Magazine article Clinical Psychiatry News

Response, Addiction to Cocaine Hinge on Gender

Magazine article Clinical Psychiatry News

Response, Addiction to Cocaine Hinge on Gender

Article excerpt

NEW YORK -- Men and women respond very differently to cocaine, and these differences have important clinical implications, Scott Lukas, Ph.D., reported at the annual conference of the Association for Research in Nervous and Mental Disease.

Men tend to obtain higher plasma cocaine levels from a given dose of inhaled substance, and they tend to experience more euphoria. They are more likely to become addicted and have a far more difficult time shaking cocaine addiction. On average, women absorb less cocaine from a given intranasal dose and experience much less euphoria. This is especially true during the luteal phase of the menstrual cycle.

Women who do use cocaine, however, are much more likely than men to experience cardiotoxic effects. At any given inhaled dose, women absorb less, but they have heart rate changes that are nearly identical to those seen in men, said Dr. Lukas, professor of psychiatry and pharmacology at Harvard Medical School, Boston.

Tachycardia, sometimes life threatening, is a very common effect of cocaine use in women. "Emergency room admissions for cocaine-related heart palpitations are on the order of six females for every one male," he said.

He and other researchers studying gender response to illicit drugs believe that these differences are largely influenced by sex hormones. In 1971, pioneering stress physiologist Hans Selye suggested that hormones regulate resistance to various drugs and toxins. The hormonal effects, however, can cut both ways.

Dr. Lukas explained that the nasal mucosa is under sex hormone control, just as the uterine mucosa is. Estrogen increases nasal mucosal thickness, as well as the viscosity of nasal mucosal secretions. Presumably, this would lower intranasal absorption of cocaine.

A study published in 1999 by other investigators documented gender-based differences in response to 0.9-mg/kg doses of intranasal cocaine. The data showed that men consistently had higher plasma levels and reported more intense subjective experiences of the cocaine high.

At the 0.9-mg/kg dose, men showed plasma levels of 150 ng/mL at 30-40 minutes, while women in the follicular phase had plasma levels of only 70 ng/mL from the same intranasal dose.

Women who were in the luteal phase had even lower plasma concentrations. The men and women had equivalent changes in heart rate.

"Men have a pretty immediate euphoric response to cocaine, and then an hour later they have a marked crash characterized by a lot of dysphoria. Women get a lot less euphoria, especially during the luteal phase," he said at the meeting cosponsored by the New York Academy of Medicine.

Given this differential in dose absorption, it is fairly easy to understand how this translates into cardiac problems for women who use cocaine. Dr. Lukas asked attendees to imagine a young couple out on a date.

"He wants to do some coke, and he's very excited about it. He snorts a line or two and gives the same to his girlfriend. He's immediately revved up, while she's not feeling very much. So he keeps giving her more and more, hoping she'll reach his level of euphoria." All too often, though, the young woman ends up reaching a frightening level of tachycardia and has to go to the hospital, he said.

Progesterone appears to exacerbate the cardiotoxic effects of cocaine. …

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