Learning Objective #1: Describe the physiologic response that withdrawing from crack cocaine has on the body

Learning Objective #2: List three subjective and objective physiologic problems smoking crack cocaine causes in the body

---

Homelessness is a problem and substance abuse is one cause. Homeless persons suffer respiratory problems and use cocaine frequently. Cocaine causes respiratory problems including rhinitis medicamentosa, but this is only documented when cocaine is used intranasally. This correlational study describes rhinitis and rhinorrhea as a cocaine withdrawal symptom, in 100 homeless cocaine smokers and relates the prevalence of these symptoms to the severity, chronicity, and recency of use. Body system problems in relation to cocaine use was also described. Cocaine’s physiologic response served as the conceptual framework. Data were gathered using the CIDI-Substance Abuse Module© and a semi-structured history and physical examination. Findings revealed that 49% of the sample reported they experience rhinorrhea when they withdraw from cocaine. Rhinorrhea was related to daily cocaine use and lifetime history of cocaine use. On review of systems 39% had rhinorrhea and 22% were diagnosed with rhinitis on physical exam, however neither was significantly related to chronicity, severity, nor recency of cocaine use. Homeless crack smokers reported subjective musculoskeletal and eye problems, but on physical exam problems of the nose and mouth were found. Persons with clinical rhinitis reported more nasal, lung, and psychiatric problems, while having more nervous system problems on physical examination. Chronicity of drug use was related to nasal, eye, and musculoskeletal problems and to clear nasal discharge. Severity of cocaine use was related to abdominal, skin, and oral problems. Recency of crack use was related to skin, and eye problems. Crack withdrawal is associated with rhinitis and affects multiple body systems. The conceptualization of the physiologic response to cocaine partially explains the findings. Nurses who provide care to homeless persons and who do not address a person’s substance abuse pattern might be enabling their addiction by treating alleged respiratory symptoms even with something as simple as a diagnosis rhinitis.