Cocaine use by the otolaryngologist: a survey.

The unique characteristics of cocaine--anesthesia and vasoconstriction--make it a valuable nasal anesthetic which is a safe topical anesthetic when used properly. The safe dose limit for cocaine used topically in the nose is surely greater than 200 mg, as evidenced by 826 otolaryngologists using greater than 200 mg in their daily practice without ever having experienced a cocaine reaction. Cocaine reactions are not simply dose-dependent, as evidenced by reactions occurring with as little as 10 mg. Fatalities secondary to topical application of cocaine to the nasal mucous membranes are exceedingly rare; only 15 fatalities have been seen in the entire clinical practices of the 2,434 physicians responding in this survey. Establishing 200 mg as the safe limit for cocaine in our literature, althugh it is not based on experimental evidence, is haphazard and carries far-reaching medicolegal implication to 48% of otolaryngologists who use greater than 200 mg of cocaine. A controlled scientific study to elucidate experimental data regarding the toxicity of cocaine in clinically useful doses is urgently needed.