Cocaine use disorder is a pattern of cocaine use leading to clinically significant impairment or distress. The majority of people who use cocaine do not have a use disorder. There is an increased risk of dependence with heavier use and when cocaine is smoked or injected.
Comorbid medical and psychiatric illnesses, as well as other substance use disorders, should be assessed.
Treatment options are limited with drug counselling as the mainstay.
There is no evidence to support the use of antipsychotic agents for cocaine dependence. Antipsychotic agents may cause QT interval prolongation and, when used concomitantly with cocaine, may compound the risk of sudden death.
Chronic cocaine use can lead to scarring of heart tissue and myocardial hypertrophy and other changes collectively known as myocardial remodelling. These changes constitute the substrate for the occurrence of lethal arrhythmias.
Psychosis can be seen in chronic users as an isolated condition or as a feature of 'excited delirium,' an agitated confusional state associated with potentially lethal hyperthermia.
Cocaine is a controlled illicit, highly addictive stimulant drug that is usually either insufflated (snorted), injected, or smoked in its freebase form (crack). Cocaine use is normally occasional, with the majority of users not meeting the criteria for cocaine use disorder.
Cocaine use disorder is a pattern of cocaine use leading to clinically significant impairment or distress, defined by presence of at least 2 of 11 symptoms during a 12-month period.
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) classifies cocaine use disorder as mild, moderate, or severe defined by the number of symptoms within a 12-month period.
See Cocaine toxicity.
History and exam
Key diagnostic factors
- presence of cocaine or other substance use disorders in family members
- chest pain
- agitation (mild to severe)
- mood changes (e.g., irritability, euphoria, dysphoria)
Other diagnostic factors
- anxiety (panic state: mild to severe)
- drug-induced formication
- previous hospitalisation for detoxification
- suspicious burns (e.g., crack lip, crack thumb)
- nasal septum ulceration, perforation
- focal neurological abnormalities
- seizure activity
- loss of consciousness/altered consciousness
- skin lesions (e.g., subcutaneous salmon-coloured patches, infections, erosions, necrosis)
- history of alcohol/other drug abuse
- history of mental illness
- male sex
1st investigations to order
- urine toxicology ± gas chromatography/mass spectrometry testing for levamisole
- chest x-ray
- CT head
Investigations to consider
- CT chest
- bronchoalveolar lavage
- transthoracic echocardiogram
non-pregnant adults and adolescents: mild cocaine use disorder
non-pregnant adults and adolescents: moderate to severe cocaine use disorder
continued use or relapse
- Methamfetamine abuse
- Amfetamine abuse
- Clinical practice guideline for the management of substance use disorders
- Unhealthy drug use: screening
Cocaine use disorderMore Patient leaflets
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