Emily, a part-time receptionist at a cardiology centre in a small New South Wales town, wasn’t used to seeing people her age at the clinic where she worked.
So when a 21-year-old – pretty, stylishly dressed, in towering heels and carrying a pricey tote – announced she had an appointment with the specialist, her first thought was that she had come to the wrong place.
She was having heart palpitations, the young woman said, and her GP referred her.
When Emily registered some surprise at this – palpitations are typically associated with older people with high blood pressure or heart disease – the patient uttered six words that took her breath away.
‘Yeah, I do coke on weekends.’
It was a join-the-dots moment for Emily, whose other job is a weekend bartender at a lively country pub where the sight of young people ‘doing lines’ in the bathrooms has become so commonplace it hardly raises an eyebrow.
Since then, Emily has begun to notice more and more young people reporting heart problems at the clinic. She recognises some from the pub.
Australia holds the unenviable distinction of having the most cocaine users per capita in the world, which is attributable to the enormous number of weekend users who don’t think twice about spending up to $350 on a bag every Friday night.
Researchers have found a worrying link between the rising number of young people suffering heart problems and the use of cocaine (stock image)
The National Drug Strategy Household Survey 2022–2023 found cocaine was the second-most used illicit drug in Australia behind cannabis. In that year, 4.5 per cent of Australians used cocaine, equating to roughly a million people.
While it’s no secret our appetite for cocaine is fuelling the bloody international drug trade, what is less often discussed is the drug’s dire effects on our heart health.
The surge in casual cocaine use in recent decades coincides with data showing sudden cardiac death (SCD) as one of the biggest killers of Australians under 50.
Researchers at the Baker Heart and Diabetes Institute last year found almost a third of young adults in Victoria who died of sudden cardiac issues between 2019 and 2021 had been users of illicit drugs, including cocaine.
Cannabis was the most common illicit drug found in the deceased’s toxicology reports, but coke – along with amphetamines and heroin – wasn’t far behind.
The study’s lead investigator and cardiologist Dr Elizabeth Paratz says there’s nothing new about drugs wreaking havoc on young people’s bodies, but the correlation between drug use and SCD has been alarming.
Dr Elizabeth Paratz (pictured) warned many young people suffer heart problems due to drug use, but some damage could be reversible
‘We certainly found that a very high number had toxicology that was positive for illicit substances, such as cocaine and methamphetamine,’ says Dr Paratz, who has since moved to the St Vincent’s Institute of Medical Research.
‘As clinical cardiologists, we’ve definitely noticed we have more young patients who’ve had issues with their heart. If people don’t have a genetic issue or a structural issue, it tends to be that they’ve been using illicit drugs.
‘We’ve certainly seen people who are in their twenties who’ve wound up requiring transplants and things for heart failure. That’s purely caused by illicit drug use – so it’s an avoidable cause.
‘It’s something that doesn’t need to happen and it’s pretty tragic when it does happen.’
Cocaine increases the risk of both heart attacks and SCD. A heart attack is caused by a blockage and can often be remedied by a stent or surgery, explains Dr Paratz, but SCD occurs when the heart stops completely and requires CPR.
‘Cocaine speeds up your heart rate, increases blood pressure and thickens the heart muscle so if you’re using it regularly it can be associated with all sorts of issues,’ she adds.
‘It’s important to note the increased heart rate is different from the high heart rate you get from exercising as drugs are affecting all the movement of your electrolytes, like sodium and potassium, and it throws your body out of balance.
‘We’ve personally seen people’s heart rates reach 250bpm. We say about 60 to 100bpm is healthy. It’s a similar story with blood pressure.
‘Serious heart damage is typically seen in people who are using illicit drugs regularly but there’s so many variables – like how much they’re taking and the drug’s purity. Some drugs are cut with actual poisons on the street. You never really know what you’re having.’
Australia holds the unenviable distinction of having the most cocaine users per capita in the world, which is attributable to the enormous number of ‘weekend users’ who don’t think twice about spending up to $350 on a bag every Friday night (stock image)
Fortunately, if young cocaine users become aware of any heart issues early on and dedicate themselves to quitting, some of the damage can be reversed.
‘It really depends on how established the damage is at the time it’s picked up and how motivated you are to stop,’ Dr Paratz says.
‘There have certainly been cases where a person has stopped using and fully reversed the damage to their heart. They go on to lead a very normal life. We’ve had some real success stories there.
‘That’s why this is such an important public health message, because it’s a health issue you didn’t need to have and it’s something you, hopefully, can reverse if you stop early enough.’
People who suffered SCD after using drugs often died while sedentary or sleeping. Patients were more likely to be male, smokers and excessive alcohol drinkers.
