What is the mortality and morbidity associated with cocaine toxicity?

Updated: Dec 31, 2020
  • Author: Lynn Barkley Burnett, MD, EdD, JD; Chief Editor: Sage W Wiener, MD  more...
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DAWN monitored fatalities reported by Medical Examiners/Coroners (ME/C) in 40 metropolitan areas in the United States. In most areas, cocaine was among the top five drugs involved in drug-related deaths in the DAWN ME/C data for 2010. [23]

Data on drug overdose deaths in the United States show that cocaine-related overdose deaths involving opioids increased from 0.37 to 0.91 per 100,000 population from 2000 to 2006, declined to 0.57 per 100,000 population in 2010, and then increased to 1.36 per 100,000 population in 2015. In contrast, cocaine-related overdose deaths not involving opioids increased from 0.89 to 1.59 per 100,000 population from 2000-2006 and then declined to 0.78 per 100,000 population in 2015. [24]

Sequelae of intravenous injection may cause morbidity. A "pocket shot" is an attempted injection of the internal jugular vein by directing the needle into the depression in the neck superior to the clavicle and lateral to the sternocleidomastoid (the same approach as the supraclavicular approach for subclavian central venous catheter insertion). Such attempts can lacerate the apical pleura and/or vasculature resulting in pneumothorax, hemothorax, or hydropneumothorax. This is usually observed in the left side because most people have right-hand dominance, and it is easiest for them to attempt injection into the left side of the neck.

Intravenous injection may cause aneurysm or pseudoaneurysm of central veins or arteries, and rupture may result in intrathoracic or intra-abdominal hemorrhage, vascular obstruction, and arteriovenous fistulae. A necrotizing angiitis similar to periarteritis nodosa may develop, frequently with severe effects upon the kidneys, such as microaneurysm formation, segmental stenoses, and thromboses. The result is severe hypertension and oliguric renal failure. Similar lesions may occur in the small bowel, liver, and/or pancreas.

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