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Thursday, April 17, 2014
Addiction and Substance Abuse
Cocaine physical side effects
I have a friend who contends that cocaine remains in her system for an extended period of time, more than 3 or 4 days. She also contends that it exudes from her skin and her eye sockets during and after use. Recently after a sustained binge (three or four weeks of a gram a day / average ) she broke out in boils on her arms. They were painful and warm to the touch. After about a week they festered and erupted and oozed pus. She also believes that unabsorbed cocaine collects in her nasal passages and when she blows her nose she believes that she is blowing out some cocaine. She hasn`t resorted to drying this stuff out and re-snorting it yet, but there is always hope. Have you ever heard of anything like this? I know it sounds strange but this not dementia as I know her quite well
Thank you for your excellent questions about cocaine use. There are several issues you bring up so I will address them one at a time:
1) Cocaine does not remain in the system ... it just does not. Generally the metabolites of cocaine do stay for a few days, and that is why the tox screen stays positive for up to four days after a binge. Patients often report that it stays in their system for a long time and that is why their tox screens are usually or always positive ... but the persistent positive tox's generally are due to persistent use and not due to remote use still showing up. We know this because when people are admitted to residential treatment or to jail, their tox screens revert to negative "right quick!"
2) The feelings of cocaine oozing from skin and eye socket concerns are likely due to phenomena known as "tactile hallucinosis" that can accompany some mild to moderate paranoia after substantial cocaine or other amphetamine binges.
3) The skin boils are fairly frequently reported by fairly severe cocaine or methamphetamine addicted people. This can be from:
- "Environmental exposure" - Being in places with people that a person would not be with if they were sober.
- Poor hygiene - When on a binge, people typically do not even eat or drink, to say nothing of bathe and scrub the skin.
- Or from so called "sterio-typic behaviors," including repetitive picking at the skin while binging.
Any and all of these can result in the post-binge skin problems that so many stimulant addicted people experience.
3) There is no unabsorbed cocaine in nasal secretions. There may be inert ingredients from the "cocaine" ... known as "cut". This is often talcum powder or other non-absorbable inert substances that can be seen when blowing the nose after a severe binge.
4) There is no dementia associated with cocaine addiction unless it is caused by multiple mini-strokes that can happen due to the massive blood pressure and heart rate increases that occur during a binge. There IS a stimulant binge associated psychosis or paranoia that I have mentioned above, which commonly includes some of the symptoms that you describe.
Finally, it sounds like the situation is very, very difficult for this person. The cocaine addiction is quite severe and very far advanced. Addiction treatment would be of the utmost importance as soon as possible. Best of luck and please write back if there are further questions.
Ted Parran, MD
Associate Professor of General Medical Sciences
School of Medicine
Case Western Reserve University