Psychotic Symptoms of Cocaine Self-Injectors in a Harm Reduction Program

ABSTRACT

Background: Psychotic symptoms are common among cocaine users. Methods: An observational naturalistic study on the effects and events of intravenous cocaine use in a drug consumption room was carried out; the patients were diagnosed of cocaine dependence (according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision). Results: Twenty-one patients, 81% men self-injected cocaine 375 times. Psychotic symptoms were observed in 62% of the patients and 21% of the self-injections; delusions were observed in 9.3%, psychotic self-reference with insight in 9.1%, illusions in 6.4%, and hallucinations in 5.3%. A higher presence of psychotic symptoms was noted with cannabis used in the previous month (76.9% versus 44.4%; P = .001) (no psychotic symptoms group); also, a greater use of benzodiazepines was observed: 75.6% versus 63.6% (P = .046). Lower use of methadone in the group with psychosis was observed: 75.6% versus 97.3% (P = .001). Motor alterations were tremor 58%, stereotyped movements 24%, and behaviour alteration 6%, significantly more frequent in the psychotic group. Conclusions: Thus, there was a high frequency of psychotic symptoms after intravenous cocaine use; patients with psychotic symptoms reported higher use of cannabis and benzodiazepines in the previous month and lower use of methadone. More tremors and stereotyped movements were observed in the group with psychotic symptoms. It is necessary to give a special approach to cocaine intravenous users.

Keywords:

• Cocaine
• cocaine dependence
• cocaine self-injection
• harm reduction programs
• psychotic symptoms

Acknowledgments

This research was supported by a grant from the Subdirecció General de Drogodependències and Pla Director de Salut Mental i Addiccions of the Department of Health of the Government of Catalonia (2007–2010).

The authors thank the cocaine program staff and researchers: Ms. Susana Gómez-Baeza and Ms. Laia Rodriguez-Cinta; and Dr. Laia Miquel and Dr. Ángel Egido, for reading the manuscript. The authors thank the Harm Reduction Program staff: Thais Ballabriga, Elisabeth Monterde, and Arnau Serra (social educators) and Oriol Esteve, Nuria Voltes, Carolina López, and Eduardo Castrillo (nurses) who collected the data. The authors thank the Agencia de Salut Publica de Barcelona (ASPB) for supporting the Harm Reduction Program of the Outpatient Drug Clinic, Vall d’Hebron University Hospital.