THE NEW COCAINE CRISIS

Cocaine Overdoses Are Four Times Higher Than They Were Eight Years
Ago - And A&E Departments Are Clearing Up The Mess

It is 1am on a balmy night in one of the ritzier enclaves of west
London, and at a four-storey Georgian terrace a party is in full
swing. In the Philippe Starck-designed kitchen and imposing
double-height living room, the thirtysomething guests - City bankers,
yummy mummies and trustafarians - are engaged in animated chatter,
while some are occupied by a raucous game of Twister. High spirits
are buoyed by a plentiful supply of amphetamines and Colombia's
finest white powder. The mood is boisterous.

Then, one of the guests collapses on the floor, clutching his chest.
One hour later, 38-year-old Max is in intensive care at St Mary's
hospital, recovering from a severe heart attack. The consultant
should be baffled by the spectacle of this seemingly healthy, lithe
man in his prime suffering such a dramatic collapse, but he has seen
it all before: toxicology reports reveal a high level of cocaine in
Max's blood, the legacy of the rowdy party just a few hours earlier.
Max will make a full recovery, but he is told that if he takes the
drug again, he could be signing his own death warrant.

It sounds extreme, but ask any doctor at the sharp end of A&E
admissions and they will tell you that it is not an uncommon
scenario: in recent years, many of Britain's hospitals have seen a
huge increase in what the white coats privately call "cocaine toxic"
or "coke strokes". The symptoms: at the "lighter" end, hallucinations
and disorientation; at the severe end, acute chest pains, heart
attack and stroke. The link is cocaine use, even if it is just a few
cheeky lines at weekends.

Certainly the statistics tell a story: figures published earlier this
year by the magazine Druglink show that the number of drug users
being admitted to hospital with cocaine overdoses is four times
higher than it was eight years ago. At one London hospital, one in
three young men attending A&E with suspected heart attacks were
cocaine users - as men are more prone to coronary disease, they seem
to be most at risk. Other research, published in the medical journal
Circulation, suggests that up to 25% of heart attacks occurring in
people under 30 may be due to regular cocaine use, instead of the
more typical coronary artery disease.

It is familiar territory for the doctors at St Mary's. Three years
ago, a study here showed that more than half of those who turned up
at A&E on Friday or Saturday night complaining of chest pains had
cocaine in their systems. As one consultant, who did not want to be
named, puts it: "We're a cocaine nation, and while it creates one
problem on the streets, we doctors are battling the other front line.
You see a guy with chest pains on a Friday night and think, 'Okay,
get the toxicology report.' Sometimes you can even tell the moment
they come through the door."

People such as Max are, of course, not the most obvious of drug
casualties - or menaces, for that matter. He is not on the rampage,
beating up police officers or stealing people's home-entertainment
systems to fund his habit. A married father of two, who annually
earns close to seven figures in the City, Max's demeanour had
previously radiated the glow of invincibility common to those who
have the lot - the wife, the kids, the house, the car and the monster
pay packet. He stayed fit and saw his prodigious weekend cocaine and
amphetamine use as no more threatening to his health than a few
tequila shots after work. "I'm not untypical of the guys I work
with," he says. "I wasn't an addict. I live a stressful life, and I
wanted to get high at weekends. I didn't see it as a big deal. It was
pretty much par for the course."

The problem, though, is that getting high at weekends can put huge
strain on the heart: cocaine, in particular, constricts the blood
vessels, raising blood pressure and making the heart work harder.
Throw in alcohol and amphetamines, and you have what some doctors
believe is a "ticking time bomb of acute cardiac problems".

One of them, Dr Murray Mittleman of the Institute for Prevention of
Cardiovascular Disease at Harvard, was among the first doctors to
carry out a large-scale study of the link between cocaine and heart
disease. He feels that we are only scratching the surface in terms of
establishing the dangers. "We know that taking cocaine significantly
increases the risk of heart attack in individuals who are otherwise
at low risk," he says. "There is a magnitude of heart-disease risk
associated with cocaine use, but more research is needed."

Jamie, a 35-year-old management consultant from Manchester, found out
the hard way. Last year, he was admitted to hospital with acute chest
pains after collapsing in a bar in the fashionable Canal Street area
of the city, and discovered he had suffered a stroke. He is now an
avowed abstainer from his previous drug of choice. "I would never in
a million years have put myself down as at risk from heart problems
at a young age," he says. "There is a history of coronary disease in
my family, but we're talking men in their fifties and sixties. I was
all about the gym and healthy eating, but at weekends, I would party
hard. That was enough to put my body under strain. At least I got a warning."

Dr Sue Paterson, a consultant forensic toxicologist at Imperial
College London, has noticed the increased prevalence of cocaine in
toxicology samples that have come across her pathology table in the
past 20 years - particularly since the department has started testing
hair follicles, which demonstrate longer-term cocaine use not
detectable in blood or urine samples. "Certainly, our capital city is
awash with the drug," she says. "It's a huge problem across the
social spectrum. My experience suggests that, if anything, the
statistics concerning usage are an underestimate."

Max agrees. These days, he still likes to "get high", but sticks to
wine and vodka, in moderation. It's not easy, because those weekend
parties he attends on occasion are still, by and large, a narcotics
free-for-all. "The attitude seems to be that I was just unlucky, a
blip," he says. "The coke and ecstasy still get passed round like
Smarties." And in those moments, it seems, the statistics count for little.

National Drugs Helpline; 0800 776600. British Heart Foundation; 0845 070 8070

All names have been changed