By Editor John Naish
Are we facing a dementia time-bomb, thanks to record numbers of Britons taking cocaine as a recreational drug?
As cocaine use among middle-aged and older Britons hits record levels, experts are warning of a wave of coke-driven dementia cases, thanks to the damage that the drug can wreak on our brains.
Investigators warn that such damage can occur among people who take the drug minimally – even just once.
The toll on other parts of the body is similarly alarming – research shows it can irreparably harm our hearts, arteries and stomachs, as well as damaging teeth, skin and important proteins.
British adults are now consuming record amounts of cocaine hydrochloride, the bitter white crystal that European chemists first learnt to refine industrially in the 1860s.
In fact the UK has the world’s second highest rate of cocaine use (Australia scored first), at around 117 tonnes a year, according to data from the Organisation for Economic Co-operation and Development (OECD) in 2023.
And it’s the biggest market in Europe, according to the National Crime Agency.
The most stark consequence is that in 2023, cocaine-related fatalities in the UK reached 1,100 – roughly a thousand times that seen 30 years earlier in 1993, when the total was 11.
And the highest drug-death rate is among men in ‘Generation X’, particularly those aged 40-49, according to the Office for National Statistics (ONS).
Early signs of cocaine’s dementia danger came in 2021, when a consortium of Portuguese and Brazilian investigators warned that using a small amount of the drug even on a single occasion may cause significant brain changes.
Their study, in the journal Frontiers in Neuroscience, discovered that in laboratory mice, a single episode showed up in post-mortem examination of their brains as ‘alterations in the prefrontal cortex and hippocampus’.
Numerous studies have implicated damage to these brain areas in Alzheimer’s disease and other forms of dementia.
The hippocampus, for example, is involved in forming new memories, while the prefrontal cortex plays important roles in regulating memory, attention and self-control.
This early damage appears to happen ‘invisibly’, with the mice showing no obvious changes in their behaviour after they’d had the drug, the study noted.
The researchers warned that recreational ‘light’ use is wrongly considered to be harmless, ‘in part, due to the belief that exposure to low doses of cocaine carries no brain damage risk’.
Meanwhile, researchers at the University of Cambridge have been looking at the long-term risks for the brain, with a study in the journal Brain Communications in 2022 that compared MRI scans of 183 current cocaine users’ brains with scans of 148 non-users (all in their mid-30s).
The cocaine users had used the drug for an average of ten years and had the drug in their systems on the day of the scan, according to urine tests.
The results showed ‘abnormal brain ageing’ among cocaine users. What’s more, researchers found changes in the way different regions of the brain communicated with each other typical of those seen in people over 60 who are entering cognitive decline.
Previous research by the same team in 2012, in the journal Molecular Psychiatry, found the rate of age-related brain volume loss in cocaine-dependent individuals was almost twice that seen in healthy volunteers.
This may be because cocaine makes our brain cells destroy themselves, according to researchers at Johns Hopkins University.
They warned that cocaine can trigger overactive autophagy (autophagy is a normal and necessary cellular ‘clean-up process’ that rids cells of debris that accumulates within them).
Writing in Proceedings of the National Academy of Sciences in 2016, they said cocaine accelerates this process.
‘A cell is like a household that constantly generates trash,’ said Dr Prasun Guha, a postdoctoral fellow at Johns Hopkins, who led the study.
‘Autophagy takes out the trash. It’s usually a good thing. But cocaine makes the housekeeper throw away important things.’
Despite all this alarming evidence, there is currently no funding available in the UK for researchers to study fully the effects of cocaine on brain ageing.
Karen Ersche, a professor of addiction neuroscience who led the University of Cambridge study, says: ‘Despite converging lines of evidence suggesting accelerated brain ageing in individuals with chronic cocaine use, I have unfortunately been unable to secure funding to continue this research.’
‘We see cognitive deficits in middle-aged cocaine users that we normally see in old age, such as deficits in working memory [remembering information for a short period of time]; attentional problems [focusing attention on something or dividing attention between two things happening simultaneously]; planning ahead and learning.’
Professor Ersche urges NHS doctors to be on the lookout for early signs of dementia in cocaine-users who might ordinarily seem too young to be developing such problems, adding: ‘These individuals’ brains may appear older than their chronological age would suggest.’
Dementia aside, new evidence is emerging about cocaine’s other potent and lasting effects on the brain.
A study published in March this year in the journal eNeuro by scientists at the US National Institute on Drug in Maryland found that prolonged cocaine use alters brain circuits and heightens impulsive behaviour.
The study, in lab rats that naturally had low rates of impulsive behaviour, found that cocaine damaged links between the brain’s mesocorticolimbic system – which can make us act impulsively in expectation of a reward – and the ‘civilised’ prefrontal cortex, which regulates social behaviour and can dampen down such impulsiveness.
And a Danish study in Nature in 2024 revealed how cocaine ‘tricks’ the brain into feeling good, by blocking a protein called the dopamine transporter.
This helps manage levels of the ‘feel good’ brain chemical dopamine – ensuring the brain doesn’t interpret every experience as pleasurable.
Cocaine blocks it, allowing dopamine to run wild and causing the brain to perceive all experiences as pleasurable.
Claus Løland, a professor of neuroscience who led the study, said: ‘When cocaine blocks the dopamine transporter, all types of input given by our senses will seem great. It is a form of chemical brainwashing.’
He added: ‘Cocaine is one of the most addictive substances out there, and it is becoming more and more affordable.’
