 Cocaine is by far the most commonly used illicit stimulant drug in Europe. There are about 2.5 million young Europeans who use cocaine every year, so that's about 2% of the young European population. Overall in Europe there are every year several thousands of cocaine-related emergencies reported. In terms of patient profile I think it's important to divide them up into two different groups, crack cocaine and powder cocaine. Crack cocaine is very much more seen and associated with heroin and individuals who are potentially living on the streets, versus powder cocaine which is much more individuals who are using the night-time economy and cocaine use in a recreational setting. Most of the cases are young, males, and they have used often other substances, mainly alcohol. With some frequent intoxications are mixed, sometimes we can know what it is, sometimes it's not by the clinic or by the information that comes from the outside, but it's common to see mixed intoxications. When the patient arrives at the emergency, the first thing they do is to observe the patient, take the story and treat the signs of trouble. It is necessary to know that the patient has a pure intoxication, cocaine or any other drug. I think that often doctors don't ask about the use of cocaine, and there's likely to be many more patients presenting with this problem than we know about. The emergencies related to cocaine are underestimated in Europe because there are some countries that have no data available. A proportion and probably half of patients will go home fairly soon from the emergency department because their symptoms such as agitation, will settle rapidly and about half of patients will be admitted to hospital. Some countries will only record the cases if they've been hospitalised, so they will miss all the cases who have been discharged directly from the emergency services. A small proportion will have severe effects that may require admission to an intensive care unit. Cocaine can cause bleeding into the brain, and it can cause semen. Cocaine can cause bleeding into the brain, and it can cause spasm or contraction of the arteries within the heart, and therefore decrease in blood flow to the heart. So it causes the same problems as a heart attack, but through a different mechanism. A classical heart attack is due to fat buildup within the arteries. Cocaine is causing it due to contraction of the blood vessels within the heart. It's therefore important for doctors to be aware that cocaine is the cause because the management of that heart attack is different to a classical heart attack. In terms of public health there's probably the potential for early prevention, assessment and referral opportunities that are currently being overlooked.