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Crack Cocaine Related Deaths In 2013 ##TOP##


Over three-quarters of DWI offenders in jail reported using drugs in the past. Among jail inmates held for DWI, marijuana (73%) and cocaine-based drugs including crack (41%) were the most commonly used drugs. Thirty percent of those in jail reported drug use in the month prior to arrest.




crack cocaine related deaths in 2013


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In 1991, 60% of federal prisoners reported prior drug use, compared to 79% of state prisoners. In 1997 this gap in prior drug use was narrowed, as the percentage of federal inmates reporting past drug use rose to 73%, compared to 83% of state inmates. By 2004 this gap was almost closed, as state prisoner reports of lifetime drug use stayed at 83%, while federal inmates rose to 79%. This increase was mostly due to a rise in the percentage of federal prisoners reporting prior use of marijuana (from 53% in 1991 to 71% in 2004), cocaine/crack (from 37% in 1991 to 44% in 2004), and hallucinogens (from 15% in 1991 to 26% in 2004).


The proportion of state prison inmates reporting the past use of cocaine or crack declined slightly between 1997 (49%) and 2004 (47%). Marijuana use (78%) remained stable since 1997 (77%), and remained the most commonly used drug. Past use of opiates, including heroin (23%) remained almost unchanged since 1997 (24%). Past use of methamphetamine rose from 19% in 1997 to 23% in 2004.


Recent findings suggest that cocaine use may be reemerging as a public health concern in the United States. For example, the National Survey on Drug Use and Health (NSDUH) indicates that in 2015, 968,000 people aged 12 or older initiated cocaine use in the past year (0.4 percent of the population), which was higher than in each of the years from 2008 to 2014. The 2015 estimate represented a 26 percent increase compared with 2014, with 766,000 new cocaine users in the past year (0.3 percent of the population), and a 61 percent increase compared with 2013, with 601,000 new cocaine users in the past year (0.2 percent of the population). The Office of National Drug Control Policy estimates that the potential cocaine production from Colombia was 420 metric tons in 2015,2 which is the highest level of Colombian cocaine production since 2007 and an increase of more than 100 percent compared with 2013.2 In addition, the number of deaths from cocaine overdose has increased steadily between 2012 and 2015 (4,400 in 2012, 4,900 in 2013, 5,400 in 2014 and 6,800 in 2015). The number of cocaine deaths in 2015 was the second highest since 1999, with only 2006 being higher when there were 7,400 deaths.3


Increases in cocaine use may be most notable among young adults. For example, a longitudinal study of students currently aged 19 to 28 found that past year cocaine use has increased from 3.9 percent in 2013 to 5.0 percent in 2014 and 5.7 percent in 2015. Based on those findings, the study investigators indicated that cocaine may be making a comeback.4 The 2015 NSDUH data also indicate that cocaine use among young adults aged 18 to 25 is of particular concern because in 2015, 663,000 young adults used cocaine for the first time in the past year; this accounted for nearly 7 out of every 10 new cocaine users aged 12 or older despite representing just 13 percent of the total population aged 12 or older.5,6


NSDUH measures cocaine (including crack) use for the U.S. civilian, noninstitutionalized population aged 12 years or older. NSDUH collects data by administering questionnaires to a representative sample of the population through face-to-face interviews at their place of residence. NSDUH collects information from individuals residing in households, noninstitutionalized group quarters (e.g., shelters, rooming houses, dormitories), and civilians living on military bases. One of NSDUH's strengths is the stability of the survey design, which allows for multiple years of survey data to be combined to examine state-level estimates on cocaine use and several other substance use or mental health outcomes. Policymakers and prevention practitioners can use current state-level data on cocaine use among young adults aged 18 to 25 to improve their understanding of the scope of the issue in this population, to identify changing trends, and to inform educational and prevention efforts in the communities they serve.


The Substance Abuse and Mental Health Services Administration (SAMHSA) provides resources for people with substance use issues, including issues related to cocaine use. For information on substance use and mental health treatment facilities and programs around the country, see SAMHSA also has a free and confidential 24-hour-a-day, 365-day-a-year information service, in English and Spanish, for individuals and family members facing substance use issues. For more information, go to www.samhsa.gov/find-help/national-helpline.


