Cocaine drug overdose

Low antiepileptic drug levels, drug overdose (e.g., cocaine, isoniazid, theophylline, phenothiazine), ethanol-related, and drug withdrawal... 

Mash, D.C. and Staley, J.K. Cocaine recognition sites on the human dopamine transporter in drug overdose victims. In Neurotransmitter Transporter Structure and Function, Reith, M.E.A., Ed. Humana, New York, 1996, 56. 

This book will focus on forensic pharmacology and drugs of abuse. Drugs of abuse, such as cocaine, heroin, marijuana, PCP, benzodiazepines, and methamphetamine, are often involved in criminal and civil matters concerning personal injury, motor vehicle accidents, drug overdose, and murder, and thus, are discussed to illustrate forensic pharmacology issues and investigations. 

Coffin PO, Galea S, Ahern J, Leon AC, Vlahov D Tardiff K (2003). Opiates, cocaine and alcohol combinations in accidental drug overdose deaths in New York City. Addiction, 98, 739-47... 

Some people have an exaggerated reaction to cocaine and overdose on small amounts. Chronic users become more sensitive to the toxic effects of the drug, and may experi ence serious problems after taking their accustomed dose. Seizures, elevated blood pressure, respiratory depression, coma, and death can follow. 

The authors of this report thought that the Brugada syndrome was probably not due to chlorpromazine or lithium in this patient, and it has not been previously described with heroin. It may have been due to hyperkalemia (as the Brugada pattern normalized when the serum potassium concentration normalized), perhaps facilitated by cocaine. Another case of Brugada syndrome is described under Drug overdose . 

The combination of opiates and cocaine in drug overdose deaths has been examined retrospectively in a review of all accidental drug overdoses that resulted in death in New York City from 1990 to 1998 (394). There were 7451 accidental overdose deaths, of which opiates played a role in 71%, cocaine in 70%, and alcohol in 40% one of these drugs was identified in 98% of all overdose deaths. As evidence of higher polydrug mortality, 58% of the... 

The role of methadone and opiates in accidental overdose deaths in New York City has been investigated using data from the Office of Chief Medical Examiner of all accidental drug overdose deaths between 1990 and 1998 (51). There were 7451 overdose deaths in all during this period, of which 1024 were methadone-induced, 4627 were heroin-induced, and 408 were attributable to both. Thus, 70% of the deaths from accidental overdose were due to opiates. Co-variates significantly associated with methadone-induced deaths were female sex, older age, and absence of cocaine, heroin, cannabis, and alcohol in toxic screens. Co-variates associated with heroin overdose were male sex, Caucasian or Hispanic ethnicity, younger age, and the absence of cocaine and methadone and the presence of cannabis and alcohol in toxic screens. 

Rush, Roll, Higgins, 1998). The combination of cocaine (or amphetamine) and heroin (or other opiate) is called a speedbair and is particularly popular among heroin addicts. Morphine and cocaine combinations have been studied in the laboratory, and as with alcohol, morphine appeared to enhance the pleasurable effects of cocaine but also increased the cardiovascular effects. Combinations of cocaine and heroin have sometimes been blamed for drug overdose deaths (as in the deaths of comedian John Belushi and actor River Phoenix), and the synergistic effects on blood pressure and heart rate may be a factor (Foltin Fischman, 1992 Rush et al., 1998). 

Petroff and co-workers reported a quantitative analysis of the H NMR spectra of six CSF samples from three patients. TTiese included a 34-year-otd man presenting with seizures several hours after injecting heroin and cocaine while intoxicated with alcohol, and a 7-month-old girl who presented as a febrile, cyanotic hypotensive in a coma. The H NMR spectrum of the CSF of the drug overdose victim showed clear and abnormally elevated signals for citrate, myo-inositol, creatinine/creatine and lactate. 

Drug overdoses involving stimulants (eg, amphetamines, cocaine, phencyclidine, monoamine oxidase inhibitors) or strychnine. 

Figure 5.1 Visualization of the distribution of the DA transporter, D3 receptor, and K2-opioid receptor in the human brain of a drug-free control subject and a representative cocaine overdose victim. (A, B) The DA transporter was measured using [3H]WIN 35,428 (2 nM) as described previously. (C, D) The D3 receptor was measured using [3H]-(+)-7-OH-DPAT (1 nM) in the presence of GTP (300 m/W) to enhance the selective labeling of the D3 receptor subtype over the D2 receptor subtype as described previously. (E, F) The K2-opioid receptor subtype was measured using [125l]IOXY on tissue sections pretreated with BIT and FIT to occlude binding to the p- and 8-opioid receptors, respectively.

Staley J., Basile M., Wetli C. et al. Differential regulation of the dopamine transporter in cocaine overdose deaths. Natl. Inst. Drug Abuse Res. Monogr. 32, 1994. 

Other effects caused by methamphetamine include headaches, decreased appetite, dry mouth, dilated pupils, trembling, chest pains, increased respiration and shortness of breath, hyperthermia (elevated body temperature), insomnia, and nausea and vomiting. In more severe cases (i.e., overdoses) it can produce seizures and convulsions, stroke, heart attacks, and death. The risk of encountering these more serious side effects are greatly increased when methamphetamine is used in combination with other drugs like cocaine, marijuana, alcohol, and heroin. 

Physical effects of high doses of ketamine include decreased respiration and heart rate, increased blood pressure, and the possibility of vomiting and convulsions. These can lead to cardiac and respiratory arrest, coma, and death. The risk of ketamine overdose is much greater when it is mixed with other drugs such as alcohol, Ecstasy, caffeine, or cocaine. Overdoses of ketamine have been reported when people boost the drug (take another dose before the first dose wears off) to prolong its psychedelic effects. 

Ketamine is often taken with other drugs, such as cocaine, marijuana, alcohol, and Ecstasy, which greatly increases the risk for overdose. Ketamine tends to be taken by people with a history of experimenting with numerous other drugs. Ketamine is also occasionally taken by physicians and veterinarians, who have easy access to the drug and want to experiment with its psychedelic effects. 

Amphetamine (Benzedrine). Amphetamine was synthesized in 1887. It was quickly found to be a potent stimulant with effects similar to cocaine, which had been discovered over 100 years before. In the subsequent years, amphetamine found a variety of uses. It was used to treat narcolepsy, Parkinson s disease, barbiturate overdose, bed wetting (enuresis), and obesity. It was also used to counteract the sedating effects of other drugs and medications including antiseizure medications and alcohol. 

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