Loosing Control: An Atypical Presentation of Cocaine Ingestion in an Elderly Lesbian Female

Document Type

Conference Proceeding

Publication Date

4-1-2022

Publication Title

Epidemiology

Abstract

Substance use has increased during the pandemic by 13%. There is variation in stimulant use among sexual minorities in the United States (US) per one study it was heterosexual (3.7%) and bisexual males (11.3%), and for heterosexual (1.8%), bisexual (4.8%), and lesbian women (6.3%). Per limited studies, lesbian and bisexual women reported significantly higher lifetime rates of ecstasy, cocaine, methamphetamine, and LSD use compared to heterosexual women. To aid in the timely initiation of treatment in atypical populations, a case presentation of likely ingestion of fentanyl or synthetic-opioid contaminated cocaine in an elderly lesbian female. Methods: We used Pubmed, Scopus, and Web of Science using the keywords and search strategy {(cocaine+ fentanyl), (cocaine + bradycardia + hypotension), (cocaine + toxidromes), (fentanyl + toxidromes) (fentanyl + bradycardia + hypotension)} 383 articles found, (cocaine or fentanyl + mirtazapine) 17 articles found (Lesbian or sexual minority or LTBQ + cocaine) 21 articles were found, 9 combined all LTBQ+ people in analysis, 2 combined lesbian and bisexual women, and 1 separated people by the genders of their sexual partners Case/Results: A 72-year-old Caucasian woman who identifies a lesbian arrived with bradycardia, hypotension, respiratory alkalosis, metabolic alkalosis, GSC of 3, miosis, and urine toxicology positive for cocaine was intubated and then extubated after four hours. Electroencephalography, CT head, CTA head and neck, other laboratory studies were nonconcerning. EKG showed Qtc of 520ms with a normal transthoracic echocardiogram. No evidence of intentional overdose or medication non-adherence, and was continued on duloxetine 60mg and mirtazapine 30mg QHS for depressive symptoms. Discussion: Fentanyl-related respiratory depression peaks at 5 minutes and requires 4 hours to recover. Fentanyl can cause QTC-prolongation. Naloxone efficacy is inconsistent. Mirtazapine can have altered pharmacokinetics CYP3A4 with concurrent use of cocaine and fentanyl, but can potentially reduce anxiety and depressive-like behavior during cocaine withdrawal. With reportedly higher use of stimulants for lesbians and the increase of cocaine with fentanyl, this case hopes to help with an education gap so that timely management can occur and hopefully improved outcomes, especially as deaths from cocaine increase in the US and overall worse health outcomes for sexual minorities.

Volume

70

Issue

SUPPL 1

First Page

S226

Last Page

S227

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