Amy Winehouse, Crack Cocaine and Emphysema

Jun 23 2008 Published by under Cocaine

EmphysemaLung.gif

2Figure 15b: Advanced emphysema in a
relatively young (36-year-old) woman with
a history of heavy cocaine abuse and unrelated
mitral valve disease. Chest CT scan reveals
diffuse advanced emphysema.

The latest news in the celebrity drug-abuse world is that Amy Winehouse's dad has informed the press that she has early stage emphysema. Her publicist has also confirmed the report.

Although health problems related to drug abuse are nothing novel in the world of musical entertainment, emphysema in a 24-year old is unusual, to say the least.


Unusual because the most salient reference point for emphysema is the long-term tobacco smoker. The Mayo clinic site on risk factors confirms the impression that emphysema is associated with a long tobacco smoking history:

Age. Although the lung damage that occurs in emphysema develops gradually, most people with tobacco-related emphysema begin to experience symptoms of the disease between the ages of 50 and 60.

Also see eMedicineHealth, MedlinePlus, MedicineNet, WebMD which confirm the impression of a slowly-developing disease which is associated with chronic tobacco smoking and tends to appear in later life; as emphysema.org describes it:

Emphysema doesn't develop suddenly, it comes on very slowly. Years of exposure to the irritation of cigarette smoke usually precede the development of emphysema.

Now, it may be the case that Amy Winehouse has a genetic predisposition for early onset emphysema, indeed a genetic risk factor can interact with tobacco smoking to greatly enhance the chances of a younger person suffering from emphysema.

In a small percentage of people, emphysema results from low levels of a protein called alpha-1-antitrypsin (AAt), which protects the elastic structures in your lungs from the destructive effects of certain enzymes. A lack of AAt can lead to progressive lung damage that eventually results in emphysema. If you're a smoker with a lack of AAt, emphysema can begin in your 30s and 40s.

It is quite likely in Winehouse's case that her reported crack cocaine smoking played a specific and causal role.
For example, Taskin and colleagues reported1 that even when you control for concurrent tobacco and marijuana smoking, free-base cocaine smoking confers substantial respiratory risk.

...heavy, habitual cocaine smoking was associated with the following: (1) a high frequency of acute respiratory symptoms (cough, black sputum, chest pain) in temporal association with freebase use; (2) an obstructive ventilatory abnormality involving the large airways; and (3) a mild but significant impairment in the diffusing capacity of the lung.

This was observed in a population which averaged 6.6 grams of cocaine per week over a 27 month interval so the fact that Amy Winehouse is so young is probably immaterial. A several year history of crack smoking may be sufficient to compromise lung function to a clinically significant extent.
A review by 2Restrepo and colleagues informs us of a number of critical issues including:

  • The average size of generated particles is 2.3 µm, which is small enough to result in the deposition of particles in the alveolar region of the lung (Snyder et al, 1988).
  • Respiratory symptoms include cough with production of carbonaceous material, chest pain, dyspnea, hemoptysis, wheezing, and exacerbation of asthma (Haim et al, 1995).
  • Massive quantities of carbon pigment are often found at bronchoalveolar lavage (BAL) in patients with a history of crack cocaine abuse. During the smoking of crack, a dark and tarry residue is formed, which many addicts collect and then resmoke along with more crack. During the inhalation of these impurities, there is extensive accumulation of large amounts of intracellular (macrophages) and extracellular carbon pigment (Greenebaum et al, 1993).
  • Pulmonary emphysema...has been reported in 2%-4% of intravenous drug abusers, with an upper lobe predominance and typically affecting young males and is associated in particular with methylphenidate injection (Goldstein et al, 1986; O'Donnell et al, 1988; Weisbrod et al, 1993).

Mitch Winehouse, the singer's dad, was quoted in a way that indicates he is perhaps a bit naive about substance abuse:

He called on drug dealers to help her recovery by refusing to supply her with crack cocaine.
-snip-
"If she hadn't done recent shows in Moscow and Portugal she could have been dead by now," he said. "She abstains and regulates her drug use when she has to do a show."

MonkeyEgg.jpg
return to hunt
Perhaps she does use less when working, when out of contact with her regular suppliers and/or when inhibited by fears of getting arrested for drug possession while traveling. This is not, however, the solution to a drug addiction. She is not going to be cured this way. She cannot do this herself by working harder at her profession. Trying to appeal to the better nature of "drug dealers" is a losing proposition.
Mr. Winehouse, get your daughter in rehab and long-term recovery before she kills herself.
__

1Tashkin DP, Gorelick D, Khalsa ME, Simmons M, Chang P. Respiratory effects of cocaine freebasing among habitual cocaine users. J Addict Dis. 1992;11(4):59-70.

