Addiction à la cocaïne : données actuelles pour le clinicien

doi:10.1016/j.lpm.2013.01.069

La Presse Médicale

Volume 43, Issue 1, January 2014, Pages 9-17

https://doi.org/10.1016/j.lpm.2013.01.069 Get rights and content

Key points

Cocaine remains the second most commonly used illicit drug worldwide after cannabis. Observed levels of cocaine use among countries considerably vary. An increased cocaine use is recorded in the general European population.

Cocaine addiction is a worldwide public health problem, which has somatic, psychiatric, socio-economic and judicial complications. It is a multifactorial disorder variable in its clinical manifestations and heritable. Compared to the general population, there is a high prevalence of somatic and psychiatric disorders among cocaine-dependent patients. There are predictable dose-related effects of pharmacological action of cocaine and effects which are uncommon, unrelated to dose and occur randomly in this population.

The number of patients entering drug treatment for primary cocaine use has been increasing in Europe for several years. However, there is no specific pharmacotherapy with established efficacy for the treatment of cocaine addiction, nor is any medication approved by regulatory authorities for such treatment. Recent controlled clinical studies and laboratory studies have highlighted some very promising medications.

The perfect therapeutic platform for abstinence initiation and relapse prevention of cocaine addiction is a combination of pharmacological treatments and behavioral treatments. Targeting somatic and psychiatric comorbidity is another way to use pharmacological treatments in addictions.

Points essentiels

La consommation de cocaïne a globalement augmenté en Europe, notamment en France ces dernières années. Ce produit psychostimulant est devenu, en l’espace de cinq années, la seconde drogue illicite la plus consommée dans le monde après le cannabis.

Les effets de la cocaïne dépendent de la dose consommée, de la voie d’administration utilisée, des sujets et des substances associées.

L’addiction à la cocaïne est une maladie multifactorielle d’installation progressive avec des conséquences somatiques, psychiatriques, cognitives et sociales.

Le nombre de demandes de traitement pour l’addiction à la cocaïne augmente progressivement d’année en année. Aucune pharmacothérapie n’est actuellement validée pour le traitement de cette maladie. Les avancées récentes en pharmacologie, en neurobiologie et en imagerie cérébrale ont permis de faire émerger des pistes pharmacologiques prometteuses.

La meilleure plateforme thérapeutique est de combiner l’approche médicamenteuse à l’approche psychothérapeutique dans les différentes étapes du traitement, à savoir l’initiation de l’abstinence (comprenant le sevrage thérapeutique) et la prévention de la rechute. Cibler pharmacologiquement les complications psychiatriques et somatiques fait partie intégrante du traitement des patients dépendants à la cocaïne.

Section snippets

Données épidémiologiques

La consommation de cocaïne est particulièrement élevée chez les hommes. Le sex-ratio est au moins de deux hommes pour une femme entre 15 et 34 ans dans certains pays. En France, ce ratio est de 3/1. Des variations importantes dans les profils évolutifs des consommations de cocaïne existent en Europe. Les pays ayant la prévalence d’usage la plus élevée en 2012 sont l’Espagne et le Royaume-Uni [1].

En France, selon le Baromètre Santé 2010, depuis le début des années 1990, la cocaïne est très

Chlorhydrate de cocaïne

Le chlorhydrate de cocaïne se présente sous forme de poudre blanche, inodore, de saveur amère [5]. Son procédé de fabrication comporte plusieurs étapes chimiques impliquant de la chaux, des solvants organiques, de l’acide sulfurique (permettant d’extraire les alcaloïdes les plus alcalins). Cette transformation conduit à la pasta (pâte de cocaïne de couleur brunâtre) [6]. Un traitement par permanganate de potassium conjointement à un raffinage par éther permet d’obtenir un produit plus pur, la

Phases cliniques de l’addiction à la cocaïne

Environ 5 % des consommateurs de cocaïne peuvent devenir dépendants au cours de la première année de consommation. Environ 20 % des consommateurs développeront une dépendance à long terme [8]. Cette pathologie multifactorielle aux manifestations variables devient progressivement sévère surtout chez les sujets les plus vulnérables à la dépendance [2]. Les différentes phases cliniques de l’addiction à la cocaïne s’inscrivent dans un cycle comprenant différentes étapes chez les sujets dépendants.

Complications de l’addiction à la cocaïne

L’ensemble de ces complications figure dans les recommandations concernant la prise en charge des sujets dépendants à la cocaïne, publiées par la Haute Autorité de santé en mai 2010 [7].

Approche thérapeutique

La prise en charge des sujets dépendants à la cocaïne doit s’envisager en deux temps lors de la mise en place d’un programme thérapeutique structuré d’une durée totale de 12 mois. Différentes approches thérapeutiques sont proposées aux patients, combinant médicaments et approches psychothérapeutiques comportementales lors de la phase de sevrage thérapeutique et celle de la prévention de la rechute [26].

