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Crack Cocaine Abuse



  • “Crack” or “rock” is prepared by mixing cocaine hydrochloride, which is the preparation usually available on the street, with an alkaline solution such as baking soda.

  • The mixture may be heated directly until it vaporizes, but this form contains impurities.

  • Freebase cocaine can be prepared by adding a solvent, such as ether, to the mixture. 

  • The mixture separates into two layers with the top layer containing freebase cocaine dissolved in the solvent.

  • The solvent layer is then separated either by filter or, less commonly today, by evaporating it at low temperatures to leave pure alkaloid cocaine crystals.

  • The product is then smoked.

Clinical  

  • Shortness of breath

  • Cough

  • Production of black sputum (2° carbonaceous materials in smoke)

  • Hemoptysis

  • Chest pain

Imaging

  • Non-cardiogenic pulmonary edema (“increased permeability”)

  • Most likely 2° to damage to capillary membrane, either by

    • Direct toxic effect on capillary endothelium

    • Intense vasoconstrictor effect leads to anoxic cell damage

  • Bronchiolitis obliterans with organizing pneumonia (BOOP)

  • Pulmonary infiltrates with eosinophilia

    • Adulterants have been implicated in producing hypersensitivity rx

      • Lidocaine, lactose, sucrose, starch and talc

  • Pulmonary hemorrhage

    • Either from anoxic cell damage 2° vasoconstriction or direct toxic effect

  • Diffuse Interstitial Pneumonia

  • Pneumothorax

  • Pneumoperitoneum

    • Both 2° extended Valsalva maneuver to enhance drug’s effect

crack cocaine lung

Non-cardiogenic Pulmonary Edema from Crack Cocaine Use. There is bilateral, central airspace disease in a perihilar distribution with no pleural effusions or fluid in the fissures. The pattern is consistent with non-cardiogenic pulmonary edema.