Professor Ersche does have some hopeful news, at least: ‘We have recently shown that an already-marketed drug can help patients with cocaine addiction to reduce their impulsivity.’
That drug, atomoxetine, is currently used to increase the ability to pay attention and reduce impulsiveness and hyperactivity in ADHD.
It works by increasing the levels of norepinephrine, a natural substance in the brain involved in controlling behaviour.
In the journal Biological Psychiatry in March this year, Professor Ersche, with colleagues in Australia and Germany, reported how the drug significantly reduced impulsivity in 28 patients who were compulsive cocaine users, and thus inhibited the risk-seeking desires that impel them to take illegal drugs.
The fact that atomoxetine is already approved for use in humans may enable it to be repurposed as a therapy for cocaine users relatively quickly.
Brain damage is, however, just one in a long list of harms that can result from cocaine use – as we reveal here…
HEART PROBLEMS
Nearly three-quarters of long-term cocaine users had some form of cardiovascular disease, according to a study in 2021 – in the report, based on MRI scans and published in the journal Cureus, the researchers added that cocaine is the main cause for drug-related emergency hospital cases worldwide, with most admissions being for cardiovascular problems.
The drug is known to have toxic effects on heart tissue.
A Rome University study in April this year, published in the journal Diagnostics, of heart tissue samples from 30 cocaine-related death victims found unusually high levels of tissue inflammation and other dangerous heart abnormalities, such as interstitial oedema – a build-up of fluid associated with heart failure.
Numerous studies also show how cocaine can cause sudden, unexpected cardiac crises, often within hours of taking the drug.
In March, a coroner’s inquest heard how Caolan Devlin, 30, died in a fatal car crash in County Tyrone last year, after suffering a heart attack while driving, which was caused by ‘excessive use of cocaine’.
So-called ‘coke strokes’ – propelled by sudden drug-induced rises in blood pressure – are another commonly seen result of cocaine use.
The symptoms are frequently worse than in standard strokes and the long-term damage more severe, according to neurologists at the University of Texas, who compared 45 cocaine-stroke patients with 105 stroke patients who had never taken cocaine.
The cocaine-taking patients were three times more likely to die while in hospital, according to the 2010 study published in the journal Stroke.
TOOTH DECAY AND LOSS
Repeated cocaine use can erode the gums and tooth enamel, increasing the risk of decay and infections.
It can also lead to jaw pain, acidic saliva that leads to tooth decay and loss, gingivitis (gum disease) and rhinitis (a chronically blocked nose).
A 2021 study in the American Journal of Dentistry by researchers at the Federal University of Santa Maria in Brazil, found habitual cocaine users are 46 per cent more likely to lose their teeth, have more frequent and severe cavities and a higher risk of gum disease.
GASTRIC PROBLEMS INCLUDING GANGRENE
Cocaine use can cause potentially fatal gastric problems such as mesenteric ischaemia (a lack of blood flow to the small intestine), gangrene of the bowel and bowel perforation (a hole in the intestines).
Back in 2006, surgeons at the North Middlesex University Hospital warned, in the Journal of the Royal Society of Medicine, that acute abdominal problems can occur between an hour and two days after taking cocaine – with initial symptoms of ‘pain, nausea, vomiting and bloody diarrhoea’.
Cocaine use is also associated with life-threatening bowel damage, in the form of ischaemic colitis – where the bowel’s blood supply is disrupted by the drug, causing damage and inflammation to the large intestine. Symptoms include abdominal pain, diarrhoea and bleeding.
INFLAMMATION AND AUTMOIMMUNE DISEASES
Although cocaine stays in the blood for less than an hour, its ill-effects can linger for years.
Doctors report how some patients who have entirely stopped using cocaine may, for example, still suffer from serious inflammatory autoimmune conditions such as vasculitis persistently inflamed blood vessels that cause numerous symptoms including pain, fatigue and organ failure.
Researchers at Columbia University in New York in 2002 identified a common cause for such chronic inflammatory problems – the fact that when cocaine breaks down in a user’s body, it attaches fragments of itself to proteins in the blood, called albumin and macroglobulin.
This not only alters these proteins, but as a result also seems transforms them into targets that are subject to attack by the body’s own immune defences – resulting in chronic inflammation and autoimmune disease.
‘COKE NOSE’
The most notoriously obvious damage caused by cocaine is catastrophic damage to the nasal septum – commonly known as ‘coke nose’, which has been publicised previously by the former EastEnders actress Danniella Westbrook and singer Kerry Katona.
The NHS warns that habitual cocaine use can cause irreparable damage to the interior of the nose because the drug narrows blood vessels and reduces the blood supply to the delicate tissues there, effectively starving them of nutrients.
Natarajan Balaji, an ear, nose and throat consultant at University Hospital Monklands in Lanarkshire, Scotland, explains: ‘When snorted, cocaine causes the blood vessels to contract very strongly, and the nasal septum is very sensitive to reduced blood flow.
‘After using cocaine a few times, the nasal structure can begin to die, causing perforations.’
In March this year, Professor Ullas Raghavan, a plastic surgeon based in Manchester, warned that here has been a ‘staggering surge’ in patients seeking nose reconstructive surgery due to severe damage caused by cocaine use.
‘I am seeing ten times more patients compared to five years ago with destroyed nasal structures, often leaving them unable to breathe properly and suffering from extreme facial disfigurement,’ he told reporters.
‘The damage can be devastating, both physically and emotionally.’