Cocaine use disorder

Last reviewed: 7 Jun 2022
Last updated: 01 Feb 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of cocaine or other substance use disorders in family members
  • hypertension
  • tachycardia
  • chest pain
  • mydriasis
  • diaphoresis
  • tremulousness
  • agitation (mild to severe)
  • mood changes (e.g., irritability, euphoria, dysphoria)
More key diagnostic factors

Other diagnostic factors

  • anxiety (panic state: mild to severe)
  • drug-induced formication
  • previous hospitalization for detoxification
  • suspicious burns (e.g., crack lip, crack thumb)
  • nasal septum ulceration, perforation
  • focal neurologic abnormalities
  • seizure activity
  • loss of consciousness/altered consciousness
  • skin lesions (e.g., subcutaneous salmon-colored patches, infections, erosions, necrosis)
  • dyspnea
Other diagnostic factors

Risk factors

  • history of alcohol/other drug abuse
  • history of mental illness
  • male sex
More risk factors

Diagnostic investigations

1st investigations to order

  • urine toxicology ± gas chromatography/mass spectrometry testing for levamisole
  • ECG
  • chest x-ray
  • CT head
  • electroencephalogram
More 1st investigations to order

Investigations to consider

  • CBC
  • CT chest
  • bronchoalveolar lavage
  • transthoracic echocardiogram
More investigations to consider

Treatment algorithm

ACUTE

acute intoxication

nonpregnant adults and adolescents: mild cocaine use disorder

nonpregnant adults and adolescents: moderate to severe cocaine use disorder

pregnant

ONGOING

sustained remission

continued use or relapse

treatment resistant

Contributors

Authors

Steven B. Karch, MD, FFFLM, FCSFS

Consultant Cardiac Pathologist/Toxicologist (ret.)

Office of the Chief Medical Examiner

San Francisco

CA

Disclosures

SBK is an author of a number of references cited in this topic. SBK declares that he has no other competing interests.

Kim Wolff, MBE, PhD

Professor of Analytical, Forensic, and Addiction Science, Director, King’s Forensics

Faculty Life Science and Medicine

King’s College London

London

UK

Disclosures

KW declares that she provides expert opinion and reports as a panel member of the Secretary of State Medical Panel for Drink and Drug Driving and as a member of the World Health Organization Expert Panel on Drug Dependence.

Peer reviewers

Timothy Albertson, MD, PhD, MPH

Chief

Division of Pulmonary and Critical Care Medicine

University of California, Davis

Sacramento

CA

Disclosures

TA declares that he has no competing interests.

Andrew Stolbach, MD

Assistant Professor

Department of Emergency Medicine

Johns Hopkins University Hospital

Baltimore

MD

Disclosures

AS declares that he has no competing interests.

Russel Falck, MA

Assistant Professor of Community Health and Associate Director

Center for Interventions

Treatment and Addictions Research

Wright State University Boonshoft School of Medicine

Dayton

OH

Disclosures

RF declares that he has no competing interests.

Christos Kouimtsidis, MBBS, MSc, MRCPsych, PhD

Consultant Psychiatrist and Honorary Senior Lecturer

Addictions, Alcohol Research

Institute of Psychiatry

King's College London

London

UK

Disclosures

CK declares that he has no competing interests.

  • Cocaine use disorder images
  • Differentials

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  • Guidelines

    • Clinical practice guideline for the management of substance use disorders
    • Unhealthy drug use: screening
    More Guidelines
  • Patient leaflets

    Cocaine use disorder

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