Cocaine

Question

Dear expert team,

I am interested if cocaine usage in CF represents a particular risk. My experiences up to now show me that during the consumption my condition is rather improving, probably due to the bronchia extending effects. During the following days, however, my physical condition was pretty bad.

Is the immune system weakened by cocaine or are there other reasons for the considerable increase of PA [translator: we assume that the questioner is referring to Pseudomonas Aeruginosa]? Or is this just caused by physical exhaustion because one does not have a sense of one's own limits? Are there any intolerances or interactions with the typical CF medicaments?

How is the situation after TX [translator: we assume that the questioner means "transplantation", especially "lung transplantation"], which risks will come added to that and how is the combinability with the medicaments?

I hope you can clarify some of my questions.

Answer

Hello,

Thank you for your question and please excuse the delay.

Cocaine belongs to the psycho-stimulants and blocks the reception of dopamine, noradrenaline and serotonine in different brain regions. This causes euphoric states in the beginning, later it causes depressive mood, sickness, appetite diminishment, fatigue, headache, uneasiness, states of fear and excitation, sometimes convulsions. The users develop a tolerance and a dependancy with severe and long-lasting withdrawal symptoms.

The following side effects and consequences have been described among others: damages of the mucous membranes and a respiratory insufficiency, further complications due to vascular constriction (e.g. kidney damages; retinal damages at the eye), liver damages, blood-clotting disorders, high blood pressure, heart rhythm disturbances, aggravation of the blood sugar values.

You see that cocaine consumption involves a high health risk, especially for CF patients, since important organ systems – that are possibly damaged already – are affected.
Particularly Pseudomonas aeruginosa, liver and kidney damages are critical points after the transplantation. A severe dependence can be a contraindication for the TX [transplantation].

Therefore, the general medical advice just like the expert advice is to stop further consumption urgently and possibly to get in contact with a pychotherapist or psychiatrist in order to stay abstinent and to manage possible complications. Psychotherapeutic conversations might help to clarify the reasons for the drug consumption; sometimes an insecurity about how one experiences the own self-respect together with a feeling of helplessness and megalomanic fantasies are behind it.

Best regards,
Prof. Dr. Holger Kirsch

14.07.2008