[Emergency room admissions in cocaine users in Spanish hospitals: first evidences of acute complications related to crack use. Work Group for the Study of Emergencies from Psychostimulants].
BACKGROUND
Acute complications of cocaine are increasing in Spain, nevertheless little information is available on its clinical and toxicological characteristics.


METHODS
Records from medical emergency rooms of 14 hospitals from Madrid, Valencia and Gran Canaria were reviewed. Records were selected if the term "cocaine" was mentioned, excluding those related with injuries or obstetric, gynecologic and pediatric problems. Emergency room episodes were classified in three groups according its relation with cocaine use.


RESULTS
223 episodes were directly related to cocaine, some of these simultaneously related to heroin (36%) or alcohol. The proportion of all emergency room episodes related to cocaine was threefold higher in Gran Canaria than in Madrid and Valencia. In Gran Canaria most of episodes (72%) were related to cocaine smoking, generally crack, but in Madrid and Valencia most were due to intravenous cocaine use. The most common signs and symptoms were anxiety, mydriasis, syncope, tachycardia, shortness of breath, confusion or coma, agitation, chest pain and palpitations. Mental disorders were the most common diagnoses. 13% of patients were admitted as inpatients to hospital or were referred to another hospital (23.6, 17.3 and 2.2%, if cocaine was smoked, injected and sniffed, respectively). Cardiovascular diagnosis were less frequent in episodes simultaneously related to opioids than in not opioids-related episodes (1.1% vs 10.7%; p = 0.005). Furthermore, 219 not cocaine-related episodes were identified. The relation to cocaine could not be established in other 275 episodes.


CONCLUSIONS
This work show for the first time in Spain the presence of crack-related emergency episodes and suggests that injecting and smoking cocaine has a greater impact on public health than sniffing this drug.
Delegación del Gobierno para el Plan Nacional sobre Drogas, Madrid.
G B
GB
Anta
M A
MA
Rodríguez Arenas
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L
de la Fuente de Hoz
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L
Royuela Morales
D000208:Acute Disease; D000328:Adult; D019970:Cocaine-Related Disorders / Q000453:epidemiology*; D016578:Crack Cocaine; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D013030:Spain / Q000453:epidemiology
D016578:Crack Cocaine