Chronic Toxicity of Cocaine use

Abstract

Once the patient survived the symptoms of an overdose, what can they look forward to next ? Cocaine, even for those who feel that they don’t use that much or that often, has some chronic effects that are not to be scoffed at. Paranoia is a consequence of alterations in dopamine activity, particularly in the limbic system. It is well known that other CNS stimulants (amphetamines, methylphenidate, etc.) can cause psychotic manifestations. Cocaine taken over some time, and in varying amounts, can lead to behavioral abnormalities, which manifest themselves most frequently as suspiciousness, hostility, delusions, hallucinations, etc. For example, many “regular” users of cocaine carry firearms, which can lead to visits to the emergency room (ER) secondary to shot wounds acquired in violent attacks.

An especially bizarre effect of cocaine are the so-called “Coke Bugs”, altered tactile sensation (tactile hallucination) that bugs are crawling under one’s skin (Fig. 45). This can lead to a person actually picking imaginary bugs off their arms and legs with tweezers and such (self excoriation). It is recorded that individuals suffering from this hallucination have produced proof of the existence of the “bugs” by bringing little vials of them into the ER of course when examined the “bugs” turn out to be pieces of dead skin.