2Restrepo CS, Carrillo JA, Martínez S, Ojeda P, Rivera AL, Hatta A. Pulmonary complications from cocaine and cocaine-based substances: imaging manifestations. Radiographics. 2007 Jul-Aug;27(4):941-56. The content of the Journals of the Radiological Society of North America (RSNA) appearing on this site is copyrighted by the RSNA, which reserves all rights therein.

16 responses so far

  • Beaker says:

    Is emphysema reversible? If Amy kicks the crack pipe now, will she get better? She already has the look of a meth hag. Nice songs, shame about the face.

  • Tony P says:

    [tangential nonsense removed by editor - DM]
    I predicted then that she'd be dead by this years end. I still have time.

  • Barn Owl says:

    In Louisiana, the cause of death is listed in the newspaper obituary, and I was initially mystified by the people in their 20s and 30s, who had died of "heart attacks", listed in the New Orleans Times-Picayune. A physician friend clued me in, saying that heart attacks in young people are usually caused by cocaine. Amy Winehouse would be at risk for this as well, of course.
    In my anecdotal experience, emphysema is not reversible-but then, that's using two older men, both cigarette smokers, as the examples. One of them, my great-uncle, was also exposed to asbestos and other carcinogens in his job as a machinist at an aircraft factory-died of mesothelioma, metastatic to everywhere.

  • Ian says:

    Is there any truth to the rumor that she's going to change her name to Crackhouse?
    Seriously, why all this publicity over a pampered celebrity when there are literally thousands of people in the same and worse positions, many of whom were addicted whilst they were still in the womb?
    The hell with the celebrity's problems. Let's deal with the real world problem.

  • Joan says:

    I Love Amy's music, but survivor Elton John said it best when he said Amy has to do it herself-- also how about the effects of long term marijuana use- no one seems to want to talk about that-- I have seen Jimmy, Janis and so many others go this route--hopefully she can move on to her gifts

  • Jake Young says:

    It would surprise me if Winehouse had AAt deficiency. For one, we screen for that now, and a lot of newborns get liver transplants to compensate. (Alpha1 anti-trypsin is made in the liver.) Two, in untreated cases, it can often results in emphysema or COPD with liver failure.
    I am not saying that Winehouse's liver is peachy keen, but I think we would have heard about liver failure.
    In any case, I definitely agree with your assertion that Winehouse's emphysema is complicated by her crack abuse. Crack abuse can cause something called crack lung which in acute cases causes a specific type of lung inflammation (eosinophil infiltration). The combination of inflammation caused by smoking and by crack undoubtedly accelerated her lung degeneration, resulting in the emphysema.
    Beaker,
    Emphysema is not reversible. It results from the progressive loss of alveoli, and they don't come back. Actually when you look at emphysemic lungs on autopsy they have the consistency of a dish rag. That is not something that you recover from.

  • clinteas says:

    Emphysema is not reversible,but its progress can be halted by abstaining from the causative agent.
    A1At def seems unlikely in Amy W because it would have been associated with other organ damage(mainly liver) and there should have been a familial history.
    The Crack Coke smoking cause was a new one to me,so thanks for an informative post mate !

  • Interrobang says:

    Damn. Speaking as a former fairly hard-core vocalist (I was a chorister for years in my misspent yout'), it's always kind of sad to see a talented vocalist blow their voice somehow. Me, I got extrinsic allergic alveolitis, and I don't sing nearly as well anymore.
    Seriously, why all this publicity over a pampered celebrity when there are literally thousands of people in the same and worse positions
    First of all, because not all those other people are talented recording artists who've had hit songs and well-selling albums, and secondly because this is DrugMonkey's blog and he can blog about whatever the hell he likes. There are lots of blogs; change the channel.

  • danfa says:

    I was diagnosed at age 35 with severe emphysema. 36% lung capacity (vs reported 70% for Amy). Mine is idiopathic. No AAT. No exposure. No genetic history. Biopsy of my lungs looks like I'm a current heavy smoker -lots of macrophages. But I've never smoked.

  • DrugMonkey says:

    Seriously, why all this publicity over a pampered celebrity when there are literally thousands of people in the same and worse positions
    First of all, because not all those other people are talented recording artists who've had hit songs and well-selling albums, and secondly because this is DrugMonkey's blog and he can blog about whatever the hell he likes.

    To be honest interrobang, I am feeling a little ashamed on this point. It is a general problem that we find the tragedies that strike famous people as more salient. I am very much not a fan of media frenzies over the latest missing-blond-white-preferablySouthern-young-woman case while hundreds of missing/killed/abused women who don't meet media criteria are ignored.
    Still, I am motivated to use the (brief) google-popularity of such events to do my little thing to advance understanding of drug use, abuse and its consequences. In this particular case, I learned something new, i.e., about the damage crack and freebase cocaine smoking can produce in the lungs after a fairly short period of time.

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