms often prompt the user to seek more cocaine. Getting off cocaine often requires help from a rehabilitation facility as a result.

Short-term effects include:

  • Euphoria
  • Increase in energy
  • Excessive talking
  • Being mentally alert
  • Decreased need for food and sleep
  • Dilated pupils
  • Increased temperature
  • Increased heart rate
  • Increased blood pressure
  • Bizarre, erratic, or violent behavior
  • Vertigo
  • Muscle twitches
  • Paranoia
  • Restlessness, irritability, and anxiety
  • Heart attack
  • Seizures
  • Sudden death

Long-term effects include:

  • Uncontrollable or unpredictable cravings
  • Increased tolerance
  • Increased dosing
  • Use of cocaine in a binge
  • Increasing irritability, restlessness, and paranoia
  • Full-blown paranoid psychosis
  • Auditory hallucinations

Medical complications from cocaine use include:

  • Heart rhythm abnormalities
  • Heart attack
  • Chest pain
  • Respiratory failure
  • Stroke
  • Seizure
  • Headache
  • Abdominal pain
  • Nausea

Treatment of Septal Perforation
Septal perforation can be somewhat challenging to treat depending on their severity. Treatment may either be conservative by lubricating the perforated area with some Vaseline or paraffin ointment or the use of nasal saline gels or sprays.

For patients who prefer to stay with a conservative option, accessories that fit into the hole called, septal buttons can be fitted to close off the connection between the sides and thus stop any whistling sounds or for the relief in the discomfort associated with the abnormal passage of air between the inside sides of the nose.

Surgical options include the rotation of local tissue within the nose to close off the defect, the use the patient’s own fat and yet other reconstructive techniques that help to close off the abnormal septal perforation.

Septal perforations demand the specialty care of an otolaryngologist, a specialist in Ear Nose and Throat surgery.

Rehabilitation Programs
In rehab programs, people with cocaine use disorder stay in a controlled environment for 6-12 months. During this time, they may receive vocational rehab and other support to prepare them to return to society.

Prevention
The best way to prevent cocaine use disorder is to never use cocaine. It is highly addictive.