Cocaine use disorder

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 counseling 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 remodeling. 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.[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edition, text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.

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.[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edition, text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.

See Cocaine toxcity.