"Driving that train/high on cocaine
Casey Jones, you better watch your speed ...
Come 'round the bend, you know it's the end
The fireman screams and the engine just gleams ..."
-- The Grateful Dead
Nearly four decades after the Grateful Dead's Jerry Garcia wrote the lyrics to "Casey Jones," the drug that inspired the song is enjoying a resurgence. More than 35 million Americans 12 years and older have tried cocaine at least once in their lives, according to the 2007 National Survey on Drug Use and Health. Over 8 million Americans in the same age range have used its derivative, crack, and over 13 million have tried the stimulant methamphetamine (speed), according to the same report.
The warning implicit in "Casey Jones" may have gone unnoticed among those who have dabbled in cocaine or amphetamines now or in the '60s, but its lyrics are particularly poignant now that researchers better understand what cocaine and certain other stimulants can do to your brain. Harvard researcher Marc Kaufman has watched the changes that occur in people's brains shortly after they're injected with cocaine. He does this using magnetic resonance angiography, which creates images of blood flow in the brain.
How can street drugs cause stroke?
"When you give healthy young men a small dose of cocaine -- much smaller than what they would use on the street -- you can see some of the structures of the brain darken," says Kaufman, who explains that's a signal of altered blood flow. "The reason this is important," Kaufman adds, "is because any interruption in blood flow can be damaging." Among other things, the changes in blood flow from cocaine and crack use can cause brain damage and a life-threatening stroke.
Cocaine, methamphetamines, and other stimulants can cause stroke in two ways. To begin with, stimulant drugs increase blood pressure. These drugs also have a direct effect on the vessel walls, and the extra pressure can cause them to rupture and leak blood into the brain. This is known as a hemorrhagic stroke. Secondly, stimulant street drugs narrow the blood vessels. This can cut off blood flow to parts of the brain and kill brain tissue, producing what is known as an ischemic stroke.
If I just try speed or coke a few times, can I have a stroke?
In rare cases, yes. Marc Wasaka, a doctor of physical medicine and rehabilitation at St. Mary's Medical Center in San Francisco, recalls how disturbed he was when, as a resident, he met a stroke victim his own age. Their backgrounds were strikingly similar, except that the patient had tried cocaine once and wound up with a devastating stroke. "We were around the same age, 27," Wasaka recalls. "He had been involved in computers and sports and would go out with his friends all the time. I could see him as one of my buddies." But at the time of their meeting, nearly a year after the stroke, the young man was hardly able to communicate through language at all. "He had a limp, and could only say three words."
There are no good statistics on how common it is for stroke to hit a first- or second-time drug user. This is partly because street drugs are often cut with other stimulants or even substances such as talcum powder, and may be used in combination with tobacco and alcohol. Researchers say, however, that the more times someone uses stimulant street drugs such as cocaine and "meth," the higher their chances of having a drug-related heart attack or stroke, particularly if there are other risk factors.
Amanda Gruber, MD, the associate chief of the substance abuse unit at the biological psychiatry laboratory of Harvard's McLean Hospital, likens using cocaine and other stimulants to throwing a pair of dice -- particularly if you're living with an unknown risk factor. "If you have an aneurysm in your brain, every episode of increased blood pressure you experience carries some risk that it will rupture. Let's say it's equal to the chance of rolling a 6. I could be unlucky and roll a 6 on the first try or I could roll 20 times and not roll a 6. But every time I roll, I have a one in six chance of rolling a 6."
What puts a drug user at higher risk for a stroke?
You're at higher risk for having a stroke if you have any typical risk factors for it, such as diabetes, heart disease, and high blood pressure, also known as hypertension. You also run a higher risk if you've had a transient ischemic attack (TIA), a so-called "mini-stroke." TIAs are called mini-strokes because they produce stroke symptoms such as weakness or paralysis on one side of the body, but the symptoms last only a short time.
If your parents or siblings have had heart disease at a young age, or have any of the other risk factors mentioned, you're probably at higher risk. Smoking cigarettes and drinking alcohol also up the odds. Unless you have regular medical checkups, you may not even know you have heart disease or other conditions that could set the stage for a stroke. No matter what your condition or family history is, if you use cocaine or speed, you'll greatly increase the odds of a stroke.
Ultimately, with all the recent revelations about how stimulant street drugs affect the brain, there are probably better gambles to take -- ones where the stakes aren't so high.
National Stroke Association http://www.stroke.org
Substance Abuse and Mental Health Services Administration
Substance Abuse Treatment Facility Locator http://findtreatment.samhsa.gov/facilitylocatordoc.htm
Table 1.1A, Office of Applied Studies, 2004 National Household Survey on Drug Abuse. http://www.oas.samhsa.gov/NSDUH/2k4nsduh/2k4tabs/Sect1peTabs1to66.htm#tab1.1a
Office of Applied Studies. Results from the 2007 National Survey on Drug Use and Health: National Findings.
Kaufman, Marc J., et al., Cocaine-induced cerebral vasoconstriction detected in humans with magnetic resonance angiography, JAMA, Feb. 4, 1998, Vol 279, No. 5. Page: 3
Drugs Causing Stroke, National Stroke Association, www.stroke.org
Interview with Marc Wasaka, MD, a doctor of physical medicine and rehabilitation, St. Marys Medical Center, San Francisco. Interview with Amanda Gruber, MD Assistant Professor, Harvard Medical School; Associate Chief, Substance Abuse, Biological Psychiatry Laboratory, McLean Hospital.
Office of National Drug Control Policy. Cocaine. http://www.whitehousedrugpolicy.gov/drugfact/cocaine/index.html
Office of National Drug Control Policy. Crack. http://www.whitehousedrugpolicy.gov/drugfact/crack/index.html