We report a dramatic case of a 19-year-old man with crack cocaine overdose with important clinical complications as cardiac arrest due to ventricular fibrillation and epileptics status. During this intoxication, electrocardiographic abnormalities similar to those found in tricyclic antidepressant poisoning were observed, and they were reversed by intravenous sodium bicarbonate infusion.


The utilization of crack cocaine is increasing around the world because this drug is inexpensive and possible to smoke. The crack cocaine can cause serious clinical complications during intoxication. There are some descriptions of cardiac arrhythmias, myocardial ischemia and infarction, myocarditis, hypertension, sudden death, seizure, hyperthermia, psychomotor agitation, and so forth [1].


We describe a case of crack cocaine overdose with clinical presentation of cardiac arrest due to ventricular fibrillation and epileptics status in which we observed an electrocardiographic pattern similar to that found in patients with tricyclic antidepressant poisoning and high risk of complications and these alterations were reversed after sodium bicarbonate infusion.


A 19-year-old man ingested large amount of crack cocaine in a suicide attempt. He arrived in the emergency department unconscious and was intubated. After this, he had a cardiac arrest due to ventricular fibrillation reversed with defibrillation. Repeated seizures were observed, and benzodiazepines were administered.


We described a case of severe crack cocaine overdose with life-threatening ventricular arrhythmias and repeated seizures in which an interesting electrocardiographic pattern similar to that found in tricyclic antidepressant poisoning was observed, and these alterations were completely reversed through the acidosis correction.


The crack cocaine form is manufactured by processing the cocaine with ammonia or sodium bicarbonate to remove the hydrochloride, and in this way it is heat stable which allows it to be smoked [1]. In our case, the patient used this drug in an unusual manner, because he ingested orally the crack cocaine in a suicide attempt.


There are many descriptions of cocaine-related sudden death, but the majority of these patients die before arriving at the hospital, and the mechanisms responsible for these deaths are unclear [1]. Ventricular arrhythmias as ventricular tachycardia and ventricular fibrillation induced by the cocaine may be responsible for it; in our case ventricular fibrillation was observed which was promptly reversed by defibrillation. Wang described one case of a 25-year-old man with cardiac arrest resuscitated with epinephrine after the ingestion of crack cocaine who presented electrocardiographic alterations similar to those showed here that improved after sodium bicarbonate infusion; however, in this case arrhythmias and seizure were not described [6].


The prevalence and prognostic of these electrocardiographic changes during cocaine overdose are unknown, but they could help identify patients at high risk of complications during this clinical setting, and the physicians need to suspect crack cocaine overdose in unconscious patients admitted to the hospital with electrocardiogram pattern compatible with sodium channel blocking.


The crack cocaine can induce an electrocardiographic pattern similar to that observed in acute poisoning by tricyclic antidepressants which is reversed by sodium bicarbonate infusion. These alterations may help identify patients at high risk of ventricular arrhythmia and seizure during crack cocaine overdose.


Methods. We used data on drug overdose deaths in the United States from 2000 to 2015 collected in the National Vital Statistics System to calculate annual rates and numbers of cocaine-related overdose deaths overall and deaths both involving and not involving opioids. We assessed statistically significant changes in trends with joinpoint regression.


The percentage of cocaine-related overdose deaths involving any opioid increased from 29.4% in 2000 to 63.0% in 2015 (Table A, available as a supplement to the online version of this article at ). Among these deaths, heroin or synthetic opioids have been increasingly contributing to these deaths since 2010, contributing to 81.5% of these deaths in 2015.


The public health and public safety response to increasing cocaine-related overdose deaths should be comprehensive and informed by the role opioids play. This is particularly important given the rapid increase in cocaine-related deaths involving synthetic opioids such as fentanyl and its highly potent analogs.


We extracted CMRs and standardized mortality ratios (SMRs). We expressed CMRs as the number of deaths per 100 PY of follow-up. We reported SMRs as calculated in the source papers. In several cases standard errors, confidence intervals (CIs) and CMRs were not reported, so we estimated them using standard calculations. We also put into the database CMRs and SMRs that were reported according to sex, HIV status, treatment status and type of drug injected, as well as data on deaths from drug overdose or AIDs-related causes.


Heroin-related deaths jumped 39 percent from 2012 to 2013, and the longer-term trends are equally disturbing: from 2002 to 2013, the rate of heroin-related overdose deaths nearly quadrupled, according to the Centers for Disease Control and Prevention.


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