Cocaine-related medical problems: consecutive series of 233 patients

Am J Med. 1990 Apr;88(4):325-31. doi: 10.1016/0002-9343(90)90484-u.


Purpose: Little information describing common cocaine-related medical problems is available. This study examined the nature, frequency, treatment, incidence of complications, and emergency department deaths of patients seeking medical care for acute and chronic cocaine-associated medical problems.

Patients and methods: A consecutive series of 233 hospital visits by 216 cocaine-using patients over a 6-month period during 1986 and 1987 was studied. Medical records were retrospectively reviewed to determine patient characteristics, nature of complications, treatment, and outcome.

Results: Patients most commonly used cocaine intravenously (49%), but freebase or crack use was also common (23.3%). Concomitant abuse of other intoxicants, especially alcohol, was frequently seen (48.5%). The vast majority of complaints were cardiopulmonary (56.2%), neurologic (39.1%), and psychiatric (35.8%); multiple symptoms were often present (57.5%). The most common complaint was chest pain though rarely was it believed to represent ischemia. Altered mental status was common (27.4%) and ranged from psychosis to coma. Short-term pharmacologic intervention was necessary in only 24% of patients, and only 9.9% of patients were admitted. Acute mortality was less than 1%.

Conclusion: Most medical complications of cocaine are short-lived and appear to be related to cocaine's hyperadrenergic effects. Patients usually do not require short-term therapy or hospital admission. Acute morbidity and mortality rates from cocaine use in patients presenting to the hospital are very low, suggesting that a major focus in the treatment of cocaine-related emergencies should be referral for drug abuse detoxification and treatment.

MeSH terms

  • Adolescent
  • Adult
  • Chest Pain / etiology
  • Cocaine*
  • Emergencies
  • Female
  • Georgia
  • Humans
  • Lung Diseases / etiology
  • Male
  • Middle Aged
  • Retrospective Studies
  • Substance-Related Disorders / complications*
  • Substance-Related Disorders / epidemiology
  • Substance-Related Disorders / therapy
  • Urban Population


  • Cocaine