Conclusion

L’addiction à la cocaïne est une pathologie complexe. À la différence de la dépendance à l’alcool, au tabac ou aux opiacés, elle présente une clinique particulière et l’hétérogénéité des consommateurs problématiques est bien plus marquée.

L’évaluation et la prise en charge d’un sujet dépendant à la cocaïne doivent prendre en compte le patient dans sa globalité. Les complications somatiques, psychiatriques, sociales doivent être recherchées de manière systématique comme l’a souligné le groupe

Déclaration d’intérêts

Laurent Karila a reçu des honoraires des laboratoires BMS, Euthérapie, Astra Zeneca, Lundbeck, Gilead, Sanofi Aventis, DA Pharma, Bouchara-Recordati.

Rim Zarmdini, Aymeric Petit, Geneviève Lafaye et William Lowenstein déclarent ne pas avoir de conflits d’intérêts en relation avec cet article.

Michel Reynaud a reçu des honoraires des laboratoires Merck/Serono, Reckitt Bensicker, Lundbeck, DA Pharma.

Références (32)

M.R. Carrera et al.
Cocaine pharmacology and current pharmacotherapies for its abuse
Bioorg Med Chem
(2004)
F.A. Wagner et al.
From first drug use to drug dependence; developmental periods of risk for dependence upon marijuana, cocaine, and alcohol
Neuropsychopharmacology
(2002)
C.A. Dackis et al.
Cocaine dependence: a disease of the brain's reward centers
J Subst Abuse Treat
(2001)
H. Rosenberg
Clinical and laboratory assessment of the subjective experience of drug craving
Clin Psychol Rev
(2009)
G. Lambert et al.
Neuro-imagerie et cocaïne : une cartographie de la dépendance ?
Presse Med
(2008)
A.J. Heinz et al.
Heroin and cocaine craving and use during treatment: measurement validation and potential relationships
J Subst Abuse Treat
(2006)
D.X. Da Silveira et al.
Predicting craving among cocaine users
Addict Behav
(2006)
P.S. Bordnick et al.
Cocaine craving: an evaluation across treatment phases
J Subst Abuse
(1998)
B.D. Sussner et al.
The validity and reliability of a brief measure of cocaine craving
Drug Alcohol Depend
(2006)
R.Z. Goldstein et al.
The effect of practice on a sustained attention task in cocaine abusers
Neuroimage
(2007)

R.Z. Goldstein et al.

Role of the anterior cingulate and medial orbitofrontal cortex in processing drug cues in cocaine addiction

Neuroscience

(2007)

R.I. Block et al.

Chronic drug use and cognitive impairments

Pharmacol Biochem Behav

(2002)

M. Selby et al.

Neuropsychological functioning in drug abusers

Drug Alcohol Depend

(1998)

R. Kahn et al.

Multi-center trial of baclofen for abstinence initiation in severe cocaine-dependent individuals

Drug Alcohol Depend

(2009)

EMCDDA. European Monitoring Center for Drugs and Drug Abuse: Annual report 2011: The state of the drug problem in...

L. Karila et al.

Diagnosis and consequences of cocaine addiction

Curr Med Chem

(2012)

Cited by (37)

