Is Cocaine Really That Harmful?

February 9, 2010 in Health Policy, Medicine by RangelMD

Sirius Radio’s Dr. Steve answers a question from a Wall Street guy who appears to be in denial about his cocaine habit. No, this is not a repeat question from 1985.

I’m a 27-year-old guy working in finance in New York City. I’ve recently put an emphasis on working out and eating right. Unfortunately, my job is pretty high stress though, so when I unwind on the weekends I do a little bit of cocaine from time to time . . Is it okay to do a small amount of coke every once in a while?

Sure it’s okay in the same way that lying down in traffic or jumping out of an airplane without a parachute is okay. It’s also a sign of his  denial that he believes his regular use of cocaine is to “unwind”.

Cocaine is a powerful neuro and cardiovascular stimulant. It raises blood pressure and pulse (hyperadrenergic state) and leads to increased oxygen demand by the heart. Cocaine use can lead to vasoconstriction, is pro-thrombotic, and is arrhythmogenic meaning that if it doesn’t kill you with a heart attack, it can still induce a fatal arrythmia and kill you that way. Or cause a seizure. Or cause a stroke or bleeding into the brain.  Therefore, any single use can cause sudden death and chronic use is associated with the development of left ventricular hypertrophy, cardiomyopathy, myocardial fibrosis, and myocarditis. And these are just the cardiovascular risks!

It’s no small wonder that cocaine is illegal but for all it’s horrible health risks and significant potential for abuse and physical and psychological dependency, it causes a mere 1,081 deaths per year (data from 1981-1996) despite its use by up to 6.4 million or 2.2% of the population. I say “mere” because in contrast,  tobacco is regularly used by 20% of the US population and leads to about 430,000 to 450,000 deaths each year directly as a result of tobacco related health conditions.

And then there is marijuana, which one would be hard pressed to find a single case where use directly lead to death despite its regular use by 9% of the US population.

And look at which of these substances are illegal. Just some food for thought.

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