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Forum Name: Heart Failure
|melhelms - Tue Jan 06, 2009 6:51 pm||
A loved one recently failed a urine screening for cocaine. The results were nearly 9,000 ng/ml. I have 2 questions. 1) Is 9,000 ng/ml an extremely high level that could be serious cocern for heart or kidney failure? 2) Based on the level of cocaine in his screening, how much cocaine could one assume he does on a daily basis (preferably in grams)
FYI, he is 6' down to 140lbs, daily user for 5 years, progressed from cocaine to crack cocaine in past year, and drinks alcohol with crack/cocaine.
I already know that any cocaine use is cause for serious concern, and I already know he needs help. What I don't know is he a walking time bomb? Knowing the level of cocaine in his system could one expect him to go into cardiac arrest at anytime?
|John Kenyon, CNA - Wed Jan 07, 2009 9:59 pm||
The figure you provide is necessarily taken out of context, since we can't know with certainty when the last time was that cocaine was used. I can tell you that a surgical dose (for purposes of local anesthesia) will peak at 6700 ng/ml within one hour in lab test subjects. The same dose is almost gone in 48-72 hours. So we can conclude either a nasal dose greater than 1.5 mg had been (probably) inhaled within an hour previous, or that a much larger amount was used at a somewhat earlier time. At any rate, tolerance of the drug varies from one individual to the next, and while overwhelmingly high doses can be patently lethal, any dose can, at any given time (but especially after chronic use) cause severe and life-threatening medical problems. The more often it is used, the greater the statistical risk of a coronary event or other dangerous medical situation. Sudden cardiac arrest is an ever-present risk with any cocaine user. It is more random than Russian roulette.
A good example of the unpredictability of idiosyncratic response to cocaine use would be the tragic death of college star and NBA 1st-round draft pick Len Bias, in 1986, who, after his first use of cocaine (although it may have been taken more than once during the evening) was also his last. Some people tolerate it for varying lengths of time. Some, however, will suffer a terminal event the first time. So every cocaine user is a potential "time bomb." There is no safe limit, there are only more unsafe ones.
Since the person in question has been developing a tolerance for (or increased yen for the pleasure of) cocaine to the extent of now using the crack form, and because he is drinking with it, he is probably on a terminal course already. The various potential dangers multiply with time, increase in use, etc. An intervention would be not only appropriate but possibly life-saving.
I hope this is helpful to you in evaluating your plans to deal with this individual's problem. This is always an emergency; let us hope it doesn't become a sudden medical crisis or worse. Good luck to you. Please follow up with us here as needed.
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