Psychoactive substance intoxication leading to general hospital admission in young and middle-aged people during and after the first lockdown
2023, Therapies
Incidence of hospitalisations related to psychoactive substance (H-PS) intoxication has been strongly decreased during the coronavirus disease 2019 (COVID-19) pandemic especially in young adult and French region of Nouvelle-Aquitaine was mostly concerned. This study aimed to describe (i) the incidence of H-PS in Bordeaux teaching hospital during and after the first 2020 lockdown in adults aged 18–29 years or 30+ then (ii) their characteristics specifically associated with the pandemic period by comparing 2020 with 2017–2019 baseline period.
This historical cohort study was conducted in adults admitted to the Bordeaux teaching hospital with main or associated diagnosis codes of intoxication with benzodiazepine, methadone, buprenorphine, codeine, morphine, heroin, cocaine, ecstasy and alcohol. Data were collected locally through the discharge database. Incidence and characteristics of H-PS were described according to patients’ age, in 2020 before (01/01–16/03), during (17/03–10/05), and after the first lockdown (11/05–31/07).
Among the 5,824 stays included over the study period, PS most involved were alcohol and benzodiazepines. Compared to baseline, the decrease in H-PS's incidence was more important in young adults (−40%; n_baseline = 450) in comparison to those aged 30+ (−18%; n_baseline = 1,101) during the pandemic period, especially during the lockdown compared to 2017 (−59%; n₂₀₁₇ = 145 vs. −35%; n₂₀₁₇ = 166) with far decrease in alcohol and ecstasy intoxications. Seriousness of hospitalisation indications was increased regardless of age during the pandemic. Particularly in young adults, the proportion of suicides attempts increased during lockdown compared to the baseline period (almost 50% vs. 29%) and the period after lockdown was associated with 1.7 more-time road accident increased and 3 more-time fights compared with pre-lockdown period.
The period following lockdown should be considered at risk H-PS due to accident. Recreational use of alcohol and ecstasy could be a target for minimize serious consequences associated to PS use in young adult.
CircTmeff-1 in the nucleus accumbens regulates the reconsolidation of cocaine-associated memory
2022, Brain Research Bulletin
Citation Excerpt :
Taken together, our results indicated that circTmeff-1 may be a key factor in the reconsolidation of cocaine-associated memory and functions as a decoy of miR-206 to regulate BDNF expression. Drug addiction has become a major concern worldwide as specific treatment for drug abuse is lacking (Karila et al., 2014). In the present study, we examined the alteration of circTmeff-1 expression in the NAc after UCS memory retrieval in cocaine-associated memory reconsolidation using a CPP model.
Reconsolidation of drug memories is the process of restoring unstable memories after unconditioned (UCS; e.g., drugs) or conditioned stimulus (CS; e.g., drug-paired contexts), and provides promise for prevention of drug relapse. Circular RNAs (circRNAs) have important effects on the transcription and post-transcriptional regulation of gene expression. However, the role of circRNAs in the reconsolidation of drug memories is unclear. Here, we observed that cocaine-induced memory retrieval significantly increased circTmeff-1 level in the nucleus accumbens (NAc) core but not shell. Importantly, the disrupted expression of circTmeff-1 using virus in the NAc core damaged the reconsolidation of cocaine-associated memories. The knockdown of circTmeff-1 in the NAc shell or without UCS retrieval or 9 h after UCS retrieval had no such effects. Mechanistically, using bioinformatic analysis and loss- or gain- of function assays, we revealed that antagomiR-206 reversed the inhibitory effect of circTmeff-1 knockdown on the expression of brain-derived neurotrophic factor (BDNF) during the reconsolidation of cocaine-associated memories. Taken together, these results demonstrate the role of circTmeff-1 in the reconsolidation of cocaine-associated memory and that circTmeff-1 may function as a decoy for miR-206 to regulate the expression of BDNF.
Illegal drugs and public corruption: Crack based evidence from California
2021, European Journal of Political Economy
Citation Excerpt :
Secondly, it is relatively cheap and a highly addictive substance, with a short lasting but instantaneous and intense high, giving the drug a large potential consumer base and creating a rigid demand (Chitwood et al., 1996; Bourgois 2003). Not only is it consumed all over the world, but it ranks second in terms of recreational drugs consumption after cannabis (Karila et al., 2014). Finally, and most importantly, crack cocaine is key for our identification strategy, allowing us to exploit the lag in its initial arrival to each U.S. state and utilize the synthetic control method (SCM) to estimate its causal effect on public corruption.
Do illegal drugs foster public corruption? To estimate the causal effect of drugs on public corruption, we adopt the synthetic control method and exploit the fact that crack cocaine markets emerged in California in 1981, before reaching any other U.S. state. Our results show that public corruption more than tripled in California in the first three years following the arrival of crack cocaine. We argue that this resulted from the particular characteristics of illegal drugs: cheap technology and rigid demand, which fosters a convergence of interests between criminals and corrupted public officials resulting in a positive causal impact of illegal drugs on corruption.
Pluripotent stem cell-derived brain-region-specific organoids
2021, iPSCs in Tissue Engineering
