Cocaine: How much to overdose?
A cocaine overdose (OD) depends on a few factors:
- purity levels of the drug
- amounts used
- an individual’s state of health state
While cocaine overdose is almost always unintentional, some suicidal attempts have been known to happen while on cocaine. Accidental overdoses can occur when you take cocaine with higher purity, in large quantities, or after a period of abstinence. Also, a common unintentional cocaine overdose involves mixing cocaine with alcohol or with other drugs simultaneously.
Cocaine doses
Cocaine doses typically range from 30 – 70 mg, but as users develop tolerance, they tend to use more and increase their doses above 1 gram.
The smallest amount of cocaine that is seen as deadly is 1.2 grams. However, individuals who are extremely sensitive to cocaine have experienced fatal overdoses from as little as 30 milligrams.
In a few uncommon instances of extraordinarily high resistance, individuals addicted to cocaine have claimed to consume 5 grams of cocaine each day, which would result in death for the majority of people.
Cocaine overdose
Patients suspected of cocaine toxicity may have the following features:
- Hypertension
- Altered mental status
- Seizure
- Chest pain
- Dyspnea
- Epistaxis
- Headache
- Paranoia
- Neurological deficits
- Hyperthermia
- Vascular spasm and loss of distal pulses
- Extreme diaphoresis
- Severe agitation, restlessness, confusion
- Pruritus
- Blurring of vision
- Corneal ulceration, vision loss
- Diarrhea, vomiting, abdominal pain (think mesenteric ischemia)
- Excited delirium
Sudden death
Most of the cocaine-related deaths were due to problems with the heart and its related systems.
According to Dr. Lucena of the European Society of Cardiology, for those who died suddenly from cocaine use, the average levels of cocaine found in the blood or urine were 0.1 and 1.15 mg/L, respectively. However, these levels varied greatly and were influenced by various factors such as:
- The method of consumption
- How the body metabolizes the drug
- The presence of other substances.
- Body mass index
- Frequency of drug use
- Overall health conditions
- Age and gender
The researchers emphasized that any amount of the drug could potentially lead to toxicity, as some individuals experienced adverse effects even with relatively low concentrations in their blood, while others could tolerate large quantities without any consequences.
Heart failure from cocaine use
The consumption of cocaine, which is a powerful stimulant for the heart and blood vessels, has been linked to irregularities such as:
- The heart’s electrical activity
- High blood pressure
- Abnormal heart rhythm
- Sudden heart attacks
The likelihood of experiencing a heart attack among cocaine users is greatly influenced by their existing heart health risks and dangerous behaviours.
Cocaine usage can cause immediate health issues through various factors, such as blocking the heart’s sodium/potassium channels and intensifying the narrowing of coronary arteries.
Several research studies have found a link between long-term cocaine use and the development of coronary atherosclerosis, which is assessed by measuring coronary calcification. On the other hand, other studies have shown no connection between chronic cocaine use and coronary calcification.
It is worth noting that the individuals involved in the studies that found an association had a higher risk of coronary artery disease than those that did not find a link. As a result, the chronic effects of cocaine may be more pronounced in individuals with a higher risk profile for CAD.
The impact of cocaine on chronic conditions is also complex.
Prolonged exposure to cocaine can have chronic effects on the heart, such as:
- Non-ischemic myocardial depression
- Blood vessels by causing damage to endothelial cells
- Formation of intracoronary blood clots.
Effects of cocaine on the heart
Low and high doses
- Inhibition of sodium channels: increased heart rate and acidity.
- Inhibition of potassium channels: Acute Myocaredial infarction (MI)
Low dose
- Increased heart rate, blood pressure and myocardial contractility.
- Coronary spasm/vasoconstriction and platelet thrombosis
- An imbalance between oxygen supply and demand.
High dose
- Blockage of sodium transport and norepinephrine uptake in the myocardium.
- Decreased left ventricular contractility.
- Vessel damages/rupture and thrombosis
- Cardiomyopathy
Effects of cocaine on blood vessels
- Acute hypertension and coronary spasm,
- Increased vasoconstriction,
- Inhibition of norepinephrine reuptake
- Blood clots
- Atherosclerosis
- Coronary artery disease
Outcomes
The initial step in addressing heart failure caused by drug use involves discontinuing the drug, if feasible.
In certain instances, ceasing drug consumption may potentially alleviate symptoms. To illustrate, a study conducted in 2017 discovered that individuals who experienced heart failure due to methamphetamine usage were able to diminish or reverse heart damage, decrease the likelihood of heart failure, or even reverse its symptoms by ending their drug use.
Heart failure can shorten a person’s life expectancy.
The outlook varies according to:
- the type of heart failure a person has
- how severe their symptoms are
- whether they have access to treatment
- whether they can make lifestyle changes
- whether they have co-occurring medical conditions
The outlook improves when a person stops using cocaine.