Other common traits included a psychiatric diagnosis, lower body mass index and lower rates of high blood pressure.
Dr Paratz is pushing for more research to be done in the area to determine exactly what drugs and dosages are having the worst effects on heart health.
However, those familiar with the nightlife in major cities like Melbourne and Sydney will tell you exactly what the drug of choice is: cocaine.
‘I think the take-home message in the meantime is, don’t wait for researchers to tell you what the safe dose is – there is no safe dose of drugs,’ Dr Paratz adds.
‘The simplest thing is to just not use them. If you do use them, stop. There’s quite a good chance damage can be reversed.’
It’s not the first time researchers have raised the alarm.
A 2012 Australian study found that young people who used cocaine at least once a month ‘had up to a 35 per cent increase in aortic stiffening, higher blood pressure than non-users and an 18 per cent greater thickness of the heart’s left ventricle wall’. These factors all increase the risk of cardiac arrest.
Lead researcher and cardiologist Prof Gemma Figtree remarked: ‘It’s so sad. We are repeatedly seeing young, otherwise fit individuals suffering massive heart attacks related to cocaine use.
‘Despite being well-educated professionals, they have no knowledge of the health consequences of regularly using cocaine.
‘It’s the perfect heart attack drug.’
Data from the Baker Heart and Diabetes Institute found sudden cardiac death (SCD) is one of the biggest killers of Australians under 50
That research from 12 years ago was prompted by a surge in otherwise healthy cocaine users presenting at hospital with heart problems. Crucially, it marked one of the first studies of social users, rather than addicts.
There were 884 cocaine-related deaths in Australia between 2000 and 2021, another study from 2022 found, citing data from the National Coronial Information System.
That study’s lead author, Prof Shane Darke, a world expert on drug deaths, said of the findings: ‘These deaths are largely due to more widespread use of cocaine.’
Tellingly, his research showed a significant increase in cocaine-related deaths among people who had no history of substance use problems.
‘Twenty years ago, 90 per cent of cocaine deaths had a history of substance use problems. Now that figure is much lower at 50 per cent,’ said Prof Darke, who also noted casual users tended to be unaware of the heart disease and stroke risk.
Emily – the bartender and cardiologist receptionist – isn’t remotely surprised by the statistics on Australia’s cocaine use. She tells me almost half her customers at the bar are under the influence by 10pm on a Friday or Saturday night.
‘It’s not always coke but often you can just look at people and see something’s not right,’ she says.
‘Every weekend we’re cleaning little plastic baggies off the bathroom floors – all used and ripped open for any remains.’
Almost a third of young adults in Victoria who died of sudden cardiac issues between 2019 and 2021 had used illicit drugs, including cocaine (stock image)
Cocaine has become so common many pubgoers don’t even care to hide their usage. One patron even asked Emily while she was in her uniform where they could buy a bag. Another ordered a round of drinks and ‘looked like he’d just smashed his nose into a plate of flour’.
Efforts were recently made to limit the number of flat surfaces in the pub toilets, but patrons have resorted to racking up and snorting drugs off toilet lids. Pub management can’t easily prevent this because cameras are banned in bathrooms.
Emily tells me that while the cocaine epidemic hit regional New South Wales hard and fast, a new wave of drugs is already taking hold.
‘There was a real phase with coke but now people have gone back to pills. I think people find them more convenient,’ she said.
‘No matter what it is, the drug problems are never going to go away.’
A large part of the problem is how readily accessible drugs are once revellers are already drunk and open to suggestion.
‘People will offer laced cocaine for free in the bathrooms and it could be mixed with anything from GHB [a common date rape drug] to meth. Free coke is not just going to be coke,’ Emily says.
‘Then that person will either get hooked or, more often if it’s a girl, they’ll get attacked.
‘Other people will spend hundreds of dollars on coke when they’re blind. They get even more desperate when the pubs shut. I’ve heard of bags being sold for $800.’
While pub workers are usually quick to spot dealers in venues, they often face trouble kicking users out.
‘Most of the time you’re just going off suspicion. You don’t want to kick someone out because their pupils are the size of dinner plates, only to find out they have a medical condition,’ Emily adds.
A person caught selling or supplying a prohibited drug, other than cannabis, can face fines up to $385,000 and/or 20 years behind bars in NSW.
If a person in NSW is convicted of dealing or supplying cannabis, they can face up to $385,000 in fines and/or 15 years behind bars.
If cocaine is affecting you or a loved one, help is available at the National Alcohol and Other Drug Hotline on 1800 250 015.
The service offers free and confidential advice, information and counselling.
