Dear Dr Puff n’Stuff
I have heard that people can die suddenly after injecting crack cocaine. Is this true?

Dear Reader

It is true that people can die suddenly after injecting crack cocaine. It can happen after smoking it too, and even after snorting cocaine powder but less frequently. Fortunately, it’s not very common, or there would be people dropping dead all over Manchester and a serious shortage of players in Premier league football.

There are a number of different ways in which cocaine can cause sudden death. The most usual is by interfering with the heartbeat, and causing a sudden change in rhythm. The most dangerous change in rhythm is called ventricular fibrillation. Here the heart beats so quickly that it is unable to pump blood at all. Rapid death is certain, unless resuscitation is immediate. Cocaine can also lead to a heart attack, probably by causing sudden narrowing of the coronary arteries.

Cocaine can cause a rapid rise in blood pressure. This can lead to arteries bursting in the brain. This so-called cerebral haemorrhage can cause death, or else a stroke.

Cocaine can also lead to an increase in body temperature. There was a recent death recorded when a crack user became excited, and was restrained by police before being placed in a crowded police van. On arrival at the nick he was dead as a result of overheating.

Epileptic convulsions can sometimes be triggered by cocaine. If sufficiently frequent and severe, they can occasionally be fatal.

Having given you all the horror stories, I should say that I have never personally seen a death as a result of cocaine, in spite of many years practising in the drugs field. Apparently three thousand people die a year in the United States as a result of using cocaine. Making the necessary population adjustment for Manchester, one would expect ten deaths a year here if it occurred as frequently. I don’t know what the local figures are because nobody has been counting, but I’m sure they are not as high as this. Either Mancunians are much more careful than Americans, or else more likely they have much less money.

However, it is best to be cautious. Deaths are much more common when people go on long binges, and do not give their heart and blood vessels a chance to recover between shots. It’s best to avoid cocaine or use very moderately, if you suffer from heart disease or high blood pressure, or if a close relative suffered heart attacks or strokes at a young age. Mixing cocaine with alcohol is dangerous, because they react together in the body to form a substance caused cocaethylene, which is bad for the heart. Be careful too about using cocaine on top of prescribed medicines, which can themselves have a very slight effect on heart rhythm.

The same advice applies for cocaine as it does for nearly all drugs: use in moderation, and you probably won’t come to much harm. Use in excess, and anything can happen.

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