Citation

Colliver JD, Kopstein AN, Hughes AL. NIDA Res. Monogr. 1992; (123): 20-43.

Copyright

(Copyright © 1992, National Institute on Drug Abuse (USA))

DOI

unavailable

PMID

unavailable

Abstract

The most important findings of this study relate to the recent decrease in cocaine-related ER episodes and ME cases. First, decreases starting in the fourth quarter of 1989 for most of the 21 DAWN metropolitan areas as well as in the total data suggest, as previously indicated, that the changes are not isolated and could not have been associated with changes affecting just a few hospitals. If only a few hospitals or metropolitan areas had been involved, the drop in cocaine cases might be argued to have resulted from factors such as administrative changes initiated to deal with ER overcrowding. Because the decrease was widespread, however, such an explanation seems less likely. The second finding related to recent trends is the simultaneous decrease in ER and ME cases related to cocaine. Both types of cases showed decreases beginning in the fourth quarter of 1989 and continuing into 1990. This, too, suggests that the change is real. A third point related to these trends is that, for the most part, decreases occurred for all demographic groups and all categories of episode and drug use variables. However, some differences in trends were observed. Notably, the secondary decreases in cocaine-related ER episodes that occurred in the first two quarters of 1990 affected white patients to a far greater extent than black patients. The increase in the Baltimore area, which is quite significant, occurred after the initial wave of decreases. Another point related to recent trends is the increasing involvement of other drugs mentioned in combination with cocaine. Assuming that the decrease in the overall numbers of cocaine-related medical emergencies is real, this pattern, together with the slight aging trend, might be consistent with the hypothesis of reduced current use of cocaine by casual users but continued use by individuals more dependent on it. These latter users might be more likely than casual users to have a secondary drug problem. Recent increase in the proportion of dependence cases among cocaine- related episodes, though not statistically significant in the present analysis, are also consistent with this hypothesis. The slight plurality of white patients in overdose episodes, with black patients predominating in cocaine-related episodes overall, has several possible explanations. For example, smoking is less likely to be the route of administration in overdose episodes than in other episodes (table 5), and other studies (e.g., Colliver and Kopstein 1991) have shown that ER patients who smoke cocaine are more likely to be black. However, if there is an association here, the direction of causality, if any, is uncertain. The high proportion of suicide cases among overdose episodes involving cocaine also is curious. It may be that the overdose in these cases was associated with another drug rather than cocaine. That overdose cases are more likely to involve other drugs is consistent with the pattern of suicides, in which individuals take whatever is available. Together with the possible involvement of individuals receiving medication under a physician's direction and persons self-medicating for emotional difficulties, this availability factor may partially account for the high proportion of drugs such as diazepam, unspecified benzodiazepines, and alprazolam in overdose cases. The differential involvement of drugs such as ibuprofen and acetaminophen in overdose cases are particularly suggestive of the 'take-anything' suicide syndrome. An alternative explanation of course, is that cocaine may disinhibit latent suicidal tendencies. It is uncertain how many overdoses result from cocaine and how many from another drug mentioned in combination with it. The blame clearly rests with cocaine in the 31 percent of overdoses in which it was the only drug reported (3,405 weighted emergency cases in 1990 or 4 percent of all cocaine cases in that year). Unfortunately, data in DAWN do not provide adequate information to answer this question for the remaining 69 percent of overdoses, and researchers are left to make what they can of the drug combination data. In practice the ER staff must distinguish between symptoms of cocaine overdose and opiate or other drug overdoses and select a treatment strategy commensurate with the diagnosis. In selecting medications in these situations, physicians must consider possible interaction with any other drugs the patient might have taken in addition to cocaine. Acutely intoxicated patients may be unable to respond to questions about the drugs they have taken. In these cases, information on other drugs frequently reported in combination with cocaine, provided by studies such as this one, may be useful in suggesting the types of interactions that must be anticipated. Possible interactions with other drugs patients may have taken also must be considered in any effort to develop new medications to combat cocaine intoxication.

Language: en

Keywords

united states; drug overdose; cocaine; review; statistical analysis; statistics; emergency ward; drug dependence; demography