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The recreational drug that’s no fun – Deborah Lyle

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  Posted by: The Probe      3rd July 2018

 

Coke, Blow, White, Charlie, Snow or Toot, call it what you like but white powder cocaine is the most prevalent stimulant in the UK.[i]Cannabis is still the most commonly used illicit drug in Britain, yet London has recently been named the cocaine capital of Europe[ii]where addiction has been described as ‘a very real problem’[iii]. Indeed, the UK has some of the highest rates of drug use in Europe and over the last 20 years there has been a statistically significant rise in the use of powder cocaine, particularly by young adults.[iv]It has been suggested that cocaine use has been ‘normalised’3and some people are even sharing their experiences of drug abuse on social media whilst mobile apps are being used to market and trade the drug.

Cocaine is processed from leaves of the coca plant, which is grown mostly in the mountainous areas of Columbia, Peru and Bolivia. Farmers mash the coca leaves adding an alkaline substance such as lime (the type used in cement) to help extract the cocaine, before mixing it with a petroleum-based liquid as well as substances such as ammonia and sulphuric acid to produce a highly toxic raw paste. It is a labour intensive process but this paste is then sold to large cocaine producing plants, where it is purified and turned into an extremely lucrative white powder ready to be smuggled out to suppliers and dealers around the world.[v]

At street level, cocaine is often mixed with substances such as chalk, flour, sugar or talcum powder to increase its value but in some cases it is blended with other ‘filler’ ingredients, which can be amphetamines to produce further stimulus and/or a local anaesthetic such as procaine for numbing effects.[vi]As an illegal substance, cocaine is not manufactured in a controlled environment so users can never be completely certain of its composition. As a consequence, there is no way of knowing the harm it could potentially cause.

This so-called ‘recreational drug’ is a powerful stimulant, which increases and maintains high levels of the neurotransmitter dopamine. This signalling chemical is the natural response to pleasure and potential rewards, which cocaine disrupts, causing increased activity and a euphoric ‘high’. Repeated use can cause the brain to adapt to the excess dopamine, which means that users need to take stronger, more frequent doses to experience the same high and is the reason for dependency or addiction.5

Sniffing or snorting the powder up into the nasal passages is a common way of ingesting cocaine – the drug coats the nose lining and is absorbed through the mucous membranes. In addition, powdered cocaine can be rubbed directly onto the gums or made into a solution for injecting or ‘shooting’. Some users also inhale the vapour produced by heating a smokable version of cocaine often called ‘crack’ or ‘rock’.

The short-term effects of cocaine are extreme happiness, enhanced energy and mental alertness, increased stamina and greater confidence. However, it can also cause irritability, hypersensitivity and paranoia as well as nausea and restlessness. Cocaine also narrows the blood vessels and can cause increased heart rate, body temperature and blood pressure.5As one would expect, with long term use, cocaine use causes toxic and permanent damage to many organs. This includes the heart and cardiovascular system leading to an increased risk of stroke and seizures as well as orofacial effects such as nasal septum and palate perforation and a wide range of neurological and cognitive problems.[vii]

There are also many oral health implications including gingival lesions and oral candida infections, oral ulcers, xerostomia, halitosis, tooth decay, dental erosion and periodontal disease to name but a few.[viii],[ix]When cocaine is mixed with saliva, either whendirectlyplacedonto the gingiva or oral mucosa, or through thenose and then into themouth, it becomes a powerful acidthat can dissolveessential minerals in both tooth enamel and dentine.[x]The use of cocaine also makes the mouth dry and a decreased salivary flow promotes bacterial growth.  When good nutrition and oral hygiene is disregarded for long periods of time, there is obviously increased risk of caries.Correspondingly, evidence indicates that regular cocaine users are prone to oral infections due to the immunosuppressive effects of the drug and there is greater prevalence of dental and periodontal diseases in these patients.[xi]

With the concerns regarding the use of cocaine increasing every day, it is crucial that dental professionals look out for probable signs of use. I would suggest we add the clinical signs here to really make this article helpful for DP’s. Naturally, the subject must be approached with sensitivity but education and advice about maintaining an effective oral health routine can go a long way to help users to reconsider their habits and improve their overall health. Along with tooth brushing, it is a good idea to recommend water flossing as it only takes a minute each day and can be especially beneficial to patients with dry mouth.Furthermore, the Waterpik®Water Flosser is clinically proven to be significantly more effective than string floss;[xii]it removes plaque and debris from between the teeth and below the gum line where regular brushing and flossing cannot reach.As well as this, dental professionals should offer information and contact details for support groups such as FRANK and Cocaine Anonymous, to help individuals to address a problem that certainly appears to be escalating.

