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June 9, 1978

Cocaine Toxicity

JAMA. 1978;239(23):2448-2449. doi:10.1001/jama.1978.03280500044012

To the Editor.—  I was extremely pleased to see the discussion on cocaine as a topical nasal anesthetic in the QUESTIONS AND ANSWERS section (239:235, 1978). There is a large body of literature on the absorption of cocaine from mucous membranes, but unfortunately, much of this information is rarely referred to by those who most frequently use cocaine.The suggestion has often been made that the maximum safe dose of cocaine quoted in the literature, 80 to 200 mg,1 is too low and that large numbers of physicians often use doses in excess of this amount.2 As mentioned by Rudolph deJong, MD, few of those reporting use of higher doses comment on the incidence of side effects nor their rationale for using higher doses. Furthermore, he makes an incisive point by stating that "no dose of any local anesthetic ever is 'safe.' " Therefore, logically the minimum amount of