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Sunday, November 4, 2018
Long-Term Health Risks of Cocaine Use: Rhabdomyolysis
Cocaine use in the United States has died down since the height of its popularity in the 1980s and ’90s. Crack cocaine use has correspondingly declined, as well.
According to the 2016 National Survey on Drug Use and Health, only about 0.7 percent of Americans aged 12 or older reported past-month use of cocaine. That number shakes out to about 1.9 million Americans, including 432,000 who used crack.
Still, cocaine use is a ways away from completely disappearing, as its prevalence has remained relatively stable since 2009. And, about 4,000 to 5,000 Americans are still dying every year from cocaine overdose.
This stimulant drug is known for side effects such as restlessness, rapid heartbeat, paranoia and bizarre behavior, but in this article, we would like to talk about one of the lesser-known, but more devastating potential effects of cocaine use: rhabdomyolysis.
What Is Rhabdomyolysis?
Rhabdomyolysis (rhab·do·my·ol·y·sis): A rare condition in which muscle cells break down and release a substance into the blood that can lead to kidney failure. (via Mayo Clinic)
WebMD notes that rhabdomyolysis starts with a direct or indirect muscle injury. Indirect muscle damage can be caused by certain medications, dietary supplements or drug use.
When a muscle breaks down, its fibers may leak a protein pigment called myoglobin into the bloodstream, which may travel to, and block, tiny tubes within the kidneys. This can cause serious kidney damage and, even, renal failure.
Further kidney damage can happen as a result of the damaged muscle. Extremely damaged muscles tend to retain a large amount of fluid from the blood, which lowers the body’s fluid supply and reduces blood flow to the kidneys.
A study published in a 2016 version of Case Reports in Pediatrics peer-reviewed journal said that there are more than 25,000 cases of rhabdomyolysis in the U.S. annually, which account for 7 percent of all acute kidney injury cases each year. WebMD says that patients can usually overcome this kidney syndrome with prompt treatment.
Symptoms of Rhabdomyolysis
The symptoms of rhabdomyolysis can occur in one area of the body or may affect the whole body. Common signs and symptoms of this kidney syndrome include:
Muscle pain in shoulders, thighs or lower back
Muscle weakness or trouble moving arms and legs
Dark red or brown urine
Nausea or vomiting
Rapid heart rate
Drifting out of consciousness
WebMD also says that 1 in 4 patients with rhabdomyolysis will develop problems with their liver, on top of the kidney setbacks.
Cocaine’s Connection to Rhabdomyolysis
During the height of cocaine abuse, a study out of the Wayne State University School of Medicine in Detroit, Michigan was hugely influential in connecting cocaine use to rhabdomyolysis.
In 1991, Wayne State researchers took a sample of 68 patients who visited the emergency department of a large inner-city hospital. There was a control group of 34 non-cocaine-using patients, and then 34 cocaine users. This study has since been published in the Annals of Emergency Medicine monthly journal.
Researchers specifically looked at the creatine kinase (CK) levels in each patient, as measured by units per liter (U/L). The study stated that a CK level of 1,000 or more U/L indicates rhabdomyolysis.
Here are the major findings of the study:
The average CK level among the cocaine users was 931 U/L (with the highest being 1,785 U/L).
The average CK level among the control group was 242 U/L (with the lowest being 168 U/L).
Eight of the cocaine users (24 percent) had rhabdomyolysis.
Not one patient in the control group had rhabdomyolysis.
One cocaine user with rhabdomyolysis developed multiorgan failure and died.
Only one cocaine user with rhabdomyolysis showed muscle pain or swelling symptoms, while three cocaine users without rhabdomyolysis presented muscle symptoms.
This shows that the cocaine use was a greater predictor of rhabdomyolysis than muscle breakdown was.
Other Potential Causes of Rhabdomyolysis
Because of findings from studies like the one mentioned above, cocaine use is now commonly listed as one of the risk factors for rhabdomyolysis.
As we mentioned earlier, direct muscle injuries can lead to this kidney syndrome. Examples of such injuries include:
Any injury that crushes muscle tissue, such as a car accident, fall or objects or building materials that fall on a person
Venom from snake or insect bite
Muscle compression caused by prolonged immobilization on a hard surface, such as after a fall
Potential causes of rhabdomyolysis that do not involve a traumatic injury include:
Prolonged use of alcohol or drugs, namely heroin, cocaine and amphetamines (such as methamphetamine)
Medications such as antipsychotics or statins (cholesterol medications), especially when ingested in high doses
Muscle strain while working out or exerting oneself
Hyperthermia or heat stroke
Seizures or delirium tremens
Metabolic disorders such as diabetic ketoacidosis
Muscle diseases (myopathies) such as Duchenne muscular dystrophy
Bacterial infections that introduce toxins into tissues or the bloodstream (known as sepsis)
Viral infections such as HIV, the flu or herpes simplex virus
If you develop a case of rhabdomyolysis and overcome it, you’re unfortunately at greater risk of having it again than someone who has never had it.
How Is Rhabdomyolysis Treated?
As you can glean from the Wayne State University study mentioned earlier, rhabdomyolysis occurs in a minority of cocaine users. And from that group, only a small percentage will die from the syndrome.
Nonetheless, the key to not letting rhabdomyolysis become fatal is early diagnosis and treatment. Doctors may even be able to reverse some of the kidney damage (although the syndrome typically leaves behind at least some level of damage).
Being diagnosed with rhabdomyolysis necessitates an admission into a hospital, possibly to the intensive care unit (ICU). Once there, intravenous (IV) fluids can help maintain urine production and stave off kidney failure. The medical team will also likely administer supplements or medication to manage electrolyte abnormalities (involving potassium, calcium and phosphorus); this helps protect the heart and other organs.
In rare cases, the patient may need dialysis treatment, which helps the kidneys filter waste while they are recovering. Additionally, a surgical procedure such as fasciotomy may be suggested to relieve muscle tension or pressure, and to reverse loss of circulation in the muscle.
Patients who undergo successful treatment for rhabdomyolysis should quickly proceed to meet with their doctor to discuss their diet, activity levels, drug use and medication use. The doctor will likely recommend many lifestyle adjustments to avoid having rhabdomyolysis happen again.
Getting Help for Cocaine Addiction
Rhabdomyolysis is just one of the many health conditions that can emerge with the long-term use of cocaine, along with paranoia, full-blown psychosis, chronically inflamed and runny nose, anxiety and depression, among others. Cocaine is one of the most addictive illegal drugs, especially when it’s in crack form, so getting off this substance will not be easy.
If you know someone who has begun using cocaine regularly, the time to act is sooner, not later. Because as their cocaine use drags on, the more this person will be at risk of overdose or one of the health conditions mentioned above.
It may take an intervention to get this individual to go to rehab. At Family First Intervention, we take a family-centered approach to interventions, and we can help chart your loved one’s complete path to recovery through professional treatment.
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