Gastrointestinal Complications of Cocaine Abuse

Cocaine is well known for its ability to trigger drastic changes in the normal cardiovascular (heart and blood vessel) health of its users. However, people who use/abuse the drug can also develop a range of problems in the gastrointestinal (GI) tract, which extends from the esophagus to the rectum. Some of these problems occur relatively frequently, but only produce relatively minor health complications. Other cocaine-related gastrointestinal problems occur relatively rarely, but can produce severe or even life-threatening health complications. These advanced complications occur when cocaine use leads to loss of normal blood flow to various parts of the GI tract.

The Basics

People typically use/abuse cocaine for its mind-altering effects, which center on an intense form of pleasure known as euphoria. These effects are produced by the drug’s ability to increase levels of a specific chemical, called dopamine, inside the body’s central nervous system (brain and spinal cord). However, apart from its mind-altering qualities, cocaine use also triggers changes in normal function throughout the body by increasing activity in the sympathetic nervous system, a network of involuntary nerves that interfaces and overlaps with the central nervous system. This heightened state of activity is produced by cocaine’s ability to increase levels of a chemical called norepinephrine. In the context of gastrointestinal health, the most important effect of increasing norepinephrine levels is an unusual amount of constriction (narrowing) in the body’s blood vessels.

Common Effects

The most common gastrointestinal effects of cocaine use/abuse are general pain and tenderness in the abdominal region. In addition, some cocaine abusers also develop symptoms such as nausea, vomiting, and production of loose, bloody stools. In many cases, these effects appear within roughly an hour following use of the drug. However, depending on the individual and specific circumstances, basic cocaine-related gastrointestinal problems may first appear as long as one to two days following active drug use.

Locations of Serious GI Damage

The locations of serious gastrointestinal damage found in cocaine abusers depend largely upon the specific method of drug use, according to an extensive study review published in 2006 in the Journal of the Royal Society of Medicine. People who nasally inhale powdered cocaine tend to develop problems below the pyloric sphincter, a ring of muscle that separates the stomach from the top of the small intestine. On the other hand, people who smoke the rock-like form of cocaine called “crack” typically develop problems above the pyloric sphincter in the stomach or esophagus. The underlying mechanism for cocaine-related problems in all parts of the GI tract is a condition called ischemia, which occurs when reduced blood flow robs tissues of oxygen and other required nutrients. As indicated previously, the cause of cocaine-related ischemia is abnormal narrowing of the blood vessels that supply oxygen- and nutrient-rich blood to the body.

Effects of Nasal Inhalation

Nasal inhalation of cocaine can lead to a significant loss of normal blood flow in the mesenteric arteries, a group of three blood vessels responsible for supplying blood to both the small and large intestine. In turn, this loss of blood flow can lead to the onset of a condition known as mesenteric artery ischemia (or ischemic colitis). Relatively minor cases of this condition will result in problems such as vomiting, diarrhea, and moderate to severe abdominal pain. However, advanced cases of mesenteric ischemia can reduce blood flow enough to produce tissue death (more commonly known as gangrene). Depending upon the extent of tissue die-off involved, potential consequences of this process include the formation of ulcers in the lining of the lower GI tract, the formation of tissue perforations that go completely through the intestinal wall, and loss of normal function in entire sections of the small or large intestine.

Effects of Lung Inhalation

The gastrointestinal complications of smoking crack cocaine differ from the complications of nasal cocaine inhalation primarily in their location, not in their type or severity, the authors of the study review in the Journal of the Royal Society of Medicine report. No one knows exactly why lung inhalation tends to produce ischemia in the upper GI tract. However, some researchers believe that crack smokers trigger the onset of upper GI ischemia by holding their breath and/or swallowing air during drug use. Despite the fact that most of the problems associated with crack use occur in the tissues of the stomach or esophagus, some people who smoke crack also develop complications in the uppermost part of the small intestine or in the large intestine.