From heart attacks to dementia, the middle-aged cocaine abusers creating a timebomb for the NHS

Being hospitalised or dying from taking illegal drugs such as cocaine is something we associate with younger generations. 

But alarming figures reveal it’s now the over-40s who are the prime victims of recreational drug damage. 

UK studies show that people born in the 1960s and 1970s are taking record levels of recreational drugs that span the spectrum from cannabis to hallucinogens. 

In terms of lethality and long-term harm, cocaine is the biggest threat to middle-aged, middle-class Britain. 

Latest Office for National Statistics (ONS) figures show that, in 2021 in England and Wales, there were record numbers of people over the age of 40 hospitalised after drug use. 

And drug deaths are seven times the levels of a decade ago, with people in their late 40s four times more likely to die after taking cocaine than those in their early 20s. (Cocaine-taking caused an unprecedented 135.6 deaths per million people aged 45-49, compared with 32.4 deaths per million among those aged 20-24.) 

In the same period, cocaine-related hospitalisations have leapt five-fold — with 209 admissions for the over-40s ten years ago, rising to 1,100. 

Shockingly, 77 of these were aged 75 and over. Those appalling rates of serious harm and death will only get worse, experts have told Good Health, because ageing bodies and brains simply can’t cope with the damage from cocaine and other recreational drugs as they did when younger. 

The damage is primarily to the users’ hearts, but emerging research suggests there’s also a serious threat of party drug-induced dementia. 

In August, a study in the journal Heart found that more than one in three patients in their 40s admitted to cardiac intensive care units had recreational drugs in their bloodstream, including cocaine, cannabis, unprescribed opioids and amphetamines. 

These people were nearly nine times as likely to die or require emergency intervention such as resuscitation as other heart patients in hospital. 

The researchers, from the Public Assistance Hospitals of Paris, analysed the urine samples of all patients admitted to cardiac intensive care in 39 French hospitals over a fortnight. 

Only half the recreational drugusers identified by urine tests had admitted, when previously questioned by doctors, taking illegal substances.

Is this being replicated in the UK? Statistics from the United Nations Office on Drugs and Crime show that for cocaine use alone, consumption in France is less than half that in England and Wales, with 1.6 per cent of the French population using it annually, compared with 3.5 per cent among the English and Welsh.

Indeed, Dr R. Andrew Archbold, a consultant cardiologist at St Bartholomew’s Hospital, London, told Good Health that while the NHS does not collect figures on cocaine-related heart attacks and strokes, in his own practice such incidents are not uncommon. 

Cocaine is particularly dangerous to the cardiovascular systems of people who are middle-aged and older, says John Martin, professor of cardiovascular medicine at University College London. 

Nitric oxide is vital for controlling how much blood vessels open and constrict. 

Evidence shows cocaine damages the cells that make up the lining of our arterial walls (the endothelium) and the nitric oxide system, he explains. 

It causes blood vessels to rapidly constrict, shutting off blood supply to the heart and brain, ‘potentially causing heart attacks and strokes’, he says. 

And while research shows that people of any age are seven times more likely to suffer a stroke during the 24 hours after using cocaine, Professor Martin warns the risks grow because ageing reduces endothelial cell function and cells become more vulnerable to the harmful effects of cocaine. 

‘What’s more, if you do go on to have a stroke or heart attack, the consequences overall are worse.’ Meanwhile, demand for treatment from older people struggling to ditch their cocaine habit seems to be spiraling. 

Figures from the private therapy provider, the UK Addiction Treatment Group (UKAT), show that in 2018, over-45s accounted for fewer than 10 per cent of the group’s cocaine admissions. 

So far this year, 143 people over 45 have been admitted — more than 20 per cent of cocaine cases. 

‘Typically, the cocaine addicts over 45 that we treat have been abusing the drug for ten or 20 years,’ a UKAT spokesperson told Good Health. 

‘In recent years, the purity of cocaine has strengthened and the drug itself is more potent. 