Brain organoids derived from human pluripotent stem cells have emerged as invaluable tools to study human-specific features in normal brain development and diseases. Given that brain regions differ in cellular composition, molecular signature, and functional specialization, establishing brain-region-specific organoids is crucial for more precise in vitro modeling of human brains. Here, we review selected protocols for generating brain organoids with various regional identities from pluripotent stem cells, including dorsal forebrain, ventral forebrain, hippocampus, thalamus, hypothalamus, retina, midbrain, and cerebellum. These organoids possess many characteristics that resemble the fetal brain tissue of the corresponding brain regions. In addition, we highlight the utilities of using these protocols in elucidating neurodevelopmental processes, studying the impacts of genetic and environmental perturbations, and facilitating strategic development of therapies.
Reprint of: Pulmonary complications in cocaine users
2020, Journal Europeen des Urgences et de Reanimation
La cocaïne peut être responsable de nombreuses complications psychiques et/ou somatiques. L’objectif de cette revue systématique de la littérature est d’exposer les données concernant la relation entre la consommation de cocaïne et les complications pulmonaires. La cocaïne peut être responsable de symptômes respiratoires aigus (toux, expectoration noirâtre, hémoptysies, dyspnée, sifflements thoraciques, douleurs thoraciques) et de pathologies pulmonaires variées : barotraumatismes (pneumothorax, pneumomédiastin, pneumopéricarde), lésions des voies aériennes, asthme, bronchiolite oblitérante avec pneumonie organisée, œdème aigu du poumon, hémorragie intra-alvéolaire, pneumopathie alvéolaire liée à l’accumulation de matériel carboné, emphysème pulmonaire et lésions bulleuses, pneumonie aiguë a éosinophiles, granulomatose au talc ou à la cellulose, pneumopathie interstitielle et fibrose pulmonaire, vascularites, hypertension artérielle pulmonaire, embolie pulmonaire et infarctus pulmonaire, anévrysmes mycotiques de l’artère pulmonaire, embolie pulmonaire septique, pneumopathie d’inhalation, pneumopathies communautaires, infections pulmonaires opportunistes liées à l’infection par le VIH, infection tuberculeuse latente et tuberculose pulmonaire, cancer bronchique et crack lung. Certaines complications sont graves et parfois fatales. Les explorations fonctionnelles respiratoires, la tomodensitométrie thoracique, la fibroscopie bronchique avec lavage broncho-alvéolaire et la scintigraphie pulmonaire peuvent être des aides au diagnostic de ces complications pulmonaires. Une consommation de cocaïne doit être recherchée devant des symptômes respiratoires survenant chez des sujets jeunes.
Cocaine can be responsible for many psychiatric and/or somatic disorders. The aim of this systematic literature review of data was to expose relations between cocaine use and pulmonary complications. Cocaine can be responsible for acute respiratory symptoms (cough, black sputum, hemoptysis, dyspnea, wheezing, chest pain) and for various pulmonary disorders including barotrauma (pneumothorax, pneumomediastinum, subcutaneous emphysema, pneumopericardium), airway damage, asthma, bronchiolitis obliterans with organizing pneumonia, acute pulmonary edema, alveolar hemorrhage, alveolar pneumonia with carbonaceous material, bullous emphysema, acute eosinophilic pneumonia, pulmonary granulomatosis caused by talc or cellulose, interstitial pneumonitis and pulmonary fibrosis, vasculitis, pulmonary hypertension, pulmonary embolism and pulmonary infarction, mycotic pulmonary arterial aneurysms, septic emboli, aspiration pneumonia, community-acquired pneumonia, HIV-related opportunistic infections, latent tuberculosis infection, pulmonary tuberculosis, lung cancer and crack lung. Some of these complications are serious and may have a fatal outcome. Pulmonary function tests, thoracic tomodensitometry, bronchial fibroscopy with bronchoalveolar lavage and lung scintigraphy may be an aid to the diagnosis of these pulmonary compications. Cocaine use must be sought in case of respiratory symptoms in young persons.
The Opioid Epidemic: Associated Infections and Diagnostic Methods
2020, Clinical Microbiology Newsletter
Citation Excerpt :
Cocaine is a highly addictive stimulant that acts on the brain’s limbic system to produce feelings of euphoria. Cocaine is also the most widely used illicit drug globally [18], and the use of cocaine has remained stable at an estimated 1.5 million Americans per year since 2009 [19]. There are a variety of methods to consume cocaine, including intranasally (snorting), smoking, orally, or by intravenous injection.
The opioid epidemic and the associated increases in intravenous drug use are significant causes of morbidity and mortality in the United States. Infections have long been associated with illicit drug use and contribute considerably to the high morbidity and mortality. Risky behaviors associated with drug use, including needle sharing and poor injection hygiene, have added to the increasing burden of infections related to drug use. This review addresses the associations between opioid use disorder and infectious organisms, highlighting the important role of laboratory testing for diagnosis and managing these patients.

View all citing articles on Scopus

View full text

Mise au pointAddiction à la cocaïne : données actuelles pour le clinicienCocaine addiction: Current data for the clinician

Key points

Points essentiels

Section snippets

Données épidémiologiques

Chlorhydrate de cocaïne

Phases cliniques de l’addiction à la cocaïne

Complications de l’addiction à la cocaïne

Approche thérapeutique

Conclusion

Déclaration d’intérêts

Bioorg Med Chem

Neuropsychopharmacology

J Subst Abuse Treat

Clin Psychol Rev

Presse Med

J Subst Abuse Treat

Addict Behav

J Subst Abuse

Drug Alcohol Depend

Neuroimage

Neuroscience

Pharmacol Biochem Behav

Drug Alcohol Depend

Drug Alcohol Depend

Diagnosis and consequences of cocaine addiction

Curr Med Chem

Mise au point
Addiction à la cocaïne : données actuelles pour le clinicienCocaine addiction: Current data for the clinician