 

For more information on Waterpik International, Inc. please visit www.waterpik.co.uk. Waterpik®products are available from Amazon, Costco UK and Superdrug stores across the UK and Ireland.

 

 

 

 

[i]European Monitoring Centre for Drugs and Drug Addiction. United Kingdom – Country Drug Report 2017. http://www.emcdda.europa.eu/system/files/publications/4529/TD0116925ENN.pdf[Accessed 14th March 2018]

[ii]European Monitoring Centre for Drugs and Drug Addiction. Assessing illicit drugs in wastewater – advances in wastewater-based drug epidemiology. EMCDDA Insights 22,

Publications Office of the European Union, Luxembourg. http://www.emcdda.europa.eu/system/files/publications/2273/TDXD16022ENN.PDF[Accessed 14th March 2018]

[iii]The Guardian. UK News. Sept 9th 2017 Confessions from the City: why firms are failing to tackle the cocaine crisis. https://www.theguardian.com/society/2017/sep/09/city-firms-failing-to-tackle-cocaine-crisis?CMP=share_btn_link[Accessed 7thMarch 2018]

[iv]Home Office. Drug Misuse: Findings from the 2016/17 Crime Survey for England and Wales. Statistical Bulletin 11/17. July 2017. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/642738/drug-misuse-2017-hosb1117.pdf[Accessed 14th March 2018]

[v]Narconon International. Cocaine. What is Cocaine? http://www.narconon.org/drug-information/what-is-cocaine.html[Accessed 14th March 2018]

[vi]National Institute on Drug Abuse. Advancing Addiction Science. What is cocaine. June 2016. https://www.drugabuse.gov/publications/drugfacts/cocaine[Accessed 14th March 2018]

[vii]National Institute on Drug Abuse. Advancing Addiction Science. What are the long-term effects of cocaine use? https://www.drugabuse.gov/publications/research-reports/cocaine/what-are-long-term-effects-cocaine-use[Accessed 14th March 2018]

[viii]Brand H.S et al. Cocaine and oral health. British Dental Journal 2008; 204: 365-369. https://www.researchgate.net/profile/H_Brand/publication/5443377_Cocaine_and_oral_health/links/02e7e5202afc3e0c4e000000/Cocaine-and-oral-health.pdf[Accessed 14th March 2018]

[ix]Maloney W. The significance of illicit drug use to dental practice. Webmed Central Dentistry: Drug Abuse2010;1(7):WMC00455
doi: 10.9754/journal.wmc.2010.00455. http://www.webmedcentral.com/article_view/455[Accessed 7th March 2018]

[x]Cocaine-Induced Dental Erosion. N Engl J Med 1990; 322:408 DOI: 10.1056/NEJM199002083220617. http://www.nejm.org/doi/full/10.1056/NEJM199002083220617#article_citing_articles[Accessed 14th March 2018]

[xi]Gurpreet Kaur Saini et al. Drug addiction and periodontal diseases. J Indian Soc Periodontol. 2013 Sep-Oct; 17(5): 587–591.

doi:  10.4103/0972-124X.119277. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3808011/[Accessed 14thMarch 2018]

[xii]Goyal CR, et al. Waterpik® Water Flosser: Significantly More Effective than String Floss for Removing Plaque. Journal of Clinical Dentistry 2013;24(2):37-42. https://www.waterpik.co.uk/professional/clinical-research/Goyal-Waterpik-vs-String-Floss-for-Plaque-Removal-2013/[Accessed14thMarch 2018

 


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