Sunday, April 22, 2012


We don't talk much about cocaine anymore. The emphasis these days is on opiates and prescription drug abuse. Yet just as many Americans use cocaine as they do heroin. The difference is that cocaine is 'marginally socially acceptable' in many wealthier circles. For that reason, discussion about it does not peak interest. Cocaine was more or less 'normalized' by high-level executives and celebrities. It is available at parties and bars and folks don't see it as an addictive substance. Even detoxes do not accept clients who only abuse cocaine. The problem however, is cocaine causes serious damage to the brain. Using it with alcohol, even socially, can produce cocaethylene which can be fatal. Smoking cocaine in crack form, causes Dopamine flooding and a slower re-uptake. That means that it is all but impossible to stop smoking until the crack runs out. It goes to the reward center of the brain and produces such a pleasurable effect that people do not want to stop smoking. So the question becomes, why do people smoke cocaine or snort it if it is damaging? Are they addicted? There is no one answer to these questions. People use illicit drugs for many reasons. But they are not addicted to the substance cocaine. They are addicted to the feeling they get when they use this substance. It takes them out of the everyday world that surrounds them and puts them in a different emotional state where no one can demand from them. They do not have to live up to anyone else's expectations. But, damage from cocaine abuse clearly outweighs the good feeling that users get when they are high. It is a negative tool to avoid reality and responsibility. In between use, folks become irritable and anxious. And combined with other drugs it can be fatal. Although not a gateway drug, rarely do we meet clients who only use cocaine. Patients come to us when their life is out of control. When the cocaine/crack use has financially devastated them. And when they have alienated their family and friends in favor of their on-going affair with the drug. Cocaine abuse is a serious problem in America. We should not turn our heads and ignore it when family members use the drug. We should encourage them to get help before they lose everything that is important to them.

Sunday, April 8, 2012


In the past seven years I have treated dozens of nurses. Some have come to us for alcohol dependence. But the majority have been Opioid Dependent. That's correct. These professionals that we depend upon to hold our hands and minister to us when we are sick, are often very ill themselves.

They begin by taking Percocets for stress, then a little Oxycontin for back pain and many of them progress to Dilaudid to get through their shift. The sad part of this behavior is that they more often than not, they take medicine from their places of work - hospitals, nursing homes and even hospice. Some even substitute placebos for the actually pain medications, leaving their patients in distress.

Although this is the minority of people in the nursing profession, it still begs the question, WHY? Is the job too stressful? Do we not provide enough down time for our most valuable caregivers? Are there folks in the profession with no regard for a work ethic and who leave their co-workers to run back to back shifts because they feel like calling in sick? Do some people enter the profession with a predisposition towards drug addiction?

I do not have the answer. What I do know is that this is becoming a problem that we need to address. I also think that support for recovery is a better idea than punishment. We need nurses. They deserve our help, if not for humanitarian reasons, than at the very least because it is good Karma.