Neuronal Recovery After Cocaine Use
Mechanisms of Cocaine Action
- Cocaine blocks presynaptic reuptake of neurotransmitters such as norepinephrine and dopamine, producing excess concentrations at postsynaptic receptors, leading to sympathetic activation and stimulation of dopaminergic neurons, according to the American Heart Association 1
- Cocaine may also have a direct contractile effect on vascular smooth muscle, as reported by the American Heart Association 1
Metabolism and Detection
- Detoxification is accomplished with plasma and liver cholinesterases, which form metabolic products excreted in the urine, as stated by the American Heart Association 1
- Cocaine metabolites (benzoylecgonine) can be detected in urine for about 24-48 hours after use in most cases, with a mean time to the first negative urine specimen of 43.6 ± 17.1 hours, according to the American Heart Association 2
- In chronic heavy users, metabolites have been detected up to 22 days after last ingestion, as reported by the American Heart Association 2
Clinical Implications
- Most cardiac complications from cocaine use occur within the first 12 hours after presentation to the hospital, with patients who continue cocaine use after initial medical treatment having a higher cumulative risk for myocardial infarction, according to the American Heart Association 3
- Behavioral interventions like contingency management combined with community reinforcement approach have shown efficacy in treating cocaine addiction, as stated by the Public Library of Science 4
- Transcranial magnetic stimulation is being investigated as a potential treatment to reduce cocaine craving and use, potentially affecting recovery of neuronal function, according to the Neuroscience and Biobehavioral Reviews 5