Pubdate: Thu, 20 Jan 2000
Source: Herald, The (UK)
Contact: herald@cims.co.uk
Website: http://www.theherald.co.uk/
Contact: letters@theherald.co.uk
Author: Alan Macdermid

COCAINE USERS FLOOD CASUALTY

Waves of cocaine users are flooding hospital emergency departments by
turning up with chest pains which mimic heart attacks.

Often the symptoms are caused by spasm of the coronary arteries - but,
according to a report in today's New Scientist, sniffing the drug can
also cause lasting heart disease.

US researchers have discovered that cocaine encourages the immune
system to turn on healthy cardiac tissue, leading to a form of heart
failure in which the heart grows floppy and pumps blood less
efficiently.

The work comes as some doctors are complaining that the abuse of the
drug is causing a hidden drain on already stretched hospital
resources, says the New Scientist report.

They believe that cocaine is making large numbers of otherwise fit
young people - most of them men - report to emergency departments with
chest pains.

The immunological study, led by Benedict Lucchesi of the University of
Michigan, suggests that cocaine activates a part of our immune
defences called the complement cascade.

This system, which is usually triggered by invading micro-organisms,
destroys cells by building complexes of proteins on cell membranes,
causing the cells to burst.

Working on rabbit hearts, the Michigan team has shown that cocaine
boosts the production of complement proteins, causing the deadly
complexes to form on heart muscle cells and the endothelial cells that
line the heart's blood vessels.

The complement cascade is already known to damage heart tissue in some
circumstances So Lucchesi's colleagues are now investigating whether
drugs that block the cascade will help patients suffering from cocaine
overdoses.

Coronary artery spasm caused by cocaine is believed to be the reason
for a growing number of young people turning up in hospital
complaining of chest pain, says the report.

The vast majority are men, and they are usually discharged after
doctors establish that they are not suffering from a heart attack. But
each case has to be thoroughly investigated, which stretches
hospitals' resources.

Dr John Henry, an expert on drug abuse at St Mary's Hospital in
London, suspects that up to 10% of people reporting to hospital with
chest pain owe their problems to cocaine abuse. He is seeking ethical
approval to carry out anonymous urine tests for cocaine on everyone
reporting to his hospital with chest pain.

Meanwhile, heroin proved to be the principal killer in most of the
drug-related deaths in Greater Glasgow last year, experts said yesterday.

An analysis of deaths in the first nine months of 1999 - published on
the eve of the Scottish Parliament's first debate on drug misuse -
relegates drugs like ecstasy and methadone to a fringe role.

Last year's total of 85 deaths was the highest ever, and the report
focuses on the 62 for which forensic pathology findings are already
available.

Heroin was implicated in 77% of the deaths, either alone (30%) or in
combination with alcohol, tranquillisers, methadone or other drugs
(47%). Ecstasy was involved alone in one death, and in combination in
one other; likewise cocaine.

The total for the year is 10 more than the previous peak - 75 in 1995
- - but the report notes an even steeper rise in the rest of
Strathclyde, to 62 for the year: 21 in Lanarkshire, 23 in Argyll and
Clyde, and 18 in Ayrshire.

Dr Laurence Gruer, of Greater Glasgow Health Board, who helped prepare
the report for the Greater Glasgow Drug Action Team, said: "There is a
lot of heroin about. The more there is about, the more people will be
using it and will be at risk. There is wide variability in the purity
of heroin and often people don't know what they are getting."

Many heroin users who had taken to smoking the drug over the past five
years had now turned to injection in search for a bigger hit.

More controversial is the role of methadone, which is prescribed as a
substitute for heroin. Dr Gruer said: "There seems to be a
misapprehension that it is killing a lot of people. There were six
deaths where methadone was implicated and only one where methadone was
the only drug involved.

"Given that around 2800 people were receiving methadone each day -
around a million doses a year - deaths involving methadone were
infrequent, underlining its important role in reducing the risk of
death, provided it is taken under supervision."

The report's authors found that: 70% of the victims were under 30,
with the youngest 16 and the oldest 44; the vast majority were known
drug injectors; four out of five were male; most deaths were at the
weekend; most took place in someone's home; nearly one in four died
within two weeks of being released from prison, often after serving
short sentences - but long enough to lose their tolerance to heroin.