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Recreational drug misuse: issues for the cardiologist
  1. A Ghurana,
  2. J Nolanb
  1. aDepartment of Cardiological Sciences, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK, bCardiothoracic Centre, North Staffordshire Hospital, Staffordshire ST4 6QG, UK
  1. Dr Nolan email: nolanjim{at}

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Alcohol and tobacco are the two legally available recreational drugs that are commonly misused in the United Kingdom, and their adverse effects on cardiovascular function have been extensively documented. In addition, many illegal recreational drugs are freely available, and their use has reached epidemic proportions in British society. Almost one in four people have used illegal drugs at some time during their life, with a proportionately higher rate of use in younger age groups. A 1996 Home Office survey showed that more than three million British people use an illegal drug every month. In addition to the problems posed by self administration of these agents, massive overdose can occur in individuals (“body packers”) who attempt to smuggle drugs by ingesting packets which rupture accidentally in the gastrointestinal tract. It is therefore inevitable that doctors will have to manage the ill effects associated with these drugs. Many of these agents have profound effects on the heart and circulation that are responsible for a large proportion of drug related deaths. Our purpose in this article is to review the cardiovascular side effects of the commonly misused non-prescription illegal recreational drugs, and provide guidelines for the management of these potentially lethal cardiovascular complications, based on the best available evidence.

Cocaine, amphetamine, “ecstasy”

Cocaine, amphetamine, and ecstasy have similar adverse effects on the cardiovascular system, predominantly related to activation of the sympathetic nervous system. Cocaine and its free base form “crack” are absorbed from all mucous membranes of the body, and can be smoked, inhaled, or injected. Cocaine is an indirectly acting sympathomimetic drug that inhibits the reuptake of noradrenaline (norepinephrine) and dopamine at sympathetic nerve terminals, and can also act through central pathways to release noradrenaline from the adrenal medulla.1 Circulating catecholamine concentrations can be raised as much as fivefold in cocaine users.2 At …

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