Megan Shields, M.D.
Shelley Research Center for Dependency Disorders and Chronic Pain, West Covina, California
Recent studies demonstrate that cocaine metabolites may accumulate in the body and that several days to weeks may be required for their elimination. Treatment outcome may be enhanced by methods which accelerate the safe and rapid elimination of drug metabolites. This preliminary study was conducted to determine if a detoxification program utilizing sauna baths as one component may precipitate the presence of cocaine metabolites in urine and sweat. Subjects were Caucasian with ages ranging from 36 to 40 years, and all met DSM-llI-R criteria for cocaine dependence and ingested cocaine by the smoking route.
Use ranged from 8 months to 18 years, and subjects reported cocaine use on over 75% of days in the month just prior to treatment. Three subjects reported last use of cocaine within 48 hours of admission, and one subject reported last use 25 days prior to program entry. Between the fifth and eleventh day of residential treatment and continuing daily for up to five weeks, subjects had multiple sauna baths each day. Urine and sweat samples were collected from subjects every two to three days during this period and tested for cocaine metabolites. Analysis was by polarization fluorescent immunoassay which has a 95% sensitivity of 30 ng/ml.
Three of the four subjects showed a measurable increase in sweat or urine cocaine metabolite concentrations when sauna baths were initiated. Two subjects showed undetectable levels of metabolites in urine prior to sauna baths and then demonstrated detectable levels after saunas were initiated. Metabolites were detectable in sweat and urine for up to five weeks following the start of sauna treatment. This study suggests sauna baths and other methods to increase sweating and metabolism may precipitate the appearance of cocaine metabolites in sweat and urine and, thereby, accelerate their elimination from the body.