Cocaine dependence: a case series from India.
BACKGROUND
Cocaine use and dependence is a wellknown phenomenon in the West but has not been reported in the medical literature from India, despite recent media reports of its use by drug abusers and seizure by authorities.


METHODS
We report 5 patients with cocaine dependence who came for treatment to the Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh.


RESULTS
All the patients were young adult men (age range 20-27 years). They were either unemployed or in medium level occupation. All used cocaine by 'snorting' (inhaling cocaine hydrochloride salt in a powder form through the nose so that cocaine gets rapidly absorbed into the bloodstream through the nasal mucosal epithelial capillary vasculature). None reported smoking or inhaling the vapour of heated freebase cocaine ('crack'). All reported intense and specific craving for cocaine (and met criteria for dependence syndrome as per ICD-10), though 3 patients were also dependent on opioid preparations (heroin, dextropropoxyphene or codeine containing cough syrups). We started them on clonidine for opioid detoxification followed by naltrexone. Since there is no approved medication for cocaine withdrawal or relapse prevention, our focus was on relapse prevention counselling using cognitive behavioural principles. The outcome was variable.


CONCLUSIONS
Cocaine dependence is present among the population in India. Patients are not necessarily from the affluent class. This case series of cocaine dependence, the first from India, intends to be both a curtain raiser and an eye opener.
Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India - Drug De-addiction and Treatment Centre, Department of Psychiatry.
Debasish
D
Basu
Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India - Drug De-addiction and Treatment Centre, Department of Psychiatry.
Sunil
S
Gupta
All India Institute of Medical Sciences, Jodhpur, Rajasthan, India - Department of Psychiatry.
Naresh
N
Nebhinani
Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India - Drug De-addiction and Treatment Centre, Department of Psychiatry.
Surendra K
SK
Mattoo
D000328:Adult; D019970:Cocaine-Related Disorders / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D003376:Counseling; D006801:Humans; D008297:Male