‘This means that, for some, the effects are stronger and more addictive in nature. [The users] struggle with the physical and mental damage and their problems spiral.’ 

On top of the threat of cocaine-induced hospital emergencies — so-called ‘coke strokes’ — other ongoing research warns that cocaine also appears to accelerate ageing processes in the brain. 

Indeed, chronic cocaine users in their 30s and 40s already show debilitating brain changes more commonly seen in people aged over 60, according to research by Karen Ersche, a professor of addiction neuroscience at Cambridge University. 

Her study, published last year in the journal Molecular Psychiatry, compared the brains of 60 cocaine users with those of 60 non-users and found that brain shrinkage in the drug takers was almost twice that of the other group. 

Particularly worrying, cocaine users had greater loss of volume in the brain’s crucial prefrontal and temporal areas. 

The prefrontal cortex regulates our thoughts and actions so that we can behave rationally and in socially appropriate ways, while the temporal area encodes our memories and processes our emotions. 

Numerous other studies show middle-aged cocaine users often have memory problems more commonly seen in older people. Cocaine may be harming the brain physically in manifold ways. 

One mechanism suggested in 2016 by Johns Hopkins University in the U.S. is that high doses interfere with autophagy, where the brain clears out toxic and dead cellular matter. 

In a lab study, the researchers found that cocaine confuses the cell-cleaning system into also discarding vital material such as mitochondria — the ‘batteries’ that power our cells. 

The study warned: ‘Without the energy they need to function, cells in your brain will die.’ 

‘We see accelerated brain-ageing in heavy and addicted users, but we don’t yet know how much cocaine you have to use in order to cause this rapid ageing,’ Professor Ersche told Good Health. 

‘Nevertheless, whether you are an addict or a recreational user, the fact is that cocaine is damaging for the brain. 

‘And as we get older, the harm is likely to get worse because our brains become less resilient and less able to compensate cognitively for such damage.’ 

She adds: ‘The cocaine epidemic really started in the 1980s, so the first large tranche of users is only now coming to retirement age. 

‘If people’s brains are ageing prematurely due to drug abuse, the public health implications could be huge.’ 

Recent studies show that longterm cannabis consumption carries a similar threat. Figures from UKAT suggest a spiralling cannabis problem among Britain’s over-45s, with admissions for treatment doubling in the past five years. 

Meanwhile, a 2023 study of more than 1 ,000 midlifers by Arizona State University linked long-term cannabis use to shrink age of the hippocampus — an area of the brain where new memories are formed — and poorer cognitive function.

 Both of these are risk factors for dementia. Dr Madeline Meier, an associate professor of psychology who led the study, warns: ‘Long-term cannabis users — people who have used cannabis from 18 or 19 years old and continued using through midlife — showed cognitive deficits compared with non-users. 

‘They also showed more severe cognitive deficits compared with long-term alcohol users and long-term tobacco users.’ 

The report said cannabis use is increasing among baby boomers — those born between 1946 and 1964 — who used it at historically high rates as young adults and continue to do so as older adults. 

Dr Meier warns: ‘We know those who show cognitive deficits in midlife are at elevated risk for later-life dementia. 

‘The deficits we saw among long-term cannabis users were similar to what we see among people in other studies who have gone on to develop dementia in later life.’ 

As with cocaine, midlife cannabis use also brings an increased risk of heart disease and stroke, thanks to overstimulation of an ageing cardiovascular system. 

The drug can increase heart rate and blood pressure — raising the chances of a stroke or heart attack, according to the U.S. Centres for Disease Control. 

One study of 4,000 people in their late 50s and early 60s, by Queen Mary University of London in 2019, found that regular use of the drug increased the size of the heart’s main pumping chamber (the left ventricle), which is a risk factor for heart failure. 

While individuals are at risk from this ever-worsening party drug problem, it also threatens to create a tsunami of long-term disability and disease that could overwhelm already hard-pressed NHS elderly care services.